What does the fall season signify to a dentist?

For most small business owners,the fall season coincides with the final quarter of our business year. Unlike most business owners dentist's practices can be affected by our patients' dental insurance. Most plans are calendar year plans that start on January first and end on December 31rst. When a patient's dental insurance maximum is reached many patients seek to defer treatments to the next year if possible. For patients with non urgent dental problems this strategy can work but obviously not always. If a patient needs a root canal, or has a large carious lesion, delaying dental treatment can be a poor choice that can have cause additional problems to develop that may end up costing more in the long run.

Another group of patients can have a different set of issues. Patients can put off going to the dentist because they are busy, nothing hurts, or they are afraid of what they will find out. Far to often they have dental needs that go unaddressed, as well as dental benefits that are not utilized. Every year towards the end of December we get a flurry of phone calls asking if we have time to start a crown or do a number of fillings.

Instead of waiting until December, these patients would be better off coming in October or November for their dental work, since this would allow us time to pre-certify their dental treatment plans and let us complete the work prior to the end of their benefit period. If you haven't been to the dentist in 2011, Now is a good time to call your dentist for a check up!

Is there a more affordable alternative to Porcelain Veneers?

Often times a patient who is on a budget for their cosmetic dentistry may be able to opt for bonding with composite instead of choosing porcelain veneers. The fee for bonding in my dental practice ranges from $250-$600/tooth depending on the degree of difficulty. The fee for porcelain veneers is $1850/tooth.

As a cosmetic dentist, practicing in NYC for over twenty five years, it has been my experience that bonded restorations can be a long lasting and natural looking alternative. The bonding may be more prone to developing small but is easily repaired. For it to be durable a patient does need to have excellent oral hygiene and should floss. Composite surfaces can develop porosities in a patients who has poor plaque control and the result can be that the restoration becomes stained and unattractive. In my experience, for patients with good dental hygiene the life expectancy for anterior bonded restorations is similar to that of porcelain veneers(10-15 years).

In the example shown above the patient had a class III malocclusion with crowding in his anterior maxillary segment. He didn't want to wear braces and he asked me what I could achieve without orthodontic tooth movement. I made a study model and applied wax to the model and was able to treatment plan 4 bonded restorations on his lateral and central incisors. The result was pleasing and affordable. His left lateral still is shorter than the right, but his occlusion would not allow a longer lateral. He was pleased with the result and it definately improved his appearance.

Are you accepting new dental patients?

I am always surprised when someone asks me this. I guess some doctors or dentists are not? We are always happy to meet potential new patients. Usually when they call we ask if they have dental insurance in order to find out if they are allowed to go out of network. My practice only participates in Delta Premier dental insurance. We are "insurance friendly", which means that we do accept assignment of benefits from most of our patients dental insurance plans and usually we ask the patients to pay out of pocket only the portion of the bill not reimbursed by their insurance.

We ask the 'dental insurance' question because many potential new patients assume we accept(participate in) their dental insurance and might be disappointed if they visited us and found out that we do not participate in their insurance. Even though most of the callers plans do allow them to go out of network,we like to make them aware if we are not participants in their plan, prior to their booking an appointment.

What does it mean if I feel an electric shock when the dentist gives me an injection?

Patients sometimes report a feeling of electricity in their jaw or lip when they are being given an injection in their lower jaw. Sometimes they report a burning or shock in their tongue. The injection most dentists use to numb the mandible is called a mandibular block. This injection is a nerve block of the mandibular nerve; a nerve that innervates the mandibular teeth. If it is pierced by the needle it will cause the patient to feel a burning sensation or a feeling of electricity in their jaw, teeth or lower lip. Anterior and adjacent to the mandibular nerve is the lingual nerve. The lingual nerve is responsible for the sensation of the tongue and if it is pierced the patient usually will report a pricking sensation or a burning on the tip of their tongue.

Although it is extremely disconcerting to patients experiencing it, this 'shock' usually causes no lasting harm and when their local anesthetic wears off their lip sensations return to normal.

If the mandibular nerve is damaged a patient can develop a lasting paresthesia of their lip on the side of the injection. Usually this paresthesia will eventually go away, but it may take 6 months to a year for lip sensations to go fully recover. Damage to the mandibular or lingual nerves is infrequent. I have been practicing for over thirty years and I have given many thousands of mandibular injections and I can count the number of paresthesias that have resulted from my injections on one hand. All eventually recovered the feeling in their tongue or lip.

Do you practice alone?

Although I have a 'solo' dental practice, I share my office with several other dentists. Rents in Manhattan are pretty high and sharing a dental office makes good sense. We share the rent, cover each others practices when we are on vacation and we can confer with each other when needed. Further more our building ( 30 East 40th St.) is filled with other dentists (last time I looked at the bulletin board downstairs I counted over forty dentists!) and physicians and most are generous with sharing their varied expertise. Although it seems like a high concentration of doctors in one building, Manhattan is a big place and has room for lots of dental and medical practices.