What is the optimal recall schedule for someone over forty?

Prevention is the best medicine and in the case of frequent recall, whether it is reimbursed by dental insurance or not, it will most likely safe patients money in the long run by preventing problems and allowing dentists to discover any problems that develop at an early stage.

Although most dental insurance covers two recall visits per year,I believe that many patients, especially those over 40 , optimally should have more frequent cleanings. A three month recall is considered the standard recall schedule for patients with a history of periodontal disease. Why should someone wait for this diagnosis to choose a three month recall?

I recommend that if it is affordable, patients over forty should have three to four cleanings per year. If they would like to cut down on non reimbursed expenses, they can choose to forgo an examination on the visits not covered by their insurance.

Why do I have sensitivity to cold after a wisdom tooth extraction?

Some patients report cold sensitivity after a wisdom tooth is extracted. If this occurs it usually is coming from the tooth directly anterior to the extraction sight. If the root area of that tooth is more exposed after the extraction it can feel increased cold sensitivity. Also if the tooth anterior to the extraction sight has been luxated (wiggled) during the extraction it can experience an increased sensitivity to cold. Usually this sensitivity will gradually go away.

What does it mean when someone says "I never have any cavities"?

As a practicing dentist I sometimes encounter new patients, who have loved their previous dentist and are especially proud of how their teeth 'never need work'. I often hear this remark with a sense of dread; Allthogh it can mean they have great teeth, it sometimes can be a tip off that their prior dentist was not detecting some dental problems. In such a situation, It can be awkward telling them the bad news, and I am always concerned that my potential new patient will not believe me If it turns out that they do have a number of dental problems. After all they trusted and loved their old dentist and I am the 'new kid in town' and it definitely can turn out to be a case of "shoot the messenger". Often patients do not want to believe bad news and seek a second and third opinion ( often from their friends and family) before having a unwanted dental procedure.

Do you have evening hours?

My office is open 9-6 P.M, Monday- Thursday. I do not have any evening hours. Our last appointment available for a patient booking is at 5 P.M.. Many years ago I tried having a late day on Wednesdays, but I found I was not comfortable seeing patients after 6 P.M., since by that time I was usually tired and I felt I wasn't able to consistently do my best job on my dental procedures.

In fact if I have a demanding dental procedure(crown preparations, endodontics), I try and have my patients book it by two pm or even earlier, since I, like most people, have the most energy and can maintain my best concentration during the first half of the day. If possible I try and schedule easier procedures towards the end of the day( fillings, crown try ins, and cleanings)

What should I do if I need a crown but can't afford one right now?

In my practice I am asked this question all the time. Usually the patient asks why can't you place a large filling for now and I will do the crown later if I have a problem. This is not a particularly good option since very few patients will remove a functioning permanent filling to place an 'elective' crown. Instead they do wait until something happens to the tooth. Usually one of two things eventually happens; Either the tooth experiences recurrent decay( Large permanent fillings can be hard to execute optimally and can be more prone to voids and recurrent decay) or the tooth fractures( large fillings do not protect teeth well from fracture).

Instead of a large permanent filling I recommend a large Miracle Mix restoration. This matereial is made of a combination of glass ionomer cement and the metal fillings from amalgam(leaving out the mercuray). They are "kind" to the teeth they restore and seem to inhibit recurrent decay. Their drawbacks can be that they can be difficult to achieve good contacts and they are more brittle than compostie. They work well as an intermediate type filling and can last from 6 months to several years or more.

I use bitine rings (or analagous device) to achieve optimal contacts. I have used this restorative for 15 years or more and when I see the patient on recall appointment I mention their miracle mix filling(s) and ask if they are ready to have a crown. Eventually they go ahead and have a crown done since it is more ideal for their tooth and will help protect it from fracture.

Should a wisdom tooth ever get root canal?

The answer is sometimes. If a wisdom tooth has a deep cavity and has a pulpal exposure it can be a good candidate for endodontic therapy if it has errupted in a cleanable position and is in good function. Like other posterior teeth, after having a root canal wisdom teeth should be crowned. In my practice I recommend full metal crowns for wisdom teeth(and second molars), since the chewing pressure they can experience can make porcelain breakage more likely when porcelain fused to metal is used.

If the wisdom tooth is not fully erupted or difficult for the patient to clean, then root canal is not the best option for dealing with a compromised pulp. Instead extraction is the best option. In this event, often the opposing wisdom tooth is extracted as well, since without an opposing tooth present, it may extrude over time.