What type of composite do you use for anterior bonding?

As a cosmetic dentist in New York I use different types depending on the situation. Most often I use "hybrid composite". This is a category of composite that has been in usage for a long duration and has 'stood the test of time'. Hybrids have variable particle size for their 'fillers' and are usually considered the strongest type of composite when exposed to biting forces. They are less polished when compared to 'microfills'(smaller particle filler size) but most of the time the exact amount of polish is not the most important feature. Teeth are most often viewed in a 'wet' state and when viewed this way hybrids often are highly esthetic. If needed hybrid composites can be veneered with microfill composites, so that the restorations can appear shiny even when the restorations are viewed in a dry state.

A newer type of composite has been developed that is promising and has properties that mimic the best properties of hybrids and microfills. These composites,termed nanofils(Esthet-X is one example)are both resistant to flexing forces like hybrids and also can be highly polished like microfills. I have used these succesfully for anterior restorations but have not tried them for posterior restorations. Posterior fillings are under the greatest stress and I am currently using only hybrid composites for fillings in stress bearing areas on back teeth.

Currently Cosmetic Dentists must choose which of these types of composite to use in each situation. All work well when used in the correct situation and most cosmetic dentists have their own opinions on which composite to use for particular applications. There probably is not a universal composite that is best for every application.

Does a cavity cause a tooth to ache?

Large carious lesions can cause a tooth to ache. Often patients report their tooth starts to hurt after eating. This is probably due to the bacteria in a carious lesion being fed by the food that a person eats. The bacteria in the process of metabolizing the food will produce acidic substances(lactic acid) and these may irritate the pulp of the affected tooth. Often these aches are transient and will come and go.

If a deep carious lesion is cleaned out carefully by a dentist and no obvious pulpal exposure occurs, the dentist can place a sedative or cement filling in the affected tooth and it may become comfortable. If the tooth is properly sealed the pulp may be allowed to recover and the tooth may become a "happy" tooth.

Of course some teeth with deep caries do require root canal since their pulps have been irreversible damaged. If after having a sedative filling has been placed in a deep lesion, the tooth continues to throb or ache,then an endodontic procedure is usually indicated. The sensitivity is coming from the tooth's pulp and removing it with a root canal will usually make the tooth comfortable.

Do you accept managed care dental plans?

Although we do treat dental patients who have PPO coverage and accept their insurance as partial payment we do not participate in most plans. The sole acception is the Delta premeir plan.
We do have a very nice dentist, Dr Natalie Goldstein who shares our office. She participates in many dental insurance plans .

She has practiced with us since June and her patients seem very happy with her. She graduated from NYU several years ago and completed her General Practice Residency at Montifiore hospital in the Bronx.

If you are looking for a good dentist in New York City who does accept your managed care dental plan why not call her at 212-433-0813. At the moment she practices Tuesdays and Thursdays and accepts on line appointments through an website called Zocdoc.

What are the purpose of deep cleanings?

Deep cleanings allow dentists and hygienists to remove tarter that can accumulate under gums along the roots of teeth. Another term for this procedure is "Root Planning". Often times when a hygienist performs a cleaning tarter remains below the gums. This tarter can make it more likely for a patient to have active periodontal disease. If a dentist finds that pocketing is present(pocket depths of >than 4 mm) and he suspects the presence of subgingival tarter, he may suggest one or more deep cleaning treatments.

At these visits, local anesthesia is administrated and then very sharp currettes( periodontal 'scalers" ) are used to scrape clean tooth surface below the gums. Tarter that has been present for long periods can be extremely tenacious and can be a challenge to remove. Visualization is often not possible and tarter is detected by tactile methods and the use of radiographs. Dentists use extremely sharp currettes to both detect and remove this subgingival calculus(tarter).