Great Dental New Years Resolutions?

I just finished writing and posting an article on this subject on my dental website. It features ten dental resolutions that patients could make and keep for the new year. Most of us would be lucky to keep just one New Years resolution. My dental resolution is to take care of a broken molar that I have been putting off repairing.

Does Root canal hurt?

With proper anesthesia root canals can be a pain free procedure. Most teeth respond to regular local anesthesia injections. For Maxillary (upper teeth) dentists usually employ a combination of buccal infiltration and a palatal injection. For Mandibular teeth(lower teeth)a mandibular or mental block is used.

Some teeth do seem to be hypersensitive at the time that root canal is started and patients still can report some sensitivity when a dentist attempts to access the pulp chamber. When this happens I sometimes use an additional intrapulpal injection in order to achieve complete anesthesia. Usually this injection does the trick for my patient and their endodontic procedure can be completed without further discomfort.

Is your office closed over the christmas holiday?

Our New York dentist office traditionally has been closed between Christmas and New Years. This year is no different. Our office will be closed until January 2, 2012. My staff and I are looking forward to having some good food, geting some rest and spending time with our families. We wish all our patients have a happy and healthy holiday season and we will be back in action early next year.

Can a successfully treated root canal tooth experience occasional pain/tenderness?

Sometimes root canal treated teeth, that we consider a success, do have some "low grade inlammation ". The teeth are not infected but are not entirely without tenderness.

Another possible explanation of continued symptoms it that some teeth have a small undetected crack and heavy chewing may cause some small movement of the the crack.

If symptoms are disturbing sometimes a retreatment of the root canal can cause the tooth to become less symptomatic. After all, most of our check radiographs are two dimensional and do not show the root canal system as it acutally is. Small discrepencies in the 3-D fill also may be responsible for symptoms.

Why do dentists bevel teeth when preparing them for a crown?

Bevels ave been used by dentists for many years in the belief that they help achieve a more intimate fit for the crown. When I was in dental school we were taught that a bevel on a tooth that was being crowned helped insure that the margin have a smaller gap when seated. There is a definite logic to this when compared to chamfer and shoulder finish lines, but It is hard to explain in a short blog post.

Now a days, with the advent of a number of metal free types of crowns(Emax,Lava,Procera,and Zirconium) chamfer finish lines are becoming more popular since these the manufacturers of these crowns do not advocate a bevel at the finish line.

In my practice for first molar and bicuspid teeth I continue to bevel and use Pfm crowns. I find that these work well and possibly better than some of these new crowns, especially for teeth with weakened coronal tooth structure. One possible reason for their success is that the bevel shifts some of the flexural forces to a relatively uncut an intact portion of the tooth tha is below the gingiva. Most chamfer or shoulder preps seem to depend more on the integrity of the coronal tooth structure and need to have considerable intact coronal tooth to be predictably successful.

Many teeth that require full coverage restorations have weakened coronal tooth structure and many have internal cracks that should be isolated from the forces involved with chewing. In my opinion the beveled preps (pfms) or feather edge preps(full metal crowns) do the best job of isolating the weakened portion of posterior teeth from flexing forces that can be generated during a patients chewing.

Although the newer types of metal free crowns are beautiful, the verdict is out on how well and predictably they will stand up in patients mouths over the long haul.

How long after a filling is done is it safe to eat?

This is a question that patients frequently ask. Dentists placing amalgam fillings often caution patients to wait 45 minutes after their filling to eat. This is advised because silver fillings tend to continue to harden after placement and the consensus is that after 45 minutes they are hard enough to withstand the forces that will be placed on them by eating.

Composite fillings are immediately ready to withstand the forces of mastication(eating) after placement- no waiting needed! That being said, most patients are numbed when having a filling and should not eat until the numbness goes away. This is especially true for patients having a mandibular block. Mandibular blocks are commonly used for achieving anesthesia prior to filling teeth in the lower jaw and they result in profound numbness in the tongue and lower lip (on one side).

My father who was a patient and a big fan of mine once returned after a dental visit and mentioned, almost apologetically, that he thought that possibly I had made a cut in his tongue during his last visit. I looked in his mouth and there was a fairly large gash in the side of his tongue. Knowing that I hadn't happened during treatment, I asked if he had anything to eat after leaving his last visit and he confessed he had a hot dog at the train station afterward.

My father's story points out the importance of not eating any food while still numb, since there is a definite possibility of a patient injuring a numb area. Hot foods may cause a burn and numb tongues and cheeks may be inadvertently bitten while they are numb and lacking normal sensation.

What should I do if my dentist has billed my dental insurance for work not done?

This is a question that occasionally does come up. Some patients have come to my New York dentist office with this complaint and have asked me to check whether the work in question was actually performed.

If a patient suspects that his insurer has been billed for work that has not been performed then if possible they should first contact their dentist and ask for an explanation. If not satisfied with the explanation, then it makes sense to contact the insurance carrier and let them know that some of the work submitted for was not completed or performed. Often the insurance carrier will contact the dentist and ask for an explanation or even ask him to refund the overcharged amount.

Some patients may not want to contact their dentist to ask for a clarification and in that case they may choose to contact their insurance company, especially if they are sure that the procedures in question have not been performed.