What radio station are you playing?

This is a question that I am frequently asked in one form or another by my patients, since it is my habit to listen to music while treating patients. I find that the music relaxes both the patient, my assistant and myself. It also seems to make the appointments go by more quickly. I use different sources, but usually I am not listening to a traditional radio station. Instead I listen to Pandora or a custom playlist from my iPhone. I try and find music that both I and the patient will enjoy and usually my patients seem to accept my choice of music. If a patient brings their ipod or iphone, we can plug that into our radio and enjoy their play list.

How to save time when doing class I,II, &V composites?

This is a tip for other dentists who may be interested. When I place buccal or facial composites on anterior or posterior teeth, I save time by removing excess composite prior to setting it with my bonding light. I use Prime and Bond NT as my bonding liquid and also use it as a solvent to remove excess composite. I dip my plastic instrument in it and then lightly brush it over the surface of a composite I have placed. I burnish the unset composite material towards the margins and hold it against the tooth as I wipe away the excess. By 'carving' my composite prior to setting it I ensure that my margins are closed and less finishing will be needed with a fine diamond or sandpaper disk afterwards.

I use a similar technique when placing composites in Class I and Class II preparations and it almost always saves me time when finishing and polishing my composites. It seems much easier to me than quickly placing an over filled composite and then spending 10 minutes finishing it with sandpaper, carbides and diamonds.

What do you do when you don't have a patient?

Aside from writing this Blog, there is always something for me to work on in my New York Dentist Office. I do like to do a certain amount of dental lab work for my patients. I choose to ditch all of my own dies.

After an impression is taken for a crown, it is sent to the dental laboratory to be poured in stone and mounted on an articulator. At that point the die that the crown is to be made on is trimmed and the  margin marked on the die in red ink. Although most dentists let their laboratories perform this task, I choose to do this myself. I like to see my dies before any alteration by the lab. I ditch the margins with a #4 round bur in order to insure that my crowns will not be over extended. Over extensions can cause crowns not to seat fully and if a lab does over extend one of my crowns on a ditched die, it will be apparent on the inside of the casting and will be more easily cut back.

I also use my down time to return and make phone calls, speak with my office manager, accountant, and the super of my building. Also I do some on my own dental office repairs, and these can not be done when I have a patient in the chair. Running and maintaining a busy dental office is time consuming and not all tasks should be delagated to others.

How do you lighten Dark Teeth?

This is an extremely good question. There are a number of ways to lighten teeth, but most don't work well for a patient desiring very white and bright teeth especially when a patient has only one or two darkened teeth anteriorly. This occurs when a patient has a past history of a traumatic injury to their front teeth and or endodotic treatment. Internal bleaching is an option for endodontically treated teeth, as are porcelain veneers, and full crowns. The choice of which to use should be made on an individual basis, after careful consideration of specificfactors involved for each patient. I have written a short article on my New York Dental office website that may explain my decision making on this issue. If you are interested please visit: http://www.lspindeldds.com/how_to_lighten_individual_dark_teeth

How do dentists make use of photography?

Dentists take photos of patients teeth and mouths to document current conditions and to plan changes to a patients teeth. Photos are show to laboratory technicians and shared with consulting specialists.  In my practice, hardly a day goes by when I don't take pictures with my camera. I find it helpful to study detailed photos of mouths when treatment planning. I make use of cosmetic bonding mock-ups in mouths and documenting proposed changes can be invaluable to treatment planning . Also I maintain a before and after book and occasionally give talks to other dentists.

What to do about worn over errupted lower anterior teeth?

Over erruption of lower anterior teeth is a problem common to "middle aged teeth". As anterior teeth wear they can compensate for the wear by slowly errupting. Teeth tend to 'want to remain' in contact with opposing teeth and can errupt until they meet them. As the lower teeth wear they become shorter and shorter and this can pose a problem to a restorative dentist. Patients with worn teeth desire longer teeth but often there is no room for the dentist to allow a lab technician to fabricate longer restorations.

Dentists have a number of different options that they can use to create this room, such as opening a patients bite (restoratively or orthodontically) or possibly sending a patient for crown leghtening surgury(removing supporting bone around a tooth in order to expose more tooth in the mouth)

Recently, I have been contemplating using Invisalign retainers to solve this issue, since in my experience Invisalign can predictably intrude lower anteriors about 1.5 mm. Many patients with worn lower anteriors that have extruded would be extremely pleased if their lower anteriors could be moved down (intruded) a little and then lengthened with bonding or bonded porcelain restorations. I look forward to trying this strategy out since it is less invasive and expensive than some of the other methods that I have previously employed to solve this esthetic problem.

How long do I have to wear my retainers for?

Most patients would like to believe that once their teeth are orthodontically straightened that they will stay that way, often this is not the case. Post orthodontics, patients who do not wear their retainers are at risk of unintended drifting of their teeth. To keep teeth their straightest, retainers should be worn for life. Most modern retainers will not only keep teeth aligned but also will offer some protection from wear.

If the retainers are made with a vacumn former, then they often can be used for home bleaching as well. Just place the bleaching solution on the inner front surface before bed and take them out in the morning. The teeth will look whiter! In my practice we recommend an 16% Nite White solution, but many different formulations work well.

What are reasons not to have porcelain veneers?

No dental restoration is perfect for every patient in every situation. Porcelain veneers are no exception to this rule. Patients with extremely dark or worn teeth may have problems with their porcelain veneers. Also older patient with significant recession are not ideal candidates for porcelain veneers. Although they can work for these patients often there are more predictable or desirable choice for them. For some patients Orthodontics, Full crowns or simple bonding can be a better solution. I have just written a short article on this topic on my office website. For more detailed information on this topic please visit: http://www.lspindeldds.com/what_are_some_reasons_not_to_have_porcelain_veneers

Why does brushing my teeth make them hurt?

If a patient has exposed dentin on some of their teeth, they can experience a stinging when they brush their teeth. Dentin can become exposed when a tooth looses it outer coating of enamel. This can happen due to wear.

When dentin is viewed under a microscope, tiny pores are visible and inside of these are nerve processes surrounded by fluid. When a tooth brush, wet with tooth paste. presses on these tubules it can sometimes cause movement of the fluid and stimulate these nerve processes. The result is the patient feels sensitivity. This sensitivity can be intermitant or even absent, but if a patient does complain of sensitivity during brushing, exposed dentin is a leading cause.

Another possibile cause for pain caused by brushing is that some teeth have problems that cause them to become sensitive to cold liquids and the water that people use to brush with can be cold and cause pain. Some teeth can become sensitive to cold when they are cracked or have a pulpitis caused by a pulp cap or deep caries.

If you are experiencing pain when brushing your teeth , letting your dentist know is a good idea, since he or she maybe able to pinpoint why you are having your discomfort.