How should I choose the dentist who is best for me?

Choosing a dentist shouldn't be like choosing a restaurant to go to. Its a very personal decision. Many younger patients with dental insurance are choosing their dentists by first going to their insurance websites and finding dentists in their zipcode and then trying to research the various choices available based on their websites, photos of their offices and online patient reviews. Although this is one way of finding your dentist, other options may be better. As has been well documented, online patient reviews can be faked, and most people are actually unable to tell which are real and which are faked. Photos of brand new dental offices attest to the money spent by a dental practice on their office, but in no way is  representative of the actual quality of their dentistry. A better  option is actually knowing someone who has personally gone to the dental office in question. A patient or another doctor who has gone to that office who personally recommends an office is  a good source of information.

Most successful dental practices will stand the test of time and develop good word of mouth, but the absolute amount of advertising dollars spent by a dental practice is not a predictor of the quality of the dentistry provided, The best dentists care about keeping up with their continuing education, their patients well being, and should offer services that they would be proud to show to other colleagues.

Dentistry certainly is a business, but it also is a health profession where practitioners are primarily responsible for helping insure that their patients maintain the health of their mouths and not just be dispensers  of dental services.

What happens to cracked teeth after they have been crowned?

A relatively high percentage of teeth that are crowned in my dental practice have vertical cracks in them ( probably more than 50%). Usually these cracks are detected during a patient recall exam. Usually I recommend crowning these teeth even before they become symptomatic since this treatment may prevent the crack from propagating further.  After crowning, most of these teeth are fine, but a minority of  them do end up needing root canals down the road.

Some of these teeth will become symptomatic years after crowning and are sensitive to chewing and / or percussion. Usually the treatment needed is a root canal. These teeth may need endodontic treatment for one of two reasons. Either the pulp has an irreversible pulpitis or it has become non vital. While a tooth with a pulpitis may display an increased sensitivity to cold , a tooth that has lost all vitality will not. Instead a periapical radiograph taken of a non vital tooth may often show a widening of the ligament at the apex of the tooth since this is where the non vital contents of the tooth will drain.

 About the Author:
Lawrence Spindel DDS is a dentist in New York, currently residing in Larchmont, NY , He has maintained a general and cosmetic dental practice in Manhattan for over thirty years .

How often should dental radiographs be taken?

This is a question is a question often asked by patients. Recently a study has reported a link to benign brain tumors and dental radio-graphs and this has increased the intensity of  the discussion.  Hardly a day goes by that I am not asked this question by a recall patient. We generally take bitewing X-rays every year to two years depending on a patients desires and their risk for dental problems. For most new patients with a past history of dental disease (treatment for caries or history of periodontal disease) we recommend a full series of dental radiographs. My dental website has an article that I have posted today indicating our guidlines and has links to relevant online information including ADA Guidelines and an article in the Washington post about the study linking dental radiographs to benign menigiomas.

What should I do about my Geographic tongue?

The short answer is usually nothing. Although it  can look ugly or scary, usually no treatment is indicated. Geographic Tongue tends to change in appearance over time. It can come and go and some patients report a burning sensation at times. If a patient insists on treatment than the usually recommended treatment is topical corticosteroid ointment, but to be honest, the last time I prescribed this was over ten years ago! Probably the best solution is to do nothing. Some patients avoid acidic or spicy food and alcohol, since these can make the tongue feel the burning sensation.

Are you taking any time off this summer?

Our Manhattan dental office will be closed from August 2nd to Aug 14 th. My staff and I are looking  forward to a a little rest and relaxation.  I Plan on doing some traveling with my son. He is seventeen and still is willing to spend some time alone with his Dad on vacation!

If you are a patient with an emergency we will leave a dentist on call to handle our emergencies, but if you are having a tooth problem that can wait, please leave a message on our answering machine and we will be back on August 15th. Also I should be checking my emails from time to  time during the vacation and if you would like,  you can email me at: lawrencespindel@yahoo.com.

Can smoking cause gingival recession?

There are a number of things that can cause gingival recession, including , in my opinion, smoking. Some other causes possible causes are excessive occlusal forces, orthodontic tooth movement, brushing, poor dental hygiene, acute necrotizing ulcerative gingivitis and overly aggressive tooth brushing.

I have written a short article about smoking and its effect on gingival recession and periodontal bone loss and if the reader is interested they can click on the link that follows to read it.

http://www.lspindeldds.com/can_smoking_cause_bone_loss?

 About the Author:
Lawrence Spindel DDS is a dentist in New York, currently residing in Larchmont, NY , He has maintained a general and cosmetic dental practice in Manhattan for over thirty years .

Have You made any all Zirconium Crowns Yet?

Not yet but I plan on trying them out soon. They are White colored and are probably most people would find them more esthetic than gold crowns. They are reported to hold up well in the posterior section of the mouth, so they should be a good alternative to having a gold crown, assuming that they "stand the test of time". It can take years to access the success or failure rate of a new type of restoration in the mouth. I have written a brief article on this topic and posted on my office website. If a reader is interested in finding out more please click on this article's link on lspindeldds.com

What type of patients have leukoplakias?

Leukoplakias are lesions that consist of a whitish patch on the mucosa, tongue or other keratinized portions of the mouth in smokers. They need to be differentiated from lesions associated with candidiasis and lichen planas. Unlike the white patches associated with candidiasis, these lesions can not be easily scraped off and consist of overly keratinized tissue. Often they are referred to as 'precancerous' lessions by dentists.

If you have a white patch on your tongue or somewhere else in the mouth, it is best to see your dentist. He may advise biopsy, since a small percentage of these lesions do have dysplastic areas that can be associated with a malignancy.

About the Author:
Lawrence Spindel DDS is a dentist in New York, currently residing in Larchmont, NY , He has maintained a general and cosmetic dental practice in Manhattan for over thirty years .

Does my fixed bridge need any special care in being kept clean?

Many patients ask this. They know that they will not be able to floss a bridge the same way that they can individual teeth. Fixed bridges have solder connections that make it impossible to use floss regularly, but they do need to be kept clean. Floss threaders, stimudents and interproximal brushes are the tools of choice to help clean between bridged teeth. Similarly bridges need to be cleaned regularly at the dentist. They have margins that can collect plaque  and should be professionally cleaned with regularly scheduled cleanings. I have written a short article on this top on my N.Y.C. Dental office website that may be interesting to those desiring more information on this topic. Just click the link below to view this brief article.

http://www.lspindeldds.com/how_to_best_care_for_a_fixed_bridge

What should be done if my lip is numb but my tooth still hurts when the dentist drills?

Most of the time when a dentist is going to work on a lower tooth he will administer a mandibular block. The signal that dentists use to determine whether a patient has achieved a mandibular block is a numb lower lip on the side of the injection. At that point the dentist usually believess the patient will be numb enough for the patient to feel no pain when a drlll touches the dentin of a tooth on that side of the mandible.

What should be done if the patients tooth still hurts when the drill touches it? Often a different type of injection should be used. Often intraligamental injections work when a  mandibular block provides insufficient anesthesia. These injections are placed into the ligament surrounding a tooth and usually require a special type of anesthetic syringe that can deliver the solution with a higher pressure so that it can enter the ligamental space around a tooth.

Why did you make July Preventive Dentistry Month?

I believe in both dentistry and medicine there is sometimes too much emphasis on treatment to cure problems and too little emphasis on prevention and patient education. So many problems might be best dealt with at early stages, by changes in life style, diet, hygiene, and exercise. Unfortunately, most people are motivated after they develop serious health problems. Similarly, many doctors and dentists, are more focused on procedures and not prevention. We dentists get paid for doing procedures, and get little or no reimbursement for counseling on prevention and hygiene. I personally get a kick out of doing recall exams and finding no problems that need addressing. I feel that my staff, my patients, and I, are doing something right when there is nothing wrong. Hopefully, by having a Preventive Dentistry Month, it will focus us all on this sometimes neglected aspect of dentistry.