Is it hard to start a dental practice in Manhattan?

The answer is that is can be difficult. There are certainly lots of potential patients that work or live in Manhattan, but there are also thousands of dentists practicing in or nearby Manhattan. I practice in the 10016 zipcode and there must be over a hundred dental practices located in my neighborhood. Many offices, my own included, have no "ground floor visibility" so the only way patients can find me is through word of mouth referral , or through the internet. Advertising can work well, but it is an expensive way to attract patients.

I have known a number of dentists who have set up practices in Manhattan, and some do better than others. There is no secret sauce to starting a Manhattan Practice, but it does help if the dentist is social, friendly and meets a fair number of people. It helps to socialize with other Manhattanites and most dentists start their practices when they are young and very social. Going out in the city and enjoying the night life can help a young dentist meet other young people and most often they need dentists. Many young professionals in the city move to Manhattan from other areas and need a new dentist, so getting out and socializing with other young people can be a great way to build a dental practice.

If you are a dentist interested in practicing in Manhattan, It certainly is an interesting place to practice. The city is a vibrant an exciting place to work and live and I have met many interesting people over the years. Just going out for a walk after work or at lunch time can be entertaining , but be aware that it may not be the easiest environment to build a dental practice.

Does poor dental hygiene lead to dementia?

I have just finished writing a short article on my dental website on this topic. This is question that has arisen due to a new study published  the Journal of the American Geriatrics Society, online August 2, 2012. 
The study started in 1992 asked participants about their tooth brushing habits and then followed up eighteen years later to determine among other things what percentage of the participants were later diagnosed with dementia. The findings really don't show that poor dental hygiene will lead to dementia, but more likely means that those with undiagnosed (or diagnosed) mental impairments are more likely not to brush their teeth every day. At least that tends to be my conclusion. Clearly people who are suffering from all sorts of mental illnesses are more likely to neglect themselves in general.

How to handle negative online reviews?

No matter how hard a medical or dental professional tries to please patients, some will not like their services. No one can please everyone, and invariably a few patients may get angry when treatment results in outcomes that they do not like. Dentists must be able to inform patients certain teeth can not  or should not be saved, and some patients have expectations that can exceed what is currently possible in the field. Sometimes a real problem arises when this mismatch is only discovered after treatment is performed and can result in a negative online review..

What should a dentist do when confronted with a negative or angry online review by a patient. If the patient's complaints have some merit, then it can't hurt to calmly contact the patient and find out if there is anyway to resolve the situation to their satisfaction. This is a strategy sometimes suggested by the online site Yelp,but it doesn't always work in every situation, and it can be counter productive, if it leads to an angry discussion.

I perform hundreds of procedures every month in my NYC dental office and also perform many dental examinations. Almost all of them are concluded on a positive note, but some very small minority  of patients will blame a dentist for outcomes that are not positive.  If I remove a filling from a patients and find extensive decay or a crack in the tooth that didn't show on the x-ray, then some patients get upset when they are informed of this finding, especially when informed that a tooth may have a compromised prognosis and may need a root canal or an extraction.


If one of these patients does write a negative or angry review online on the internet, a dentist has limited practical options on how to proceed. Some medical professionals have written letters threatening legal action,  to either the website that posted the review, or too the online 'trasher'. Although this threat can sometimes result in a  negative review being removed,often it does not, and actual libel lawsuits can be expensive, time consuming and can hard to prove.

In most cases I believe the best policy is for the medical professional to continue to strive to provide their  best  services and attempt to get 'happy' patients to write positive reviews, that better reflect the type of  services  normally provided . Most savvy readers of online reviews will understand that some patients will become disgruntled, but if the vast majority of a dentists reviews are positive, they will assume a medical or dental practice must be doing something right. I personally do not mind asking  patients who are obviously pleased with their treatment to consider writing a review on the internet. I explain that there it will not be a problem if they do not find the time to, but that these reviews, when posted, in my opinion, help provide a more balanced view of the nature and quality of the services provided by a dental practice.

It is an old adage in dental practice that one angry patient will tend to go out of their way to tell 10 friends, but a happy one  will probably tell just one. Asking "politely" if a patient will post an online 'success story' can be a good idea, since the best defense against  negative online reviews, is a bunch of positive ones that surround it. Most online readers realize that when dealing with the public some can be hard to please and end up complaining about about a business with a  generally good reputation.

Some online services (Zoc Doc, Demand Force) do contact patients after treatment and ask patients to fill out  a  satisfaction survey of their last visit. This can be extremely helpful since it eliminates the need for a dentist of staff member to actually ask a patient to write an online  review, but the results of these surveys can be posted on the internet and can result in a more positive and truthful representation of a practice online.

Clearly if a business has  a relatively high proportion of negative reviews, most readers will assume (often correctly) that there may be  a problem with quality of the serviced being provided by that  business. If a dental practice does have this problem then most likely it is time  for them consider making changes that will result in generating better reviews.

Can digital x-rays be emailed?

I was emailed this question today by a reader, She explained that she requested a copy of her digital x-rays from a dentist,  in order to obtain a second opinion, and was told that they could be printed out and given to her, but the office was not happy about emailing the digital images to her. She also asked if the jpeg format was suitable for her, since the office had relented and emailed the x-rays to her in that format.

Digital x-rays can be emailed and the jpeg format is easily readable to most dentists and probably is the best format use to obtain  digital radiographs that will be used for a second opinion. Most dentists will accept emailed radiographs. Many dental offices will print out a hard copy for a patient to take with them, but often digital x-rays are best viewed on a digital monitor.

Can I have pain from a root canal tooth after it is extracted?

Although it is theoretically possible,due to a sensitization of a nerve ganglion (phantom limb pain), if you are still having persistent pain after a tooth is removed, most likely the pain is coming from a problem involving the extraction, or possibly a nearby tooth.  If pain persists after an extraction and doesn't show signs of improving after one or  two weeks, than it is best to return to your dentist. If your dentist is unable to pinpoint the problem, getting a second opinion from another dentist or a dental specialist (an endodontist or an oral surgeon ) might be a good idea. Only after all other causes are ruled out, should a diagnosis of a sensitized nerve ganglion be strongly considered. A consultation with a neurologist then would probably be the best way to confirm this diagnosis. Another possible diagnosis is Trigeminal Neuralgia which is a neurological condition that also is usually diagnosed after all other dental causes are ruled out. The symptoms of  both of these conditions may be alleviated by medication prescribed by the neurologist.
 
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 .

What are the best ways to maintain a healthy mouth?

 I have just returned from my vacation and I will start back at my office today.  While on vacation I wrote a short article entitled "Top Ten Secrets to Maintaining a Healthy Mouth" , This article was posted on my dental office website and attempts to explain some of the habits that people can develop that will help insure the ongoing health of their mouths. I will list my top ten list. Most of the these are no brainers, but here goes.
1.Take responsibility for your mouth!
2.Brush and floss your teeth on a daily basis
3.Schedule regular checkups and cleanings at the dentist
4.  Ask the hygienist or dentist to check your brushing and flossing technique
5.Do not chew on bones and ice cubes
6.Wearing a night guard is usually recommended for patients.
7. Refrain from excessive drinking of carbonated sodas
8.Diet plays a large role in keeping our teeth healthy.
9.Do not wait until you have pain to visit your dentist
10.Find a good dentist and try to stick with them

For an explanation of why these factors make my top ten list please click on the link to my website that follows  ..... read more

Clearly there are many additional habits that play a role, including ., not smoking, and controlling acid reflux, I invite readers to add to this list with their own suggestions in the comment section.

Where did you go on Vacation?

My son and I took a short trip to Spain. We started with touring Barcelona and ended up in Madrid. In Barcelona we toured the city on double decker buses, took a swim in the Mediterranean Sea and rented bicycles to expore the city. My favorite feature of Barcelona was the interesting architecture. My son liked the beach and touring on our rented bikes. In Madrid we also took the double decker buses to see the city. We visited the Prado Museum and went to La Paella de la Reina and had a terrific Paella made with chicken and sausage. We are now back in New York and my dental office will reopen on Wednesday August 15th,