As most of my patients and colleagues know, in addition to a family practitioner I am also a Prosthodontist. I received a DDS from Columbia University School of Dental Medicine, a General Practice Residency Certificate from Montefiore Medical Center and a Prosthodontics Certificate from New York University.
In this entry I will attempt to explain what a Prosthodontist is. The American Dental Association(ADA) recognizes a handful of specialties in the practice of dentistry. The ADA's definition is as follows; Prosthodontics is the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth and/or oral and maxillofacial tissues using biocompatible substitutes. In simpler terms a Prosthodontist has additional training in various techniques and procedures in restoring and/or replacing teeth.
It is a unique specialty in the sense that is relatively diverse as compared to other specialties. A Prosthodontist has a distinct advantage of not only being the primary restorative dentist, but also having a unique insight into all other specialties, allowing him/her to better coordinate a multi-disciplinary team of specialists.
Prosthodontics allows the capability and expertise to handle many different treatments from a simple procedure such as an onlay to a rather complex one such as a full mouth rehabilitation or cosmetic make over.
Tuesday, September 29, 2009
Wednesday, September 23, 2009
The true value of teeth.
Time and time again I see new patients who are dissatisfied with work that was done previously. More often than not, the condition is irreversible and more complex treatment is necessary to rectify the situation.
As adults we all have approximately 32 teeth and there are no spares. Once a tooth is damaged or lost it is not coming back. This is the reason why every single tooth is so valuable and irreplaceable.
In my opinion the key to better dental care is proper diagnosis and treatment in the first place. Too many people assume that a dentist is a dentist and that you get the same caliber of dentistry no matter where you go. Unfortunately this is far from the truth. Even more unfortunate is that by the time a patient realizes that previous treatments were faulty, it is often too late.
My staff and I have many years of training and experience and pride ourselves in providing the most conservative and clinically sound treatment bar none. There is absolutely no substitute to doing it right in the first place!
As adults we all have approximately 32 teeth and there are no spares. Once a tooth is damaged or lost it is not coming back. This is the reason why every single tooth is so valuable and irreplaceable.
In my opinion the key to better dental care is proper diagnosis and treatment in the first place. Too many people assume that a dentist is a dentist and that you get the same caliber of dentistry no matter where you go. Unfortunately this is far from the truth. Even more unfortunate is that by the time a patient realizes that previous treatments were faulty, it is often too late.
My staff and I have many years of training and experience and pride ourselves in providing the most conservative and clinically sound treatment bar none. There is absolutely no substitute to doing it right in the first place!
Tuesday, August 25, 2009
Dental care in a down economy.
Before I start, I would like to recognize that some of the materials that are mentioned may seem repetitive. This is due to the fact that various tips and recommendations are relevant to different topics and circumstances. One such recommendation is a minimally invasive approach to oral health in conjunction with a preventative and comprehensive philosophy.
In a down economy the last thing you should be doing is avoiding the dentist completely. It is very important to maximize your care by continuing all routine visits such as bi-annual cleanings and examinations. This will ensure that firstly, the status quo is maintained and any potential problem is avoided(preventative approach). Second, if a pathology is diagnosed, it can be treated in a timely manner before it progresses and require more aggressive treatment in the future(minimally invasive approach). Finally, in those instances where multiple pathologies need to be treated, seeing the whole picture will allow you and your dentist to devise an appropriate treatment plan with beneficial sequences(comprehensive approach).
Remember that just as in life in general, ignoring potential and/or existing problems will usually lead to bigger ones.
In a down economy the last thing you should be doing is avoiding the dentist completely. It is very important to maximize your care by continuing all routine visits such as bi-annual cleanings and examinations. This will ensure that firstly, the status quo is maintained and any potential problem is avoided(preventative approach). Second, if a pathology is diagnosed, it can be treated in a timely manner before it progresses and require more aggressive treatment in the future(minimally invasive approach). Finally, in those instances where multiple pathologies need to be treated, seeing the whole picture will allow you and your dentist to devise an appropriate treatment plan with beneficial sequences(comprehensive approach).
Remember that just as in life in general, ignoring potential and/or existing problems will usually lead to bigger ones.
Thursday, August 6, 2009
Tooth Whitening
Many people are not pleased with the appearance of their own teeth and one of the easiest methods of improving this appearance is by tooth whitening.
Enamel, the first layer of tooth surface, is actually semi-translucent, or clear. The layer underneath the enamel, known as dentin, is typically yellow, but may be gray, brown or black. This hue is what is seen penetrating through the enamel. In order to whiten the dentin, a peroxide solution is placed on the enamel. This process opens the pores of the enamel, allowing the solution to reach the layer of dentin. The solution will then begin to lighten the dentin, resulting in the appearance of whiter teeth.
As far as specific techniques and systems go, there are three basic categories. The first and least effective are over-the-counter products such as whitening strips. The second used to be the only professional option and consists of trays that are made by dentists and worn at home by the patient. The newest and most effective are chairside methods in which the entire procedure is preformed in the office over the course of approximately two hours. In this system a special light is used in conjunction with the whitening agent in multiple applications.
The good news for the patient is that many options are available nowadays and many are proven safe and effective.
Enamel, the first layer of tooth surface, is actually semi-translucent, or clear. The layer underneath the enamel, known as dentin, is typically yellow, but may be gray, brown or black. This hue is what is seen penetrating through the enamel. In order to whiten the dentin, a peroxide solution is placed on the enamel. This process opens the pores of the enamel, allowing the solution to reach the layer of dentin. The solution will then begin to lighten the dentin, resulting in the appearance of whiter teeth.
As far as specific techniques and systems go, there are three basic categories. The first and least effective are over-the-counter products such as whitening strips. The second used to be the only professional option and consists of trays that are made by dentists and worn at home by the patient. The newest and most effective are chairside methods in which the entire procedure is preformed in the office over the course of approximately two hours. In this system a special light is used in conjunction with the whitening agent in multiple applications.
The good news for the patient is that many options are available nowadays and many are proven safe and effective.
Wednesday, July 22, 2009
A question of priority
In my 18 years of private practice as a family practitioner and Prosthodontist, I've heard all kinds of excuses for avoiding and/or delaying dental treatment. Regardless of what the excuse is, I think in most cases it is simply a question of priority. Most people can understand, on an intellectual level, that an existing pathology needs to be removed and corrected. However unless the person is in pain or discomfort, they may feel that the recommended treatment can wait or in some extreme cases totally avoided. Of course the problem with this line of thinking is that clinical pathologies never go away and as a matter of fact usually lead to irreversible damage which will require even more treatment down the line. I have seen patients regret not following through with recommended treatment too many times and those who remain consistently healthy are the ones that do not procrastinate!
Tuesday, June 30, 2009
A comprehensive approach
The oral cavity or mouth consists of many parts and can roughly be categorized into hard tissues(teeth and bone) and soft tissues(gums, cheeks, palate, etc.). Optimal function and appearance requires that all the parts are healthy. So when it comes to treating the mouth, it is absolutely imperative to apply a comprehensive approach. I've come across many situations in my career where certain aspects of a condition were ignored during previous treatment and as a result the outcome is poor or failing.
Recently, I did an examination on a patient who just had some restorative work and needed a second opinion because he was not pleased with the results. I found that the patient had moderate to severe bone loss(Periodontitis) and had to tell the patient that all the recent work should be removed in order to treat the supporting bone and gums. Needless to say Mr. X was not happy. The moral of this story is to make sure that a thorough evaluation(clinical and radiographic) is performed before a treatment plan is derived and carried out. As we all know, its always better to do it right the first time!
Recently, I did an examination on a patient who just had some restorative work and needed a second opinion because he was not pleased with the results. I found that the patient had moderate to severe bone loss(Periodontitis) and had to tell the patient that all the recent work should be removed in order to treat the supporting bone and gums. Needless to say Mr. X was not happy. The moral of this story is to make sure that a thorough evaluation(clinical and radiographic) is performed before a treatment plan is derived and carried out. As we all know, its always better to do it right the first time!
Monday, June 15, 2009
Onlay
As I have mentioned previously, existing restorations in our teeth do not last forever. Due to a constant wear and tear, older fillings tend to break down over the years. It can be somewhat confusing to the average person as to what is an appropriate replacement for an old and defective filling. There are many choices but as a general rule the proper choice for a replacement is directly proportional to how much tooth structure is remaining after the excavation. So the size of the original restoration is definitely a factor. Another factor is the nature and severity of the defect, meaning how much recurrent decay is present at the time of diagnosis. It is also very important to be conservative and not remove any more healthy tooth structure than is necessary.
In my experience most existing defective fillings are best restored with an Onlay. An Onlay is a type of dental restoration that is the best of both worlds not only in the sense that it provides proper coverage but also it is not overkill in preparation. What happens in most situations is that after a defective filling is cleaned out, the walls that contained the old filling will be too thinned out to support another direct filling especially at the very top of the tooth. Those thin walls are then reduced by a couple of millimeters and the Onlay is fabricated in the Laboratory from an impression of the teeth. The analogy that I like to use is a mushroon shape in cross section where the "cap" covers most of the biting surface and the "stalk" sits in the tooth where the filling was. This design is ideal because we are essentially only removing what is defective. It is also relatively more conservative in preparation than some other choices such as a crown for example. The idea is that the more of your own tooth we can hold on to now, the better off you are in the long run and more options are available in the future.
Onlays are made of a type of porcelain and are bonded in with a resin cement. This is a very strong combination and teeth that are restored in this way will typically not require further treatment for many years.
In my experience most existing defective fillings are best restored with an Onlay. An Onlay is a type of dental restoration that is the best of both worlds not only in the sense that it provides proper coverage but also it is not overkill in preparation. What happens in most situations is that after a defective filling is cleaned out, the walls that contained the old filling will be too thinned out to support another direct filling especially at the very top of the tooth. Those thin walls are then reduced by a couple of millimeters and the Onlay is fabricated in the Laboratory from an impression of the teeth. The analogy that I like to use is a mushroon shape in cross section where the "cap" covers most of the biting surface and the "stalk" sits in the tooth where the filling was. This design is ideal because we are essentially only removing what is defective. It is also relatively more conservative in preparation than some other choices such as a crown for example. The idea is that the more of your own tooth we can hold on to now, the better off you are in the long run and more options are available in the future.
Onlays are made of a type of porcelain and are bonded in with a resin cement. This is a very strong combination and teeth that are restored in this way will typically not require further treatment for many years.
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