Fluoride

Everyone knows that fluoride is good for your teeth, however few people realize that there are actually two different mechanisms by which Fluoride can be introduced to tooth structure. First is a systemic introduction through ingestion which occurs inside the jaw and before exposure to the oral cavity. Second is a topical application to teeth that have already erupted.
The actual mechanism of fluoride action is still a subject of debate. A dogma has existed for many decades, that fluoride has to be ingested and acts mainly pre-eruptively. However, recent studies concerning the systemic effect of fluoride supplementation concluded that the caries-preventive effect of fluoride is almost exclusively posteruptive. Moreover, epidemiologists have cast doubt on the validity of the 'old' studies dealing with fluoride use. The concept of the posteruptive fluoride effect is supported by in vitro and in situ investigations demonstrating that the mode of action of fluoride can be attributed mainly to its influence on de- and remineralization of dental hard tissues. Therefore, topical fluoride application in the form of fluoridated dentifrices(tooth paste or mouthwash) should be encouraged.

Bruxism/TMD

Bruxism put simply is the conscious or subconscious grinding and/or clenching of teeth. Most people have heard of the abbreviation; TMJ, this stands for Temporomandibular joint which are the jaw joints directly in front of the ears. TMD is any dysfunction that is associated with the TMJ.
There are various severities of TMD, ranging from slight pressure or discomfort to very severe pain and dysfunction. The etiology or cause of TMD is usually some form of occlusal discrepency or unbalanced bite. When the teeth don't line up and come together evenly, our bodies natural and often subconscious rection is to clench or grind in certain spots. This in turn will lead to problems with the jaw joints or some form of TMD. Bruxism is often cyclical( comes and goes) and progressive( tends to worsen with time). The good news is that for most people there is an easy fix in the form of an occlusal appliance or custom fitted hard night guard.

Prosthodontist.

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.

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!

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.

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.

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!

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!

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.

Interesting facts

In this post, I've decided to keep it light and just list some interesting facts that are dentally related;
The average woman smiles about 62 times a day! A man? Only 8!
Kids laugh around 400 times a day. Grown-ups just 15.
Smilers in school yearbooks are more likely to have successful careers and marriages than poker faced peers.
More people use blue toothbrushes than red ones.
The average toothbrush contains about 2,5000 bristles grouped into about 40 tufts per toothbrush. The tufts are folded over a metal staple and forced onto pre-cored holes in the head and fused into the head with heat. The handle is made of at least two materials, usually plastic and rubber.
Top of the American teeth stakes in the poll for greatest looking teeth were Hollywood actors Brad Pitt and Julia Roberts.
50 % of the general population consider the smile the first facial feature they notice and 80% are not happy with their smile.
38.5 = the total days an average American spends brushing teeth over a lifetime.
Americans spent nearly $2.025 billion on Halloween candy this year. That would fund the National Institute of Dental and Craniofacial Research for almost six years.
33% of Americans have untreated tooth decay.
90% of systemic disease have oral manifestations.
83% of people believe their teeth are more important to their appearance than hair and eyes.
How people take care of their mouths is often a reflection of how they feel about themselves. At birth the only fully developed organ is the tongue which is needed for sucking. For the first two months of life our mouth is our primary organ. We use it for survival, expressing ourselves and to explore our new world. consequently it is very significant in our unconscious. Because of this it can be assumed that how we take care of our mouths is a reflection of how we feel about ourselves. People who feel good about themselves take good care of their mouth and people who have a poor self image generally do not take good care of their mouth.

Discomfort

In deciding the topic of my next entry, I always try to put myself in the patients' shoes and think from a patient's perspective. What came to mind recently is the discomfort that most people automatically associate with dental treatment. In my mind the vast majority of the "usual" discomforts of dental treatment can be avoided. In other words an assumption that dental treatment is inherently uncomfortable is false. My staff and I always try to pay attention to the smallest detail in dealing with patients and our priority is to keep our patients mentally and physically comfortable at all times. This attention to detail goes a very long way and the positive reaction of our patients even surprises me at times. Not a day goes by where I don't get a "Wow, that wasn't bad at all" and I take pride in the fact that I am exceeding my patients' expectations on every level. So the next time you find yourself apprehensive at the thought of dentistry, just remember it doesn't have to be that way!

Benign neglect

Benign neglect is a policy or attitude of ignoring a situation instead of assuming responsibility for managing or improving it. I take this topic very seriously as I've had some experience with it and it's consequences. Years ago when I took over an existing practice, I came to realize that some of the patients did not want any treatment unless they were in pain or half of their tooth fell out! I found myself explaining and educating my patients as to the importance of early diagnosis and treatment of conditions that they were not aware of. Later after some investigating I realized that the previous dentist rarely did a thorough examination and basically if the patients did not have a complaint they were given a clean bill of health and sent on their way. This practice may seem like a conservative approach on the surface but of course it is not only detrimental to the health of patients, but also unethical. It is a proven fact that by the time a patient experiences some symptoms, some irreversible damage has already occurred. For example some recurrent decay under an existing restoration is usually diagnosed at a periodic exam and subsequently the filling and decay are excavated and a new restoration placed. Now, if the same tooth is neglected, the nerve could easily become invaded by the advancing decay and become infected, thus requiring more invasive treatment such as root canal therapy. I feel that it is my professional and ethical duty to use all technological advances at my disposal to make thorough diagnosis on a regular basis and protect the health of my patients in the long run.

Sticking with your treatment

Some of us are lucky and have very few dental issues in the way of gum disease or recurrent decay.
On the other hand the majority of the population, at one point or another, will develop more than one form of pathology at the same time. In these situations it is imperative to have a comprehensive approach in treatment. Now it's human nature to deal with your problems one at a time and it is totally understandable that to many people problems in multiple areas of their mouth seem overwhelming. I have been told by some of my patients, "why don't we deal with this first and then we'll see....." and over and over again the result is a vicious cycle that never ends! One needs to always keep the big picture in mind. The pathologies that are put on the back burner not only don't go away, but by the next check-up are worse and would require even more invasive treatment. The much wiser approach is to hunker down and try to eliminate all problems as soon as possible. There is always a light at the end of the tunnel and by addressing all issues, one can quickly get back on track.

Dental Implants

Although you have a number of restorative options for the treatment of missing teeth, none have proven to be as functionally effective and durable as implants. In many cases, dental implants may be the only logical choice for the restoration of all necessary functionality of the teeth and supporting structures. An important advantage of dental implants over more traditional forms of treatment such as a fixed bridge, is that your other teeth are not prepared to hold the prosthesis. Thus they are much more conservative in terms of your own teeth.
Today's dental implants are virtually indistinguishable from other teeth. This appearance is aided in part by the structural and functional connection between the dental implant and the living bone. Implants are typically placed in a single sitting but require a period of osseointegration. Osseointegration is the process by which direct fusion of a dental implant root and the bone of the jaw occurs. An osseointegrated implant takes anywhere from three to six months to anchor and heal, at which point we would complete the procedure with the placement of a crown. Dental implants can also be utilized to replace multiple teeth.

Flossing & Overall Health

By the time we reach adulthood, most of us know that the consequences of not flossing are pretty tough on our teeth. Daily flossing is a vital part of dental care and promotes healthy teeth and gums. Sounds easy enough. But what if you knew that this simple daily ritual not only protects your mouth, but also may protect your heart and arteries? Suddenly, that little white string becomes more like a lifeline.
True, lack of flossing can lead to gingivitis and periodontal diseases, but the consequences of poor dental health may reach beyond your mouth and to your heart. Research has shown a distinct connection between periodontitis and cardiovascular disease. Researchers speculate that bacteria from the mouth may enter the bloodstream and contribute to inflammation and artery clogging. In one emergency room study, patients who came to the ER with chest pain were found to have a higher rate of recurring gum infections. Researchers are not sure what is behind the connection, but the worrisome data makes the simple task of flossing a no-brainer for optimal health.

"The check-up"

check-up, recall, re-care, cleaning, prophy, .......it really doesn't matter what you call it but what does matter is that you have at least two a year. I have been a clinician for 17 years and if there is one piece of advise that I could give, it is to never miss your bi-annual dental exam & cleaning.
This may seem very obvious to some but too many times I have seen patients stay away for too long and get into trouble because of it. Regardless of how much or how little treatment you are having, those periodic "check ups" should not be missed. Also one needs to realize that there is no substitute for these visits meaning that just because you have had some other treatment at the dental office doesn't mean you can miss your 6 month cleaning/exam. It is ONLY at these visits that your dental professionals can preform a comprehensive and thorough evaluation of ALL your teeth and recommend an appropriate course of action or alter an existing plan.

LUMINEERS

Statistics show that many people tend to be dissatisfied with the appearance of their teeth. This is usually due to discoloration, spaces or uneven positioning of teeth. I would like to discuss a possible solution to many of these common issues called Lumineers. Lumineer porcelain veneers are custom designed to give you the beautiful smile you desire and much easier to place than you may have thought. It used to be that when we did a traditional porcelain veneer case, some of the enamel had to be removed from the teeth being treated. This was to make room so the veneers would fit properly and usually required anesthesia and some form of temporization in between visits. However unlike traditional veneers, there are no shots and no drilling of sensitive tooth structures with the Lumineer system. Due to advances in technology, Lumineers are fabricated to be as thin as a contact lens and for this reason there's no reason to make room by removing your own tooth structure. Also, this process actually increases the bond strength between the veneers and the teeth because enamel is the best material to bond to and much less of it is removed with this system. Lumineers have been proven to last over 20 years which is significantly longer than traditional veneers. They’re even reversible. So to summarize one can have a safe and permanent new smile in two easy and comfortable visists that consist of impressions and delivery.

Delaying Treatment

Putting off recommended treatment is never a good idea, but particularly in dentistry it is guaranteed to aggravate the condition and require even more work down the line. Weather we are talking about some recurrent decay under an old restoration or gum disease, procrastination will ensure more involved treatment and irreversible damage in the future. An old silver filling that is defective can usually be excavated and restored with an onlay, but the same tooth ~6months to a year later may require root canal therapy, post and crown. A relatively mild case of gingivitis, if untreated can escalate into periodontitis and permanent bone loss. So always remember that just like life in general, if problems are ignored they will come back to haunt you!

when to brush and floss

Everyone knows that we should brush and floss our teeth daily. What's not that clear to some is when is the most important time of day to do it. The answer is before bedtime because teeth and gums are most vulnerable to decay and disease during the night while we sleep. The reason is that when we are sleeping our salivary flow decreases significantly and saliva happens to be a natural defense against cavities and gum disease. Saliva neutralizes the acids that are produced by the bacteria in dental plaque, which would lead to cavities or decay. Any plaque that stays on various surfaces of your teeth overnight can do damage. So all teeth surfaces should ideally be brushed and flossed before bed.

Invisalign

If you ever wanted to straighten your teeth or improve your bite, but conventional metal braces were out of the question, then Invisalign maybe the answer for you. Utilizing the Ivisalign system we can move teeth into a more desirable position by having patients wear a series of transparant aligners or trays. This technology eliminates the need for conventional metal brackets and wires and is practically unnoticeable. The Invisalign system is a proven method which is also utilized by many Orthodontist and quite simple to employ. My staff and I are trained and certified to provide this service to our patients.

existing restorations

Contrary to popular belief and regardless of type of restoration( filling, bonding, inlay, onlay, crown, etc.), nothing is truly permanent. The oral cavity is subject to lots of wear and tear and in my experience no matter how well a restoration is placed, eventually it will fail. Now as depressing as this may sound, there is some good news! We can all minimize the risk of dental defects by following certain guidelines such as having good hygiene habits( proper brushing and flossing) and regular check-ups to remove plaque and calculus and to diagnose problems as soon as possible.

Conservative & timely treatment

One of the most important keys to better dental health are regular check-ups. The American Dental Association(ADA) recommends a minimum of two cleanings and exams a year. Our philosophy is to always do the most conservative treatment as soon as possible when faced with a defect or pathology. By having an examination every six months, we are able to catch and treat most conditions in a timely manner.

The importance of teeth

It's never too late to improve your dental care. As adults we only have one set of teeth and they are so important in so many ways. Not only are our teeth essential for health reasons but they are also a huge part of our personal and professional appearance, influence and self confidence!