Dr. Mitchell A. Josephs' Blog - This is the blog for Palm Beach Dentist Dr. Mitchell Josephs and is about topics related to cosmetic dentistry, implant dentistry, root canals, and general oral care.

Canker Sore Nightmares; Never Again!

Posted on: May 8th, 2013 by Dr. Mitchell Josephs No Comments

Q: I am going nuts with several canker sores that have erupted since having major dental work last week. None of the over the counter remedies work. What can I do? Donna in Palm Beach Gardens

A: Canker sores, known in the “biz” as apthous ulcers, are like a bad houseguest who overstays his welcome. (Living in Florida seems to attract more of them. Funny. When I lived in New Jersey for a year, nobody visited me.)

These suckers are caused by an unknown virus that takes over after a small micro-trauma to the tissues. Unlike cold sores, which are on the dry parts of the lip, canker sores are white craters surrounded by a red border found inside the “wet” portions of the mouth. They sting from spicy and acidic foods.

Solutions: A fantastic drug called Debacterol, applied by a dentist or physician will axe the bugger in 5 seconds. This is not available over the counter and cannot be applied by the patient. Another treatment is the diode laser, which we also use to remove ugly purple lip bumps called hemangiomas. For free consumer info on these treatments, email us.

Editor’s Note: Dr. Josephs will be emceeing a night of comedy at the Improv comedy club at City Place, West Palm Beach on Wednesday May 15^th 8:00 PM sharp. Call 561-833-1812 to reserve your seats today!

Dr. Mitchell Josephs practices Implant Cosmetic and General Dentistry and hosts “Tooth Talk” on WBZT AM123.0 Dr. Josephs is on staff at West Palm Hospital (Formerly Columbia Hospital) and is a Faculty Advisory Board member at McGill University’s Faculty of Dentistry and completed his residency at Manhattan’s Beth Israel Medical Center and Mt. Sinai Hospital.

Tags: canker sore, General Dentistry, Mitchell Josephs
Posted in General | No Comments »

Operating Microscopes for Dentists

Posted on: May 1st, 2013 by Dr. Mitchell Josephs No Comments

Q: I recently changed dental offices. I notice my new doctor uses what looks like a set of binoculars strapped to his glasses and sometimes a microscope. Is this something that should be in all dental offices now? Meg in Wellington

A: As the saying goes: “you don’t know what you don’t know”. (My guess the great Yogi Berra or the not-so-great Donald Rumsfeld coined that one.) With so much patient loyalty in the dental industry, many of us will not know what is “new and cool” until we visit another practice. Although not all dentists will be using operating microscopes or magnifying loupes, they do offer several advantages to both doctors and patients.

The exceptional magnification allows incredible detail aiding in our almost anal retentive nature of striving for un-obtainable dental perfection. When I first began using operating microscopes and loupes, I felt as if I had superman powers. My endodontist (root canal doctor) uses a $15,000 operating microscope that neurosurgeons use as she enters hair-thin canals within the confines of a single tooth. Both loupes and operating microscopes now incorporate fiber optic or LED lights for better visibility. All these hi-tech goodies can lead to more accurately fitting dental work, making the doctor AND patient very happy.

For a short video preview of my next FREE seminar to the public (info below), contact us and I will email you the video.

Editor’s Note: Dr. Josephs will be giving a FREE seminar to the public: “Teeth for Life”: A hi-tech update on the latest techniques in Implant, Cosmetic and General Dentistry. Join us at 10:00 AM at the Double Tree Hotel on PGA Blvd. in Palm Beach Gardens on Friday May 3^rd. Only 30 seats remain. Call 561-832-2917 to register today! Free copies of his latest book will be given to all attendees.

Dr. Mitchell Josephs practices Implant Cosmetic and General Dentistry and hosts “Tooth Talk” on WBZT AM123.0 Dr. Josephs is on staff at West Palm Hospital (Formerly Columbia Hospital) and is a Faculty Advisory Board member at McGill University’s Faculty of Dentistry and completed his residency at Manhattan’s Beth Israel Medical Center and Mt. Sinai Hospital.

Tags: General Dentistry, Mitchell Josephs, Operating Microscopes for Dentists
Posted in dental | No Comments »

Dental Impressions-“Same Mold Thing?”

Posted on: April 24th, 2013 by Dr. Mitchell Josephs No Comments

Q: I notice that when my dentist puts in crowns, I notice the edges often do not meet my gum line. Why is this? … Danny K. in Palm Beach

A: You really know how to push a tooth doctor’s buttons. We lye awake at night battling this reality that is one of the most challenging aspects in placing artificial substances (porcelain) next to living, human tissue (ie. your gums).

Sometime an extra step associated with the dental impressions, called a soft tissue model, is needed to get the crowns closer to the gum line. This step instructs the lab to pour two models; one that shows the gum, the other: just the tooth to mount the crown for fabrication.

I prefer the use of digital dental impressions (Google: iTero by Cadent) which takes a 3-D scan to create a single robot-CAD CAM milled model of both teeth AND gums. Some patients have thin gums and will never have aesthetic perfection in this area, but will be hidden from the public by the lips. I will show this technique of an actual case in action at my next seminar. For a short video preview of my next FREE seminar to the public (info below), contact us and I will email you the video.

Tags: dental crowns, dental impressions, General Dentistry, Mitchell Josephs
Posted in General | No Comments »

Unsightly “black on gumline” bothers patients

Posted on: April 17th, 2013 by Dr. Mitchell Josephs No Comments

Q: I notice my friends dental work at lunch the other day shows an ugly tinge of color that I can only call: black on gumline, for lack of a better term. What is this? Anne F. in Boca

A: Apparently lunch did not go so well for your friend, I take it. (If you broke the news to her.)

The most common reason one would see black at the gumline would be gum recession above a PFM (porcelain fused to metal) crown. This type of crown has metal that can be visible at the gumline with age or in patients with genetically thin gingiva. Many doctors like myself use all-porcelain, metal-free crowns in the esthetic zone to prevent this occurrence.

Another possibility is minor gum recession around dental implants, exposing the metallic, abutment post that connects the crown to the implant, imbedded in the bone. The use of metal free, ceramic abutments can prevent this in some, but not all, cases.

For a short video preview of my next FREE seminar to the public (info below), contact us and I will email you the video.

Editor’s Note: Dr. Josephs will be giving a FREE seminar to the public: “Teeth for Life”: A hi-tech update on the latest techniques in Implant, Cosmetic and General Dentistry. Join us at 10:00 AM at the Double Tree Hotel on PGA Blvd. in Palm Beach Gardens on Friday May 3^rd. Only 38 seats remain. Call 561-832-2917 to register today! Free copies of his latest book will be given to all attendees.

Tags: dental work, General Dentistry, Mitchell Josephs
Posted in dental | No Comments »

Adjusting Dentures at Home

Posted on: April 10th, 2013 by Dr. Mitchell Josephs No Comments

Q: I recently had dental implants to secure a full lower denture. I am back at my summer home and noticed a sharp projection cutting into my gum. Is there anything wrong with adjusting dentures with some home tools? Fred in Nantucket

A: Back in the early 90’s, I performed at an open mike night at a comedy club. I did a whole routine on the “Home Vasectomy Kit by Ronco.” “If you buy now, you get the Pocket Fisherman AND the Ginsu Knives for FREE! But wait, there’s more…..” You had to see it live. Trust me it killed.

Although adjusting dentures at home is not recommended, if you cannot get to a dentist and happen to have a small, sharp projection of metal or acrylic on the removable parts of the denture, not the implant attachments in the mouth, you could file it down with an emery board used for finger nails. Don’t take the denture to the lathe in your garage wood shop.

If you have a standard non-implant supported denture with metal clasps that seem to have loosen, only use light inward pressure with your thumbs to spring the clasp a bit closer to the teeth. Do not use a needle nose plier from the toolbox. You don’t want to risk breaking a clasp or making it so tight that it traumatizes the tooth or slips down and lacerates your gum.

Hopefully you can avoid dentures all together, which are usually made for those with limited finances or for patients who waited too long and have no bone left to install permanent teeth with implants. For a short video preview of my next FREE seminar to the public (info below), contact us and I will email you the video.

Editor’s Note: Dr. Josephs will be giving a FREE seminar to the public: “Teeth for Life”: A hi-tech update on the latest techniques in Implant, Cosmetic and General Dentistry as well as Botox and Juvederm Treatment. Join us at 10:00 AM at the Double Tree Hotel on PGA Blvd. in Palm Beach Gardens on Friday May 3^rd. Only 40 seats remain. Call 888-DRTOOTH (561-832-2917) to register today!

Tags: Adjusting Dentures at Home, General Dentistry, Mitchell Josephs, palm beach dentist
Posted in General | No Comments »

Oklahoma “Dirty Dental Office”

Posted on: April 3rd, 2013 by Dr. Mitchell Josephs No Comments

Q: Should we be worried about the latest news story about the Health Department warning 7000 Oklahoma residents that they might have been contaminated by dirty dental instruments from an oral surgeon’s office?…Dave in Boca

A: ABSOLUTELY NO NEED TO PANIC. Palm Beach Post readers, including you, are savvy consumers who will ask their current dental offices how they sterilize their instruments. The answer you want to hear is: “Autoclave” or “Steam under pressure.” This is the only method that kills viruses, bacteria and spores. Although “rust” was mentioned in this story, no one gets sick from rust. Rust is only oxidized metal. Killing the bugs is what counts!

Surfaces that are not placed in the mouth are cleaned with special bacterialcidal wipes. Disposable items such as suction tips and retractors are trashed.

When choosing a new office, ask for a tour by the staff to show you the sterilization process. Use common sense. If the office looks dirty and out of date, proceed with caution!

FACT: There has never been one case where a patient has been infected with HIV from a dental office. After the Kimberly Bergalis/Dr. Acer case settled in the early 90’s, a University study later proved that the three patients did not get AIDS from the dental office. The middle aged man frequented prostitutes, the grandmother had blood transfusions before 1981 and Ms. Bergalis was found not to have been a virgin. This is not to disrespect the plaintiffs, but to state facts.

Editor’s Note: Dr. Josephs will be giving a FREE seminar to the public: “Teeth for Life”: A hi-tech update on the latest techniques in Implant, Cosmetic and General Dentistry as well as Botox and Juvederm Treatment. Join us at 10:00 AM at the Double Tree Hotel on PGA Blvd. in Palm Beach Gardens on Friday May 3^rd. Only 45 seats remain. Call 888-DRTOOTH (561-832-2917) to register today!

Tags: Dirty Dental Office, General Dentistry, Mitchell Josephs
Posted in General | No Comments »

Gallup Pole: Dentists Rank High

Posted on: March 27th, 2013 by Dr. Mitchell Josephs No Comments

Q: Why do so many people hate their dentist? Beth in Boca

A: In my 25 years of practice the two most popular first statements a new patient utters are: “Nothing personal, but I hate dentists.” And “ Is it true that dentists have the highest suicide rate?” (What a great way to start my day!) My initial response is: “Well, with statements like the first one you are certainly not LOWERING the suicide rate!”

The Gallup Pole shows the top three most trustworthy professions are Clergy, Dentist and Pharmacist. I always felt this would be a great set-up for a joke: “This Rabbi, a pharmacist and a dentists walk into a bar…”

A Gallup pole shows the number one reason that 50% of the population never goes to the dentist is due to fear, not money. The fear is from a bad childhood experience at a dental office. Most fear the shots, but if you seek care at a dental office that uses a Vibraject, Dental Vibe and a Computer Controlled Syringe, or Dental Wand, you will have much more comfortable injection. Many patients say they don’t feel the needle at all.

As far as our suicide rate; we may not be number one, but I have read that we are tied with psychiatrists. We are microsurgeons operating on awake, moving patients in a very small orifice, like building a ship in a bottle. Tomorrow, give your dentists a hug, he or she is doing the best they can to allow you to have beautiful, permanent teeth for the rest of your life.

Editor’s Note: Dr. Josephs will be giving a FREE seminar to the public: “Teeth for Life”: A hi-tech update on the latest techniques in Implant, Cosmetic and General Dentistry as well as Botox and Juvederm Treatment. Join us at 10:00 AM at the Double Tree Hotel on PGA Blvd. in Palm Beach Gardens on Friday May 3^rd. Seating is limited to the first 50 people who register. Call 888-DRTOOTH (561-832-2917) to register today!

Tags: General Dentistry, Mitchell Josephs
Posted in General | No Comments »

Temporary Teeth During Implants

Posted on: March 20th, 2013 by Dr. Mitchell Josephs No Comments

Q: I need some more teeth removed and implants placed. One is right in the front of my smile. I don’t want to go the whole summer without a tooth and I don’t want to have to use those bulky pink dentures with the metal clips other dentists have made for me. What else can I do? Miriam in Delray

Sounds like you are describing what we call in the tooth biz a “flipper”. Not the most appetizing of dental temporaries; not even if ordered with the house dressing. The fact is most implants cannot have any teeth attached to them until the bone- healing phase, called osseous integration, has past. This is usually 3 to four months.

Other options to discus with your doctor to provide temporary teeth during this time: 1. A bonded tooth pontic: a fake tooth is adhered to the sides of the adjacent natural teeth. 2. A cantilevered, two-unit acrylic temporary: removing an old adjacent crown and having a two-tooth temporary bridge cemented in place. 3: An Essex retainer: a clear bleaching tray, similar to an Invisalign retainer that has acrylic teeth embedded in it to fill your empty spaces. For great photos of the Essex retainer and free info, drop us an email or call us.

Note: Dr. Josephs’ FREE seminar on Hi-Tech Implant, Cosmetic and General Dentistry is available for your next meeting. His multi media presentation is perfect for country clubs, community centers, churches and synagogues, private groups, hospitals and healthcare facilities. Please contact 561-832-2917 to book your next event.

Tags: General Dentistry, Mitchell Josephs, Temporary Teeth, Temporary Teeth During Implants
Posted in Dental Implants | No Comments »

Extractions and Antibiotics

Posted on: March 13th, 2013 by Dr. Mitchell Josephs No Comments

Q: I recently had a tooth extracted and had quite a bit of discomfort for several days. My sister is a nurse and was surprised that the my doctor did not prescribe antibiotics. Is she right? Dawn in Royal Palm Beach

A: I don’t want to put a scalpel between siblings, but I beg to differ with your sister. (The last time I agreed with my two sisters, I was watching the first season of All in the Family.)

In January 2013 the Clinicians Report Newsletter published a consensus of antibiotic guidelines following various dental procedures. (Note: these are not the guidelines related to pre-medicating before dental work due to artificial joints or heart issues. That is a topic for another column. )

Removal of single teeth, weather routine or involving surgical cutting as in impactions, without signs of infection (puss, swelling, fever, or radiographic findings) do not require antibiotics. The pain patients experience is due to normal postoperative pain much like those that have had orthopedic surgery; or any type of surgery for that matter.

Antibiotics are usually given after the removal of many teeth at once, infected teeth, “hot” teeth, ie. teeth with acute pain and in patients who have certain medical problems such as diabetes. We also prescribe antibiotics following implant placement and bone grafts to help prevent rejection. As far as which antibiotics? The most common ones used are Penicillin, Amoxicillin, Clindamycin and Cephalexin.

Tags: Extractions and Antibiotics, General Dentistry, Mitchell Josephs
Posted in General | No Comments »

Antibiotics do not Cure Dental Abscesses

Posted on: March 6th, 2013 by Dr. Mitchell Josephs No Comments

Q: A lower left side molar was producing moderate pain. My doctor X-rayed the area and told me he would need to do a root canal. He started me on an antibiotic, and in two days the pain went away. If the antibiotic killed the infection why do I have to spend $1500 on a root canal? Colonel X, USAF.

A: The mouth is a very different animal from the rest of your “bod”. The bone that the teeth are set in does not behave the same way as the long bones of the rest of the skeleton. The teeth are individual organ systems that play by whole different set of rules compared to the rest of your “kishkas” (Mandarin for “guts”.)

When the nerve dies inside a tooth due to decay, leakage around dental work, or trauma, gangrene takes over as the circulation is cut off from the inside of the tooth. Bacteria from the mouth infect the pulp (center of the roots and teeth) forming an abscess. Unlike a swelling in the soft tissues of the body, the tooth is a closed, hard chamber preventing the infection from escaping. Many of these abscesses are chronic, meaning no pain. However, if ignored, the pain will become acute, spread to the face, sinuses, and neck, which can actually be fatal. The antibiotic is to help calm the infection down and impede its spread to the face. All dental infections require physical debridement, not just antibiotics. Do not ignore the doctor’s recommendation. For a free consumer guide to root canals, contact us.

Tags: Antibiotics do not Cure Dental Abscesses, Dental Abscesses, General Dentistry, Mitchell Josephs
Posted in dental | No Comments »