2009 December Archive - Dr. Mitchell A. Josephs' Blog

Archive for December, 2009

To Graft, or Not to Graft

Posted on: December 30th, 2009 by Dr. Mitchell Josephs No Comments

Q: I had a tooth pulled and was told that I need a bone graft before the placement of an implant. Is this necessary?

A: As Shakespeare’s lesser known dentist- third-cousin once said: “To graft or not to graft, that is the question.”

Often times the socket left behind after an extraction is too large or the bone is too thin. Sometimes a graft is necessary to create a more substantial foundation for the implant site, says periodontist, Dr. Mauricio Gutierrez.

We in the ‘tooth biz” use three types of grafts: autogenous bone= bone from your own body, xenografts=bovine (cow) bone, allografts=human cadaver bone and more and more popular, alloplast grafts=synthetic bone.

The graft material serves as a scaffold, allowing your own bone to grow from within.

Why Did My Dentist Remove My Silver-Mercury Filling?

Posted on: December 24th, 2009 by Dr. Mitchell Josephs No Comments

Q: I recently read in your paper that the FDA now declares silver-mercury fillings as “safe”. Then why do dentists always seem to be removing and replacing them? Robin in Palm City

A: Robin? As in “Batman and Robin”? Riddle me this, “boy wonder”: When does a dentist go to jail? Answer: When he practices in West Virginia and removes a patient’s silver filling, telling them that the mercury is poisoning them. That’s right, man in tights. In some states this is a felony.

Amalgam has been proven safe time and time again. It is the most researched subject matter in the history of biomaterials. The main indications to remove fillings is if they show leakage, fracture, decay or the patient just does not like the look of blackness between their teeth.

There are better choices of materials these days that chemically bond to tooth structure and require less drilling away of your natural tooth: porcelain and composite inlays.

What is the best way to bleach my porcelain veneers?

Posted on: December 21st, 2009 by Dr. Mitchell Josephs No Comments

Q: Finances are such that I cannot afford to do porcelain veneers right now. What is the best way to bleach my teeth?… TL From Royal Palm Beach

A: A timely question, indeed, as many dental practices across America are offering “summer white sales” on teeth whitening procedures.

With twenty years of schlepping teeth under my belt in the dental “biz”; I have tried them all. Not only on patients, but on my self and my two pugs, Bella and Wrinkles.

As a dentist on the lecture circuit, I meet some of the most innovative practitioners who share the lecture podium with me. I use a great technique called “deep bleaching”; developed by a California DDS named Rod Kurthey. It uses the Sapphire Bleaching light (not Zoom and not Brite Smile) coupled with a pre treatment and post treatment solution applied directly to the teeth that allows for better results and no sensitivity.

I have seen patients go thirteen shades lighter in one hour without wearing trays of bleaching gook. Most patients will at least lighten from 4 to 7 shades. The US average fee for this procedure is $650.

Blood Thinners and Implants

Posted on: December 17th, 2009 by Dr. Mitchell Josephs No Comments

Q: Can I have implants even though I am on blood thinners?… A.L. in Golden Lakes

A: My father in law is retired from the brassiere industry. If you own an Exquisite Form bra, chances are he had his hand it. (Uh, let me re-phrase that…)

He is on Plavix, a blood thinner. We placed four implants in one appointment with no complications using the following protocol:

Firstly, Your DDS should chat with your MD to get clearance to stop any blood thinners. If you get the ok, common recommendations are: 1. If on daily aspirin, stop it 5 to 7days before. 2. If on Coumadin; stop it 5 days before. 3. If on Plavix, stop it 3 days before.

Stage two surgeries, when implants are uncovered after their 3 to 4 month integration time in the jaw bone, can often be accomplished with lasers or electro surgery which would not warrant stopping the meds.

Teeth Bleaching Booths

Posted on: December 14th, 2009 by Dr. Mitchell Josephs No Comments

Q: Why should I pay my dentist $700 to whiten my teeth when I could get it done at one of those teeth bleaching booths?

A: Are you not a bit skeptical having medical or dental treatment performed in a booth next to the Ginsu Knife demonstration at the Toilet and Urinal Manufacturers Association’s Convention?

Most of these booths are not manned by dentists. In Florida it is a Board of Dentistry violation to apply bleaching materials with out the dentist being on the premises. These “carnival” booths try to get around it by making the customer apply the bleaching gel to there own teeth, making the claim that they are not “touching” a patient.

Before any type of dental treatment is performed, a dentists needs to examine the patients mouth and look for leaky restorations that could allow the solution to penetrate and cause severe sensitivity to the dental pulp (never bundles). He also needs to determine if you are not a candidate for this and are about to throw away some coin.

Who will follow up with you should you have any complications? Not the former Hooters girl who was operating the booth that day; she is now in St. Louis at another trade show.

SCUBA and Flying Can Hurt Teeth

Posted on: December 10th, 2009 by Dr. Mitchell Josephs No Comments

Q: Is it true that pressure changes while flying or scuba diving can be harmful to teeth and cause an abscess?

A: Groucho Marx used to say on his show “You Bet Your Life”: “The secret ‘woyd’ is: barotraumas. (I cannot believe my spell check recognized barotraumas, but not Groucho! Obviously a 20 year old wrote this program.)

Barotraumas describe a physical injury caused by a rapid or extreme change in air pressure. These areas include compromised teeth: teeth with inflammation, necrotic (dead) pulps or inadequate, leaky dental work.

Boyle’s law states the volume of a gas is inversely proportional to the ambient pressure. Meaning, if you have a leaky filling or an already abscessing tooth, scuba diving will exert pressure on any air trapped in the nerve canals or under faulty fillings. If you are flying, the trapped air would expand and could cause intense pain.

Make sure you see your dentist to examine your dental work with intra-oral cameras and digital X-rays to find problems before your next dive or your next flight.

Baby Teeth

Posted on: December 7th, 2009 by Dr. Mitchell Josephs No Comments

Q: Why should I pay to have my child’s baby tooth filled when it will just fall out anyway? …..Ellen via email

A: That’s like saying “why take a two year old to Disney world, he wont remember it anyway.” In my 20 + years in the tooth biz, I have always been amazed how often this question is asked. I have had top physicians as patients ask me the same question.

Baby teeth, known as deciduous teeth, need to be kept in the mouth until they “exfoliate” at their pre-programmed time, and not before. They act as space maintainers to allow for the proper eruption of the adult teeth. If you let a cavity get too deep and expose the pulp, the tooth can abscess , spreading infection to the face and even the brain. Never, never ignore fixing your kids teeth.

Atrial Fibrillation

Posted on: December 3rd, 2009 by Dr. Mitchell Josephs No Comments

Q: I have a heart problem called atrial fibrillation and am worried about starting my dental treatment which includes extractions, implants and bridge work. Should I be worried?…LBJ in Manalapan

A: I’m glad someone is putting their heart into their writing! (Better than a bunch of corny jokes and dental puns)

Atrial fibrillation (AF) is a cardiac rhythm disturbance arising from disorganized electrical activity in the chambers of the heart. Very often patients are treated with the drug Coumadin to prevent the formation of clots and the possibility of a stroke and beta blockers such as Atenolol to control the heart rate.

Several precautions should be considered: Your hygienist should avoid using ultrasonic scalers during teeth cleanings, but instead use hand scalers. Some local anesthetics containing drugs that constrict blood vessels (vasoconstrictors) need to be used in ways that prevent direct injection into blood vessels. Certain antibiotics, pain medications and anti-anxiety agents prescribed during dental treatment can decrease the effectiveness of the drugs used to treat AF.

You may have all the above needed dental procedures as long as your dentist keeps a few points in mind, starting with a chat with your physician.

The $10K Denture

Posted on: December 1st, 2009 by Dr. Mitchell Josephs No Comments

Q: A friend of mine told me that she paid $10,000 for a set of dentures. Is this not excessive?

A: I have an unusual philosophy about dentures. (And an even stranger philosophy about life in general, but we will save that one for the analyst’s couch) To a patient, a denture that fits well, is comfortable, looks decent and can actually cut food is worth $30,000. A denture that spends most of the time inside a Tupperware container is worth $0.00.

B: Toothless areas will shrink a couple of millimeters every year, eventually leaving very little ridge for dentures to hang on to at any cost. If you don’t have enough bone for implants or are limited by finances, you must resort to full dentures.

For years I thought there was not much progress in the denture world until I attended seminars given by a famous denture dude named Dr. Barotz of Colorado. On average a good set of upper and lower full dentures run about $4000.

A set made for $10,000 would have custom porcelain teeth (not acrylic), special matching pink fake gums with artificial capillaries to mimic real human oral tissues, fake fillings in the back teeth, and intentionally crooked teeth for “realism”.