2010 January Archive - Dr. Mitchell A. Josephs' Blog

Archive for January, 2010

Dental Treatments Before College

Posted on: January 29th, 2010 by Dr. Mitchell Josephs No Comments

Q: Before I ship my kid off to college, are their any special dental concerns I should address now? …B.J.S. Beverly Hills CA via internet.

A: I appreciate the concern for the tooth stuff, but I think a little “birds and bees” discussion might be in order. And I don’t mean ornithology or apiculture; (Have “Joe College look that one up!)

This time of year many doctor colleagues of mine send in their offspring for a pre-college check up. It is important that digital X-rays are taken to check for decay, gum disease and other oral pathology. These young folk have a tendency towards chewing surface decay, called pit and fissure decay, due to the partial loss of the sealant material that was applied when they were younger plus a high sugar diet. Bacteria gets stuck in the grooves, causing massive decay that is often invisible on the X-ray due to its location within a the thickest part of the tooth, impeding the X-ray beam.

A great tool to detect this type of decay (on all patients) is the Diagnodent; a laser decay detector which reads the phosphorescence produced from the bacteria laden decay. This will find the decay early, and hopefully allow its removal without invading the nerve canal of the tooth.

Prices of Crowns

Posted on: January 27th, 2010 by Dr. Mitchell Josephs No Comments

Q: Why do some dentists charge $600 for a crown and some charge $1400 for a crown?…LH Jupiter

A: I have the same “Shtick” when it comes to men’s shoes. Why are Macy’s own brand, Alfani around $100 and identical looking Gucci loafers are almost $400?

Firstly, let’s eliminate the regional fee differences and just call the average fee in the USA for a crown is around $1100. What makes the difference are the materials used, the laboratory’s quality, added procedures needed to reinforce the tooth (posts and cores) and the dentist’s techniques and equipment used to perform the procedure.

A cheap crown could be made in a high-volume lab in Tijuana Mexico (no joke) and contain a low percentage of gold (there fore less biocompatible with human tissue). My lab only has about 25 doctors in the country as clients. They charge me an arm and leg, but their porcelain work is phenomenal when it comes to all-porcelain, metal free crowns and veneers.

The office that performs the procedure may not use the latest in Hi-Tech equipment and materials that I have written about in my column. Digital X-rays, Lasers, Intra-oral cameras, computerized numbing syringes, etc. These items provide both early diagnoses of disease as well as greater patient comfort. You get what you pay for. Those Gucci loafers do have softer leather than the Macy’s brand.

DDS vs DMD

Posted on: January 25th, 2010 by Dr. Mitchell Josephs No Comments

Q: What is the difference between a dentist with a DDS degree vs. one with a DMD degree? LZ in South Palm Beach

A: A lot of confusion for the public, for one! You say ‘toe-may-toe’ and I say “toe-mah-toe”; let’s forget the whole darn thing…..”

The DDS and DMD degree are the EXACT same degree, but with different names. Both doctors have received the same training. It does not imply one is an oral surgeon and the other one is not, nor does it indicate if the dentist in question has completed any type of specialty such as orthodontist or periodontics.

In the 1800’s all dental schools used the name DDS (doctor of dental surgery) Some of the more “snooty” institutions decided to go with the Latin degree, called DMD (Dentiste Medicinae Doctor). About one third of current dental schools still use the Latin degree name. (Hey, it’s all Greek to me!)

Do I need a new crown?

Posted on: January 22nd, 2010 by Dr. Mitchell Josephs No Comments

Q: I had a crown done 6 months ago. The gum always bleeds around it when I floss and it feels sore between the teeth. What could be wrong? Dr. D. in Highland Beach

A: I appreciate you writing to me, but first bring it to the attention of the dental artist that made it; and do be kind! ( Remember my series entitled “Don’t shoot the dentist”)

The crown might be too bulky where it meets the gum line or may have an open contact which is trapping food between the teeth and under the gum. A new crown is needed.

A digital X-ray must be taken to evaluate this puppy, as well. An important principle in crown and bridge work is called “biological width.” This is the minimum distance required between the gum line edge of a dental restoration and the crest of the underlying bone. If you encroach on this minimum distance, you don’t have enough room for healthy gum tissue to flourish.

If more width is needed for a better final result, we remove a little bone and gum tissue with a laser or electro cautery unit, before a final impression is taken for the crown. This is known as crown lengthening surgery and is a minor, painless procedure. Often, we do this to save teeth that have fractured or decayed below the gum line.

Do I Need X-Rays With Teeth Cleanings?

Posted on: January 20th, 2010 by Dr. Mitchell Josephs No Comments

Q: I recently went to a dental office for a cleaning. They refused to clean my teeth without having a recent set in front of them. I feel they were just looking for more money. What do you think?

A: Certainly your $150 set of X-rays was not going to pay for the Doc’s next boat payment. You can’t even get one night’s stay at the Concord hotel in the Catskills for that! His all-you-can-eat brisket buffet will have to wait until another patient comes along.

All “kibitzing” aside, your dentist was doing the ethical thing in refusing to have any dental instruments touch your pie hole with out X-rays. A brain surgeon would not open your cranium without a set of films to see where he is going first.

Many dentists today, including me, use very sophisticated digital X-ray systems that use much less radiation than the old school systems. The X-rays appear instantly on a computer monitor with specialized soft ware that allows us to see if you have more serious problems that require more than just a “cleaning”. We can see bone loss, decay, abscesses, benign and malignant tumors, cysts, fractures and impacted teeth.

Crown Loosens Over Implant

Posted on: January 18th, 2010 by Dr. Mitchell Josephs No Comments

Q: I have a crown that is screwed into an implant that has spun loose three times. My dentist just keeps tightening the screw. Is this normal? JR in West Palm Beach

A: We all have a few loose nuts in our families, but you should not be one of them. My cousin Ira in Vegas comes to mind.

The implant fixture is the root-shaped cylinder that stays anchored in the jaw bone. The abutment is the post that connects the crown to the implant. Sometimes the small screw that attaches the abutment to the implant will reverse itself (“righty tighty; lefty loosey”) causing the crown to rotate and loosen. Many times a new crown is needed.

To prevent this from happening, your DDS can flow some composite resin “goo” onto the hex-shaped screw head, locking the screw in place as the resin hardens, then proceed to make the crown.

Canker Sores- A Pain in the Mouth

Posted on: January 13th, 2010 by Dr. Mitchell Josephs No Comments

Q: I frequently get canker sores inside my mouth. My dentist just says: “wait 10 days and they will go away.” What can I do?….. … JHC Palm Beach

A: You and me both, kiddo. Every time I have dental work or slip with the toothbrush and scratch my gum, bite my cheek or tongue, I wind up with what is known in the “biz” as an apthous ulcer. These are caused by unknown viruses floating around in the normal flora of our mouths. (Personally, I think the city should evict them!)

Apthous ulcers look like a white moon crater, surrounded by a red, inflamed border. Spicey and citris foods make you want to punch a hole in the wall. These are not to be confused with the herpes labialis cold sores on the lip; these are inside the lips, cheeks, tongue and near the gums.

Your dentist just does not have the right “goo”. I have been using a product called Debacterol for years that instantly chemically cauterizes the pesky canker in five seconds. The pain stops immediately and within a day or two that puppy is history.

Can my dentist save my crown?

Posted on: January 11th, 2010 by Dr. Mitchell Josephs No Comments

Q: A front crown fell off my tooth with the tooth stump broken off inside. My dentist wants to do a root canal, post and a new crown for almost $3000. Can’t he save the existing crown?

A: The late George Carlin once said: “save all your nail clippings scabs, dry patches of skin…anything that falls off your body; you may need them in the after life.”

I had two patients last week with the same problem. First, I drilled out the broken piece of tooth out of the crown. Then, I was able to use a hi-tech material called Encore which allowed me to place threaded pins into the broken tooth, build up the tooth stump and retro fit the existing crown.

However, if your crown no longer fits the remaining tooth or if the break in the tooth crosses the nerve canal, you will require a root canal, post and new crown.

Broken Bridges

Posted on: January 8th, 2010 by Dr. Mitchell Josephs No Comments

Q: I had a three tooth permanent bridge supported by two implants placed in the upper front area. The doctor used temporary cement for a “trial run” to see if I liked the shape and color. After I explained that I would like the teeth longer and whiter, he tried to remove the bridge but could not get it out and told me he did not want to risk damaging the underlying implants. What can I do?…Hillary in Hollywood

A: Not an uncommon experience for us “keepers of the teeth.” Always a topic of discussion at the dinner table when the spouse of the DDS says: “How was work today, honey?” It’s actually a testament to how well your doc’s lab work fits.

If the implants are well integrated in the bone, as they should be since a permanent bridge was made, a tap-off bridge remover can be used to dislodge the bridge. It’s ok if the bridge is damaged since it has to go back to the lab anyway for aesthetic porcelain changes. He/She will make you a temporary bridge to use while the lab is working on your bridge work.

Canker Sore Prevention

Posted on: January 6th, 2010 by Dr. Mitchell Josephs No Comments

Q: I get canker sores quite often, especially after going through a round of chemotherapy for cancer treatment. Is there anything I could do to prevent their occurrence?

A: These nasty buggers which affect 25% of the population, called apthous ulcers, are painful white craters with a raised red border. The culprit is an unknown virus which seems to take over the oral cavity like Tommy Lee Jones on a manhunt when our immune system is taxed.

For treatment: Debacterol is a chemical cauterizer that is not over the counter which practically makes them disappear on contact. For prevention: Ben-Gurion University in Israel discovered that a nightly dose of vitamin B12 (1000 mcg) is a simple, effective and low risk therapy to prevent recurrence.