Q: My son and daughter both play Lacrosse. Are mouth protectors sold at sporting good stores ok to use? Spike V. Jupiter Farms

A: Negative. Negative. (And I’m a “glass is half full kind of guy!)

Millions of dollars are spent each year in replacing missing teeth on adults and children due to blunt trauma to the teeth while playing sports. I do not recommend the one-size-fits all, boil and bite, store- bought mouth guards. They do not fit well in many cases, causing teeth to move out of alignment and exert un- wanted pressure on the gums, causing recession.

You must have your dentist take impressions of the teeth and fabricate custom athletic night guards. I use a special lab in California that makes extremely protective appliances that can be created in your team’s colors. The average fee in the USA for this is $500. Well worth it, considering the cost of replacing just one knocked out tooth can clime to an “enamel shattering” $4000!

Have these made for loved ones that play basketball, football, Lacrosse, Soccer, hockey and baseball. But, don’t forget skateboarding, Jet-Skiing, BMX, martial arts and boxing.

For free information on this subject, drop me an email or call 1-888-DRTOOTH

by Dr. Mitchell A. Josephs

Question: Are root canals really a nightmare? — D.M., West Boca Raton

Answer: During the president’s State of the Union address, he remarked: “I liked the bank bailout as much as I like a root canal.”

When an abscessed nerve is removed from a tooth, the procedure is done under strong local anesthetics like Septocaine, which has great penetrability of the jaw bone, numbing the nerve and the surrounding areas next to the tooth.

The only time a patient may have discomfort during the procedure is if they were told to treat the tooth previously and chose to postpone the treatment.

This can lead to a “hot tooth,” which can be more difficult to get completely numb. Often we put them on antibiotics first. Tip: Never ignore your dentist’s recommendation to get a root canal even if you currently have no pain.

For a free copy of the Hi-Tech Dental Office Checklist, contact us.

Dr. Josephs will be giving a free lecture, “Dental Care for Cancer Patients: Why Your Cancer Team Should Include a Dentist,” at 4 p.m. Feb. 19 at the Palm Beach Cancer Institute/Sari Asher Center in West Palm Beach. Seating is limited; call (561) 578-5913 to register.

Dr. Josephs practices in Palm Beach and can be reached at drjosephs@palmbeachdentist.com, or call 1-888-DR TOOTH or visit www.palmbeachdentist.com

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.

For a free consumer booklet on these materials, contact us.

Dr. Josephs practices in Palm Beach and can be reached at drjosephs@palmbeachdentist.com , 1-888-DRTOOTH or visit www.palmbeachdentist.com

Ask the DDS

Q: I where an upper partial denture, replacing my back teeth. My natural remaining front teeth have spaces that keep getting worse. My dentist keeps adding bonding to their sides to close the spaces, but this makes my teeth look too wide. What is going on? ….Ronnie James Dio (not his real name) in Port St. Lucie

A: When your shrubs grow too high and are blocking your kitchen window, do you raise your house on stilts; or do you cut the shrubs? Slapping on bonding to close the spaces will not solve the problem and will give you teeth that look like canoe paddles.

Your teeth are “splaying” outwards due to a lack of posterior support from a worn denture or bone loss around the roots of the teeth or a combination of both. Your bite must be “opened” by replacing your missing teeth with permanent teeth (ideally) vs. dentures. During this treatment, the upper anterior teeth can have their spaces closed with some STO (short term orthodontics. Visit www.6monthsmiles.com) after the bonding is removed.

With the correct bite on the posterior teeth and a permanent retaining wire bonded to the tongue side of the upper front teeth, you will not fall victim to splaying again.

For a free booklet entitled: “Why replace missing teeth?”, contact us.

Dr. Josephs practices Cosmetic, Implant and General Dentistry in Palm Beach and can be reached at drjosephs@palmbeachdentist.com ( 888-DRTOOTH or 888-378-6684) or visit www.palmbeachdentist.com

Q: Is there any danger in swallowing impression material when the dentist is taking moulds of your teeth?

A: This question could not be timelier. If you asked me two days ago, I would have said: “No way, dude!” But today I say: “Way”, dude.

One of my physician patients is a world renounded eye surgeon who brought in the Journal of the National Medical Association – December 2009, which contained an article describing an extremely rare scenario where a patient swallowed some impression material which resulted in abdominal surgery and 8 days in the hospital.

Normally, any swallowed material would pass through the intestines, but this patient had many previous surgeries and medical issues causing scarring along the intestinal lining, blocking the goop from reaching the “light at the end of the tunnel”- so to speak.

According to Gordon Christensen DDS, a leading dental researcher, this provides another advantage of digital impression scanners (iTero and D4D) which already produce very accurate models and accurately fitting dental work, vs. the “goopy” stuff.

For free consumer info on digital impressions, contact us.

Dr. Josephs practices Cosmetic, Implant and General Dentistry in Palm Beach and can be reached at drjosephs@palmbeachdentist.com (888-378-6684) or visit www.palmbeachdentist.com

Q: I had an implant to replace a missing front tooth and am unhappy with an ugly gray line that is visible at the gum-line above the crown. Why is this so? Mdm. X

A: Getting in touch with my feminine side, I do feel guilty that you gals experience the pain of childbirth and, what we call in the cosmetic tooth biz, a “high lip line.” This means when you smile, your lip rises up like the opening curtain at Ballet Florida, revealing your gum-line. Most guys have it hidden beneath our lip and ugly go-tees.

To avoid exposure of the metallic implant abutment post from normal gum recession, a tooth-colored ceramic abutment can be used called Zirconium.

For a free consumer info sheet on this, contact us.

Dr. Josephs practices in Palm Beach and can be reached at drjosephs@palmbeachdentist.com , 1-888-DRTOOTH (888-378-6684) or visit www.palmbeachdentist.com

Q: I am in need of dental work but fear getting a shot on the roof of my mouth which I know can be painful. Is there a way to avoid this? Erica in Jupiter

A: Forty % of the population does not see a dentist and I will bet you a box of large “black and white” cookies (my favorite dessert) that one third of those stay away due to palatal injections. The pain is due to the many nerves in the area and the lack of space between your gum tissue and your hard palate. The anesthetic solution has no where to run, resulting in intense pressure at the injection site.

A great technique is to coat the area for 2 min. with a special topical gel made in one pharmacy in California called Profound. Then, freeze the area with a product called Endo Ice, a refrigerant, followed by injection with a C.C.S. (computer controlled syringe and a Vibraject to vibrate the needle.

You will be back at your dentist in no time!

For more information on this technique, contact us.

Dr. Josephs practices in Palm Beach and can be reached at drjosephs@palmbeachdentist.com , 1-888-DRTOOTH (888-378-6684) or visit www.palmbeachdentist.com

Q: I need major dental work but am horrified about getting a needle. Has there been anything new to eliminate the shot, but still get me numb to work on my teeth?

H.W., Boca Raton

A: Have no fear, technology is here! Your dentist can give you a painless injection if he/she uses three items:

1. Profound: The strongest topical anesthetic gel in the universe. It’s made in one pharmacy in the USA, as far as I know, Steven’s Pharmacy (no, he’s not a drug dealer!) This is applied to the tissues for two minutes before the shot.

2. A computer controlled syringe (CCS): This is not your typical scary-looking, chrome plated hypodermic needle you are used to seeing in Three Stooges Movies. The CCS looks like an IV pump you see in a hospital room, but it goes next to the tooth, not in your arm. A computer driven pump expresses the anesthetic extremely slow and backs off as it feels pressure, for a much more comfortable injection.

3. The Vibraject: a motorized attachment that vibrates the needle 400,000 times per second, like a humming bird’s wings, blocking the pain stimuli from traveling down neurons (nerve pathways) to your brain.

Dr. Josephs practices Implant, Cosmetic and General Dentistry in Palm Beach. As an author of many articles and a recent book on modern dental practice, he lectures internationally. Tune in to “Tooth Talk” on WBZT radio AM1230 every Monday at 6:05pm.

To submit a question: email drjosephs@mindspring.com, visit palmbeachdentist.com or call the hotline at 888-DR TOOTH. All questions will be answered, even if not published.