Q: My dentist told me I need to replace a missing tooth with a permanent bridge. I don’t like the idea of cutting down two perfectly good teeth to replace one tooth. What else can I do?

A: I feel your pain! Firstly, ask about the implant option. A titanium cylinder mimicking the root of the tooth can be placed in the bone in the spot where your missing tooth lies. A few months later, a porcelain crown can be cemented to a post connected to the implant. Voila! No chopping down neighboring teeth to little tree stumps.

What if you are not a candidate for an implant; perhaps you are deficient in the bone department in the old “pie hole”?. (Don’t feel insecure about this; it’s not associated with your libido!)

You have some creative options. The inlay bridge, the hugger bridge and the Maryland Bridge. All are various types of fake teeth that are permanently attached to the adjacent teeth with zero to minimal tooth reduction.

They may not last as long and can not be used in some cases in individuals who have a bite like a St. Bernard, but I have seen many a patient quite happy with this choice when implants are just not in the cards.

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

Q: I am nearing the end of orthodontic treatment and have noticed the gum between my top two front teeth is missing, leaving an ugly black triangular “hole” at the gum line. Can this be fixed?

A: My best friend from dental school was Dr. Mike Cronin of Fitchburg, Mass. He and I were the only Americans accepted to McGill University’s Faculty of Dentistry in Montreal from ’84 to ‘88. His dad graduated McGill, back in 55. With no dentists in my family, I think bringing my parents along to the interview helped. What Jewish mother from NY is going to accept no for an answer?

Dr. “Mike” has the same gum issue-a blunted papilla. I will be giving a seminar this Friday in Boston to a room full of dentists, including my old buddy. Solution: Shaping off a few millimeters of enamel on each side of the teeth, raising the contact point (where the teeth meet in the midline) closer to the gum line. Then attach clear STO (Short Term Ortho) brackets to the teeth and a special elastic called a powerchain, to close the space.

For more info on this, contact us.

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

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.

For free literature on implants, contact us.

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.

Q: Due to personal finance issues I cannot afford porcelain veneers ($14,000!) and yet my teeth are too sensitive for bleaching. What other options do I have?…B.G. in Boca

A: As Captain Stubing would say on the Love Boat: “Your ship has come in.” (Or in this case, your smile has come in.) Over the past twenty years, many patients have asked me: “Can’t you just put some kind of white paint over my teeth; like Liquid Paper correction fluid?” Finally, we tooth docs can now say YES!

Bleach-free whitening made by Denmat, the company that brought you Lumineers, has come out with a “paint-on” whitening material. The dentist applies a super thin layer of an opaque resin that is hardened with a UV light, followed by a glaze. For under $1000, your whole mouth can be done in one visit with no sensitivity and more predictable and longer lasting results compared to bleaching. However, you cannot change the shape of the teeth or correct any crookedness as in veneers.

For a free consumer guide on this breakthrough, contact us.

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

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.

For a free consumer guide: “The Hi-Tech Dental Office Checklist, contact us.

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