2012 May Archive - Dr. Mitchell A. Josephs' Blog

Archive for May, 2012

Loved the Temporaries, Hated the Permanent Ones

Posted on: May 30th, 2012 by Dr. Mitchell Josephs No Comments

Q: I recently had porcelain veneers done. I loved the temporary ones that I had for three weeks, but I hate the permanent ones that were just put in; they don’t look like the temporaries at all! What happened?!…..P.O’ed in Vero

A: I had this nutty dental professor in school 25 years ago named Dr. Woolhouse. He looked and acted like David Lederman; dry sense of humor and sounded just like him. He had a blue collar, French Canadian practice in Montrealand told us: “Don’t make the temporaries too nice; the patients won’t come back for their permanent work!”

“Oh contraire mones amis!” (check French spelling) Not the best advice. The temporary crowns or veneers in aesthetic cases that are hand shaped by the artistic talent of the dentist must be approved by the patient before the permanent work is made. Patient should return to the office on a day when they are no longer numb from the anesthesia to evaluate the temporaries. Once the temporaries look good, we take photos and moulds of the temporaries and send them to the lab to “copy” the design in the final porcelain work. This leads to the permanent veneers or crowns having the same shape as the temporaries that you had come to love.

For some photos of actual cases showing patients in their temporaries and their final permanent work, email us.

Dr. Mitchell Josephs practices Cosmetic, Implant and General Dentistry in Palm Beach and hosts “Tooth Talk” on WBZT AM1230 (www.radiotoothtalk.com) Dr. Josephs 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.

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drjosephs@palmbeachdentist.com
44 Cocoanut Row, Palm Beach, FL 33480
888-DRTOOTH (888-378-6684)
www.palmbeachdentist.com

Osteoporosis Drugs and Dental Treatment

Posted on: May 22nd, 2012 by Dr. Mitchell Josephs No Comments

Q: Is it true you can loose part of your jawbone if you have dental work done while taking drugs for osteoporosis? Logan in Boca Raton

A: It’s a rarity that I repeat a subject matter, but after 390 columns, this subject is worth repeating. Some new conclusions have been reached concerning the taking of bisphosphonate drugs such as Boniva, Fosamax, Actonel, Zometa, Reclast, Aredia and Alendro.

The worry is ARONJ (Antiresorptive Drug Associated Osteonecrosis of the Jaw.) Old name; ONJ. The reduction in blood supply to the jawbone can result in “dead bone” areas, becoming exposed in the mouth following removal of teeth. New studies show that special tests, including CTX tests, have yet to be reliable for diagnosis or prediction of ARONJ.

The “not- to- worry” part of the story is this: Patients taking these drugs by mouth have only a 0.1 to 0.4% chance of ARONJ. Those taking it by injections, have a 2 to 10% chance. If you take these drugs by I.V. injections and are told that you absolutely cannot stop them, diseased teeth should receive root canal treatment and /or conservative restorative treatment vs. extractions.

With proper precautions taken by your dentist, such as wound closure techniques, prescribing special rinses pre and post-op, ordering a temporary “drug holiday” (discussed with your physician.), you can have extractions, periodontal treatment and dental implants without fuss. Once on these drugs, denture patients should consider making new dentures to avoid irritation of the thin tissue that covers the jawbone, called the mucosa to prevent ARONJ. Email us for useful websites and copies of the latest studies on this topic.

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drjosephs@palmbeachdentist.com
44 Cocoanut Row, Palm Beach, FL 33480
888-DRTOOTH (888-378-6684)
www.palmbeachdentist.com

Problems with Posts

Posted on: May 15th, 2012 by Dr. Mitchell Josephs No Comments

Q: Two years after I left my old dental office, my new dentist took some check-up X-rays. He pointed out that a tooth my former dentist worked on two years ago showed an incorrectly placed post, perforating through one of the roots. I remember this tooth had a root canal, so I have not felt any pain. I now need to have the tooth removed and replaced with an implant and crown. Is this malpractice? I.M. Shyster

A: Another subject for my book’s chapter: “Don’t Shoot Your Dentist.” A poor outcome is not necessarily malpractice. If the doctor’s chart notes show that he followed all the proper protocol in treating the tooth, but due to the pre-existing, frail condition of the tooth, the tooth fractures or the post perforated through a curved root, than most likely, no negligence was committed. Most dental offices have patients sign an informed consent, not to eliminate the ability to litigate, but to make sure the patient knows all the risks and possible negative outcomes to a procedure.

There are numerous dental journal studies that show that root perforations and fractures are “common complications” on teeth that have had root canals; especially on neglected teeth that were full of decay before the treatment was rendered. My suggestion is to speak to your former dentist, as he might be willing to reimburse your fees that were invested in that tooth.

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drjosephs@palmbeachdentist.com
44 Cocoanut Row, Palm Beach, FL 33480
888-DRTOOTH (888-378-6684)
www.palmbeachdentist.com

Removal of Lip Hemangiomas

Posted on: May 8th, 2012 by Dr. Mitchell Josephs No Comments

Q: For several years now, I have had a growing purplish bump on my lower lip. I had consulted with a plastic surgeon, but he said it is not dangerous and did not want to attempt to remove it. I really hate the way it looks. What can be done about it? Marge in Wellington

A: I’m with you Marge. A recent survey performed by a group of social psychology researchers showed that the first part of the human body that one human looks at upon meeting another human is the mouth and teeth. I believe it goes back to our ancestors who had to make sure a fellow cave dweller was not sporting a growling attack face. We all look at each other’s mouths first to see if we can trust that person and to see if we are attracted to that person for possible procreation and continuation of our species. (Postal workers are trustworthy and usually have decent teeth.)

You are probably describing a hemangioma, or venous lake; a pooling of blood under the translucent skin of the lip. Many surgeons are cautious to remove these due to excessive bleeding and possible scaring from incisions and sutures. The fastest, least invasive way to remove these puppies is with a diode laser, which many dentists already use in the mouth on a daily basis for periodontal treatment and just before crown and bridge impressions along the gum line. Within 45 seconds the lesion will turn white and in about four weeks, your little purple friend will be gone. For some great before and after photos of these cases, contact us.

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drjosephs@palmbeachdentist.com
44 Cocoanut Row, Palm Beach, FL 33480
888-DRTOOTH (888-378-6684)
www.palmbeachdentist.com

Synthetic Bone Grafting Before Implants

Posted on: May 1st, 2012 by Dr. Mitchell Josephs No Comments

Q: I need to have several teeth extracted, followed by dental implants and permanent crowns. I notice on my treatment plan estimate, my doctor has listed “bone grafts” in each area that I am losing the teeth. This sounds complicated and adds additional costs. Is this always necessary? Martino in Jupiter Farms

A: What separates the “men from the boys” (and the girls from the women, as 52% of dental school grads are female) is “judgment”. The surgical part in dentistry takes mechanical skill and dexterity, it’s the decision on “what to do and when” that is even more critical. You either have to trust your doctor, or not. (Or, get a second opinion.)

After reviewing digital, computerized X-rays of teeth and bone, we make an assessment of the quantity of bone we have to sink our implants into. If bone levels are insufficient due to proximity of the sinus, less than 9 millimeters in height and thin in cross sectional width, we will often recommend adding bone graft material into the socket, right after extractions to “bulk up” the bone. I prefer to use a synthetic material called OsteoGen, which stimulates your own bone making cells (osteoblasts) to start doing what they have been programmed to do. Some docs will use cadaver, bovine or even your own bone for grafting. For free consumer info on OsteoGen, contact us.

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drjosephs@palmbeachdentist.com
44 Cocoanut Row, Palm Beach, FL 33480
888-DRTOOTH (888-378-6684)
www.palmbeachdentist.com