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

Archive for August, 2012

Tilted Implants? Do Not Worry

Posted on: August 29th, 2012 by Dr. Mitchell Josephs No Comments

Q: I recently had several implants placed in my upper and lower jaw. After the dentist was finished, he took an X-ray to check his work. Although he said everything was fine, I noticed the implants looked tilted on various angles; none being straight up and down. Is this something to be worried about? Jacob in Vero

A: The weather was so bad this past weekend from tropical storm Isaac, I could not swim, bike or run. Bummed-out that my son left for college a week prior, I remained inside with a pile of dental journals. (And an even bigger pile of Entennmans’s chocolate frosted donuts.)

I would not worry one bit on seeing that your implants are not perfectly straight. Many times implants do better placed at an angle to create better distribution of forces when cantilevering several crowns off of them or avoiding important anatomical structures such as the sinuses and the large nerve canal in the lower jaw. A recent article in the Journal of Implantology (my copy covered in chocolate stains) showed a mathematical formula using trigonometry to determine the “safe” distance between tilted implants.

Flapless, incision-free implant surgery will be covered extensively in my next lecture in early October with some great slides! (See info below.)

EDITOR’S NOTE: Dr. Mitchell Josephs will be giving a FREE LECTURE on Incision-Free Dental Implant Surgery, Digital Crowns & Veneers, Choosing a Dental Office and NEW TOPICS: “Laser Lip and Gum Treatment” and “Why Botox at the Dental Office?”, at the Double Tree Hotel, PGA Blvd. in Palm Beach Gardens on Friday October 5th at 10:00 AM. Attendees will receive a FREE copy of his book: “Tooth Talk”. Only 39 seats remain! Call today to register at 561-832-2917

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

Not Getting Numb Enough?

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

Q: I recently had major implant, root canal and crown work on lower teeth. I kept telling the doctor that I am still feeling pain as he was working on me, although he kept re-injecting me in the same spot repeatedly. What can be done to not go through this experience again? Allen in Loxahatchee

A: There is no need to replay the roll of Dustin Hoffman in Marathon Man in today’s modern world of dentistry. (“Is it safe?”…. Asks Lawrence Olivier) A recent study in the JADA (Journal of the American Dental Association) reiterates what many practitioners have known for quite some time in an article entitled: “A Randomized Trial of Supplemental Local Anesthesia After Nerve Block Failure.” Translation: What’s the best way to get lower molars numb when the first injection fails to do so.

It turns out that just re-injecting the same site of the nerve block won’t cut the mustard. The two most effective methods to get “hot” teeth numb were injecting the drug articaine into the soft pink tissue just next to the tip of the root of the tooth. The second method, intraosseous injections, involves making a small hole in the jawbone next to the stubborn tooth and injecting lidocaine. Both these methods aid in getting better penetration of the anesthetic into the bone and finding its way to the nerve supply of the teeth.

For a free copy of this study, drop us an email.

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

____________________________________________________________

drjosephs@palmbeachdentist.com

44 Cocoanut Row, Palm Beach, FL 33480

888-DRTOOTH (888-378-6684)

www.palmbeachdentist.com

Costly Bone Grafts Not Always Needed

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

Q: I need some teeth pulled and would like permanent teeth with porcelain crowns anchored to implants. I thought I could afford the work until the dentist told me I also would need costly bone grafting before the implants are placed. Is there an alternative? Leonard B. in Palm Beach Gardens

A: My fitness trainer recently argued with a salesman who wanted $500 for a set of floor mats on a $30,000 car. I told him to tell the dealership to keep the mats and just throw in some of those nifty paper mats from the service department with the graphics of shoe prints.

A recent article in a widely read dental journal posed the same question to an authority on all things dental. Here are the hi-lights: Firstly, adding bone grafts to all sockets after extractions is not yet ‘standard of care’, but certainly should be, at least in the “smile zone” (anterior portions of the mouth) or in any area where the bone is deficient warranting more “bulk” to better anchor the implant or to improve the final aesthetic outcome of the case.

Not all grafts are created equal. Placing freeze-dried cadaver bone covered by dissolving membranes with multiple sutures can be costly. More economical methods consist of synthetic bone graft materials, (Osteogen) covered by collagen plugs (OraPlug) and minimal suturing can often do the trick just fine. Three to four months later, you are ready to pop in the implants and begin the road to getting teeth close to the real thing! For a free copy of my book, “Tooth Talk: What Educated Dental Patients Need to know About 21^st Century Dental Care”, drop us an email request.

____________________________________________________________

drjosephs@palmbeachdentist.com

44 Cocoanut Row, Palm Beach, FL 33480

888-DRTOOTH (888-378-6684)

www.palmbeachdentist.com

WANTED: Hi-Tech Hygienist?

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

Q: I recently needed to have 7 teeth removed due to gum disease and yet I have been getting my teeth cleaned by the same hygienist for 15 years. Why did she not see this coming?

A: Assuming you brush and floss every day, your hygienist may not be utilizing today’s hi-tech diagnostic and treatment modalities for periodontal disease.

Remember the movie 2001 A Space Odyssey, starring Hal-9000, the talking computer? My hygienist has been using a computerized, talking probe, called the STM Probe.

A small, blunt, plastic probe placed into the pocket between tooth and gum, measures bone or ligament loss around a tooth. The computer “speaks” the measurement and records the readings on a print-out, placed in the patient’s chart. If the computer generated voice speaks of pockets of “five” or greater, these areas need treatment to prevent further bone loss, and eventual loss of the tooth. The recordings are compared from visit to visit to see if the periodontal disease is progressing.

The first and least invasive line of treatment would be a thorough scraping of toxins along the root surfaces and the inner lining of the pocket sometimes using a laser, followed by the placement of antibiotic granules, called Arestin, which dissolve over a ten day period under the gum.

Very often this will prevent you from needing extensive gum surgery and loss of the tooth.

____________________________________________________________

drjosephs@palmbeachdentist.com

44 Cocoanut Row, Palm Beach, FL 33480

888-DRTOOTH (888-378-6684)

www.palmbeachdentist.com

Teeth and Yoga, Who Knew?

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

Q: I have implants, porcelain veneers and crowns. My dentist tells me I am grinding my teeth. My husband says he does not hear or see me grinding them. What do you think can be going on? Gina in Wellington

A: At the start of my Monday night yoga class, Connie the yogini always asks us to relax and “feel the space between our upper and lower teeth.” It is amazing how every time she says this, the whole class finds their teeth clenched together and must consciously separate the teeth upon her command. (Sometimes her voice is so soothing; I wake up an hour later, missing the whole class.)

The point is it is most likely during the daytime that you are gnashing your teeth together. Stress clenching and chewing would be the times for tooth to tooth contact, if you are not a Nocturnal Bruxer, or “Knight Grinder”. (Wasn’t Nicholas Cage in that movie?)

There is nothing wrong using a thin, clear “day-guard” while at work that your dentist can make for you on custom impressions of your teeth. You can take it out when you eat and use it at night too. If your doctor determines that your traumatic bite is contributing to headaches, ear aches and tinnitus (ringing in your ears), a dentist well versed in TMJS (temporo mandibular joint syndrome) may be needed.

It is important that after major porcelain or implant dental work, “grinders” should consider having a bruxism appliance made to protect their investment.

____________________________________________________________

drjosephs@palmbeachdentist.com

44 Cocoanut Row, Palm Beach, FL 33480

888-DRTOOTH (888-378-6684)

www.palmbeachdentist.com