dental Archive - Dr. Mitchell A. Josephs' Blog

Archive for the ‘dental’ Category

Operating Microscopes for Dentists

Posted on: May 1st, 2013 by Dr. Mitchell Josephs No Comments

Q: I recently changed dental offices. I notice my new doctor uses what looks like a set of binoculars strapped to his glasses and sometimes a microscope. Is this something that should be in all dental offices now? Meg in Wellington

A: As the saying goes: “you don’t know what you don’t know”. (My guess the great Yogi Berra or the not-so-great Donald Rumsfeld coined that one.) With so much patient loyalty in the dental industry, many of us will not know what is “new and cool” until we visit another practice. Although not all dentists will be using operating microscopes or magnifying loupes, they do offer several advantages to both doctors and patients.

The exceptional magnification allows incredible detail aiding in our almost anal retentive nature of striving for un-obtainable dental perfection. When I first began using operating microscopes and loupes, I felt as if I had superman powers. My endodontist (root canal doctor) uses a $15,000 operating microscope that neurosurgeons use as she enters hair-thin canals within the confines of a single tooth. Both loupes and operating microscopes now incorporate fiber optic or LED lights for better visibility. All these hi-tech goodies can lead to more accurately fitting dental work, making the doctor AND patient very happy.

For a short video preview of my next FREE seminar to the public (info below), contact us and I will email you the video.

Editor’s Note: Dr. Josephs will be giving a FREE seminar to the public: “Teeth for Life”: A hi-tech update on the latest techniques in Implant, Cosmetic and General Dentistry. Join us at 10:00 AM at the Double Tree Hotel on PGA Blvd. in Palm Beach Gardens on Friday May 3^rd. Only 30 seats remain. Call 561-832-2917 to register today! Free copies of his latest book will be given to all attendees.

Dr. Mitchell Josephs practices Implant Cosmetic and General Dentistry and hosts “Tooth Talk” on WBZT AM123.0 Dr. Josephs is on staff at West Palm Hospital (Formerly Columbia Hospital) and 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.

Unsightly “black on gumline” bothers patients

Posted on: April 17th, 2013 by Dr. Mitchell Josephs No Comments

Q: I notice my friends dental work at lunch the other day shows an ugly tinge of color that I can only call: black on gumline, for lack of a better term. What is this? Anne F. in Boca

A: Apparently lunch did not go so well for your friend, I take it. (If you broke the news to her.)

The most common reason one would see black at the gumline would be gum recession above a PFM (porcelain fused to metal) crown. This type of crown has metal that can be visible at the gumline with age or in patients with genetically thin gingiva. Many doctors like myself use all-porcelain, metal-free crowns in the esthetic zone to prevent this occurrence.

Another possibility is minor gum recession around dental implants, exposing the metallic, abutment post that connects the crown to the implant, imbedded in the bone. The use of metal free, ceramic abutments can prevent this in some, but not all, cases.

For a short video preview of my next FREE seminar to the public (info below), contact us and I will email you the video.

Editor’s Note: Dr. Josephs will be giving a FREE seminar to the public: “Teeth for Life”: A hi-tech update on the latest techniques in Implant, Cosmetic and General Dentistry. Join us at 10:00 AM at the Double Tree Hotel on PGA Blvd. in Palm Beach Gardens on Friday May 3^rd. Only 38 seats remain. Call 561-832-2917 to register today! Free copies of his latest book will be given to all attendees.

Dr. Mitchell Josephs practices Implant Cosmetic and General Dentistry and hosts “Tooth Talk” on WBZT AM123.0 Dr. Josephs is on staff at West Palm Hospital (Formerly Columbia Hospital) and 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.

Antibiotics do not Cure Dental Abscesses

Posted on: March 6th, 2013 by Dr. Mitchell Josephs No Comments

Q: A lower left side molar was producing moderate pain. My doctor X-rayed the area and told me he would need to do a root canal. He started me on an antibiotic, and in two days the pain went away. If the antibiotic killed the infection why do I have to spend $1500 on a root canal? Colonel X, USAF.

A: The mouth is a very different animal from the rest of your “bod”. The bone that the teeth are set in does not behave the same way as the long bones of the rest of the skeleton. The teeth are individual organ systems that play by whole different set of rules compared to the rest of your “kishkas” (Mandarin for “guts”.)

When the nerve dies inside a tooth due to decay, leakage around dental work, or trauma, gangrene takes over as the circulation is cut off from the inside of the tooth. Bacteria from the mouth infect the pulp (center of the roots and teeth) forming an abscess. Unlike a swelling in the soft tissues of the body, the tooth is a closed, hard chamber preventing the infection from escaping. Many of these abscesses are chronic, meaning no pain. However, if ignored, the pain will become acute, spread to the face, sinuses, and neck, which can actually be fatal. The antibiotic is to help calm the infection down and impede its spread to the face. All dental infections require physical debridement, not just antibiotics. Do not ignore the doctor’s recommendation. For a free consumer guide to root canals, contact us.

Note: Dr. Josephs’ FREE seminar on Hi-Tech Implant, Cosmetic and General Dentistry is available for your next meeting. His multi media presentation is perfect for country clubs, community centers, churches and synagogues, private groups, hospitals and healthcare facilities. Please contact 561-832-2917 to book your next event.

Digital Impressions; No Goop!

Posted on: February 27th, 2013 by Dr. Mitchell Josephs No Comments

Q: I have read almost all of your columns and must ask you; if digital impressions are so good, why don’t all dentists have them? Phil in Hollywood.

A: I’m glad you have been keeping up with the dental field by reading my column; bad jokes and all. By the way, this is # 312, but whose counting? Phil, it’s like all technology. When color TV’s came out, not every household had one, although clearly it was the better technology. It goes for just about anything that has come down the pipe: police radar guns, smart phones, MRI imaging machines etc. Sometimes new technologies are at first too costly or too cumbersome to be practical.

However, 3-D digital impression scanners have been in use for at least five years now. No radiation is used. They are images that are emailed to specialized model makers that though CAD CAM technology, use robots to mill out the perfect, virtual model of the patients teeth. These models are then sent to the doctor’s local lab for making of the crowns, bridges or veneers.

They are slowly replacing traditional “triple G” impressions. (Gloppy, Gagging Goop). The brand that my practice uses as well as 13% of USA doctors use, is called iTero by Cadent. A recent article in the most widely read dental journal, the J.A.D.A stated this: “ Digital impressions allow practitioners to see enlarged images of the tooth preparations and the tissue management (the gums). More adequate impressions are possible. The dental labs and dentists state that digital scanning of teeth leads to higher quality impressions”. For a free consumer guide on this breakthrough technology, email us.

Correct Contours of Veneers

Posted on: January 30th, 2013 by Dr. Mitchell Josephs No Comments

Q: I notice my gums are always inflamed around some recent upper veneer and crown work I had done. I floss and brush constantly. Why is this?… Terry in Pompano

A: Welcome to dental prosthetics 101; put your pencils down and hear me out. (Pay attention in case there is a quiz!) One possible cause is an unfavorable “emergence profile”; how the porcelain is contoured from the gum line all the way to the chewing edge of the tooth. If the contours are too drastic, or step-like, this can create a bulkiness that can trap more plaque than a hygienist’s spit sink, resulting in chronically inflamed, puffy red gums.

If left untreated this form of gum disease, called “iatrogenic (pronounced: eye-at-trow-gen-ick) gingivitis”, can lead to gum recession and even bone loss.

I recommend to first have the dentist who placed them try to bevel the contours with a fine diamond bur followed by porcelain polishing wheels. If this does not help; you must consider remaking the dental work.

For free consumer info on veneers, contact us.

Dr. Josephs practices Implant Cosmetic and General Dentistry and hosts “Tooth Talk” on WBZT AM123.0 Dr. Josephs is on staff at West Palm Hospital (Formerly Columbia Hospital) and 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.

Changes for Joint Replacement Patients

Posted on: January 22nd, 2013 by Dr. Mitchell Josephs No Comments

Q: I have had both hip and knee replacements. My doctor wants me to take antibiotics before every dental visit. They make me sick to my stomach; is it really necessary? Joan K. in N. Palm Beach

A: A bit off topic, but what makes ME sick is paying $30 for a piece of fish at Florida restaurants that are 10 yards from the ocean!

And now, back to my column. It was thought for a long time that dental treatment could cause bacteria normally found in the mouth to enter the blood stream and wind up infecting new prosthetic joints. Following a collaborative systematic review of scientific evidence, the ADA and the American Academy of Orthopaedic Surgeons last month released a co-developed guideline that does not support routine prescription of antibiotic prophylaxis for joint replacement patients undergoing dental procedures.

Invasive dental procedures such as implants and extractions with or without antibiotic premedication did not increase the odds of developing a prosthetic joint infection. Ask your own physician and dentist.

EDITOR’S NOTE: Dr. 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?” on Friday February 1^st at 10:30 AM at the Boynton J.C.C. on Jog Rd. Call 561-259-3016 to register.

Attendees will receive a FREE copy of his book: “Tooth Talk”. Seating is limited; these seminars fill up rapidly; call today. Dr. Josephs practices Implant Cosmetic and General Dentistry and hosts “Tooth Talk” on WBZT AM123.0 Dr. Josephs is on staff at West Palm Hospital (Formerly Columbia Hospital) and 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.

Growing Bone after Tooth Loss

Posted on: January 9th, 2013 by Dr. Mitchell Josephs No Comments

Q: I had a tooth pulled and will be getting an implant in three months. The doctor placed a bone graft using something called Osteogen. I am concerned about anything-foreign left in my body; what is this material? Agnes in N. Palm Beach

A: Not to worry. Osteogen is less foreign than a Tibetan cab driver. Hydroxylapatite, also called hydroxyapatite (HA), is a naturally occurring mineral form of calcium apatite crystals. Up to 50% of bone by weight is a modified form of hydroxylapatite (known as bone mineral). Carbonated calcium-deficient hydroxylapatite is the main mineral of which dental enamel and dentin are composed. It is commonly used as a filler to replace amputated bone.

Many modern implants, e.g. hip replacements and dental implants, are coated with hydroxylapatite. It has been suggested that this may promote osseointegration (the fusing of bone to the implant).

For free consumer info on Osteogen dental bone graft materials, contact us.

EDITOR’S NOTE: Dr. Mitchell Josephs will be giving a FREE SEMINAR 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?”, Friday February 1^st at 10:30 AM at the Boynton J.C.C. on Jog Rd. Call 561-259-3016 to register.

Top Five Dental Innovations 2012

Posted on: December 19th, 2012 by Dr. Mitchell Josephs No Comments

As we wind down 2012, I would like to give you my “top five” list of the most effective new dental technologies of the year. Look for these items in your current dental office, or offices you are considering to utilize.

Digital impressions: iTero by Cadent. No more runny goop; just a quick 3D scan of your teeth emailed to the lab in order to make great crowns, veneers and bridge work.
New Age Bone Graft Materials: Ex: Osteogen. Great non-animal, non-human synthetic bone graft material to build up bone for dental implants after teeth are removed.
New Generation Bonding Agents: Ex: Clearfill S3 Bond Plus: allows composite bonding, white filling materials to adhere to your existing tooth enamel more strongly.
Fiber Posts: non-metallic posts that build up teeth that have had root canals, allowing a strong foundation for crown to follow.
Platform Switching, Coated Implants: specially designed implant systems that shorten the treatment time of traditional implants and maintain better bone levels for the long term.

All these will be discussed at my next two free seminars to the public; see below for details. I wish you all a happy and healthy new year!

EDITOR’S NOTE: Dr. Mitchell Josephs will be giving two FREE LECTURES 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 West Palm Beach Downtown Library on Clematis St. on Thursday January 10th at 6:30 PM. To register, call 561-868-7701. And, on Friday February 1^st at 10:30 AM at the Boynton J.C.C. on Jog Rd. Call 561-259-3016 to register.

Digital Impressions for Implants and Crowns

Posted on: December 12th, 2012 by Dr. Mitchell Josephs No Comments

Q: I have large boney projections the size of ½ my pinky finger on my gums; the doctor called them “tori”. I need implants and crowns, but when my doctor tries to take impressions, I scream in pain when the tray holding the goop scrapes against these boney areas. How can I avoid this?

A: You are talking to the right guy. I have an “exostosis”, or tori in my own mouth that can hold a rack of Passover china. Peanut butter loves to rest there as well.

A great technology that I have been using called digital impression scanners avoids the whole goop and impression tray deal completely. A small scanner/camera takes a 3-D image of the teeth or implant abutment posts and emails the image to a special lab that uses robots to mill out a virtual model of your mouth. These models are sent to our local dental lab to construct the final crowns, veneers or bridges for your natural teeth or implants. For free consumer info on iTero digital impressions, contact us or see it demonstrated live at our next seminar!

Attendees will receive a FREE copy of his book: “Tooth Talk”. Seating is limited; these seminars fill up rapidly; call today. Dr. 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.

Severe Root Decay: Implants or Root Canals?

Posted on: December 5th, 2012 by Dr. Mitchell Josephs No Comments

Q: I find as I get older, I am becoming more cavity- prone. It seems like every year more teeth begin to decay underneath crowns and fillings that were done no more than five years ago. Did my doctor do a poor job? J.K. in Boca

A: This is another fine example of: “don’t shoot your dentist.” Many patients get angry if their dental work does not last a lifetime. The body is always changing and disease can occur at any time no matter how recent the dental work was completed.

You are one of many that are suffering from this common disease facing patients 65 and older. “Root caries caused by xerostomia induced by medications and the aging process itself.” In simple terms: dry- mouth, which destroys the acid reducing, buffering capacity of the oral cavity resulting in decay of the teeth, under the gum-line, along the root surfaces. Many of these teeth are better off not being root canaled and re-crowned, but instead, extracted and replaced with dental implants which have a much better long -term prognosis. Ask your dentist for some preventive treatments for root caries such as custom fluoride trays and saliva substitutes.