Q: I see that many dentists are now doing Botox as well as many types of MD’s who are not plastic surgeons and dermatologists. Who is best for lip jobs that wont make me look like a duck? Angie in West Palm

A: Firstly, I don’t know why so many woman think us guys even notice their lips. No offence, but we must be concentrating on other parts of the anatomy……like teeth and hair. Evolution tells us we are attracted to healthy looking humans who appear to aid in procreation of the species. Crazy looking lips have nothing to contribute to this endeavor. (Neither does ankle tattoos of barbed wire; have you been to a state fair lately?)

Dentists who take many hours of continuing education are now trained in Botox and Dermal fillers (Juvederm) for the face, forehead and perioral tissues, lips, nasolabial folds, marionette lines, etc. We dentists have been injecting patients with syringes every hour on the hour for our entire careers.

The reason why so many patients wind up with flat, thick, fish, duck or platypus lips is due to clinicians who only add volume. The technique taught to dentists in their training is injecting dermal fillers into the vermillion border of the lip. (The dividing line between flesh and red-colored lip tissue.) This will roll out the lips creating a natural plane of fullness. Check out dentist who have certificates from the AAFE (American Academy of Facial Aesthetics.)

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

By: Dr. Mitchell Josephs

Q: I have worn full dentures for decades and have had no complaints. Is there any general health concerns that should make me consider implants?…Moe in Boynton.

A: There are two denture-related lines that stick in my mind (both, I believe were uttered by Henny Youngman in between screeching violin strokes.) “Be true to your teeth or they will be false to you.” And: “Darling. Your teeth are like stars; they come out at night.”

Most of the time dentures are fabricated as a compromised treatment due to limited finances. Replacing missing teeth with permanent teeth via implants has the following advantages:

• 1. Improved appearance
• 2. Improved confidence
• 3. Comfort and convenience
• 4. Durability
• 5. Improved eating
• 6. Improved taste
• 7. Improved nutrition and general health
• 8. Improved speech
• 9. Reduced chance of further tooth loss and
• 10. Arresting of further bone loss in the face and jaw.

Technology has allowed the success rate of dental implants to range form 95 to 99%. Check with your dentist to see if you are an ideal candidate for implants. For a free consumer guide to implants, 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 have gotten two completely different opinions from two dentists . I am missing my upper right four back molars and refuse to where a removable denture. I do not have enough bone for an implant way in the back.  One dentist said I can have two implants towards the front of the space with three crowns attached; the last one being a floating, cantilevered tooth connected to the other two. The other dentist said this is doomed to fail due to having a floating tooth without the support of a third implant underneath. What should I do?…Irwin in West Palm Beach

A: Irwin, you made me miss my favorite show tonight, “Chasing Classic Cars”! After a thorough literature review; I must tell you to go ahead with dentist #1. Historically cantilevered bridges on NATURAL teeth have a poor long term prognosis; HOWEVER, these same bridges anchored to two IMPLANTS have shown positive results equal to bridges supported with three implants, without a “floating” tooth. For a free consumer guide to implants, contact us.

Editor’s Note: Dr. Mitchell Josephs will be giving a free lecture on Implant, Cosmetic and General Dentistry and signing his latest book on the Island of Palm Beach on Friday December 3^rd, 11am to 12. Call 561-832-2917 for registration and info. Seating is limited.

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

Question: My dentist recently took out an upper back tooth and left me with a hole into my sinus cavity. I had to be treated by an oral surgeon to fix the problem. What went wrong? – Mr. L., Lake Worth

Answer: A famous oral surgeon with whom I shared the lecture circuit once told me: “If this has not happened to one of your patients yet, you either just graduated dental school or you are lying!”

The fact is that upper back molars, especially ones that stand alone without a neighboring tooth, have roots that practically penetrate the sinus floor. Removal of these teeth often results in an “OAC” – oro-antral communication. (Sounds like an e-mail between two dentists.)

Not to worry. A dentist or oral surgeon will put the patient on antibiotics, nasal sprays and a decongestant and see him or her once a week until uneventful closure is realized. Occasionally, larger OAC’s require a small surgical procedure under local anesthesia using a rotating flap of tissue or synthetic membranes to close the defect.

For a free booklet on tooth extractions, contact us.

By Dr. Mitchell Josephs

Q: The last time I had a crown done, I noticed the dentist was burning my gum with something; the smell of burning flesh scared me. What was this?

A: Wasn’t it Robert Duval in the film Apocalypse Now who said:  “I love the smell of burning gingiva in the morning; it smells like……..Victory.” Wait, I think it was Napalm, not gingiva.

When a tooth has been reduced in size to create room for a crown to cover and protect, we need to move the gum tissue out of the way by about one millimeter to allow the impression material, or the new digital scanners, called iTero, to capture the part of the tooth just below the gum line. This area, called the finish line, is an important area to reproduce accurately on the lab model of your tooth.

An older method to push the gum out of the way with thick threads soaked in chemicals which can temporarily raise your hear rate is one way to do it. A more accurate, drug- free  way is with a laser or electrocautery unit that precisely creates a trough around the tooth, accomplishing the same thing. A bit of a smell, but no big deal.

Q: Very recently I had a porcelain crown placed on my upper right molar. There was a little bubble on the new crown which I became aware of only after my long time dentist cemented it in place. After I brought it to his attention, he smoothed it down. I am angry because it is not smooth, was not perfect and I paid $1300 for it!  What do you think?

A:  Cool. My favorite category to write about: The “don’t- shoot- your -dentist” category.

It is not uncommon for a bubble to be present on the porcelain. If it is not in between the teeth or on the edge near the gum line and does not interfere with the bite, it is perfectly acceptable for the DDS to adjust, smooth and polish the crown. Sometimes we are able to fill these small areas with tooth colored materials and special adhesives that stick to porcelain.

To get a smooth surface, I use a special polishing kit that uses a series of fine grit, diamond dust rubber wheels to make the crown as smooth as the linoleum floor in my Aunt Rose’s kitchen in Queens.