Tag Archive for "crown" - Dr. Mitchell A. Josephs' Blog

Posts Tagged ‘crown’

Why Do I Have a Racing Heart During Dental Injections?

Posted on: July 18th, 2012 by Dr. Mitchell Josephs No Comments

Q: Recently at a new dentist’s office I experienced a scary bout of heart palpitations after getting a shot for a crown. I am afraid to go back. What went wrong? Annie C. in Weston via email

A: When ordering a cheese steak in the City of Brotherly Love, one must say: “With” or “Without.” This tells the cook whether you want Cheez-Wiz or not. When I ask my dental assistant to pass the anesthesia syringe, she will ask me the same question; only this time it implies do ‘I want anesthetic “with” epinephrine or “without” ‘. Local anesthetics with “epi” used to constrict blood vessels to increase the duration of numbness, often make the heart race as adrenaline would; especially in patients taking certain heart medications. To lessen the chance of these episodes, the dentist needs to review your medical history and medication list and aspirate (pull back) on the syringe while injecting to avoid direct injection into the larger blood vessels of the jaws.

The good news is these episodes are short lived and usually not dangerous. And, again, are very common.

EDITOR’S NOTE: Dr. Mitchel Josephs will be giving a FREE LECTURE on Incision-Free Dental Implant Surgery, Digital Crowns & Veneers, Choosing a Dental Office and NEW TOPIC: Laser Dentistry, at the Double Tree Hotel, PGA Blvd. in Palm Beach Gardens onFriday July 13^th at 10:00 AM. Attendees will receive a FREE copy of his book: “Tooth Talk”. Only 16 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. 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.

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drjosephs@palmbeachdentist.com

44 Cocoanut Row, Palm Beach, FL 33480

888-DRTOOTH (888-378-6684)

www.palmbeachdentist.com

Crowns Over Implants, Connect Them or Not?

Posted on: June 26th, 2012 by Dr. Mitchell Josephs No Comments

Q: I recently had two implants with bone grafts placed on my lower left missing molar area. The dentist who placed them said he placed 10 mm long implants, but wish he had “placed longer ones”, but could not due to the location of an important nerve at the bottom of the jawbone. He recommended that my regular dentist make the two crowns connected to each other. My regular dentist told me, ask the implant dentist!

This worries me as I once had a bridge that was three teeth all connected, preventing me from flossing, resulting in my losing two teeth due to decay and gum disease. My question is should I have two single floss-able teeth, or play it safe and have two connected crowns? Stanley in Palm Beach Gardens

A: Let’s not allow “too many cooks to spoil your dinner.” Both doctors are asking the other one to “make the call” on splinting the two crowns or fabricating two single unit crowns. Splinting crowns together is usually done if less implants are placed then the number of teeth needed in the final result. Or, natural teeth that have loose roots due to severe bone loss from periodontal disease. If the dentist who placed the implants has tested them three months after the surgery, and they seem well integrated into the bone, then I say create single crowns for easy flossing.

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 TOPIC: Laser Dentistry, at the Double Tree Hotel, PGA Blvd. in Palm Beach Gardens on Friday July 13^th at 10:00 AM. Attendees will receive a FREE copy of his book: “Tooth Talk”. There are only 40 seats left! 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.

____________________________________________________________

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

Onlays: A More Conservative Treatment than Crowns

Posted on: February 28th, 2012 by Dr. Mitchell Josephs No Comments

Q: I need some crowns, but I hate the idea of having my tooth drilled down to a stump and capped. What else can be done? Mortimer in Wellington

A: The good news in dentistry is that there are often more choices in restoring a tooth than a Vegas buffet. The bad news is that it confuses the public like sending a man to buy laundry detergent at the supermarket. Too many choices!

Very often, rather than drill away the whole outside of a tooth to fit a crown (cap) over the tooth, we can remove only the weak parts of the tooth; the decay and old filling materials and then take an impression (digitally scanned, “goop-free” impression are great for these). The lab will then construct a conservative all-ceramic, metal-free “onlay” to be chemically adhered to the tooth at the final visit. For free consumer info on onlays, contact us.

EDITOR’S NOTE: Dr. Mitchell Josephs will be giving a FREE LECTURE on Incision-Free Dental Implant Surgery, Digital Crowns & Veneers and Choosing a Dental Office, at the Downtown West Palm Beach Library, on Thursday March 8^th at 6:30 pm. Attendees will receive a FREE copy of his book: “Tooth Talk”. Seating is limited. Call 561-868-7701 to register.

Dr. Mitchell Josephs practices Cosmetic, Implant and General Dentistry in Palm Beach and hosts the “Tooth Talk” radio on WBZT AM1230. (www.radiotoothtalk.com) Dr. Josephs is a Faculty Advisory Board member at McGill University’s Faculty of Dentistry.

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

Avoiding Bone Grafts and Sinus Lifts Before Implants

Posted on: February 21st, 2012 by Dr. Mitchell Josephs No Comments

Q: I am missing my bottom back teeth and was told I need complicated jaw surgery and bone grafting even before the implants are placed. Is there another means to avoid this costly and aggressive procedure? Carol in Boynton

A: I would need to see digital images of your bone to properly answer this, but many times the above can be avoided by the old stand-by: The K.I.S.S rule. Keep It Simple Stupid. (Or in my neighborhood growing up, Keep It Simple Shlomo.)

“When insufficient bone exists, osseous grafting and ridge expansion are surgical options, but have serious morbidities (non-fatal complications or failures of the procedure), according to a recent article by Dennis Flanagan DDS in the Journal of Oral Implantology. A technique using a very short 6.5×5 mm implant may be placed at steep angle to successfully support permanent bridge/crown work, allowing you to “K.I.S.S.” your dentures goodbye! For free consumer info on this, contact us or attend our seminar.

EDITOR’S NOTE: Dr. Mitchell Josephs will be giving a FREE LECTURE on Incision-Free Dental Implant Surgery, Digital Crowns & Veneers and Choosing a Dental Office, at the Ross Jewish Community Center on Jog Road in Boynton Beach on Wednesday February 22^nd at 10:00 am. Attendees will receive a FREE copy of his book: “Tooth Talk”. Seating is limited. Call “Shawn” at 561-259-3016 to register.

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

Less Implants Can Achieve Same Result

Posted on: January 3rd, 2012 by Dr. Mitchell Josephs No Comments

Q: I am missing three molars. My dentist wants me to have three implants and three crowns. If I did two implants and three crowns, this would save me $2600. Is this safe to do? Melvin in Boynton

A: Let’s compare kiwis and pomegranates here. If your bone is super dense and plentiful as verified by digital imaging, you can get away with two implants to support three crowns, HOWEVER these three crowns will be connected to each other, like a permanent bridge, with a floating tooth in the middle that can trap food and will require the use of a floss threader. If you are OK with this and have great oral hygiene and see your hygienist regularly (at the dental office, not at Starbucks.) then, you are OK with the two implants. The ideal treatment would be three implants.

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 TOPIC: Oral Care for Cancer Patients, at the Double Tree Hotel, PGA Blvd. in Palm Beach Gardens on Thursday January 19^th at 4:00 pm. Attendees will receive a FREE copy of his book: “Tooth Talk”. There are only 30 seats left. Call today to register at 561-832-2917

Dr. Mitchell Josephs practices Cosmetic, Implant and General Dentistry in Palm Beach and hosts the “Tooth Talk” radio show on Fridays at 11am and Tuesdays at 8:30am on WBZT AM1230. (www.radiotoothtalk.com) On staff at Good Samaritan Medical Center, Dr. Mitchell Josephs is a Faculty Advisory Board member at McGill University’s Faculty of Dentistry.

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

Is a Prosthodontist Necessary?

Posted on: November 29th, 2011 by Dr. Mitchell Josephs No Comments

Q: I need extensive implant, crown and cosmetic work. Must I go to a prosthodontist? Beverly in West Palm Beach

A: If you ask ten people in a room: “What does a prosthodontist do for a living?” nine out of ten will say: “Remove hemorrhoids?” Sorry, wrong end of the body. A prosthodontist does an extra 24 months of training after dental school, in crown and bridgework placed over natural teeth or on top of implants, as well as porcelain veneers. This allows them to classify themselves as “specialists” and limits the scope of their practice. Their fees tend to be higher on average compared to highly qualified general dentists.

It is not mandatory to be treated by a prosthodontist. There are tens of thousand of general dentists in the USA who have done more of the above procedures than many prosthodontists. A general dentist who practices in an affluent area is likely to have performed more veneer and implant cases than a prosthodontics in a rural or lower socioeconomic area. Either type of dentist can do the job.

EDITOR’S NOTE: Dr. Mitchell Josephs will be giving a FREE LECTURE on Incision-Free Dental Implant Surgery, Digital Crowns & Veneers and How to Choose a Hi Tech Dental Office at the Double Tree Hotel, PGA Blvd. in Palm Beach Gardens on Thursday December 1stat 4:00 pm. Attendees will receive a FREE copy of his book: “Tooth Talk”. There are only 13 seats left. Call today to register at 561-832-2917

Dr. Mitchell Josephs practices Cosmetic, Implant and General Dentistry in Palm Beach and hosts the “Tooth Talk” radio show on Fridays at 11am and Tuesdays at 8:30am on WBZT AM1230. (www.radiotoothtalk.com) On staff at Good Samaritan Medical Center, Dr. Mitchell Josephs is on the Faculty Advisory Board at McGill University’s Faculty of Dentistry. Send questions to drjosephs@palmbeachdentist.com or call 888-DRTOOTH (888-378-6684) or visit www.palmbeachdentist.com

Crown Alternatives

Posted on: February 1st, 2010 by Dr. Mitchell Josephs No Comments

Q: My dentist wants to crown (cap) another one of my teeth, but I hate the idea of having another tooth filed down to a stump. Are there any alternative treatments?

A: When a tooth has already been stuffed with more filling than a Christmas turkey, it might be time for a crown. Large fillings, especially old silver (amalgam) fillings tend to leak and crack over time, leading to decay underneath.

The dentist must then remove the remnants of the filling along with decay. This can leave a tooth too weak to re-fill. The tooth must be completely covered by a porcelain or gold crown for strength. This does require that the tooth be “filed down to a stump” to allow for room for the porcelain or gold.

There is an alternative. If you have a fair amount of healthy tooth structure left after decay and old filling removal, the dentist can stop drilling and do an inlay or onlay. This is a custom porcelain filling made by a dental lab off of an impression of your tooth. You will preserve what is left of your tooth and have a restoration that is actually easier to clean than a crown since they rarely go under the gum line.

Prices of Crowns

Posted on: January 27th, 2010 by Dr. Mitchell Josephs No Comments

Q: Why do some dentists charge $600 for a crown and some charge $1400 for a crown?…LH Jupiter

A: I have the same “Shtick” when it comes to men’s shoes. Why are Macy’s own brand, Alfani around $100 and identical looking Gucci loafers are almost $400?

Firstly, let’s eliminate the regional fee differences and just call the average fee in the USA for a crown is around $1100. What makes the difference are the materials used, the laboratory’s quality, added procedures needed to reinforce the tooth (posts and cores) and the dentist’s techniques and equipment used to perform the procedure.

A cheap crown could be made in a high-volume lab in Tijuana Mexico (no joke) and contain a low percentage of gold (there fore less biocompatible with human tissue). My lab only has about 25 doctors in the country as clients. They charge me an arm and leg, but their porcelain work is phenomenal when it comes to all-porcelain, metal free crowns and veneers.

The office that performs the procedure may not use the latest in Hi-Tech equipment and materials that I have written about in my column. Digital X-rays, Lasers, Intra-oral cameras, computerized numbing syringes, etc. These items provide both early diagnoses of disease as well as greater patient comfort. You get what you pay for. Those Gucci loafers do have softer leather than the Macy’s brand.

Do I need a new crown?

Posted on: January 22nd, 2010 by Dr. Mitchell Josephs No Comments

Q: I had a crown done 6 months ago. The gum always bleeds around it when I floss and it feels sore between the teeth. What could be wrong? Dr. D. in Highland Beach

A: I appreciate you writing to me, but first bring it to the attention of the dental artist that made it; and do be kind! ( Remember my series entitled “Don’t shoot the dentist”)

The crown might be too bulky where it meets the gum line or may have an open contact which is trapping food between the teeth and under the gum. A new crown is needed.

A digital X-ray must be taken to evaluate this puppy, as well. An important principle in crown and bridge work is called “biological width.” This is the minimum distance required between the gum line edge of a dental restoration and the crest of the underlying bone. If you encroach on this minimum distance, you don’t have enough room for healthy gum tissue to flourish.

If more width is needed for a better final result, we remove a little bone and gum tissue with a laser or electro cautery unit, before a final impression is taken for the crown. This is known as crown lengthening surgery and is a minor, painless procedure. Often, we do this to save teeth that have fractured or decayed below the gum line.