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

Posts Tagged ‘teeth’

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.

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

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

Options for Bleach-Free Teeth Whitening

Posted on: May 17th, 2010 by Dr. Mitchell Josephs No Comments

Q: Due to personal finance issues I cannot afford porcelain veneers ($14,000!) and yet my teeth are too sensitive for bleaching. What other options do I have?…B.G. in Boca

A: As Captain Stubing would say on the Love Boat: “Your ship has come in.” (Or in this case, your smile has come in.) Over the past twenty years, many patients have asked me: “Can’t you just put some kind of white paint over my teeth; like Liquid Paper correction fluid?” Finally, we can now say YES!

Bleach-free whitening made by Denmat, the company that brought you Lumineers, has come out with a “paint-on” whitening material. The dentist applies a super thin layer of an opaque resin that is hardened with a UV light, followed by a glaze. For under $1000, your whole mouth can be done in one visit with no sensitivity and more predictable and longer lasting results compared to bleaching. However, you cannot change the shape of the teeth or correct any crookedness as in veneers.

Teeth Like a Celebrity

Posted on: May 6th, 2010 by Dr. Mitchell Josephs No Comments

Q: A friend of mine told me she was able to get the “same teeth that Hale Berry has” from her dentist. Is this really possible?

A: Did she promise to return the teeth to Ms. Berry before the weekend? I hope she sterilized them!

I think what your crony means is that she had some porcelain laminate veneers that copied the shape, color and style of the celeb in question.

Over the years, I have had patients bring me smiling photos of Demi Moore, Cindy Crawford, Julia Roberts and Sara Jessica Parker. We send these to our lab to aid in designing the veneers, crowns or bridges to mimic these “famous” smiles.

As long as your teeth are not way out of whack, like actor Hugh Grant’s teeth which resemble a rotting mummy, you can get some nice results.

Do I Need A Root Canal?

Posted on: February 5th, 2010 by Dr. Mitchell Josephs No Comments

Q: At my last dental visit I asked my dentist about a lower front tooth that has turned yellow. With an X-ray, he determined that the tooth needs a root canal. This tooth has no cavities and no old fillings. Why would it need a root canal and must it be filed down to make a crown afterwards? …..anonymous

A: “Easiest solution to yellow teeth? Where a brown tie!” (Old Rodney Dangerfield joke) It is possible that virgin teeth can have a dead nerve. (Note: when I say “virgin” teeth, I mean teeth without any dental restorations or decay, not teeth that are celibate.)

Sometimes just the trauma caused by excessive grinding on a tooth that is not in ideal alignment (as in “no braces when you were a kid”) can cause a tooth to abscess. Or a previous fall when you were a kid.

If the tooth has most of its structure remaining after the root canal, sometimes a crown can be avoided by restoring the tooth with an internal core. (A composite resin material chemically bonded to the internal aspect of the root canal access channel.)

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.

Do I Need X-Rays With Teeth Cleanings?

Posted on: January 20th, 2010 by Dr. Mitchell Josephs No Comments

Q: I recently went to a dental office for a cleaning. They refused to clean my teeth without having a recent set in front of them. I feel they were just looking for more money. What do you think?

A: Certainly your $150 set of X-rays was not going to pay for the Doc’s next boat payment. You can’t even get one night’s stay at the Concord hotel in the Catskills for that! His all-you-can-eat brisket buffet will have to wait until another patient comes along.

All “kibitzing” aside, your dentist was doing the ethical thing in refusing to have any dental instruments touch your pie hole with out X-rays. A brain surgeon would not open your cranium without a set of films to see where he is going first.

Many dentists today, including me, use very sophisticated digital X-ray systems that use much less radiation than the old school systems. The X-rays appear instantly on a computer monitor with specialized soft ware that allows us to see if you have more serious problems that require more than just a “cleaning”. We can see bone loss, decay, abscesses, benign and malignant tumors, cysts, fractures and impacted teeth.

Broken Bridges

Posted on: January 8th, 2010 by Dr. Mitchell Josephs No Comments

Q: I had a three tooth permanent bridge supported by two implants placed in the upper front area. The doctor used temporary cement for a “trial run” to see if I liked the shape and color. After I explained that I would like the teeth longer and whiter, he tried to remove the bridge but could not get it out and told me he did not want to risk damaging the underlying implants. What can I do?…Hillary in Hollywood

A: Not an uncommon experience for us “keepers of the teeth.” Always a topic of discussion at the dinner table when the spouse of the DDS says: “How was work today, honey?” It’s actually a testament to how well your doc’s lab work fits.

If the implants are well integrated in the bone, as they should be since a permanent bridge was made, a tap-off bridge remover can be used to dislodge the bridge. It’s ok if the bridge is damaged since it has to go back to the lab anyway for aesthetic porcelain changes. He/She will make you a temporary bridge to use while the lab is working on your bridge work.

What is the best way to bleach my porcelain veneers?

Posted on: December 21st, 2009 by Dr. Mitchell Josephs No Comments

Q: Finances are such that I cannot afford to do porcelain veneers right now. What is the best way to bleach my teeth?… TL From Royal Palm Beach

A: A timely question, indeed, as many dental practices across America are offering “summer white sales” on teeth whitening procedures.

With twenty years of schlepping teeth under my belt in the dental “biz”; I have tried them all. Not only on patients, but on my self and my two pugs, Bella and Wrinkles.

As a dentist on the lecture circuit, I meet some of the most innovative practitioners who share the lecture podium with me. I use a great technique called “deep bleaching”; developed by a California DDS named Rod Kurthey. It uses the Sapphire Bleaching light (not Zoom and not Brite Smile) coupled with a pre treatment and post treatment solution applied directly to the teeth that allows for better results and no sensitivity.

I have seen patients go thirteen shades lighter in one hour without wearing trays of bleaching gook. Most patients will at least lighten from 4 to 7 shades. The US average fee for this procedure is $650.

Teeth Bleaching Booths

Posted on: December 14th, 2009 by Dr. Mitchell Josephs No Comments

Q: Why should I pay my dentist $700 to whiten my teeth when I could get it done at one of those teeth bleaching booths?

A: Are you not a bit skeptical having medical or dental treatment performed in a booth next to the Ginsu Knife demonstration at the Toilet and Urinal Manufacturers Association’s Convention?

Most of these booths are not manned by dentists. In Florida it is a Board of Dentistry violation to apply bleaching materials with out the dentist being on the premises. These “carnival” booths try to get around it by making the customer apply the bleaching gel to there own teeth, making the claim that they are not “touching” a patient.

Before any type of dental treatment is performed, a dentists needs to examine the patients mouth and look for leaky restorations that could allow the solution to penetrate and cause severe sensitivity to the dental pulp (never bundles). He also needs to determine if you are not a candidate for this and are about to throw away some coin.

Who will follow up with you should you have any complications? Not the former Hooters girl who was operating the booth that day; she is now in St. Louis at another trade show.