Posts

How long have you been blogging?

 I started the Ask Dr Spindel dental blog with 3 posts in 2005... so I have been blogging for twenty years. I started it as a demonstration of my writing skills. Several of my patients were involved in a start up called Ivillage that featured article that might interest woman readers. After publishing my first posts I forwarded the link to one of my patients who worked there. Unfortunately, soon after, he left his job and I was left with the blog that I didn't need. . Since it was hosted by Blogger for free (Thank you Google) I kept it active and used it as a source of possibly relevant dental information for my patients and the public. Initially I started writing up my answers to frequently asked questions by my patients and eventually I pretty much answered all their questions (at least those that were suitable for publication) in the first three years. Now I just write about what ever I feel like discussing online or maybe an interest to dentists and the public.  At the m...
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What are your New Year predictions for dentistry?

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  First an update on our practice's new schedule for 2026 . David is seeing patients at our office on Thursdays and some Wednesdays. My schedule is Monday, Tuesday, and Thursdays as well. Friday I am an attending our Mount Sinai's general dental practice Residency. As the new year approaches and the office is closed until January 5th, I have had time to reflect on how things are going in our practice and I am looking forward to the new year and starting my 46 sixth year in dentistry. Its been a long and fascinating journey! When I started, some dentists were still taking copper band impressions for crowns, but most dentists had adopted elastomeric impression materials to accurately capture the details of their preparations. I had been trained in both techniques, but clearly taking elastomeric impressions was easier and allowed fewer steps in crown fabrication.  Now dentists coming out of school are trained in elastomeric and digital impressions. Now my son works in anoth...
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What are my choices if I have a badly broken down tooth that needs fixing?

 This is a situation that I encounter when I work as an attending at Mount Sinai hospital. Patients show up for emergency treatment at our dental facility. Often they have had the problem for a long time and wait until the tooth is bothering them. Many of the patient pool is dependent on their dental insurance or a possibly a sliding fee scale that they can apply for. If a patients mouth is not missing a high number of teeth, fixing the tooth is a viable option for some patients if they can afford the procedures needed... These can include multiple procedures such as root canal, post and core , crown and possibly crown lengthening. These are all feasible for many teeth, but can be time consuming and expensive. A number of the patients seen at our program opt to extract these teeth rather than to save them.  If multiple teeth are badly decayed with compromised tooth structure extraction often is the preferred option for our patients and replacement of the teeth with removable...
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What should I do if I don't have enough bone to have an implant?

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  Although the usual alternative options are a removable denture (partial or full) or a fixed bridge attached to natural dentition, these are not always desired or even possible. My oral surgeon and periodontist can sometimes perform grafting procedures that can miraculously add bone to make implant placement possible even for some extremely deficient ridges. Today my oral surgeon placed three guided implants for one of my patients who had extensive grafting about 4 months ago. He sent me photos of the procedure, and I was extremely impressed. This was the result of diligence for all concerned... My patient helped by not wearing a denture during the last 4 months, even though she had an important family event to go to. Our office helped by sending intraoral scans of the patients preexisting bridge and also fabricating an Essex retainer that could be placed in my patients mouth in order to aid him with his planning and execution.  My surgeons often play the biggest part in...
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We have met the enemy and he is us?

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  This Pogo could describe the current  state of our healthcare system, including dentistry. Market forces are pushing to provide ever more affordable dentistry and the dental insurance industry is trying to deliver ever more economical dental care to their subscribers. They know that most people do not want to pay alot for their dental insurance.  I have been participating with two insurance plans in my office for over 15 years and the fees that I am allowed have been mostly static. Unfortunately the costs for rent, insurance  salaries, supplies and labor have steadily increased, year after year.  My practice is dedicated to delivering the type of excellent dental care that helps patients maintain their dental health and preserve their teeth for a lifetime. Sometimes my patients experience adverse dental events, but these are minimized by the high quality dental treatments they routinely recieve. Unfortunately, the market forces that most dental practices ...
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How should I restore my short teeth?

 Last week in our study club, we watched an excellent presentation by Frank Spear on restoring short teeth. Since there are many different reasons that teeth appear short, there are a number of different way to make them look better. Some of the reasons for a person having short teeth include altered active and altered passive eruption , Tooth size-arch discrepancy , or excessive wear. The solutions to fixing the appearance is varied and dependent on why the teeth are short, the position in the face of the short teeth and how the teeth should appear after they are restored.  Worn teeth tend to experience compensatory eruption and to fix them , we have to be aware of where their  edges should be when the restoration is completed. These teeth should not be lengthened with out consideration of other factors. Optimum restorative solution can vary but include orthodontic intrusion, crown lengthening, and/ or bite opening.  For a dentist to make a appropriate trea...
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Why is preventive dentistry under emphasized by most dentists?

 Patient education and follow ups really are often needed to make sure recommended changes are followed through by our patients are not really properly reimbursed by patients or their health insurance. Coaching a patient either by a dentist or one of their staff actually can requires more than one appointment in order to assure that the patient has properly implemented home care properly.  Given the way things in healthcare is moving, patients are expecting lower out of pocket costs and desire  treatment covered by their dental insurance. Unfortunately most dental insurances efforts seem focused on saving their companies money by cost containment and rejecting payments for submitted expenses that they deem 'unnecessary' . Maybe I'm exaggerating but possibly they don't seem that concerned with patients keeping their teeth for a life time. I believe their ultimate goal is to maximize their own profits during the short term, especially since many patients do not maintain ...
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