Dental Info

 When patients ask how long do crowns last, I usually answer about 10-20 years. That being the case, I do not automatically replace crowns that have been in service longer. Last week a patient came in and asked if it was time to replace his single gold crown since it was pretty old. I replied that crowns do not have any expiration date and that I would tell him when it was time for his crown to be replaced.  It is true that some long standing crowns that look  good on a radiograph may have some cement wash out along some of their margins, mostly we do not replace crowns until there is evidence of some deterioration around the margins or there is a perforation on the occlusal surface.  There is a risk of causing a problem when replacing a crown that is still serviceable iincluding  the crowned tooth becoming more sensitive or even requiring a root canal procedure. While this risk is small,  to my mind it's best to continue monitoring older crowns to see deterioration of the adj

 Last week one of my long time patients came in and had a cleaning and exam. He has a history of a extremely high caries rate and apparently his dry mouth has contributed to his problems. He complained that when he sleeps his mouth gets really dry and we reported that he sleeps with his mouth open.  I find that I too have been sleeping with my mouth open and I wake up multiple times per night with an extremely dry mouth. I asked him if he had some time and we could watch some lessons on Spear Online about "the Seattle Protocol" which is an introduction to "sleep dentistry". He said he did and we watched about 30 minutes of the lessons called Nasal Breathing Therapy . I had remembered watching these awhile ago and there was a mention of taping the mouth shut at night (   Buteyko Mouth Taping  )  so that mouth breathing might be discouraged.  I should add that I have been quite skeptical about sleep dentistry but I have little or no firsthand experience with trea

Although NYC has over 8 million residents, I do run into patients from time to time. It can be disconcerting if I don't immediately recall their name but some are clearly more memorable than others and their personal details are forever stamped into my longterm memory banks. Yesterday I was teaching at NYU College of Dentistry and a student asked me to please go over her examination of an 88 year old patient. When I came over to her cubicle, I recognized her patient as one of my long time patients whom I haven't seen for more than 10 years. I recognized her immediately and greeted her happily "Hi Gail!". She looked confused and I removed my mask and said "It's Dr. Spindel". We chatted for a few minutes about her and her family and seeing her really made my day. She had kept all her teeth and they were still in great shape. I'm not sure why she stopped coming to the office (I think she told Ida she was on a fixed income and felt she could

 Screw retained implant restoration with properly shaped emergence profile  The angle and the shape of the abutment or screw retained crown should be flare slowly and be concave if possible. This shape will not press on adjacent bone and tissue that will support the implant restoration. This should minimize inflammation and facilitate the dentists ability to full seat and torque down the implant restoration. A properly designed restoration is kinder to the surrounding tissues and may make their continued health and preservation more likely as well as facilitate proper cleansabilty by the patient. Often times these restorations are designed by technicians who don't always understand the principles involved with proper perio prosthodontic design. The photo below shows an area about one mm away from the platform switch implant where the interface has a small ledge that brings it closer to the osseous interproximal bone. This is usually correctable by carefully using rotar

 I have been a dentist for over 40 years and at this point most dental procedures are straight forward and relatively easy for me. Taking care of  people with differing expectations can sometimes be the more challenging part of dentistry. I personally enjoy chatting with patients while I'm treating them. Of course sometimes our conversations can be more of a monologue since at times their mouths are propped open and they can't contribute easily. Most of the times our banter serves to distract my patients from the procedure they are having done and lessens their anxiety, but not always. I was cleaning a long time patients teeth and it became clear that she wasn't enjoying the conversation and really just wanted her cleaning finished without a lot of chit chat. . She seemed to be channeling Sargent Joe Friday from an old episode of Dragnet ( just the facts please!) It can be hard to figure out why a patient clams up, but there are a number of possible explanations including

 I went to Costco and took it yesterday. My last booster was in April and according to the FDA website"  "i ndividuals 12 years of age and older  are eligible for a single booster dose of the Pfizer-BioNTech COVID-19 Vaccine, Bivalent if it has been at least two months since they have completed primary vaccination or have received the most recent booster dose with any authorized or approved monovalent COVID-19 vaccine" This is the fifth covid vaccine shot I have taken and so far I have been lucky. To the best of my knowledge I have avoided a Covid infection. I wear a N-95 mask while taking public transportation and treating patients. That being the case,  lately I have not been a complete hermit. I attend small group study club meetings where food is served and none of the attendees are wearing masks and I occasionally eat out at restaurants with several people sitting at my table. Many of us are "through" with Covid, but apparently Covid is not through w