Dental Info

 Our office does take a number of different plans. I personally am a Delta Premier Provider and a Cigna Provider. My son David has joined Metlife Dental Insurance. That being said our office a fee for service dental practice that participates with a few dental insurance plans. We have plenty of patients that have plans that we are out of network for, but we bill their dental insurance and then bill them the for what is not covered. We treat all our patients the same way regardless of which insurance they have. Appointments are usually scheduled for one hour (or two for crown preparations) . This amount of time makes it possible for us to have  sufficient time to ensure a uniform high standard of care.  Since dental offices need to cover their expenses and make a profit to pay their dentist/owner, some offices have procedures engineered to be done in shorter amounts of time. By this I mean, they try to figure out techniques that are more efficient but hopefully still allow them to pro

 My son is practicing in my office on Thursdays.. We did our own version of Trading Places. He finished his Mount Sinai general practice residency in June and I started as an attending there on Thursdays and he now works in my office on Thursdays. He has joined Metlife dental plan an is a preferred provider with them and he is in the process of joining a couple of other plans.  My assistant Jennifer is helping him find where everything is and he is sharing my treatment room with me. He can work on other days as well, but he has filled up his other week days by working in other dental offices. I encouraged him to get experience in a wide variety of dental settings and he has three other part time positions.  He seems to be enjoying dentistry and he is a fine addition to our dental practice.   I have been thinking about him joining me since he started dental school and am extremely happy to have him join me and my staff in our dental practice. from Ask Dr. Spindel - http://lspindeln

  Don't get me wrong... I think having the ability to treatment plan implant restorations has added a great tool to most dentist's tool box, but sometimes salvageable teeth are extracted to facilitate implant placement and a definitive full arch fixed restoration.  I myself do this when the bone is needed to place an implant that will serve as an abutment for a multi implant treatment plan. Sometimes teeth do get in the way.  That being said, there seems to be an increasing tendency for dentists to advocate the removal of all remaining teeth to fabricate a "hybrid" full arch implant restoration. There is a nasty joke going around about all on 4 implant cases ... they are great unless one of the implants doesn't take or last long and then the entire case can be considered a failure since there is no such thing as an all on three case. Also many patients are encouraged to have expensive full arch implant treatment cases without empasizing the need for the cleans

 Probably because I currently see patients in three settings I see a whole lot of different patients from varying socioeconomic backgrounds.  The patients who I see in my private practice and who buy into preventive maintenance and good home care do very well and even into their nineties have most of their teeth. The patients I see during my teaching tend to have less money allocated to their dentistry and have mouths that are missing more teeth. Also they are more prone to severe bone loss due to ongoing periodontal disease. It is not terribly uncommon for a patient at one of my days spent teaching to come in with a mouth full of loose teeth that probably should be removed. The other day one such young patient in her thirties came in and had been told by her dentist she needed to have her teeth removed. Sure enough they all were loose without good bone support. Sooner or later her teeth will fall out or get infected. She explained that she was very attached to her teeth and would lik

In general good quality patient dental care should be about helping our patients achieve the best dental care possible. This doesn't necessarily entail getting our patients to spend maximum money. Instead it is about our ability to educate our dental patients about the factors that can undermine their dental health and lead to tooth loss. Most times tooth loss can be prevented through early intervention and patient education about the importance of home care and showing them how to achieve optimum dental health.  Most often  dentists do not get paid for the time spent on educating our patients. Instead there seems to be an increasing emphasis in health care about achieving efficiencies. and insuring our ability to generate a profits in spite of the ever increasing costs of delivering  dentistry in an optimal fashion. In my opinion our government and the insurance companies bear a certain responsibility for these developments. Both the government and the insurance  companies se

When I went to dental school shadowing was not required. My only experience was as a patient. When I started dental school I was surprised how "difficult" dentistry could be. After all, my uncle was my dentist and he always made my care look easy. I had a lot to learn when I started school. I am not sure if I fully understood the difficulties involved with running a practice, seeing patients and making them happy. If I had shadowed I would have had a much better understanding about what is actually involved in being a practicing dentist.  We are currently hosting a recent college graduate who is taking a gap year and I asked her how much shadowing she needs and she reported that most schools require 100 hours of shadowing. I think this is a good thing, since the amount of schooling required to complete a dental degree is both time consuming and expensive.  Not all dentists are comfortable having a prospective dental student shadow them in their office, but many are and

 David finishes his general practice residency July 1rst. Even though he has passed all his licensure exams, He has to wait one -three months for his NYS license. Accordingly he will join our practice in September and probably be seeing patients primarily on Thursdays. He may see pattients on additional days if he is available.  Clearly my staff, myself and David are excited for him to join us and many of my patients are asking me about Davids plans. Many of them have known him since he was a small child who often came to my office to visit us. I would dress him up in a smock , gloves and a mask and introduce him as "Dr. David"  Although it was a "secret fantasy" that someday he would become a dentist, I never really promoted this to David and it was his idea to become a dentist like his father. I couldn't be happier with his progress and look forward to working side by side with him over the next years.  from Ask Dr. Spindel - http://lspindelnycdds.blogsp

For the last 5 years I have been teaching at NYU College of Dentistry on Fridays.  Recently I started teaching on Thursdays as an attending at the Mount Sinai supervising the residents in their general practice residency program. I changed my office schedule so that for the time being we are open to see our patients Monday, Tuesday and Wednesday. My son David is planning on joining the practice sometime this September and he may end up seeing his patients on Thursday or Friday.  Fortunately, even though we have condensed our schedule to three days, it still is fairly easy to book an appointment in our practice since we usually have openings each week and most patients do not have to wait more than a week to see us. Emergencies can still be accommodated sooner if needed.  Recently, I went see one of my doctors and his physician assistant teased me that I am a workaholic. She may have a valid point,  since I haven't been slowing down even though I am old enough to be collecting soc

  I attend Study Clubs about three times per month. These occur after work at an office of one of the members. The purpose of our study clubs that are run using a "Spear" Model is to have  presentations  that are interactive that encourage our members  to  ask questions and share their related experiences.  Our members understand that its best  tnot to be critical of other attendees but they are free to politely disagree and explain why. The purpose our clubs is to help improve the skills and knowledge of our attendees. This should help them become more effective and able to achieve more predictable dental outcomes.  Since all dentists occasionally experience non ideal outcomes,  it is important for us to analyze why they may happen and how to avoid them in the future. I have been participating in Spear study Clubs for more than 13 years and it has helped me become a better dentist. Currently I lead my own club 10 times a year and am an assistant leader in two

 The answer is simple... to remove plaque  a long the facial and lingual surfaces of the teeth. No other technique will accomplish this as well as using a tooth brush properly . Plaque consists of colonies of bacteria attached to the teeth with a mucopolysaccharide matrix. It is like the colonies of bacteria that are grown in petrie dishes, soft, slimy and relatively easy to remove.  Yesterday I was treating one of my patients, a young man with rampant decay through out his mouth. He comes in weekly for me to clean out cavities and place " medicated fluoride releasing fillings" . These needed treatments are the result of years of neglect on his part and poor oral hygiene.  Even though he should be sufficiently motivated he still seems to be not brushing properly. Yesterday I disclosed his plaque using some chewable disclosing tablets that stain plaque red and then I asked him to go to the bathroom and brush it off. He was able to get a lot of it off and I gave him some ta

According to the dictionary a serf is "a servant or laborer of olden times who was treated as part of the land worked on and went along with the land if it was sold"  and now a days it seems that healthcare workers are being bought and sold by large corporations and this analogy seems more and more apropos. I read an article today in the Wall Street Journal about CVS negotiating buying a chain of Doctor clinics from Oak Street Health. According to the article  "CVS's deal would be the latest in a series of moves by a range of players, including health insurers to acquire clinics and doctors focused on primary care. Of special interest to the buyers are clinics that manage and treat patients with chronic health conditions such as diabetes, whose care can be costly if not managed closely" It is clear that the hope is that through "greater efficiency" managing and preventing worsening conditions may save money and lead to greater profits for the own

Lately I've seen an uptick in new patients entering our practice.   It seems that an increasing  number of my contemporary dentists (baby boomers) have chosen to retire and some of their patients were not particularly happy with their younger replacements.  Boomer  dentists are defined as those born between 1946 and 1964 and many are retirement age.  When I queried these new patients as to why they left their previous dentist,  many were unhappy with the dentists who took over a prior dentist who retired and they implied that either they didn't feel like they were getting the same "personal attention" and/ or the new dentist was finding problems that their previous dentist didn't mention. Over the years I have had the good fortune to take over a number of dental practices when collegues have chosen to retire. I can attest that this is both an opportunity and a challenge. While I feel flattered that these dentists have chosen me to be their successors, It can be

  Often patients come in with the hope that the solution to their dental problem will be a simple fix, especially if their tooth problem is not associated with any painful symptoms. Sometimes they are right but sometimes they are not. Unfortunately, pain is not always a good indicator of a dental problems severity. some extremely decayed teeth do not cause a lot of discomfort, but tooth structure can be so compromised by the amount of missing tooth structure, that refilling the tooth may not be an option.  Often salvaging a tooth with advanced decay is not always feasible and when it is possible, multiple costly procedures may be required to save the tooth (root canal, crown lengthening, post and core). Sometimes the most predictable solution is to remove an extremely decayed tooth and to arrange for its replacement with an implant and implant restoration.  This involves multiple steps and can be costly, but often the implant option offers a more predictable long term solution. Ob