Dental Info

  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...

  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 ...

 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...

 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 ...

 Often young dentists are afraid of treatment planning 'ideal' dentistry because they are afraid their patients will reject more expensive recommendations. Obviously 'upselling' dentistry is not appropriate, but informing patients of possible treatment plans that are most ideal is a dentist's responsibility. Of course it has to be presented in a non judgmental manner.. Just the facts... .Often patients have a number of options that will work to some extent and we make sure we spend the needed time to explain a few options, if the patient needs them. If we present the most ideal treatment plan and it is accepted by our patients, then further discussion is not needed, but if our ideal is not immediately accepted, then a further discussion of other options will be valuable. Some problems are not necessarily immediately fixed and probably could be delayed for a year or two. This is the point of this post. When patients are seen in my practice on recall visits, I go...

  Most people understand the difference between going to a fast food restaurant vs going to a Michellin rated food establishment.   They both provide meals, but they are really going not providing the same level of product.. The fast food establishments claim to provide a tastee meal, fast and affordable (not so much now-lol). The Michelin rated restaurants are aiming to provide  a more leisurely dinning experience, often with fresh high quality ingredients prepared using a careful technique by highly trained chefs. All consumers understand that going to a Michelin rated restaurant will be more expensive than a meal at Mcdonalds but feel that the meal is worth the extra expense. They may reserve this high end meal for a special occasion , which considering the expense is understandable. Not all people want to acknowledge  that choosing their dentist may be similar to choosing where you may dine. In some ways this analogy can be applied to dentistry today. T...

 This is a simple way of saying that dealing with things early saves a lot of trouble and effort later. I have been practicing for over 45 years and have worn many hats over the years. I have been a general dentist, a cosmetic dentist, a preventive dentist , an Invisilign provider and a dentist expert at prosthodontic restorations. It safe to say there are a lot of tools in my dental tool chest. That being said probably my most important tool is preventive dentistry. I held a teaching position for two years in the 1980's in the Preventive Dentistry department at Columbia University Dental School. It really made me aware of the importance of preventive measures in preserving dental health.    Proper daily home care very important to maintaining dental health. I continue to recommend braun oral be rechargeable tooth brushes. I feel they are the best, even the least expensive Vitality model is excellent. They require the least effort to get teeth maximally clean. After tha...

 Close to two years ago, my son David joined Aetna PPO. Almost immediately Aetna started incorrectly processing claims for my own patients as if I was an Aetna provider. My son wasn't that happy with his Aetna experience and got off the panel over 6 months ago.  Evidently Aetna isn't that quick at updating its provider network.. My secretary complains almost every week about incorrectly processed claims and each time she needs to spend time on the phone with Aetna getting them to reprocess our claims to correct them. When we speak to supervisors, we are told that neither of us  are in network and the claims were not processed correctly.  Also almost every week appointments are booked each week from our online booking application by patients with Aetna dental insurance. When we call them to explain that we are out of network, most times they cancel their appointment.  The only explanation that I can think of is that Aetna is probably not updating their list of...

Some Patients may  have shrinkage of their jaw bone(s) after the denture was inserted and experience lack of seal. While bone resorption may play a role, in my experience there are a number of other possible causes.  Uneven bite is at the top of my list. If a dentures occlusion is unbalanced, when a patient closes, their denture may loosen. Another common reason is that a patients muscle attachments are being impinged on. Muscle attachments are little bands of fibers that connect the cheeks, lips, and tongue to the jaws. Over and under extended dentures can also cause dentures to be more likely to come loose. Under extended dentures have less surface area to help develop the adhesion to help keep a denture in place. Over extended dentures tend get dislodged by patients facial muscle movement or opening and closing. A patient with a dry mouth may also find that their denture comes loose easily, since adequate saliva is needed for a denture to develop proper adhesion. De...

 Even though I work hard to do excellent work and send my dental Labs clear impressions, not every lab fabricated restoration fits well in a patient's mouth. Yes, there are times when a restoration does seem to fit without any adjustments needed, but that is not what happens in most cases. Part of a dentist job is to be methodical and check that each restoration is adequate and will actually help preserve a patient's tooth. Our patient may hope that their new crown or filling maybe perfect, but that is not always the case and while it may be true that 'perfection is the enemy of good' , we should not place inadequate restorations in our patients mouth, just because we are afraid to momentarily disappoint a patient or employer. I take a bitewing radiograph when fitting a crown or after I place a new filling. Of course I have my fingers crossed that my new crown or filling fits perfectly, and often it is the case, but sometimes it is not. When this happens, I may try...

 As I have written before I participate in three Spear Study Clubs. Each club consists of a mix of general dentists and specialists. Because we meet frequently the members get to know each other quite well. It isn't a coincidence that most of my specialists are members of one or more of these club chapters. When I refer a patient to specialist, ideally we either email or speak on the phone  before the patient sees them. This is very helpful since it ensures we are on the same page and we both have better communication with our patients as well. I know why I want my specialist to see my patient but it helps me to hear what he thinks even before the patient gets to their office. Also surely it helps my specialist as well.  My favorite periodontist has an office in my building and often I will ask him to stop down to my office for a brief consultation with a patient prior to their making an appointment. This helps me to understand what he can and cannot do for my patient a...

Silver Diamide Fluoride (SDF) is an FDA and ADA (American Dental Association) approved clear topical liquid that is used to treat cavities. It is applied to the cavity area of a tooth to control  and stop the growth of the cavity. Young children, children with special health needs, any child who has a difficult time at the dentist or who may have a lot of cavities may benefit from this type of care. It can used as an alternative cleaning out decay with a drill and placing a restorative material . For some patients, especially those who can't tolerate traditional fillings it has some advantages. It is painless and may stop cavity progression. It can help with tooth sensitivity and is an especially helpful alternative cavity treatment  for children who are very young or struggle with longer appointment times. How Does SDF Work?  SDF is composed of two main components, silver and fluoride. The silver part acts on the bacteria causing the cavity while the fluoride helps ...

  Ever since the 2020 Pandemic, commercial realestate in our neighborhood has not been doing well. There are a lot of office space available and in our midtown neighborhood there are no longer many large employers renting space. Traditionally midtown dental practices relied on these large employers for supplying many of our patients. Also a number of long time residents of Manhattan have moved elsewhere.  In our building , 30 East 40th st, most tenants arevmedical and dental practices. Traditionally, because construction costs of dental offices were high enough that it discouraged dentists from moving to other buildings when there leases were up for renewal. We renewed our least last May and signed a five year lease. It seems that some of my colleagues have chosen not to renew.  ln the last two weeks , I was able to walk through six of vacant dental offices. The dentists left for a number of reasons including retirement, joining other dental practices, selling their ...

 At the moment we are taking impressions two different ways. The traditional way is still valid and involves using elastomeric impression material, usually PVS type. Often this requires cord packing prior to taking the impression. If use properly it can take extremely accurate impressions . The models are poured up by the lab and mounted using a bite registration. The resulting dental restorations made on these models can fit extremely well. Some inaccuracies can result when the opposing models are mounted and can necessitate occlusal adjustments on the restorations before they are luted in the mouth. We recently purchased a state of the art Trios 3D Scanner and my son has been using it extensively for taking full arch impressions of the mouth and opposing arch, even for single restorations. These scans, if done with appropriate care are extremely accurate. I believe their digital mountings are even more accurate than the 'old school' techniques that I use. We ask the lab to u...

  It used to be said that word of mouth was the best way to market a dental practice. It's sort of true now as well, but a little different then it used to be. When I first started out , it was more or less true because happy patients referred patients. Yes sometimes insurance could play a part, but most of our patients had insurance that allowed them excellent coverage, even when they went to an out of network dentist.  Now, most dental insurance plans are less generous with their payments to out of network dentists. We recently had a patient who had a crown completed in our practice and their coverage only allowed 50% of their "network" fee (which wasn't very generous) so my patient had to pay a fairly high amount that was at least two times the amount that their insurance covered. Clearly this low coverage may make patients more likely to choose an in network dentist instead of a word of mouth recommended fee for service dentist. This clearly limits our marketi...

I have been reading a lot about Artificial Intelligence impacting all sorts of professions. I found this quote byf Bill Gates on a website called Make it.  BillI Gates: Within 10 years, AI will replace many doctors and teachers—humans won’t be  needed ‘for most thing—humans won’t be needed ‘for most things’ Artificial intelligence is already making in roads in all professions and obviously will have a greater and greater impact on all health professions in the forseeable future ( the next 10 years). W hile I don't think expert health professionals will be completely replaced in immediate future, there will be greater and greater use of Artificial assist technology, probably reducing the  numbers of experts health professionals that are needed.  This week we have been using our new 3 shape scanner to take digital impressions for our patients. It uses a great deal of artificial intelligence including taking and enhancing digital tooth impressions, taking shade...

  This April I will celebrate my 72nd birthday. I feel truly fortunate to still be active in my dental practice, three Spear Study Clubs and still enjoy being an attending at the Mount Sinai General Dental Practice Residency. I also have enjoyed being a clinical faculty at NYU and have found my experiences there truly rewarding.  My experiences there not only helped me further develop my clinical skills but kept me stay engaged with  helping train the next generation of dentists .  That being said ,  Given some ongoing health issues,I have recently resigned from my faculty appointment at NYU College of Dentitry, because this was one commitment too many. Teaching their was physically difficult , since I was a very active clinic instructor and worked with a large number of students every day. I loved it, but my health comes first.. so now I have moved my shcedule around and reserve Wednesday for my day off and a little R& R. from Ask Dr. Spindel - ...

  I took a course offered by the New York State Office of Children and Family Services  last weekend. It was supposed to take two hrs to complete and was free.  It was supposed to take about two hours, but that doesn't incluede the time it took to register for the course and the course took closer to three hours to finish. The good news was that the questions that were asked could be answered incorrectly and the person taking the course wasn't required to go back and answer the questions again and again , until the correct answer was given. Instead, if you answered incorrectly , the correct answer was given along with the explanation for why it was the proper response. According to the N.Y.State Ofice of Professions website: Updated Mandated Reporter Training Requirements.  Chapter 56 of the Laws of 2021 amended Social Services Law § 413 to require  additional training to include protocols to reduce implicit bias in decision-making processes, strategies for...

  I have spent limited time in my practice since June because I had a medical condition taken care of. I  have had a lengthy period of recuperation.but the good news is I am doing well and starting Jan 2, I am seeing patients in my office and have returned to being an attending at the Mount Sinai general dental practice residency program.  My son has been doing a great job holding down the fort and will continue collaborating with me as an associate dentist. We just put a deposit down on a 3 Shape cordless scanner, that will allow us to take digital impressions for restoration,s without us having to use silicone impression materials. This technology doesn't work well for every situation but it is the right time for us to start using it.  My son also works part time in other dental practices and has been using digital impressioning technology routinely and he likes it and he and his patients have been happy with the results it provides. I look forward to using it ...