Dental Info

 We have always made our hard guards without tissue contact and most times we use full maxillary coverage. Most times we specify two metal ball clasps between the first molar and second bicuspid. These clasps can be adjusted if needed to tighten the fit of a loose night guard (night guards tend to wear and get   looser with time. We still use a lab that knows how to fabricate these guards using an analog manner  but are using digital impressions to capture both arches and the bite. Our lab uses a 3D printed model and then applys the metal ball clasps and applies cold cure acrylic. These 'hybrid' nightguards seem to combine the 'old' tried and true lab techniques with newer digital techniques for taking the impression and fabricating a 3D printed model.  These guards require less effort to fit to patients mouths and patients seem to be very satisfied with their fit. They seem to fit more passively with less discomfort due to the tightness that many patients compl...

 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 ...

 Nothing lasts forever, but the reason for  having a crown done is to "preserve your tooth". Often patients avoid going along with a dentists idea of making a crown for their tooth and instead ask can have a filling.  he truth is that almost any tooth can have a filling but the larger the restoration, the less predictable the result. Teeth with large fillings can me more prone to recurrent decay, food impaction( due to faulty contacts) and fracture ( since the tooth structure is compromised by not having a crown). The other day I was at my office. My son David was treating a longstanding patient of mine whose crown had come off. I peeked into his mouth and it was clear that he had experienced a fair amount of gingival recession around the tooth and he had developed recurrent furcal decay( decay between the roots).  David cleaned out the decay and filled it with a glass ionomer restoration and was able to recement the crown. I looked through my patient's old paper ...

My son David joined my practice last September and is seeing  patients. He is doing a great job and the feedback from our patients has be extremely promising. The timing couldn't be have better since I have needed a surgery and the medications I am currently taking will render me immunocompromised for the next couple of months. All of my staff has stayed on and my son is truly talented and capable dentist.  I really look forward to returning to practice as soon as my doctor(s) give me the green light. The truth is I feel better now than I have in the last few years and I have a great support system. It also has been heartening hearing from concerned friends, patients and colleagues. Sometimes,  just sometimes, something that seems bad news, can turn out to be good. In my instance it has been a positive experience that has been given me improved health.  While my hospital stay was not a bowl of cherries, it was necessary and I received excellent care. I am truly fort...

 When discussing oral health, preventing problems from worsening is the way to go.  Small fillings are better than waiting until problems worsen. A small filling can lessen the need for a root canal or an extraction in order fix the problem once it worsens.  Getting cleanings and check ups also lessons the probability of patient developing periodontal poblems. Brushing well and flossing also keep the teeth cleaner and less likely to develop smooth surface decay  (not in the pit and fissures).  Unfortunately many patients ignore the dental problems until they are hurting. By this point prevention is not an option and our fixes, sad to say, are not guaranteed to permanently fix tooth problems. Often by the time a patient "feels" significant tooth pain the situation is so advanced that the long term prognosis for their tooth is compromised even after their problem is addressed. This is why dentists advise their patients to come for checkup and cleanings every...

Acrylic dentures ,as a opposed to cast framework partial dentures, are used for patients whose remaining teeth have a guarded prognosis due to mobility, bone loss and /periodontal disease. Patients who are candidates for these often do not want to remove their remaining teeth and may not find implants an affordable option. Since these "transitional" dentures are made from acrylic, adding additional teeth is a relatively easy procedure that involves taking a pickup impression and sending this with the denture to the lab so that they can pour up a new model and add a replacement tooth to the denture.  These all acrylic dentures are a common choice for patients who don't wand definitive comprehensive treatment but instead just want to replace their currently missing teeth.   The other day, one of our residents filled out her Rx to the laboratory for fabrication of an acrylic partial denture. These partial appliances are all acrylic with the acception of hand bent wires t...

 Patients often present with dental pain and would like to get a diagnosis and appropriate dental treatment. They often complain of a tooth ache, which is not very specific, since There can be a number of causes for tooth pain and there are many differential causes.  Often my residients and students try diagnosing using the dental radiographs as their primary tool. Dental radiographs are just one of the items in our tool box. For me , the first thing I do is ask the patients a bunch of questions... When do you have pain? do you have pain on biting, pain after eating, hot or cold sensitivity  or prolonged pain. The answers to these questions have a lot to do with narrowing down why the patient is having pain.  I definitely look at the radiographs to see if their is an obvious problem in the quadrant they are feeling pain( perapical radiolucency or a large carious lesion).  If a tooth is sensitive to cold it means that it is vital and any teeth with root canals i...

 Our study club just watched a lecture on how he does examinations of his patients..It makes alot of sense. 'First he goes over problems he sees and gives a tour of the mouth to his patient. Then he explains what could happen if the problems are not addressed. Only after this initial tour does he go over possible treatment options.  I use a similar approach with my patients. I find that this allows patients to better understand their problems and why I recommend specific treatments. Also the last part of the exam is the cost of various treatment options as well as the pros and cons of each choice. I find that hearing about cost of treatments , especially if given at an earlier point of the exam can keep my patient from "hearing" my explanations, since once they hear the cost they can fixate on picking an inferior but less costly treatment plan. After all, who wants to spend thousands of dollars completing their treatment. This is especially true if they don't unders...

 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 all...

 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. Sp...

  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 ...