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...

 Most weeks I am working a full schedule on Monday and Tuesday. David is seeing patients on Thursday. Some Thursdays I am in the office, but mostly I am not seeing patients. Fridays I spend time as an Attending Dentist at the Mount Sinai Dental Residency. Occasionally if I am performing a lengthy procedure I see a patient or two on Wednesday. My assistant Jennifer is answering our office phone on Wednesdays. My goal is to come into the office no more than three days each week.  As a recovering Liver Transplant patient, my doctors have advised me to limit my work to 4 days per week. Having Wednesdays off seems to agree with me and Thursdays I spend time on clerical office matters for the most part. I understand that my 'limited' schedule may frustrate some people, but for now its what I can do. from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2026/04/what-days-are-you-in-office.html - http://lspindelnycdds.blogspot.com/

 It really depends on the dentist and his practice. I personally enjoy doing some of our patients cleanings. Historically  I have always been open to accepting hygiene appointments and find it a good way of connecting with our patients.  That being the case, many dentists choose to employ hygienist to do their patients recare appointments in order to free up time for them to do their restorative dental or other more challenging and lucrative procedures. For most of my career I have employed hygienists to perform some of the cleanings for my patients. This was an efficient way to handle recare and most paitents like having a hygienist clean their teeth. Still some patients seemed to prefer my cleanings and the time I would spend with them. When my son David has joined our practice, He also accepted hygiene appointments. As a matter of fact, recently when my long time hygienist left, we decided not to  replace her and My son and I have been able to absorb her patient...

 In the last 10 years or so , it has never been easier to deliver both excellent and time efficent dentistry for my patients. New technologies and materials have made this true. At this point, for most crowns I utilize either Zirconium or lithium dislicate materials to fabricate monolithic crowns , that are easier to fit and more durable than the older pfms that I utilized. While I still schedule one hr for fitting my crowns, truth be told, they now rarely require the full hr and often are completed and my patient dismissed in about 35-45 mins. Also digital radiographs, 3d scanning and AI , when used properly, are terrific tools that make a dentists easier. All of our technologies still require skill and judgment to provide optimal outcomes, but I am convinced that when properly utilized these tools make dentists better at achieving great results for our patients. Our office doesn't do single visit permanent crowns since the labs I use probably provide a higher quality result the...

Many dentists are in at least two businesses. First and formost is their dental practice. This should be by far our most important endeavor.  This is in my opinion our most rewarding business, since it usually provides the most financial and professional satisfaction. That being said , I and many other dentists maintain dental offices that are larger than we need for our own personal needs. In fact our dental supply houses strongly encourage us to build offices with extra operatories for other dentists to use.These operatories give us the opportunity to obtain sublet rental income or facilitate our hiring another dentist(s) to see patients.  In my case, for most of my career, I have sublet one of the operatories in my office and this allows me rent a more spacious office .  I have dabbled with hiring a dentist using my extrao peratory  but truth be told , this hasn't worked out so well for me. Employee dentists seem to come and go and place additional stress on m...

 When dental students are studying to become dentists, often their schools focus on teaching a 'core curiculum'. The logic is that dental schools want to make sure their graduates achieve a level of basic skills and can perform procedures to a level of competency. Often there is a conscious decision made to not 'confuse' our students. That being said there are many ways to do dentistry and students of dentistry need to be open to learning new ideas and new ways of doing their dentistry Unfortunately many dentists fall into a complacency trap , where they develop a routine way of doing procedures and aren't always open to learning different ways of doing things. They probably believe that doing things the same will provide consistent acceptable results. This is what I mean by cookbook dentistry since they probably find it easy to follow their recipe over and over again. The problem is that dentistry (and all professions) is constantly changing and improving and we ...

 I am asked this question almost every week by someone. The answer is obvious.... I am doing what I enjoy. I am seeing patients in my office 4 days per week (with some help from my son David) and teaching at the Mount Sinai General Practice Residency on my day off (Friday). The truth is that being able to do what I am good at , helping my patients and my residents every week is very satisfying. It keeps my mind and body active and healthy.  I still participate in three Spear Study Clubs and enjoy interacting with my study club collegues This  activity allows me to earn over 90 hrs of continuing ed each year and almost every week I learn something new about dentistry I plan on continuing as long as my mind and body allow me to maintain the high level of service that I am accustomed to offering in my clinical practice and my teaching position.  Being at service and having a purpose makes my life more worthwhile and I feel truly blessed to have been given the opportuni...

                                                                                Often it is desirable to increase the length of a patients anterior teeth. We can have our dental laboratory make a wax up proposal and can often transfer this proposal to the mouth by utilizing a putty matrix made from the wax up. These proposals are very helpful, but they may not be representative of the most desirable shape of the final restorations. Because the finished crown need to function in the mouth and allow dental excursions and most dentists prefer cuspid guidance. Cuspid guidance means that when a patient moves their lower jaw laterally their canine tooth bears the brunt of the occlusion. Although other teeth can be used to bear the forces created by lateral jaw movements, most dentists pr...

  As dentistry inevitably evolves, the types of crowns our practice recommends has changed as well. It used to be that our default posterior crowns were either gold or porcelain to fused crowns... While I still recommend full gold crowns for second and third molar teeth, I am utilizing Full thickness esthetic zirconium crowns for most other posterior teeth ( first molars, first bicuspids and second bicuspids). The Esthetic zirconium crowns , when properly done are great restorations for many posterior teeth.  I believe that with proper tooth preparations and the use of more modern cements , these crowns may  last an extremely long time (10-30 years).  For anterior teeth, I use different types of crowns, depending on the individual saturation. In most situations I prefer lithium disilicate crowns with full lingual lithium disilicate but with minor porcelain layering on the facial surface to allow for superior esthetics.  For some teeth with compromised tooth...

 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...

  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...

 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...

  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...