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What are my choices if I have a badly broken down tooth that needs fixing?

 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...
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What should I do if I don't have enough bone to have an implant?

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  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...
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We have met the enemy and he is us?

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  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 ...
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How should I restore my short teeth?

 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...
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Why is preventive dentistry under emphasized by most dentists?

 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 ...
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Have you given any thought to....?

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 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...
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Fast Food dentistry vs "High end" dentistry?

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  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...
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