Dental Info

  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 ...

 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 hi...

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 t...

  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...

  retentive crown preparation for all zirconium crown I was asked this question by a frustrated dental student. She explained that she tried in a zirconium crown and it had no real retention. She asked me why this had happened. I asked her to show me the crown and the model it was made on. Now truth be told, zirconium crowns can have more relief between the prep and the crown than some porcelain fused to metal or full metal crowns, but all types of crowns can have a problem with being non retentive due to a number of circumstances. I explained the following reasons for a poorly retentive crowns to result from our efforts: 1) the degree of taper. In theory crowns can be fabricated on preparations with miniumal taper (3 degrees), but many practitioners are unable to make this sort of preparation without producing undercuts. In their effort to make a preparation without undercuts, it is not uncommon to end up with preparations with greater than a 10 degree taper. These ...