From Fear-Full to Fear-Less

So its Friday again and we are only working a half day!!
Looking at my appt. book this morning I see a young lass scheduled...however...she doesn't always like to come see me...seems she has a mortal fear of me!? She has had at least three appointments where she sent her mother instead!!
Can you imagine that...someone afraid of me?? Well she came in today and I decided to do my best to change her opinion of me...
I put on my gentle gloves...I sang a duet with her mother to entertain her...and proceeded to do a filling with novocaine...yes I had to give her a shot...and what was the result...
I am happy to report that we have successfully reversed her fears...at least for now...she is so happy that she is even showing off her new smile and her mom is actually my new dental assistant...at least for this procedure!!

Super-Teeth!

So take a look at fig. 1...seemingly two pretty normal looking teeth?
Well the patient certainly thinks so....they look good, they feel good and they bite good! But these are no ordinary teeth...they are super teeth....because underneath them they are just a little different than your average ordinary teeth!
This patient had lost the teeth in this region and we decided to replace them with implants...so...an implant surgeon placed two implants into the region and I was able to use the posts that emerged from the gum, also called the abutments, to build two caps(crowns).
Contrary to what many people have heard, there was minimal discomfort with the implant surgery and now the patient has two teeth that are probably stronger than any other teeth in his mouth....hence...superteeth


And in case you did not notice...the last tooth, that big molar, is also on an implant as the x-ray clearly shows!

So if you have lost a tooth...or two...or more...or even all of your teeth...then you can also have some superteeth....just ask for implants!!

Office rebuild update

Well we are hoping to move back into our office at 370 by the first of the new year...
the place has been painted, new floors are in place and the equipment men are there today working on restoring and reupholstering the dental chairs...still quite a bit to go but we are getting closer...tomorrow the new custom cabinetry is being installed...that will be followed by a new phone and computer system...I am hoping to have a computer screen mounted right on my chair so that those of you who are interested can see what I am doing...if you so wish!
It will be nice to go home!

gums, gums, go away....

Hello Phellow Phlossers....

So the most common question I get when doing a crown(cap)is why do you need novocaine just to take an impression...well this post will help answer that question...
In fig. 1 we have what appears to be a very nice tooth....

but in fig. 2 I have drawn an outline around what is a large tooth colored filling existing in this tooth....we are going to prep this tooth for a crown and take an impression....

After preparing the tooth I have to take a rubber impression of the tooth so that my lab tech can fabricate a well fitting cap...but how do we get the rubber material to completely surround the lowest edges of the tooth at the gum line??
Well... we have to convince the gums to go away...at least temporarily...so that I can squirt some of the rubber to the edge of my preparation...and how do we do that...??
Well....we gently insert a small string or piece of chord into the space between the tooth and the gum...see fig. 3 and you can see the small space into which we place a layer of the string...

In fig. 4 you can see the space with the string in place...

And when I remove this string there is a nice little trough around the entire tooth into which I can squirt the rubber for my impression...see arrows in fig. 5

And this is why you need novocaine for an impression..the physical displacement of the gums to accomodate the rubber impression material is not something you want done without some anesthetic!!
After the impression was taken I placed a temporary crown and will try in the permanent crown next week...fig. 6

See you next time...

small, medium and large...dental work comes in sizes also!

It may seem boring, but bonding is what I do during most of the day...people not only want to feel good but they want to look good as well...and that includes their teeth!
Here is a woman who exhibited some gum recession which exposed the roots of her teeth. The roots were beginning to erode and we decided that we would restore the tooth back to its original form factor with some our newest bonding materials.

After administering local anesthetic, I prepared the teeth for bonding...due to the adhesive qualites of the bonding agent the amount of tooth reduction needed is minimal...sometimes I even do this without anesthetic!
And in very short order we have three teeth bonded and restored..

The teeth will not only look better but the bonding material will prevent further erosion of these teeth!!

Multiple choice...

Sometimes we get choices...take a look at these...
1. New decay on a tooth that never had work...needs a new filling.
2. Old silver filling(amalagam)breaking down..needs removal and restoration.
3. Old crown has the porcelain breaking down...new crown needed.
What do we do first? Well I am going to leave the crown replacement for another day...today we will focus on placing two new fillings.
Step 1..removal of old filling and excavate new decay....

Decay fully removed from both teeth now...

Here you can see the two teeth each with a matrix retainer applied...and then the finished fillings...



Have a happy thanksgiving...

Tooth du Jour!

Friday's are wonderful...only half day of patients and then the weekend!

But before we go...here is one to hold you over till Monday...
Here is one of my wonderful patients... complaining of pain in the lower right region...all I see that might be suspicious is a tooth with an old silver filling...but it looks solid and the x-ray doesn't really show a problem. I, or rather we, decide to replace it since it looks pretty lousy anyways...and just maybe her pain will subside.

Fig. 1 shows our tooth du jour with the intact silver filling...however when I removed the filling I saw that there was most certainly decay lurking underneath...fig. 2.

Much to my dismay, the decay was actually much deeper than I expected...see fig. 3, which shows that even after the initial excavation there was still more decay.
Finally....and I say that because I am now getting close to the nerve...I reach a point where although there is still some staining...it is not decay..just stained tooth structure...fig 4.
At this point the matrix retainer is already in place and I am able to bond in a beautiful tooth colored restoration.


So until Monday...

You've got nerve!...Not!

So let's conclude with our last patient of the day.
Lower left pre-molar....x ray shows a very large area of decay and clinical exam shows the tooth has a big hole!!(fig. 1)...I advise patient I will have to excavate the decay and it is likely that the tooth will need the nerve removed...often called root canal treatment ...
So here is the series as I took care of this situation...As I expected the amount of decay was very large(fig. 2), luckily no root canal was needed, as the excavation(fig. 3), did not expose the nerve and I was able to place a large sized tooth colored filling(fig. 4)...

Crack therapy

Here is today's first patient of the day...young woman with a filling in a lower molar...reporting that she has pain when she bites...
pain on biting usually means a crack in a tooth which transmits the pain to the nerve...you can see on the x-ray that this is a moderate sized filling and the nerve seems healthy.

Clinical exam of the tooth shows that there is a possible crack, but it is difficult to visualize(fig. 1)...adding a little indicator solution shows off the cracked area more dramatically(fig. 2)

This tooth will need a crown or cap to fully restore...so after local anesthetic was administered I proceeded to prep the tooth for a full crown. As you can see there was additional decay readily apparent once the tooth was prepared.

The decay was removed and a temporary crown was placed and an impression was taken to have a new crown made....
check back in about 10 days and you will see the final result!

Caps for sale!

Ok...just when you thought all we did was nice easy stuff...here is a case sure to make your jaw ache!!...

This patient had gum surgery on her upper left quadrant and the existing crowns, which I had done 15 years ago now had all the edges exposed...it was really not very aesthetic. We therefore decided to replace the old crowns with new crowns that would meet the new gum line and provide a much nicer smile.
Figure 1. shows the crowns before we started...three crowns all had exposed edges.
Figure 2. shows how we remove crowns that are permanently cemented. A slit is drilled vertically into each crown and then we use a stiff straight instrument to wedge and loosen the crowns.
Figure 3. shows the temporary crowns that I made for the patient...which already provide a much more aesthetic result.

The patient is now dismissed and will return in a few days for an impression so that my lab can make the permanent caps...

So make sure to keep flossing so this doesn't happen to you!

To Bleach or not to Bleach...Week 1

About a week ago I decided to bleach my teeth. I have been using a 22% solution of carbamide peroxide in a custom tray for one hour per day. The trays are very comfortable and I usually wear it during the day...usually while I am seeing patients.
I am experiencing some slight sensitivity but nothing serious and certainly nothing that requires any type pain killer!

As far as I can see the teeth are somewhat whiter...I will continue the bleaching for one more week and then I will post my results...

In any case here is a comparison photo....and remember I am taking these photos on myself so I am doing the best I can!!

Serious business

We all like to have a good time at the work place and our office is no exception. We treat our patients like family and we enjoy our work, especially when we make people feel good and look better.

However...sometimes we face some serious issues. One of those issues is oral cancer.
Cancer in any part of the body is something to be treated as soon as possible, so early detection is always best. When patients come in we routinely examine the soft tissues in the mouth. This includes an inspection of the lateral or side part of the tongue on both sides.
Here is a case
where there is a suspicious lesion on the border of the tongue. These are usually nothing more than just traumatic irritation. But once in a while the lesions we find are the beginnings of oral cancer.
I referred this patient to an oral surgeon for a biopsy of this small area...with a little luck the biopsy will be negative..but we are always looking out for out patient's health.

Break Away

It has been a very busy day today...quite a few emergencies today and here is the one of them....
a gentleman had a lower molar with a large silver filling...he called the office saying something broke off and he would like to come in as soon as possible. We brought him in and clinical exam revealed that on his lower left first molar, he broke an entire section of tooth...the disto-lingual cusp. The filling was still intact but the filling had weakened the tooth and the result was the cusp breaking away....see photo..
After giving him a local anesthetic I proceeded to remove the entire filling...I found that there had been some leakage around the old filling so I excavated the decay until I was down to healthy tooth structure all around. I then placed a tooth colored base or foundation into the entire area. The patient was then dismissed and was re-appointed for another visit. The patient will need a cap or crown to restore this tooth as the affected area is much too large for a filling.

The foundation that I placed will keep the patient comfortable until next visit when I can begin the crown.

Bleaching---How to Video!

OK...we all want white teeth...so how do we do it?
Well here is a small video that will give you the basics...this technique utilizes custom made trays that you load with bleaching gel....the loaded trays are placed in your mouth for a specified time and after about 7-10 days you will have whiter teeth.
There is no way to predict the amount of whitening...but you will definitely have some whitening.
I personally am using a 22% solution of carbamide peroxide...very powerful and only needs one hour per day. No overnighting needed!

Another alternative would be to do the so called one hour whitening using an even more powerful bleach along with a special activator light. But as I said in a previous post I am not a big fan of that technique.

Seek and ye shall find!

Tooth decay is often hard to find...sometimes it is hiding between the teeth in places where you are not expecting to find it.

Here is a case where a 16 year old boy with no fillings, presented for examination. Clinical exam seemed to show that all the teeth were in good condition. However, my digital x-ray system revealed a carious lesion (fancy way of saying decay) on a tooth that appeared to be in perfect condition...figure 1.

After giving the young patient some local anesthetic I was able to make a small entry point to pinpoint the decay..and sure enough there it was...see figure 2.
Additionally the stained groove on the biting surface also seemed to have incipient (early) decay underneath it...figure 3.

Careful excavation of the decay resulted in a moderately sized cavity in which Iould place a tooth colored filling...figure 3. Here you can also see the clamp or matrix assembly that I use when I place this type of filling.

In the final picture...


you can see the tooth with the completed filling...so next time you think you don't see anything...make sure to take a second look. Something may be hiding between your teeth...so keep flossing and have a good weekend!!

Dr. Stan

X-Rays are your friend!!

Many patients are often hesitant to take x-rays...some fear the radiation, others just don't like that big thing in their mouth that I ask them to bite down on...and others just don't want the extra expense.

Well I am here today to tell you that x-rays are your friend!! How so you ask?
Well a wonderful young lady came in today and a routine visual examination did not really show anything too unusual. She had many fillings placed in various teeth over the years and nothing was bothering her. Now in these cases I am usually pretty conservative and will not recommend replacement of a filling unless I see a definite reason.

Well... I recommended we take a set of X rays and we proceeded to take a full mouth set. With my digital radiography system I was able to quickly and easily view all the x rays in a matter of minutes on my computer screen. And there it was...hiding under an old silver filling was a nasty area of decay. Without the x rays I might have said that everything looked OK...but now I knew that treatment was needed.

So instead of the patient returning in a year or two needing a root canal treatment and a post and crown(cap)....we are now able to excavate the tooth and treat it in a much more conservative fashion...

That's all for now....!

To bleach or not to bleach...that is the question!

So many people inquire about teeth bleaching and whitening products that I have decided that I am going to bleach my own teeth to really get the full experience and be able to properly relay a real experience.

My teeth are definitely showing signs of yellowing as the picture shows, but they are good candidates for bleaching since there are no fillings or caps on the front teeth. I had impressions taken today and I am making custom bleaching trays which I will wear for the next two weeks.

A few words about bleaching....
1. First try the drug store options like white strips..they do work, up to a point, and they may give you the result you want...this is an easy and inexpensive option.

2. If this does not work you may want professional dental bleaching of which there are two ways to accomplish this.
a. You can have the one hour type bleaching which utilizes a special light which activates a bleaching gel that has been applied to your teeth... this method will definitely give you some whitening but you may get some moderate to severe tooth sensitivity. The sensitivity usually can be treated with pain killers and it will usually decrease over time. The whitening of the teeth that you will see is part whitening and part tooth dehydration which gives the tooth a whiter appearance. Once the teeth re-hydrate the shade may rebound down a little, but they will still be whiter than when you started. This is a good method if you need your bleaching done in a hurry.

b. You can have custom bleaching trays made. The patient fills the trays with a dentist dispensed bleach and the trays are worn overnight for about 7-10 nights. I like this method best, if you are not in a hurry, as this gives the most predictable and long lasting result when instructions are followed. The whitening you get will not be due to dehydration, but you may still experience tooth sensitivity. However you can always reduce the frequency of your wearing the trays if you have excessive pain, and you can stop once you feel you have enough whitening.

That is all for now...I will keep you all posted on the bleaching results!

Bonding...cervical abrasion

Well today is Friday and we are all anxious for the weekend to start but we do have patients scheduled today!
Here is another very simple case in which a young woman with otherwise healthy teeth presented with an area of gum recession around an upper canine. The recession caused the patient to abrade and wear away some of the tooth structure at the gum line, often termed cervical abrasion.
Within just a few minutes we were able to bond (a fancy dental term for glue) an esthtetic tooth colored filling into the area. This will restore the tooth back to its original form and prevent further abrasion of the tooth!

See you next week...have a good weekend!

30 minute rescue

Hello fellow flossers...as promised...here is a very straight forward case from today.

Like many of us... this patient had put off doing dental work for a while and presented with a tooth that had a large filling fall out. The patient did not want a cap placed so instead we opted for a quick procedure...30 minutes... I was able to place a tooth colored composite filling. With today's newest generation bonding materials available, I felt this was a reasonable choice. Although this tooth really needs a cap this will probably hold up well for many years.

Getting Started

Welcome to the first posting of floss n' blog!

Dental office of
Stan Weiss and Manny Tennenbaum
370 Lexington Ave. Suite 1403
New York, NY 10017
212-685-1717

Considering the events that have happened to me over the past few months I thought this would be a good forum to chronicle my own and my office's events. So many of you have called and e-mailed that I figured this would be a good way to convey news.

For those of you who know me, you may know that on July 18, 2007 a
Con Edison underground steam pipe exploded...the blast resulted in damage to the building in which my practice is located.

Luckily, even though my partner was in the office working on a patient, there were no injuries. The windows cracked, but everyone in the bldg. evacuated safely. As for me...I was on a train heading home to New Rochelle... when I got home and turned on the news I saw that the blast occurred directly adjacent to our bldg. The area was now sealed off and was labeled the "frozen zone". Seven weeks later we were allowed back in and we are presently renovating the entire office....

We were fortunate to be able to move our practice into a nearby dental facility which is where we are now practicing until our new (old) office is ready!

In addition to news updates about our office renovation, I will use this blog to post items that would be of interest to dental patients looking for information....as I do dental procedures in the office, when something that might be of interest to my patients is done, I will attempt to blog it...

so stay tuned....and keep flossing.