Saturday, October 2, 2010

Sealants: Not just for kids.

     Like most things, the need for dental sealants should be evaluated on an individual basis. Caries Risk Assessment is the name for the current process for determining which patients have an elevated risk of tooth decay.
     Adults who continue to develop decay in the deep grooves of the back teeth should have sealants placed in any tooth that does not already have a restoration (filling) in it.

     Dental sealants act as a barrier, protecting the teeth against decay-causing bacteria. The sealants are usually applied to the chewing surfaces of childrens' back teeth (premolars and molars) where decay occurs most often.

This is what the process looks like....

Thursday, August 26, 2010

Implants: The new normal

The modern practice of dentistry is primarily focused on prevention, and the newly emerging links between dental health and total body health bear out this model. We should be doing everything possible to keep our mouths and bodies healthy, so we never need to have any teeth removed.
However, when missing teeth need to be replaced, implants should now be the frontline therapy. Dentures and bridges, less effective therapies, should be considered when an implant solution is not possible.

The video below is an excellent review of current treatment options in Implant Dentistry.

3i Patient Video

Thursday, April 29, 2010

Letter to the Editor

To the Editor of the Los Angeles Times:

     Imagine my frustration  reading about the shortage of dentists at the Remote Area Medical clinic held in Los Angeles this past weekend. Hundreds of needy people went without care because California will not allow doctors licensed in other states to volunteer their services.
     I was prepared to fly to LA for this event, but my application was rejected as unacceptable because I am licensed in the state of New York.  This policy is truly inexplicable. Many doctors would willingly take time away from their own practices, patients and families, fly out at their own expense, and help those truly in need, if only it were allowed.
     California is a progressive and innovative state. There must be a way to promote and encourage this kind of volunteerism, as many other states do.

Mitchell Rubinstein D.M.D.

Printed in the L.A. Times, May 3rd 2010

Monday, April 19, 2010

The "Waiting" Room ?

   What is a reasonable period of time to keep a patient waiting? I recently took my 4 year old son to an opthalmologist, who kept us waiting over an hour. Our appointment was at 1:00 and we were taken into the treatment room (which also turned out to be a "waiting" room) a little after 2:00. It was at least another 10 minutes before the doctor appeared. What sort of mood to you think my 4 year old was in by then?
   No one would tolerate such a delay with a restaurant reservation or when bringing a car in for service. Why do some doctors consider this normal? Why do some offices run continuously late, whereas others are able to run on time? There is rarely a good excuse for keeping patients waiting an inordinate amount of time. 
Staff should be trained to consider the patient's feelings when scheduling appointments. The goal can not be to cram as many patients in as possible. Visiting a dentist's office is often a stressful event. A caring and helpful scheduling procedure will make the whole office run more efficiently.

Monday, March 8, 2010

Oral Pain ? Don't be so quick to request antibiotics.

     We dentists are in a constant struggle to please our patients and serve their health needs. People come to us with many types of problems and they expect us (quite reasonably) to fix them. As with sore throats, coughs and earaches, oral pain is often presumed by our patients to be caused by infection, and antibiotics are therefore requested as the treatment of choice.
     Not so fast, though. Pain can have many other possible causes, and unnecessary antibiotics are a leading cause of adverse drug reactions, allergies, and drug resistant bacteria.
     Choosing the right antibiotic for an oral infection is a crucial part of our job, but equally important is knowing when NOT to prescribe, and when to look for other causes beyond infection.
     TMJ problems, trauma, tooth decay, immune system disorders, and even cardiovascular disease can produce symptoms in the mouth, and none of these will be helped by antibiotics. Quite the opposite in fact.

The most important service we can offer our patients is a careful and accurate diagnosis, and a complete discussion of the possible solutions. Only in this way can the problem be truly solved.

Monday, January 25, 2010

The links between oral health and general health continue to develop

     Dentists and physicians have long suspected a link between gum disease and a host of pregnancy complications including premature delivery, low birth weight and spontaneous abortion. The link has been difficult to study because even healthy pregnant women may experience bleeding and inflamed gums (also known as pregnancy gingivitis), and this by itself  is not a risk to the infant. The concern is that a woman with untreated periodontal disease who becomes pregnant risks passing those bacteria to the fetus.
     A recent case in Ohio is the first clinical example of the mother's oral bacteria being cultured from the lungs and placenta of her stillborn infant.

This article summerizes the findings to be published in the February issue of Obstetrics & Gynecology
    The best defense against this risk is for women to make sure that any periodontal/gum issues be identified and treated before becoming pregnant, and that they maintain a regular schedule of preventive dental cleanings throughout the pregnancy.

Tuesday, January 19, 2010

Does YOUR community have fluoridated drinking water? Mine doesn't

    I find it astonishing that a recent New York Times article  (Fluoride, 1931) concludes, triumphantly,  that "Today, according to the Centers for Disease Control and Prevention, more than 60 percent of Americans use fluoridated water."  60%  ? This is a GOOD thing?  When I was doing my residency, we routinely treated dental infections in the emergency room which could have been prevented by fluoridated water.
The lack of fluoridation in many parts of this country is a national disgrace. If 60% of children were being vaccinated, or if 60% of women had access to adequate prenatal care we would be appalled. Water fluoridation costs pennies per person per year, and is one of the great public health triumphs of the 20th century.
Considering our current concerns with runaway health care costs, fluoridation, which costs pennies per person per year, really ought to be a no-brainer.

Friday, January 1, 2010

Botox is NOT Dentistry.

In my practice, I am offering my patients improved health, function and comfort. Intentionally injecting Botulism toxin into people's bodies is inconsistent with that mission. Botox is a poor substitute for the real, lasting, aesthetic improvements we create every day with tooth whitening, bonding and porcelain veneers.

Please see this video as a good example of what NOT to do for your patients.
Please don't do ANYTHING you see promoted in this video.