ASK: Dr. Joseph Goodman • New Developments In Dentistry

 

Our “New Developments In Dentistry” article in our last issue successfully launched our—ASK Dr. Goodman  column that will appear each month to help you get the inside scoop on achieving and maintaining beautiful and healthy teeth.  And when it comes to turning back the aging clock… a dazzling, white smile is #1 to revamp your look and rejuvenate your face. 

Choosing A Cosmetic Dentist

Elizabeth C: I have a dentist who claims because he is a professor at a school, he’s better than other dentists in private practice. Is he right? 

Dr. Goodman: It’s an interesting statement—like asking if you had the choice to be taught by Gunter Ghartrich, a mathematics teacher or Albert Einstein—who would you choose?  Ghartrich was Einstein’s teacher, but never taught more than simple mathematics.  

•  Extensive ‘hands-on’ experience in cosmetic dentistry is a must.  Just having knowledge is not enough. 

•  A dentist must be a clinician: able to avoid problems, but if a problematic case arises, know how to fix it.

•  Ask to see before and after photos of patients and inquire as to how many “cosmetic cases” he/she does a month.

• Ask to look at lab cases ready to be delivered to patients.  It may sound a bit intrusive, but before you put your trust and money in a dentist’s hands, see the quality of his/her work.  A qualified dentist will proudly show you his/her work.

I participated in a program in which the lecturer was an expert in theoretical and literature dentistry and knowledgeable in past and present research and dental literature.  However, it was evident that his “clinical skills” were not equivalent to his intellectual knowledge.  In fact, his clinical skills were poor.  Dentists have but make sure they are spending most of their time as a clinician with hands-on know how and skills to get the job done correctly.

Metal In Your Old Crowns Could Be Making You Sick

John B: My porcelain crowns contain metal and I’m allergic to nickel.  My insurance only covers the standard porcelain fused to metal crowns.  Are there any crowns without nickel?  

DR. Goodman: Three categories of crowns are distinguished by what is inside each. Left: Porcelain outside fused to metal inside; metal is precious or non precious and gray. Middle: Porcelain fused to gold with the highest amount of gold, therefore, more yellow, more biocompatible.  Right: Zirconium Crown, white inside and outside, no alloy; the most esthetic crown.

It is possible to have a metal crown that has no nickel: nickel allergy can manifest itself with red, puffy, blotchy gums that are swollen and bleed easily.  Women find they are allergic to nickel when they wear fake jewelry next to their skin.

Your Choices: Porcelain fused to gold crown (such as BIO 2000, contains 99% gold, or Captek) or an all porcelain crown such as zirconium crowns which are white inside and outside, contain no alloy and are very strong.  I’ve done numerous 3, 4, and 5-unit bridges with this material and it withstands the stress of biting and chewing. Porcelain fused to metal crowns, made by a high quality lab, come with a certificate of authenticity.  A label lists percentages of alloys used so the dentist knows the exact composition of the crown.  Full gold and zirconium crowns are usually a little more expensive.  If you don’t mind a full gold crown in the far upper back area of your mouth, you could keep your crown for decades!  I treat dentists in my practice who choose gold crowns.  That tells you something. 

My Porcelain Filling Chipped

Tracy Q: A dentist said my porcelain filling would last a lifetime.  After seven years it chipped.  Did he do something wrong? 

Dr. Goodman:  Claiming dental work will last a lifetime is nothing more than a slogan.  Dentists do their best, but some dental work can unfortunately give in.

•  Eating hard candies or biting a fruit pit.

•  Opening a bottle of beer with your teeth (no joke, people use their teeth to do this).

• Just plain fatigue from eating and chewing over the years. 

Porcelain fillings (inlays) are better than bondings or composites (white fillings), which might not last a desired 10+ years. It’s frustrating for dentists and patients when dental work fails, but so far no unbreakable porcelain has been invented. However, laboratory fabricated porcelain is the strongest material and aesthetically pleasing because it is tooth colored.  I’ve had great experiences with porcelain made from the porcelain of Lumineers (by Cerinate).  After 9 years, the porcelain looks like it was just placed yesterday. Your dentist did nothing wrong.

Amalgam Fillings Are Poison?

Peter M: I know dental amalgam has mercury and mercury is a poison.  But my dentist said some amalgam fillings are absolutely not toxic.  My gut feeling tells me he is wrong.  How many amalgam fillings in a mouth can cause a heath risk?  

Dr. Goodman: No one knows how many amalgam fillings are “too many” for the body.  The American Dental Association considers them safe.  Many in the dental community say they should be avoided.  In the world of medicine and dentistry, “absolutely” does not exist because the truth is nobody knows absolutely for sure. Einstein said, “Everything is Relative” and called his thesis “The Theory of Relativity”, not “The Absolute Theory of Relativity.”  I like your statement about your gut feeling because

in the end doctors often believe they know the facts and years later revise them.  Nobody knows absolutely if amalgam fillings are safe, but in the dental community it is widely accepted that high noble gold, ceramics and certain biocompatible composites are potentially less toxic.  

New Fillings Have Made My Teeth More Sensitive

Melody A:  I had old fillings replaced because of decay.  Now my teeth are sensitive and just don’t feel the same.  I am very upset!  Did he drill too deep?

Dr. Goodman: A tooth with “no problem” before could have preexisting damage from decay or an undetectable crack without showing symptoms.  When a dentist drills in the tooth, the nerve can get irritated, but if your dentist doesn’t drill out the decay, your tooth might need a root canal.  Decay doesn’t just disappear. You are far better taking care of the tooth earlier rather than later, risking more pain and infection.  Teeth can react to dental treatments but can be fine after initial sensitivity. The notion that dentists “drill too deep” and cause  root canal complications is a misconception. Dentists drill as deep as the decay goes in order to remove all decay.  No dentist drills deeper than needed since we are aware of the consequences.  You might need a simple adjustment of your bite. Your fillings might be too high and could be touching the opposite tooth each time you chew, causing pain and cold sensitivity.