Today’s patient came in to have new zirconium crowns placed on #8 and #9.  Here is a summary of the patient’s previous relevant visits:

First visit - #6,7,8,9,10,11 prepped based upon lab models

Second visit – zirconium crowns placed for #6-11 with Nexus base clear. Patient requested darker shade – changed to A2.5 and canines to A3.0 with lab on same day

Third visit - patient feels #8,9 are too thick palatally. Pt informed that space at mesio-gingival margin can be closed

Fourth visit – crowns on #8,9 removed, slightly reprepped and new temp placed

The patient had signed a consent form before cementation, stating that the patient is happy with the try in and understands the consequences of changing their mind once the crowns have been cemented. However Dr. Dorfman was went out of his way to accommodate her and agreed to place new crowns on #8,9.

Today the new zirconium crowns for #8,9 were placed so the patient could see the new look. However she was still unhappy after the try in. She felt that it was still a bit thick palatally and also didn’t like the convergence of the teeth mesio gingivally. At another office, the crowns would have to be sent back to the lab and the patient recalled. However Dr. Dorfman called up his lab tech who showed up in minutes. He noted the changes the patient wanted and advised it would take a few hours.

The impression was taken with Impregum polyether impression material, using both light and heavy body. An anterior tray was filled with the polyether regular body and the light body was placed around crown preps. The lab technician said it was a good idea to blow air over the light body to prevent bubbles from forming. Once air had been blown all over the light body, another layer of light body was injected. Then the anterior tray was placed. The lab tech took his impression back to the lab to make the necessary adjustments.

The adjusted crowns had outstanding contours in the mesio-gingival area. The patient did still feel a slight thickness palatally so this was adjusted down. The crowns were then cemented on with Nexus Base Clear.

This experience really showed me the importance of always giving the highest standard of care, regardless of the circumstances. The patient clearly signed the waiver and knew once the crowns were cemented in, it would be difficult to make any changes. However, it’s clear from all my visits so far that Dr. Dorfman takes tremendous pride in the work he delivers to his patients. It is this reputation that he has build, which draws patients from all over the world to his office.

R.A., Columbia University School of Dental Medicine

Read the Wall Street Journal article.

Our New York City dental practice has considered the whole body relationship of dental disease for 24 years. We obtain periodontal cultures of patients with advanced gum disease, based upon the early work of Dr. Max Listgarten. The recent discovery of diabetes in a patient based initially on periodontal (gum) diagnosis is a case in point. The Center for Special Dentistry (www.NYCdentist.com) is proud to work with Dr. Keith Berkowitz at the Center for Balanced Health (www.CenterForBalancedHealth.com) in mid-town NYC. The fasting glucose tolerance test they performed to diagnose the patient’s diabetes will contribute to the overall health of this 42 year young woman. This should be considered the standard of care in dentistry particularly with the present Administration’s push to expand healthcare for all. It will improve health, save lives and is cost-effective. For microbiology results from Temple University’s Oral Microbiologic Testing Lab visit:
http://www.nycdentist.com/?fuseaction=atlas.displayImage&im_id=2249&at_id=243&at_parent_id=242

Read the Wall Street Journal article.

Reply:

Please re-read my comments:  I said our dental practice screened the patient for diabetes but worked with Dr. Keith Berkowitz (M.D.) at The Center for Balanced Health for diagnosis and treatment.  Dentists should not diagnose and treat diabetes but they can be invaluable in screening patients.

Separately, most physicians do not have any understanding of dentistry nor how it relates to systemic health.  It should be part of medical school.  Just 15 minutes ago we had to reschedule a patient who underwent AV Nodal Reentrant Tachycardia (AVNRT) in March at a prominent Long Island heart hospital but was not given instructions to premedicate for dental procedures for the first six months post-op.

Professional tooth whitening typically involves the application of a whitening gel onto the teeth for a duration of 24-30 minutes per visit.  The use of laser light or bonding light on the gel yields similar results (only laser manufacturers disagree).  The main variables are concentration of the hydrogen peroxide in the whitening gel and the duration it is on the teeth.

“Whitening” toothpastes and mouthwashes don’t make sense because:
1)  the concentration of hydrogen peroxide is typically lower than that offered in professionally-applied gels.
2)  the duration of contact between the toothpaste/mouthwash and the teeth is only for a few seconds.

Professor James Dower of the University of the Pacific published a letter in JADA (Journal of the American Dental Association) questioning the benefit vs. risk of using Septocaine (articaine) because of the higher risk of post-operative parasthesia.  All dentists who use Septocaine should read this article.