About Dental Schools - Worldwide dental schools and dental colleges directory

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Beasleydentistry.com - Dr. Brad Beasley's cosmetic dentistry has won medals in International Smile Gallery competition.

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Californiaimplantdentist.com - Dr. Robert Thein is a diplomate of the American Board of Oral Implantology who practices implant dentistry in the Los Angeles area.

Chicago Dental Implants - Dr. William Cohen is a renowned cosmetic dentist in Chicago who offers dental implants done with an artistic eye.

Chiropractor - Dr. Jamie Bassel, NY Chiropractor based in mid-town Manhattan.

Cleveland cosmetic dentist - Dr. Jay H. Goldstein practices in the Cleveland suburb of Beachwood.

Cleveland Dentist - Dr. Brad Hylan practices general and cosmetic dentistry in Cleveland.

continuingedstudies.com - Affordable, high quality home study courses for dentists, hygienists and dental assistants.

Cosmetic dentists - Access profiles of American cosmetic dentists and select a dental professional in your local community.

Dental Books - Buy all your dental books in one place with convenient, fast, online shopping.

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Dr. Sparkly Smiley - A child's first visit to the dentist.  25 cents goes to Operation Smile & AAPD's Healthy Smiles Healthy Children Foundation.

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Fredericksmiles.com - Dr. Nils Olson practices cosmetic dentistry in Frederick, Maryland, and is accredited with the American Academy of Cosmetic Dentistry.

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Health Directory and information on the web.

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NDScare.com -Naperville Dental Specialists is a clinic of several dental specialists in one practice. They provide cosmetic, pediatric, and implant dentistry as well as orthodontics and surgery.

New Jersey Cosmetic Dentist - Dr. Allyson Hurley is an accredited member of the American Academy of Cosmetic Dentistry.

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Pain Medicine - pain management and physiatry in New York City with Dr. Doug Allen. 

Phoenix implant dentist - Dr. Arthur Chal is a renowned implant dentist in Phoenix, Arizona.

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Plano Dentist - Dr. Marcus Whitmore is a cosmetic dentist in Plano, Texas who also provides Invisalign services.

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Seattle cosmetic dentist - Dr. Brian McKay practices cosmetic and laser dentistry in Seattle, Washington.

Sino-Dental - China International Dental Exhibition & Scientific Conference

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TopBocaRatonDentist.com -  Dr. David Kagan practices conservative general dentistry in the south Florida community of Boca Raton.

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Website Directory - Pedsters Planet - A keyword-driven web site directory, includes a search box and the ability to submit your site to our directory

Weight Loss - holistic internal medicine and extraordinary weight loss programs in NYC with Dr. Keith Berkowitz.

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     There are many types of medical and dental health plans someone might seek.  This information is presented for general patient information.  Please note that The Center For Special Dentistry is NOT a member of any medical or dental health insurance plan network.  If you are seeking a New York dentist who participates and accepts some dental insurance plans then please visit Artista Dental Studio.  We are unable to refer you to an insurance dentist outside of the NYC area.

FEE FOR SERVICE – Medical or Dental Health Insurance Plans

     This is the upper end of medical or dental health insurance plans that may offer coverage to patients who choose their own out of network doctors or dentists.  In this type of coverage doctors or dentists are allowed to charge their prevailing fee but the insurer will only pay up to a fixed amount.  The difference between what the insurer pays and the doctors or dentist’s fee is usually paid out of pocket by the patient.

     Most doctors and dentists will either accept payment directly from a medical insurance company or will at least fill out the paperwork for patient reimbursement.  This type of plan will allow patients the freedom to see the greatest number of dentists and with the highest amount of dental benefits but this coverage comes at a much higher cost in premiums to the patient and/or employer.  Some patients may not be willing or able to pay the higher premium and the same is true for employers.

     Even with this type of premium medical or dental health insurance plan patients may find that their covered benefits and annual maximum still keep their overall reimbursement lower than hoped.  This is because the benefits patients receive, including the nonsensical UCR (usual, customary & reasonable) rate, annual lifetime maximum and covered/excluded procedures is again directly related to the premium paid.  These other terms are discussed elsewhere in this series.

Flexible Spending Accounts (FSAs) – Medical Dental Health Savings Accounts (DSAs)

     These accounts allow patients to allocate future medical and dental expenses from their pre-tax income in the calendar year – usually December – before it is needed.  In other words, the employee will allocate $2,500 in FSAs in December 2007 knowing that they will need to use it in 2008.  Patients cannot allocate and use the money in the same calendar year.  In addition, whatever money is not spent during the calendar year remains with the employer plan and is lost by the patient.

     A significant benefit of flexible spending accounts and dental savings accounts is that they give patients complete control over their dentistry and it can be used for most costs that are not covered by a dental insurance plan.  There is typically an annual maximum for these kinds of accounts of around $5,000.  When added to a high end Fee For Service dental insurance plan of $2,500 per year, a patient can get a significant total of $7,500 per year in benefits.

Tax Deductions For Medical and Dental Health Expenses - this section by Jay D. Edelman, CPA

     An individual is entitled to an itemized deduction for medical and dental health expenses paid during the tax year, to the extent the expenses exceed 7.5% of adjusted gross income.  If your medical and dental health expenses do exceed 7.5% of adjusted gross income, only the portion of the expenses that exceed the threshold will be deductible.

     Proper planning and timing can help to increase your potential deduction: For example, if you know you must undergo a series of medical and/or dental procedures, by planning them, and paying for them, in a single tax year, you may incur enough expenses in that tax year to generate a tax deduction. On the other hand, by splitting the procedures between two years, you may be under the 7.5% threshold in both years, thereby forsaking valuable deductions.

      Other planning opportunities may exist if your income fluctuates from year to year, or if you have some control your income. For example, can you delay a bonus from December 31 to January 1, keeping income lower in a year when you might have greater medical and dental expenses?  The combination of lower income and higher medical expenses in a given year maximizes the tax deductibility of the expenses, saving you the greater amount of taxes.

      Medical and dental health expenses include amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease. Other allowable expenses include such items as transportation to and from medical/dental appointments and the cost of eyeglasses. Medical and dental expenses paid on behalf of a spouse or dependent may also be included. Insurance premiums may also be included.

UCR - Usual, Reasonable & Customary Fees with a Medical or Dental Health Insurance Plans.

     This term is intentionally misleading by the insurance industry.  It is common to see on a patient’s dental insurance plan Explanation of Benefits (EOB) that accompanies the dental reimbursement check a statement saying, “The fee charged exceeds the Usual, Reasonable & Customary Fee.”    This is misleading because there is no such thing as a UCR fee!  The UCR varies, within the same insurance company, proportionally to the amount of insurance premium paid. 

     For example, Aetna may pay $200 for one patient’s dental cleaning but $150 for another patient’s dental cleaning at the same office if they have a different dental insurance plan from different employers.  The “UCR” rate is determined by the amount of premium paid.

     The amount of reimbursement an insurance company will pay for any dental procedure is determined by the premiums paid by the patient and/or employer. 

     But insurance companies don’t want to say that since they get their business from employers who buy their insurance.  It is this gracious deference to employers that makes insurance companies want to avoid the suggestion that a reimbursement is low because the employer has cheap coverage.  Instead they give the appearance that the coverage is low because the dentist is too expensive.  It should be illegal.

Gift Giving And Your Medical Dental Health Expenses - this section by Jay D. Edelman, CPA

     If your parents directly pay your medical or dental health expenses, any potential tax deduction may be lost: You cannot take the deduction if you do not actually pay the bills; your parents cannot take the deduction if you are not their dependent.

      A solution to this problem is for your parents to give you a monetary gift, and then you can pay the expenses yourself. Then, since your income level is lower than your parents are, and thus the deduction threshold is lower, you may be able to deduct a portion of the medical/dental expenses. The gift itself would not be taxed as long as you have not received total gifts in a single year from the donor in excess of $10,000.

     Gift giving along with proper planning can help convert your medical and dental expenses into tax savings.

PPO - Preferred Provider Organization – Medical or Dental Health Insurance Plans

     This is an intermediate medical or dental health insurance plan, which offers mid-level medical or dental health care through a panel (or network) of doctors or dentists.  These doctors or dentists agree to charge PPO patients a discounted rate in exchange for the hope of receiving a high volume of referrals from the insurance company.  The difference between the doctor or dentist’s usual fee and the PPO fee is given up by the doctor or dentist.

     Does the dentist usually get enough referrals from a dental insurance plan to compensate him/her for the loss from discounted fees?  Sometimes.  If not, an intelligent dentist will recognize the need to cut costs somewhere to make up for the loss.  Patients may feel they have less time to learn about their diagnosis and/or discuss multiple treatment options. 

     Frequently, the seemingly smallest details can be more expensive to provide than the dental insurance plan will reimburse.  Patients may find that a general dentist, not a specialist, performs their root canal therapy and it hurts afterwards.  Or the color of a front tooth crown (cap) may not match the surrounding teeth as much as they had hoped.  PPOs can be a reasonable compromise for many patients who need to carefully balance dental cost and care.

DMO - HMO - Medical Dental Health Maintenance Organization – Medical Dental Insurance Plans

     This is the lowest type of medical dental health insurance plan because it usually is a capitation plan.  This type of plan is commonly found with union dental plans.  After a patient picks a dentist on the DMO plan the insurance company then pays the dentist a pre-arranged monthly rate regardless of the amount of work performed on the patient.  This is called capitation.  This pre-arranged rate can be as low as $10 per month.  This is usually found in high volume practices where the focus is on providing minimal diagnosis and treatment.

      How much dentistry can a dental office really provide if they are only receiving $10 per month or $120 per year per patient from the dental insurance plan?  Very little.  I have read that it costs $15 just to cover the cost of disinfection and sterilization of a treatment room between patients.

      Patients will also find that they will have very limited treatment time with the dentist and perhaps little or no time for discussion.  This can increase fears in phobic patients.  Dental cleaning visits will typically be for twenty minutes instead of one hour in our office.  A visit with an orthodontist will typically be for 5-10 minutes instead of one hour in our office.

      Ironically, I suggest that these practices that charge the lowest fees are in fact most concerned with money and not dentistry.  It is not an unreasonable assumption that those dentists who take the most pride in their work will not belong to DMOs or HMOs.  I think they should be avoided.

ANNUAL MAXIMUM - LIFETIME MAXIMUM with a Dental Health Insurance Plan

     Nearly all dental health insurance plans have an annual maximum benefit in contrast to medical insurance plans that do not.  In addition some dental insurance plans may have a separate lifetime maximum specifically for orthodontics (braces).  When an insured procedure is covered under a lifetime maximum it is not counted towards an annual maximum.

     Dental health insurance plans have a low annual maximum (proportional to the potential cost of dentistry) that really haven’t increased in the nearly 25 years I have practiced dentistry.  Regardless, a higher premium dental insurance policy will provide a higher annual maximum. 

DENTAL “INSURANCE” IS REALLY DENTAL “FINANCIAL ASSISTANCE”

     The concept of insurance is to provide the insured against catastrophic loss.  Fire insurance or medical insurance will ideally pay for the complete loss of your home or quadruple heart bypass surgery.  Dental insurance is not like that because it does not pay for a catastrophic loss.  Instead, dental insurance plans have a very low annual maximum that really haven’t increased in the nearly 25 years I have practiced dentistry.  Dental insurance will not even cover close to the cost of even one tooth needing root canal therapy and a crown in my office.  So what is it?  It is really financial assistance not
insurance.

     Dental insurance plans, and particularly usage of dental benefits by employees, is very statistically predictable.  Insurance companies can profit on the difference between premium dollars paid in and “dental loss”, dental claims paid out.  It is a relatively inexpensive perk that can be offered to employees -- if the coverage is limited.  That is why it is limited.  The only situation where coverage may not have a maximum is within a DMO (dental maintenance organization) discussed elsewhere, because in this special case it is the dentist, not the insurance company, that has an interest in limiting the benefits provided.    

--Dr. Jeffrey Dorfman, Director
The Center for Special Dentistry

The Center For Special Dentistry is NOT a member of any dental insurance plan network.   If you are seeking a New York dentist who participates and accepts some dental insurance plans then please visit Artista Dental Studio. We are unable to refer you to an insurance dentist outside of the NYC area.

Canker Sores = Aphthous Ulcers

A lot of patients confuse the terminology for Canker Sores and Cold Sores.  They may use many other words such as:  Fever Blisters, Sun Blisters, Herpes Labialis, Herpes Type I, and Aphthous Ulcers without understanding the difference.  This section discusses Canker Sores (Aphthous Ulcers).  Cold Sores (Herpes, Fever or Sun Blisters) are discussed in the next section. 

Canker sores are Aphthous Ulcers.  Canker sores appear as a white oval on the cheeks, lips, palate and tongue that typically lasts for one week.  They usually occur as a solitary, larger lesion that appears on the red oral tissues like the inside of the cheek.  They can also be quite painful.  Unlike Herpes, canker sores are not considered a sexually transmitted disease and are not contagious.  People may get them with irregular frequency and they can be associated with stress or during immune supression like when getting the flu.  Canker sores usually last for seven to ten days. 

Treatment:  In our office we use a medication that can greatly reduce the pain severity and duration of an outbreak.  The medicine causes a chemical cautery (burn) on the canker sore.  The exposed nerve endings of the canker sore are covered in a callus that forms in response to the burn. The callus will last for one week but during that time nearly all of the pain associated with the canker sore will be gone. This medicine may also help those suffering pain associated with Oral Mucositis.  The treatment itself is relatively painless and takes only a few minutes.

To see comparative photographs click on "Dental Photos" at the top of this page and then click on "Aphthous Ulcer" in the left margin. Hundreds of photographs are in this section.

This material is presented for patient information.  Patients need to be diagnosed and treated by their dentist or doctor.

Canker sores (also known as Recurrent Aphthous Stomatitis, RAS or Recurrent Aphthous Ulcers, RAU) are oral lesions that occur for an unknown reason in about 10% of the population.  They frequently recur several times a year.  Immunosuppressed people are more likely to get major canker sores.  Major canker sores can reach up to one half inch and last for more than one month.  All canker sores can be extremely painful.  The pain from canker sores can prevent people from eating and/or drinking; this can lead to malnutrition and dehydration. 

Biting the inner lining of the mouth (cheek biting, pizza burn), diet, stress, or an allergic reaction to a food, toothpaste or mouthwash can cause a canker sore.  Vitamin B12 & folate deficiency, gluten sensitivity, allergy to sodium lauryl sulfate in toothpaste and smoking cessation can also cause canker sores. Women develop canker sores more than men.  People who have Ulcerative Colitis, Crohn's Disease and Celiac Disease will frequently have more canker sores.  It also appears more frequently in people who have Neutropenia, Reactive Arthritis, HIV/AIDS and those undergoing Cancer Chemotherapy who develop Oral Mucositis.  There is a genetic component to canker sores.

Treatment for canker sores include: analgesics, anesthetics, antiseptics, anti-inflammatory agents, steroids, fumaric acid esters, sucralfate, tetracycline suspension and silver nitrate.  Two common anesthetic gels applied to aphthous ulcers are Benzocaine and Lidocaine.  Another approach would be to use topical Benzydamine Hydrochloride (Amlexanox), an anti-inflammatory, anti-allergic medication.

Barriers, such as topical Hyaluronic Acid or Cyanoacrylate adhesives, are also used to relieve the pain associated with canker sores.  Topical Hyaluronic Acid acts as a protective barrier and serves as an anti-oxidant.

Antimicrobials may reduce the pain of a canker sore and aid healing.  Some antimicrobials used are Chlorhexidine, Triclosan, Tetracycline, and Penicillin G.  Chlorhexidine comes in a 0.2% mouth rinse or 1% gel.  Triclosan is an anti-inflammatory and antimicrobial agent that is used to reduce the number of canker sores, relieve pain, and shorten duration.  There is some safety concern, however, about the use of Triclosan.  Penicillin G can be used to reduce the pain, duration and size of the ulcer.  Tetracycline has an anti-inflammatory effect.

Steroids and Immunomodulation can also be used in the canker sore healing process as well.  Steroids come in mouth rinses (Betamethasone Valearate), ointment, and creams (Triamcinolone Acetonide).  Immunomodulation treats canker sores by affecting the immune system.  A few immunomodulators are Thalidomide, Colchicine, Pentoxifylline, Levamisole, Dapsone, and Cimetidine.  The immunostimulant, Thalidomide, is especially useful in HIV positive patients with RAS.  Some adverse drug reactions may occur.  Levamisole will reduce the pain and frequency of ulcers and also promotes healing.

Other medications used to treat canker sores are:  Adalimumab, Alefacept, Cyclophosphamide, Cyclosporine, Dapsone, Efalizumab, Etanercept, Infliximab, Interferon, Methotrexate, and Penoxifylline.  Herbal remedies include:  Sage, Echinacea, Licorice Root, Chamomile and Myrrh.  Magic Mouthwash provides a limited benefit.  Milk of Magnesia, Hydrogen Peroxide, salt water rinse and liquid antihistamines can be used as mouth rinses.  Silver Nitrate Sticks cause a chemical burn when applied to the canker sore. 

Physical Treatment may include: laser ablation, chemical cautery, surgical removal, and low dense ultrasound.  Laser therapy reduces canker sore pain and may reduce the frequency of recurrence.  Freezing the canker sore (Cryotherapy) does not work.

To see comparative photographs click on "Dental Photos" at the top of this page and then click on "Aphthous Ulcer" in the left margin. Hundreds of photographs are in this section.

    Dental implants serve as anchors for teeth that don't move when you speak or chew!  Dental implants may be thought of as artificial tooth roots which allow the fabricated teeth to be firmly attached to the mouth.  They may be used to replace all teeth missing in a jaw or just to replace one or several missing teeth.  The treatment choices can vary tremendously.

   Most dental implants are made from commercially pure titanium, a very biocompatible metal.  This metal is so biocompatible it is used with heart pacemakers.  A dental implant could, however, develop an infection around it similar to a tooth, and this could lead to a need to remove it.  Titanium is also very strong.

    To understand how dental implants work one may consider the jawbone as a piece of wood and a dental implant as a screw.  There needs to be enough length, width and depth of wood to contain a screw of a given size without the wood fracturing during insertion.  In addition, a longer and wider screw in dense wood will hold better than a shorter, narrower screw in soft wood.  The anatomy of the individual patient determines the amount of bone (length, width and depth) that is available for dental implants.  This can vary greatly in different areas in the same jaw or in the opposing jaw.  This anatomical variation may be due to osteoporosis, traumatic loss of a tooth or teeth, infection around a tooth destroying jaw bone, prolonged cigarette smoking, and the presence of normal anatomic landmarks like nasal sinuses and facial nerves that travel through the areas involved.  Lastly, the upper jaw may generally be consider to be a soft wood like balsa while the lower jaw may be considered a hard wood like oak.  Therefore, with all other things being equal, the prognosis of implants in the lower jaw should exceed that in the upper jaw.

   The most common type of implant technique involves a dental implant screw that is made in two pieces:  1) The first piece is about 10 millimeters long and at its top there is an internal female screw threading.  2) The second piece is about 5 millimeters long and at its bottom there is a male external screw threading.  The first piece of the dental implant screw is placed and left to heal in the jawbone under the gum, unseen and undisturbed, for 3 to 6 months.  After 3 to 6 months the gum is minimally surgically opened and the second piece is screwed into the first piece.  The gum is sewn back and this second implant piece now protrudes through the gum and a crown (cap) can now be made to cement to it.

    There are other types of dental implants; some also go into the bone like that described above but have very different shapes.  Other types of dental implants sit on top of the bone (not in it) but under the gum.  There are other types of dental implants that just sit in the gum.  Patients should seek dental implant care from a premium implant dentist who is skilled and very experienced with all types of dental implants.  Some dentists learn one technique over a weekend course and start offering services in implant dentistry.

   The type of implant chosen for each patient depends upon a complex interaction between functional and cosmetic needs, available bone, quality and quantity of remaining teeth, medical health, emotional temperament, treatment time and finances.

   The treatment options available for patients are frequently quite varied and are better discussed in the office on an individualized basis.

     Dental school students and dentists interested in dental implants should read Dr. Leonard Linkow, a major historical figure in implant dentistry since the 1950's.  Now retired, four of Dr. Linkow's classic textbooks are reproduced with permission and exclusively available for free by clicking on this Dental Textbooks hyperlink.

Mandibular Implants Dental Implant textbook

Maxillary Implants Dental Implant textbook

Theories and Techniques of Oral Implantology (Vol 1) textbook

Theories and Techniques of Oral Implantology (Vol 2) textbook

--Dr. Jeffrey Dorfman, Director

The Center for Special Dentistry

NYC

The Center for Special Dentistry®

Creative Solutions for Complex Dentistry

Dr. Jeffrey Dorfman, Director

The Center for Special Dentistry® is comprised of a large group of dentists and dental specialists, dental laboratory technicians, dental hygienists, and students. We offer premium services in a spacious, new mid-town Manhattan office:

 
Our practice particularly enjoys Oral Rehabilitation Dental Reconstruction - Smile Makeover - for dental phobia patients involving our multi-specialty in-office team. We are sought out for the most complex cases in dentistry.  Significant cosmetic changes can occur in one treatment visit.  We provide stunning full mouth Teeth Porcelain Dental Veneers in just two visits.  We have performed Oral Microbiology Culture testing on our periodontal gum disease patients and have referred them for medical examinations for over two decades.  This was long before the relationship between gum disease and heart disease or diabetes hit mainstream media.  Dental hygiene and oral health are important for your entire body.

We offer unique Dental Fear Phobia Management techniques that include:  1) Providing significant pain control with gentle dental anesthesia during, and appropriate pain medication, after office visits, 2) Providing significant dental anxiety reduction with behavioral therapy and when necessary through the use of medication - nitrous oxide gas & dental sedation, 3) Providing realistic treatment plans and time/action calendars based upon individual patient needs.  Professionally and/or physically powerful people frequently need assistance with dentist fear management because of their difficulty in giving up control over a sensitive part of their body.  We give our patients the control they need to feel comfortable.

New patients may schedule an initial visit using the Appointment Scheduler or by calling 212.758.1000.  At The Center for Special Dentistry® a patient may consult with or be treated by a Cosmetic Dentist, Periodontist, Endodontist, Oral Surgeon, Pedodontist and/or an Orthodontist during one visit. Our practice does not participate in any managed care dental insurance plans but dental plan insurance payments may be applied towards patient balances.  Payment plans and major credit cards are accepted. 

Our private practice also has a significant academic teaching component partially because Dr. Dorfman is a former professor at two dental schools.  We frequently have visiting dentists and/or dental students from around the world studying with us.  Our pre dental school Dental Education Program offers college graduates who intend to become dentists the opportunity to learn by watching master clinicians.

This dental website provides over 4,000 pages of exclusive content written or edited by Dr. Jeffrey Dorfman.  Nearly all of the procedures shown in the pictures were taken in our office.  The bulk of the content is in the  Dental Photos, Dental Articles and Dental Textbooks sections above.  Nearly two million pages of our dental internet content is downloaded each month.

Our dental website has been on online since 1998.  It is our mission to provide free information on dental care and dental health to a global internet community.  Additional links may be found here.

Smiles are Romantic®

Sugar is bad for your teeth. The issue really is the frequency of eating sugar and the duration of its presence in your mouth. It is probably better for your teeth if you ate a lot of sugar over a relatively short period of time, and then cleaned your teeth, than if you just kept a few pieces of sugar candy in your mouth all day long.

It is not usual to see patients who have been relatively cavity free for many years suddenly present with new cavities. An increase in sugar intake is almost always the cause.

Fruit and fruit juice contain citric acid which, given the name, is highly acidic. Fruit juice may also contain sugar additives. Though fruit and fruit juice are excellent nutritionally they can also be a significant cause of cavities. Again, the issue is frequency of contact with the citric acid and the duration of its presence in your mouth.

Drink all the juice and eat all the fruit you want but do so in a finite amount of time and then ideally, clean your teeth.

Several glands in the mouth secrete saliva. They respond to many stimuli including acidity and dryness. Saliva helps to cleanse teeth, begins digestion of food and acts as a lubricant to the food we swallow.

Drinking water is a convenient way to clean your teeth when you don' t have access to a toothbrush, floss and/or mouthwash. It is also an extremely important part of daily nutrition. An average adult should drink about 50 ounces of water, or its equivalent, per day. You should drink even more water if you also consume significant amounts of caffeine or alcohol because these drinks cause dehydration. Water is the only liquid that should be kept bedside for those who get thirsty at night.

   Orthodontics is the dental specialty associated with straightening crooked, rotated or malpositioned teeth in children and adults with fixed or removable braces. An Orthodontist is the dental specialist who usually performs this procedure.

     Orthodontics physically moves teeth with braces into their proper position by pushing them through bone.  When the proper amount of pressure is exerted on teeth (with the use of wires and springs) bone will disappear (resorption) in the area where the tooth is being pushed and will reappear (deposition) in the area where the tooth was originally.

     It is usually healthier to treat crooked teeth with braces rather than cosmetically (without braces) because orthodontics actually corrects the problem while non-orthodontic methods cosmetically hides the problem.  The drawback to orthodontics is that treatment can typically involve six months to two years of annoying braces while non-orthodontic cosmetic treatment can frequently be completed in one to two weeks.

     One big benefit of premium orthodontics is the dramatic decrease in time necessary to complete many orthodontic cases.  High volume insurance practices will typically spend 10-15 minutes per patient per month while a premium orthodontic practice may spend 60 minutes per patient every two or three weeks.  Braces that might have taken two years might be completed in one year but at greater cost to the patient.  For many adult patients the timesavings is worth the cost.

     Traditional fixed (non-removable) braces have brackets that can be clear (white) or metal.  Premium cosmetic orthodontic practices typically only offer clear (white) brackets.  Fixed braces are typically used to treat more complex orthodontic problems.  They can be used to correct rotations and can cause bodily movement of teeth through bone.

     Removable braces (spring-loaded or Invisalign type) look much like a retainer or bite plate but they aren’t the same since they are used to actually move teeth.  Removable braces are typically used to treat less severe orthodontic problems where teeth may be crowded out of the dental arch, in either direction to the tongue or lip, but where the teeth are not rotated.  Though these braces are removable the patient must have the dedication to wear them close to 23 hours a day during active treatment to physically move the teeth.  This is in contrast to wearing a retainer only at night to hold teeth in position following active treatment.  Beware of dentists and orthodontists offering removable braces for anything other than simple tooth movement or you will probably waste your time and money.

     Crowding of lower front teeth is common and continuous throughout life regardless of the presence of wisdom teeth. This occurs because our lower teeth tend to move forward over time.  This crowding of teeth occurs slowly, yet progressively, over decades.

     The lower front teeth of most people bite against the inside of the upper front teeth. As one (or more) lower front teeth begin to be pushed out of the dental arch they typically hit harder against their opposing tooth in the upper arch.

     Over time this upper tooth (or teeth) will also begin to be pushed forward resulting in an unattractive smile that is more susceptible to gum disease. Notice this happening to many of your friends and family who are over the age of 50. Proper diagnosis and early careful treatment by an Orthodontist can help prevent this because these problems get increasingly difficult to treat as the years of damage increase.

--Dr. Jeffrey Dorfman, Director

The Center for Special Dentistry
NYC

Wisdom teeth can cause significant damage to surrounding healthy teeth and gums. The flap of gum tissue that covers a partially submerged wisdom tooth also provides a great breeding ground for bacteria that can cause long-term gum problems around adjacent teeth. This type of gum infection can sometimes flare-up quickly and painfully without much advance warning.

A partially submerged wisdom tooth also frequently presses against the adjacent molar in front of it; this can cause a cavity in the healthy tooth.  This can occur without symptoms!

These are some reasons why patients inevitably remove their wisdom teeth.  Don't wait for the damage to occur or for emergency pain before you seek treatment.

An Oral Surgeon is the specialist who typically performs these surgeries. He can remove one, two, three or all four of your wisdom teeth in one visit. The skill of a surgeon can have dramatic impact on the level of post operative discomfort.

To view photographs of Wisdom Teeth Extraction click on 'Dental Photos' at the top of this page and then in the left margin choose 'Wisdom Teeth'.  This section contains hundreds of photographs.

     The intention of root canal therapy is to eliminate infection and tooth pain.  An Endodontist, a root canal specialist, should typically perform this procedure.

     Symptoms that might indicate the need for root canal therapy include: 1) significant, constant pain, including pain that can wake you up at night, 2) increased symptoms specifically when you lie down, 3) significant sensitivity to hot or cold, 4) pain upon chewing on that tooth, 5) a darkening of the color of only one tooth, or, 6) the appearance of a pimple or fistula in the gum.

     A tooth might need root canal therapy even in the absence of any pain.  This can occur if the damage to the nerve is so severe that all sensation of pain is lost.  Root canal therapy may still be indicated to prevent the spread of infection, asymptomatically, in the surrounding jawbone.   

     The two main objectives of root canal therapy are:  1) to completely clean out diseased tissue and bacteria from within the tooth to the end of the tooth roots and 2) to completely fill the internal hollow root with a good filling material also to the end of the tooth roots.

     There are many techniques and materials available to accomplish this; some are great and many are bad.  Some of these bad techniques allow the dentist to quickly, yet incompletely clean out and incompletely fill the internal hollow root and this can be the cause of future problems including continuing pain and infection.  Patients should ask to see the final x-ray following root canal therapy.  It's better to get something done right the first time in a premium dental practice.

     Root canal therapy is NOT painful when properly performed in a tooth that has not yet reached the point of becoming a painful emergency.  Some people mistakenly wait until they have severe pain before seeking root canal therapy.  They are the cause of the pain, not the procedure itself.  An important lesson is therefore to seek out root canal therapy if you think a tooth is becoming more symptomatic; don't wait for the emergency.

     Root canal therapy should ideally be left to specialists and this is what patients should expect in a premium dental practice.  The skill level of the dentist determines the amount of time/visits required for root canal therapy. The Journal of The American Academy of Endodontics consistently shows comparable success rates of 95% for either single or multiple visit root canals therapies, assuming they are performed at the same skill level. A good root canal specialist should be able to complete your root canal in one hour in one visit.  There should usually be no pain during the procedure.

--Dr. Jeffrey Dorfman, Director
The Center for Special Dentistry
NYC

Oral Surgery is the dental specialty associated with tooth extractions (frequently wisdom teeth), dental implant placement, removal of pathology (disease) and realignment of the facial bones including the TMJ. An Oral Surgeon is the specialist who usually performs these procedures.

Click on specific topics at left for information on Oral Surgery procedures.

To view photographs of Oral Surgery click on Oral Surgery Photos, Wisdom Tooth Extractions, Extraction of Teeth, or Dental Implants and scroll through the numerous pages listed at the bottom of the table  These sections contain hundreds of photographs.