Composite Resin YES - Silver-Mercury NO

One of the most common questions asked in our practice concerns our choice of the material that we use to restore cavities.

Silver-mercury (amalgam) fillings were introduced to dentistry over 100 years ago. At the time, this mixture of silver and mercury was considered a miracle material (of course, at that time, so was indoor plumbing). Today, amalgam fillings are made of a mixture of silver/tin/copper alloy and mercury in about 50/50 proportions. And as of today the American Dental Association believes that amalgam is a safe and effective material for use in the human mouth. They are entitled to their opinion. Here is my personal opinion about amalgam:

It is possible that the mercury in amalgam is not harmful to us. However, mercury is a toxic substance and according to the EPA, must be disposed of in a Toxic Waste Disposal Site. In my opinion, anything that must be disposed of in a Toxic Waste Disposal Site should maybe not be placed in our mouths. But this may simply be an over-cautious position on my part. I do not actually know what the long term outcome of on-going research will be. I do know that some European countries and a couple of states in the U.S. have regulated amalgam use, mostly because of environmental contamination reasons. Some European countries have banned the use of amalgam in pregnant women and young children.

I want to be clear on this. I have not used amalgam since April of 1982. And the reason has nothing to do with its safety or non-safety. The jury is still out on that.

The reason I do not use amalgam is that, in my opinion, it is a poor restorative material compared to newer materials we have now. Like everything else, improvements have been constant over the last 100 years. It took science until the 70’s to develop an alternative to amalgam, and into the early 90’s to perfect it to its current level.

The material I favor and use as my first choice is bonded composite resin. This material is extremely biocompatible and flexes and wears like natural teeth. A silver-mercury restoration has no bond to tooth structure. Expansion and contraction of this material over the years causes cracks in teeth and eventually, many teeth will fracture. You may have had this happen to you, even when you were eating something soft. Amalgam tends to leak after five or ten years, causing recurrent decay. Amalgam corrodes and turns black.

There is no way I will ever place amalgam in a patient’s mouth again.

When aging amalgam restorations are replaced by bonded composite resin restorations, the strength of the tooth is increased and underlining tooth structure is sealed.

Plus, of course, composite resin restorations are tooth colored and are so much more attractive and natural looking than metal fillings.

Now let me talk with you about the economics of composite resin. Composite resin restorations are more technique sensitive and are more time consuming to place. Special care must be exercised to operate in a controlled environment that can be moist when desired and dry when desired. Composite resin is more sensitive to moisture control procedures than amalgam. When placing composite resin fillings, we seal the dentin against bacterial infiltration and protect the dental pulp from irritation. As a result of this necessary expertise and the increased time associated with composite placement, the cost of restoring teeth with composite resin is a little higher than with amalgam.

Insurance companies are slow to embrace new techniques, especially when it could cost them money to provide state-of-the-art care to their insured. Many insurance companies will only cover the cheapest material to restore teeth. That’s amalgam, and many will pay their amalgam benefit even when composite resin is used. Yes, they are allowed to do that.

My patients have mostly learned about the ways insurance carriers pay benefits. For example, they have learned not to be fooled by the “usual and customary fee” jive and they know that this is bogus and is intended to drive a wedge between patient and doctor. If you are concerned about anything you read in an Explanation of Benefits you receive, just call. We’ll explain it with straight, honest talk. You don't have to be my patient to get advice; we'll be glad to help you.

Composite resin is one of a wonderful list of modern, state-of-the-art beautiful materials dentists use to help you have the strong, functional teeth and great smile you have always wanted.

You can post a comment or ask a question by clicking on the word "comments" right below this post.

Sensitive Teeth: Ouch!

Does ice cream or hot coffee, or even brushing your teeth make you wince? Do you get a twinge of pain – or even worse – from hot or cold or sweet foods?

You may have a common dental problem called sensitive teeth.

There are a number of causes of this uncomfortable condition. Some of them include worn tooth enamel, decay, tooth roots that are exposed at the gumline from aggressive brushing or gum disease, worn or leaky fillings or crowns, or cracks in teeth.

Teeth are protected by enamel above the gumline and by cementum on the roots. Under enamel or cementum is the basic structure of teeth, called dentin. Dentin has tiny channels called tubules that run from the inner pulp of the tooth to the place where the dentin joins the enamel or cementum.

In these tubules is fluid and also some very fine nerve fibers.

When the enamel or cementum is worn or damaged, these little nerve fibers can get stimulated and that causes the "ouch".

Sorry. Sensitive teeth can really take them pleasure out of eating some foods we really like.

So what to do? Here are some things to think about:

1. Good oral hygiene tools and techniques are very important. Aggressive equipment and aggressive technique can cause the damage that makes teeth sensitive, as well as damaging tooth surfaces and making them need repair. In our office we definitely spend plenty of time helping our patients get equipped with terrific tools and learn how to use them so they not only prevent disease but also do not cause harm. What you use and how you use it matters.

2. Grinding your teeth, especially in sleep, can cause amazing tooth wear. If you do this and are not aware of it (most people are not), there are effective ways we can help you with to prevent damage. This kind of grinding is also an important cause of severe headaches, sometimes diagnosed as migraine (there is a blog on this here if you are interested). If you have worn down your teeth (hint: lower front teeth are not supposed to be flat on top) have that taken care of.

3. Get worn out fillings and crowns and bridges replaced. If a tooth is cracked internally dentists can detect this and take care of it. This also helps prevent other problems.

4. Prevent gum disease, or if you have it, get it taken care of. Periodontal disease is very treatable. Take a look at our blog on periodontal disease. Gum disease is the reason that most adult teeth are lost. Gum disease can cause gum recession and exposed roots, which wear and become (you guessed it) sensitive.

For minor sensitivity, all that may be needed is for you to use a special toothpaste that helps some people. These toothpastes work by helping to block sensations from moving from the surface of the teeth to the nerve fibers inside. Sometimes they take a while to work.

Fluoride gels or rinses can sometimes help with mild sensitivity. Again, dentists know how to recommend what's right for you.

Dentists can protect sensitive surfaces with bonding resins that block the tooth surface and reduce sensitivity.

If you have lost a lot of gum tissue and have exposed roots, gum tissue grafting can often replace that coverage.

A last resort might be to remove the nerve tissues from the inside of the tooth ( root canal therapy).

But the bottom line is that you do not have to live with this kind of sensitivity. Get help. Dentists know what to do to help you enjoy eating again.

Don’t live with pain.

If you would like more information, or would like us to take a look at your situation, all you have to do is call or send an e-mail. We'll be glad to advise you.

Bon Appetit!

Ten Good Things To Remember To Make Your Life Work Better

General Colin Powell has a list of things he lives his professional life by.

They are good rules for everyone. Here they are:

1. It’s not as bad as you think. It will look better later.

2. Get mad, then get over it.

3. Avoid attaching your ego to your position,

so when your position falls you won’t fall with it.

4. Never let style overpower substance.

5. Don’t let adverse facts stand in the way of a good decision.

6. Triple-check the small things.

7. Share credit.

8. Remain calm. Be kind.

9. Don’t let your fears be your only counsellor.

10. Optimism and enthusiasm are force multipliers.

Straight Teeth Without Braces - Clear Aligner Ortho

Many of our patients wish their teeth were straighter but some of them do not want to wear braces or have their teeth capped.

Well, there is very good news. It is now possible to get your teeth straightened without the appearance, hassle and discomfort of metal wires.

It's called Clear Aligner Orthodontics and it is comfortable, easy and best of all, just about invisible. There is no interference with eating, no sore lips, no rubber bands and pretty near no discomfort.

Not only that, but it normally takes much less time than with traditional metal braces.

There are two methods of aligner ortho we are Certified in: ClearCorrect and Invisalign. You can visit their web sites: ClearCorrect.com and Invisalign.com. We definitely favor ClearCorrect because they have become a much friendlier company to work with.

Why not have straight teeth? They are better looking, easier to clean, less likely to trap food, fit together better and today, it's comfortable and fast.

Find out if straighter teeth are possible for you. Call us at 845-297-6206 or just send e-mail to DrSteveRoss@aol.com. We'll bring you in for a no-charge evaluation.

Just another way today's dentistry can help you be all you can be.

Come visit our web site at DrSteveRoss.com and check out what we're about and how we can help you.

Snoring and Sleep Apnea. You Could Die!

Sorry for the drama. But this is important.

One of the things many of the women patients in our practice tell me is that their husbands snore. Even some of the men tell us that about their wives. It really disturbs their sleep.

That's not good, but that’s not the most important thing.

Many of the snorers also stop breathing and than suddenly gasp for breath — sometimes dozens of times an hour!

This is called Obstructive Sleep Apnea, or OSA. It’s very dangerous.

Obstructive sleep apnea is a common disorder that affects more than 18 million people in the United States. In many of these people, the condition is undiagnosed. People with OSA literally stop breathing repeatedly during their sleep, often for a minute or longer and as many as hundreds of times during a single night.

Sleep apnea can be caused by either complete obstruction of the airway (obstructive apnea) or partial obstruction, both of which can wake one up. OSA occurs in approximately 2 percent of women and 4 percent of men over the age of 35.

It is important to emphasize that, often, the person who has obstructive sleep apnea does not remember the episodes of apnea during the night.

The main symptoms are usually associated with excessive daytime sleepiness due to poor sleep during the night. Often, family members, especially spouses, witness the periods of no breathing.

A person with obstructive sleep apnea usually snores heavily soon after falling asleep. The snoring continues at a regular pace for a period of time, often becoming louder, but is then interrupted by a long silent period during which there is no breathing. This is followed by a loud snort and gasp, and the snoring returns. This pattern repeats frequently throughout the night.

During the nonbreathing episodes, blood oxygen levels fall. Persistent low levels of oxygen may cause many of the daytime symptoms. If the condition is severe enough, pulmonary hypertension may develop, leading to right sided heart failure.

Symptoms that may be observed include:

Abnormal daytime sleepiness, including falling asleep at inappropriate times

Awakening unrefreshed in the morning

Depression (possibly)

Episodes of no breathing (apnea)

Lethargy

Loud snoring

Memory difficulties

Morning headaches

Personality changes

Poor concentration

Restless sleep

Abnormal heart rhythm (arrhythmia)

Excessive carbon dioxide levels in the blood

High Blood Pressure

Heart disease

Sleep deprivation

Stroke

So why is a dentist talking to you about this? Because dentists can be terrifically helpful with mild to moderate OSA.

Dentists with a special interest in this issue know how to make an oral appliance that advances the jaw in sleep and keeps the airway open. Sometimes this is all that is needed to stop the problem.

These appliances are easy to wear in sleep and the involvement in sleep quality, to say nothing about the improvement of the sleep for the partner, can be remarkable.

The alternatives are for the OSA person to use CPAP (continuous positive airway pressure) devices, which involve a mask that fits over the face and and a machine that pumps air under pressure to force breathing. And there are surgical procedures that may be able to help.

I personally favor the oral appliance called Somnodent, and my patients have found it to be comfortable and effective.

If you are told you snore loudly or stop breathing in sleep, or if your partner does this, please seek help. The diagnosis is usually made by having a sleep study at a sleep center, but some cases are just plain obvious.

But don't neglect OSA. It can kill you.

Call us if you want more information about this. 845-297-6206. Or write: DrSteveRoss@aol.com.

So You Think You Have Migraine? Maybe Not!

For years I've been telling patients who are taking medication (a polite name for drugs) for migraine headaches that they may not actually have migraine.

What, you say?

No, really.

This month, Redbook Magazine, the ultimate source for dental and medical information, had an article about the four most frequently misdiagnosed syndromes. Guess what number 2 was.

2. Headaches and/or ringing or aching ears, plus aching back, neck, and/or teeth.

The doctor says: It's migraines (or an ear disorder).

It could be: Temporomandibular joint syndrome. The temporomandibular joint (say it three times fast) are the two jaw joints in front of your ears.

When this joint, which connects your jaw and skull, becomes inflamed, the pain radiates and causes headaches and pain in your face. And sometimes TMJ problems are really chewing muscle problems, where the muscles that move your lower jaw get stressed out. This often happens when you clench or grind your teeth in your sleep.

It hurts! It makes you avoid chewing foods that are not soft or that take a lot of chewing to get down.

And it can give you headaches. Sometimes bad ones. And sometimes your M.D. will call it migraine and give you drugs.

TMJ is best treated by a dentist with training in this stuff. We have a special interest in this and have helped a ton of patients become comfortable. Without strong drugs. Without jaw joint surgery.

Maybe you are the one who fits this situation.

I hope this blog was helpful. We'd be glad to talk with you if you have questions or want to explore help.

Validation

Today I just want to share something really special.

Trust me. It will make you smile.

It's a short video. Watch it through.

Please. The link is right below.

Because you are great! You are amazing!

http://www.metacafe.com/watch/yt-Cbk980jV7Ao/validation/

Are You Throwing Away Dental Insurance Benefits?

As long as I'm on the subject of dental insurance (take a look at my last blog) it's time to talk about a big mistake that lots of people make with their dental insurance plan.

Because it's half way through August already and the time is flying by. Soon it will be Autumn and after that the year-end is getting near. Time really goes fast when you're having this much fun, right?

What's the mistake? Throwing away valuable dental insurance benefits! Why would you do that, you ask? I'll tell you.

Most insurance plans have an annual maximum benefit payment limit that usually expires at the end of the year. This means that if you don't use this year's benefits, you lose them! Unused benefits do not roll over at the end of the year. The dollars that your insurance company will pay you toward dental treatment that were not paid out at year's end, are lost dollars. They're just gone, and you can't get them back.

This is a big bonus for the insurance company, because they get the premium no matter whether they pay out benefits you could have gotten or not. They get richer and you get nothing for it.

If you have dental insurance, get your dental treatment done before December 31st! Or start some of your treatment NOW and continue treatment in January to possibly DOUBLE your benefits! This way you use double your yearly maximum in a two month period (December and January).

You or your company pay good money to get these benefits. Don’t put off treatment and lose your yearly allowance. Avoid the holiday rush and schedule today!

A Smart Patient doesn't sit around and throw away help. If there is care you need or care you just plain want, but have not gotten around to it, now is the time to get moving. Make an appointment. As Ben Franklin said, "Any job, once begin, is half done."

Be smart. Don't waste your benefits. Call your dentist!

Dental Insurance: Storm Clouds on the Horizon

If you are a dental patient with dental insurance, change is coming and you may not like it!

When I was beginning in dental practice there was no dental insurance. Imagine that! No insurance. Everyone had dentistry anyway: crowns, bridges, root canals, fillings, checkups - the whole thing.

Then dental insurance came along and that made things a lot easier for people. They had help with the cost of care and their employer or union paid for the insurance plan.

But. As the years past, employers and unions began to feel the weight of the dental insurance (and health insurance generally) on their bottom lines and they began to cut back.

In 1970 the maximum benefits you could use in one year was about $1000, and that bought quite a lot of dentistry at 1970 fees. Almost 40 years later in 2009 the maximum benefits you could use in a year is still $1000 to $1500 for most plans. That buys much less dentistry at today's fees.

And now most people have to pay part of the cost of their dental insurance through payroll deductions and co-pays. So the value of your insurance is getting smaller and smaller.

And to make it worse, many businesses - especially small businesses - are discontinuing health insurance completely because the cost is killing their business.

To add to the burden, most people who lose their job or change jobs lose their insurance. Ow!

Feel bad enough? Wait - there's more. We have noticed something that some employers and their dental insurance carriers are beginning to do. They are reducing the benefits for specific services.

Here's an actual example and it happens every day. A patient whose fee of $133 and was benefited in full last year and who had the same service last month now is getting only $126.39 for that same service. The benefit has been lowered and it's only the beginning.

Another thing that is happening is that waiting periods for replacement of dentistry are getting longer. For example, most insurances plans will pay a benefit for a new crown if the old one breaks after 5 years in the mouth. But now we are beginning to see 10 year wait periods.

It's the same for things like x-rays. A good standard of care in dentistry is for a patient in good dental health to have diagnostic x-rays every three years. This is good preventive practice, like mammograms or colonoscopy in medicine. But now we are seeing insurance plans that will not pay the benefit until 5 years have passed. Waiting that long is dangerous and leads to undiscovered problems that are much worse when they are found.

But employers do not care much about that when they are struggling to keep the business going in the face of rising health insurance premiums.

Why is this important to you? Because if you wait until next year to have recommended dental treatment, you may be paying more out of pocket for it, due to this new trend. The insurance company saves money at your expense, because some people will not use their full annual maximum and those people help offset the insurance company's annual outlay of benefits.

The employer saves money at your expense because they can purchase a lower-cost policy for each of their employees. There is only one loser with this trend: You.

So what can you do?

Your dental health is important. If you lose it you will suffer. Things will get difficult. But you can do a few things:

1. Have regular evaluations. Do not skimp on the schedule. We establish an interval with our patients based on their individual situation. Those evaluations and professional cleanings have a powerful effect on our patients' dental health. Not only do they make sure things are not overlooked but they are, let's face it, motivating. That matters.

2. Personal oral hygiene is critical. Our patients know how we always talk with them about the bacterial biofilm called plaque and how we work with them to be sure they have great tools and techniques for reducing it. It works. It's in your hands and you have the power.

3. Don't put things off. If you need dental treatment, move to get it done before you find that you are now receiving less help from your insurance carrier. Or even that you have no insurance at all. If we have suggested or recommended care for you, try to stop talking yourself out if it. Three of the most powerful words in getting what you want are these: Just do it!

4. Share your economic situation with the office. Like most dental offices, we have payment plans and we can help. Sometimes things can be staged. There is usually a way. But it all starts with you saying “YES!”

5. Stay positive. Earl Nightingale wrote a famous book about what he called “The Strangest Secret”. It is this: You become what you think about. If your thinking is negative, negative will come into your life. Zig Ziglar, famous motivational speaker, calls that “stinkin' thinkin'. Colin Powell, distinguished General and former Secretary of State, says, “Do not let fear be your only counsellor.” And I like the well known acronym for FEAR. Here it is: False Evidence Appearing Real.

6. Be smart. Understand the situation and act to protect yourself. Dental insurance is uncertain, even though we have become used to it. The world is changing and we can't stop it. But we can still win by being a Smart Patient.

If you have questions or want to talk with us about anything just call or send e-mail. We are a dental office that cares and we can help.

Fear of the Bike

Getting Over Fear of Dentistry is Like Learning to Ride a Bicycle.

Why?

Because when you are learning to ride a bike the main problem is fear of falling.

Remember when your dad or mom taught you how to ride a bike? He or she ran alongside the bike and held the bike up so you wouldn't fall. For ten minutes, you rode the bike while your parent held you up. Once you got over the speed and steering hump, it was easy. The hard part was the fear of falling.

Learning to ride a bike is what is called a binary activity. Either you are riding or your are falling. No in-between. Falling...riding. Failing...succeeding.

Learning things that are binary like this is difficult. They are difficult because people don't like to fail.

In our office we love teaching people how to be comfortable in the dental chair. We hold up the bike while they learn to ride. This reduces the fear of failure. Then, if the patient doesn't give up after ten minutes, in a blink, they're fine.They always say it's a sort of miracle. And that they never thought they would get over their fear and especially not that easily. It turns out, getting over the fear of dentistry is just like leaning to ride a bike.

Easy with a good teacher who will hold up the bike for the first little bit.

Are you a "dental phobic"? Give us a call. We can help.

Periodontal Disease: A Serious Threat To Teeth and to General Health

Hi,

Dentists have been diagnosing and treating periodontal disease for a long time. We have always known it to be the major cause of the loss of teeth in adults. And we have been pretty successful over the years in helping patients overcome their gum disease and become dentally healthy.

Dentists have always been concerned with the detection and control of gum disease as a part of helping their patients keep their teeth healthy through their lives. Now we know that this effort is part of a larger picture and that we must be aware of the part that gingivitis and periodontal disease plays in our patients’ general health.

The Bad News

In July of 1998, the American Academy of Periodontology launched an effort to educate the public about new findings which support what dental professionals had long suspected: Infections in the mouth can play havoc elsewhere in the body.

Evidence has continued to mount to support these links. We now know that people with periodontal disease are at higher risk for developing heart disease, stroke, uncontrolled diabetes, preterm births and respiratory disease. And most recently, a possible link has been identified between periodontal disease and pancreatic cancer.

How does this work?

Periodontal bacteria can enter the blood stream and travel to major organs and begin new infections. Additionally, periodontal inflammation is associated with increased circulating levels of certain proteins, such as C-Reactive Protein (CRP) that are associated with multiple systemic illnesses. Research continues to explore these links to understand more about how the connections work.

So What Can You Do?

If you value your oral health as well as your overall health, a thorough periodontal evaluation is a good idea. Of course, our regular patients have this kind of evaluation at their initial visits with us and at every regular checkup.

Recently, improved methods of detection of periodontal disease in its very earliest stages have become available and we have been adopting these methods as they are proven. Modern methods of treating periodontal disease, such as PerioProtect, have made treatment much, much more comfortable and effective. You can check out PerioProtect at www.perioprotect.com. We hold Premier Certification in PerioProtect and have enjoyed very good results with our perio patients here in our Dutchess County office.

No one should lose their teeth or get sick from gum disease.

We can help. If you would like a free group of articles telling about the connections between periodontal disease and serious general health issues, just send us e-mail to DrSteveRoss@aol.com and we'll get it right out to you.

Here's a good You Tube video showing dental hygienists talking about their PerioProtect experience and how it helped their patients: www.youtube.com/user/perioprotect.

Dental Implants: Replacement Teeth That Look and Feel Like Your Own

Last Wednesday I spoke with a patient who needs to replace a missing tooth and wanted to know all about the use of an implant to do it. After we talked she suggested I add the information to our blog site, so here it is.

A dental implant is an artificial tooth root that is placed into your jaw to hold a replacement tooth or bridge. Dental implants are an ideal option for people in decent oral health who have lost a tooth or teeth due to periodontal disease, an injury, or some other reason.

Many people get kind of anxious when they think about something being put into their jawbone. But if you talk to people who have had implants, they will tell you that the whole procedure was simple and was not painful or uncomfortable and they always say they were amazed by how easy it was.

Sometimes things sound scarier than they actually are.

Dental implants allow us to replace missing teeth without the need to use teeth on each side of the space to hold the replacement. This dramatically reduces any trauma to the other teeth -- a good thing, right?

Here's how it works. The first step is for the dentist who will place the actual implant in the jaw to check out the site and make sure all is ready. I like to ask a trusted colleague to do the placement of the implant. I have some favorite periodontists and oral surgeons I have worked with for years and who really know what they are doing. We plan the work together to determine the best position and other factors to ensure the best and most successful placement.

After the implant is in, there is a period of waiting while the implant and the jawbone kind of marry and the implant becomes completely solid to the bone. It is rock solid at that point. During the waiting period a little cover is placed on the implant and if needed, a temporary replacement tooth is placed to eliminate the space if it is in the visible zone.

OK. Once the implant is ready, I take over. It usually takes me two visits to do what is needed to create and place the new tooth and attach it to the implant. Sometimes, if the situation is complex it can take more than two visits. These are comfortable visits.

Here's what dental implants can do.

- Replace one or more teeth without affecting bordering teeth.

- Support a bridge and eliminate the need for a removable partial denture.

- Provide support for a denture, making it more secure and comfortable.

Implants are:

Esthetic. Dental implants look and feel like your own teeth! Since dental implants integrate into the structure of your bone, they prevent the bone loss and gum recession that often accompany bridgework and dentures. No one will know that you have a replacement tooth.

Tooth-saving. Dental implants don't sacrifice the quality of your adjacent teeth because neighboring teeth are not altered to support the implant. More of your own teeth are left untouched, a significant long-term benefit to your oral health!

Reliable. The success rate of dental implants is highly predictable. They are considered an excellent option for tooth replacement. The success rate is 90%-98% in my office.

Dental implants are so natural-looking and feeling, you may forget you ever lost a tooth. You know that your confidence about your teeth affects how you feel about yourself, both personally and professionally. Perhaps you hide your smile because of spaces from missing teeth. Maybe your dentures don't feel secure. Perhaps you have difficulty chewing. If you are missing one or more teeth and would like to smile, speak and eat again with comfort and confidence, there is good news! Dental implants are teeth that can look and feel just like your own!

If you are missing a tooth, or several teeth, or if you are wearing a denture that is loose or troublesome, let us show you how implants can help you. Don’t let anything stop you from having a strong, healthy, attractive, comfortable mouth and smile. We are here to help! Give us a call at 845-297-6206, or send e-mail to DrSteveRoss@aol.com, or visit our web site at DrSteveRoss.com.

We’d love to help you.