Jack of All Trades, Master of None.

By Dr. Max Zaslavsky

Barber Dentist

Remember when doctors made housecalls? It wasn’t too long ago where a doctor would know you were too sick to make it into the office, so after work, he would bring his little black bag, with the wooden stick to check your tongue, and that thing that shines light into your eyes, and would diagnose you at the comfort of your own bed. My oh my, how things have changed……

I remember back when I was in college, a physician came to lecture to my undergrad pre-med/pre-dental society and I asked him, “Hey doc, what happened to the housecall?”

He responded, “With the changes in technology, and as we have progressed in the medical field, the black bag is no longer sufficient to properly diagnose an ailment.” The same holds true in what I do in the dental field.

Once upon a time, barbers were the original dentists. It’s true! Google it! You would get a haircut, and if you had a toothache, your barber would lance the tooth out after a few good shots of whiskey, bourbon, or whatever moonshine was there. Now with the ever changing field of medicine and dental that we live in, barbers cut hair….and maybe a shave.

Routinely I refer patients to a specialist for various reasons. The primary reason is because it is out of my field of expertise. Every so often, I get the complaint that a patient is upset because I will not do a certain procedure like a root canal. Even claiming it’s because under their insurance plan, I would not be compensated adequately and I don’t care about them. Realistically, it’s not that I won’t do THAT root canal. It’s more that a specialist in this particular incident, someone called an endodontist, will do it faster, better, and probably under a microscope in order to access and clean every canal of that particular tooth. Remember, in dentistry as in carpentry, the right person will know when to measure twice in order to only drill once. It saves time, and redo’s.

On the other end of the spectrum, I see patients who regret having a general dentist do a procedure that a specialist SHOULD have done. I saw the ramifications of an implant procedure done so poorly that the general dentist had broken the patient’s jaw. The referred patient came in from another office not knowing why she was in so much pain, and we had to give her the bad news. Of course, this was after she had spent so much time and money in the other office, and now we would have to start from scratch.

So the point to all this- yes a specialist is more money than seeing a general dentist. And yes, a general dentist can SOMETIMES do the same procedure at a reduced cost, and be extremely good at it. Sure you will save money, but what happens when something fails, and now you need the periodontist, oral surgeon, etc. to redo all of it? Short term it’s cheap, but long term it’s more time and money. And just like you the reader, “I ain’t got time for that!”

In the end, just be sure you are in the right hands. As technology, and dental research grows, the days of the “super general dentist” are coming to a close. Sure, you will have general dentists who are more than capable to do more than the usual and customary procedures, but as always, do your research!

 

“It’s Never JUST a Cleaning!”

By Dr. Max Zaslavsky

I was at LA Fitness one Friday night and I happen to run into a patient. “Sam,” as I would call him came up and said hello to me, with a great big smile on his face. He was working out his back, and so was I. In between lat pulldown sets, he said to me, “You know I love all of your staff!” He continued, “That Joanne….man, I have had a lot of cleanings, but never one so thorough as what she does.” Obviously I was proud. It takes a lot of work to assemble the perfect team, and make them a cohesive unit. I definitely took some pride in what he said about my star hygienist. Because of that incident, this blog is dedicated not to what I do, but what should be done in your initial visit to your recalls with your hygienist.

For some of you reading this who are my patients, you know Joanne, and how awesome she is. Joanne, my stellar hygienist, has been a blessing in my life for the past 10 years. She is one of the few people who has always kept in contact with me since I graduated dental school. We had worked together in another office in Deerfield Beach, and I said, “If I ever get my own office, I want her.” Sure enough, almost 5 years ago, she came into my office and began my small startup.

Photo4

Let’s get into the role of what a hygienist should do. Obviously if you know how we do things in our office, this is the criteria you have been accustomed to. If you are in a different office, perhaps you should look to see if these procedures are indeed occurring. Initially, we begin with a full mouth series of x-rays. I know some offices do only 4 bitewings, but not us. It’s not comprehensive, and you are only cheating yourself with only 4. The reason is 4 bitewings (which usually come along with those $39 Groupon offers) can not diagnose infection. Although they can diagnose dental cavities in between the teeth, they will never, ever detect an infection. Different angles of x-ray radiographs detect different facets of a tooth and its surrounding bone structures. We always want to be as complete and comprehensive as possible to see every angle.

Some may argue that we are over exposing a patient to radiation, but with today’s digital x-rays (which is what we have in our office), you are exposing yourself to up to 70% less radiation.

There had been some literature in the news as of late in regards to brain tumors and dental x-rays. The documentation is honestly untrue and the reality is your cell phone usage is probably going to give you cancer before we ever do.

Next up, the hygienist along with your dentist will determine what kind of dental cleaning you will need. If you are a smoker, chances are you will need a more detailed cleaning than the regular prophylaxis. If you do not floss, more than likely you will need more than just a regular 1-hour cleaning. If you have not had a dental cleaning in over 2 years, more than likely you will need more than just a regular cleaning.

How do we determine gum disease?

Periodontal Probe

Bone loss can be determined not only visually, but also via the x-rays we have taken, and periodontal probings. Joanne uses a small measuring stick called a periodontal probe and measures the architecture of the bone structure around each and every tooth you possess. Each tooth has 6 surfaces- 3 in the front and 3 in the back. Normal probing depths are sort of like golf scores- the lower the number the better the prognosis of a tooth. Generally 1-3 millimeters is normal. It means you are flossing and doing what you’re supposed to be doing. It could also mean you aren’t flossing and you just have awesome genetics. Whatever it is, to pseudo quote the Dos Equis man, stay periodontally strong my friends…stay strong.

Anything above 3mm is when things become a red flag that we need to address with more scrutiny. If a probing depth of 6 millimeters or greater is measured, we would obviously need to treat things more aggressively than if it was a 4 millimeter pocket. Our hygienist may even suggest a medication to be placed in the gum pocket (called Arrestin) in conjunction with the cleaning in order to clean out the bacteria invading the tooth. The key thing in all this is that a deep pocket needs to be cleaned by a hygienist. Floss and a Waterpik can only go so far into a tooth. If we are addressing a pocket that is 6 or greater, there is no way at all that you can do this on your own. Don’t think you as a patient can fix a periodontally diseased pocket. This is when you need a hygienist like Joanne to get in there and “get ‘er done.” Don’t be that guy who thinks you can do it on your own, and it only becomes worse.

See it’s all about bacteria. It’s all about keeping it clean. If we remove the bacteria, we can remove the plaque that acts like a splinter that hurts the bone surrounding the tooth.  Furthermore, removing the bacteria and plaque surrounding the teeth will only help you and your heart. The same bacteria in gums is the bacteria that you swallow that goes through your system and can create heart issues. Gum disease has been linked to pancreatic cancer, esophageal cancer, and a whole bunch of other things. It’s all connected, and when the primary source of nutrition is your mouth, you need to fix the dental problems before they impose upon everything else.

Periodontal Probe Photo Credit: Durham College

How to Have a Jolly Holiday in Fort Lauderdale without a Dental Emergency.

By Dr. Max Zaslavsky

Emergency Dentist

Tis the Season... For a Toothache!

As I sit down writing this article on Christmas Eve, drinking my Ovaltine with chia seeds, I know I will be getting a phone call from someone needing some sort of emergency dental treatment due to a toothache. Whether it be a root canal or an extraction, I can only advise you on how to handle the situation if and when it may occur, and then finish it all up with what you can do to prevent forest fires! Sorry, wrong article… What you can do to prevent a dental emergency!

‘Twas the Night Before Christmas… and You Have a Toothache.

Ok, the reality is you probably had that toothache for a while and you should have taken care of it earlier. A toothache just doesn’t happen that day. There’s a tingling, a slight pain, and you ignore it until….tada….Christmas day. I know, I know, you were shopping for presents. Little Jimmy needed the new Xbox and Sophie wanted the latest Barbie.  Quite frankly there’s a ton of excuses but the reality is life in general gets in the way. We all have a tendency to procrastinate, and it just sucks because its Christmas. Now you need someone. You don’t care if it is me or some other dentist in Fort Lauderdale, but you want to get out of pain.

First thing you should do is call your dentist. Usually there is an emergency answering service, or as it is in my office, I have my cell phone on the answering machine. I don’t mind you calling me on Christmas day, Hannukah, Yom Kippur, whenever. As long as you call during a reasonable time, and you are an existing patient, I can call in a prescription for you. If it is a dental infection, we can control (not eliminate) the infection so you may enjoy your holiday, and we can treat you after you have enjoyed your family time and your egg nog. Do not call me at midnight (yes that has happened), or else I will turn into Mr. Grinch!

If you are not an existing patient, or you simply do not have an emergency dentist, things can become a bit more complicated. If you need a dental professional on a holiday, and you have never seen him or her before, the law requires you are seen for a prescription, and obviously for any dental treatment. Generally opening up the office on a holiday will have an added fee attached to that emergency dental treatment. Furthermore, for an emergency dental visit on a national holiday, there is almost no way I will be able to verify your dental insurance. Therefore everything from the time you walk in, to the procedure itself is your responsibility to pay. On the same token, however, I know I will be able get you out of pain so you can appreciate that Honey Baked Ham a little more.

Dental Emergency

The last option is to go the emergency room at a hospital. We had someone call up the office this past week, and when we told her how much it would be to take out a tooth, she said, “I’ll just go to the ER.” I didn’t want to argue, but the truth is, if you have a dental emergency in Fort Lauderdale, the LAST place you want to be is at the ER!!! A physician knows as much about treating a toothache as I do about delivering a baby. We all have our sub-specialties, and the truth of the matter is a physician will give you an antibiotic, a pain med, and tell you to see a dentist after Christmas. All this, and you will spend a ton more – not only in time waiting to be treated, but also in expenses. Last time I checked, hospitals cost way more on any day than me on a day when I’m not even supposed to work.

The best thing you can do is see a dentist regularly (meaning at least every 6 months) for a check-up, cleaning, and diagnostic x-rays. Prevention is always key. If we can prevent the problem from happening in the first place, it will save you time, money and most importantly tearing you away from family on this special day.

Emergency Dental Clinic

The second best thing you can do is DON’T BE STUPID! Yeah, you heard me. Don’t get drunk the night before Christmas and get into a fight at a bar with your cousins. Don’t get drunk and trip over your dog and break your two front teeth. Don’t relive your glory days, and do double dutch with your daughter, and then the top of her head hits up underbelly of your chin. Those have been my last few Christmas emergencies.

All you should want for Christmas is to keep your two front teeth. Dream of a white Christmas, white teeth, because after all…..this is “The Most Wonderful Time of the Year.” Have a good one my friends.

Broken Teeth – When Humpty Dumpty Can Be Put Back Together

By Dr. Max Zaslavsky

Max Wod

Up until a month ago, I was unbreakable. For those of you who know me, aside from dentistry, I work out a lot. I love my Crossfit, my gym, my hot yoga, and whatever other activity I can do to keep active. Then, I decided to take a kickboxing class when I was visiting my family in the Bronx, and a novice hit me from behind when he wasn’t paying attention. Down I flew, and after 10 days, I realized it wasn’t a sprain. My achilles was torn and before the news even came out of the doctor’s mouth, I was being scheduled for repair.

Things happen. It’s as simple as that. I was taken down by a beginner who was going through a midlife crisis. So things can happen that are out of your control. So often I have patients come in who were “just” eating a bagel, a piece of bread, and BAM….tooth broken. Teeth can break. There are reasons why, but generally that last thing you just ate was not the reason but rather the straw that broke the camel’s back.

Sometimes a tooth will break because of a large filling (silver or white) that is within the tooth and the enamel just can’t hold it anymore. Another reason would be that there is decay that is so extensive, that the tooth is weakened and cracks. We can go on and on and on…and on, but the bottom line is let’s stop asking why, and let’s talk about how we can fix all this! I mean really, who cares why (except dental nerds like me). You as a patient wants to know how we can fix it….and YOU WANT to fix it.

Cosmetic Dentist Fort Lauderdale

One of the easiest options would be to fill the tooth. Realistically, this rarely happens. The tooth breaks to such a point that a cusp is missing, and a filling won’t suffice. But hey miracles happen, and maybe you luck out. Other times a crown is warranted. A crown is where we make a smaller version of your tooth. We take an impression of it, and a lab creates a tooth that looks like what you once had. Generally, this is what happens, and maybe 85% of the time, this is what I can do for you in your office.

Now let’s go with some more severe cases. If the tooth had such severe decay that the tooth broke, you may need a root canal in addition to the crown. People tend to freak out about the term, “root canal,” but it’s not as bad as your friends will tell you. Your friends at times can be your worst enemy, but in the hands of a qualified endodontist (a term for a specialist in root canals), your root canal will be no harder than performing a filling. After the tooth is treated, you will need a crown. The main reason is because there is so much tooth structure lost, you need something to protect that tooth that is now in a weakened state.

The last thing is if the tooth is so broken, it can not be saved. If that’s the case, well…you’re looking at a removal. If you remove the tooth, you can do nothing. I mean, it’s in the back, right? WRONG!!! We always want to replace what mother nature gave you. If teeth are taken out and you have spaces, your teeth can shift creating greater complications. Shifting teeth will put more pressure on those other more innocent teeth that never broke, and  potentially cause them to break. Therefore, we always want to replace missing teeth. Your best option will be dental implants, but other options can be partials or a full denture. (Dentures are never sexy. Remember that.)

So look, we want to replace teeth because you got to eat. The ones in the back help you chew, so if you think, “oh it’s just in the back, no biggie,” you are wrong. Teeth in the front rely on teeth in the back for support and vice versa. Don’t ignore the entire package or else you will find far greater problems in the long run. Don’t ignore the problems either thinking it will all get better, or you are afraid of the costs involved. Trust me, it’s always cheaper to fix a problem with your body sooner than later. Furthermore, you will have a better outcome when its fixed ASAP.

From the moment of injury to the moment of treatment, it took me 10 days to get my achilles repaired. I was told, “don’t worry, it’s just a sprain” by the trainer in the gym. Remember to always listen to a professional opinion by someone in the medical or dental field before you rely on friends or someone who moonlights as a trainer when he is not working as a physical therapist. It delayed me significant healing time, and I don’t want this to happen to you and your broken tooth. Replacing a tooth with an implant, as good as they are will never give you back a natural tooth. And repairing an achilles is never the same as when it’s 100%, but we can get you back to almost as good as new.

Photo Credit: Andy Wetherill

Everything You Wanted to Know About Dental Abscess & More…

By Dr. Max Zaslavsky

Abces Parulique
A decayed and broken down tooth, which has undergone pulpal necrosis (death of the tooth pulp). A periapical abscess (i.e. around the apex of the tooth root) has then formed and pus is draining into the mouth via an intraoral sinus (colloquially termed a gumboil).

A dental abscess is the accumulation of pus in a tooth or surrounding areas of a tooth.  Dental abscess is caused by a bacterial infection that leads to a breakdown and inflammation of the tissue in the mouth.  The pus is a thick fluid that contains dead tissue bacteria and white blood cells. The infections usually strike individuals with bad dental health practices and those who have inadequate and improper dental care.

Types of Dental Abcess

  • Gingival– This type of abscess strikes the gum tissue but does not affect either the periodontal ligament or the tooth.
  • Periapical – This is the most commonly occurring type of dental abscess.  Periapical abscess originates from the dental pulp (the center of the tooth) and occurs when a decayed tooth begins to develop a complication. The decay starts to destroy the dentine and enamel which are the tooth’s protective layers.
  • Periodontal – This type of abscess develops in the periodontium (located between the tooth and gum). The abscess can come about due to gum disease that infects and/or inflames the tissues surrounding the teeth. Symptom of periodontal abscess is swelling next to a tooth. This abscess is sometimes called gum boil.

Causes

A tooth cavity is often a breeding ground for bacteria. The bacteria can cause tissue inflammation that can be quite painful. The infection gradually enables pus to form on the infected site causing the pain to become even more severe until the pus ruptures and drains (on its own or through surgical methods).

Symptoms

Dental abscess symptoms include:

  • Vomiting
  • Tooth swelling
  • Face and mouth redness
  • Nausea
  • Tooth loss
  • High fever
  • Diarrhea
  • Chills

Signs

Dental Abscess signs include:

  • Tenderness and difficulty in swallowing or opening your mouth
  • Gum inflammation
  • Cavities
  • The skin where the abscess is located is reddish and inflamed.

Treatments

If you exhibit dental abscess symptoms you need to consult with a dentist as quickly as possible to avoid pain and complications. The pus is drained by the dentist helping relieve the pain. The dentist may prescribe antibiotics to treat leftover infection.

Periapical abscess may entail a root canal procedure. The root canal procedure is to salvage and restore the diseased inner part of the tooth. This helps prevent the abscess from recurring.

A periodontal abscess will require the dentist to clean the site where the abscess had developed.  The dentist will likewise repair the root surfaces of the tooth to enable the gum to close back on the tooth and cause the pocket to disappear. This will help prevent the infection from coming back.

Prevention

The main reasons for the rise of dental abscesses are tooth decay, gum disease or a combination of the two. They can be prevented by limiting sugary drinks, avoidance of smoking and alcohol, and proper oral hygiene (brushing and flossing).