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My neighbor recently returned from a foreign country where he had extensive dental work done. He says he saved a lot of money by doing this. Isn’t having dental work done out of this country a bit risky?

added on: January 20, 2012

This country enjoys one of the highest standards of dental care in the world. There are some countries that have care equal too that in the U.S. but those are not the places where dental tourism occurs. In countries such as Switzerland the costs of dental care can be much higher than here in New York. I have seen many cases of foreign dentists coming to the United States and attempting to gain licensure here. If they can pass the pre-requisites they then need to take the entire dental program over again. Our dental educational program is very rigorous and each student must take arduous national boards.

If a patient has dental work done out of the country, what recourse do they have when things go wrong? State dental boards have peer review groups that oversee breakdowns in doctor/patient relationships and act as patient advocates in recouping losses when needed. Good luck seeking legal council against dentists outside of our borders. Unfortunately, I have had to inform patients of their need to replace all or most of their dental work done abroad. The pinch in their expense account pales in comparison to their anger and frustration about having to go through the whole process again.

I need to have my teeth fixed with crowns and some veneers. I am anxious about this because I want to make sure they really look natural on me. How can I make sure I will be happy with them.

added on: January 20, 2012

The best way to ensure that the patient is completely satisfied with what they will ultimately have in their mouths for a very long time is to have custom temporaries placed on the teeth. These are the same as the final product but made out of acrylic. Not only will you be able to see how they will look, but you will also be able to evaluate how you will chew and speak with them. The temporaries look and feel almost exactly like the final product except they are made out of a material that won’t last as long.

The other benefit to having these temporaries is that this is the best tool for the dentist to use in communicating exactly to the laboratory the details such as shade and shape. Dental photos and a model of the temporaries is sent to the lab ensuring that the final restorations are exactly what you are expecting.

I have always thought that my smile showed my gums too much. I try to avoid smiling too wide but whenever I see myself in a photograph all I see is gums. Is there something we can do about this?

added on: January 20, 2012

Your situation is quite common and easy to change. We have very specific parameters for evaluating a person’s smile. They include how much of the upper teeth show in a smile, the person’s age, the curvature of the smile line, and how much gum tissue shows. When a person shows too much gum we evaluate for two possibilities. One is when there is a large amount of tissue covering over the natural tooth that disguises what would ordinarily be a very pleasing smile with a normal amount of gum showing. The second possibility is when the whole tooth shows but there is still a large amount of gum tissue visible in the smile. In either case, a simple procedure called crown lengthening is done where the gum tissue is pulled higher. This is not an arbitrary amount as usually a guide is made mapping the exact amount and position that the patient and doctor agree on beforehand. If the second scenario exists the crown lengthening is followed by restoring the newly exposed tooth roots to provide a spectacularly beautiful result!

A recent article in the New York Times discussed a new technology in dentistry called cone beam radiology. The use of this is increasing greatly due to heavy promotion by manufacturers despite its use of greater levels of radiation than any other modality in dentistry. How can a patient be certain what’s best for them?

added on: January 20, 2012

Many points in this article ring true. This technology provides greater diagnostic accuracy combined with incredibly detailed three dimensional images which can aide in many procedures. However, it does expose an individual to much higher dosages of radiation than any other images taken in dentistry. This can seem ironic since there has been a big push in dentistry to switch to digital radiography over convention films since the exposure rates are orders of magnitude lower in radiation.

Cone beam images have their strength in the delicate area of implant placement where its use allows prosthetics to be placed more safely and accurately. The uses of cone beam in orthodontics and endodontics are still in their infancy though claims are made of faster and more predictable results. That said, exposure of any patient to this level of technology should involve a thorough discussion to satisfactorily allow a patient to make an informed decision before consenting to treatment.

My retired parents recently went to a new dentist in the area they relocated to. The whole family was shocked to hear they have so many cavities since they have always been regular dental patients. How can we know if this diagnosis is correct?

added on: January 20, 2012

Trust is paramount in a doctor/patient relationship. Word of mouth referrals can strengthen the trust factor but sometimes some element of doubt can persist. Perhaps because of our changing world devices have been created which can verify the doctor’s words. Caries detection devices not only make the job of detecting a cavity easier for the dentist. They make it so that the patient can actually see on a screen where the cavity is and to a certain extent, how bad the cavity is. Seeing is believing when these devices make healthy teeth look green on camera and the cavity looks red. Both patient and doctor can now rest assured.

If your parents are seeking another opinion it may be to their benefit to inquire if the office has one of these devices.

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