We offer thorough check-ups and analysis of the bacteria in your saliva for determining decay and periodontal risk.

Tooth decay and gum disease is caused by specific species of bacteria. These bacteria can be detected in your saliva through microscopic and DNA analyses. We can also test these bacteria for antibiotic resistance so that if antibiotics are appropriate for your therapy we can pick the most effective one and minimize your dosage.

 Preventive dentistry is based upon sound diagnosis.

The species of bacteria that cause cavities and gum disease are different. Mechanical cleaning of your teeth with regular dental cleanings, flossing and brushing will help get rid of all the species of bacteria. Chemotherapy with mouthwashes, however, is specific to the species of bacteria we want to primarily eliminate. There are two types of mouthwashes: 1) those that are directed towards eliminating the bacteria associated with cavities and 2) those that are directed towards eliminating the bacteria associated with gum disease. These mouthwashes should be used twice a day, everyday, after flossing and brushing.

Any over the counter mouthwash with Fluoride is effective in reducing cavities. Some brand names include Act or Fluorigard but generic Fluoride mouthwashes will work as well. We typically recommend Fluoride mouthwashes for children under age 18 and adults who are experiencing a lot of new cavities.

There are only two mouthwashes, however, which have been scientifically proven to reduce the bacteria associated with gum disease: Peridex and Listerine. Peridex is an expensive ($18/bottle) prescription mouthwash that is significantly more effective than Listerine but has side effects, most notably tooth stains develop which can be removed by dental cleanings. We recommend Peridex for patients who have more advanced gum problems. Listerine (or Listerine Mint Flavor, or generic equivalents of Listerine) is the only other mouthwash on the market which is effective in fighting gum disease and is the product we recommend for most adults who are not experiencing a lot of new cavities. Other mouthwashes, e.g. Plax, Scope or generics, have not been shown to be clinically effective.

Gum tissue is very influenced by female hormones.  There is a lot of scientific literature on gums becoming inflammed and/or bleeding during a certain point of the menstrual (PMS) cycle.  Pregnant women may also notice that their gums will begin to hurt and/or bleed.  Keeping your gums clean with regular dental flossing, Listerine (or generic equivalent) mouthwash and regular professional dental cleanings should greatly help reduce this discomfort and bleeding for those women whose gums are otherwise healthy.  Women who have more severe gums problems should seek out a periodontist (gum specialist).

It is also worth noting that phobic, i.e. fearful, female dental patients might want to avoid dental cleanings during the time in their menstrual cycle that their gum tissue is most sensitive.

     Periodontics (Gum Therapy) treats bad breath, swollen and/or bleeding gums and a bad taste in the mouth that is caused by bacterial infection.  A Periodontist is the dental specialist who treats gum disease.

     Many patients are mistaken in their belief that dental cleanings are trivial and high volume managed care insurance offices are sufficient for this kind of work.  The truth is the skills of individual hygienists vary as greatly as those of dentists and high volume offices will typically schedule patients in 15 – 30 minute time slots whereas premium practices will typically schedule patients for one hour.  (Who has time to sterilize the room between patients??)  If bacteria is left behind after a poorly performed cleaning then the ravages of tooth decay and gum disease may progress unnoticed by the naked eye.  Patients may only begin to notice years after the damage has occurred.  A Periodontist should be available to diagnose these problems early especially since most dentists fail to diagnose gum disease.

     A combination of early gum disease diagnosis, early preventive therapy and bacterial cultures with species-specific antibiotic regimens should dramatically reduce the need for gum surgery in a premium, conservative periodontal practice.  Our practice sends cultures to the Oral Microbiology Testing Lab at Temple University School of Dentistry.  Our office is relatively rare in providing this service but the reader will agree after a review of the literature on the National Institute of Health's U.S. Government website (www.NIH.gov).  The results we obtain are quite significant.

     If a patient still needs gum surgery then all the initial preventive care described above should dramatically reduce the amount of teeth involved. 

     There has been a lot of recent press regarding the relationship between periodontal and cardiovascular (heart) and other diseases.  There is a lot of truth to this and is one reason why we have been obtaining periodontal bacterial cultures of our patients for 23 years.  It is logical that the presence of chronic bacterial infection anywhere in your body is unhealthy; why leave it in your mouth?  Again, refer to the NIH website to review  'periodontal and cardiovascular disease' for an unbiased, scientific opinion.  Most patients in our office who demonstrate significant periodontal infection are referred to an internist and cardiologist for examination.

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

     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 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

Bleeding - A few drops of blood in you mouth will turn your saliva red.  Don't panic!  What you might see in your mouth is red saliva not real bleeding.  It is ok if you swallow your own blood; it's part of you!  The best thing to prevent bleeding is pressure, e.g. biting on the cotton we gave you or Kleenex.  Caffeinated tea bags like Lipton or Tetley contain Tannic Acid that is a good blood clotting agent. You could wrap a moistened tea bag in cotton or tissue and gently bite on it.  Never spit!  This is the worst thing you can do because it will create a vacuum in your mouth that will make you bleed!  If you must get rid of the red saliva in you mouth you may occasionally wipe your mouth with tissue.

When you brush your teeth for the first few days post operatively, avoid the wound and instead of spitting out the toothpaste let it gently (and gracefully) fall out of your mouth.  You might want to use an old pillowcase and sheets for the first few nights because you might drool a little red saliva at night.

Smokers should refrain from smoking during healing because this does delay healing, but if you must smoke don't inhale!  This was good enough for President Clinton and more importantly, inhaling will create a vacuum in your mouth (like spitting) and might make you bleed.

ICE - Use it for the first couple of days.  Ten minutes on then off, as much as possible while watching t.v.  Ice will help minimize swelling if it does occur.

DRUGS- Take them if necessary!  Two types:  antibiotics and pain relievers.

1.  Antibiotics - For example, Penicillin, Erythromycin or Tetracycline may be prescribed following certain surgical procedures four times a day for the week following surgery.    You will be informed following your surgery if antibiotics will be necessary for you.  Ladies taking birth control pills should inform their Ob/Gyn who might recommend additional birth control procedures during that cycle because some antibiotics decrease the effectiveness of The Pill.  The antibiotic may be used to ensure that the surgical site does not become infected.  It is a precaution worth taking.  Be sure you have made us aware if you have any antibiotic allergies!

2.  Pain relievers - Two types; an anti-inflammatory pain reliever, e.g. Advil or Motrin and a narcotic, e.g. Percocet.

1. Anti-inflammatory (ibuprofen) pain relievers like Advil or Motrin (Not Tylenol!) inhibit prostaglandin synthesis that is an early event in your body's pain response to surgery.  Take Advil or Motrin immediately after surgery.  Then take one or two tablets every six hours up to the daily maximum listed on the bottle for the next several days.  Take this recommended dosage even if you don't have pain because this will significantly help prevent you from feeling pain in the first place!  If you wait to first feel the pain you have lost the anti-inflammatory advantage.  Although these products do not contain aspirin some cross-reactions may occur in aspirin sensitive patients!  If you are sensitive to aspirin you should take Tylenol instead but you give up the anti-inflammatory benefit Advil or Motrin provide.  You should not drink alcohol with these drugs because in combination they can be highly toxic to your liver!

2. Narcotic pain relievers - Typically this will be Percocet that is similar to Percodan but it does not contain aspirin.  Take one tablet every four to six hours for pain, if your Advil or Motrin are not providing you with an adequate amount of pain relief.  Percocet may be taken along with these non-narcotic pain relievers.  Do not drink alcohol, take other medications without approval, and perform activities that require eye-hand coordination or drive a motor vehicle when taking this narcotic.

 Drug Dosage - The antibiotics, anti-inflammatory pain relievers and narcotics can be taken together but some people might find they get a sensitive stomach.  Drugs are easier to handle with food in your stomach.  Some patients might vomit around their second postoperative day; this is almost always from the medication and rarely from the surgery itself.  If this happens spread out your pill taking to give your stomach a break.  Eat smaller meals to stay nourished and avoid taking all of your pills at the same time.  If you do vomit, you could reduce your drug dosages a little, e.g. take only two or three antibiotic pills a day or take a little less Advil or Percocet.

 Drug Warnings - Don't drive your car!  Avoid alcohol!  Patients who take other medications, have drug allergies, or who have other medical conditions should speak with me directly for special info!

 Swelling And Skin Discoloration - This may occur following any surgery.  You might even notice the glands under your neck becoming a little enlarged as they drain from the surgical site.  Mild swelling is normal.  If you think your swelling might be excessive, or it is still increasing after several days, call!  Your skin might discolor black and blue or sometimes purple, green or yellow.  Wear all white or all black clothing so you don't clash!

 Nourishment - Eat numerous small meals to stay nourished, tons of ice cream if you want-hooray!  Drink plenty of liquids to stay hydrated.  If you become dehydrated and undernourished you will not feel nearly as well.

 Mouth Washing - For the first week post operatively you may rinse with 50% Hydrogen Peroxide and 50% water several times a day.  Afterwards you should rinse with just plain water to get rid of the peroxide taste.  Remember not to spit - just let the mouthwash fall out of your mouth.  (I only recommend peroxide rinses following surgery not as a routine mouthwash).

 Your Tongue And Lips - They are your friends!  Be careful not to bite them until you have regained full sensation from the Novocaine.

 Your Nose - If you have had surgery on your upper jaw try to avoid blowing your nose for the first few weeks after surgery.  Hard nose blowing could disturb the newly forming blood clot and make you bleed.

 Stitches - You may, or may not, receive stitches (sutures) following oral surgery.  If you do receive stitches we usually use a type that resorbs (dissolves) over two to three weeks without intervention.  Sometimes these stitches will begin to hang loosely around the wound and you may feel more comfortable if you return to the office for their removal; this should only take a few minutes and is painless.  Please be sure to confirm the type of stitches we use after your specific oral surgery.  Thanks, RS!

 Questions???? - Call!  Get some rest.

     An apicoectomy is a surgical procedure that attempts to remove infection from the tip of the tooth root (apex) that is inside the jawbone.  This infection may be present in the absence of pain.  X-ray evidence usually shows an unresolved, black circle around the tooth long after the initial root canal therapy was performed.  Sometimes a fistula, or pimple, might be present in the gum. 

      An apicoectomy is usually performed only after traditional root canal therapy has failed.  It might be necessary even when root canal therapy objectively appears well done.  It should not be attempted unless re-treatment of the root canal through traditional root canal therapy is inadvisable.  A filling material like silver, IRM or MTA is usually placed in the root tip after removal of the infected area.

      The long-term success rate or prognosis for a tooth is significantly reduced when an apicoectomy is needed.  Apicoectomy is more difficult to perform in posterior teeth because of difficulty in vision, surgical access and the complexity of multi-rooted teeth.  An endodontist (root canal specialist) or oral surgeon is typically most skilled in this type of procedure.

To see photographs of an apicoectomy click on 'Dental Photos' at the top of this page and then click on 'Apicoectomy' in the left margin.  There are hundreds of photographs in this section.

     This technique is described here because it is not typically found in many popular dental implant texts.  The technique was developed by Dr. Gustav Dahl in the 1940's.  It is worth studying for those who desire a more complete understanding of implant dentistry.  Photographs may be seen in the Color Photo Atlas on the top of this page under the Implant section.

     Intramucosal implant snapinserts are mushroom-shaped titanium projections which are attached with cold cure acrylic to the palatal side of a removable full or partial denture.  They can only be used in the maxilla because the snapinserts require significant thickness of palatal attached gingiva receptor sites.  The resultant connective tissue encapsulation around the mushroom-shaped insert heads result in mechanical retention of the prosthesis.  The divergent paths of insertion lead to a secondary mode of retention and stability.

     Snapinserts are used for additional security and retention with properly fitting and well constructed dentures, which have already been worn and adjusted.  Patients should have a complete opposing occlusion.  Palatal tissues should be firm and healthy.

     Site selection for each insert is determined on the palatal side of the denture after verifying there are not palatal soft tissue contraindications.  An acrylic receptor site bur is used to prepare sites within the denture for placement and attachment of the 12-14 insert bases.  One row of three to four inserts are placed on the crest of the ridge, from the canine to the tuberosity. Another row of three inserts are placed along the junction of the palate and the alveolar ridge in a staggered fashion.  The perimeter around each prepared insert base location is coated with dye from a purple denture transfer stick. 

     The patient's palate is dried with gauze and is then instructed to close hard with the denture in place.  The dye around each base site provide exact transfer of crest and palatal slope sites.  Twelve to fourteen circles representing the snapinsert locations in the denture should be outlined in purple on the patient's palate.  A few drops of a local anesthetic with 1:100,000 epinephrine can be injected into each site. 

     A tissue receptor site bur is used at right angles to prepare a tissue channel in the center of each tissue site.  The sites should be chosen where there is thick underlying tissue.  If the palatal tissue is too thin at any given implant receptor site, the patient will experience pain when chewing or occluding because the head of the implant will push through the gingiva into crestal bone.  That particular implant can be removed from the denture without loss of retention.

     A tissue undercut bur is used to create an undercut in the tissues at the top of each insert channel.  This undercut corresponds to the head of each insert.  This bur is rotated only AFTER it is placed deeply into the tissue receptor site.  This will create a female mushroom-shaped tissue receptor site that will retain the male mushroom-shaped implant.

      An ac rylic trim bur may be used to remove residual cold cure acrylic after it has hardened around the snapinserts in the denture.  A small round bur is also helpful.

      If the clinician finds that after putting the snapinserts into the denture they are unable to reseat the denture properly they should examine the path of draw of the snapinserts.  Some divergence of the snapinserts between those on the ridge crest and those on the palatal junction is desired for maximum retention but if it is too great it will keep the denture from reseating.  The clinician should remove the offending snapinsert and adjust the angulation before replacing it.

      The patient should try to keep their teeth closed as much as possible for the next several weeks after the snapinserts are placed and to avoid chewing hard food.  They should be on Peridex mouth rinse and can swish mouth rinse under the their denture to clean under it.  They can also direct an oral irrigator under the denture to clean it.  They should not remove the denture under any circumstances.  It takes between three to six weeks for the palatal epithelium and connective tissue to properly heal around snapinsert heads so it is essential for both the clinician and patient to refrain from removing the denture because this will tear the newly formed epithelium and connective tissue.  The patient should experience little postoperative pain.

     T he palate of the denture may be removed after two months if the patient desires.  The clinician should attempt to minimize the frequency of removal of the snapinsert retained denture because this will adversely affect retention.  The connective tissue in which the snapinserts are retained are torn each time the denture is removed.

      Snapinserts typically come in two sizes with corresponding burs.  It is recommended that the clinician first try this procedure with the smaller snapinserts because if there is inadequate retention around any given snapinsert the clinician may remove that one and prepare both the tissue and the denture with a larger one.

      Some clinicians perform this procedure using trial snapinserts which allow nonfunctional healing analogous to two stage endosteal screws but this is usually not necessary.  This technique involves placement of trial snap inserts into the tissue receptor sites without them being attached to the palatal side of the denture.  The tissue is allowed to heal for several weeks before the trial snapinserts are removed and the regular snapinserts are attached to the denture.

     The trial snapinserts have very thin metal bases which  should be flush with the tissue when properly seated.  The prepared base receptor sites in the prosthesis are then filled in with a soft tissue conditioner.  A denture adhesive is applied to the maxillary prosthesis and inserted over the trial snapinserts.   

     In six weeks the snapinsert receptor sites are cleaned and the tissue conditioner is removed.  The final snapinserts are attached to the previously prepared base site locations with cold cure acrylic resin.  Local anesthetic is often not needed during this second appointment.  The prosthesis is then placed into the mouth, and the final snapinserts should go into the healed tissue receptor sites.  The occlusion and periphery is checked to make sure that the prosthesis is completely seated and stabile.

     The intramucosal implant snapinsert denture can provide significant mechanical retention in the maxilla and should be considered a viable treatment option.  It is relatively simple, quick, minimally invasive and easily reversible.

To see photographs of this technique click on "Dental Photos" at the top of this page and then click on 'Implants, Intramucosal.' There are hundreds of photographs in this section.

There are three broad classes of periodontal (gum) therapy for treatment of gum disease:

1.  Dental cleaning (prophylaxis or prophy)
2.  Scaling & Root planing (SRP)
3.  Periodontal (gum) surgery

A dental cleaning is what one typically receives at a six-month check-up.  It is appropriate for those who maintain excellent home oral hygiene and have minimal gum pocket depths around their teeth.  Patients should be aware that calling to schedule a 'check-up' doesn't necessarily mean that one desires a cleaning.  A check-up could mean just x-rays and exam.

Scaling & root planing (SRP) is usually recommended when one needs more work than a typical cleaning.  This may be due to lack of adequate home oral hygiene, high sugar diet, deeper gum pocket depths around teeth or more extensive dental work that might inhibit access for a regular cleaning.  Root planing & scaling is usually divided into two to four office visits.  Novocain is frequently used since this cleaning will attempt to get to the full depth of the deeper gum pockets.  This procedure usually involves minimal pain and one should expect to resume social and professional activities later that same night and certainly the next day.  Most people feel a tremendous difference in how much cleaner their mouth feels and how much fresher is their breath.  The benefit can be quite profound and immediate.

Three to six months after completing the RP&S the periodontist would perform a reevaluation examination and would usually recommend one of the following:

1) Go back to regular cleanings but at a frequency of every three, not every six months,
2) Repeat the scaling & root planing, or,
3) Periodontal surgery is indicated for either the whole mouth or just refractory sections.

Periodontal surgery is similar to that performed during root planing & scaling except that the periodontist actually cuts the gum and moves it out of the way during the procedure.  This allows him or her direct vision to really see the problem and direct mechanical access to attempt to clean and repair the diseased tissue.

Microbiologic testing will frequently provide valuable information regarding the species of pathogens that compose a gum infection.  When appropriate, it should be done before RP&S or surgery.  Local or systemic chemotherapy, typically antibiotics, can be very beneficial in these cases.

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

1.      Some soreness is normal during the first few days after braces are bonded or tightened.  Use a pain reliever that you are medically allowed to take, such as Advil or Tylenol, to control any discomfort that may occur.  If pain persists one hour after taking a pain reliever, you may also take a prescribed narcotic.  Remember that you cannot drive a car, drink alcohol or mix this with other prescription drugs without permission.  And remember to keep narcotic medications away from children.

2.      Careful attention to good oral hygiene is especially important for those wearing braces. Cleanings with our hygienists should be scheduled every three months during orthodontic treatment. Proper brushing with a soft toothbrush and proxabrush after each meal and before bedtime is necessary. You must floss daily using Flossthreaders and use Listerine (or generic equivalent) twice daily.  Substantial tooth damage can occur if you neglect your oral hygiene during braces.

3.      Keeping regularly scheduled orthodontic appointments is essential.  Broken appointments increase treatment time and expense while following the recommendations of the orthodontist may shorten your treatment time.

4.      You will experience loose teeth throughout treatment as the braces move teeth into their new position.  This will be particularly noticeable when the orthodontic wires are changed at most visits. Don’t worry.

5.      Always use orthodontic wax (or a tiny amount of tissue paper) to cover any sharp edges or wires during the first few months of treatment.  Otherwise you might get tiny, annoying cuts in your mouth.  If this occurs rinse with half hydrogen peroxide and half water to clean the wound and thin rinse out with water.  Do this several times a day.  Then cover any sharp edges or wires…

6.      Cut food into small pieces and chew carefully to avoid breaking, bending or loosening your braces.  Eat a healthy diet. Drink lots of water!  AVOID ALL STICKY, CHEWY OR HARD FOODS like:

Chewing Gum (even sugarless)          Hard chips or cookies

Pop corn, caramel corn, nuts               Chewing on ice

Hard rolls, pizza crusts, bagels            Raw vegetables and firm fruit like apples

Hard or Sticky Candy                          Sucking on lemons or limes

Sugary carbonated drinks or fruit juices

7.      Do not pick at your braces with your fingers or play with them with the tongue.  Please notify the office if a bracket or tooth band comes off so that your next appointment time may be extended.  It is usually not an emergency and can be left until your next visit as comfort allows.

8.      If you have questions about your braces, please contact us if you are a patient currently under our care.

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 performs these surgeries in our office. 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.