Dr. Michael Sinkin, D.D.S.
Dr. Sinkin's Blog: The Dental And The Incidental

Summer’s End

September 11th, 2014 by | No Comments »

With the flip of a calendar page and the start of September, we say good-bye to yet another summer. I have already a perceived an amplified buzz both on city streets and below them-the crowds have returned to the subway platforms.  West End Avenue has a steady stream of school buses and the street corners are decorated with school-bound children, some of them clad in the required plaid dress or mandatory white shirt and khakis; others wearing clothing of their own choosing or of their mothers.

Yes, summer is over and autumn is on its way and along with this changeover comes a palpable increase in activity. People are returning to their offices fresh from summer vacation wearing their “game faces” (albeit tanned) and ties, knowing that it’s back to the grindstone. (That’s maybe not the best idiom to use in a dental blog.)

The summer of 2014 is over. But, what an eventful summer it has been in our office! It all started with Barbara’s retirement at the end of June. This, of course, was preceded by months of preparation and interviews. Barbara was instrumental in helping me find her successor. And while I knew that I could count on her to leave me and the office in good stead, I am both excited and relieved that what could have been a harrowing gut-wrenching (my gut) experience has been more like a well- orchestrated dance, admittedly with some missed beats and missteps along the way.

I am thrilled to have Sandra Rolon on board as my new office manager and look forward to an enthusiastic collaboration committed to improving our ability to offer quality care in our characteristically caring manner.

As an aside, Sandra is the “go to person” should you have any questions about the practice, etc.

This summer also saw the completion of my first year of studies at NYU College of Dentistry’s dental implant program. It was nothing short of fantastic. I have gained far more than I ever could have anticipated and far more than the knowledge and surgical skills that I have acquired. Strangely, this is the first time in my life as a student that I was sorry to see classes end. Classes start up again on September 10th…I’m so psyched.

Another big change that occurred this summer was assuming control of my entire office space. I now have more flexibility, more elbow room, and another room to hideout.

Thankfully, we had a very busy summer treating our patients while all this other stuff was going on. While it wasn’t a particularly hot summer, our new air-conditioning system worked like a charm and I feel that it’s far easier for my staff to wear sweaters than it is for me to turn up the thermostat.

In addition, FIOS has come to our building, so not only can you get WIFI, you can watch whatever you want during your visit (you can even control the remote)!

 

 

 

 

 

 

 

On a personal note, my wife and I celebrated summer’s end by  going on our first two-week vacation (alone!!!!) since 1986. Our last two-week vacation (with children) was fifteen years ago. No special occasion, just a deep sense that it was about time we indulged ourselves. (Besides, my skiing injury this winter dashed any plans for a winter getaway.)

We took a five-day gourmet bike tour through the Loire Valley in France. It’s really a brilliant concept: eat three meals a day (including an outrageous gourmet French dinner) totally guilt-free because you’re biking 35 miles per day. The countryside was magnificent with endless fields of sunflowers, vineyards and innumerable chateaux with otherworldly gardens. What was an unexpected and pleasant surprise was that Ann and I were the only ones on the tour (with the exception of our two guides)!

We then spent four days driving through the south of France. We ended up in Barcelona where we spent the rest of our trip. It was a very special and adventurous experience for both of us. It’s kind of nice to be able to hang out with your spouse 24/7 for fifteen days and truly enjoy each other’s company. Even after 32 years of marriage.

We also got our first three stamps in our new passports. Not that our expired passport had all that many more.

Summer is my favorite season. Summer vacations are simply the best. A vacation is an opportunity for a time out. It’s a chance to take a break from your day-to-day life, and experience something different. It’s also a chance to recharge the battery.

Surprisingly, two weeks eventually seemed like a long time to be away. By day twelve I was looking forward to my return home. Mind you, I wasn’t wishing my vacation was over…I was having a great time. I was just mindful and appreciative that while I was truly in the moment of being away and enjoying our time abroad, I enjoy my life back home.

 

 

 

 

 

 

So summer is over. I’m happy to be back in the office caring for my patients with my wonderful office staff. I am looking forward to working with my new office manager Sandra, and developing a close professional relationship with her for the betterment of my practice. And I can’t wait for school to begin (as an upperclassman no less).

It’s time to put on my game face….but then again, I never really took it off!

 

 

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WHY A TOOTHACHE HURTS SO MUCH

August 14th, 2014 by | No Comments »

why does a toothache hurt so much?

There is a phenomenon known all too well by dentists in private practice – the predictably unpredictable dental emergency that requires immediate attention. All too frequently, the patient who calls my office with an urgent problem, had an inkling that something was amiss for quite awhile. But he or she often delayed making the call in the the hopes that said problem would dissipate given enough time.

Yet, when necessity dictates immediate action (i.e. “I can’t take this pain any longer!”) and the call for help is made, yesterday is never soon enough. The patient in acute distress is ready to drop everything to get relief, regardless of time demands. My office staff will “move mountains” (or at least juggle the schedule) to make me available.

Why Toothaches Hurt So Much

A severe toothache can be a harrowing experience, and is in many ways unique from your body’s other aches and pains. The intensity of tooth pain can be extraordinary with severity rivaling true neuralgia (intense neurological pain of almost unparalleled proportions).

And, a painful tooth is literally in your head. That fact offers you little opportunity to find a comfortable position for to neutralize the waves of discomfort, as opposed to a painfully sprained foot, for example, which you can elevate and use ice packs to get some sort of reprieve. Additionally, your teeth have an abundance of neural connections to the pain centers in the brain. This seems to amplify the noxious “distress signals.”

The face and head, including your teeth, are richly served by the nervous system and make for an exquisitely sensitive and responsive anatomic region.

This is one of the “benefits” of being at the top of the evolutionary ladder.

For all that make your teeth especially sensitive to painful stimuli, they are also much like any other part of the body; namely, they can experience transient discomfort that can dissipate almost as quickly as it arises. Aches and pains are a part of an active lifestyle (at least for those of us over 40!) so why should teeth be any different? I’m sure you are familiar with the a sudden wince when biting into something unexpectedly hard, or the piercing jolt when chewing ice cold fruit or taking too big a mouthful of ice cream.

But equally familiar is the agony of a stubbed toe. In most cases, no real damage is done, but the painful sensation is no less real. A stubbed toe need not be broken to hurt and similarly a traumatized tooth that encountered a foreign object during the chewing cycle need not be cracked (as in broken or split) for you to experience pain.

With all of that said, your teeth are unique “organs.” Within the body of each tooth lies the dental pulp, commonly thought of as the nerve of the tooth. In actuality, the dental pulp is more complex than that. It contains specialized cells that form tooth structure, blood vessels that nourish the tooth, connective tissue, and nerve fibers. Unlike other parts of the body, the delicate blood supply to the dental pulp is limited by a tiny opening in the tip of the root and the rigid walls of the tooth itself.

But teeth do not respond to trauma in the same way as other parts of your body. When you stub your toe or bruise yourself, the injury is mitigated by a robust blood supply that aids in the inflammatory and healing response. Swelling is a natural part of this process, which in time will recede, in large part because of the increased circulation to the area.

But because your tooth is a solid closed container, the blood supply is restricted and confined. If the injurious insult such as a broken filling, a chipped tooth, or early to moderate decay, is not too severe, the dental pulp may be able to respond adequately to the challenge and maintain its vitality.

On the other hand, if the trauma (severe physical damage, deep decay, gum disease, etc.) is extreme, your tooth’s circulatory system is not flexible enough to cope with the noxious threat. This can lead to cell death, pulp necrosis and even abscess formation (infection). Yuck.

What’s more dental nerves do not feel heat, cold, sweets, or touch. When the dental nerve is stimulated, its response is pain. While dentists may test a tooth’s status by using various stimuli including thermal testing and biting pressure to diagnose a dental problem, any reaction to such stimuli is pain. What stimulus the tooth responds to and how long the discomfort lingers is often diagnostic to the status of the pulp/nerve and helps determine the appropriate treatment which can be a bite adjustment, desensitizing application, a filling, a crown, the root canal, etc.

I written numerous blogs about dental issues including tooth related problems (5 Ways To Get Relief For A Toothache, Cracked Tooth Syndrome, 7 Home Remedies For A Toothache, to name a few) which have brought thousands of visitors to my website. Consequently, I have also been the recipient of hundreds of comments from people around the world who are dealing with dental emergencies.

The vast majority of these correspondences are questions about pain and what to do about it. Of course my responses only can be of a generic nature because I don’t have the luxury of a clinical evaluation, but the urgency, and often the desperation, conveyed is troubling. I can only offer what I believe to be useful information, professional guidance, and encouragement to seek dental care. Unfortunately, what I am unable to offer is a dental miracle.

Dental pain can be disabling. When confronted with a toothache, a visit to the dentist is warranted. And while this may seem self-evident, many of the inquiries I receive express trepidation about seeing a dentist. In fact, national statistics demonstrate a steady and dramatic rise in the number of dental emergencies being seen in hospital emergency rooms, as opposed to dental offices or clinics. Not only is this a more costly approach to dental care, it is largely ineffective because hospitals will usually only dispense pain medication and antibiotics without treating the actual cause of the problem.

Emergency relief of tooth pain can be likened to first aid with definitive care (root canal, crown, extraction, etc.) being deferred until after the immediate crisis is alleviated and it is best performed in a dental office.

If you are suffering from a toothache, please seek a dentist’s care as soon as you can. I feel your pain.

 

Dr. Michael Sinkin is a general dentist in New York City. He loves being a dentist and is known throughout the city for taking wonderful care of his patients and for his wicked sense of humor. For more about Dr. Sinkin, click here

 

 

 

 

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Barbara Has Retired

June 29th, 2014 by | No Comments »

This past week marked a huge milestone in the history of my dental practice. Barbara, my trusted office manager, confidant, and ever-present sounding board, retired. For nearly 30 years Barbara was at the front desk; the first person everyone saw when they entered my office, and the last person they saw when they left. An emotional week of good-byes to the dear patients she has known and happily served ended on Thursday June 19.

Barbara’s Last Week

On Monday, in true “Barbara fashion” she brought in her home-baked cupcakes for all who walked through the door. The hostess with the mostests’ wine and cheese buffet greeted Tuesday’s visitors. Thursday featured a plethora of tasty morsels and sangria, too.

On Friday night the entire staff celebrated Barbara with a wonderful dinner party at Carmines. Simultaneously joyous, celebratory, and bittersweet, it was mostly a night where we all got the chance to show our love and gratitude to the veritable Grande Dame of Suite 803.

Throughout the week Barbara was in her glory while reminiscing about past moments in the office and wistfully musing about what lies ahead for her. Following is the tribute I paid to Barbara at her party (minus the “roast” part which shall remain, um, private!).

A Tribute To Barbara

“After the Beatles broke up, George Harrison released an album entitled All Things Must Pass. That album was a nod to one of life’s realities: virtually everything that we experience during our lifetimes has a beginning, and an end. What happens in-between is what we call living. And sometimes things must end before something new can begin.

Tonight, we are here to acknowledge and congratulate Barbara for her retirement from dentistry. This marks the end of a very eventful 50-year career. And we are also here to rejoice and regale in Barbara’s new beginning as she starts the next, as yet unscripted, chapter in her life, unencumbered by the ringing of the alarm clock, the 2-hour commute, and all those subway stairs.

So, we are here tonight to celebrate Barbara, and to thank her for being such an influential force in our lives. And I emphasize the word force!

It was almost 19 years to the day that my path crossed with Barbara’s (or perhaps a more apt description would be “our paths collided!”). Having left my dental partnership of eleven years in Forest Hills, I was experiencing a professional do-over of sorts. When I bought Dr. Pekarne’s practice I was feeling a bit unsure of myself, somewhat vulnerable, and quite unsettled about the financial and personal uncertainties I was facing. But Dr. Pekarne was a kind and gentle soul with whom I felt an immediate connection. His earnest reassurances led me to consummate the deal without ever meeting the staff!

Then I met Barbara. My heart froze.

Barbara was the person upon whom I was going to be most dependent for a successful transition. Within hours of my arrival she and I had our first of many confrontations. I came in with wide-eyed wonder and idealism and Barbara greeted me with scornful cynicism and suspicion. To say we didn’t “hit it off” is an understatement. For weeks, and months, I feared that I’d made a terrible mistake and was consoled only by the notion that one day I could and would fire her.

But time passed (boy, does time pass!) and Barbara and I, still wary of each other’s motives, began to find common ground. We began to trust each other and help each other. We ended up developing a relationship based upon caring. At first, it was all about caring for our patients. Then somewhere along the line, it became about caring about each other.

Over the past 19 years Barbara has been much more than my trusted office manager. She has become even more than a colleague, or even a friend. Barbara is family. During the almost two decades that we worked together, we developed a closeness that boggles the mind. It’s something that could never have been imagined all those years ago. Barbara is devoted, loyal, and loving. She’s always had my back and I’ve always had hers. And despite retiring, she will always be a part of this office.

Barbara, you truly have been the sentimental heart and soul of the practice.

• You have inspired and touched so many with the multitude of special hand-picked cards you sent out to express joy, sorrow, congratulations or just “thinking of you.”

• You remember everyone’s birthday (except Carmen’s, for some reason).

• You instill the office with holiday spirit (for just about every holiday there is) with your creative decorations. I’ve always wondered if you own stock in Hallmark!

• You’ve always been so mindful of the little things. The little things that have transformed a dental office into a place of love.

• And, you convinced me to dress up for Halloween all those years ago and a grand tradition was born. We expect a visit from you ever Halloween (in costume). Remember, you started it!

I only hope that we will be able to emulate your creativity. We will surely continue to reach out and touch our patients in a manner that will make you proud.

So, I would like to raise my glass and propose a toast: To our beloved Barbara: Thank you for your guidance, your wisdom and your love. May this next phase of your life be filled with awe and wonderment, joy and love, good health, and fun.

To Barbara:

Salute!”

 

 

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Toothcrackers: 5 Common Food That Can Crack Your Teeth

June 4th, 2014 by | No Comments »

I can’t recall how many times I have treated a dental emergency stemming from a cracked tooth brought on by an “eating mishap.” Often my patients will state in earnest that they were just eating a salad or something soft when they noticed a chunk of tooth missing or a sharp shard of enamel that has suddenly appeared and is cutting up their tongue. Well, invariably it was not the lettuce, tomato or piece of cheese that inflicted the damaging blow, but rather a more substantial food that cracked a tooth. So unless you like super crunchy croutons, crispy bacon bits or fail to adequately wash the sand from the spinach leaves, enjoy your salads with dental piece of mind. That said, there are foods that have bragging rights for wreaking dental disaster. Here’s my list of the top 5 dietary delectables that are potentially damaging to your dental work and teeth:

1. POPCORN: Innocent enough in their overall fluffy and puffy state and low in calories to boot, popcorn is the quintessential dental destroyer. Sitting in a movie theater or on your couch with freshly popped goodness, you slowly bring these morsels to your mouth with your fingers and begin savoring their deliciousness. As the level of popcorn lowers into the bag, fingerfuls expand to handfuls which produces mouthfuls and that’s when disaster strikes. Mindlessly munching on popcorn, you unsuspectingly chomp down on an un-popped kernel and CRACK GOES A TOOTH.

Teeth often break when in the process of eating something thought to be soft, an unexpected hard object is encountered and the force of impact overcomes a tooth’s integrity. I have seen perfectly healthy teeth with nary a cavity or filling split in half thanks to a wayward corn kernel.

So the lesson here is not to give up popcorn, but rather take your time and know what you’re shoveling into your mouth. Another common dental problem brought on by popcorn consumption is the localized gum abscess caused by a popcorn “shell” getting wedged in the gum. Gently flushing the gum or using a rubber tip to dislodge the popped intruder can often resolve this.

2. OLIVE PITS: A close second to popcorn as a notorious tooth cracker is the wayward olive pit. Whether the pit’s presence is due to poor food processing, poor meal preparation or failure to recognize that the olive to be consumed was in fact not pitted, olive pits break teeth in the same manner that popcorn kernels do their dental damage – unexpectantly chomping down on something hard when only softness in anticipated. Two bits of advice: be mindful of salad bars and be sure your martini olives have pimentos and not pits.

3. BAGUETTES, DUTCH PRETZES, BISCOTTI: Hard crunchy foods have a definite appeal. However, one must be aware: hard crunchy foods are hard and crunchy. The question is which is harder, that which is crunching the treat (your teeth) or what you are crunching with your teeth? Tooth enamel is the hardest substance in the body, but also the most brittle. Teeth with large restorations or fillings are structurally compromised and especially susceptible to fracture when being challenged by something especially hard and dense.

Being mindful of what and how you are biting can spare you from some unnecessary dental grief. Small bites with an initial exploratory nibble can be a wise approach to hard foods. Don’t bite off more than you can chew! Additionally, avoid chewing bones (Buffalo chicken wings, ribs…) especially if you have porcelain veneers or extensive dental work.

4. CANDY: Frozen Milky Way bars, Jawbreakers, Peanut Brittle, rock candy…do I really need to say more? These rock-hard morsels of sweetness were the cravings of my childhood and perhaps a harbinger of my as yet unknown career path. I remember my dad breaking his bridge with his first bite of a Milky Way right out of the freezer…. perhaps another prophesy of my future profession.

But perhaps more insidious and damaging than these very obvious teeth cracking confections are the Nibs, sour balls, lemon drops, Jolly Ranchers and numerous other examples of popular SUCKING CANDIES. The operative word on these delights is sucking, as in allowing them to linger languishly in your mouth as they slowly dissolve and release their sweet essence. But who can really suck on a Tootsie Roll Pop without biting it to get to the chewy chocolate center? I have seen numerous broken teeth in people who just did not have the self-control to NOT BITE THE NIB or NOT CHEW THE CHARMS. Enough said.

Of course one cannot discuss tooth-breaking candy without mentioning such gooey offenders such as Starburst, caramel, taffy, jellybeans and my all-time favorite, Mary Janes. I get a kick out of my patients who come to the office with a crown or filling carefully gift wrapped in tissue that is smothered or encased in some fluorescent-colored sticky glob of goo. Chewy candies have an unparalleled ability to engulf your dental work and yank it out. So stay away.

If temptation gets the better of you and mishap occurs, don’t wrap your dental restoration in tissues. I have seen more than a few people who accidentally threw out their crowns while cleaning out their pockets or purses!

5. FOOD PACKAGING: So you‘re on the go and pick up a little snack-a bag of peanuts or a protein bar.  Or you need to open a small pack of something, anything, but the wrapping is on so damn tight and you don’t have a scissor or knife handy and your finger nail just can’t seem to get under the flap. So what do you do? Well in a moment of absolute determination to get the darn thing open there is nothing handier than your teeth, right? I just saw a patient this past week who ironically tried to bite open a pack of dental stimulators and ended up breaking his tooth!

Teeth are designed for incising, biting and chewing FOOD and not as a replacement for a Swiss Army Knife. Think twice before using your incisors as a kitchen utensil. When it comes to proper care of your teeth, common sense is often overlooked. So here’s a cautionary piece of professional advice:

Before you bite into that green Gobstopper ask yourself…is it really worth it?

 

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Spring: A Time for Renewal

May 13th, 2014 by | No Comments »

So at the time of this writing, it’s been just over a month since we celebrated the Vernal Equinox and the official arrival of Spring.  At least that’s what the calendar tells us. But Mother Nature, in her infinite wisdom or her fiendishly odd sense of humor, has decided to let linger a little longer this already laboriously long and laggard winter. A bit verbose, perhaps? -But no less true. This has been one long and cold winter.  In fact, while the tulips in my garden look lovely, it’s pretty cold out there which is why I’m inside with the heat on.  In fact my neighbors on Fire Island had a lovely fire burning in their living room fireplace last night to offset the chill that still persists even though we are into the month of May.

The harshness of this past winter shuttered many indoors. I can’t recall a winter with so frequent a storm barreling through the Northeast wreaking havoc on mass transportation, forcing schools to close, spurring power outages and (surprise, surprise)…yielding an unprecedented number of weather related appointment cancellations. But despite all the snowy bluster, there was no dearth of activity in and around our office.  There was no hibernating here at 30 East 40th Street.

By the time we enjoyed our first dusting of snow (was that in October?), I was well ensconced in my implant studies at NYU College of Dentistry. For those who are not aware, I went back to school to master implant surgery and bone grafting techniques. It’s a two year program which takes me out of the office every Wednesday for lectures and patient care, not to mention reading assignments and lab work. A major time commitment and I love it (I am 70% sure that I will do an optional 3rd year). So I’ve been very busy with my new routine: getting up early to study, preparing power point presentations for class discussion prior to performing surgery, packing my lunch and trekking over to the school THROUGH THE SNOW. Anyone notice that it seemed to snow mostly on Tuesday nights and Wednesdays?

Just as my academic pursuit fell into a routine, a slight winter-related complication developed. In January, I tore up my knee skiing. No surgery, but a grueling course of physical therapy three times a week (7 AM, MWF). Forty-two sessions so far and counting. Why did it seem to snow more frequently on my days of therapy? Trudging through slush with a cane and a knee brace was no fun. But as the saying goes, gotta keep on keep on-ing.

Amidst all of this, we repainted the office, replaced the office central air-conditioning and after more than 20 years of tenancy, I asked Dr. Alter, the other large dentist in my office, to find other accommodations. He had his own practice and sublet space in my suite since before I arrived.  The time and need had arrived for more room to grow and to accommodate my expanding implant practice.

And of course the biggest winter storm and atmospheric upheaval of the year was Barbara’s announcement that after 28 years in our office (she predated me by 10 years) and 50+ years in dentistry, she was ready to retire. (Say it ain’t so!!!)  Ever- present Barbara: the eyes, the ears, the VOICE of the office, is ready to move on.  Barbara, who so insulated me from the details of “running” the practice, gave me the freedom to immerse myself in the care of my patients without regard or concern for all that other stuff (insurance, billing, scheduling, accounts payable, accounts receivable, payroll, taxes, licensure, management, lunch, etc, etc…). Barbara once asked me if I knew what she did, if I could itemize her job description. I said, “Sure I can, Barbara you do everything.” Except of course the dentistry. More about Barbara to come in a separate posting, but suffice it to say there were times when I wasn’t sure who was who’s boss.

As if I didn’t have enough balls in the air (a juggling metaphor), now I had to search for her replacement. No small task. Of course Barbara was intimately involved in the process but with all that was going on, I was feeling like I had way too much on my plate. So I did the only logical thing I could do-I got a bigger plate.

There’s an old expression that says if you want to get something done, give it to a busy person. As I said before, this has been one very long and active winter. Thankfully, the snow has melted and everything’s coming up roses. After many interviews, we found someone to assume Barbara’s role at the helm. Her name is Sandra and she begins this week. My physical therapy is soon to end and I have plans to start walking to the office again.  My first year of the implant program is almost complete. The office feels more spacious and Spring has finally arrived.

Amen!


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This Letter From A Patient Made Me Cry

April 22nd, 2014 by | 1 Comment »

I received this letter from a patient the other day. I was so touched by it that I just had to share it. This is a perfect example of why I love being a dentist.

 

Dear Dr. Sinkin,

I have been your patient for many years. Your office is so friendly and your staff so attentive and wonderful. I have expressed my gratitude over and over for how you helped me overcome my dental phobia. As a matter of fact, when I needed a filling last month, I didn’t even have one bit of nervousness!

But this time I want to thank you for the incredible transformation that my husband has had because of you.

As you know, my husband has had dental problems his entire life. He has been to many dentists and prosthodontists, but in spite of that, his suffering just got worse. It has broken my heart to observe the pain he has had to deal with, not to mention his inability to eat normally and his embarrassment about the change in his appearance. We felt that there was no hope, and that he would have to live this way for the rest of his life.

But when I met him the other night after his appointment with you, his smile was the first thing I saw. Then I noticed that the pained expression he always has on his face was gone. His mouth was back to its beautiful former shape. And his self-confidence was apparent just by the way he was walking down the street. He was truly a sight for sore eyes. We celebrated by going out for a steak dinner and he actually was able to eat the steak (for the first time in years)!

Words cannot describe how grateful we are that you didn’t give up and kept trying until you found the right solution. You are truly a miracle worker.

 

Thank you, thank you, thank you!

 

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5 Signs That You Need To See A Dentist

March 25th, 2014 by | Comments Off

So many of us lead such busy lives that in reality, it is our busy lives that are leading us. So much so that we are often so preoccupied with our day to day activities and responsibilities that we fail to take care of some of the seemingly more mundane yet no less important things, like taking care of ourselves.

This is especially true for how many people approach their dental health. We are so busy being busy with work, family and other obligations that we push the need for a visit to the dentist off the radar….until a problem rears its head and an emergency dental visit is required. How do you know if you need to see a dentist? These are 5 signs:

1. Bleeding Gums. The fact is that healthy gums do not bleed. Do your eyes bleed when you rub them or your skin bleed you scratch it? Kind of gross imagery…but you get the point. Bleeding gums are a sign of inflammation, which can lead to significant periodontal problems if left untreated (such as gum recession, bone loss, and abscesses!).

Helpful hint: If you want to monitor your gums use white toothpaste. Blood is more easily detected with white toothpaste than when using some of the more colorful gels.

2. Sensitive Teeth. Teeth only possess nerves that perceive pain. An indication that there may be a problem brewing is pain or sensitivity from hot, cold, or sweets. Cavities or defective fillings are common causes of dental discomfort. Plaque build-up can often precipitate sensitivity and a thorough cleaning may be all that is needed to take care of the problem.

Helpful Tip: Using toothpaste like Sensodyne for sensitive teeth may address the problem, but if the sensitivity is a more recent or sudden development, you may be masking the symptoms of a larger problem.

3. Red, Tender, or Swollen Gums. Healthy gums are firm, pink and resilient. They should not hurt or adversely respond to brushing or eating. Swelling and tenderness of the gums are a more advanced state of inflammation than bleeding alone. Food can accumulate in the gum and cause an infection or an acute abscess. This can happen more frequently when the gum tissue loses its healthy architecture because of plaque build-up.

A common area for the gums to become inflamed and swollen is around a partially erupted wisdom tooth. Plaque can accumulate under the gum flap and cause mild to severe discomfort and if left untreated, can lead to an acute infection.

4. Bad Breath (Halitosis). This can be caused by a number of conditions including diet, acid reflux, chronic sinus infection, dry mouth, medication, uncontrolled diabetes and of course gum or periodontal disease. Gum disease and bacterial plaque are the most common causes. Mouthwashes and breath mints are helpful, but may serve to mask the problem. I

Helpful Tip: If people are avoiding close contact with you or are turning their heads away while you are speaking, you may want to take the hint and check it out.

5. Pregnancy. Hormonal changes during pregnancy and the postpartum state can make the gums more reactive to plaque and more susceptible to inflammation. Pregnancy Gingivitis is a common condition that can be controlled or avoided with more frequent cleanings. Additionally, periodontal and gum problems during pregnancy have been associated with low birth weight. So along with regular visits to your obstetrician, don’t forget to see your dentist for the health of you and your baby.

The frequency of emergency dental appointments in a typical general practice is not insignificant. Many of these “unplanned” visits are for people who have never had a dental problem before. I cannot tell you how many times I have treated a dental emergency for someone who put off seeing a dentist simply because he or she was “just too busy.” And, visits are often put of because the patient doesn’t have dental insurance. The reality is this: the time spent and the cost of a routine dental cleaning and checkup is quite reasonable, especially when compared to the price tag of an avoidable root canal and/or crown.

Yes, we lead very busy lives. But be smart! Make time for the dentist.

 

 

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Dental Fear – A Dentist’s Perspective

February 11th, 2014 by | No Comments »

I recently experienced a personal epiphany of sorts regarding the angst, anxiety, if not outright fear of the anticipated pain associated with medical treatment (In my world, this phenomena is commonly known as Dental Fear). This “eureka!” moment of clarity was inspired by pain – my pain – visited upon me (the patient) by a very caring and proficient health professional during still ongoing and regular treatment sessions (every Monday, Wednesday, and Friday at 7am). Waking up at 5:30 in the morning is difficult enough, but, getting-up knowing that I am rising so early for the express purpose of being tortured (my initial visceral feelings as slumber gives way to consciousness) is not the optimal way to start one’s day. And knowing deep down that I am being well cared-for by someone I both like and respect, does not mitigate the dread of what I anticipate.

It was exactly one month ago today that I was happily skiing on the slopes in Steamboat, Colorado. I was in ankle-deep powder, cruising the blues (I don’t do moguls, I don’t do trees, and I don’t push the speed envelope) and gleefully enjoying the Rocky Mountain High when a mishap occurred. I fell with my body going in one direction and my right knee going in the other. Three days later, I was back in New York, and with a knee swollen beyond recognition from a torn medial collateral ligament. The prescribed treatment course: physical therapy, three times per week for at least 8 weeks. Thankfully, no surgery is planned.

Now, I’m no neophyte when it comes to physical therapy. Having had two shoulder surgeries, a torn calf muscle, a dislocated collarbone (another skiing mishap) and arthroscopic neck surgery, I am an unfortunate veteran of rehab medicine. I guess that’s the price one pays when blessed with the bone structure of a brontosaurus and the ligaments of a hummingbird! So, when I showed up for my first physical therapy session with expectations based on previous experiences (and a familiar therapist) I was unprepared for what was in store for me.

Heretofore, physical therapy for me consisted of strengthening exercises, gentle range of motion movements, and feel-good modalities such as heat, electro-stimulation, ultrasound, ice compresses, etc. Never did I envision the scope and intensity of the pain associated with rehabbing a torn knee ligament. Basically Gerry and Ken, my trusted therapists, have the intent and determination to move my swollen, tender, immobile leg to where it does not want to be or more precisely: they move it to where I can’t and don’t want to move it because IT HURTS; I mean it really, really hurts! And as compassionate as they are and as nice as they are, they are “killing me” to get my over-sized appendage moving again by breaking up the scar tissue.

All of those catchy euphemisms be damned: ”No Pain, No Gain,” “It’s Got To Hurt To Help,” “Cruel To Be Kind,” etc.

So, it was while I was scheduling my next series of physical therapy appointments (ever mindful of my pain-provoked perspiration) that I made the connection between what I was feeling and what many dental patients or would be dental patients experience when confronting their dental fear. Fear of pain can be and is, a major obstacle for many in need of dental care.

While the importance for a dentist to have compassion, empathy, reassurance, and a gentle demeanor cannot be overstated, pain avoidance is of paramount importance. Mastering the technique of a virtually painless injection is not enough. Administering sufficient anesthetic and allowing enough time for each individual to achieve profound numbness (everyone is unique in that department) ensures a comfortable experience and instills a sense confidence and relief.

The most unsettling scenario in dental treatment is when the patient is not sufficiently anesthetized and feels an unexpected jolt of pain during care. From that moment on, no matter how much more anesthetic is given, no matter how completely effective subsequent injections are, the patient will be sitting on the edge of his/her seat waiting with clenched fingers to feel the next jolt….even if it doesn’t come. The memory of that pain can linger for a long time (for some people, even a for a lifetime).

I have been practicing dentistry for more than 30 years and have always made my patients’ comfort my first priority (well, maybe I have two first priorities; the other is providing excellent dental care). My recent experiences in the physical therapy “hot seat” have given me a deeper appreciation and greater insight into the psyche of the dentally anxious. And while there may be other factors and dynamics in play for those suffering with dental fear and phobia, it is the relief of pain, the avoidance of pain, and a commitment not to hurt those who seek help that lays the groundwork for successful care.

 

Dr. Michael Sinkin has been practicing dentistry for over two decades. He truly cares about the experience his patients have and takes great pride in making them feel relaxed and comfortable during every visit. Come in for an appointment and experience a different kind of dental practice. To find out more about Dr. Sinkin, please click here

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Dental Implants vs. Dentures – A Lot To Consider

January 27th, 2014 by | No Comments »

dentures versus dental implantsDid you know that approximately 30 million people in the U.S. (over 17% of the adult population) are missing all of their upper teeth? About 40% are missing at least some of their upper back teeth (bicuspids and molars). And, about 10% are missing all of their teeth, top and bottom!

A direct consequence of tooth loss is not just the resulting functional and esthetic compromise, but also a change in local oral physiology resulting in continuous bone loss in the jaw throughout a person’s lifetime. In other words, when a tooth is extracted, its supporting bone goes through a lifelong process of resorption. When multiple teeth are gone, even more bone is lost.

Since recently returning to the classroom at NYU to participate in the implant program, I have been exposed to a significant amount of literature about dental implantology and the human dentition. In addition to gaining new knowledge, I have refreshed my memory with regards to the whys and wherefores of many of the disciplines that I have been practicing lo these past 30 years as a general and cosmetic dentist in New York. In some areas of study I am reminded of facts and scientific theorem that I once learned as a student, internalized over several decades of clinical dentistry and perhaps even thought I had forgotten only to rediscover that “Oh yeah, I remember that.”  Being a pupil again has been a reawakening of sorts, especially about the pros and cons of dental implants.

One of the rationales for replacing lost teeth with dental implants is to preserve the existing bone.  Unlike other any other prosthetic tooth replacements (dentures and partial dentures), implants maintain a patient’s bone volume indefinitely. But implant dentistry comes with a much higher price tag than dentures. And while various treatment options can moderate the cost significantly (more about that in a future posting), the fact remains that complete and partial dentures are still very much a part of contemporary dental care.

Denture Wearers in the United States

Statistics vary regarding the number of denture wearers in the United States. I have seen statistics citing that there are as many as 30-40 million adults wearing complete dentures and 49 million adults wearing partial dentures. (FYI, a complete denture replaces all of the teeth in a given dental arch while a partial denture utilizes remaining natural teeth for stability and retention by way of metal connectors.

Well-fitting dentures, complete or partial, can and do provide a valuable service to the edentulous patient. The problem with them however, is this: the supporting bone under the denture will continue to shrink away creating the perpetual need for the denture to be refitted (relined or rebased). And this cyclic process of bone loss and refitting will continue indefinitely until a point is perhaps reached that the denture cannot gain enough support and stability from the diminished bone for comfortable function.

Bone Loss – A Serious Problem

Simply put, when natural teeth or implants are not present, the remaining bone will undergo a process of continual loss. This rate of loss dramatically slows down after the first year following tooth removal, but it doesn’t stop. As the bone shrinks, the fit of the denture loosens causing even more trauma to the supporting bone and teeth and thus accelerating the damage.

Dentures have been a part of mainstream dental care for a very long time (see my blog: The Truth About George Washington’s Teeth) and will continue to play an important role in restoring dental health. Dental implants offer a multitude of restorative options, including stabilizing dentures, all the while maintaining skeletal integrity. Sometimes an existing denture can be modified to accommodate newly placed implants providing a significant improvement in stability while containing excessive cost.  Denture wearers must realize that the fit of their prosthesis must be safeguarded to ensure comfort and to help preserve the underlying bone.

In conclusion, (finally!) while implant dentistry comes with a larger price tag than conventional dentures, over the long term they can provide a healthier outcome, fewer visits to the dentist, and a much happier and more comfortable patient.

 

Dr. Michael Sinkin is a NYC dentist that has been in practice for over two decades. He truly cares about the experience his patients have and takes great pride in making them feel relaxed and comfortable during every visit. Come in for an appointment and experience a different kind of dental practice. To find out more about Dr. Sinkin, please click here.

If you enjoyed this post, please make a comments or log-in to my Facebook page to share it with your friends. Thank you!

A Job Well Done

January 6th, 2014 by | No Comments »

business man smiling doing the okay signRalph Waldo Emerson said, “A reward of a thing well done is having done it.” And while I can’t disagree with this pronouncement (who am I to question the esteemed Mr. Emerson), I do find it incomplete. I am not gourmet chef, and yet I know that I make a mean chili, to-die-for baby back ribs, and an awesome chopped liver (created in my grandmother’s wood chopping bowl with genuine chicken schmaltz). How do I know this? Because of the overwhelming feedback I receive, the frequent requests for one of my three culinary creations, and the total lack of leftovers after the meal is served. In other words, the reward of a job well done includes the recognition and praise that follows.

This couldn’t be truer for me than in my role as a cosmetic dentist.

The experience of exceeding one’s expectations and the spontaneous joy expressed over a “job well done” cannot be put into words. It is an intoxicating feeling that once experienced is sought to be repeated (and this is not some middle child phenomenon- perpetual pursuit of validation and acknowledgement…hmmm…I’ll have to get back to you on that after I speak to my thera… oh nevermind!). Jonas Salk said, “The reward for work well done is the opportunity to do more.”  Now this rings true for me and the opportunities that I have been afforded as a cosmetic and restorative dentist to improve not just one’s smile, or one’s ability to function, but to improve one’s self esteem and quality of life have been rewarding beyond anything I could have imagined when I first embarked on my professional journey.

Over the course of this past year, I have had the good fortune to make a difference in people’s lives by doing what I love to do and doing it to the best of my abilities. Whether it was completing Invisalign treatment for Jen in time for her pending nuptials, restoring lovely Rachel’s front teeth, correcting dental work gone bad for Lauren so she could put her dental nightmare to bed and start a family: I have been spiritually rewarded by the trust given to me by virtual strangers (new patients) and the gift of gratitude, appreciation and friendship for a job well done.  (After hours of “togetherness,” we are no longer strangers.

Case Study: Ben

Ben has been a patient of mine for quite a few years. He is an affable fellow and a very successful businessman. Always on the go, always working the next big deal, he never seemed to have the time to commit to addressing the dental dilemma that had bothered him for quite some time. Ben did not display any of his teeth, not when he spoke, not when he laughed, and certainly not when he smiled. He looked as if he didn’t have teeth to show. And while he most certainly had a full set of natural teeth, they were very small and very dark – forever hidden under the drape of his lips and within the shadow of his cheeks.

It was just before Thanksgiving that Ben decided that now (as in “yesterday”) was the time to take action. So having allowed enough time for proper planning, Ben was given two lengthy appointments to enact his “cosmetic make-over.” Without going into too much detail, his treatment involved porcelain crowns on all of his teeth…that is all 28 of them! No small undertaking.

He came in for his first appointment ready for action in loose-fitting attire, music playlists pre-selected, and with appropriate anesthesia and nitrous oxide on board, we then began his first 6-hour appointment. Lost in his music with pad and pencil in his hands to scribble us notes or share with us his occasional epiphanies, with nary a break (by his request) save to visit the restroom and to secretly order us in a lunch buffet, the time flew by.

When then day’s treatment had concluded, I had designed a new smile for Ben by placing beautiful provisional (temporary) crowns on all of his upper teeth. Now for the coup de grace….I escorted Ben in front of a full length mirror for him to behold his new visage for the first time. He gazed into the mirror and flashed himself a smile…his face lit up with glee and he let out a very audible “Hoot!” as he jumped up and down, clapping his hands with joy. He looked at himself again and became giddy. He turned around and embraced me in a huge bear hug and kissed my dental assistant Kim.  He looked in the mirror again and started laughing once more. His first words…”Game changer.” I couldn’t have been happier. Kim was brought to tears as was the rest of my staff when they came rushing in after hearing his hooting. Truly, a job well done.

Case Study: Sarah

I first met Sarah this past January: a mature, pleasant, and attractive professional singer who was in a dental crisis. Sarah came to me for a second opinion/consultation regarding her oral predicament.  Actually it was more like a fourth or fifth opinion. Sarah had serious problems, which jeopardized her health, her looks, and above all, her career. She came equipped with all relevant X-rays and many, many questions.  I examined her and spent about an hour reviewing her condition and how I would approach what would most definitely be a lengthy and involved treatment process (which involved bone grafting procedures, implant dentistry, and multiple provisional restorations). I emphasized that a top priority would be to maintain her ability to sing and perform during the multiple phases of dental care and healing.

This was back in January and I didn’t hear back from Sarah until November. In the intervening months, she had continued her “research” until her condition became critical. She was told by two dentists that little could be done for her, and that she was destined to become a dental cripple with no hope of even successfully wearing a denture: a harsh pronouncement, which was extreme, insensitive, and not true.

Sarah reappeared for a re-evaluation and yes, her condition had deteriorated, but it was certainly not hopeless. She was quite distraught (can you blame her?). We reviewed my plan with multiple contingencies, and she scheduled her appointment to begin in mid-December (two weeks ago). Over the nearly three weeks that transpired before her actual treatment (I had much to do in the way of pre-operative preparation): I received numerous phones calls from Sarah and gave her much needed reassurance. She couldn’t shake the image of a dental cripple-unable to eat, to smile, to sing.

Finally, the day arrived for Sarah’s first appointment. She appeared anxious, but ready. Seven hours, two root canals, three posts, 10 provisional crowns, a “permanent” bridge on all of her remaining upper teeth and innumerable jazz sets of Ella Fitzgerald, Louis Armstrong, Frank Sinatra later, we had completed the first step of her dental journey. She looked fabulous and breathed an audible sigh of relief when she looked in the mirror and saw that her smile was intact (better than what she started with) and more importantly secure (her teeth were a bit wobbly before we started that morning). Tears of relief and delight followed, and I’m sure I needn’t say that the mood in the office was celebratory.  Certainly another job well done. I will be Seeing Sarah again very soon to continue our odyssey.

Patients often ask what “What are you going to do to me today?” My reponse never varies, “I’m not going to do anything to you, but this is what I’m going to do for you.” In the context of work, making a good widget can be a job well done. Closing a big deal after months of work is a job well done. But when one’s focus is on caring for people, a job well done is well done for someone. And for me that makes all the difference.

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© 2008 Dr. Michael Sinkin, D.D.S.