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

This Letter From A Patient Made Me Cry

April 22nd, 2014 by | No Comments »

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.

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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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My First Report Card

November 26th, 2013 by | No Comments »

So, it’s been nearly three months since I re-entered the hallowed halls of higher education to participate in a two-year program in Dental Implantology at the NYU College of Dentistry where I’m studying the theoretical and practical aspects of the surgical preparation and placement of dental implants.

I had originally thought to report on my “back to school” experience around midterm time. But, here we are with just days until Thanksgiving and Christmas break being a mere three weeks away. Wow, Christmas break! Now that’s certainly a throwback to days gone by. But not anymore! I’m a student again and I’m LOVING IT!

What I originally conceived to be an opportunity for professional development has blossomed into an unexpected adventure that has infused me with a sense of AWE and WONDER. I am in awe that I’m actually doing this; going to school one day a week (listening to lectures and acquiring new surgical skills), getting up early each morning to read textbook assignments and various research papers (yellow highlighter in hand), and preparing Power Point presentations of my implant patients prior to performing the actual surgery (never knew from Power Point presentations until now!).

I am filled with wonder because I’m completely fascinated by what I am learning and I’m enthralled by the open exchange of ideas and support by all involved. I am decidedly older than the other participants by a good twenty years. In fact, I am older than most of the faculty! But I kid you not when I say that I have the biggest grin on my face as I sit in the lecture hall or “dance” around the clinic taking it all in (and getting faculty to sign off on the numerous procedures performed.)

In as much as I tower over everyone, I may as well be smiling.  (I’d rather be a lighthouse beacon shedding some brightness as opposed to a large (make that huge) wallflower casting an even larger shadow). I feel motivated to be an active part of the program and be invigorated by the process of learning.  I’m not sure where I heard the expression “the more you know, the more you realize you don’t know.” but that’s exactly what I’m experiencing. Well, one can never know it all, but I am inspired to keep expanding my knowledge.

I was told by one of the deans at NYU that this program would change my life.  I think he may be right. It certainly has added a bounce to my step:

 

Of course, when you create your own report card, you can say whatever you want!

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!

Dental Implants – Be Informed Before You Choose

October 14th, 2013 by | No Comments »

dental implants, cheap dental implants

It seems that you can’t pick up a newspaper, daily circular (any New Yorker going into the subway knows what I’m talking about), listen to the radio or even watch TV, especially late-night TV, without reading, hearing or seeing some advertisement about dental implants. “SAME DAY TEETH” “ALL ON FOUR” “CLEAR CHOICE” are some of the most visible examples media of promotion for dental implants.

Claims that you can walk into to a dental office edentulous (without teeth) and walk out the same day with a full set of “permanent” choppers are not uncommon. And while the field and practice of implant dentistry has exploded over the last decade with many great advances made, dental implantology remains a surgical and restorative discipline requiring great care, skill and judgment.

Dental Implants are not a “one size fits all” procedure as many of these promotions seem to suggest and is certainly not an assembly line production where an implant(s) is stuck into the jaw and a tooth is slapped on (“next!”). It is not my intention to denigrate any skilled conscientious clinician who happens to have a successful marketing campaign. I just want to make the uninformed aware that implant dentistry, especially the surgery, requires careful individualized planning (including thorough evaluation utilizing appropriate diagnostic imaging) and meticulous execution.

Dental implant surgery gone awry can lead to disastrous consequences including:

• Serious infection

• Nerve damage causing permanent loss of sensation (numbness)

• Uncontrolled bleeding

• Sinus perforation

Additionally, improper alignment of the dental implant may render actual tooth replacement impossible. In reality, patients are not really seeking implants, they want teeth! So while implant dentistry is truly remarkable and can be a life-altering experience that can enhance the quality of one’s life immensely, I can’t over-emphasize the importance for those of you seeking implant dentistry to educate yourself and don’t be persuaded merely by cost.

That $395 dental implant just may end up costing you a helluva lot more.

 

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!

What Are Wisdom Teeth?

September 26th, 2013 by | No Comments »

 

Wisdom teeth are probably the most variable and problematic teeth to form in the human dentition. In fact, many times wisdom teeth don’t form at all and are the most common of teeth to be absent from mouth (followed by the upper lateral incisor). It’s when wisdom teeth are present that problems can arise most often leading to the need for extraction.

Wisdom Teeth – The Third Molars

Wisdom teeth are actually third molars and are the last teeth to develop and appear in the mouth, generally between the ages of 17 and 25. Hence the name wisdom teeth for they arise during the “Ages of Wisdom” (but don’t tell your teenage kids that for they just may try to “outsmart” you with their newly found intellect).

Oftentimes, wisdom teeth erupt fully into the oral cavity where they’re meant to be, and they function and behave like any other molar. Molars are the large back teeth upon which most of the motion and machination of mastication occurs. They literally pulverize and grind your food to make for easier digestion.

Our Stone Age ancestors (remember we were once hunters and gatherers) had a tougher, more fibrous diet requiring larger more powerful jaws and greater tooth surface to ruminate otherwise indigestible cellulose (think of cows chewing grass). As we evolved, our diets changed (softer) and so did our bone structure. Our jaws got smaller and the third molars were crowded out over many millennia, which leads us to the heart of the problem with most wisdom teeth: not enough room!

A less Darwinian explanation for the lack of space for those pesky molars is simply that one can inherit small jaws from one parent and large teeth from the other. The end result of this tooth/jaw size discrepancy can result in partially erupted or impacted wisdom teeth. Tooth/jaw size mismatches also explain why orthodontic treatment is often necessary to correct a crowded dentition.

An impacted wisdom tooth is a third molar that has not erupted fully into place and through the gum-line. There are different classifications describing impactions. A full boney impaction is when a wisdom tooth is fully encased within the jawbone. A soft tissue impaction is when the tooth has emerged from the jawbone but is still covered by the gum. There are also degrees of impaction where a tooth can be partially impacted within the gum or bone.

wisdom teeth, impacted wisdom tooth, michael sinkin

Perhaps the most troublesome situation involves the incompletely erupted wisdom tooth that is also partially impacted. Partial exposure to the oral environment, even just a little tooth peeking through the gum, is like the tip of an iceberg and can lead to disaster. Tooth decay, periodontal problems, and acute infection can develop on and around the tooth beneath the gum and lead to damage of its more important neighbor, the second molar. In this scenario, extraction is often necessary.

But don’t despair! Not all wisdom teeth require treatment. In fact, there is ongoing debate whether fully impacted asymptomatic wisdom teeth should be extracted at all. Some experts recommend leaving these hidden pearls alone and just examine them periodically to detect the possible development of cysts, tumors or other pathological changes.  As mentioned before, third molars that erupt “normally” often only require routine care. And, about 25% of the population is completely lacking one or more of their wisdom teeth!

Wisdom teeth are thought to be on their way out as we continue to evolve as a species. Who knows, 10,000 years from now, they may actually be a thing of the past. In the meantime, evaluation for the presence of un-erupted or partially erupted wisdom teeth as well as careful monitoring of them is of paramount importance to ensure good oral health.

As the saying goes, “A word to the wise is sufficient.”

It’s 5pm. Do you know where your wisdom teeth are?  Make sure you have them checked out.

Photo Credit: http://www.fairview.org/healthlibrary/Article/89767

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!

It’s Back To School For Me!

September 10th, 2013 by | 1 Comment »

One does not need a calendar to know that summer is over. In the days leading up to Labor Day, there were telltale signs everywhere heralding summer’s end including sales on barbecue grills, beach chairs, and summer apparel. But the real giveaway that summer fun is being eclipsed by thoughts of more serious enterprises is the ubiquitous Back-To-School specials being promoted by every retail merchant from Urban Outfitters to Costco. Mailboxes are stuffed with circulars touting new fall styles for classroom attire and new computers for college-bound students (don’t forget the bed sheets and plastic storage containers.)

Backpacks are on full display at just about every store including CVS, Walgreens, Modell’s and, of course, Eastern Mountain Sports. The variety of styles, shapes, and sizes of these modern day school bags is mind-boggling; not to mention the innovative add-ons such as built-in headphones for iPods and cell phones (I am amazed and perhaps bewildered by how many school children I see lugging around backpacks that are almost as large as themselves – it’s a wonder that they don’t fall backwards!).

Yes, it’s back to school time and for the first time in 25 years, I do not have a child heading back to the classroom and…I don’t have any tuition checks to write. Amen! So, what does this liberated parent decide to do after finally being freed from a quarter century of tumult that a new academic year brings? I am going back to school. That’s right, back to school!

I have enrolled in the formal two-year Dental Implant Program at the NYU School of Dentistry (my Alma Mater) and will be attending six hours of classroom and clinical instruction every Wednesday for the next two years. While I have been restoring implants for nearly 30 years, I have not actually performed the surgery to place them. The program is fairly comprehensive and I will learn how to place dental implants for my patients.

So why am I doing this now?  Well, golf is not my thing and with three decades of clinical practice under my belt, I’m just hitting my stride. Developing additional expertise in the field of implantology is an opportunity that I must seize upon for my own professional growth and to better serve my patients (not to mention the infusion of enthusiasm I feel). I am very excited (and a little bit nervous) to become a formal student again, but mostly I feel energized. Obviously my office hours will change on Wednesday, at least while school is in session, but rest assured I am not cutting back on my practice.

Now I have to go shopping for school supplies including a BIG back pack and of course write another tuition check!

- Michael

 

photo credit: http://centerforspinaldisorders.com/

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Making a Difference

September 3rd, 2013 by | 1 Comment »

Note: My marketing consultant told me that this blog is too long, but I ignored her. Hope you enjoy it!

In the day-to-day course of any job or profession, repetitive tasks, while not exactly mundane, can and do become routine. There are of course subtle variations and nuances that alter the “playing field” and introduce uniqueness to each situation. This is especially true in my role as a dentist in new york city, when the “playing field” is the actual person receiving my care. A job “well done” is not just a beautiful porcelain veneer, a well placed crown, a successful and painless root canal or for that matter the completion of major cosmetic or restorative treatment. A job “well done” is not only measured by the success of the treatment, but also and especially by how it was received and experienced by the patient. And it is that experience and the personal feedback which follows that makes all the difference. Yes, I make my living from the fees collected for the services I render, but I gain self-worth, pride and sustenance from the appreciation, gratitude and improved quality of life of the patients I treat (and of course from the relationships I develop with them).

“Kate”
Cosmetic Dentistry 

dentist nyc, michael sinkin

 

 

 

 

 

 

 

Just a few weeks ago, I received an unexpected email from a patient I had treated some years ago. At the time I knew “Kate,” she was a college and graduate student. She was a beautiful young woman who, do to no fault of her own, had an unsightly smile that betrayed her beauty. Over the years, she developed a well-practiced smile that concealed her teeth. I remember the day she and her parents came to my office for an evaluation and consultation. Kate had always dreamed of having pretty teeth and a smile to match. She was all too aware of her self-consciousness and her parents wanted to help her to the best of their abilities.

Long story short, after a number of months and several semesters of treatment, we created a dazzling smile for Kate that was natural and beautiful in appearance (they looked like beautiful teeth, not pretty crowns). So overjoyed was she the day we completed care that her eyes misted up (as did ours). That was several years ago and Kate had subsequently graduated and moved away.

Fast forward to now. As I was saying, I received word from Kate that she has once again relocated. One evening while out and about with some friends or co-workers, someone came up to her with no particular agenda to just say, “I couldn’t help but notice what a beautiful smile you have.” She wrote to me that evening to share. Her dream of a gorgeous smile was a reality. That she took the time to relay her experience and the unexpected surprise of her communication was the perfect beginning of my day.

“Walter”
Restorative Dentistry

restorative dentistry, michael sinkin

 

 

 

 

 
When I first met “Walter” it was clear that he had not seen a dentist for quite some time. His dental needs until very recently, had been the least of his problems. He had been a dedicated teacher but his health had deteriorated to the point that he was no longer able to conduct class. Several years ago, he had been forced to abandon the classroom for the waiting room, and into a retirement characterized by hospital stays and doctor visits. When Walter walked into my office, I joined the long list of doctors and health professionals that helped fill his days. (So much for the golden years ☹.)

Walter’s dental health had declined to the point that eating had become problematic. Had his physical and financial health been better, Walter would have been a candidate for implant dentistry whereby all of his remaining natural teeth would be removed and ultimately replaced with the help of strategically placed dental implants and a well designed dental restoration. Such was not to be.

Removable dentures were a valid and perhaps the only viable option (he had so few “treatable” teeth remaining) but Walter’s adamant refusal to give up what he had nixed the idea immediately. As frail as Walter’s physical state had become, he was a proud man and did not want to lose what little dignity he had left. No teeth in a bedside glass of water for him. Time for me to think out of the box.

Walter’s biggest problem was his inability to eat and the presence of multiple dental infections. After careful consideration, I suggested that we start treatment by stabilizing his upper teeth and eliminating all infections (top and bottom). My plan was to save five of his own upper teeth and fabricate a “permanent ” temporary bridge that would give him a nearly full complement of teeth. Give him back a part of himself that had been missing for such a long time: his smile, his self-respect, and some teeth to sink into something worthy and delicious. His only request, aside from the desire to avoid pain, was to maintain the space between his front teeth (a family trait that helped define him.) Strangely, it was the latter request for a gap-tooth smile that presented among the greatest challenges.

Treatment commenced and after six visits, Walter left the office with his upper teeth cemented in place (front gap conspicuously present) and just as important, with a little bounce in his step. His wife, who accompanied him on every visit, was tearfully overjoyed when Walter left the treatment room and flashed her a smile. A great almost celebratory feeling filled the office.

Unfortunately, Walter’s story doesn’t end here. As I had mentioned, Walter had originally presented with multiple dental infections accompanied by swelling. I had consulted with his physician about the swelling in his lower jaw. The hope was that this would resolve when the offending teeth were extracted. Such was not the case. Sadly, further evaluation including surgical biopsy led to the diagnosis of cancer of the jaw and salivary gland.

When Walter’s wife got the news, she called me in a state of frantic despair. She knew that he needed more dental care urgently because radiation therapy requires impeccable dental health. The risk of life threatening infection is very real.

It would not have been wrong, at least from a medical/dental perspective to extract Walter’s remaining lower teeth and make a full lower denture. Expeditious treatment was necessary because the radiation treatment and subsequent chemotherapy could not be delayed indefinitely. However, one side effect of Walter’s therapy, including irradiation of all of his salivary glands, would be permanent and severe dry mouth where virtually no saliva can be produced. Mouth ulcerations are another problem to be dealt with. A lower denture under these circumstances would be disabling and implants would be impossible, even at a future date, because of the radiation treatment to his jaw.

Walter had also exhausted his financial resources (it’s a sad reality that poor physical health can ruin one’s financial health and security.) He and his wife were dealt a bad hand and faced an arduous path ahead. Walter was already frail. Maintaining proper nutrition is paramount to wellness especially while undergoing cancer care. Despite the success of treatment of his upper teeth, Walter’s weakened and loosened lower teeth precluded him from chewing anything of substance. What to do?

Time for me to think out of the box again. I removed all but four of Walter’s remaining lower teeth. They were weak but not diseased. I made another permanent temporary bridge which when cemented in place gave Walter more teeth than he started with (9 lower teeth!). His treatment took ten days to complete including the making of fluoride trays to protect him from radiation-induced tooth decay.

When I saw Walter for his final follow-up visit, he told me that he had enjoyed a steak dinner for the first time in five years. That and a big hug from his wife were payment enough.

Yes, dentistry has been very good to me. It has afforded me so many pleasures and so many opportunities to make a difference in people’s lives. I have been enriched by the experiences. To quote Lennon and McCartney:

“In the end, the love you take, is equal to the love you make.”

 

- Michael

 

 

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© 2008 Dr. Michael Sinkin, D.D.S.