Fort Myers Dentist

   Franchise Discount Dental Offices

 Q: I tried getting a refund for faulty implant and denture work I had done at a franchise dental office. The doctors told me they “do not own the business” and I must “deal with their corporation’s headquarters in another state”. What’s up with that? “Angry Al” in Boca

A: Let me begin by telling all the angry dentists who will read this and send me hate mail that I am only the messenger and will be merely quoting my source. At the last meeting of the county dental society, an expert in dental practice transitions, Dr. S. Auerbach stated: “ According to The Florida Department of Health, Board of Dentistry, Division of Medical Quality Assurance, statute 466.028(1)(h) states that ‘being employed by any corporation, organization, group, or person other than a dentist(s) is illegal in Florida. Three popular outfits are Gentle Dental, Aspen Dental and Affordable Dentures”.

Pre-Cancer Treatment Dental Treatment, a Must

Q: My husband is about to undergo cancer treatment and his doctor says he might have severe dental problems during and after treatment. What can he do to prevent this? Jill in Lake Worth

A: Many physicians, including oncologists, are not aware of an important publication written by the N.I.H (National Institute of Health), entitled “To Fight Cancer Best, your Cancer Team Should Include a Dentist.” I have recently re-written a version of this booklet with easier verbiage for the general public. This publication will be distributed for free at my next seminar, listed below. I will be covering this important topic as well.

    Important pre-cancer treatment needs: Digital X-ray examination, minimizing radiation exposure, fabrication of custom fluoride trays to prevent massive root decay from chemo and/or radiation, removal of un-restorable teeth that could abscess during cancer treatment, possibly resulting in the suspension of the treatment, and relining or re-making ill-fitting dentures. 

Less Implants Can Achieve Same Result

Q: I am missing three molars. My dentist wants me to have three implants and three crowns. If I did two implants and three crowns, this would save me $2600. Is this safe to do? Melvin in Boynton

A: Let’s compare kiwis and pomegranates here. If your bone is super dense and plentiful as verified by digital imaging, you can get away with two implants to support three crowns, HOWEVER these three crowns will be connected to each other, like a permanent bridge, with a floating tooth in the middle that can trap food and will require the use of a floss threader.

    If you are ok with this and have great oral hygiene and see your hygienist regularly (at the dental office, not at Starbucks.) then, you are ok with the two implants. The ideal treatment would be three implants.

Dental X-rays do not lead to Tumors

Q: The news reported last week that Dental X-rays can lead to brain tumors. Is this True? Joanne in Deerfield

A: One of the most flawed studies ever to hit the medical journals surfaced last week, scaring people into thinking that dental X-rays contribute to forming brain tumors. According to John Graham DDS, MD (dual degrees) and Mathew Massina DDS of the ADA, the study by Dr. Elizabeth Claus, an epidemiologist, is so fraught with troubling variables, that the validity of data “degrades the veracity of any of its findings. Absolutely no cause and effect link was found”. This single study was useless and only instilled fear in the public.

      The biggest flaw is how the data was gathered. They made phone calls to 1433 patients, age 29 to 79, with a certain, benign (non-cancerous) brain tumor and simply ASKED them to recall how many X-rays they have received over lifetime. They never checked the actual dental charts, which would have shown exactly how many X-rays were truly taken.

     In my research, one hundred percent of all dentists surveyed stated that when they “ask” a patient: “When were your last X-rays, what type and how many did you have?, most patients answer incorrectly, compared to what the patient’s dental chart from their previous dentists actually shows”. There is no way I could possibly answer this question myself! Also, they did not take into account how many CAT scans, chest X-rays and sun exposure these patients had; all creating significantly more radiation than digital dental X-rays.

     Avoiding safe DIGITAL dental X-rays used with lead aprons will only result in missing dental problems, which rarely cause pain, leading to extremely expensive and extensive dental treatment.  Please call if you have any questions 239-936-5252

Seek Second Opinion Before Gum Surgery

Q: My dentist told me I need gum surgery to “get more mileage” out of my teeth. Are there alternatives? Les in Jupiter

: A common topic on my radio show Tooth Talk is “When to Get a Second Opinion.” When you are told you have deep pockets, get a second opinion before your hands reach into your own deep pockets looking for cash. Firstly, how are the pockets being measured? A hi-tech hygienist will use one of the computerized probing systems (Florida Probe or STM Probe) where a computer generated voice will speak the pocket measurements and display them on a hard copy print-out or save the data to a computer’s hard drive for comparison at each check -up visit. This can be more accurate compared to the metal periodontal probe used for nearly a century. Computerized probing eliminates the variation in your hygienist’s hand pressure as she inserts the probe into the space between the tooth and gum, called the sulcus. (My childhood hygienist, “Deadly Debbie”, had the hands of a bricklayer.)

If you have periodontal pocketing of 5mm or greater with bleeding and or puss, a non- surgical treatment consisting of deep scaling, root planning and curettage with placement of antibiotic granules, called Arestin would be the first line of treatment. No incisions and no stitches. If pocketing is 6 to 12 millimeters and digital X-rays show significant bone loss, it could make more long term economic sense to replace the teeth with implants before all the bone is lost .

CT Scans and Dentistry

Q: I need dental implants. My dentist wants me to have a type of  3-D “CAT scan” with something called an iCat machine. It is expensive and not covered by my medical or dental insurance. Must I have this scan done; he has my X-rays?..Gigi on Jupiter Island

A: As strange as this may sound, I can answer this question due to my love for  steak. My local implant study club has changed the venue of our monthly meeting to Morton’s Steak House. Now, I never miss a meeting. (Denny’s, just never got me to show up.) Last week, a well known University of  Florida dental educator, Dr. Bill Martin, gave a presentation on implants. He informed us that only 8% of patients going through the university affiliated implant clinic required this expensive and sophisticated type of scan. A recent article in the NY Times showed that the companies that make these 3D scanners are paying some dentists to promote the device on the lecture circuit and pose in ads in dental journals. Currently, regular digital X-rays are just fine for evaluating the bone for implants and use much less radiation than any CT scanner.

Osteoporosis Meds and Dental Surgery

Q: I need some teeth pulled and some implants, but have heard medication I take for osteoporosis can put me in danger of getting complications in my jawbone. Should I be worried? Doris in Wellington

A: Sometimes the media gets on a topic like orange on a Home Depot apron. They just love juicy stories that scare the public half to death.

A comprehensive article in the November Journal of the American Dental Association now sets the guideline straight. “The prevalence of patients getting ONJ (osteonecrosis of the jaw: areas of dead bone that protrude through the gum tissue.) Is .10 percent”. (As in one 1/10^th of one percent i.e. small.) And, “no validated diagnostic test including the CTX test, predicts a patient’s risk level of developing ONJ. There is insufficient evidence to recommend a holiday form these drugs (Boniva, Aredia, Actonel,  Fosamex, etc.) or waiting periods before performing dental treatment for prevention of ONJ”. If you have any questions please give us a call at 239-936-5252.

Q:I would like you to address how often dental X-rays should be taken. It seems like I am always getting Xrays.- Ruth in Boynton

A: I don’t know why, but women with biblical names seem to be my biggest fans. I bet lady Gaga can’t say that! As you might have read in a previous column I did express that as long as you are going to an office that is using digital X-ray systems and lead aprons with thyroid collars, you will not have any ill effects from the minimal radiation used. The US Food and Drug Administration Guidelines for prescribing dental X-rays was published in 2006. For an adult or adolescent new patient who has had a history of extensive dental work or currently has generalized dental issues, a full mouth set of eighteen individual X-rays consisting of bitewings which show the posterior teeth (and in between) and periapicals which show the entire root and surrounding bone are needed. If the adult or adolescent new patient does not have any history of major dental work or has no evidence of current dental disease upon examination, then a panoramic X-ray and four bitewings is acceptable. At check-up time, four bitewings need to be taken of the posterior teeth EVERY six to eighteen months, again depending on the past history of decay, periodontal disease and quantity of dental work. Periapical X-rays should be taken every three years to examine the roots of the teeth to void missing abscesses and other boney pathology.

Question: I get annoyed every time I am asked to fill out a medical history at dental offices. Many times I am only in for a

cleaning. Why do they need to know what I am taking? -Frank in Vero

Answer: Hey Frank,  you may only need a cleaning today, but one day you may require some emergency or elective dental care where the dentist will need to give you one or more of various medications that may cause adverse reactions with one you are already taking. Many medical

conditions dictate the course of dental treatment as well as the medications the dentist will prescribe. For patients taking birth control pills (not you, Frank),certain antibiotics render the pill ineffective. Aspirin can result in severe bleeding in patients taking Coumadin, Plavix and other blood

thinners. Patients taking tricyclic antidepressants such as Amitriptyline can have very adverse reactions from being given local anesthetic shots of Novocain-type drugs, resulting in high blood pressure, chest pain, headaches and irregular heartbeats.