Karl H. Gruendl, DMD, PC

Here is a picture of the "No shot" product. Every patient gets their own little sprayer. The medicine gets squirted up the nose like the product, "Afrin" which is used for nasal congestion.

Let's revisit ancient Egyptian dentistry. Recently, some mummies examined w CAT scans revealed a dental treatment that actually may have afforded some relief of pain. Small pieces of linen soaked with embalming fluid have been found packed in large cavities of mummy teeth in an apparent, desperate attempt to relieve pain. This may actually have worked. If the cavity or "hole" was close enough to the offending pulp or "nerve", the embalming oil may have mummified the tooth's nerve and stopped the pain.

Pigeon poop for a toothache? Over the centuries many ancient cultures experimented with concoctions to place in a hole in a tooth to relieve pain. The ancient egyptians tried pigeon droppings.Their results were crappy. (sorry). Please do not try this at home.

"Tooth Worms" : Hundreds of years ago it was thought that a hole that appeared in a tooth was due to a "tooth worm" eating its way out of the tooth. Taking the example from their observations in nature where a worm eats its way out of an apple it was assumed that holes in teeth originated from the same process.

"If I need a 'root canal' should I go to an endodontist (root canal specialist) or have my general dentist do it?" My answer may cost me because I do root canals in my own practice, however, in my opinion, endodontists do excellent work and have a very high success rate for root canals. There are also many general dentists who do excellent root canals. The standards that general dentists must meet is that their "root canals" must be at the same level of quality as the specialists (endodontists) in their community.

When is a "cavity", a "cavity"? There are three layers to a tooth, the outer enamel, the next layer of dentin and the pulp or the "nerve". When decay is just in the enamel it is not a cavity that requires a filling. It is called enamel decay and should not be restored as enamel decay can be reversed. When the decay extends into the dentin, it requires repair with a restoration or "filling". If the decay extends into the pulp or "nerve" the tooth may need endodontics or "root canal".

Be wary of advertised offers of a free checkup or "cleaning and bitewings, $59.00". "There is no such thing as a free lunch", is the adage that applies here. In my experience through 2nd opinions, patients who take advantage of such offers have a very likely chance of being told they need multiple crowns and fillings.This after their previous dental checkup where they were told no treatment was recommended.

When does a tooth need a crown or a "cap". Boy, is this a can of worms. I will give the reasons that an insurance company will accept for payment. Officially a tooth needs a crown if there is so much damage due to fracture or decay that the tooth cannot support a filling. The debate comes into play when we ask, "How much damage is too much to restore with a filling?" The other determinant is a fracture,. When I say fracture, I don't mean the little white "craze" lines that a...ll teeth will eventually get. I mean a deep fracture that causes symptoms during biting or a large portion of the tooth has fractured off. When a tooth has a large filling and it is intact, it does not need a crown. When a tooth is dark and ugly, it does not functionally need a crown. A subsequent crown would be lovely but it would be for aesthetics only. Most insurance companies do not pay for aesthetics as a reason. There are many other reasons to place a crown but I have covered the reasons that insurance companies will pay for.

Which lasts longer, white, composite fillings or amalgam fillings? Say all you want about the down side of silver amalgam fillings, they do last longer than white composite fillings. Many dentists will disagree with me but I have statistics from insurance claims filed by dentists. Based on the mercury in silver amalgam and junk science, I believe silver amalgam may be outlawed in our lifetime.

Kovanaze, the nasal spray local anesthetic, works moderately well. There is adequate numbing for routine procedures like a filling or a crown. When used in more invasive procedures like a root canal or extraction, the anesthesia needs to be augmented with a local anesthetic injection.

Update on Kovanaze. Kovanaze is the nasal spray local anesthetic I mentioned in a previous post. A box of Kovanaze, which will service 10 patients costs the dentist $800.00. A box of lidocaine cartridges which has around 50 doses costs $40.00. So, if a dentist chooses to use Kovanaze, I'm certain there will have to be some sort of surcharge for the use of Kovanaze. Don't expect most insurance policies to pay a surcharge for anesthesia. Insurance policies expect the local anesthetic to be bundled with the cost of the procedure .

Here is a picture of the "No shot" product. Every patient gets their own little sprayer. The medicine gets squirted up the nose like the product, "Afrin" which is used for nasal congestion.

The proper way to ask for a second opinion is to acquire a copy of your x-rays. Do not bring a copy of Dr. No. 1's treatment plan. Don't give the name of Dr. No. 1. Simply hand Dr. No. 2 your x-rays and ask, "What do I need?" Don't tip your hand by telling what Dr. No. 1 said. This would result in an honest 2nd opinion. As some patients do, they will say, "Dr. No.1 wants $5,000.00 for a root canal and a couple of crowns. With this info, a shrewd dentist knows if he just gives you a proposal a few dollars below $5,000.00 and you will likely stay with his/her practice.

The most common form of dental fraud is unnecessary over-treatment.This is not an opinion. It is based on publications using insurance company data. To avoid being a victim of over zealous treatment, get a second opinion.