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Sunday, November 18, 2012

Post injection numbness

A patient recently came into the office and relayed the following story concerning a friend of hers.
She said that a friend of hers had been to the dentist recently and following the appointment had numbness in her jaw that was quite painful.  The story she told and I now relay was that during the injection the patient felt a stinging pain.  After the appointment the patient remained numb in her jaw and the feeling was a painful feeling.  She went to speak to her dentist who said that perhaps the needle broke at the site of the injection and was now stuck inside or perhaps something else happenned.  My patient asked me what do I think?

I first keep in mind that as usual, who knows what the actual story really is.  Remember, we all played broken telephone when we were kids and we know how that turned out.

I told my patient that I did not beleive that there was a broken needle inside unless he specifically told her that there was.  We know the lengths of the needles and if something breaks, we will know it.  Besides, we can always take a radiograph that will show us right away any broken metal objects.
I told the patient that numbness after an injection can happen due to the injection or injection material.  The injection could have actually hit the nerve or the local anaesthic could be somehow toxic to the nerve etc.  In most cases this  numbness is temporary but in a very small number of cases it can be permanent.

I asked her how long her friend had the numbness?  She answered, "about 8 months."  This was not good, I told her that temporary numbness does generally not last that long. 

If this does happen let your dentist know and he can tell you what the prognosis is and if there is anything that can be done.

All the best

Dr. Ron Barzilay

Enjoying Dentistry in HAMILTON ONTARIO

Wednesday, September 12, 2012

Why do I have to pay the Co-pay? (Why do I have to pay what my insurance doesn't?)

This question we get asked from time to time here in Southern Ontario.
For those who don't understand the term.  The Co-pay is that portion of the cost of treatment that the insurance provider does not pay and is the responsibilty of the patient.  For example, if the insurance provider pays 80% of the cost, the patient must pay the other 20%.  Or if the inusrance pays 100% on an older fee guide then the patient must pay the difference.  This is called the Co-pay.  Some patients ask the Dentist if the Dentist would accept whatever the insurance company pays as full payment.  In our jurisdiction, the Province of Ontario, this is not allowed.  A dentist caught doing this, in our province, would face consequences visa vie his dental liscense and from the insurance companies.  The reasoning behind not allowing this discounting of the fee to the patient is that if the provider discounts  his fees to the patient then he should also be giving that same discount to the insurance company.  Although everyone thinks what is the big deal the insurance company is paying, well the insurance company is no different from anyone else.  The way you look out for your money so do they.  If you get a discount then they want one too.  I don't know what the laws are in other jurisdictions but I would imagine that they are similar.
We are always trying to help out our patients but as professionals our word truly is our bond and any Dentist who does not collect this fee is in violation of the terms of his certificate and will suffer the consequences if caught.  Any dentist who plays fast and loose with the rules, at the end of the day is not the type of person you want performing your dentistry either.

All the Best

Dr. Ron Barzilay

Having fun in Hamilton Ontario

Saturday, August 25, 2012

I had a root canal many years ago and since the crown falls out all the time and it bleeds and smells really bad.

Sometimes you get a letter with questions that touch on numerous issues.  I received one such letter this past week and I would like to share it with you.

Hello Dr Barzilay,
I had a root canal many years ago and since the crown falls out all the time and it bleeds and smells really bad. After telling my dentist over and over again they referred me to a specialist who just found out that the dentist who did the first root canal missed a canal and it got infected that's why i was having so much pain. My question is if i get a crown on it again will it keep falling out? Or did it fall out because it was infected. Also my appointment to get my crown on isnt until 2 weeks from now how do I keep this clean from getting infected again I have a huge hole there it is my number 3 tooth. Thanks

Wow, these are great questions I thought I would put up this letter on the blog for discussion.  There are a lot of important issues that have been brought up here that deserve discussion and many things that I have seen throughout my years of practise.

1)  Why has this crown been falling off since it was placed.  A properly place crown does not fall off.  If this  crown has been falling off since it was placed we can only assume that it was not placed properly.  Meaning that perhaps the underlying tooth is too short to give retention to the crown and if so it may be necessary to lengthen the underling tooth or find retention by another method.  Another reason the crown could come off would be if the tooth was rotten underneath but we will assume that this was not the case since it was coming off from the beginning and a new crown would not have decay underneath.  My question here to the writer would be, how many years ago was the crown done? and what does falls out all the time mean?

2)  Bleeding gums and a bad smell around a crown can mean that the crown is loose and bacteria is getting in around the crown causing inflammation of the gums. ( when you touch inflammed gums they bleed).  Also, if the crown is loose and bacteria and debris are getting between the tooth and the crown you can get decay of the tooth and supporation of the debris leading to bad odour.

3)  Is the crown falling off related to the missed canal and pain you were having?  No.  The missed canal will not cause the crown to come off.  It most definetly may be the cause of your pain among other possible reasons (such as a moving crown or a cracked tooth).

4)  If you get a new crown on the tooth, will it keeping falling out?  You must get a new crown on the tooth and if it is done properly should not fall out as the original should not have fallen out.  Remember, the crown holding onto a tooth is just related to the physical properties of the tooth.  In other words, if the crown has what to hold it will hold.  If it doesn't have what to hold we have to start thinking about either making the tooth longer so there is more of what to hold or perhaps extracting the tooth and placing an implant as a regular crown will not hold.  You have to ask your dentist flat out "will this crown hold?"

5)  Now this last question is really important.  The patient say she has a huge hole there and wants to know how to keep it clean so it won't get infected.  Her appointment for the new crown is in two weeks.  Sometimes a hole is a result of the temporary filling being compressed into the crown space, in which case you may be getting bacterial leakage and you should go back to the dentist to top up the temporary filling.  This is simple and not a problem.  If for some reason there is no temporary crown or filling then that is a problem as bacteria can percolate through exposed root canals and cause reinfection of the canals.  Speak to your dentist regarding this.  The last issue here is also, as I have mentioned in point 1,  if  you are going to be having a new crown done in two weeks, ask your dentist what is different that now that will make the new crown stay on.

All the best

Dr. Ron Barzilay

Enjoying dentistry in Hamilton Ontario

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Tuesday, May 22, 2012

I have no dental insurance so I can't go to the dentist!

I have no dental insurance so I can't go to the dentist!

Well I hear this line at least 2-3 times a month from either a new patient or an emergency patient and everytime I hear it, my blood just starts to boil.  Why?  It is just not true.  This may be what the patient believes but they are Wrong!
The new patient maybe coming in after years of neglect but now he has dental insurance and now he can afford the dentistry.  Many times he is about to be surprised.  Most plans have yearly maximums and because of the neglect he is going to be way past that.  His options may come down to extractions and dentures. 
The emergency patient comes in with pain.  By the time we do the exam, x-rays and treatment you can be sure he is leaving with a hefty bill.  If he continues this way at the end of the day he will have no teeth.
So why am I angry?  How do I know what someone can afford and what they can not? 
Well here is the reality.  Taking care of your teeth is not expensive.  Excuses are very expensive.
When your teeth are healthy, a visit to the dentist from time to time is not expensive.  If you are in financial distress cut the time period so that you are visiting less often but still visiting from time to time for a check up.  In this situation, if you have a small filling or even a few fillings, they can be done while they are still small.  You can do them once a week or once every two weeks or once a month or once every two or three months.  Do it at your own pace by what you can afford and believe me, once you start you will finish and you will have a healthy mouth.  Remember, a small cavity from time to time everyone can afford but a small cavity that has now become a root canal treatment and crown is ten times more expensive than the filling.  Now you may not be able to afford it and if it is in multiple teeth you are in trouble. 
Now we all know that when we drive our cars we need to change the oil from time to time and do some minor service or else  we are going to have to kick in big bucks to change the engine.


All the best

Dr. Ron Barzilay
A dentist having fun in Hamilton Ontario

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Tuesday, April 24, 2012


I am too scared to visit the dentist!!

How many times have I heard this? 

Too many times to remember.
Well of course the patient is now sitting in my chair and telling me this.  I guess something overcame the fear.  That something was the PAIN!
I always get a little chuckle out of this momemt because it is inevitable and it just repeats itself over and over again.  I always tell these patients that it had to happen.  They may not like to come to the dentist but one way or another they are coming.  The difference being that either they will be walking through the door or they will be crawling through the door.  BUT THEY ARE COMING!

Unfortunately now, there is a lot of damage that needs fixing and they will be coming for many more sessions than if they had come earlier.

We as dentists are experts at pain and anxiety control.  We really can give freezing almost completely pain free.  If regardless of the freezing the patient is still nervous, we have many methods to alleviate that anxiety.  From laughing gas to oral sedation, to IV sedation, to general anesthetic, we do have solutions.
Please let your dentist try to help you when the work is miniscule as opposed to your mouth falling apart.
Remember, one way or another you are going to visit your dentist.

All the best

Dr. Ron Barzilay

Having fun in Hamilton, Ontario

Wednesday, March 28, 2012

My Tooth Hurts But My Dentist Can't Find the Problem- Good Chance It is a Cracked Tooth

A patient comes into the office and says that he is having discomfort on one side. He has hasn't eaten on that side for months if not years.  The culprit tooth has a small filling in it or no filling at all.  In the x-ray the tooth looks perfectly normal.

I am most definetly starting to think CRACKED TOOTH!!

I place pressure on each cusp separately.  On one of the cusps, as the patient opens from pressing, then the tooth starts to hurt.  Yes it is a cracked tooth.

Can you see it on the x-ray?  No you can't since the tooth is fractured and not broken.  When it is fractured the two sides are close together and an X-ray will not pick up the fracture.

Why is it hurting if the sides are still together?  This is because, as you bite down on the tooth, the sides of the tooth are flexing.  At that point fluid moves in and out of the tooth causing pain.

So how do you fix it?  This is the easy or hard part.  It all depends where and how far down the root the tooth is fractured.  To fix this problem you need a crown on the tooth.  By shaving the tooth down and then covering it with a crown (or cap) all the forces of biting will be directed internally and the fractured parts will be held together thus stopping the pain.  To test this, we place a temporary crown on the tooth first.  If the symptoms disappear then we can go ahead with the permanent crown and have reasonable confidence in the outcome.  If the fracture goes further down the root and beyond the crown then the symptoms may persist.  We may need to do a root canal and the symptoms may then disappear.  But overall the prognosis is now guarded.  When the crown does not encompass the entire fracture the tooth may still be flexing and the long term prognosis is questionable.

Does this happen a lot?  Actually it happens quite a bit, even teeth that have never had a filling in them get fractures.  This is called wear and tear.  If you never use your teeth this will never happen to you.  Since most people use their teeth quite a bit and of course many of us also grind our teeth which makes this worse, quite a few of us will experience this throughout our lifetimes.

If you have any questions, you can always send me a note.

All the best

Dr. Ron Barzilay
Hamilton Ontario

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Sunday, February 5, 2012

Is it time to have all my teeth out?

How many times has a patient come in and said, "Dr. I want all my teeth out!"
So many times I have said, YES you are right it is time to have them out and so many times I have said, NO it is not time.

How does a dentist decide whether  this patient needs or should have all their teeth out?
There are a number of issues we must look at before arriving at the decision.  Remember, once you take them out, you can't put them back.  Afterwards the patient may have to deal with other issues such as retention of a denture, gaginess and general discomfort.  And of course, even though a patient wants all his teeth out that doesn't mean that we have to do it.

The simpler cases are when the patients teeth are hopeless.  When, the teeth are so rotten or the teeth are moving so much that there is really no choice but to extract all of the patients teeth and make them dentures.  It starts to get complicated when those rotten teeth can be fixed and those receded gums can also be stabilized.  Then what?
A partial denture is better than a full denture because it is more stable in the mouth since it can use solid teeth as aids for stabilization.  Of course, no denture is the best, if we can just fix your teeth or create a fixed bridge.  Nothing to take out and of course the feel is the most natural.

So here we move into the grey area.  A patient comes into the practise and he has a fair number of teeth that are decayed and moving.  He has not brushed his teeth in a number of years.  When I ask him if we can fix his teeth will he start brushing them?  He answers NO.  Then the teeth are going to be lost no matter what and there is no point in wasting time trying to save these teeth because no matter what they will develop new problems again after we have done all the work to fix them.

A patient comes in with decay in his teeth, we fix all the teeth and then 6 months later the patient returns with large amounts of decay just as he had entered on the first day.  He now tells us that he has 5-6 Tim Horton's triple triples every day.  (That is triple sugar with the coffee)  He says he refuses to stop this as it is his one vice.  In this case we would also take the teeth out since the battle is lost before we even fired the first shot.

Sometimes a patient will come in who hasen't seen the dentist in 15 years, she may have 1-2 cavities and a lot of cleaning to do, but she is adamant that she needs all her teeth out.  Well of course we won't take her teeth out because she doesn't need it.  We will try to make the patient understand that their situation doesn't need such drastic measures and that they would be a lot happier with their own teeth.

All of these situations have happened to me and were dealt with as I have described.  Every case is different and requires a different response.  On the whole, keeping your teeth is better than extracting them, even keeping a few teeth is better than extracting them all but in some situations extracting all the teeth is the treatment of choice.   The black and white cases are easy to decide.  But through years of experience, through discussions with our patients of their needs and wants, we learn to make the proper and informed choices in the gray zone.

All the best

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