Dr. Mitchell A. Josephs, MD

The practice uses the 'Woodpecker super pen', an electronic anesthetic device that delivers anesthesia slowly and precisely, resulting in an absolutely painless injection. This avoids the traditional syringe method.

A crown is indicated for a tooth that has an old filling, decay, a crack, or an old crown with decay underneath.

The process involves removing all decay, shaping the tooth to a cylinder, and taking a digital impression with a scanner. A laboratory then creates a full porcelain cap that fits over the tooth, protecting it for many years.

A missing tooth can lead to a 'domino effect' of negative consequences. It impacts the bone supporting the cheeks, potentially causing a gaunt facial appearance, sucked-in cheeks, and lips rolling in. Adjacent teeth can drift, creating gaps that trap food, leading to decay, periodontal disease, and further tooth loss. The opposing tooth may also super erupt. It is important to replace even a single missing tooth to prevent these issues.

Dr. Josephs advises against permanent bridges that require preparing two healthy adjacent teeth to support a three-unit bridge. A significant drawback is the inability to floss underneath, which often leads to decay of the supporting teeth. This can result in a cycle where supporting teeth fail, requiring removal and extension of the bridge, potentially repeating throughout a patient's life.

It is definitely possible to close spaces between teeth without braces. Two effective methods are porcelain laminate veneers and Invisalign. Porcelain laminate veneers are thin facings of porcelain permanently attached to the fronts of teeth, which can last over 20 years. Invisalign involves a series of clear, removable appliances worn over several months.

The initial consultation for porcelain laminate veneers often focuses on color choice. Dr. Josephs involves the patient by asking for their preference, providing a hand mirror, and using different shade tabs against existing teeth to assess desired lightness. For patients with platinum blonde hair, fair skin, and blue eyes, the lightest 010 shade is recommended. For those with an olive or Mediterranean complexion, the 020 shade (second lightest) is often chosen, accounting for 99% of the practice's veneer cases.

The practice does not perform Lumineers or no-prep veneers. Dr. Josephs explains that placing a veneer without any tooth reduction can result in a bulky appearance and a ledge at the gum line, leading to food and plaque trapping and chronically inflamed gums. Additionally, no-prep veneers are often too thin to mask underlying tooth discoloration like darkness, yellowness, or tetracycline stains. Instead, all veneer cases performed by the practice are minimal prep veneers, which involve removing 0.8 millimeters of tooth enamel. This creates sufficient space for porcelain placement, avoiding the issues associated with no-prep options while still preserving significant tooth structure.

An implant overdenture is a treatment for patients with no teeth on a jaw (edentulous). It involves placing two implants in the bone of the lower jaw, followed by a three-month healing period. After healing, an impression is taken, and two attachments called locators are added to the implants. The denture is designed to clip tightly to these implants, providing stability and preventing it from moving around, while still being removable for easy cleaning of the implants.

Cosmetic dentistry is not a recognized specialty like orthodontics or periodontics; it is only an emphasis of practice. When considering a smile makeover with porcelain veneers, it is crucial to choose a general dental office that performs a high volume of veneers to ensure expertise and experience.