Important information Dr. Hertz would like his patients to know:

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A crown is placed when there is not enough tooth structure remaining to support a filling.

A crown is a helmet for the tooth. It surrounds the tooth and covers the remaining tooth structure.

The tooth must be prepared so that there’s an adequate amount of space for the material of the crown.

The crown can be made of a solid material (in gold) or can have porcelain baked over a metal substructure (sort of like a thimble) or it can be all ceramic. There are several types of ceramic crowns including pressed ceramics, cad cam milled or layered porcelains. The best one for you is determined by the location of the tooth to be restored personal habits as well as what remains of the tooth and the surrounding teeth. Your dentist will help decide which type of crown is best.

Because a crown is placed after there is no longer enough tooth structure to support a filling, this tooth has been beaten up. It has a history of fillings, breaks and or trauma. For this reason most teeth with crowns have root canal therapy first. This is not necessarily the case but it is true most of the time. We know a root canal is necessary if the tooth becomes sensitive or if we prepare into the nerve chamber because of exiting decay.

Although a broken tooth requiring a crown may not be sensitive before preparation it could be sensitive after preparation. The work done to make the crown itself is an additional trauma to the tooth and we never know what the “last straw” going to be.

Oral appliances: Here to Stay

As oral appliances (OAs) become more accepted as an alternative to CPAP, sleep laboratories, sleep dentists, And OA manufactures are working together to give patients the most appropriate appliance to treat snoring and mild to moderate OSA. CPAP is still the gold standard for the treatment of mild to moderate OSA, but there are a number of signs that oral appliances (OAs) are becoming a popular and wildly accepted alternative. More than 2 years ago, the American Academy of Sleep appliance therapy, opening the door for sleep physicians to prescribe OAs as an option for the treatment of mild to moderate OSA, Of course CPAP remains the most widely used treatment for OSA, but there are signs that OAs are beginning to gain market share.


Heavy Snoring as a cause of carotid Artery Atherosclerosis

Recent studies have suggested that snoring and obstructive sleep apnea hypopnea syndrome may be important risk factors for the development of Carotid Atherosclerosis and stroke. Previous studies have not made it clear if snoring per se is independently related to the risk of developing Carotid Atherosclerotic plaque. The investigators conducted this observational study using volunteers examined in a sleep laboratory. One hundred ten volunteers (snorers and nonsnorers with only mild, nonhypoxic obstructive sleep apnea hypopnea syndrome) underwent polysomnography with quantification of snoring, bilateral carotid and femoral artery ultrasound with quantification of atherosclerosis, and cardiovascular risk factor assessment. Subjects were categorized into three snoring groups: mild (0%-25% night snoring), moderate (>25%-50% night snoring), and heavy (>50% night snoring).
Results showed that the prevalence of carotid atherosclerosis was 20% with mild snoring, 32% with moderate snoring, and 64% with heavy snoring. Appropriate statistical analysis was used to determind the independent affect of snoring on the prevalence of carotid and femoral atherosclerosis. After adjustment for age, sex, smoking history, and hypertension heavy snoring was significantly associated with carotid atherosclerosis but not with femoral atherosclerosis. The authors concluded that heavy snoring significantly increases the risk of carotid atherosclerosis and the increase is independent of other risk factors, including measures of nocturnal hypoxia and obstructive sleep apnea severity. Considering the high prevalence of snoring in the community, these findings have substantial public health implications for the management of carotid atherosclerosis and the prevention of stroke.
Sleep Apnea Risk and Severity in a Population of Dental Patients

Obstructive sleep apnea is a commonly undiagnosed chronic disease. While dentists represent an important resource for identifying people at risk for primary snoring and sleep apnea, less than 50% of dentists are capable of identifying the common signs and symptoms of sleep disordered breathing. The purpose of this study was to assess the prevalence of probable obstructive sleep apnea/sleep disordered breathing and symptoms associated with this condition a population of dental patients using a validated questionnaire and software that could be administered in a dental office. A retrospected analysis was conducted using questionnaire responses obtained from 170 men and 156 women, and sleep study data obtained in the patients homes from 75 men and 30 women with a portable recorder.
Forty-six percent of the men and 19% of the women reported snoring frequently or always. Of the 67% of the men and 28% of the women identified as having a high pre-test probability (high risk) of having at least mild sleep apnea, over 33% of the men and 6% of the women surveyed were predicted to have moderate or severe sleep apnea. In a subgroup of 105 patients classified at high risk who completed an overnight sleep study, 96% had an apnea hypopnea index (AHI) greater than 5 events per hour. Seventy percent of those predicted to have moderate or severe OSA by questionnaire had an AHI greater than 20. All patients previously diagnosed with sleep apnea were correctly classified at high risk. There was a high concordance between the predicted OSA risk and the degree of sleep disoriented breathing.
The high prevalence of undiagnosed sleep apnea in dental patients suggests that dentists could provide a valuable service to their patients by incorporating sleep apnea screening and treatment into their practice. Those who practice sedation dentistry should consider additional precautious when managing patients with risk of sleep apnea.

Contratulations on your pregnancy!
while it'simportant to eat healthy and exercise appropriately,
you also need to take good care of your teeth and
gums. Scientists have recently learned that your
oral health may affect your baby's birth-weight.
Thanks to an important study researchers at
the University of Norht Carolina, scientist have
found a connection between a serios gum disease,
called periodontitis, and pregnant women whose
babies were born too early or at a low weight.
What Is Periodontitis?
Periodontitis is a bacterial gum infection that can lead to the destrcution of the bone and fibers that support your teeth. It cam usually be easily treated when discovered early. Signs of periodontitis may include tenderness, bleeding, swelling of the gums or loose teeth. You may, however, have no signs at all. Only a dental professional can tell for sure, so it is important to see a dentist regularly.

How Can Periodontitis Affect My Baby?
As in other infections, when you have periodontitis, your body tries to fight it to stay healthy. Scientists bealive that this fight produce byproducts and chemicals that can travel through your blood stream into other parts of your body. if these chemicals reach your uterus (womb), they may cause you to go into labor before your baby has fully developed.
According to some estimates, periodontitis may contribute to as many as 45,500 preterm, low birth-weight babies every year in the United States alone. That is more than those attributed to smoking and alcohol use.

What is Invisalign®?
- Invisalign® is the invisible way to straighten your teeth without braces.
- Invisalign® uses a series of clear removable aligners (pictured to the left) to straighten your teeth without metal wires or brackets.
- Invisalign® has been proven effective in clinical research and in orthdontic practices nationwide. In fact, over 70% of all U.S. orthodontists are certified to treat patients with Invisalign®.
How Does Invisalign® Work?
- You wear each set of aligners for about 2 weeks, removing them only to eat, drink, brush, and floss.
- As you replace each aligner with the next in the series, your teeth will move - little by little, week by week - until they have straightened to the final position your orthodontist or dentist has prescribed.
- You'll visit your orthodontist or dentist about once every 6 weeks to ensure that your treatment is progressing as planned.
- Total treatment time averages 9-15 months and the average number of aligners worn during treatment is between 18 and 30, but both will vary from case to case.
- Click here to download an informational video from the Invisalign® website to learn more about Invisalign and hear from actual patients.
How Are Aligners Made? You'd Be Amazed...
- The aligners are made through a combination of your orthodontist's or dentist's expertise and 3-D computer imaging technology. (click here to open the Invisalign® website into a new browser window)
Patient Prefer Invisilign to traditional braces
- Since there are no brackets or wires the Invisalign trays are smooth to the tongue and almost invisible to others. They are especially good for retreatment of lapsed orthodontic cases where the teeth have shifted undesirably after the original treatment was completed.


Porcelain laminates, also termed Porcelain Veneers, involve a procedure that was invented by a New York City ceramist Adrian Jurim in about 1982. As he tells it he was trying to make a new smile for his wife and he didn't want bonded filling material placed on her teeth nor did he want her to crown her teeth. He collaborated with several different New York City dentists in developing this technique in which a thin cosmetic layer of porcelain is bonded to enamel and the process of using porcelain veneers to cover the teeth was successfully developed . He has been granted a patent for this process of etching the veneers with hydrofluoric acid so that bonding material would stick to the porcelain(this strengthens the porcelain and allows the veneer to be attached to tooth structure.
Porcelain laminates can be a terrific way to get a new smile. In a relatively short amount of time, with out the need for extreme tooth preparation, a cosmetic dentist can create a new more pleasing smile. This is especially good for people with worn or miss positioned front teeth. Also, If after attempting bleaching, you are still unhappy with your teeth's color, laminates can be used to change the color as well as the shape and position of your teeth. Dr. Spindel is an experienced cosmetic dentist who can specify a highly gifted and artistic technician to create your new teeth and there numerous success stories attesting the value and length of service of well done cosmetic porcelain laminates.
Before beginning this treatment Dr. Spindel sends photographs and study models to a special cosmetic dental laboratory. Usually Dr.Spindel requests that a special wax-up preposal be made so that the final result can be previewed by him and the patient. After a final smile treatment has been approved by him and the patient a beautiful final result can be accomplished in as little as one week. Preparation of the teeth is usually necessary to provide room for a ceramicist to fabricate attractive facing for the teeth that are not bulky. Although some techniques claim to not need any preparation of the teeth, lack of any preparation of the teeth tends to result in bulky, non natural looking final results.
An impression is made of the prepared teeth, the opposing teeth and a bite registration and these and other records are sent to a specialized dental laboratory for the veneer fabrication. While waiting for the final veneers the patient often doesn't need to wear temporary restorations since the waiting time is usually about one week and the preparation of the teeth is minimal. If the patient desires, temporary veneers can be fabricated.
After the veneers have been fabricated they are tried in to check their form and color. Minor adjustments can be accomplished at this time, but if either the patient or Dr. Spindel isn't satisfied they will have to go back to the laboratory for major changes.
Once a satisfactory result has been achieved, Dr Spindel carefully applies bonding to the teeth and places the veneers in the mouth. After placement, , excess bonding material must be carefully removed so as not to irritate the surrounding tissues. All surfaces must be carefully checked for smoothness and if any rough margins are detected they should be smoothed by the dentist at this time.
Porcelain laminates that have been properly fabricated and carefully placed can last for many years. It is not uncommon for them to remain attractive and functional in the mouth for more than ten years. Patient home care and habits are important to achieving a result that lasts... Good oral hygiene, including proper brushing and flossing technique, is a must. With that in mind, there is no reason why someone desiring a more attractive smile shouldn't consult their dentist about whether porcelain laminate might be a good option for improving their smile.


Our team of dental specialists and staff strive to improve the overall health of our patients by focusing on preventing, diagnosing and treating conditions associated with your teeth and gums. Please use our dental library to learn more about dental problems and treatments available. If you have questions or need to schedule an appointment, contact us.

A denture is a removable replacement for missing teeth and adjacent tissues. It is made of acrylic resin, sometimes in combination with various metals.

Types of dentures

Complete dentures replace all the teeth, while a partial denture fills in the spaces created by missing teeth and prevents other teeth from changing position.

Candidates for complete dentures have lost most or all of their teeth. A partial denture is suitable for those who have some natural teeth remaining. A denture improves chewing ability and speech, and provides support for facial muscles. It will greatly enhance the facial appearance and smile.

Complete or full dentures are made when all of your natural teeth are missing. You can have a full denture on your upper or lower jaw, or both.

Complete dentures are called "conventional" or "immediate" according to when they are made and when they are inserted into the mouth. Immediate dentures are inserted immediately after the removal of the remaining teeth. To make this possible, the dentist takes measurements and makes the models of the patient`s jaws during a preliminary visit.

An advantage of immediate dentures is that the wearer does not have to be without teeth during the healing period. However, bones and gums can shrink over time, especially during the period of healing in the first six months after the removal of teeth. When gums shrink, immediate dentures may require rebasing or relining to fit properly. A conventional denture can then be made once the tissues have healed. Healing may take at least 6-8 weeks.

An overdenture is a removable denture that fits over a small number of remaining natural teeth or implants. The natural teeth must be prepared to provide stability and support for the denture.

Partial dentures are often a solution when several teeth are missing.

Removable partial dentures usually consist of replacement teeth attached to pink or gum-colored plastic bases, which are connected by metal framework. Removable partial dentures attach to your natural teeth with metal clasps or devices called precision attachments. Precision attachments are generally more esthetic than metal clasps and are nearly invisible. Crowns on your natural teeth may improve the fit of a removable partial denture and they are usually required with attachments. Partials with precision attachments generally cost more than those with metal clasps.

How are dentures made?

The denture process takes about one month and five appointments: the initial diagnosis is made; an impression and a wax bite are made to determine vertical dimensions and proper jaw position; a "try-in" is placed to assure proper color, shape and fit; and the patient`s final denture is placed, following any minor adjustments.

First, an impression of your jaw is made using special materials. In addition, measurements are made to show how your jaws relate to one another and how much space is between them (bite relationship). The color or shade of your natural teeth will also be determined. The impression, bite and shade are given to the dental laboratory so a denture can be custom-made for your mouth.

The dental laboratory makes a mold or model of your jaw, places the teeth in a wax base, and carves the wax to the exact form wanted in the finished denture. Usually a "wax try-in" of the denture will be done at the dentist`s office so any adjustments can be done before the denture is completed.

The denture is completed at the dental laboratory using the "lost wax" technique. A mold of the wax-up denture is made, the wax is removed and the remaining space is filled with pink plastic in dough form. The mold is then heated to harden the plastic. The denture is then polished and ready for wear.

Getting used to your denture

For the first few weeks, a new denture may feel awkward or bulky. However, your mouth will eventually become accustomed to wearing it. Inserting and removing the denture will require some practice. Your denture should easily fit into place. Never force the partial denture into position by biting down. This could bend or break the clasps.

At first, you may be asked to wear your denture all the time. Although this may be temporarily uncomfortable, it is the quickest way to identify those denture parts that may need adjustment. If the denture puts too much pressure on a particular area, that spot will become sore. Your denture can be adjusted to fit more comfortably. After making adjustments, you may need to take the denture out of your mouth before going to bed and replace it in the morning.

Start out by eating soft foods that are cut into small pieces. Chew on both sides of the mouth to keep even pressure on the denture. Avoid sticky or hard foods, including gum.

Care of your denture

It's best to stand over a folded towel or a sink of water when handling your denture, just in case you accidentally drop it. Brush the denture (preferably with a denture brush) daily to remove food deposits and plaque, and keep it from becoming permanently stained. Avoid using a brush with hard bristles, which can damage the denture. Look for denture cleansers with the American Dental Association (ADA) Seal of Acceptance. Pay special attention to cleaning teeth that fit under the denture`s metal clasps. Plaque that becomes trapped under the clasps will increase the risk of tooth decay.

Hand soap or mild dishwashing liquid to clean dentures is also acceptable. Other types of household cleaners and many toothpastes are too abrasive and should not be used for cleaning dentures. A denture could lose its proper shape if it is not kept moist. At night, the denture should be placed in soaking solution or water. However, if the appliance has metal attachments, they could be tarnished if placed in soaking solution.

Even with full dentures, you still need to take good care of your mouth. Every morning, brush your gums, tongue and palate with a soft-bristled brush before you put in your dentures. This removes plaque and stimulates circulation in the mouth. Selecting a balanced diet for proper nutrition is also important for maintaining a healthy mouth.


Over time, adjusting the denture may be necessary. As you age, your mouth naturally changes, which can affect the fit of the denture. Your bone and gum ridges can recede or shrink, resulting in a loose-fitting denture. Loose dentures can cause various problems, including sores or infections. Dentures that do not fit properly can be adjusted. Avoid using a do-it-yourself kit to adjust your dentures, as this can damage the appliance beyond repair. Glues sold over the counter often contain harmful chemicals and should not be used on a denture.

If your denture no longer fits properly, if it breaks, cracks or chips, or if one of the teeth becomes loose, see your dentist immediately. In many cases, dentists can make necessary adjustments or repairs, often on the same day. Complicated repairs may require that the denture be sent to a special dental laboratory.

Over time, dentures will need to be relined, re-based, or re-made due to normal wear. To reline or re-base a denture, the dentist uses the existing denture teeth and refits the denture base or makes a new denture base. Dentures may need to be replaced if they become loose and the teeth show signs of significant wear.

Common concerns

Eating will take a little practice. Start with soft foods cut into small pieces. Chew slowly using both sides of your mouth at the same time to prevent the dentures from tipping. As you become accustomed to chewing, add other foods until you return to your normal diet.

Continue to chew food using both sides of the mouth at the same time. Be cautious with hot or hard foods and sharp-edged bones or shells.

Some people worry about how dentures will affect their speech. Consider how your speech is affected when you have a number of your natural teeth missing.

Pronouncing certain words may require practice. Reading out loud and repeating troublesome words will help. If your dentures "click" while you`re talking, speak more slowly. You may find that your dentures occasionally slip when you laugh, cough or smile. Reposition the dentures by gently biting down and swallowing. If a speaking problem persists, consult your dentist.

Denture adhesives

Denture adhesives can provide additional retention for well-fitting dentures. Denture adhesives are not the solution for old, ill-fitting dentures. A poorly fitting denture, which causes constant irritation over a long period, may contribute to the development of sores. These dentures may need a reline or need to be replaced. If your dentures begin to feel loose, or cause pronounced discomfort, consult with your dentist immediately.