515 Madison Avenue
T. 212.755.9055
T. 212.753.0056
F. 212-371-3664
office@drsboyd.com

Dr. Justin Boyd

Dr. Ned Boyd

Reviews

Patient Education

Dental amalgam fillings, or silver fillings, have been used by dentists for more than 150 years. They are relatively long-lasting and inexpensive and have been used to restore teeth in more than 100 million Americans. Amalgam fillings contain a mixture of silver, copper, mercury, and tin. The mercury, one of the few metals which is a liquid at room temperature, renders the other strengthening metals malleable so the dentist can shape the filling into the prepared cavity.

Dental amalgam has an indisputable safety record and has been extensively reviewed. The U.S. Public Health Service issued a report in 1993 stating there is no health reason not to use amalgam, except in the extremely rare case of the patient who is allergic to a component of amalgam. This supports the finding of the FDA, the National Institute of Health Technology Assessment Conference, and the National Institute of Dental Research that dental amalgam is a safe and effective restorative material. The current debate regarding amalgam has more to do with the impact that the disposal of the excess filling material may have on the environment, than its safety for use in humans.

Mercury, in large doses, can be toxic. The majority of mercury that enters our bodies comes from food (seafood), water, and air. In fact the most directly toxic form of mercury is organic mercury, such as that found in fish. The World Health Organization (WHO) has estimated that eating seafood once a week raises the amount of mercury in the urine 2-8 times the level from the placement of an amalgam filling. You would need to have 200 amalgam fillings placed every day or eat 25-100 servings of fish every day to reach a toxic level of mercury. For a recent article from WebMD about the safety of amalgam fillings, please click here.

Because of structural and esthetic reasons, however, Dr. Boyd may choose not to place an amalgam filling. Gold fillings are usually the strongest and porcelain or composite fillings are the most esthetic. If you would like to have your silver fillings replaced for any reason (esthetics etc.) or if they are defective, Dr. Boyd would be happy to remove them using techniques that reduce the amount of mercury released upon removal. If you have any further questions, please ask Dr. Boyd.

Patients with certain preexisting conditions may require "antibiotic prophylaxis." This involves taking an antibiotic 1 hour before certain dental treatments in order to prevent the possibility of bacteria growing on the valves of the heart, known as "bacterial endocarditis." If you have a condition (listed below) which requires antibiotic prophylaxis or think you may, Dr. Boyd may confer with your physician on how best to manage your particular situation.

To learn more about antibiotic prophylaxis and the links between dental health and heart disease, click here http://www.americanheart.org/presenter.jhtml?identifier=3047083 to visit the American Heart Association's web page.

According to American College of Cardiology and the American Heart Association guidelines, Antibiotic prophylaxis with dental procedures is reasonable only for patients with cardiac conditions associated with the highest risk of adverse outcomes from endocarditis, including:

•Prosthetic cardiac valve or prosthetic material used in valve repair

•Previous bacterial endocarditis

Congenital heart disease only in the following categories:

•Unrepaired cyanotic congenital heart disease, including those with palliative shunts and conduits

•Completely repaired congenital heart disease with prosthetic material or device, whether placed by surgery or catheter intervention, during the first six months after the procedure

•Repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)

•Cardiac transplantation recipients with cardiac valvular disease

ARESTIN® (minocycline hydrochloride) is an effective antibiotic treatment in treating periodontal (gum) disease. It comes in a powder form that is easily placed inside infected periodontal pockets just after the dental professional finishes the scaling and root planing (SRP) procedure.

ARESTIN contains "Microspheres"-tiny, bead-like particles that are smaller than grains of sand not visible to the eye. The Microspheres are filled with the antibiotic minocycline, and they release the drug over time into the infected periodontal pocket, killing bacteria that live there for up to 21 days.

ARESTIN Microspheres continue to fight the infection for up to 21 days after SRP. In clinical studies, ARESTIN has been proven to be more effective than using SRP alone. ARESTIN also significantly reduced the size of periodontal pockets compared to SRP alone, killed the bacteria most commonly associated with periodontal disease, and reduced bleeding on probing of the gums.

When a tooth is missing, one option to replace it is a bridge. A bridge fills the space between two (or more) teeth by suspending a "fake" tooth (or teeth) between the crowns. This necessitates preparing some teeth on either side of the space.

Usually a bridge is made out of porcelain that has been fused onto metal (gold). This enables the dentist to imitate the color and shape of the surrounding teeth. Click here for a picture.

Make sure you are brushing with a SOFT nylon toothbrush.

•Wet and apply toothpaste. The toothpaste companies love to advertise huge ribbons of toothpaste on toothbrushes, but only a pea-sized amount is necessary.

•Hold your toothbrush at a 45-degree angle to the teeth so that the bristles of the brush aim at and under the gums. Move the brush in small circles, gently massaging the gums and teeth.

•You may use more vigorous back and forth motions for the biting surfaces of your teeth.

•In order to avoid abrasion of the outside surfaces of the teeth, start your brushing on the inside of the lower teeth. This is especially beneficial since the majority of calculus (tartar) accumulates there.

•Don't forget to brush your tongue, either with your toothbrush or a specially designed tongue-scraper. Bacteria love to colonize the back of the tongue.

•The entire process should last about 2 minutes.

Composite (or bonding) is a kind of tooth-colored plastic material which is applied to a tooth in a soft state and is then hardened by a light or laser.

While this is an excellent material for smaller cavities, small chips (fractures), or spaces, larger cavities require materials that are stronger, such as gold or porcelain.

Cosmetic dentistry is the art of improving a smile through procedures like bleaching (tooth whitening), orthodontics (Invisalign™), porcelain veneers, porcelain inlay/onlays, composite fillings, bonding, gingival recontouring, bridges etc.

If you are unhappy with any aspect of your smile, please talk to Dr. Boyd.

When the whole tooth needs to be restored, a crown is fabricated which replaces all of the surfaces that can be seen in the mouth. Gold and porcelain can be used in these restorations.

When all the teeth of one arch (upper or lower) are missing, a complete denture can be made. Either acrylic or porcelain teeth are held in an acrlyic base which covers the gums. Even though the denture-wearing patient no longer has teeth and may be satisfied with the performance of the existing denture, regular check-ups with Dr. Boyd are recommended every six months.

This is to ensure that the gums underneath the denture remain as healthy as possible and that problems can be identified as early as possible. If you are dissatisfied with the performance of your denture, speak to Dr. Boyd about the possibility of getting implants to help secure the denture.

•Break off about 12 inches of floss and wind it around the middle finger of each hand until only 4-6 inches of floss separates your fingers.

•Holding the floss tightly, guide the floss between your teeth without snapping it through.

•Once the floss passes through where the two teeth contact, allow the floss to curve against the neck of one tooth and then the other, rubbing the tooth beneath the gums.

•Remember: flossing mechanically removes plaque on the surfaces in between teeth that a toothbrush can't reach.

•Don't forget to get the back surface of the last teeth in the back.

•If this is very difficult for you, you might prefer another instrument to help you clean between your teeth, such as a stimudent or interproximal brush.

Ask your hygienist in the office for more information.

Fluoride is a mineral that occurs naturally in all water sources, even oceans. More than 50 years ago, a dentist in Texas noted that children in areas of naturally occuring fluoridated water had fewer cavities. Since then, the ideal quantity of fluoride has been determined to be 0.7-1.2 parts per million. In an effort to take advantage of a very cost-effective means of reducing the occurence of cavities in children, local governances began regulating the amount of fluoride in their water supplies.

Community water fluoridation has been hailed as one of the greatest and most cost effective public health efforts ever achieved. For the price of a few cents per year per person, the occurence of cavities dropped 60% in children born in areas with treated water. Although fluoride in a dose much higher than is in tap water can discolor teeth (fluorosis) and in tremendously high doses can even be fatal (just as sodium or potassium are), its impact on dental health has been dramatic.

Patients should be aware that although Manhattan and most of the surrounding areas in New York and Connecticut have closely regulated, fluoridated water supplies, parts of Long Island and most of New Jersey do not. Currently, New Jersey ranks 49th in the percentage of state populations that drink fluoridated public water at the CDC’s recommended therapeutic level of one part per million. Shockingly, 80 percent—7.4 million New Jerseyans—do not receive fluoridated water from the public drinking supplies.

In order to check whether your home is receiving fluoridated water, you can call your local governance, your local water supply company, or to search for New York counties, click here, for New Jersey click here, for Connecticut click here.

Brita™ water filtration systems have been tested and verified to remove only a trace amount of fluoride over the life of a filter, so we recommend Brita water filtration systems. Many brands of bottled water, however, do not contain the level of fluoride recommended by the ADA. In fact, bottled water is not required to state how much fluoride is contained in it and may in fact contain none at all.

Along with the fluoride received in the drinking water, topical applications of fluoride (like ACT Rinse) aid the body in rebuilding teeth already eaten away by small cavities. This is where fluoride in toothpaste and topical applications of fluoride in the dental office play a role especially if you are not receiving fluoride from your local water supply or only drink bottled, non-fluoridated water.

In certain cases where patients have moderate to high risk of dental cavities, Dr. Boyd may write a prescription for a special toothpaste which has an even higher concentration of fluoride. This may help prevent the incidence of new cavities in your mouth.

Unlike teeth with obvious fractures, teeth with fractured tooth syndrome usually have fractures that are too small to be seen on X-rays. Sometimes the fracture is below the gum line, making it even more difficult to identify. People who grind or clench their teeth may be more susceptible to cracked tooth syndrome because of the constant forces put on their teeth.

Sometimes a person's normal bite causes certain molar cusps (the highest points of the tooth) to exert so much pressure on the opposing tooth that it cracks. Back teeth with large fillings or teeth that have undergone root canal treatment are weaker than other teeth and may be more likely to crack. People with one cracked tooth are more likely to have others, either at the same time or in the future. If the crack worsens, the fractured portion may become loose.

If you grind or clench your teeth, talk to your dentist about treatment. Grinding can increase your risk of cracked tooth syndrome. A night guard may help prevent further damage.

Symptoms:

Many people with cracked tooth syndrome have symptoms for months, but it's often difficult to diagnose because the symptoms are not consistent. You may experience pain in the tooth when you bite or chew. However, it probably will not happen all the time. The tooth may be painful only when you bite in a specific way. You will not feel a constant ache, as you would if you had a toothache, but the tooth may be more sensitive to cold temperatures. One particularly telling symptom is pain upon release of biting.

Diagnosis:

Dr. Boyd will do a thorough examination of your mouth and teeth, focusing on the tooth in question. He may use an instrument to feel for cracks in the tooth and will inspect the gums around the tooth for irregularities. Dr. Boyd may also use a special instrument to test the tooth for fractures. One instrument looks like a toothbrush without bristles that fits over one part of the tooth at a time as you bite down. If you feel pain, the cusp being tested most likely has a crack affecting it. Your dentist may shine a fiber-optic light on the tooth or stain it with a special dye to search for a crack. If the tooth already has a filling or crown, your dentist may remove it so he or she can better inspect the tooth.

Treatment:

Treatments for cracked tooth syndrome do not always completely relieve the symptoms. Treatment depends on the location, direction and extent of the crack. Cracks vary from superficial ones in the outer layers of the tooth to deep splits in the root affecting the pulp (the center of the tooth, which contains the tooth's nerves). If the crack affects one or more cusps of a tooth, the tooth may be restored with a crown or onlay. If a crack affects the pulp, you probably will need root canal treatment. About 20% of teeth with cracked tooth syndrome require root canals. After a root canal, the tooth will no longer be sensitive to temperature, but it still will respond to pressure. This means that if you felt pain when you bit down before the root canal, you probably will not feel it as intensely as before, but you may feel it from time to time. In some severe cases, the tooth may need to be extracted. Some cracks extend into the root of the tooth under the bone and there's no way to fix the tooth. If your dentist decides the tooth needs to be extracted, you can have it replaced with an implant or a bridge.

Bad breath can be caused by foods such as garlic or onions, tooth decay, periodontal (gum) disease, continued mouth dryness, use of tobacco products, sinus or respiratory infections, some medical disorders (e.g. diabetes), inadequate oral hygiene, or some medications.

In most cases, bad breath is caused by bacterial breakdown products called volatile sulfur compounds (VSCs). In people with healthy teeth and gums, bacteria that live on the far back region of the tongue produce the VSCs. If the back of the tongue is the source of the halitosis, a tongue scraper or toothbrush used on the tongue may help to remove the odor-causing bacteria.

In people with periodontal disease, bacteria reside in pockets on the roots of teeth beneath the gums. It is of great importance to clean these area by regularly flossing and brushing, as well as receiving regular dental cleanings. Ask your hygienist and/or Dr. Boyd about methods to reduce or eliminate bad breath.

An implant is a titanium screw placed in the jaw bone into which another screw can go. Essentially, the titanium screw replaces the root of a tooth. If you are missing a tooth, an implant may be the best way to replace it considering that implants have a success rate of greater than 90%.

If Dr. Boyd decides that an implant is the best option, he will confer with another specialist (either a periodontist or an oral surgeon) who will then place the implant. Usually, 3-6 months are needed to allow the bone to heal around the implant before a crown can be placed on it.

This is the phase of treatment that Dr. Boyd will perform. It is important to remember that the charge for the connector to the implant is separate from the crown.

When too much tooth structure has been lost or there has been a fracture in a tooth, a larger restoration may be needed. Gold is the best material for inlays (smaller) and onlays (bigger) due to certain properties of the metal which enable it to be strong but kind to opposing natural teeth and keep teeth from fracturing further.

Porcelain can sometimes be used in cases where esthetics is of the utmost importance. However, porcelain is a brittle material that can fracture or wear away opposing natural teeth.

Invisalign™ is a way of straightening teeth without metallic braces. Instead, clear acrylic shells (like a night/mouthguard) are worn all the time (except when eating) and slowly move the teeth into proper alignment. Every two weeks, a new shell will be given to you by Dr. Boyd, until you have reached the intended result.

A partial denture replaces several missing teeth in one arch. Usually, a partial denture replaces both the teeth and the gums in those areas where teeth have been lost.

Periodontal Disease is the loss of the bone support around teeth. There are certain bacteria which live in and around the teeth in the periodontal pockets that chemically cause the body to resorb bone around those infected teeth.

Reducing the number, altering the kinds of bacteria, and limiting the amount of their food source is the best treatment for the disease. This entails regular cleanings, proper oral hygiene (i.e. brushing and flossing), and proper diagnosis. In some patients, medium-sized pockets can be treated with Arestin™, a local antibiotic, to help eliminate the bacteria in conjuntion with cleanings.

In our office, we offer 3 different types of cleanings. For patients with a healthy mouth with no bone loss, our hygienists perform Preventive Care Therapy (diagnosis: healthy—1 visit cleaning). For patients with gingivitis, they perform Preventive Periodontal Therapy (diagnosis: gingivitis—multiple visits).

The multiple visits allow us to remove all pathogens from around the teeth and make sure that the gingivitis gets reversed. If it is not, it could progress to periodontal disease which is no longer reversible. For patients who have lost bone support around their teeth (periodontal disease), we perform Non-surgical Periodontal Therapy (diagnosis: periodontal disease—multiple visits).

If patients do not respond well enough to this last line of therapy, they may be referred to a periodontist, who specializes in the treatment of periodontal disease, for evaluation and/or treatment.

In order to improve the appearance of your smile, you might consider porcelain veneers (laminates). Veneers are shells of porcelain that cover the outside of the tooth and can correct not only misshapen or dark teeth, but even teeth that are poorly aligned. It is always best to whiten the teeth before cosmetic procedures like this one. The procedure typically takes two visits with about one to two weeks in between. In the first visit, a very small amount of tooth structure is removed and the teeth have temporary veneers placed. In the second visit after the case has returned from the lab, the permanent veneers are cemented. Click here to see before-and-after pictures of porcelain veneers.

After root canal therapy has been performed, if a lot of tooth structure has been lost, a cast gold post and core will be required to give the future crown something to fit around. The post end goes into the root(s) of the tooth; the core end acts to replace the lost tooth structure. At the first visit, Dr. Boyd will prepare a space for the post down the root and take an impression. At the next visit the cast gold post will be cemented and the tooth will be prepared for the crown. Click here to see photos of a post and core

If you are pregnant or thinking about becoming pregnant, now is the time to pay particular attention to your teeth and gums. That’s because pregnancy—and the changing hormone levels that accompany it—can exaggerate some dental problems. Taking good care of your mouth during this time is important not just for your own sake, but also for the developing baby. Research indicates that the worse the condition of your gums, the greater the chance of having a low-birth weight, pre-term baby. Many women who previously had healthy gums may notice that their gums become swollen or bleed during their pregnancy. This condition is sometimes called “pregnancy gingivitis.” The rising hormone levels exaggerate the way your body reacts to irritants in plaque. But remember, it’s plaque, not hormones, that is the major cause of gum disease. You can prevent gingivitis by keeping your teeth clean, especially around the gumline. Dr. Boyd may recommend more frequent cleanings during your second or early third trimester to help control your gingivitis. If you are planning a pregnancy, it is a good idea to schedule an evaluation with Dr. Boyd. Having your teeth examined and cleaned before your pregnancy can help reduce the risk of having a dental emergency during your pregnancy. Continue all regular dental visits throughout the 40 weeks. Non-emergency treatment can be performed safely during this time. However, you may be advised to postpone elective treatment during the first three months. We avoid taking radiographs (x-rays) on women who are, or may be, pregnant. If, however, a radiograph is needed for a dental emergency that cannot wait until the baby is born, every precaution will be taken to minimize radiation exposure

Patients with certain preexisting conditions may require "antibiotic prophylaxis." This involves taking an antibiotic 1 hour before certain dental treatments in order to prevent the possibility of bacteria growing on the valves of the heart, known as "bacterial endocarditis." If you have a condition (listed below) which requires antibiotic prophylaxis or think you may, Dr. Boyd may confer with your physician on how best to manage your particular situation.

To learn more about antibiotic prophylaxis and the links between dental health and heart disease, click here http://www.americanheart.org/presenter.jhtml?identifier=3047083 to visit the American Heart Association's web page.

According to American College of Cardiology and the American Heart Association guidelines, Antibiotic prophylaxis with dental procedures is reasonable only for patients with cardiac conditions associated with the highest risk of adverse outcomes from endocarditis, including:

•Prosthetic cardiac valve or prosthetic material used in valve repair

•Previous bacterial endocarditis

Congenital heart disease only in the following categories:

•Unrepaired cyanotic congenital heart disease, including those with palliative shunts and conduits

•Completely repaired congenital heart disease with prosthetic material or device, whether placed by surgery or catheter intervention, during the first six months after the procedure

•Repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)

•Cardiac transplantation recipients with cardiac valvular disease

Prosthodontics is the specialty in dentistry that is concerned with the more complicated work like full-mouth rehabilitation, dentures, partial dentures, placing crowns on implants, and cosmetic dentistry. Across the country, in order to specialize in prosthodontics, a rigorous three-year-residency is required after the four years of dental school.

When the nerve in a tooth is no longer alive, either from decay, fracture, or trauma, a root canal is needed. Dr. Boyd will refer you to a specialist in this area called an Endodontist who will treat the tooth. In the specialist's office, the tooth will be anesthetized and the canal in which the nerve lies will be cleaned with tiny files and irrigated with antibacterial agents. Then the endodontist will fill the canal with an inert, sterile material. After this procedure you will most likely need a post and core and a crown.

There are many reasons why a tooth may be hurting you. It is important to come in and see Dr. Boyd as soon as you can once a tooth begins to hurt. After a thorough exam, Dr. Boyd will diagnose the problem and take steps to take you out of pain. If you have a toothache after working hours, please call the answering service at (212) 774-1485 and they will be able to locate one of the doctors who can assist you.

We have achieved the best whitening results using a combination of in-office Zoom!™, followed by two weeks of at-home whitening trays and gel, followed by another round of in-office Zoom!™. There is one fee for this comprehensive service and our administrative team would be happy to discuss that with you. Zoom!™ in-office tooth-whitening is a procedure that lightens teeth an average of 8 shades using a combination of a hydrogen peroxide gel and a specially designed ultraviolet lamp. The lamp accelerates the results of the gel and allows maximum results in a shorter time. During the entire treatment, a plastic retractor will be placed in the mouth to keep the lips, cheeks and tongue away from the teeth and the mouth open. A light-cured barrier and gauze will be placed over the gums and maybe even parts of the teeth to shield them from the light and the gel. Lip balm with SPF and UV-protective eyewear will be used as well. The teeth will be exposed to the light with the peroxide gel for three (3), 15-minute sessions. There are two kinds of sensitivity associated with the procedure, the first of which is gum-sensitivity. This can occur if some of the gel gets under the barriers if they become dislodged by excess movement. This can result in a stinging sensation on the gums. The second type of sensitivity is tooth-sensitivity. This occurs when the peroxide penetrates to the dentin layer of the tooth through microcracks. It most frequently occurs in the lower front teeth and causes what we call “zingers,” which feel like short electric charges inside one tooth. They most often go away within a few hours. In very few people, “zingers” last up to 24 hours and can be quite bothersome. Both kinds of sensitivity are short-lived and only occur in a small number of cases. To counteract sensitivity, we recommend that most people take two to four ibuprofen or Advil™ one hour prior to the procedure. In some cases, the trays that are used for at-home whitening can be used with desensitizing agents. Many people find that the worst part of the procedure is boredom. To address this, please feel free to bring your iPod™ or video iPod™ to listen to/watch your choice of material. If you should forget, we have an iPod™ in the office with a limited musical selection. Click here for some before and after photos of our patients.