Everything listed under: Marc Gottlieb DDS

  • Lingering Toothache

    Many of my patients will tell me that the worse pain they have ever felt is the pain of a dental toothache. For most patients a visit to the dentist usually leads to a clear-cut direction of care and a predictable resolution of pain. The solution may require a root canal or extraction. Depending on the location of the toothache, root canal therapy is 95% successful. The remaining 5% that remain symptomatic is the result of the irritated ligaments and bone that supports the tooth. Normal chewing will produce pain. The tooth may throb and wake you out of a sound sleep.  A number of conditions may still persist and the tooth pain now becomes chronic. If you experience tooth pain after a root canal, that lasts for more than two weeks, then the dentist needs to examine the tooth for an untreated canal, a tooth fracture, or possible neurological condition. 

    When a tooth fracture and untreated canal have both been ruled out medications are the first and most likely therapy to help restore the health of the ligaments and bone.  A dose of antibiotics may be administered to rule out an active dental infection. If the pain persists after dental treatment and antibiotics then the cause of the pain may be neurologic in origin and require a dentist that specializes in this type of pain management or a neurologist. The oral medications of choice are often not easily tolerated by patients and require some creativity in terms of dosage, time of administration, and the need for polypharmacy. Common choices include low-dose tricyclic antidepressants inclusive of amitriptyline, nortriptyline and sinequan. Additional medications such as benzodiazepines, lyrica, gabapentin, baclofen and trileptal are frequently used as well. The amount of medications will vary from case-to-case and may at times require the use of liquid suspensions instead of pills to achieve a balance between effectiveness and side effects. Topical medications used intra or extra orally may be beneficial as well. In situations where an autoimmune influence may be suspected medications called biologics (Enbrel, Humira) may be required. These medications should be prescribed by a rheumatologist whose skills are often essential as part of the pain care team. There are times, however, that response to these therapies is poor and pain continues. At some point in time if the pain just doesn't get any better you must consider extracting the tooth and hope this solves your problem.  

    For additional information or a second opinion call Dr. Gottlieb for a consolation without an obligation.

  • Dental Cleaning with sedation.

    Yes, you can have your teeth cleaned with sedation. You can have every dental procedure done with sedation. Sedation dentistry is not limited to oral surgery. When you need to have a tooth removed many patients request sedation to help them overcome their anxiety or fear of the dentist and the dental procedure. A significant number of men and woman would like to have sedation just to have their teeth cleaned or to fill a few cavities. 

     At Anxiety Free Dental we understand that you mouth is a very sensitive part of your body.  Dr. Gottlieb offers Oral or IV sedation to every patient for all dental procedures. Below is an example of a very apprehensive young man who put off cleaning his teeth for years. He was afraid of the pain and anxious about hearing the sound a dental instrument makes while scraping the tartar off the teeth. With oral sedation and good local anesthesia he was able to have a couple of fillings done and his teeth professionally cleaned. For a no obligation consultation call Dr. Gottlieb at the Levittown  dental office.

    Before cleaning with sedationafter cleaning with sedation dentistry

     

  • Post Featured Image

    Fear of Needles and the dental injection.

    One of the biggest fears many patients have in the dental chair is the fear of the needle or dental injection. Many patients worry about the pain of the injection or the shock type feeling when trying to numb a lower tooth. Even the thought of the dentist using dental instruments for cleaning, examining, and/or drilling teeth causes them to break into a cold sweat. Of the many sharp and pointy objects a patient may first encounter is the needle. Today most dentists will typically apply a topical anesthetic  (cherry flavored) to help eliminate any sensations of the injection. Today's modern local anesthetics have a neutral Ph so you hardly feel any discomfort. The type of local anesthesia can be tailored to the procedure so your entire face doesn't have to be numb for hours after you leave the dental office.  

    Fortunately, we do understand needle phobia, also known as trypanophobia. It is completely natural and common among patients of all ages. If you are terrified of needles, we understand that you can’t “just get over it” and mentioning this phrase to you would probably not help you to either.  After all, the slight pinches you feel are very minor compared to pain you would feel without the anesthesia and you sure won’t want to undergo dental work without it.
    Here are two tips to help your fear of needles:
    1. Focus on how much better you will feel after your dental work. Understand that Sedation Dentistry helps alleviate your fear of the dental injection and once numb you can receive pan less dental care.  
    2. If sedation dentistry is not you you then perhaps listening to music, through your head phones or trying your best to close your eyes and relax. The point is not to build up anxiety about the perception of pain you will feel by being stuck with a needle. Modern dentistry has come a long way to eliminate your fear of the needle.
    Hopefully, you find these tips helpful when visiting us in the Levittown office. Ask Dr. Gottlieb as many questions as you like and he will explain the many options you have to overcome your fear of the dentist and the fear of the dental injection.

    If your terrible fear of the dental injections is preventing you from even staying in the dental chair comfortably, sedation dentistry is an option that can be taken which would help you overcome your fear of needles. Sedation dentistry is a very safe option for many patients. You are given pills or a liquid to take about 30 minutes before treatment. The medication will make you drowsy and relaxed. You will not be unconscious however, many patients do not remember the appointment. For those very nervous patients I.V. Sedation may be another option as well.  Sedation dentistry helps many patients get over their initial fears of needles. 

    Katherine Ynsinare
    & Marc Gottlieb DDS


  • Why Patients Fear the Dentist

    Fear of the dentistFears not only paralyze, they also lead to avoidance. A fear of heights, for example, would make one stay far from anything that isn’t grounded. Similarly, a fear of the dentist can make someone avoid the dentist. In efforts to avoid the dentist individuals may brush their teeth three times a day. They floss daily and rinse with a Fluoride mouthwash. Unfortunately, most apprehensive dental patients neglect proper oral care and wait until they are in pain to start dental treatment.

    If you are someone who will go to the dentist only when it is absolutely necessary, not only are you more likely to delay treatment, the treatment may be more costly and complicated. This procrastination may in turn make your fear of the dentist worse and turn into a vicious cycle of dental fear.” Frankly, the longer you wait for your next dental visit, the more fearful you’re likely to be.

    For many patients, this stems from previous experiences with a dentist, especially during childhood. If this is the case for you, you should be very glad to know that the field of dentistry is continually advancing and there are many options for you to be treated so you feel no pain. The newer generations of local anesthetics are virtually painless. Sedation dentistry is also a very safe option for most apprehensive dental patients.

    We are here to make you feel more comfortable. Before any procedure, the dentist will clearly explain what you will be feeling and for what duration. Don’t let your fear of the dentist keep you from receiving the preventative oral care you need or suffer with a toothache that can be painlessly treated in our Levittown office.

    Written by
    Katherine Y. and Dr. Marc Gottlieb

    Sources:
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945617/

    http://www.biomedcentral.com/1472-6831/7/1


  • Pacemaker / Defibrillators and the dental appointment

    Dentistry and Cardiac Devices: Is there an interference?

    Individuals with abnormal sequences in their electrical impulses, also known as arrhythmia, could have medical devices, such as Cardiac Pacemakers and Implantable Cardioverter Defribillators (ICDs), which can help prevent future complications and or treat their heart conditions. If you currently have one of these devices or will soon be receiving one, your physician will remind you to be aware of surrounding items in your environment that might cause interference with it.

    According to the American Heart Association, an item as simple as a pair of headphones can cause interference with defibrillators and pacemakers due to a magnetic substance they contain. The interference is dependent on their distance to the medical device. Being conscious of your surroundings, you might have wondered whether electrical dental devices could cause any interference.


    Several studies have suggested select dental devices may cause interference with pacemakers and ICDs. Thus, dentists have been cautioned to avoid these dental devices. However, many of these studies were conducted in vitro, in laboratory settings, which are not necessarily the same conditions as in the clinic or operatory. The authors of a recently published study aimed to demonstrate that dental devices do not interfere with pacemakers’ and defribillators’ pacing and sensing function.

    Perhaps, you may be wondering what these electrical dental devices include? Some of the more commonly used electrical dental equipment in our office include the battery operated curing light (used in many restorative procedures), ultrasonic bath (for sterilization of our instruments), cavitron (used during dental cleanings), amalgamator, and hand pieces. Investigators in the study operated these devices at various distances of the cardiac devices on 32 patients, making this one of the largest in vivo study to investigate these effects. These participants ranged in ages from 18 to 90 years of age. It is significant that there was not a single major interaction among them. After testing pacemakers and ICD units, it was concluded that “…dental devices presented minor electromagnetic interference with programmers that interrogate cardiac devices implanted in patients. Those interactions are not typically observed in a dental setting because cardiac devices wouldneverbe interrogated there, and the observed interactions were not associated with significant clinical implications.”

    Although the study noted interference with the telemetry from the cardiac programming unit, there is “no clinical impact on patient safety.” If you’ve ever been concerned about how items in our office may affect devices used for your heart conditions, we hope this information reassures you that dental devices have posed and continue to pose very little threat to you. We hope future studies are conducted to provide even greater validity, not only for dental professionals but for our patients. Continue visiting your dentist without worries! If you have any questions or have a dental emergency don't hesitate to call Dr. Gottlieb at the Levittown office.

    AHA:
    https://www.heart.org/HEARTORG/Conditions/Arrhythmia/PreventionTreatmentofArrhythmia/Devices-that-may-Interfere-with-Implantable-Cardioverter-Defibrillators-ICDs_UCM_448464_Article.jsp

    Interference between dental electrical devices and pacemakers or defibrillators
    http://jada.ada.org/article/S0002-8177(14)00026-9/fulltext

    Electromagnetic interference of electrical dental equipment with Cardiac pacemakers (2007):
    http://www.ncbi.nlm.nih.gov/pubmed/17937372brillator

     
    Written by: Katherine Ynsinare
     Dr. Marc Gottlieb's Levittown Dental Assistant


  • Gagging and the gag reflex.

    What’s this gagging?:

    Have you ever experienced a feeling when you are brushing your tongue where all of a sudden, you almost have the urge to vomit? If so, you have activated your gag reflex, also known as the pharyngeal reflex. The gag reflex is usually described by a contraction of the back of the throat in response to an object touching the posterior part of the tongue, the roof of your mouth, or really any area at the back of the throat. It helps to prevent us from choking or ingesting harmful substances. [1]

    I have never known the severity of a gag reflex until meeting patients that have been really difficult to treat because of a gagging issue. In fact, I have come to meet some individuals with such a severe gag reflex that brushing or flossing their teeth is a major problem. Imagine the difficulties they would have keeping up with dental hygiene at home. Patients have confessed that eating certain foods have also become problematic. This can result in picky eating and/or malnourishment.[2] And while some patients claim to have this issue since infancy, others seem to develop it as an adult.

    Gagging at the slight touch of a dental instrument in the mouth could very much also be psychological. Maybe your anxiety in the dental office is getting the best of you.

    “Well, I don’t know why I gag so much. Is there any way I can stop gagging?”

    The first step should be to figure out what is causing the gagging. Removing the gag reflex during dental work could be just a simple yelling of “aaaaahhhh” or require simple to heavy sedation. You could just as easily see a huge difference in the activation of your gag reflex by not eating for a certain number of hours prior to sitting in the dental chair. Perhaps you could ask your dentist to distract you or have you calculate math problems. Depending on the type of dental treatment required and the location in the mouth Oral or I.V. Sedation will be required. Back molars are harder to treat than front teeth and lowers next to the tongue more difficult than uppers.

    The best way to determine how to treat your gagging is to have a simple dental exam. Often we can take the initial X-rays outside your mouth. A panorex type X-ray only requires the patient to bite on a stick using the front incisor teeth.

    For additional information on gagging and the dentist follow the links below or call for a free consultation without an obligation.

    [1]Anxiety Symptoms Series: http://www.healthcentral.com/anxiety/c/157571/119343/anxiety-symptoms/
    [2] What is the Gag Reflex?: http://www.livescience.com/34110-gag-reflex.htmlk
    [3]A Long-Term therapeutic Treatment For Patients With a Severe Gag Reflex: http://www.tandfonline.com/doi/abs/10.1080/00207140490914252#.VK5w3dLF-Xo

    Katherine Dr. Gottlieb's dental assistant.  

    Written by Katherine Ynsinare  DA
    Anxiety Free Dental Levittown, NY 11756


  • Cracked Tooth

    Everyone uses their teeth to chew food and sometimes other uses. Your teeth are not to be used as a tool. The tooth is made of enamel and a core material known as dentin. Enamel is as hard as glass and the dentin bone. If you chip the enamel many times it can be smoothed off or repaired with a composite bonding material. If the crack goes through the enamel and into the dentin then it can be a problem. Unlike bone, a tooth cannot repair itself so once a crack propagates into the dentin you may need a crown, root canal , or extraction.

    The symptoms of a cracked tooth varies from a simple rough edge to throbbing toothache. If you can chew on a soft object without pain then the fracture is likely limited to the enamel. If upon chewing something soft like a rubber band and you experience shooting pain then the crack likely continues on into the dentin and possibly down into the bone. 

    If you can't chew on your tooth call for an immediate appointment. Don't wait until it hurts. 

Long Island Dentist Photo

Dr. Marc Gottlieb is one of Long Island's leading dental practicioners, specializing in helping those who feel anxiety or apprehension when visiting the dentist. He can be reached at marc@anxietyfreedental.com