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In recent decades civilization's millennia-long search for clean, safe drinking water has become much easier with modern purification methods. Today, there are few places in the United States without adequate access to potable water. And about three-fourths of the nation's tap water systems add fluoride, credited with helping to reduce tooth decay over the past half century.

But in recent years some have voiced concerns about the safety of tap water and popularizing an alternative: bottled water. Manufacturers of bottled water routinely market their products as safer and healthier than what comes out of your faucet.

But is that true? A few years ago a non-profit consumer organization called the Environmental Working Group (EWG) performed a detailed, comprehensive study of bottled water. Here's some of what they found.

Lack of transparency. It's not always easy to uncover bottled water sources (in some cases, it might actually begin as tap water), how it's processed, or what's in it. That's because unlike water utilities, which are rigorously monitored by the Environmental Protection Agency (EPA), the Food and Drug Administration (FDA) oversees bottled water production with less strenuous guidelines on labeling. Eight out of the top 10 selling brands were less than forthcoming about their water's contents in EWG's investigation.

Higher cost. According to the EPA, the average consumer cost in the last decade for tap water was $2.00 per 1,000 gallons (0.2 cents per gallon). The retail cost for even bulk bottled water is exponentially higher. It can be a costly expenditure for a family to obtain most of their potable water by way of bottled—while still paying for tap water for bathing and other necessities.

Environmental impact. Bottled water is often marketed as the better environmental choice. But bottled water production, packaging and distribution can pose a significant environmental impact. EWG estimated the total production and distribution of bottled water consumes more than 30 million barrels of oil each year. And disposable plastic water bottles have become one of the fastest growing solid waste items at about 4 billion pounds annually.

While there are credible concerns about tap water contaminants, consumers can usually take matters into their own hands with an affordable and effective household filtering system.  EWG therefore recommends filtered tap water instead of bottled water for household use.

If you would like more information on drinking water options, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Bottled Water: Health or Hype?


Academy Award-winning actress Kathy Bates knows how important it is to present your best face to the world — and one of the most important features of that face is a beaming smile. But there came a point when she noticed something was a little off. “I've always had good teeth, but it seemed to me as I was getting older that they weren't looking as good,” Kathy explained in a recent interview with Dear Doctor magazine.

That's when she decided it was time to take action. Kathy had orthodontic treatment when she was in her fifties, and she keeps her smile bright with tooth whitening treatments. She uses a kit provided by her dentist with a safe, effective whitening solution.

Of course, a bright, healthy smile looks great anywhere — whether you're on the red carpet or “off the grid.” And you don't have to be a Hollywood star to have professional whitening treatments. In fact, teeth whitening is one of the most popular and affordable cosmetic treatments modern dentistry offers.

The basic options for professional teeth whitening include in-office bleaching or take-home kits. Both types of dentist-supervised treatments offer a safe and effective means of getting a brighter smile; the main difference is how long they take to produce results. A single one-hour treatment in the office can make your teeth up to ten shades lighter — a big difference! To get that same lightening with at-home trays, it would take several days. On the plus side, the take-home kit is less expensive, and can achieve the same results in a bit more time.

It's important to note that not all teeth can be whitened with these treatments. Some teeth have intrinsic (internal) stains that aren't affected by external agents like bleaches. Also, teeth that have been restored (with bonding or veneers, for example) generally won't change color. And you can't necessarily whiten your teeth to any degree: Every tooth has a maximum whiteness, and adding more bleach won't lighten it beyond that level. Most people, however, find that teeth whitening treatments produce noticeable and pleasing results.

What about those off-the-shelf kits or in-the-mall kiosks? They might work… or they might not. But one thing's for sure: Without a dentist's supervision, you're on your own. That's the main reason why you should go with a pro if you're considering teeth whitening. We not only ensure that your treatment is safe — we can also give you a realistic idea of what results to expect, and we will make sure that other dental problems aren't keeping you from having a great-looking smile.

How often does Kathy Bates see her dentist for a checkup and cleaning? “I go about every four months,” she noted. “I'm pretty careful about it.” And if you've seen her smile, you can tell that it pays off. If you would like more information about teeth whitening, please contact us or schedule an appointment. You can learn more in the Dear Doctor magazine articles “Important Teeth Whitening Questions Answered” and “Teeth Whitening.”


Contrary to what you might think, a knocked out tooth doesn’t inevitably mean tooth loss. Time is of the essence — the shorter the interval between injury and replanting the tooth, the better the tooth’s long-term survival. The longer the interval, on the other hand, the less likely the tooth can survive beyond a few years. That phenomenon is due to the mouth’s natural mechanism for holding teeth in place.

The tooth root maintains its attachment with the jaw bone through an intermediary tissue known as the periodontal ligament. Tiny fibers from one side of the ligament securely attach to the tooth root, while similar fibers attach to the bone on the opposite side of the ligament. This maintains stability between the teeth and bone while still allowing incremental tooth movement in response to mouth changes like tooth wear.

While the ligament fibers will attempt to reattach to a replanted tooth’s root, the longer the tooth is out of the socket the less likely the fibers will fully reattach. An “ankylosis” may instead form, in which the root attaches directly to the jaw bone without the periodontal ligament. In this situation the body no longer “recognizes” the tooth and begins to treat it like a foreign substance. In all but the rarest cases, the tooth root will begin to resorb (dissolve); at some point (which varies from patient to patient) the attachment becomes too weak for the tooth to remain in place and is lost.

Ideally, a knocked out tooth should be replanted within 5 minutes of the injury (for step-by-step instructions, refer to The Field-Side Guide to Dental Injuries available on-line at www.deardoctor.com/dental-injuries). Even if you pass the 5-minute window, however, it’s still advisable to attempt replanting. With a subsequent root canal treatment (to remove dead tissue from the inner tooth pulp and seal it from infection), it’s possible the tooth can survive for at least a few years, plenty of time to plan for a dental implant or similar tooth replacement.

If you would like more information on treatment for a knocked out tooth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Knocked Out Tooth.”


Due to financial circumstances, people often have a lost tooth restored with a removable partial denture, an effective appliance that restores function and a degree of aesthetic appearance. Later, though, they may want to improve both function and appearance with a dental implant.

If this describes you, you’re making a great choice. Dental implants are the closest technology we have to a natural tooth. But there may be a roadblock to your implant, especially if a long time has passed since your tooth loss—there may not be enough bone at the site to place an implant.

The heart of an implant is a titanium metal post surgically imbedded in the jawbone. The titanium naturally attracts bone cells, which grow and adhere to it to form a solid hold that can support a porcelain crown or other restorations like bridges or dentures. But to achieve a natural appearance it’s important that the implant is placed in the right location. To achieve that requires adequate bone.

But there may not be adequate bone if the tooth has been missing for a while. The forces generated when we chew travel through the teeth to the jawbone, which stimulates bone growth. If that stimulus is absent because of a missing tooth, new bone cells may not replace older ones at a healthy rate and the total bone volume begins to diminish. A denture can’t compensate and, in fact, accelerates bone loss.

But there may be a solution: bone grafting. With this procedure we place a donor bone graft into the area of bone deficiency some time before implant surgery. The graft serves as a scaffold for new bone cells to grow upon. Hopefully, this will produce enough healthy bone to support an implant. If the bone deficiency is minor, we may place the implant and the bone graft at the same time.

If you have experienced bone loss, we must first determine the amount of bone at the missing tooth site and whether grafting is a viable option. Bone grafting postpones your implant, but the delay will be worth the wait if we’re successful. With increased bone volume you’ll be able to obtain a new tooth that’s superior to your current restoration.

If you would like more information on dental implants, please contact us or schedule an appointment for a consultation.


Teeth can take a lot of force over a lifetime of biting and chewing, thanks to enamel, their outer layer made of the strongest substance in the human body. Unfortunately, they’re not invincible: it’s even possible for you to break or “fracture” a tooth while biting or chewing normally.

Although such a fracture might seem to occur out of the blue, it’s usually related to a condition known as cracked tooth syndrome. It usually occurs in three stages: in the first, miniscule cracks in the outer enamel known as craze lines develop. They’re not immediately dangerous since they only involve the enamel surface; but left untreated they could deepen and progress to the next stage, a larger crack that penetrates the tooth’s underlying dentin.

If allowed to grow, this crack in turn can lead to the third stage, a full fracture that could extend down to the root. A fracture can put the tooth in danger of loss, especially if its inner pulp becomes exposed. To avoid this worst case, it’s best to treat the tooth at the earliest stage possible when craze lines are just developing.

There is a difficulty, though, with detecting craze lines — they’re small, too small to detect normally with x-rays. We, therefore, rely on other methods such as using an instrument called an explorer to feel for cracks, having the patient bite on a stick or rubber pad to replicate pain symptoms or using fiber-optic lighting with special dye stains to highlight possible cracks. Endodontists, specialists in root canals, can use microscopic equipment that’s quite adept at detecting craze lines.

There are also some signs you can be on alert for that might indicate a craze line or crack. If you feel a short, sharp pain — a “wince” — when chewing and releasing food, you could have a crack that hasn’t yet affected the nerves. If a true fracture occurs, the pain will intensify and you may notice pieces of the tooth coming off. If the crack extends to the root, the pain will become greater and more chronic.

It’s important then that you see us for any recurring pain symptoms as soon as possible. If it’s a crack, the sooner it’s treated the better your tooth’s chances for survival.

If you would like more information on cracked tooth syndrome, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Cracked Tooth Syndrome.”

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