Crowns and Bridges: Why Quick Fixes Fail with Dr. Feinberg

You mentioned, if they tell you it only takes two settings or two days to complete the work.

Oh, you mean like crowns in an hour? That is junk. And in dentistry, when I make crowns and bridges, what enabled my dad and I to have so much success is that the crowns and bridges are modeled on the idea of a mason jar cover, which is the best known method of food preservations. So I almost never get decay under my crowns and bridges almost never. And also because I have a good grip on the root, I don't have crowns falling out or bridges falling out. That is very unusual. If I ever had that, I would do it over in a heartbeat. I wouldn't even think about it and I'd want to know why that happened. And usually it's because you didn't get enough grip on the root and you have to go and create a little bit more room and then there's no problem. And that's not what a lot of them are doing. They're doing what you call butt joint restorations, where you create a ledge all around on the tooth.

You're listening to Cold Press Conversations with Dr Jewel White-Williams, a lover of numbers, lists and a good glass of cold press juice, who is sharing episodes each week to help you explore the back end of healthcare and health sciences, where a lot of that grit is done. We'll dive into topics covering research, education and clinical practices, as well as guest shows with other leaders in the field. Pull up a seat and let's dive into these amazing and game-changing conversations. Hello and welcome to cold press conversations. This is dr jewel, and I am here with a very special guest. I am your host.

We're going to delve into a critical topic and we're going to talk about our teeth. Yep, we're talking about teeth today. I'm making it very simplistic because Dr Feinberg, who is our expert today, will give us such an insight about our health, our teeth, and he's going to take us on a journey of his background to where he is now and how he is assisting other dentists, as well as his dad did, to ensure that we're meeting the needs and health of those of us who are in our communities. And we're going to even show even further the impact of our mouth, our teeth, why we must clean the way we do, because it's a huge impact to the health of which we live daily. So, before I go any further, how are you doing, dr Feinberg?

I'm doing great, and you.

Awesome, awesome, awesome. You know I've got to give them a little bio about who you are, because you have a wealth of knowledge and I think they need to hear this. You know Dr Feinberg, isa graduate of Tufts University, he has practiced dentistry for over 40 years, initially in Scarsdale, new York, and is now in Arizona, trained by his father, dr Elliot Feinberg. A pioneer in full coverage restorative dentistry, he continued a legacy documented with over 100,000 photographs spanning over 70 years. As the director of Onward, an online teaching platform, dr Feinberg has created more than 30 courses and provides an extensive library of educational materials for dentists. A nationally recognized lecturer and author, dr Feinberg has contributed significantly to dental literature and serves as a reviewer for the Journal of Oral Implantology. He holds leadership roles in several dental associations, including the American Dental Association, the Arizona Dental Association. He's received numerous awards for his service and he is also an author of open, wide essays on challenges facing dental practitioners and how to evade them to achieve excellence. Now he also has a textbook. Am I correct, dr Feinberg?

Yes, I also have a textbook on a very niche subject in dentistry. And that subject is precision attachment removable partial dentures, which very few dentists know anything about, and it's a wonderful solution to a lot of restorative problems.

And that's the key you focus on full coverage restoration right.

Yes, which really means crown and bridge work, whether it be on natural teeth or on implants. That's what that's what I really do. So the whole point of doing that is to preserve the foundation, which are the roots and the bone, so that you can hold on to your teeth.

And I like that. Now, one thing I did want to state is that when I was reading everything in the book that I am going to probably be using just a little bit just to help us with the flow of the conversation, open wide the essays on challenges facing dental practitioners and how to evade them to achieve excellence. I understand that you had a blog and you realized you didn't realize the wealth of understand that you had a blog and you realized you didn't realize the wealth of information that you had and you thought you'd turn it into a book. Is that true?

That's correct. Yeah, One day I looked at it and said this could be a book, and so that's what I did. I turned it into a book and I thought well, this might Okay go ahead.

Oh, no, no no, I thought we were pros, that's okay, but no, I thought that was pretty interesting because I had a chance to read several of the essays.

They're impactful. Yes, I originally wrote it for my profession and for dentists, but I really think a lot of it has a public appeal and it really gives an eye-opening look at some of the things that are going on in our profession, some of which are good and some of which are really terrible.

Do you mind just giving us a little background? I know I mentioned a little bit into your biography about how Dr Elliot Feinberg, your father, and you discuss it in your book, how you had an opportunity to learn from him. Now, it was a little pivot that you had to take in order to learn from him, because he had high expectations he had high expectations.

Oh, he was a tough cookie, let me tell you, and I learned he was a genius and a real pioneer in full mouth reconstruction and crown and bridge dentistry and he was my mentor and teacher. I learned everything from him and the techniques and basic philosophy that I learned is completely different from what's being taught in dental schools and in other mainstream institutions Completely, and that's why I have this collection of pictures that he started in 1950. Thousand pictures of quick cases that go back to 1950, where all the teeth were prepared and handled the same way and the cases followed for decades with x-rays. So I have a lot of cases that I did in the mouth 30 and 40 years with minimal changes in the bone, and I don't see that from anyone else in my profession, which is very upsetting, because my dad had a mentor.

His mentor was Dr I Franklin Miller, and what I'm doing really is an extension from the very origins of Crown and Bridge Dentistry and somewhere along the line the profession went off in a different direction and that is one of the reasons why they're having so much trouble with Crown and bridge and so much so that they want to pull all the teeth out and put implants in, and that's not as good as saving your own teeth I don't think, but a lot of it is simply because they don't know how, and that's why I started the teaching website. And unfortunately, a lot of dentists are indoctrinated in wrong thinking, so they never get on the right track and they have ideas that are wrong, and it bothers me that they're having trouble with things that were actually solved in the 1930s. That's upsetting, and if we're going to live in I did- read something about that.

I thought that was pretty interesting how you stated that, like from the 1930s. You said about 40 years ago we didn't have the problems that we're having today because it's just the way that they're taught. I thought it was really interesting that you stated that.

Yes, and it's the truth, the origins of Crown and Bridge. They didn't have the problems with recurrent decay and crowns and bridges falling out that most practitioners are having today when they do Crown and Bridge, because their approach was different. That's what I'm doing. Because their approach was different, that's what I'm doing and I know why that happened.

But it's very hard to get the profession back on track so that we really do move ahead, because you know, a lot of emphasis now is on technology and a lot of patients think, oh that, you know. Wow, they're using high technology and it came out of a computer. It must be better. But nothing could be further from the truth, because technology is just a tool, not an end in itself, and if it has to conform to basic principles that are tried and true if it's going to be any good. So some is good and some is terrible, and I could look at it one, two, three and size it up. And some is terrible, and I could look at it one, two, three and size it up. But most practitioners, because they don't have the same background, have no way of evaluating whether the technology is any good.

And that's that's a problem too. Yeah, and it's interesting because that was one of the things I know. We learned a little bit more about your background, your experience, and we went and touched into the current practice of what you're doing and it sounds like being that I talk about research, I talk about education. It seems as though your father began a form of research and which, which he was just taking pictures, you know, keeping track of what he was doing, but he moved it into a port, where now it is. It's a legacy of where it's in your hands now and you want to make sure that we're meeting the needs of the dental community. There was a piece in here that was pretty interesting. It was page 23. And I think this is the part that I think you're leaning towards. That I think you're leaning towards. Dentists have to effectively communicate that they can help patients in ways that few practitioners can. Onward skills have the potential to open doors in ways one could never imagine, and that really was pivotal for me to read.

Yes, we've done miracles for patients that most dentists have no idea can be done. We save teeth that most dentists would extract in a heartbeat because they would say they can't be saved. But that's not true, and one thing your listeners should be aware of is not to just take at face value what someone says that they can and cannot do, because if one practitioner can't do something well, maybe another one can. So it's a good idea to seek other opinions before you go and do something that you might regret later.

Okay, so okay, I got to bring this up In your book. I may not have it highlighted, but it's here. There was a piece that you discussed. I'm trying to see if I can find it. It was some type of program that you went into where you had an opportunity. I didn't highlight it. You had an opportunity to go and see other practices. It was like the same. Yes, yeah, this was exciting.

I've done a lot of interesting things, and this was one marketing thing. I never did conventional type marketing and it was. It was started by a chiropractor from Philadelphia and he was going to match you up with alternative practitioners in your area so you could meet them and establish a relationship and maybe send each other referrals. Well, I met so many of them that that became impossible, but I had. It was eye-opening because I realized that not all plastic surgeons are the same. I was in one office where they had four lasers in the operating room. So you know right then and there that nobody knows more about lasers than that guy. And then I was in another office where they were doing a physical therapy and one of them was specializing in hand physical therapy and something happened to my office manager and she needed hand physical therapy. Guess where I sent her? Only because I did that program. I would never have known otherwise. So I learned a lot. I got to yeah, because it was called alternative therapies?

Was it called alternative therapies and it was dealing with a?

program where yeah, like adjunctive medical services, like chiropractic, Right right. I got to meet the. I got to meet and became friends with the chiropractor for the Yankees and he had a TV show. He had me on his TV show. It was fantastic.

Yeah, and I thought that was pretty interesting.

It was. It was totally fascinating. It didn't really result in many referrals because it takes time to really establish a relationship. You can't do it with one visit and I was meeting two and three a week for with one visit and I was meeting two and three a week for weeks on end and I was too much. But in the meantime I really did learn a lot and it was eye-opening.

So I'm going to go to helping patients outside of your field, which you give an explanation. You stated that Dr Irving Shapiro, former clinical assistant professor of preventive medicine and community health, he noted the word doctor, which is derived from the Latin doctor, which means to teach. The word teacher, as well as the word learning, means different things to many people and doctor means teacher, and you give us an empirical article that goes along with it. There was something that really hit me. A great teacher this is you. A great teacher does not have to have all the answers, however. A great teacher is willing to do whatever it takes to find the answers. A great teacher knows when that patient is better off in other hands and finds the appropriate. That was a powerful statement.

Yes, you know, I give you a perfect example. In the beginning of my career I was also doing some root canal therapy, and that's one area of dentistry that has made huge strides. It's so much better than when I graduated from dental school, but it requires very specialized equipment to do the best work. Like, all good endodontists have the microscope, which I did not have. And then all good endodontists have a way of treating the strange anatomy inside teeth that you can't get at and you can't see. So you can't get at that conventionally. That's why a lot of root canals failed, even though they look perfect on the x-ray, because there were side canals and flutes with tissue that you can't see. So there's two methods that both require specialized equipment. One is called the gentle wave, which is kind of like a washing machine is the best way I can describe it, and the other is lasers, and I've worked with endodontists who do both of those things. So because I couldn't do endodontics to that standard, I stopped doing it. So I knew that there were other people who could do it far better than me, and I wanted the best for my patients.

My area of expertise is crown and bridge work, and that's what I'm sticking to. But at least I have a background, because all of the specialties are related together in some way and if you're going to do any kind of dentistry, you have to be aware of when to ask for help from specialists to see what they could do for your patient. So I always do that. I've gone to orthodontists and periodontists and oral surgeons with x-rays and models what can you do for my patient? And I get the information and then I can present it to my patient and we could figure out what's best for that patient, because there is really no one size fits all. We're all individuals and the patients are individuals and a lot of times you have to have outside the box thinking in order to come up with the solution that's really best for each patient.

One of the problems that I see out there now in my field is that a lot of practitioners become very adept at one procedure and I'll say it's implants 99% of the time and then the solution to that becomes every solution becomes an implant solution. That's not true Most of the time. It should be a last resort, not a first resort. Isn't that what you would want? To save your own teeth? That's what I believe in.

I think, except in certain circumstances, like somebody has a perfect mouth and they were born with missing lateral incisors, that's a perfect place for implants as a first resort. But most of the time bridge work is a better choice because you could do something good for the whole area. You can correct all the problems that are wrong, bring the forces up close to the bone and that's the end of it, whereas an implant only fills a space and does nothing for the teeth around it. And if you go to the lectures or read articles on implants and you look at the teeth around the space they're going to place the implants, they're not virginal teeth, they're teeth with big fillings, teeth with bone loss, teeth with crowns. They're going to need crowns and bridges. That makes no sense to put an implant in that space. And yet that's what people are doing most of the time. And it boggles my mind that people don't think of bridge work first, when that would be a much better solution. The whole area. That would be the end of the patient's problem, because they're going to need the work anyway. So the other way, with the single tooth implant, their problems are never solved and it's perpetual work that needs to be done.

I don't think that's right. I want to see the patients cured Well, not cured, because dentistry is not really lifetime, but I have patients with dentistry that I did in 40 years. And because the changes were why? Because their techniques violate basic principles that allowed my dad and I to have success over the last 70 years, and it's very hard to get them to appreciate what it is that I'm showing. I find it very, very difficult to connect with them, especially the younger practitioners. They're set in their ways and they're not so open-minded. That's terrible. So anyway, I don't want to be a whistleblower.

No, no, you're fine. You're fine. There was something when you were talking. You allowed me to think of one thing. It was somewhere in there, and then I want to talk about another thing you mentioned. If they tell you it only takes two settings or two days to complete the work.

Oh, you mean like crowns in an hour.

That is junk. And in dentistry, when I make crowns and bridges, what enabled my dad and I to have so much success is that the crowns and bridges are modeled on the idea of a mason jar cover, which is the best known method of food preservations. So I almost never get decay under my crowns and bridges almost never decay under my crowns and bridges almost never. And also because I have a good grip on the root, I don't have crowns falling out or bridges falling out. That is very unusual. If I ever had that, I would do it over in a heartbeat. I wouldn't even think about it and I'd want to know why that happened. And usually it's because you didn't get enough grip on the root and you have to go and create a little bit more room and then there's no problem. And that's not what a lot of them are doing. They're doing what you call butt joint restorations, where you create a ledge all around on the tooth and then you make the restoration to that ledge. And so they came up with this machine called a CEREC machine C-E-R-E-C and it mills the crown from a computer. And the problem with butt joint restorations is that they can never be sealed. So there's a lot of problems with decay under them and some of these things coming out, because bacteria are microns and you can't see what's sealed and what's not sealed. We don't have any way of looking to see on that level whether something is sealed or not sealed. So the mason jar cover concept is a way of getting around that, the fact that our techniques aren't that accurate compared to a bacteria, and the fact that we do not have any bonding or cements that can really seal the teeth properly. So in any case, this end product from a computer is no different from the old high-fusing porcelain crowns that were baked in an oven in the 1960s. They're both butt joint restorations.

You think we didn't know what was wrong with those things in the 1960s. And here now the young people don't understand what this is. I looked in two seconds and knew it was no good. But the poor patients who have no way of judging what they're getting, they think, oh, this is high tech crams. In an hour I don't have to come back, it's got to be better. But that's not true. Nothing could be further from the truth. That's all I can say there. On the other hand, I'm not one of those Luddites who doesn't like technology, because I love technology, but it has to conform to basic principles that I believe in. So there is some good technologies that I believe in. So there is some good technologies. Milling of precious metals is going to replace the hundred year old technique of waxing and casting. There's still a few little problems to work out, but it is superior. So that's an example of good technology.

Okay, I have this other piece that I want to talk about stated. I'm going to ask a question and hopefully you can help give me some light. What about the majority of patients? Except for practices that specialize in pediatric dentistry, the bulk of patients in most practices are middle age and older. Many have chronic conditions like diabetes, heart disease. All right, how does dentistry uphold on these patients?

Well, I know the techniques that I'm showing and the cases that I'm showing are not cases on young people. Like you see, when you go to the lectures most lectures you only see people with perfect gingiva and perfect mouths and they're having crown and bridge. You could almost get anything to work under those circumstances. But I have those patients who were middle-aged, who got diabetes, cancer, heart disease, and if you can get something to work in those patients, when you have everything against you, you know you're doing something right and that's what I have to show, that's what I have to offer. That's awesome and I wanted to bring that up?

Yeah, I wanted to bring that up. So my question is and this is my question then we know that we have geriatric physicians. Are there people who meaning people who specialize in geriatrics? Are there dentists who specialize in geriatric conditions?

Yes, there are. However, I don't like to treat people that way. I treat them as individuals and I can do things for them that most dentists would never think of. So I can help those people and I've helped. I know how to make, for example, really good temporaries with copper bands, and so somebody is not a candidate for sophisticated dentistry.

I never let them walk around with no teeth. I could make them something right then and there and you know it's not going to last forever, but at least they have teeth. I think it's terrible. I never let anybody walk out of my office with no, but at least they have teeth. I think it's terrible. I never let anybody walk out of my office with no crown. I wouldn't even care if it was completely flush with the gum. I've saved all those teeth. That doesn't bother me because while most of the profession is concentrating on tooth structure above the gum, I only care about what's below the gum and I get a good grip on the root. I don't need anything sticking up above the gum. I think all the teeth are the same and I handle them the exact same way.

When I make dentistry. I let the patients wear it on a trial basis with Vaseline, ointment or a rubber material or silicone, something like that, on a trial basis. So when I'm satisfied, I cemented it and they don't fall out and I don't build them up, I don't put posts, I don't do any of that. And this is this is the years I've been doing this and I can't reach people in my profession to let them know that they are going in the wrong direction. And all of the because I'm an outsider. I don't know how I got to be an outsider, coming from the origin of the profession and crown and bridge, because that's where I'm from, but I'm considered a radical and an outsider and what I'm doing my dad's teacher did that amazes me.

Yeah, no, no, no, and that's the reason why I wanted you on here. We talked about a lot to our audience. We talked about bridge work, crown work, all in four implant. I would love to go even further in regards to this. What is one last thing that you would like for our audience to know? And then I'm going to have you kind of do a call to action in regards to your Onward program, so dentists can get that wealth of information, because, as you state, doctors are learning. It's a teaching, it's a teaching platform for us?

Yes, well, we are supposed to be a learned profession and I myself take a lot of continuing education courses. I don't know everything. I want to see what they're doing, even if I don't agree with it, and so I've taken a lot of. I was told in 1989 to start keeping a list of all of the courses that I was taking. It's now 51 pages. Are you serious is? Are you serious? I'm serious. I'm always taking continuing education and I'm involved with the dental association in putting on some of the big meetings. I've served on the ADA's council on annual sessions, where you put on the big meeting for 50,000 people, and the greater New York dental meeting, also the largest meeting in the country, and I'd have a blast doing it. And then you always learn something, always. So not only like to teach courses, but I also like to take courses, and I think that's very, very important.

It's clearly noted when I read your book. It really is One thing that they didn't hear beforehand, because you and I were just talking about our periodontal disease and how it correlates to our health. Can you give just a little? We don't have much time, but just a little bit about the importance of why people need to go to the dentist.

This is a problem of dentistry. Prevention is everything. The problem in dentistry is that the teeth are connected to the bone by a ligament. The problem in dentistry is that the teeth are connected to the bone by a ligament, and the way most people get into trouble with losing their teeth is not so much from decay but from bone loss, and one of the things that we know causes bone loss is letting tartar and plaque and calculus build up, because that can cause the gums to become inflamed and that can spread to the underlying bone and, as we were talking about at the beginning, unhealthy gums is a direct route into your body for the bacteria in the mouth and can certainly cause systemic problems and other problems like missing teeth or a bad bite.

When you have missing teeth, for example, the teeth around the space shift and the teeth opposite the space erupt and they start taking forces in abnormal directions and nobody knows when the body's not going to tolerate that and when it can't. Something gives and either the teeth wear or the bone goes, and now you're talking about upper and lower the whole area and the whole mouth collapsing. That's why it's so important to replace missing teeth to prevent that from happening, because as you get older, the body can tolerate less. But the single best thing that you could do for your oral health is to have regular hygiene. Maybe some people need more than every six months, and every three or four months is the best thing you could do for your mouth to keep yourself healthy. So that's, that's the best advice I could give. I think that's, that's, that's. If that helps somebody, it's all worth it. And just you know, just something simple like that.

Now I thank you, I really thank you for this. You just you bring light to dentistry for me and I do love teeth. It's just one of my passions. I believe in carrying that toothbrush and toothpaste wherever I go, and I know a lot of people fear the dentist, so that's the reason why I really wanted you on, so they can hear that it's not just you know, let me come in here, take a tooth out, or let me come in here and just sort of like clean it. There's a background to why we go to see the dentist. There's a background to why the dentists go to school to learn. There's a background to the purpose of a crown versus a bridge versus an implant, partial implants versus full. I mean, there's so many things we could talk about.

There's one last thing I want to say. The best thing about being a dentist is the relationships that you make with people. I loved my patients. I really cared about them. I love the staff members I worked with. I had amazing people. We're still in contact to this day, even though we all moved to different States. Um, we're still in contact and they're just. They were just so wonderful. We we were such a great team and that I miss.

I'm sure you do. Um, before we go, just a quick announcement. Uh, dr Feinberg has a program called Onward, something that your father started, that you continued and is out there for other dentists. I know that we are here for the general public, but we are also here for the community, for the patient. We are here for the community person as well as for medical professionals so they can gain additional insight.

So, dr Feinberg, would you mind just giving us just a quick bit about what Onward is and how they can the other dentists can learn how to get your program so they can advance themselves as well, the Onward website is the place where I cover every aspect of the philosophical approach that I was talking about, and I have videos of how to do the techniques and why you're doing what you're doing, and each video is an hour in length, because most people don't have an attention span longer than that.

I found that out, so I make the videos myself and now I have to update them, because some of them are five years old. But I'd like to update them and make them a little bit more current, and I'm better at it now than I was when I started and I also have a blog which I send out to a lot of like over 2000 people in my profession so that I can discuss these issues, and I have all different things in my book from these blogs. Some are uplifting, some are about these marketing things that we talked about, and some are scathing indictments of things that I don't like and that I know we're going in the wrong direction.

No, he's honest. He's honest, so that may not adhere me to some people.

No, no, you're honest about it. You're honest, you know. Dr Feinberg, I just want to say thank you once again for just joining me here on Cold Press Conversations. This was a delightful interview. I'm sure that people will continue to stay tuned to learn more about what you can offer Later on. We hope to have him back so we can delve into so much more. Oh, my gosh, my notes are ever ending in regards to dentistry, but because we know that our mouth, it, predicts a lot, so we just need to learn even more. And I just want everyone until next time this is Dr Jewel signing off I just want everyone to remember, to take care and remember. This is in regards to your health and your cognitive health. Thank you very much, dr Feinberg, and may everyone have a beautiful day.

Thank you.

You're welcome. I hope you enjoyed this episode of cold press conversations. If you love this episode as much as I did, I need you to head on over and subscribe so you never miss an episode. This is Dr Jewel signing off to health and cognitive happiness.