Choosing Care That Lasts a Lifetime - Dr. Edward Feinberg

Discover the surprising pitfalls of modern dentistry and how to navigate them with wisdom from Dr. Edward Feinberg, a veteran in restorative dentistry with over 40 years of hands-on experience. As our special guest, he challenges the widespread dependency on implants, advocating for the preservation of natural teeth as the true mark of quality dental care. Tune in to get equipped with practical advice on how to engage with your dentist effectively and ensure your treatment plan puts the health of your teeth front and center. Dr. Feinberg shares his time-tested techniques for preventing decay and enhancing the lifespan of dental work, emphasizing that well-executed crowns and bridges often present better alternatives to implants.

But that's not all—this episode sheds light on the pressures faced by today's dental students, burdened by debt and driven towards prioritizing quantity over quality in their practice. Dr. Feinberg argues for the importance of treatments designed to last a decade or more, rooted in strong foundational principles. We'll explore the long-term benefits of comprehensive treatment plans over single-tooth implants and the financial considerations that patients should weigh when choosing their options. By taking a holistic view of dentistry, we champion the notion that the best dental care is not just about the immediate fix but about crafting a sustainable path to lifelong oral health.

Chapters

• 0:00 Exploring Dental Health and Treatment Options
• 14:24 Quality Dentistry and Treatment Choices

Transcript

Speaker 1: 0:00

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Speaker 2: 0:59

Hello and welcome to Prezor Principles, where we dive deep into the conversations that enrich our lives in all the ways that matter, from personal health to professional mastery. I'm your host, avik, and today we are tackling a topic that affects us all dental health. Be exploring the crowns, bridge, walk and implants, the key procedures that can make or break your oral health. To guide us through this, we are joined by Dr Edward Feinberg. So welcome to the show, dr Edward. Thank you Lovely, lovely. Welcome to the show. So, dr Edward, before we start our conversation, I'd quickly love to introduce to all of our listeners, dear listeners, dr edward is a highly experienced dentist, educator and author. So, with over like 40 years of practice and a rich legacy in restorative dentistry, dr fienberg brings unmatched expertise on how we can preserve and improve our dental health. So, whether you are considering a dental procedure or just want to better understand the options available, this episode is for you. So welcome to the show again, dr Feinberg.

Speaker 3: 2:18

Thank you very much.

Speaker 2: 2:19

Lovely, lovely. So, Dr Feinberg, if you can briefly explain what crowns, bridge walk and implants are and why they're so, so important for the dental health?

Speaker 3: 2:31

Sure, I'd be happy to. First let me just tell everybody a little bit more about myself, because I have a very unique background that's very different from all of my colleagues just about everyone I know I grew up in dentistry and I was trained by a master and pioneer of full mouth reconstruction and crown and bridge dentistry. I have 100,000 pictures of crown and bridge cases that go back to 1950. All the teeth were paired and handled the same way and the cases followed for decades with x-rays. That's 70 years of documented evidence for the techniques that I'm doing, and I see a lot of dentists having trouble with crowns and bridges that they didn't have in the past.

Speaker 3: 3:21

All the problems that they are having were actually solved in the 1930s, and the problems that they're having are crowns falling off and decay under the crowns, and it all has to do with the fact that the teachers in the 1970s wanted to teach techniques that they thought would be easier for the students to do, that they thought would be easier for the students to do, and they ended up violating the basic principles that enabled my dad and I to have so much success.

Speaker 3: 3:51

So then along came implants in the 1980s, and implants are artificial roots, like metal roots that are implanted in the bone, and then they can make a restoration on top of these implants, which are called fixtures. And saving your own teeth is so much better if you can save them. But less and less dentists have good crown and bridge techniques, so their first choice is to extract the teeth and place implants, and, except in certain circumstances, I really believe that implants should be a last resort rather than a first resort. But that's not how they're being done today. So the implants are being overused and also used inappropriately, which I'm against. So I'm trying to sound the alarm so that my profession will sit up and take notice, because it's going in the wrong direction and I'm very upset about that.

Speaker 2: 4:55

That's really lovely, and also you have mentioned that many teeth are being extracted that could actually be saved. So how do patients ensure that they are getting the best advice for their dentist.

Speaker 3: 5:09

That is a very big problem because there's no real way for them to evaluate exactly what they're getting and they won't know for at least five years or so whether their dentist is any good. I have dentistry that I did for patients in the mouth 40 years and that doesn't mean that everybody's dentistry gets to last 40 years, because it really depends on changes that occur. And I have some patients where the changes are minimal and gradual, so they get away with it and they get to hold on to their dentistry for decades. And then I have other patients where changes occur and then the dentistry should be replaced, maybe after 10 or 15 years, and it can be a very tough call as to when you should step in there and do it, because the changes are also minimal and gradual. Usually that's the case and if you see drastic changes then I want them to have a complete physical because there may be some underlying medical condition responsible for that. But that's not common.

Speaker 3: 6:12

But a lot of dentists are really having so much trouble with crowns and bridges that they tend to shy away from it. Even teachers from advanced dental institutes and we have one here in Scottsdale shy away from doing crown and bridge and do all these invasive treatments and difficult treatments when the easiest and most predictable would be crown and bridge. See, crowns and bridges are corrective and that's what a lot of dentists don't understand. They're trained to think of them as mere tooth coverings. But if you know how to do good crown and bridge work, you can compensate for any periodontal bone loss that occurred to prevent future bone loss. And I make my crowns on the model of the mason jar cover, which is the best known thing ever devised for food preservation, so I almost never get decay under my crowns. My dad's teacher did that, and yet they all veered away from it. And a lot of dentists are doing what they call butt joint restorations, such as all ceramic restorations. So typically when you make an all ceramic restoration, you prepare the tooth with the ledge on it and then you make a crown to the ledge. Those crowns can never be sealed because there's always an opening, and to a bacteria which is microns, that might as well be the Grand Canyon and you cannot see it. And coupling that with the fact that our techniques aren't accurate at the level of a bacteria, that just opens the door for trouble. So that is one of the reasons why they're having problems with crown and bridge.

Speaker 3: 7:58

I'm able to save teeth that are completely flush with the gum and I don't build them up with posts or build-ups or have fancy orthodontic extrusion procedures or a lot of crown lengthening. Because I was trained differently and I don't share the misconceptions and paradigms that the dental schools are teaching, and I can't get anybody to listen to me. I have a teaching website, wwwtheonwardprogramcom, in an attempt to try to train anybody who will listen, Because I really believe that if we're going to advance as a profession, anything new that comes down the pike must be compared to the standard of what came before. Otherwise we are not advancing. So there's a lot of technology. Some of the technology is good technology, but some of it is bad and violates the basic principles that enabled my dad and I to have so much success. And this is being pushed on the public.

Speaker 3: 9:02

Crowns in an hour that's what that is. Butt joint, all ceramic restorations, Essentially no different than the old high fusing porcelain crowns that we baked in an oven in the 1960s. You think we didn't know what was wrong with those things, and now a machine is making the same thing. It doesn't matter how it's made, it's the outcome. That's most important. But today there's an emphasis on workflow and economics, which I'm against. It should be an emphasis on health and longevity.

Speaker 3: 9:38

That's how I was brought up in dentistry, and the best feeling in the world is when you do something for a patient and then they come in year after year for their hygiene visits and you get to watch the work that you did last in health. There is no better feeling than that. That's why I'm a dentist. I get such a big kick out of that and that's what I got from my father and that's what he got from his teacher, and the rest of the profession went off in a different direction and that concerns me.

Speaker 3: 10:09

So it's tough for the patients to find people who know how to do the kind of work that I'm doing. That's really very difficult, but I think they should know and at least seek somebody who you know has a better background for crown and bridge work and not afraid to do crown and bridge work. I had a patient come in this week and she had, you know, kind of extensive decay on a few teeth. They wanted to pull out all of her upper teeth and put in this case they call an all-on-four case, where they put four implants in and then they build this huge superstructure on top of it and you can't even clean under it and this is overloading the implants and very likely to fail, because implants are feats of engineering and you can't overstress any feat, any engineering structure, Otherwise it will fail. In the engineering world there's a lot of famous disasters where they didn't take into account the forces that were going to be acting on those structures, and the same exact thing happens in the mouth.

Speaker 2: 11:28

I understand. So, like some listeners might wonder that with new technology in dentistry, is there still a place for traditional bridge work or is it outdated?

Speaker 3: 11:45

Well, I believe in basic principles. Technology that conforms to basic principles is good technology. So scanning and milling conforms to basic principles, with an exception, which I'll tell you about in a second, and I know that to be accurate. In fact it might even be an improvement. But technology is only a tool, not an end in itself, and we as dentists are only responsible for the outcome, not the means by which we arrived at that outcome.

Speaker 3: 12:17

So when I do dentistry, I get a good grip on the root. I go all the way down and in the x-rays it looks like the crowns and bridges are sitting right on the bone. They're not, of course, because the body wouldn't tolerate that, but that's the best architecture that you could have for health, and most people are not doing that. And they haven't invented a scanning technique where you can get an impression of the entire root surface above the bone and below the gum. That has not been invented, so there's no way to get around doing things in the analog way, meaning taking impressions and making models, and then you can scan the models into the computer and design dentistry, and that's good.

Speaker 3: 13:08

Dentistry and milling is superior to casting, and there's a company in Pennsylvania that's at the forefront of milling precious metals, that I'm very impressed with what those people are doing. So I am not just, you know, one of those Luddites who doesn't like computers or who doesn't like advancement. I believe very strongly in basic principles, and if technology conforms to those basic principles, I'm all ears because I want to do better. But if it doesn't, I'm not interested, and a lot of it does not, and that's why they're having all these problems with crowns and bridges and would rather extract the teeth and place implants.

Speaker 2: 13:48

That's great, yeah, lovely. So also on this, like in your extensive experience, have you noticed certain dental procedures that is becoming more commercialized, Like could this be affecting the quality of patient care?

Speaker 3: 14:06

Oh, absolutely. I'll give you a perfect example. Here in Arizona we have an increasing maybe the most in the United States of any state of these DSOs which are like corporate dentistry and they capture a lot of the young people. Because one thing that's really terrible which we didn't have when I went to dental school is that the dental students are getting out of school with these enormous debts. It's not uncommon for them to have debts in excess of half a million dollars before they even get started doing anything and at a time when they're supposed to build up their knowledge and skills, because their skills are rudimentary and what they can give you in dental school is a rudimentary foundation. Your education begins the day you graduate, but they're forced to think about how they're going to pay these loans back. So they get involved in these corporate mills that's what I like to call them and they end up being forced into a production mindset instead of a quality mindset and they never become good, they never like the profession and they never give back anything to the profession. So this is a lose, lose, lose for the public. In my opinion, it's really terrible, a very bad problem that needs to be solved and addressed, and so far, there seems to be money available for everything that nobody wants, but the things that are really important, and this is important.

Speaker 3: 15:39

So when I started in dentistry, I had nothing but quality to think about. I was not forced to produce or to be fast. See, when you start, you have to learn how to do things, so it's going to take longer. So you have to concentrate on doing the very best. You know how. And as you get better, you will get faster. But if you start out trying to do things too quickly and you don't know what you're doing, it's going to be you're never going to get there. You can't be any good that way, and that's true in everything.

Speaker 2: 16:13

Understood, yeah. So also on this, like what role does longevity play in your work?

Speaker 3: 16:22

I'm sorry I didn't hear the question, yeah.

Speaker 2: 16:25

I'm saying like what does the longevity play in your work?

Speaker 3: 16:28

Well, if I don't get at least 10 years out of the work that I'm doing, I think it's a failure. Nobody can claim to have 100% success, but my success rate is in the high 90s. My crown and bridge lasts at least 10 years and I have lots of cases that I did in the math 30 and 40 years and I have lots of cases that I did in the math 30 and 40 years and I don't see anyone when I go to the lectures showing follow-up of their cases. So I can only conclude that they don't have it. And I have the x-rays and all the evidence and I can show case after case and how it held up, because they were all done according to the same basic principles. And how it held up because they were all done according to the same basic principles and that's important. Now they're not taught in dental schools, so most dentists don't even know what the basic principles are that are necessary for success and longevity, and that's unbelievable to me, because my dad's teacher did this and they had better success than I. See now what's going on.

Speaker 3: 17:30

And implants are no panacea. They have problems, they're not appropriate in a lot of places. Sometimes the bone isn't good or you can't put good long ones in that they could support the dentistry. Those are of no value. So they are not the answer to every restorative problem. And I also believe patients deserve choices. So if you know how to do good crown and bridge work and you know how to do good implants and you know how to do good bonding, you can pick and choose the treatment type that's best for each patient, because patients are individuals. And if you can give them a choice and tell them the pros and cons, then you can help them make the choice that's right for them, because there's no one size fits all. But too many dentists now are one trick ponies because all they know how to do is implants and that's what everybody gets, and that's a disaster, because most of the time it is not the right treatment, it's the wrong treatment and the perfect.

Speaker 3: 18:32

You see, I look at dentistry with an overall approach. I'm looking at the whole mouth and what could be done to prevent this patient from losing their teeth and what could be done so that they can maintain a healthy mouth for a lifetime. And most dentists are looking at things from a piecemeal approach which only involves filling a hole or a space and the poster child for the piecemeal approach to dentistry is this single-tooth implant. Because when you look in the articles and you go to the lectures, tooth implant? Because when you look in the articles and you go to the lectures, you don't see virginal teeth around the space where the implant is going. You see teeth with periodontal bone loss and decay and big fillings or crowns, or they're going to need crowns.

Speaker 3: 19:21

That patient would be much better off with bridge work that does something good for the entire area and then that's the end of the patient's problems. Instead, they get this implant and their problems are never solved and they end up with a hodgepodge of treatments and they never have the health that they should have had right from the start. And that's what I have against the single tooth implant. Now there are places where single tooth implants are appropriate. Let's say, somebody was born without lateral incisors. That's a perfect place to place an implant because the teeth are in perfect condition around the space and that would be the best thing in that case. But that's not what you see for the majority of cases. What you see is what I just described and it's the wrong treatment. That patient would be better off with crown and bridge work by somebody who knows how to do good crown and bridge work.

Speaker 2: 20:18

Lovely, lovely, great, great, and, and so that's really great to connect with you today. And for the listeners who are worried about costs, is there a middle ground between high-end solutions like implants and more affordable options like bridges?

Speaker 3: 20:37

Well, I think both are going to be expensive. I think bridge work could be comparable in cost to a single-tooth implant. What is going to last the longest? See, that's the other side of the coin. What has the best chance of lasting the longest? And what I just described.

Speaker 3: 20:55

If you do bridge work, usually that's the end of the patient's problems and that could last 30 and 40 years. You know, I could never guarantee that because you don't know what's going to happen. Nobody does, but I have a high percentage of my cases that lasted that long. And what's the right treatment, what has the best chance of longevity. And then worry about the cost afterwards. And obviously, if you do it once and you don't have to pay for that to be redone over 30 or 40 years, whatever it costs, that was a bargain, because a lot of dentists are content to get five years, you know, especially since the insurance company will pay for a new one after five years and then they're doing this over and over and over again. Consider what the cost of that is over 30 and 40 years. That's much, much more expensive. So I always say that the best is always the cheapest. So, if you can get, if people are reaching to do dentistry and they can get a loan, that they can manage it very well and they're going to get top quality work. That's a good investment that's the best way I could put it. But both are going to be expensive. So I'm not in favor of doing schlocky cheap treatment because it's going to cost more. In the long run. The quality treatment should last a lot longer.

Speaker 3: 22:24

The problem, as I mentioned in the very beginning, last a lot longer. The problem, as I mentioned in the very beginning, is that patients cannot really evaluate what they're getting. That's the truth. The things that we're evaluating on by patients are meaningless. Like he gives a good injection and the office is nice and he's nice. These things actually have nothing to do with the quality of the work that they're getting. But don't get me wrong, those things are important. I want my patients to be comfortable. I want to give the best injection that I know how. But that has no bearing on the quality of the work, ultimately, and it's very hard for them to know what they're getting. And so a dentist has to sit down and educate patients. So I like to show patients what I'm giving them, and so I like to say to patient let's say at the end of treatment, and I sit down and I show her before x-rays and explain to her.

Speaker 3: 23:22

You see all the periodontal bone loss here and you see what I did for you over here and I took a new set of x-rays after I finished the case. Nobody could tell you ever had bone loss. So I didn't grow back the bone because that's impossible, but I compensated for the bone to prevent future bone loss. So now you have to take care of it and maintain it and that should be the end of it and some of the problems with people that people have with periodontal bone loss it's not just bacteria and hygiene, it's also the dentitional architecture, where the teeth are shaped wrong and they take, they pack food and they take deleterious forces and that causes problems.

Speaker 3: 24:06

So when you do crown and bridge, the object is to correct all of that, to minimize the forces on the bone and the roots and bring the forces up close to the bone. That's why I said when you look at my x-rays you could see that dentistry relates right to the bone. It's made that way because I have a three-dimensional approach to preparing teeth, where I prepare the tooth, the gingiva and the bone at the same time so that they relate ideally to each other. So I get rid of all of the problems that the patient has to start off with health, because if you don't start with health, you're not going to end up with it. And that's the whole point of doing dentistry to create health.

Speaker 2: 24:56

Perfect, perfect, that's lovely, agreed. So thank you, Dr Weinberg, for sharing your insights today on this podcast, and I think our listeners have learned a lot about not just the procedures themselves, but also the importance of making informed choices about the dental health. So for anyone who is interested in learning more about or diving deeper into this topic, be sure to check out Dr fienber's website, which is theonwardprogramcom, and always remember that because one dentist says extraction is the only option, it doesn't mean that there isn't another way. So thanks again for tuning in and until next time, take care of your mind, body and the smile. So thank you so much.