Episode 82: Navigating Dental Treatments What’s Truly Needed

[Eon Engelbrecht – E-Radio-SA] (0:04 – 0:35)

Welcome to Save Your Money, Save Your Teeth, our OptiSmile podcast on eRadio and I’m Ion and today’s episode will help you navigate dental treatment choices. Also, avoid over-treatment and make sure you only pay for what you actually need. Dr Clifford Yudelman is here to answer 10 important questions that could save you money, time and trouble at the dentist. Let’s jump straight in. First of all, Dr Yudelman, welcome back.

[Dr Clifford Yudelman – OptiSmile] (0:35 – 1:40)

Thanks. Thanks for having me back. There’s a lot of fun doing these podcasts.

We’ve been going since last February. I can’t believe it’s already number 82 and we’re into the second week of our 10th anniversary month at OptiSmile. We’ve been going 10 years since 2015.

We’ve got over 400 wonderful reviews on Google and we’ve made a lot of people happy. Hopefully, my podcasts are really helping people to save money, save time and avoid having unnecessary treatments and that’s what today’s about. What is really needed?

These are some interesting questions. I’m looking forward to it and like our previous couple of episodes, this one and the next three will all relate back to one of our previous podcasts. So, every podcast today, you will be able to go back and listen to a full podcast on each of the subjects if you have an interest in that particular subject.

[Eon Engelbrecht – E-Radio-SA] (1:41 – 1:49)

To kick off with, when should you choose a filling and when does a small cavity not need to be treated right away?

[Dr Clifford Yudelman – OptiSmile] (1:49 – 5:17)

So, in podcast 55, unveiling dental fillings, I go over why sometimes a spot on your tooth isn’t an automatic ticket to the dentist drill. If it’s superficial and you’ve got a good home routine, remineralisation or healing the cavity, making it go away is possible. There are also special supplements, something called Tooth Moose.

There’s now a nice toothpaste from 3M called Finipro that is only available at the dentist and there’s other ways, oral hygiene instruction, etc. where you can actually heal small cavities that show on the x-ray or that are starting at the gum line. But in this one, we talk about if the decay penetrates deeper into the dentine and you postpone it, it just makes it more complex and expensive.

That first chat with your dentist is always vital. Ask him to show you the x-ray of the image and like at OptiSmile, we put it through AI and it actually puts a red circle around any potential cavities. Maybe your dentist doesn’t have that, but they should be able to show you.

Hopefully, they’re using digital x-rays and not those little films that you develop and you hold up to the light to see any little tiny black spots. With digital, obviously, you zoom in on the screen and the dentist, if the dentist can see something, he should be able to explain it to you. I’m always Googling for the patient because I know they’re going to go home and use Google or chat GPT and I put in their stages of dental decay, when does it need treatment, and then I show them how we stage these cavities on x-ray and so on.

You get an honest take on urgency, ask what are the alternatives, say to them what happens if I wait, what are the risks. It’s about making the most informed wallet-friendly call for you. Not long ago, I had a patient in and she had about 15 new fillings, literally in between every single upper molar and premolar and a few on the lower.

I took further x-rays and I could see a lot of these black spots that we’re talking about, but many of them hadn’t gone through the enamel into the dentine. I just think that in a patient like that, rather than going and doing so many fillings, you put them on an intensive routine of flossing and avoiding acidic. There’s usually something like eating a lot of sour worms or drinking diet Coke with phosphoric acid or hot water and lemon, things that we’ve covered before, and maybe just not flossing properly.

There’s so many things that one can do to try and avoid a filling that dentists don’t often take the time to explain to their patients. That’s why we’ve got this podcast called Save Your Money, Save Your Teeth. I’ve mentioned it before and I’m working on it fervently for my 10th anniversary.

I’m hoping to finish my book, don’t hold me to it, but it’ll be a book that covers everything we’ve done in our podcasts, Save Your Money, Save Your Teeth. Hopefully, it’ll be on during our anniversary year. Let’s see what we can do this year.

[Eon Engelbrecht – E-Radio-SA] (5:17 – 5:21)

Yeah, I’ll have to ask you with every episode, how’s your book coming along?

[Dr Clifford Yudelman – OptiSmile] (5:21 – 5:35)

Yes, how’s the book? That’s like when I practised in Australia near the university, there’d be like students walking around in these t-shirts that on the back it said, thank you for not asking how my thesis is going.

[Eon Engelbrecht – E-Radio-SA] (5:37 – 5:55)

Yeah, but you need someone in your life to push you with the book as well, hey, because I’ve noticed when you write, sometimes you’re like, ah, no, I’ll leave it for next week and the next week becomes next month and then it becomes next year. So you’ve got to have someone who holds you to it and say, hey, how’s that book coming along? Have we got a new chapter?

[Dr Clifford Yudelman – OptiSmile] (5:57 – 6:50)

And that’s how these podcasts happen is I was working on my book and then I came across eRadio and I thought if I’d write the book, then I’ve got to go and find somewhere to go and do a whole lot of podcasts to try and sell the book. And I thought, why not just put all the material that’s in the book in the podcast? And I mean, we basically have the bones for the book, as you can see from this episode and the previous ones, we can talk about quite a few things now and we’ve got all these other 30-minute, 20, 30-minute podcasts to back us up.

So there’s way more material now than one needs a book. A book’s about 500 pages and we’ve got about over 1,500 pages. So what I need now is not a book, I need an editor.

Yeah, yeah, you do. But maybe this is just the audio book. There you go.

Okay.

[Eon Engelbrecht – E-Radio-SA] (6:51 – 7:17)

So, Dr Yudelman, when you were recently on my visit also to the dentist, they put me in this kind of spaceship thing where you stand and then you bite onto something and then you’ve got this thing circling your head a few times, some sort of x-ray machine. And I thought to myself, is this really necessary? So I want to ask you, are x-rays really required at every appointment or can you actually say to your doctor, no?

[Dr Clifford Yudelman – OptiSmile] (7:18 – 9:43)

Yeah, so in podcast 15 about dental x-rays, I explained that x-rays are an amazing tool for revealing hidden problems. But like most things, balance is the key. If your mouth is healthy and you’re not in pain, x-rays every visit definitely isn’t needed unless every visit is every three, four years.

But if you’re going in every six months, when I practised in America, the medical aid, the dental insurance back in those days used to pay for two sets of x-rays a year and dentists would just take two sets of x-rays a year. And that was really driven by financial stuff. And that’s why this podcast came along is to actually explain.

So there are a few things when it comes to x-rays. There’s an international thing called ALARA, as low as reasonably achievable. I believe that’s what it stands for.

I can’t remember, but it’s A-L-A-R-A. And you can look that up and that’s to do with all kinds of x-rays. Do you really need a CAT scan or can an x-ray work depending on the amount of radiation?

But basically most adults are fine with them every one or two years and children could be more often depending on the new symptoms, dental work, are they high risk? Is it a teenager that last time you did x-rays, there were a whole bunch of cavities starting and a year later, the oral hygiene is still poor and they report that they’re still eating sweets and drinking Coca-Cola, etc. And then you’re definitely going to take what’s called little bite-wing x-rays.

The big panoramic ones are more for an overview. Yeah, there’s a lot about x-rays. I think podcast number 15, we went over that.

But don’t hesitate to ask like, do I need this x-ray? What do you think you’re going to find on the x-ray? Some dentists, if you have a dentist that gets rude or says, I’m doing my job or whatever and they don’t give you, they should be happy to answer questions.

Maybe you’re not at the right dentist. I know there’ll be dentists listening to this that don’t agree with me and they might get upset by that, but your patients are paying you good money and they have a right to know it’s their mouth, it’s radiation, it’s not 100% safe if you do it too often, and it costs money to get an x-ray. Don’t feel pressure.

It’s your health and it’s your choice.

[Eon Engelbrecht – E-Radio-SA] (9:44 – 9:54)

That’s it. That’s the very good answer there. Dr Uterman, what are red flags that a treatment plan might be more aggressive than you actually need?

[Dr Clifford Yudelman – OptiSmile] (9:54 – 12:50)

Yeah, so again, you know, not to upset any dentists that might be listening. I believe we’ve got a big following amongst dentists, especially new graduates, as well as I want to shout out to all the dental reps that drive around from one dentist to another, and I believe that a lot of dental reps are listening to this podcast to learn sort of some inside, you know, get inside information on dentistry without having to go to dental school. So I want to say hello to all the dental reps that have told me they listen to the podcast.

Yes, hello. And thanks for subscribing, and to any dentists that may be lurking out there and listen, but they maybe don’t like everything I say, but red flags that a treatment plan may be more aggressive than you need. We could be touching on a sore spot here.

So podcast 56, choosing your dental care provider wisely. I walk through what should set off alarm bells, you know, a sudden jump from no issues to a hefty plan full of crowns, root canals, or extractions. You know, if you don’t see clear evidence like photos or x-rays, or you feel rushed to commit, it’s time for a second opinion.

You deserve clear language, transparent reasoning, and options. You know, that’s respectful, that’s sensible care, and it may be more affordable too. We often get patients come in.

I had one just yesterday that came to see me, and she went to like a franchise dentist in New York. The dentist looked around their mouth for five minutes, took some, you know, they had x-rays and everything that the assistant had taken, and then she ended up with a treatment plan coordinator sitting with a big bill for 20,000 rand that the dentist didn’t even explain to her, but they were offering a payment plan, like a five-year plan, like, oh, it’s only $200 a month or something, and the only reason why she didn’t sign it was she was moving back to South Africa, and, you know, she did need some work. She needs some Invisalign and a couple of fillings, but it wasn’t really that much, and it’s not a five-year payment plan, and also none of it’s urgent.

You shouldn’t feel under pressure to commit to 20 veneers to protect your teeth that have slight wear. There are dentists even in Cape Town that tell their patients they need veneers to protect their teeth. That’s the biggest load of nonsense I’ve ever heard in my life.

If you’re listening to this, you know who you are. I’m definitely going to be in trouble, but I’m 65. I’m a big boy.

I can handle it.

[Eon Engelbrecht – E-Radio-SA] (12:52 – 13:01)

Dr Yudelman, I also want to ask you, when is it smarter to repair a chipped tooth with bonding instead of a crown or veneer?

[Dr Clifford Yudelman – OptiSmile] (13:01 – 15:11)

That’s one of my favourite subjects. So, in our podcast number 43, The Art and Science of Dental Bonding, I tell patients that for small chips or cracks, nothing beats bonding for simplicity, price, and tooth preservation. It’s fast.

It isn’t invasive, and with today’s materials, it looks fantastic. I had a patient today. He had an old chip on his tooth, and he had Invisalign with Dr Harris in our practise, and halfway through his Invisalign, the bonding or the chip came off, and Dr Harris, who mainly does Invisalign, I mean, he does the odd filling here and there. A shout-out to Dr Harris with over 20 years of experience in Invisalign. He did put a quick filling on the patient so that it didn’t look ugly while he was straightening, and it actually lasted two years, but it wasn’t done as a permanent bonding, and eventually, it came off, and I fixed it for him today. I didn’t even charge him, and he was in for about 20 minutes.

It didn’t take long, and I did it for free. He spent a lot of money on Invisalign, and no injection, just polished it back, tried on a few different colours, put the etch, the bond, shone a light on it to cure it, put the stuff on, polished it back, and we had another 10, 15 minutes to catch up and to have a nice chat. His girlfriend’s coming to us for Invisalign, so he’s like a patient for us.

Look, it’s fast. It isn’t invasive. Like I said, crowns and veneers are great in the right cases, but really, it’s very rare that we see teeth that even need crowns or veneers when a little bit of straightening, some whitening, or injection moulding can sort that out.

I believe you have other questions for me, so I don’t want to talk too much about that, but why pay more or lose more tooth structure if bonding can get the job done beautifully and it can last a long time? Most times, you can’t even see that the chip has been fixed.

[Eon Engelbrecht – E-Radio-SA] (15:12 – 15:22)

I also want to ask you, Dr Uterman, what is the lowdown on injection moulded composite veneers? When are they best value?

[Dr Clifford Yudelman – OptiSmile] (15:23 – 16:14)

Composite bonding using 3D printed models. In podcast 22, we speak about injection moulded composite bonding or veneers, and they’re perfect if you want a big visual impact without aggressive work or huge bills. They’re minimally invasive and can be redone or updated as needed.

We’ve got some going now six years, and they look great. Very often, someone might chip something, but they’re quick to repair, and there’s no drilling. If you want a Hollywood teeth on a realistic budget or especially for younger patients, and these days, anyone under 65 is a younger patient, you know, why drill your teeth?

It’s often our favourite option that we suggest.

[Eon Engelbrecht – E-Radio-SA] (16:14 – 16:25)

Okay, and then how can you be sure that a root canal is actually necessary before committing to it? I think that’s something we try to avoid. It’s almost like a last resort, isn’t it?

[Dr Clifford Yudelman – OptiSmile] (16:26 – 18:32)

Yeah, look, it is pretty much the end of the road before pulling a tooth out. In understanding toothaches in podcast 12, I make it very clear. Not every sore tooth is a root canal candidate.

Sometimes it’s just what we call reversible pulp or nerve inflammation, a bite issue. It could be a sinus problem. You need a proper exam, some special tests, thorough x-rays, maybe a 3D x-ray.

You need to talk to the dentist about the history before you start major treatment. Don’t just jump into that, and if you’re unsure, don’t be shy to get a second opinion. It might save your tooth and your wallet.

Some of the tests like how you know when a tooth needs a root canal is if you have swelling or pus draining near the tooth, near where the root tip would be. If the tooth is tender, when you tap on it, or if you drink a hot cup of coffee and your tooth throbs for hours, but sensitivity to cold that only lasts for 10 or 15 seconds, that tooth definitely doesn’t need a root canal yet in 90% of cases. If you get something cold on a tooth and the tooth then hurts for a minute, that’s possibly irreversible pulpitis.

A lot of the time, just polishing down the bite a bit. Sometimes you have a new filling done and the filling is a little bit high, and two weeks later, the tooth is really sensitive. You go back to that dentist and he’s like, oh, you need a root canal now, when in fact, you maybe just need your bite adjusted.

Or if you go to a new dentist, they’re like, oh, this dentist did a filling and it must be touching the nerve, now you need a root canal. Most of the bite is high, especially if you put ice on the tooth and the ice only lingers. You put the ice, it gets very sensitive.

You jump halfway out the chair, but five, 10, 15 seconds later, there’s no pain. That’s not root canal time.

[Eon Engelbrecht – E-Radio-SA] (18:34 – 18:43)

Why would you say it’s a personalised treatment plan with options better than a one-size-fits-all solution?

[Dr Clifford Yudelman – OptiSmile] (18:43 – 22:12)

Our whole approach, every single person has unique needs, routines, sensitivities, and wishes, and a good dentist should lay out every option with pros, cons, and all the costs, the affordable, the premium, and the in-between. There’s always other options. I don’t like to give people too many choices.

I’ll try and do what’s called co-, well, not try, we do what’s called co-discovery and co-diagnosis. Rather than looking in your mouth and saying, we can leave this tooth alone and wait until it really hurts, and then you can pull it out, blah-de-blah, or we can do a half-dash-a filling that will get you by for a few years. Why give that option if it’s not the best option?

Or we could do an inlay, which will be X and Y, or we can do a crown. It just confuses people. I would just say, this is really too big for a filling.

I don’t want to file your whole tooth down and put a crown on. This needs an inlay or onlay, and then I explain what that is. If you really can’t afford it and we’re sitting there looking at it together, I can work with you and say, all right, well, we can do a big, maybe not a half-dash-a, I hope you know what that means.

Yeah, I get it, I get it. A half-a-job, yeah, filling. But if you understand that my best filling might only last two or three years and that you’re going to need an inlay or an onlay in two or three years, hopefully, you’re still coming to me.

It will give us a chance to get the rest of your cavities sorted. When you get your promotion, you’ll come back and we’ll put the inlay or onlay on there. You want to make it personalised with options and discuss it with your dentist, or if you’re a dentist, discuss it with your patient.

There’s no such thing as a low dental IQ. I hate that when dentists tell me, oh, no, that patient’s got a low dental IQ. It’s like, well, you’ve got a low IQ when it comes to AI, and that patient knows about AI, so I bet you you come across like a low IQ person.

If they can build computers with their eyes closed, what makes you think that they need to know everything about teeth? Explain it. Google it with them.

Show them pictures. It’s not that difficult. New patient exam, we book an hour and a half because that’s your opportunity to learn everything that’s going on in your mouth, everything you might need or might not need for the dentist to tell you that black spot.

Don’t ever let a dentist tell you you need a filling there. That means it’s a cavity that’s gone away. It’s an arrested caries.

You move to London, and the dentist says you need a cavity there. Just tell them, no, Dr Yudelman said that tooth will never need a filling. It’s already healed itself.

There’s things that you can learn in an hour and a half that you can’t learn. If you’ve got a medical aid dentist, and they’re only getting paid 50 rand to do an exam, and it takes them five minutes, that’s what you’re going to get.

[Eon Engelbrecht – E-Radio-SA] (22:12 – 22:35)

Exactly. We often see teens going through this, and sometimes adults. I think I was in my 20s when I had my wisdoms removed.

Are all wisdom tooth extractions really necessary, or can some be avoided, Dr Yudelman? In my case, mine had to come out because they were pushing up against the others and causing crowding or something.

[Dr Clifford Yudelman – OptiSmile] (22:36 – 24:24)

Yeah. In our podcast about wisdom teeth, I always say just because you have wisdom teeth doesn’t mean they need removal. If they’re healthy, they’re fully erupted or out.

They’re not bothering you. You can monitor them. You don’t have to remove them, especially if you’re able to keep them clean.

We do see patients who are able to eat on their wisdom teeth, and they’ve got plenty of space, but it’s if you keep getting infections, they’re halfway in, and the gum is halfway over. If they’re on x-ray, they look like they’ve got cysts. There are no two mouths alike.

We base the decision on your needs. It’s not a rulebook. My rule of thumb is if the patient’s under age 30, and a wisdom tooth has given trouble once or twice before, and there’s others that may give them trouble, and they’re going to go and get the one out, I’ll usually ask the oral surgeon to discuss it with them.

But just in the last couple of months, I’ve had a lot of patients, including my 21-year-old son who needed his wisdom teeth out, and a few other patients. We’ve had quite a few wisdom teeth patients. It’s not fun, but when they need to come out, they need to come out.

If there’s no space, you don’t really have a choice. But if you’re 30 or 40, and your wisdom teeth are covered in bone, and the dentist says, oh, we need to book you in, and it’s going to be R10,000. We’re going to need to take out that wisdom tooth.

You need to start asking questions, especially if it’s never bothered you. And if a dentist tells you you need your wisdom teeth out because they’re making your lower teeth crooked, I believe that’s a lot of nonsense. There are dentists who truly believe that, but all the science says that that’s not the case.

[Eon Engelbrecht – E-Radio-SA] (24:25 – 24:32)

Okay. And then moving to implants, what do you need to know before you say yes to an implant doctor?

[Dr Clifford Yudelman – OptiSmile] (24:32 – 26:47)

Yeah. So in the podcasts about implants, we spell out what really matters. Do you have enough bone?

Are you going to be committed to cleaning it really well? There’s certain things that are like a no-go. If you have uncontrolled diabetes or other health issues, if you’re a smoker and you’re not willing to give up smoking while the implant’s healing, once it’s healed, you can start smoking again, but you can’t be smoking and get an implant.

It’s a really bad thing. There’s the cost, the time. Is that manageable?

Implants, if you’ve had a tooth that’s been missing for a long time, like a lower molar and you’ve got your molars on the other side, you might chew better if you get that replaced. But certainly if it’s been a long time and you don’t really miss it, don’t let someone talk you into an implant for what they cost and what you’ve got to go through unless you really need it. I would definitely not go for a bridge where you’ve got to file down the adjacent teeth, what we call virgin teeth.

So you can go figure that one out. A virgin tooth hasn’t been by a dentist yet. So yeah, we love virgin teeth.

We don’t like to mess with them. Look, implants are life-changing when chosen well in the right situation, when they’re done properly, but you want the right indication, the correct plan. And the person that does the implant for you, it should all be planned with a 3D x-ray, with an implant guide, guided surgery, digital planning, digital rounds are really, it’s unbelievable.

We do a lot of implants at OptiSmile and they go like clockwork. I can think in 10 years, I think we had one implant that didn’t quite take and then the dentist in the practise that did it, he just removed it and a couple of weeks later, he put another one in at no charge and that one worked. We don’t even know why that one failed because it really doesn’t happen often.

One implant in 10 years, that’s pretty good.

[Eon Engelbrecht – E-Radio-SA] (26:47 – 26:56)

And then Dr Yudelman, our final question for today, how can you tell if a filling or crown really needs replacing or if it’s still safe?

[Dr Clifford Yudelman – OptiSmile] (26:56 – 28:35)

So in our podcast about dental fillings, I speak about something like a bit of a stain or some ageing or small little surface cracks, doesn’t necessarily mean urgent replacement, but if there’s pain, if there’s gaps, visible decay, or it’s very worn down or there’s bite issues, then it’s a good time to start looking at replacing a filling. And with a crown, if there’s an open margin, what we call open margin where the cement is washing out or the glue that they glued it in with, if the gum has receded and you can see a black line and you blow air there and it’s sensitive and the dentist pokes around and the probe kind of gets stuck in there, it might be time to replace that crown. That’s why we don’t like doing crowns.

We prefer doing inlays or onlays, but we show our patients magnified photos, scans, x-rays, AI. We explain all the options so you never feel pressured and a smart assessment is what saves you from spending on things that you don’t need. And especially if you go to a dentist and you’ve got four crowns in your mouth and they say, oh, these three crowns need replacing, that’s when I’d get a second opinion.

I mean, maybe they do need replacing, but they should be able to at least show you or explain. Like I say, it’s dentistry. It’s not brain surgery or rocket science.

It’s very straightforward. You should be able to see what the dentist sees. There’s no magic.

[Eon Engelbrecht – E-Radio-SA] (28:36 – 29:08)

Okay. And yeah, that’s a wrap for this episode of our podcast. And remember, if you want truly unbiased advice or a second opinion on your dental treatment plan, book a comprehensive 90-minute digital consultation at OptiSmile and you can get clear professional guidance and no pressure, just answers.

You can also book a free online video consultation on the WhatsApp line or through the website OptiSmile.co.za. Dr Jodeman, thank you so much once again.

[Dr Clifford Yudelman – OptiSmile] (29:09 – 29:22)

Thank you very much. And there’s still two weeks left of the OptiSmile 10th anniversary month, October 2025. And we’re getting ready for podcast number 83 next week.

[Eon Engelbrecht – E-Radio-SA] (29:22 – 29:47)

Looking forward to it, Dr Jodeman. Thank you so much. And also remember while we strive to provide valuable insights, always consult with your own dental professional for advice tailored to your personal health.

Don’t forget to like, subscribe, and most importantly, share this episode with your friends, your family and colleagues who want to make smarter dental choices. We’ll see you next time and keep smiling smart.

[Speaker 3] (30:09 – 30:53)

Discover the world of dental excellence with OptiSmile. Join us for a weekly podcast featuring Dr Clifford Jodeman, a seasoned expert with 40 years of dental experience across four continents. Game unique insights and expert dental advice by visiting OptiSmile.co.za for articles that illuminate the path to optimal oral health. If you’re seeking unparalleled dental care in Cape Town, get in touch with OptiSmile or book directly online on OptiSmile.co.za. OptiSmile, where global expertise meets local care.