Dental Questions: Why are x-rays so useful?

In modern dentistry, we take x-rays fairly frequently. The average patient will receive four "periodic" radiographs annually, and an entire "full mouth" set of images every five to seven years (depending on multiple factors). Why do we need so many pictures? As it turns out, x-rays are an invaluable tool in diagnosing, documenting and monitoring changes in dental diseases. Take a look!

Dental x-rays give a dentist much more information that simply "looking in the mouth." In regards to tooth decay, radiographs can show cavities forming in areas that are impossible to visualize, such as in-between two teeth. Furthermore, they give more information on the location and depth of decay, helping inform decisions on placing fillings versus crowns, the risk of nerve irritation and what materials to use to fill the tooth. In most instances, we will not perform a filling on a tooth without an acceptable x-ray of the effected area. Radiographs are also necessary in assessing gum disease and bone loss. They can document the amount and pattern of recession, helping make decisions on dental cleanings and possible periodontal surgeries. In severe circumstances, heavy tartar hidden beneath the gum line will be visible on radiographs as well. 

This image shows the progression of cavities, as seen on dental x-rays. In the last image, the decay has reached the tooth's nerve, necessitating a root canal

X-rays are also of great use in documenting and monitoring dental problems. Particularly in working with insurance companies, radiographs help demonstrate the necessity of certain procedures. This can improve the approval process and speed up reimbursements. Additionally, x-rays can help track the changes in dental conditions over time, aiding in decisions on treatment or continued monitoring. 

This image shows the progression of gum disease, as seen on an x-ray. The small white bumps that form on the sides of the teeth are tartar below the gumline. 

Radiographs are useful in visualizing much more than gum disease and tooth decay. Procedures like root canals, extractions and implants are impossible to perform without good radiographs. To learn more about the diagnostic tools we use in dentistry, please give our office a call. 

What causes tooth decay? - A Halloween refresher

With Halloween around the corner, we would like to take a moment to remind kids of all ages about the tooth decay process. While those sugary treats might make you happy now, they can cause a lot of problems if you aren't careful. Like many things in life, moderation is key to keeping your teeth protected from bacteria and cavities. 

The biggest point in understanding cavities is that duration, not amount, of sugar consumed is the main factor in the tooth decay process. Every time we eat or drink anything other than water, our mouth drops into an acidic state for the next hour. With this in mind, someone who snacks on candy all day will spend 24 hours bathing their teeth in acid and fueling bacteria with carbohydrates. If that same person ate the same amount of candy after a single meal, there would be a much less drastic effect on the teeth. 

Furthermore, it is important to remember that all carbohydrates can contribute to enamel demineralization and decay. Even foods that aren't necessarily sweet like goldfish crackers and pretzels are harmful to the teeth. Additionally, naturally sweetened or organic foods like fruits cause decay all the same as processed sugars. In fact, raisins are one of the most tooth-harmful snacks, due to their high sugar content, dryness and ability to stick to dental enamel. 

What can you do to prevent tooth decay? For starters, limit snacking and candy consumption to set times or pair them with scheduled meals. Do not let yourself graze on sweet food all day or take multiple hours to finish food. Additionally, rinsing your mouth out with water after eating sweets is an easy way to clear the carbohydrates from your teeth and limit their contact. Finally, brushing twice a day with fluoride toothpaste and flossing daily is the gold standard in preventing dental diseases. If you have other questions about tooth decay, candy or tooth healthy snacks, please give our office a call!

Dental Questions: Can eating fruit harm your teeth?

Fruits and vegetables are often hailed as the healthiest parts of a balanced diet. They bring vitamins, minerals and antioxidants to almost every dish, while avoiding harmful fats and oils. However, since many fruits are acidic and high in sugars, they can be potentially harmful to your teeth.

As with all foods, the quantity and quality of the fruit you eat doesn't matter as much as the duration in which it is consumed. The bacteria in your mouth don't care if it's organic and natural or processed and preserved. To them, sugar is sugar. As such, the best way you can modify the bacteria's response is to limit the time that your teeth are exposed to carbohydrates.

Every time we eat or drink our mouths turn to an acidic state for 30 minutes. During this period, dental enamel becomes softened and prone to decay. In this sense, someone who eats every 30 minutes spends nearly the entire day damaging their teeth. This is why snacking on apple slices all day is more harmful than eating a single candy bar immediately after a meal (in a strictly dental sense).  

Another factor you can control is the consistency of the foods you eat. Sticky and dry fruits like raisins can be much more harmful than something crisp and moist like pear or apple. This is particularly true in children, who don't have a natural tendency to pick food out of their teeth. 

In total, fruit makes an excellent healthy snack, but must be enjoyed in moderation. Realize that it still contains acids and sugars that fuel the tooth decay process. As with any sweet food, we recommend keeping snacking on fruits to a minimum and sticking to eating only at mealtime. If you must snack, make sure that you are cleaning your teeth of any residual food and rinsing with water when you're finished. If you have any more questions on diets, tooth decay and cavity prevention, please give our office a call!

Dental Questions: Can a dentist diagnose decay in the mouth that is not evident on an x-ray?

Yes, it is absolutely possible to diagnose decay in the mouth from a visual exam with a mirror and explorer.  Decay on the biting surfaces of the teeth can often be hiding in a pit, groove or fissure of the outer enamel layer. On a visual exam, the area can look like a dark spot in the white of the enamel or an explorer can get stuck in the cavitation. The x-ray won’t show the decay in this area if is still primarily in the enamel layer. However, once decay spreads past this first layer of defense and lands in the internal dentin layer of the tooth, it will definitely show up on an xray.

Take a look at the following pictures, taken from the same patient in the same appointment:

In reviewing the radiographs, there is no apparent decay in this patient’s molars. There aren’t any suspicious shadows or defects in the enamel and the teeth generally look healthy. 

However, a visual examination reveals the beginnings of a cavity forming in the two maxillary molars. The geography of the tooth allows the decay to be hidden as the three dimensional object is translated into a 2D X-ray. Conversely, not all pit and fissure stains are cavities. Dentists can recognise unique shapes, patterns and texture changes in teeth that differentiate staining from active decay. This further highlights the importance of the entire dental exam to make a proper diagnosis. 

Bacteria and Tooth Decay

An electron microscope image of S. Mutans, a common oral bacteria. 

As you probably know, nearly every surface of the human body is home to bacteria. In even the cleanest, healthiest individuals, bacteria outnumber human cells by a ratio of 10 to 1! Your mouth is no exception to this, as it contains one of the the highest bacterial counts and organismal diversities in the entire body. With this in mind, microorganisms play an enormous role in dentistry and oral diseases. Today, we want to take a closer look at how bacteria are major contributors to tooth decay and cavities.

Nearly every surface of your teeth are covered in a bacterial structure called a biofilm. This formation is a sticky “home” that the bacteria produce to allow them to adhere to hard surfaces. While the biofilm is still soft and removable, we call it plaque. Proper homecare can remove plaque daily and keep the bacterial count down. However, if the plaque remains undisturbed for about 48 hours, it starts to harden and turn into tartar. Once tartar forms, it creates a strong bond to enamel that needs to be removed by a dental professional.

In the dental biofilm, the most destructive bacteria is known as Streptococcus Mutans. S. Mutans likes to colonize teeth early on in biofilm formation, along with many other species of microorganisms. When we eat sugars, starches and carbohydrates, S. Mutans processes the glucose molecules to make acid. This acid, in turn, is a primary contributing factor to tooth decay. Thus, individuals with a high S. Mutans count typically have an elevated risk for cavities.

Interestingly enough, S. Mutans species are highly correlated between children and their caregivers. Even adopted children and kids who hereditarily lack teeth tend to have the same S. Mutans breeds as their mothers, fathers or nannies. With this in mind, it is important to remember not to share utensils or cups with your children (if possible). Furthermore, cleaning off pacifiers or other teething toys with your own saliva is not recommended. Ideally, you want to lower or prevent your child’s exposure to S. Mutans for as long as possible.

Fortunately, there are a number of products targeted against S. Mutans that you are likely already using. In addition to remineralizing enamel, fluoride has been shown to disable a specific bacterial enzyme and prevent it from making energy. This has a significant impact on how fast and large S. Mutans colonies can grow. Furthermore, the sugar substitute xylitol is known to interfere with how S. Mutans can adhere to tooth structure. Xylitol is a natural compound made by plants that is used in a number of sugar free gums and mints. If you are chewing Trident, Ice Breakers or Spry gum (or others), you are getting a healthy exposure of Xylitol every day!

Our office offers Dr. John's brand candies- a great treat made with xylitol!

S. Mutans represents only one of a number of oral bacteria that cause diseases in the mouth. Gingivitis and other gum problems are mediated by entirely different breeds and colonies of bacteria that survive below the gumline. But have no fear: we will be covering those (and more) in articles to come! If you would like to know more about tooth decay, how bacteria are involved and how to best prevent cavities, please give our office a call.

Dentistry Through The Ages: Elderly Patients

Greetings and welcome to our on-going blog series, Dentistry Through the Ages. In these blog posts, we will cover age-group specific dental needs and concerns. Your life is constantly changing, and we want to equip you with the best information possible to keep your teeth healthy!

In this article, we will be covering the dental needs of our elderly patients. Current projections estimate that persons aged 65 and older represent between 13% and 17% of the current United States population. As such, the dental healthcare industry is becoming better adapted and prepared to handle the needs of an aging population. Our office wants to take a moment to highlight some predominant oral health concerns to keep you aware and healthy!

Dry Mouth (formally known as xerostomia) is one of the biggest concerns when treating elderly patients. As we progress into old age, our bodies become more susceptible to diseases, injuries and other medical concerns. These conditions will often result in new prescriptions and medications- many of which decrease saliva flow or limit the function of salivary glands. This, combined with the natural degradation of the parotid gland (a major salivary gland) with age, leaves many patients with little to no resting saliva.

Our saliva are crucial to limiting the activity and progress of cavity forming bacteria. As such, many patients will see an increase in cavities as they transition to old age. Certain biological factors put the elderly population at particular risk for root surface cavities, where decay arises in areas of gum recession or where the tooth meets the gum tissue. However, there are a number of great products to counteract the progression of cavities in old age. Fluoride products, remineralizing gels and xylitol rinses can all help keep decay and bacteria at bay. As an added bonus, xylitol products can help stimulate saliva flow to help combat dry mouth directly!

In addition to xerostomia, many elderly patients will encounter increased incidences of periodontal disease. Limited salivary flow, years of bacterial attacks and reduced immune response can all culminate to a loss of gum tissue and bone level. Many patients will be candidates for deep cleanings or a more frequent cleaning schedule to keep plaque and tartar levels down. Others with advanced periodontal disease may even be candidates for the services of a periodontist (gum tissue specialist).

For patients with very aggressive periodontal disease, teeth may need to be extracted. Depending on the extent of the condition, number of extractions needed and patient’s overall health, our office offers a number of tooth replacement options. Single teeth can be replaced permanently with bridges and implants or removably with a partial denture (depending on the location of the gap). Partial dentures use a metal framework to replace teeth and gum tissue back to a natural appearance. They benefit from using clasps to mount to permanent teeth and sit on the gum tissue.

Full dentures can provide the same esthetic results as partial dentures for edentulous (toothless) patients. Full dentures typically require about four to five appointments to take proper impressions, fabricate the denture, adjust it and deliver the final product. While this process is lengthy, it helps ensure a great fit that minimizes irritation to the gum tissue.

We hope you found our review of oral health concerns in the elderly informative and helpful. Our office is fully committed and equipped to care for aging patients and wants you to know you are in great hands.  If you have any questions about your oral health needs, our treatment options or any other concerns, please give us a call. We are always available to answer your questions!

CAMBRA and Preventative Dentistry

    At Thousand Oaks Family Dentistry, we tend to ask a lot of questions. Some of them are are expected (“Do you floss regularly?”), while others (“What type of water do you drink?/Do you chew gum?”) might raise some confusion. While our investigations might seem slightly tedious, they are critical to our practice philosophy and how we treat our patients. These questions are part of a revolutionary preventative dentistry strategy known as CAMBRA.

    CAMBRA, or Caries (cavity) Management By Risk Assessment is a series of weighted factors and criteria that allow dentists to quickly and effectively determine tooth decay risk. By going over your dietary habits, home care techniques and medical history, we can obtain an accurate picture of how your tooth decay will progress (or continue to stay static) in the coming years. While this isn’t a “crystal ball” looking into your smile’s future, it is the best marker we have at determining your unique oral health situation.

    This screening technique relies on a simple thought process: if your habits and lifestyle lend themselves to an acidic, dry or bacteria prone mouth environment, then you will be at a greater risk for tooth decay. While this may seem obvious, what CAMBRA does is determine which factors are the most destructive, which ones can be “treated” and which ones are based on habits or lifestyle. Using this information, we can help our patients better manage their tooth decay, ultimately resulting in fewer office visits, fillings and incidences of dental discomfort.

Once we have determined your risk for tooth decay, we can make recommend products that can help you better manage your unique risks. One of these great products is Carifree Ctx3. This mouthwash-like rinse combines pH neutralization (to minimize mouth acidity), fluoride (to rebuild enamel) and xylitol (to naturally inhibit acid-producing bacteria). We love this rinse because it targets three of the decay cornerstones outlined in CAMBRA in an easy and convenient delivery method.

    Here is an example of how CAMBRA works: A 24 year old male comes in with and is diagnosed with a cavity on one of his molars. We go over his medical history and see he is taking medications that cause dry mouth. When discussing his eating habits, we find that he is a frequent snacker and enjoys sticky, processed foods. Finally, we note that he almost exclusively drinks bottled water and sports drinks. Using CAMBRA, we can determine that his tooth decay risk is likely caused by his medication and eating/drinking habits. We then recommend that he considers cutting back on snacking and sticking to 3 meals a day, stops drinking sports drinks (when not necessary) and starts drinking more filtered water, to both counteract the dryness caused by his medication and add fluoride exposure. While we will still need to treat his current tooth decay, we have now given him the knowledge and tools to better manage his oral care in the future.

    At our office, we treat every patient as a unique individual with unique needs. This is why CAMBRA fits so well with how we perform dentistry. It is not a one-size-fits-all approach, but rather a dynamic diagnosing tool that flexes with you. We are proud to operate our office on the CAMBRA model, and are incredibly satisfied with the results our patients have seen!

Fillings on Decayed Teeth

            Tooth decay (also known as caries within our profession) is a condition that affects over 90% of adults in some degree. It is the most prevalent dental condition in the United States and likewise fillings on decayed teeth are the most commonly performed procedures in most dental offices.

 Decay follows two simple equations-

Food + Bacteria + Time = Acid

Acid + Healthy Teeth + Time = Tooth Decay.

          When the decay is shallow, it sits in the top layer of the teeth, called the enamel. Once it progresses beyond the enamel, it reaches the inner layer, called the dentin. Once decay progresses into the dentin (or very deep into the enamel), it becomes problematic and must be treated.

            Some decay can be spotted visually or identified using a tool called an explorer. However, most decay (and the depth of ALL decay) must be identified and confirmed using dental x-rays.  Since x-rays work by showing relative densities, decay will appear as a dark (less dense) spot against light (more dense) teeth.

The top left arrow is pointing to the "shadow" left by decay on an otherwise healthy tooth. 

            Once decay is identified, it can typically be treated by performing a standard dental filling. In our office, a variety of technologies and techniques make this as quick and pain free as possible. We start by getting you numb using a syringeless anesthetic delivery system known as The Wand. From there, a combination bite block and suction called an Isolite is used to keep the area clean, dry and protected while we work in your mouth. Decay is removed quickly and completely, using a combination of electric handpieces (commonly known as “drills” although they do not perform a drilling motion), and diamond tipped burs (analogous to a “drillbit”).

            Once the tooth is “prepared” (cleared of all decay and shaped properly), we begin the actual filing process. At Thousand Oaks Family Dentistry, we utilize the most advanced composite materials for longevity, esthetics and speed of use. The composites we use match or surpass the durability of silver fillings, and thus we only place tooth colored (nonmetal) fillings.

          In fact, we use four different composite filling systems matched to one of three bonding systems in an entire spectrum of tooth colored shades to address a variety of concerns. We firmly believe that there is no one-size-fits-all approach to dentistry, and will curtail our process to each individual person.

         After the teeth are filled, we will give the tooth an anatomically correct shape using a “finishing bur.” After that, we adjust the filling using contact (biting) paper, polishing disks and polishing burs to make sure it looks and feels outstanding. Our ultimate goal with any filling is that you cannot tell where the filling stops and your natural tooth begins!