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!

Dentistry Through the Ages: Infants and Newborns

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!

    Today, we want to address the dental concerns of families with newborns and infants. We know this can be an exciting and stressful time, with childcare advice coming from many (sometimes conflicting) sources. Hence, we want to ease your mind with our professional and scientifically proven advice on proper newborn dental care.

    Infant dental concerns actually begin during the prenatal months. Studies have shown that women with periodontal disease are at a higher risk for low birth weight and early term infants. It is important to minimize this concern by keeping up with your regular dental cleanings before and during pregnancy. Additionally, hormonal changes, increased snacking and morning sickness all put pregnant women at a significantly higher risk for tooth decay. We recommend that all of our pregnant patients pay special attention to their oral health and consider supplementing their current home care with further preventative products, such as xylitol rinses or chews.

    You can start your newborn on the path to great oral hygiene even before their teeth start to erupt. An important fact to remember is that oral bacteria is often transferred from caregivers to their children. Avoid sharing saliva with your infant, as your bacteria can start to colonize their mouth and cause tooth decay at a very young age. In fact, studies show that the bacterial profile of mothers and children match, even before the baby teeth come in! Once teeth begin to show through the gums, you can clean them using a washcloth or xylitol wipes. After two or more teeth “touch,” you should start to floss between them.   

    Once the teeth begin to develop, it is important to never put your infant to sleep with a milk bottle. The milk will sit on the teeth all night and eventually cause rampant decay. In fact, the decay pattern of night time milk bottles is so characteristic, it has earned itself the title of “bottle mouth.”

The unfortunate consequences of "bottle mouth."

    Beyond toothcare, infancy is a period of rapid craniofacial development. While much of this will occur naturally, proper development can be encouraged. Breastfeeding has been shown to be beneficial to proper facial growth. Global studies show that breastfeeding during the first four months of infancy are particularly critical to lower jaw development.

    Your babies teeth need to stay healthy for as long as 13 years. Thus, it is very important that you protect them right from the beginning. On top of proper home care, we recommend you bring your child in for their first check up at 12 months. This can allow us to catch decay and developmental problems before they become a much larger issue. At Thousand Oaks Family Dentistry, we are prepared to see all of your family members, no matter what the age!

How to Brush Your Teeth- Ten Steps to Better Home Hygeine

Since Childhood, you’ve heard the same old story about tooth care: brush twice a day for two minutes, floss nightly, and no food between brushing and bed. However, this isn’t the end of the story.  In today’s fast paced world, we are all looking to optimize our efforts spent on healthcare and grooming. By following these ten easy steps, you can maximize your home oral hygiene while saving time, money and headaches!

1. Brush 30 minutes before your first meal and 30 minutes after your last meal. Brushing twice a day is an important and well-known standard of home hygiene. However, the timing of brushing can also be influential on the outcome of your efforts. Brushing before breakfast helps remove the bacteria and biofilms that build up during sleep, while brushing after dinner removes any food particles that could potentially sit in your mouth all night as you rest. But why wait 30 minutes before and after? This has to do with the acidity of food and the abrasiveness of toothpaste and toothbrush bristles. Brushing directly after a meal can have the same effect as removing old paint with acetone and a wire brush. The combination of low pH and rough scrubbing can be corrosive enough to remove enamel and actually weaken tooth structure. The 30-minute period lets your saliva naturally readjust your mouth’s acidity and remineralize teeth before rigorous cleaning.

2. Instead of brushing for two minutes, brush for 30 seconds in each quadrant of the mouth. This small change in thinking makes sure that you tackle each area of the mouth with equal attention. Focusing on areas that catch food is good, but the true benefit of brushing is reached when no area of the mouth is neglected or forgotten.

The mouth can be divided into four quadrants: Upper Left, Upper Right, Lower Left and Lower Right

3. Reposition your toothbrush to reach your gums. Many people hold the toothbrush bristles 90 degrees to both the biting surfaces and sides of teeth. In reality, the bristles should be positioned at 45 degrees to where the teeth and gum meet for the majority of brushing. While brushing the biting surfaces of teeth is still important, the space between your teeth and gums is an often neglected hotspot of bacteria. This space, known as the gingival margin, is both difficult to reach and easy for bacteria to cause inflammation, decay and gum recession.

Hold the brush at a 45 degree angle, unless you are addressing the biting surfaces of the teeth. 

4. Consider switching to an electric toothbrush. Electric toothbrushes offer a wide variety of advantages over standard manual units. The added motion of mechanical or ultrasonic motors allow bristles to reach difficult areas, while built-in safety features can minimize overly aggressive brushing and abrasion. The most important features to look for in an electric brush is a small brush head (to reach your entire mouth) and built in timer (set to two minutes).

5. Bad breath? Look beyond mouthwash. Bad breath is a problem that plagues many patients. Mouthwash is often viewed as the best (and only) solution to this condition, with many patients using it multiple times throughout the day. Unfortunately, mouthwash is only as effective as long as the minty smell lasts, and the low pH of many consumer mouthwashes can lead to further tooth decay. The best way to cut back on bad smelling breath is to start flossing correctly (see below) and brushing the tongue.  Tongue brushing is done by holding your brush 90 degrees to the tongue and brushing away from the face.

6. Focus on flossing correctly. The absolute best step to boost your home hygiene routine is to start/keep flossing once a day. Using the floss to break the contact between the teeth is a good start, but the true benefit of flossing arises when you go below the gum line. This can be accomplished via the “scoop the tooth” method. Once the floss is between the teeth, use it to “scoop” around both of the touching teeth. This allows the floss to dislodge bacteria and food that live in the gingival margin between teeth. Those with braces, bridges and dental appliances should use threader floss to make sure they can reach behind wires and other structures.

How to floss: 1. pull off a forearm's length of floss. 2. put tension on the floss. 3. Break the contact between the teeth. 4. floss between the teeth, between the back tooth and gums and between the front tooth and the gums. Flex the floss with the tooth to "scoop the tooth."

7. Follow up meals with a water rinse and xylitol product. While you might feel the strong urge to brush following a meal or snack, you are better off waiting until your mouth remineralizes before taking a brush to them. The best way to dislodge food particles, avoid staining and prevent decay after meals is to rinse with water and chew gum/mints containing xylitol. Xylitol is a plant based sweetener that interrupts bacteria’s’ ability to make tooth destroying acid. It is completely natural (our bodies make a small amount every day) and is an ingredient used in most sugar free gums.

8.  Keep snacking to a minimum. Any time a food product or drink is consumed, our mouth pH turns acidic for about 30 minutes. This happens with almost every type of food, no matter how much (or little) you are eating. Over time, this acidic environment can weaken tooth structure and lead to rampant decay. Hence, snacking, or frequent eating, can be as damaging to a mouth as a sugary, carbohydrate heavy diet. For example, eating a small dessert after both lunch and dinner only leads to two exposures of 30 minutes of acidity. However, eating five baby carrots once an hour for an eight-hour workday would lead to 4 hours of acidity. Yikes!

9. Get Fluoride exposure. Fluoride is a safe and highly effective way to effortlessly boost your oral health. Fluoride works by allowing the calcium-phosphate found in our diets to reenter the tooth structure and remineralize enamel. In addition to being found in most commercially available toothpastes, the Southern California water supply has been fluoridated for many years. Drinking tap water or most filtered waters will give you a preventative dose of fluoride.

10. Report changes in oral health/eating habits/lifestyle at your cleanings. Dental cleaning and home care are no longer addressed in a “one size fits all” approach. Letting our staff know about changes in your diet, medications or lifestyle can allow them to suggest changes to your routine or new supplements to better aid in home care. Remember, we are always here to help you reach a beautiful and healthy smile!