Root Canal Rumors

    If you search the web for “root canals” right now, chances are you will get two kinds of results: advertisements for local endodontists (root canal specialists) and articles on the dangers root canal treatment. Multiple pages will come up claiming endodontics are everything from toxic to cancer causing and even DNA altering. Is there any merit to these arguments? In this article, we hope to show you the truth behind root canals- a safe and remarkable treatment that has saved millions of teeth from extraction!

    Before we explain the controversy behind endodontics, we need to clarify how the procedure works in general. When a tooth becomes traumatized -be it from decay, physical force or extreme temperatures- the nerve tissue inside can become irritated and dies. This leaves behind a perfect space for bacteria to colonize and form an abscess. The abscess is a collection of bacteria that your immune system has contained and walled off, but cannot eliminate.

Notice the dark halo around the tooth root (where the arrow is pointing)? That is an abscess that will need to be treated with a root canal. 

A root canal tries to interrupt this process before the abscess leads to a dangerous systemic infection or damages the tooth beyond repair. Essentially, the inner tooth structure is cleaned, shaped and sterilized using very specific techniques. After the tooth is completely prepared, the roots are filled with a material called Gutta Percha. Gutta Percha is a natural rubber derived from tree sap that both seals the tooth and resists breakdown. After the endodontic treatment is completed, a crown is placed for increased rigidity and longevity.

A visual guide on how root canals are performed

    Many articles that criticize endodontic treatment quote studies that were performed by Dr. Weston Price in the 1920’s. His research indicated that bacteria from incompletely sealed root canals could spread out to the rest of the body and cause systemic problems like arthritis and cancer. These conclusions were quickly disproved, as his data was obtained using outdated and inaccurate scientific methods. Current research shows no correlation between root canal treatment and increased risk for any disease. It is important to remember that the end goal of endodontics is to lower the bacterial load from infection, so that your immune system can naturally eliminate any residual microorganisms. In this sense, endodontics seek to work with your body, not against it!

    Still, many internet blogs insist that root canals can cause cancer. A commonly quoted statistic is that 97% of terminal cancer patients have at least one root canaled tooth. First, it is unclear what scientific study this number actually originated from. Secondly, even if there is a correlation, there is no causation between root canals and cancer. It would be equally (in)valid to say that cancer causes root canals- a truly absurd notion. Finally, this statistic is almost certainly false. A 2013 study by the Journal of the American Medical Association found that patients with root canals actually had a 45% lower cancer risk (again, this describes correlation and not necessarily causation).

    Overall, we can see that the majority of the anti-root canal argument relies on 90 year old disproven research, conjecture and anecdotal evidence. In contrast, peer-reviewed scientific research on endodontic treatment has continuously demonstrated that root canal therapy is safe, effective and highly successful. If you have further questions on root canals and why they are great treatment options, please give our office a call. We are always excited to keep our patients informed and knowledgeable on the best practices in dentistry!

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.

Case Presentation: Acid Erosion Repair

At Thousand Oaks Family Dentistry, we offer an entire range of treatments and services for our patients. From pediatric exams to esthetic reconstructions, we have the knowledge, skill and equipment to handle any dental concerns. Today, we would like to highlight a recent case where we restored the esthetics and functionality of a patient with severe acid erosion.

Acid erosion affects many patients in one form or another. It can be linked to dietary habits such as sucking on lemons or certain types of medications that turn the saliva acidic. Most commonly, it is the result of a gastric disorder, such as acid reflux or bulimia. In rare cases, it can be attributed to genetic conditions that prevent dental enamel from "maturing" and becoming resistant to low pH. No matter what the origin, the results are always the same: decreased enamel thickness and tooth anatomy due to constant bathing in an acidic environment. 

Treatment

 Here, the patient needed their lower arch of teeth rebuilt from years of acid wear. When approaching a case like this, we have to be mindful of both esthetics and function. Close cooperation between our office and the dental lab assures that we deliver a final product that both looks great and respects the patient's jaw and chewing function. 

Pretreatment photograph

Stone modelwork of the patient before treatment

Here, we see the patient's pretreatment condition.  In order to best treatment plan for esthetics and function, stone models of their teeth were sent to our dental lab. The lab used wax on the models to mimic an ideal outcome. We were then able to show the patient what to expect when we treat the teeth. This waxed up model is also used to make temporary acrylic crowns, which hold space while the patient awaits the final crowns. 

Initial waxup of patient’s left side

Initial waxup of patient’s right side

After reviewing the wax models with the patient, we decided to do a combination of minimal preparation composite onlay crowns and lithium disilicate full coverage crowns.  Also, note the gap on the photo left (patient's right). Here, we added a bridge to replace the missing second premolar. After the teeth were readied for crowns, we sent impressions, previously waxed ideal models, pictures and instructions to our dental lab.

Picture of the patient’s teeth, after being prepared for final crowns

Our lab then took all of this information and fabricated crowns for the prepared teeth. This process took two weeks. Special attention was paid in matching color, texture, tooth bulk and biting function to the patient's needs. 

The final crowns on a stone model

The crowns were then sent back to our office, where we checked them for color, fit and size. Once we determined the crowns were a perfect fit for the patient, we permanently adhered them with crown cement.

Results

Overall final product

Closeup of patient’s right side

Closeup of patient’s left side

The finished product!  Not only did we restore the cosmetics of the patient's lower teeth, but we added back functionality and tooth structure. Both our office and the patient are ecstatic with the results!

As mentioned before, this patient represents a small portion of the services offered at our office. Every day, we treat a wide spectrum of dental problems, from fillings and cleaning to implants and full mouth veneers. If you would like to know more about the types of cases we treat and what they involve, please give us a call. We are always ready to meet all of our patient's dental needs!

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!

Important Announcement Regarding Our February Schedule

Thousand Oaks Family Dentistry has some exciting news! Dr. Kari Ann Hong's third baby boy is scheduled to arrive the first week of February. As such, she will be out of the office from the 1st until the 14th (tentatively). However, our staff will still be available to help out and assist you in all your needs. Our office manager Michael will be available for emergency appointments, referrals and coordinating specialist visits. Additionally, our hygienists (Lori, Adrienne, Kristi and Sharon) will still be providing cleanings during this time period. If you have any questions about these changes to our schedule, please give us a call. Congrats Dr. Kari!!

The Golden Proportions: A Case Study

Last month, we posted a blog article on  The Golden Proportion, a set of dimensions based on ideal proportions found in nature. When it comes to the smile, these proportions are only one piece of the aesthetic puzzle. The position of the lips framing the teeth, the angulation of the teeth, and the location of the dental midline are all examples of factors that influence our interpretation of a pleasing smile. However, the golden proportion is an interesting feature to study, as it is so deeply rooted in mathematics.  To better explain how the golden proportion helps define facial esthetics, we assembled a few real-life cases for you to examine!

Case 1

Central tooth width to length ratio: 74% (ideal is 75-80%)

Golden proportion ideal measurements based on a 2D picture:

• Central 1.618
• Lateral 1
• Canine 0.168

Golden proportion ideal measurements, assuming the central is ideal width:

• Central 7.4
• Lateral 4.6
• Canine 2.8

Comments:

Case 1 has centrals that follow an ideal width to length ratio at 74%.  In evaluating the golden proportion, the laterals and canines are wider than ideal. The frame of the lips is much wider than in Case 2 or 3, so the gum tissue above the gum/tooth margin is very visible.  

Case 2

Central tooth width to length ratio: 96% (ideal is 75-80%)

Golden proportion ideal measurements based on a 2D:

• Central 1.618
• Lateral 1
• Canine 0.168

Golden proportion ideal measurements, assuming the central is ideal width would be

• Central 8 
• Lateral 4.9
• Canine 3.0

Comments:

Case 2 has centrals that are nearly 1:1 in the width to length ratio and have a square appearance.  It appears that the centrals have some wear on the biting edge and that they could stand to be 1-2 mm longer.  The laterals and canines are slightly wider than the golden proportion measurement.  The patient's lips frame the overall smile so that hardly any of the biting edge or gum/tooth margin of the teeth show.  Thus, the aesthetic discrepancies are less noticeable.

Case3

Central tooth width to length ration: 90% (ideal is 75-80%)

Golden proportion ideal measurements based on a 2D picture:

• Central 1.618
• Lateral 1
• Canine 0.168 

Golden proportion ideal measurements, assuming central is ideal width:

• Central 9
• Lateral 5.6
• Canine 3.5 

Comments:

In reviewing the three cases presented here, Case 3 has nearly exact golden proportions.  The central tooth width to length ratio is slightly greater than ideal at 90%, but the upper lip covers enough of the gum/tooth margin of the centrals that this ratio isn't as relevant in evaluating aesthetics.  Also, the upper and lower midlines are slightly off center from one another, but the upper central midline is perpendicular to the floor of the mouth and centered with the patient's nose.  Thus, the midline is aesthetic even though the upper and lower midlines don't match each other.

Dentistry Through the Ages: Adults

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 the adult population. For better or worse, this is one of the most stable periods of oral health. Patients who took good care of their teeth from childhood will likely continue to avoid cavities and plaque buildup. Likewise, those with poor oral health will need to work harder at keeping their gums and teeth clean.

Since tooth decay is (generally) caused by bacteria in the mouth, we can look at past histories of cavities as good indicators of the future. Patients with few dental problems (lower bacterial counts) will generally continue to have healthy teeth (and vice versa). However, changes in diet, medication and certain activities can interrupt the balance. This can be both harmful or beneficial. Healthy patients who start to eat more in response to stress or begin new medical regimens can find themselves developing their first cavities late in life. At the same time, patients with a history of tooth decay can introduce new habits or therapeutics to stop bacterial growth and improve their oral condition. This continuum is important to remember as we grow older, take on more responsibilities and develop new medical conditions and diseases.

The adult years are also the time that many patients start to show the signs of periodontal disease. Years of plaque buildup, trauma, and tartar deposits can leave your gums in less-than-optimal condition. While good home care can stave off the progression of gum and bone loss, some will find themselves in the need of a deep cleaning. Our office utilizes a range of services that can target many different stages of periodontal disease, from mild recession to severe pockets. Those with the most extreme losses of gum and bone height may be candidates for grafting or other periodontal surgeries, typically offered by a periodontist.

The important idea to remember in regards to adult oral health is that good habits will be rewarded with a healthy mouth. Even as your life becomes more complex and stressful, it is important to stay on top of your home hygiene. Our office is here to serve as a partner in keeping your teeth and gums in top shape- no matter what the concern. If you would like to know more about home dental care, cleanings or any other questions, please give us a call!

Floss and Flossing Alternatives

As you probably know, flossing is one of the best ways to preserve gum health, prevent decay and ward off tartar and plaque between the teeth. Even though this information nearly universal, only about 50% of Americans floss daily. Where does the discrepancy originate? For many, flossing either takes up too much time or doesn’t fit in with their schedules. Others simply don’t like using dental floss. With this in mind, we wanted to take a moment to introduce different types of floss, flossers and flossing alternatives. We are sure you can find a product that fits in with your dental care needs!

This Oral-B floss is both waxed and has a threader built in. 

Although there are many different brands of traditional dental floss on the market, they all generally produce the same results. The real difference comes from preferences in packaging, flavoring and texture. For patients who have found floss too “sharp” or “cutting” to use, we suggest looking for a waxed variety. Furthermore, those with orthodontic appliances, bridges or permanent retainers might benefit from floss with an attached threader tip. While these varieties may be more expensive than using a reusable threader, they offer added convenience and ease of use.

GUM Soft Picks are great alternatives to traditional floss.

Beyond traditional floss, there are a number of great alternatives designed to clean between your teeth. Many patients enjoy single-use flossers with handles, as they are portable, disposable and easy to use on-the-go. These devices are also great for kids who don’t yet have the motor skills to use regular floss. Others may prefer flossing picks, such as GUM Soft-Picks. These tree-shaped products expand below the gumline to remove plaque similarly to regular dental floss. Because of their shape, they great for cleaning around orthodontic appliances as well.

A Typical Water Flosser

Water flossers such as the Waterpik systems can also be utilized in cleaning between the teeth. Research suggests they are not as thorough or effective as other flossing methods, but they still represent an improvement over doing nothing. There are certain scenarios where water flossers can be a benefit to patients with periodontal disease, but this needs to be evaluated on an individual level. As with any oral hygiene product, make sure to follow the manufacturer’s recommendations when using water flossers. Regularly changing tips and cleaning water reservoirs prevents the buildup of harmful bacteria and biofilms.

At Thousand Oaks Family Dentistry, we know that our patients are presented with a number of choices in dental home care. We want to give you the information to make the best choices for your personal needs. If you would like to know more about flossing, toothbrushes, toothpaste or any other dental products, please give our office a call!

Bisphosphonates and Dentistry

There are many different types of bisphosphonates on the market. 

At Thousand Oaks Family Dentistry, we take our patient’s medical histories very seriously. Every new patient appointment includes a questionnaire that covers hospitalizations, medications and trauma to the head and neck. While our records may seem tedious or unnecessary, they are vital to understanding and planning individualized treatment. For example, many dental-unrelated drugs will have side effects that manifest themselves in the oral cavity. One example of this are bisphosphonates, a type of drug commonly used to treat osteoporosis.

Osteoporosis is a medical condition that affects over 75 million people worldwide. Although many conditions trigger the onset of this disease, the result is always the same: decreased bone mass combined with increased porosity. While both men and women are affected, hormonal changes induced by menopause make the disease more prevalent in women. Bisphosphonates are a class of drug that counteract osteoporosis by down-regulating the cells that digest bone. These cells are normally utilized in balancing calcium and responding to fractures, but in osteoporosis they operate out of control. By preventing your body from absorbing bone, other cells can work towards repairing and thickening bone mass back to healthy levels.

While bisphosphonates can show great results in slowing or reversing the effects of osteoporosis, they also have a number of side effects. In the case of the oral cavity, their use can lead to increased risk of osteonecrosis of the jaw (ONJ). ONJ is a condition where the bones of the upper or lower jaw do not heal properly, typically following injury or invasive dental treatment such as extractions or gum grafts. Bisphosphonates are believed to interfere with wound healing, causing traumatized areas to become necrotic (dead tissue). The link between bisphosphonate use and ONJ is particularly strong in cancer patients who receive the drugs through an IV, but is also a concern in patients who take it orally.

Although the idea of developing ONJ may seem frightening, its risk is mitigated by effective planning and communication between physicians and dentists. This may include finishing all dental treatment prior to starting bisphosphonate therapy, or altering medications to minimize side effects. By working as a healthcare team, we can assure the best outcomes possible; even in complex diseases such as osteoporosis.  

Bisphosphonates and ONJ highlight the absolute importance of our patients’ medical histories. Being thorough and honest with our office can only result in safer and more appropriate treatment. There are hundreds of commonly prescribed drugs that can cause serious changes to the teeth and oral cavity. If you would like to know more about drug interactions and the mouth, please call our office. We are always striving to keep our patients informed, happy and healthy!

The Muscles of Mastication

From the time you get up this morning to the time you go to sleep, your jaw muscles will activate about 1500 times to chew and process food. These muscles are relevant to many of our daily activities, from eating to creating words and even exercising. But, have you ever given thought to what muscles control your jaw or how they do it? In this article, we will provide a brief overview of mastication- the process of opening and closing our jaws for eating!

The motion of the condyle and the TMJ. Notice how it moves both forward and rotated downward when transitioning from (b) to (a). 

When we open our mouths, a complex set of motions occur at the temporomandibular joint. Essentially, the condyle of the mandible (jaw bone) fits into a specialized groove in the skull. When muscles are activated to open the jaw, the condyle moves forward and out of this groove while rotating open. This movement allows a greater range of motion for chewing and swallowing. Unfortunately, this intricate machinery can become damaged or displaced. Some patients with histories of grinding or clenching their teeth will develop Temporomandibular Joint Disorder (TMJD).

Although there are a number of muscles that assist and aid in the opening and closure of the jaw, there are four main muscles whose sole purpose is mastication. The masseter, temporalis and medial and lateral pterygoid muscles are all uniquely dedicated to making eating possible. Interestingly enough, all of these muscles are controlled by the same nerve- the mandibular branch of the trigeminal nerve. Together, they allow us to open our jaw, move it left and right and close it with incredible force.

The muscles of mastication labeled. In the second image, the first masseter, temporalis and part of the jawbone have been removed. 

The masseter muscle runs from the side of the skull down to the bottom of the jawbone. If you place your hand under your temple and before your ear, you can feel it tense as you bite down. It’s main purpose is to help close the jaw. If you follow the masseter around the underside of your jaw, it makes a sling with the medial pterygoid muscle. This muscle also helps close the jaw, along with moving it from side to side. The lateral pterygoid sits just outside of the medial pterygoid and opens the jaw while assisting in side to side motion as well. Finally, the temporalis muscle sits along the side of the skull and is composed of two different types of muscle fibers. The vertical fibers (running top to bottom) help close the jaw, while the horizontal fibers (running from front to back) are responsible for retracting the jaw.

Each of these motions is crucial to how we use our jaws in daily life. Particularly in chewing, these complex movements allow us to properly process our food before it reaches our digestive tracts. If you were keeping tally, we have three muscles dedicated to closing the jaw, and only one that functions in keeping it open (lateral pterygoid). This gives us some insight into how incredibly important proper chewing function is to our overall health. If you would like to know more about the muscles of mastication, facial anatomy or any dental topics, please contact our office. We want our patients to be both excited and well informed on topics in oral health!