Cosmetic Bonding

Often times, patients will be very satisfied with their oral esthetics aside from one feature. Thier teeth can be straight, white and well spaced, saving for a single tooth. In these cases, orthodontics may be impossible or unnecessary for purely esthetic results. Here, cosmetic bonding proves to be the most predictable and reliable treatment to a perfect smile.

In this case, bonding was added to compensate for a short lateral incisor (left of center).

Cosmetic bonding is one of the most underappreciated cosmetic procedures offered in dental offices. Using the same tooth colored material as fillings, we rebuild and recontour teeth to better fit and fill out your smile. This material is extremely durable, and can be used to lengthen, widen or "even out" the appearance of your front teeth. Our patients are always satisfied with the results, as the transition from natural tooth to filling material is virtually undetectable.

Here, bonding was used to close the gap between the patient's two front teeth.

Your appointment will begin with a short consultation on esthetics and a few photographs. We strive to match your expectations and desires before we start working in your mouth. Once a decision has been made on how and where to add bonding, we use high pressure air abrasion to temporarily roughen the tooth surface. This step is comparable to rubbing wood with coarse sandpaper before painting. After the tooth surface is prepared to accept composite, we add our bonding agents to the indicated area, followed by the tooth colored composite. Our composites come in a variety of shades and color, and can match practically any tooth shade. The material is added slowly, contoured to your tooth, and set solid via a high intensity curing light.

After we select an appropriate tooth color and light cure it, we begin shaping the material to resemble a completely natural tooth. The refinement process utilizes  sanding discs, polishing points and a number of sensitive techniques. The results look and feel completely natural in your mouth.

However, there are limitations to cosmetic bonding. It can generally compensate for deficiencies in tooth structure, but cannot address size issues such as overcrowding. Additionally, once structure has to be built out over 3-4mm, bonding becomes a less reliable long term cosmetic solution. For these in-depth cases, we typically recommend more involved esthetic procedures. Finally, bonding can interfere with teeth whitening or whitening results. Since bonding material does not respond to hydrogen peroxide, it does not change shade proportional to your natural teeth. Hence, we recommend you complete a bleach treatment prior to performing esthetic bonding.

Many consider veneers, orthodontics and whitening  as the standard of dental esthetics. However, we urge you to consider bonding to address your mild to moderate cosmetic dental concerns. The minimally invasive nature of these procedures makes them convenient and accessible to many patients. Feel free to call our office with any questions or concerns you have about the process, materials or results behind cosmetic bonding.

Athletic Mouthguards

Almost every physical activity carries some risk of harm or injury to your person. Bikes crash, lacrosse sticks get launched and soccerballs never go exactly where intended. We often take precaution against these injuries with helmets, kneepads and special footwear. However, we rarely consider the potential for tooth injury- unless a coach or league mandates mouthguard use.

In reality, there are a number of ways in which your teeth can be damaged during any activity. Many of these injuries can be minimized or prevented by using a custom fitted mouthguard.  These soft appliances help redistribute forces and protect the teeth from blunt trauma during athletic events.

A finished mouthguard. Notice how the material sits flush against the gums for extra support. Your personal appliance can be adjusted and contoured entirely to your liking. 

Who could benefit from using a mouthguard? A general rule of thumb is any sport or activity where you would wear protective padding (Such as a helmet) will present a risk of tooth injury. Studies show that athletes have 10% risk of sustaining an orofacial injury every year, with a total risk of injury of about 30%-50% over a lifetime. Furthermore, mouthguards protect beyond tooth injuries. Lip lacerations, TMJ trauma and tongue injuries can also prevented be via sports mouthguards. Some studies suggest that mouthguards could be protective against certain types of traumatic brain injuries as well. Additionally, many athletes feel that mouthguards allow them to feel more balanced and focused by providing a flat and even surface rest and concentrate on. 

The mouthguards we make at our office take your entire mouth anatomy into consideration. We use stone models and vacuum packing to form them not only to your teeth but up flush against your gums as well. This process eliminates the loose and flimsy feeling that comes with many “heat and bite” style mouthguards. The plastic is contoured and smoothed so that it feels natural in your mouth without losing any protective ability. The bottom side is layered with two types of protective acrylic, so that clamping injuries (such as an elbow to the lower chin) are counteracted by evenly distributed forces. The whole process only takes two appointments, firstly to take the initial impressions and a follow up to deliver and adjust the appliance.

At Thousand Oaks Family Dentistry, we want patients to be as educated and safe as possible in their daily activities and hobbies. Even if you are comfortable with your current mouthguard or not interested in having one made, please call our office if you have any questions about oral injuries. We feel that many types of trauma are preventable via education and want to be available to answer any questions you may have!

Additional Reading:

Types of Dental Trauma:

http://www.dentaltraumaguide.org/

Sports Related Dental Injuries: http://www.dentalcare.com/en-US/dental-education/continuing-education/ce127/ce127.aspx?ModuleName=coursecontent&PartID=1&SectionID=-1

Custom Mouthguards and Traumatic Brain Injuries:

http://www.traumaticbraininjury.net/custom-made-mouthguards-may-help-prevent-sports-related-brain-injuries/

ADA article on Sports Mouthguards:

http://www.ada.org/en/press-room/news-releases/2013-archive/april/play-it-safe-prevent-facial-injuries-with-simple-s

Removal of Amalgam Fillings

One of the hundreds of beautiful amalgam swaps we have performed at our office. 

Amalgam fillings are a tested and proven dental material and have been in effective use for over 100 years. There are many aspects of these metal fillings that make them excellent candidates for tooth restoration; they are durable, easy to place and have many of the same physical properties as natural tooth structure. However, they are not perfect (there are no perfect materials in dentistry). Over time, amalgams can crack, “leak” or become surrounded with decay. Furthermore, they are not as esthetically pleasing as tooth colored materials and can tarnish from silver to black very quickly.

These are some of the compelling reasons that we remove amalgam fillings at Thousand Oaks Family Dentistry. While we recommend replacement for ALL compromised fillings (both metal and tooth colored), we only replace amalgams for esthetics upon patient request. Additionally, we do not recommend removing metal fillings over concerns of mercury exposure. The long term safety of amalgam fillings and their associated mercury content is well understood and documented. Additional information can be found at http://www.ada.org/en/member-center/oral-health-topics/amalgam or by calling our office.

The result of an amalgam replacement procedure. While amalgam fillings are easy to spot, composite fillings blend very well with natural tooth structure. However, this difference in esthetics does not necessarily make one type of filling functionally superior. 

The removal process is a simple procedure that parallels how we place fillings on decayed teeth. We start by removing the existing amalgam from the tooth by carefully cutting it with a high-speed handpiece (“drill”). While amalgam fillings are very safe, there is a slightly elevated risk of mercury exposure upon their removal, as the material becomes loosened and aerosolized. To counteract this, we rely on two forms of suction and isolation to prevent any of the metal from being swallowed. Typically, we pair an Isolite suction/bite block with our high speed suction to gather any stray metal.

Once the amalgam is removed, we eliminate any decay under or around the filling and reshape the tooth to better accept the new composite. Once the tooth is “prepared,” we proceed by bonding and curing in tooth colored material. After it is set, we recontour the filling to the natural shape of your teeth and adjust so it feels natural in your mouth. The entire process takes under an hour, and can be considerably shorter depending on the size and shape of the existing amalgam.

If you have any questions, or would like more information on how and why we remove amalgam fillings, please call our office. We regularly remove amalgam fillings under a number of different scenarios, and would be more than happy to walk you through the process.

Teeth Whitening

Teeth bleaching is one of the most common and sought out dental treatments nationwide. There are numerous options and products offering whiter teeth, from toothpastes to bleaching “strips” and even professional procedures. At Thousand Oaks Family Dentistry, we offer two forms of whitening procedures: in-office bleaching and take home trays.

Firstly, it is important to understand how teeth whitening works. In actuality, there is no bleach (sodium hypochlorite) in any whitening products. The active ingredient in almost all whiteners is hydrogen peroxide. Peroxide works by oxidizing the molecules that cause staining, which in-turn prevents them from dying the teeth. These staining compounds reside in the layer of the teeth known as the dentin. This zone sits between the tooth enamel and nerve chamber and is composed by  thousands of tiny ducts known as tubules. Whitening sensitivity usually arises from these tubules opening, allowing the peroxide to penetrate and “bleach” the teeth.

Take home bleach trays combine flexibility and enduring results of whitening strips with the speed of professional strength bleach. After you decide to whiten using trays, we will take impressions of your teeth and turn those into plaster study models. We then vacuum form plastic to your model, making a perfect relief of your teeth. After trimming the plastic, your trays are ready to be picked up and used. The entire process can be completed in as little as two days (if necessary).

(From left to right)- We start by taking impressions which are turned into stone models. These models are used to make your custom trays. We then send you home with a supply of professional strength peroxide bleach.

We will send you home with a peroxide intensity appropriate to your comfort level and desired results. Many first time bleachers will opt into a lower peroxide percentage until they understand their personal level of sensitivity. Trays are typically used for one hour a day for two weeks, followed by one hour a day, once a month. This schedule allows for deep dentin bleaching and an enduring white smile. Patients who use this method typically reach a very stable tooth shade that lasts for many years.

In-office bleaching is a great whitening solution for those who want immediate results or cannot devote the time to slower bleaching methods. We start by retracting your lips and blocking out your gum tissue and mucosa. Once we have created an effective barrier between your teeth and other mouth structures (peroxide will remove color from any tissue it contacts), we apply a 40% peroxide bleach to the facial side of your teeth. We typically leave the peroxide on for two 20 minute sessions. In the meantime, you can enjoy netflix, pandora internet radio or cable tv on our in-operatory TVs.

Top left- Blockout material used to protect your gums. Bottom left- In-office bleach, before activation. Right- Cheek retractors commonly used in our whitening procedures.

Feel free to enjoy one of our many entertainment options during your whitening procedure. 

If you have any further questions on teeth bleaching or would like to schedule an appointment, feel free to call our office. We have helped hundreds of patients achieve healthy and beautiful smiles and can accommodate all of your esthetic needs and desires.

Sleep Apnea Screening and Treatment

Do you wake up feeling unrested? Do you snore often? Is it loud enough to be heard through walls? Do loved ones hear you “stop breathing” during the night?  If you answer yes to these questions, you may have a condition known as sleep apnea.

Sleep apnea is the temporary stoppage of breathing during sleep. It leaves suffers feeling continuously unrested and tired, regardless of how much rest they are actually getting. However, the complications go much deeper than tiredness. Apnea has been linked to increased incidences of health conditions such as cardiac arrhythmia, stroke and high blood pressure.

Although there are a number of different causes and types of apnea, the most common is Obstructive Sleep Apnea (OSA). This occurs when the soft tissue at the back of the throat collapses and blocks air from entering the lungs. OSA (and all types of apnea) result in fragmented and inconsistent sleep.

A diagram showing the difference between a normal patient and an OSA sufferer. Note the bottom middle of both pictures. 

Patients suffering from apnea essentially spend their sleeping hours in an oxygen deprived state. As your body struggles to manage breathing, extra stress is placed on virtually all organs and tissues. This is why it can be detrimental to so many biological processes. The poor sleep quality arises from your brain detecting a lack of oxygen and attempting to arouse the body. This ultimately prevents you from entering and staying in a deep and restful sleep.

At Thousand Oaks Family Dentistry, we diagnose all types of apnea and can treat some OSA. We can prescribe you a take home sleep test, which gathers information on blood oxygen levels, sleep movement and other vital signs to determine the presence or severity of apnea. If you qualify and are diagnosed with OSA, we can treat you using a custom apnea sleep appliance. This appliance works by shifting your lower jaw forward, which pulls the soft tissue away from the back of the throat and opens airways. The result is easier breathing, less snoring and more restful sleep!

Our take home sleep test. These various monitors measure almost every facet of your sleep and give us an accurate picture of your nighttime breathing habits. 

Top Left: A finished sleep apnea appliance. Right: part of our apnea diagnostic kit. These plastic pieces allow us to measure various parts of your mouth and airway.

If you think you might have sleep apnea, or are curious on how to better manage your snoring, please schedule an appointment with our office. Our sleep tests can give results in as little as 48 hours and can be interpreted as you return the test. We will handle your medical insurance billing from start to finish and  accommodate you in every way possible. Call us today for a good night’s sleep tomorrow!

Invisalign Invisible Braces

One of our very satisfied Invisalign patients. Crowding was addressed on both the upper and lower arches, along with bleaching using the Invisalign trays. The total treatment took 17 aligners and 8.5 months. 

Your smile is one of your most noticeable and forthcoming facial features. Naturally, you take great care of your teeth, brush and floss daily and possibly use whitening products. Still, there is one feature of smile and facial esthetics that cannot be addressed by home care: Orthodontics. If you are interested in having a straighter smile with minimal dental appointments, excellent predictability and discreet treatment, you may be a good candidate for Invisalign.

Invisalign is a system that uses dental impressions, advanced computer programs and clear plastic trays to provide virtually invisible orthodontics. The process is very simple. On your first appointment, we will take a series of impressions and pictures and send them to Invisalign’s headquarters. After that, a representative will send Dr. Kari a digital mockup of your smile, including the movements each tooth is predicted to make. After she approves and adjusts Invisalign’s plan, a set of aligner trays are shipped to our office.

You then return for your second appointment, where we use composites (same kind used in tooth colored fillings) and a special template tray to construct a series of tiny “buttons” on your teeth. These buttons allow the trays to latch and move teeth with extra torque, when necessary. This appointment lasts about 45 minutes and you leave with your very first set of trays!

From left to right: We use the blue trays to take a quick impression of your teeth, followed by a "bite impression" using the purple material in the applicator gun (called Regisil). After invisalign receives and processes your impressions, we receive your custom trays (pictured far right). 

Most Invisalign treatment plans last around 9 months to 2 years, with about 15-30 included trays. You will be expected to periodically return to our office to ensure your treatment is going as planned. While this timeframe may seem lengthy, remember that the trays are invisible, comfortable in the mouth and removable. Any time you need to eat, brush or whiten your teeth, you can remove your appliance in a matter of seconds.

While Invisalign is an extremely predictable and effective process, not everyone is a good candidate. Those who cannot devote the majority of their day (awake and asleep) to wearing trays will encounter a delayed or entirely ineffective orthodontic treatment. For this reason, we do not recommend Invisalign for children, as “patient compliance” is especially difficult to obtain. Furthermore, certain tooth movements are impossible without traditional wire-and-bracket braces. Being a removable piece of plastic, there are limitations to the directions that Invisalign can precisely realign teeth. To determine if you are a good candidate, or address your questions and concerns, please schedule a consultation with our office. 

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!

Dental Cleanings and Exams

Cleanings and Exams

At Thousand Oaks Family Dentistry, we feel that routine cleanings and dental exams are the cornerstone of modern preventative dentistry. On top of monitoring the progress of our patients’ oral health, these appointments allow us to better understand and address each individual’s unique needs.

In our office, teeth are only the beginning of what we screen during a routine check up. Through a combination of new technology and proven techniques, our patients are assessed for many conditions, including oral cancers, TMJ disorders and sleep apnea. Our end goal with every visit is to address every single one of your oral concerns and design a game plan towards your optimal health!

Our main focus is finding the intersection of accuracy, safety and patient comfort during all dental procedures. During cleanings and exams, this is achieved through a number of modern techniques:

Digital Xrays- These state of the art sensors utilize high sensitivity to provide us the clearest pictures with the absolute lowest levels of radiation exposure possible.

Ultrasonic Scalers- Many patients find the motions and sounds of scaling (removing) plaque by hand to be uncomfortable. To counteract this, each of our dental chairs is equipped with ultrasonic scalers, which utilize high frequency vibrations and water to effortlessly remove any buildup on the teeth.

Physical screenings and questionnaires- By assessing your diet, sleeping habits and medical history, we can pinpoint certain oral conditions and risks before even looking in your mouth! Our techniques are backed by academic research and years of scientific advancements. Furthermore, visual inspections and palpitations can help us predict the onset of TMJ disorders and oral cancer.

Outstanding Hospitality- We know that dental cleanings only work if our patients attend their appointments! Your cleaning and exam should be an enjoyable and educational experience, not something you dread. To ensure this, our office provides a number of services to make your feel at home. Each operatory is equipped with its own TV screen (Cable, Netflix, Pandora), we have blankets and pillows upon request and we have hot towels to make sure you feel fresh leaving our office. If you ever need anything at all, please let us know!

Dental Implants Thousand Oaks

Lost teeth can be replaced by a number of different dental treatments, including implants, removable dentures, and bridges.  Implants are the most technologically advanced treatment option and act the most like natural teeth.  Dental implants are bio-compatible titanium alloy cylinders that act as a root replacement for a missing tooth.   In their current form, dental implants have been around since the late 1970s when a Swedish orthopedist named Dr. Branemark developed them for dentistry. 

Today dental implants are the preferred course of treatment for replacing a single missing tooth.  They are similar in cost to doing a bridge and far more comfortable than wearing a removable appliance such as a partial denture.  In addition, unlike a bridge, dental implants do not require disturbing the tooth structure of surrounding teeth. 

According to the Academy of Osseointegration website, the long term success rate of implants remaining stabile in the bone is 90%.  A study published in Clinical Oral Implants Research (July 2010) showed a 16 year survival rate of 83%.  In either case, implants have an amazing long term success rate, that makes them a predictable option to replace a missing tooth. 

Implants have become a billion dollar industry.  Two of the leading implant manufacturers, Nobel Biocare and Straumann each reported yearly revenue in 2013 and 2012 respectively of over 780 million US dollars.  In my office I have been placing dental implants since 2007.  I have chosen to place Straumann implants, because they are an industry leading company that has been developing implants in Switzerland since 1974.  They produce a high quality and consistent product, including the implant and all of the parts that connect to the implant that allow us to restore the implant with a prosthetic tooth. 

As a general dentist, I enjoy placing implants in my office because I know where the ideal placement is so that I can restore the implant with an ideally fitting and functioning crown.  The actual surgery of placing the implant isn’t much different than drilling an ideal hole in a tooth to fix a cavity.  Implants are placed by surgically making a small incision in the tissue, followed by drilling a hole similar in size to the implant, and then using a torque wrench to screw the implant in place.  The entire procedure is done with local anesthesia in under an hour.  Patients have told me that having an implant placed is less traumatic than having a tooth removed, and the recovery isn’t much different than having a filling placed. 

After a tooth is lost, it is ideal to wait four months for the bone to heal before placing the implant.  It takes an additional four months once an implant is placed for it to osseointegrate in the bone and for the permanent crown to be placed.  So from the initial tooth loss it takes eight months for the procedure to be completed.

In restoring the implant, there are a couple of steps.  We take an impression of the location of the implant.  Then my lab fabricates a custom abutment, which replicates the missing part of the tooth that sticks above the gum tissue.  These abutments are made of either a high noble metal, titanium or zirconia and they are screwed onto the implant.  Finally a traditional crown is made to attach to the abutment.

Patients frequently ask about the cost and timeline for dental implants.  To restore a single missing tooth with a dental implant, abutment, and crown, the cost is approximately $3500.  Implants are most predictable in their long term success when they are given the proper amount of time for the bone to integrate and heal to the implant.  When advertisements are made for implants that cost less or take less time, it generally involves using less quality implants and connecting parts.  I believe in using industry leading parts, custom abutments, and quality local labs to complete all of my implant cases.

Kari Ann Hong, DDS
1000 Newbury Rd. #190
Thousand Oaks, CA 91320
www.thousandoaksfamilydentistry.com