Video Blog on Mouth Guards

Greetings, my name is Dr. Kari Ann Hong and I have a family dentistry practice where I see patient from all age groups.  One of my goals in my practice is to help patients keep their teeth for their entire lives.  Mouth guards are a great way to protect the teeth.  If you play a sport like rugby, football, soccer, basketball, hockey, or martial arts, then you would likely benefit from a mouth guard.  In my practice we make custom fitted, dual layered, heat pressure formed mouth guards.  A custom fitted mouth guard is made to fit on the upper arch and protects that bone above the teeth, the teeth, and the jaw joint.  It is possible to talk and breath with a custom fitted mouth guard.

Mouth guards can be made in a variety of colors and thicknesses, depending on your team and the sport being played.  Sports injuries to the teeth are a completely preventable emergency.  The life long cost associated with losing a tooth due to injury is thousands of dollars. If you would like more information about how to protect your teeth, please feel out the contact us form below.

Video Blog on Periodontal Services

Greetings, my name is Dr. Kari Ann Hong, and I have a family dentistry practice, where I see patients from all age groups.  Approximately ⅓ to ½ of the population at large is affected by periodontal disease.  Periodontal disease is when the bacteria in the mouth causes loss of the bone surrounding the teeth.  From a patient’s perspective, gum disease can be characterized by bleeding gums, loose teeth, bad breath, and a feeling of deposits stuck to the teeth.

As a dentist, I determine if someone has periodontal disease by a combination of evaluating the bone levels and build up on a dental x-ray, measuring the gum health with something called periodontal probing depths, and by a visual inspection of the quality of the gum tissue.  Periodontal probing depths are a measurement of the height of the gum tissue to where the tissue is attaching to the tooth.  In health these measurements are 1-3mm.  Periodontal disease is diagnosed as mild, moderate, or severe and this is primarily based on the amount of bone loss present.

I diagnose a service called scaling and root planing when the probing depths are 4mm or more, the gum tissue bleeds when touched, bone loss is present, and there is tartar build up under the gum tissue.  Scaling and root planing is done with local anesthesia and is usually billed by quadrant and/or the number of appointments required to adequately remove all of the build up. In severe cases, scaling and root planing can take as many as four separate appointments.  

There are some practices that will recommend procedures called irrigation,  localized antibiotic placement (Arrestin), or laser treatment to help with the treatment of periodontal disease.  Irrigation involves squirting an antibacterial prescription mouth wash called Chlorhexidine or Peridex around the teeth.  Arrestin is an antibiotic called doxycline that is injected directly into the deeper pocket depth areas.  Laser treatment involves shining a specific wavelength of light in the pocket area to kill the bacteria.  In my opinion, the irrigation and Arrestin treatment are helpful at the time of treatment, but do not have enough long term benefits to justify doing the procedure.  Laser treatment is an effective way at killing bacteria and has longer acting benefits than the irrigation and Arrestin, but is not a cure all for periodontal disease.  Those with periodontal disease need to adhere to a consistent professional periodontal maintenance routine in order to maintain their dental health.

If you are interested in periodontal services, please fill out the contact us information at the bottom of this page.

Video Blog on Dental Emergencies

What constitutes a dental emergency?  If your face is swollen and you are in pain, that is the number one reason to call a dentist today.  Swelling of the face is the sign of a serious infection called an abscess.  It is necessary to seek treatment immediately to prevent the spread of the infection.  If it is after hours, then it is recommended you seek treatment at an urgent care or emergency room.  

The second biggest emergency is when an adult  tooth is knocked out of its socket.  This can happen from running and falling, falling off a bike, getting hit by a car, playing sports and getting hit in the face. It might be possible to replant the "avulsed" tooth, but it needs to be done in the first 30 minutes to one hour after it falls out, in order for the replantation to have a chance at being successful. To transport the lost tooth, it is best to either place it in a cup of milk or store it in your mouth until you are able to see a dentist.

The first two emergencies I mentioned are relatively rare occurrences.  The most common emergency I see is when a patient is having tooth pain.  And the second most common is when someone chips a front tooth or breaks a back molar.  

If you are having a dental emergency, please call my office and we will do our best to see you as soon as possible.

Video Blog on Sleep Apnea

Greetings, my name is Dr. Kari Ann Hong, and I have a family dentistry practice where I see patients from all age groups.  In my practice, we help educate our patients about medical conditions that can affect someone’s long term health.  Sleep apnea is one such condition, that is characterized by someone that stops breathing for at least 10 seconds for multiple times an hour.  Severe sleep apnea is defined as anyone that stops breathing 25 times or more an hour for at least 10 seconds at a time.  

Snoring is sometimes a symptom of sleep apnea, as is being able to easily fall asleep during the day.  The only way to diagnose sleep apnea is to do a test while sleeping.  Fortunately, these sleep tests can now be done in the comfort of your own bed. Once the sleep test has been done and a diagnosis of sleep apnea is made, then a variety of treatment options can be considered. For patients that have been diagnosed with mild or moderate sleep apnea or those that are unable to tolerate a CPAP, BIPAP, or APAP machine, then a dental sleep apnea appliance is recommended.  In my office we have a machine that sends sonic sound waves through the mouth to determine the best jaw position to maximize the airway.  An acrylic appliance that fits on the upper and lower arch is then made to mimic this jaw position.  

The fabrication of a dental sleep apnea appliance is covered by PPO medical insurances.  We have the ability to bill your medical insurance for you.  If you are interested in a dental sleep apnea appliance, please fill out the contact us page below.

Dentures

One of the greatest aspects of modern dentistry is our ability to replace missing or extracted teeth. Today, patients typically seek out implant crowns and bridges as quick and safe methods of restoring their smiles. But what about dentures? The name alone might conjure up pictures of older relatives and seltzer tabs, but they are still an excellent way to fix a gap in your dentition. At Thousand Oaks Family Dentistry, we offer a number of denture options for patients needing everything from temporary single tooth replacement to permanent appliances for entire arches. No matter what your needs, there is likely a denture solution to fit it!

Patients who still have some existing teeth are typically eligible for partial dentures. These appliances bridge one or more empty spaces between teeth to recreate a natural smile. They usually require healthy molars or premolars to snap on to and give them rigidity. Some partial dentures are made entirely out of acrylic. These are commonly referred to as “flippers” and typically serve as temporary solutions until an implant can be placed or a permanent denture can be made. Because they are plastic, they need to be made thick for rigidity. Likewise, flippers can feel bulky and uncomfortable and are prone to becoming brittle. Still, they are an excellent interim esthetic solution for patients missing teeth.

a full acrylic partial denture or "flipper"

Partial dentures can also be made using a combination of acrylic and cast metal. These devices are stronger, thinner and typically more comfortable than flippers. When you smile or open your mouth, pink and enamel colored acrylic hide the metal framework beneath and the appliance looks like natural tissues. Rigid metal partial dentures are appropriate for long term use and are often the most comfortable option. If you have enough teeth to anchor the device, they can fit snugly and comfortably in your mouth.

A partial denture with metal framework

If you are missing all teeth on an entire arch, you are likely eligible for full dentures. Full dentures are made out of acrylic and stay in your mouth using the suction created between your gums and the denture base. Since they rest on your gum tissue, full dentures can take some time to get used to. Many patients will feel sore spots or an uneven “rocking” sensation until they become accustomed to the feeling of the appliance. Our office can make small adjustments to dentures to better accommodate your mouth, but they will never feel as natural as something anchored to your teeth. Still, they are a great alternative to smiling, chewing and speaking with no teeth.

a full upper and lower full denture

A final subset of dentures are implant supported dentures. Here, an acrylic appliance is mounted to 2 or more implants (depending on the number of teeth replaced) through rubber snaps. These are typically the most comfortable denture style for replacing whole arches of teeth. However, this treatment option is both costly and time consuming; Implant placement can take up to six months to become healed and sturdy enough to support a denture. Still, many patients are extremely satisfied with the resulting product, as the implants keep the appliance rigid and out of contact with gum tissue.

A diagram of how implant supported dentures are mounted

No matter what type of denture we are making, our office needs three types of impressions: one impression of the teeth (or gums) on which the dentures will be made, one of the opposing teeth and one of how the teeth come together when you bite down. Once we take these impressions, we send them off to a lab along with instructions on tooth color, transparency and brightness. From there, the lab will either fashion your permanent denture, make a wax try-in (a soft, denture lookalike used by our office to ensure fit and esthetics), or send us custom trays. Custom trays are impression trays that precisely fit the dimensions of your mouth. These instruments insure a perfect impression (and a better fit) for the final denture. Once we are ready to deliver your appliance, you will return to our office for a short fitting appointment where we can make minor adjustments.

The true scope of dentures extends into many different devices, materials and mounting styles. We like to have a lengthy discussion with every patient prior to taking impressions, to make sure they will satisfied with the final product. Only a consultation between you and Dr. Hong can show us what kind of denture is appropriate for your specific needs. If you would like to know more about dentures or any other type of appliance offered at our office, please give us a call. We are always happy to walk you through any and every procedure!

Retainers and Space Maintainers

When most patients think of a “retainer,” they imagine a plastic and metal device that snaps across the upper or lower teeth. In reality, there are a whole array of products that assist in the retention and maintenance of tooth position. At our office, we offer a number of retainer solutions to keep your teeth beautiful and straight.

No matter what type of retainer, the general process for fabricating and delivering the appliance is the same. We typically need to take three types of impressions; one of the teeth that the appliance will fit on, one of the “opposing” set of teeth, and a final impression of how your teeth fit together when you bite down. The last two impressions help guarantee that the appliance doesn’t interfere with the occlusal surfaces (where the bottom and top teeth touch each other). Plastic and metal clasps covering these areas can potentially lead to an uneven bite, headaches and even jaw pain. After taking impressions, we need about two weeks for our lab to fabricate your appliance and send it back to us. When you return to our office, we will do some minor adjustments, check the fit and send you off with your brand new retainer!

At Thousand Oaks Family Dentistry, we frequently deliver three types of retainers. The first is the Hawley Retainer. This is the most recognizable “plastic and metal” type appliance. It is removable, easy to clean and usually very comfortable to wear. This type of retainer typically best fits the needs of our adult and teen patients. We also offer clear plastic retainers, known as Essix Retainers. While these appliances are not as noticeable while wearing (the entire device is made from thin clear plastic), the nature of their constructions requires material to cover the biting surfaces of the teeth. This can lead to a whole host of painful problems, particularly in patients who grind or clench.

Finally, we offer a specialized individual tooth retainer called a Space Maintainer for young children who lose a primary tooth prematurely. Decay, cracks and infection can all indicate that a primary tooth needs to be extracted before the adult tooth is ready to erupt. Once removed, the adjacent teeth will typically “move in” and try to fill in the leftover gap. Since the primary teeth serve as placeholders for their adult counterparts, this shift can result in uneven or improper eruption of the adult dentition. A Space Maintainer counteracts this by holding the space of the lost primary tooth. It is physically cemented to the more rearward tooth and butts up against the more forward one, bridging the gap. We recommend space maintainers to almost all of our young patients having primary teeth extracted. This small device can save time, money and headaches by preventing the need for extensive orthodontic work or surgery to correct the adult tooth’s position.

Hawley Retainer

Essix Retainer

Space Maintainer

On top of the retainers offered specifically at our office, there are a number of more complex devices aimed at maintaining tooth position. These appliances can be more discreet, maintain difficult cases or even provide mild repositioning or realignment. For our patients needing these devices, we will typically refer out to our network of wonderful orthodontists. They all have countless hours studying and fabricating these retainers, and can bring years of experience to your needs. After a consultation, we will gladly refer you out to a specialist to best suit your specific case.

As with any of the services offered at our office, a consultation and exam are necessary to determine the best type of retainer for your personal needs. If you are interested in having an appliance made, or have more questions about the process, please give us a call. We are happy to assist you with every step towards optimal oral health!

Video Blog on TMJ Pain and Night Guards

Greetings, my name is Dr. Kari Ann Hong and I have a family dentistry practice where I see patients from all age groups. In my practice, I see a number of patients that clench or grind their teeth at night.  This extra function at night can cause headaches, morning muscle pain when chewing, temporomandibular joint (TMJ) pain, tooth pain, and breakage of teeth.  The number one way to protect the teeth and muscle groups from the clenching and grinding is to wear a custom fitted night guard.

The first step in making a night guard is to take impressions of your teeth and to take an impression of how your teeth come together when your jaw is slightly open.  From the impressions, we make stone models that are used to fabricate a custom fitted acrylic night guard.  Usually we make the appliance for the lower arch.  During the one hour fitting appointment, we adjust the surface of the acrylic so that when the upper teeth touch the appliance, they all hit evenly.  Also, when you grind side to side or forward, the appliance is adjusted so that the majority of the force happens on the front off the appliance. This helps protect the facial muscle groups and the TMJ.

Due to concerns about the cost of a custom fitted night guard, sometimes patients will buy over the counter boil and bite type appliances.  The disadvantage of these boil and bite appliances, is that the opposing teeth don’t have freedom of movement, thereby potentially causing additional interferences for the TMJ and increased firing of the muscle groups that help our jaw open and close.  Depending on your medical and/or dental insurance plan, there usually is some coverage for a custom fitted night guard to treat TMJ pain.  If you would like to find out if a custom fitted night guard is right for you, and what your cost would be, please fill out the contact us page.

Viroxyn Cold Sore Treatment

Viroxyn is packaged in a convenient vial/swab combination and can be applied in a matter of seconds. Credit: Quadex Labs

Every year, millions of Americans develop one or more cold sores on their lips. These blisters are unsightly, painful and contagious- often causing us to avoid or limit socialization while they are inflamed. Fortunately, there is an excellent medical solution to this pain and embarrassment. Our office is proud to offer Viroxyn- a professional strength cold sore treatment.

Cold sores are caused by a viral infection that enters the body via the mucosal tissue (i.e. lips) or dry/cut skin. Once inside, it can lie dormant for months or years, until it becomes activated and begins to replicate. As the virus grows, your body’s immune system kicks in and begins to supply the area with white blood cells to combat the infection. This process causes the typical cycle of pain, irritation and appearance of blisters associated with cold sores.

Untreated, the entire biological process takes about 2 weeks to resolve itself. The virus then becomes dormant until reactivated, as it is never actually eradicated from your body. Typical cold sore sufferers receive an average of 1-3 outbreaks a year, often coinciding with times or stress or irritation to the lip tissue. Dry weather, hectic work schedules and even sunburns can cause the virus to engage and begin replicating.

Viroxyn helps minimize the hassle of these outbreaks through a combination of an effective pain reliever and antiseptic. One applied, the topical anesthetic begins to numb the pain, while the antiseptic helps the body target and eradicate the active virus. Many patients find their pain eliminated in one hour, with the visible outbreak minimized in as few as three days. Viroxyn works best when the outbreak is caught early on, and is typically administered as soon as you feel the first signs of a cold sore. The medicine is delivered in a convenient single use swab system and takes less than a minute to apply. 

If you suffer from cold sores, please let us know at your next visit. This product does an excellent job of stopping pain from cold sores and can drastically shorten your time spent suffering with an unsightly blister. If you have any further questions about this product, or would like to learn more about what causes cold sores, please call our office. We are here to help in every way that we can!

Cleanings and Periodontal Maintenance

The most common and essential function of our office (and any dental office) is the administration of routine cleanings and exams. These are critical steps to your long term tooth preservation, decay prevention and gum care. However, many patients would likely be surprised to learn that there are an array of services offered under the “realm” of cleanings. In this article, we will uncover the different types of dental cleanings, who gets them, and their overall “goals” in terms of your oral health.

Before going into the different types of cleanings, it is important to understand a few key terms in diagnosing and treating gum disease. Please consider the following:

Plaque- A biofilm created by bacteria to allow it to better attach and anchor itself to the tooth.

Tartar/Calculus- The result of plaque hardening on tooth structure. This substance can cause rapid tooth decay and progression of gum disease. Additionally, it is very difficult to remove with home hygiene techniques.

Periodontal pockets- The depth of space between teeth and gums as measured by a “perio probe.” Pockets ranging between 1-3mm are considered healthy and maintainable with normal brushing. Anything deeper is the result of plaque/calculus irritating the gum tissue away from the tooth root.

Bone Loss- The loss of bone height around a tooth as a result of the body’s immune response to the long term presence of plaque and calculus.

A perio probe- The indentations show 1mm and 5mm intervals for measuring pocket depths. 

The majority of patients that come to our office receive what is called a prophylactic cleaning (or “prophy”). This is typically considered a standard cleaning that you would receive twice a year on a 6 month recall. The word “prophylactic” indicates that this type of cleaning is strictly preventative care. Here, the patient’s gum tissue is considered to be within the healthy spectrum- mild plaque and calculus, shallow periodontal pockets and no bone loss. Our hygienists will remove any buildup you have incurred since your last visit and make sure there is no progression of gum disease. The purpose of this appointment is to “prevent” your healthy gum tissue from progressing into the spectrum of periodontal disease.

Some patients fall within an in-between state of periodontal disease. While they do not have aggressive bone loss, their levels of calculus, gum recession and periodontal pockets are not within a healthy spectrum. For these patients, we usually recommend a periodontal recall cleaning. This service, usually administered in three month intervals, is a more aggressive maintenance of the teeth and gums. We are no longer preventing periodontal disease; widespread calculus inflammation and tissue detachment marks the clinical presence of disease. These patients are receiving dental scaling for multiple pockets over 4mm- much deeper than a toothbrush can clean. The ultimate goal of this appointment is to prevent moderate disease from progressing further, with the hopes that you will soon be back to normal “prophy” cleanings.

A diagram visualizing the difference between healthy and diseased gum tissue and bone. 

A final category of cleanings exist for individuals who typically have not seen a dentist in a number of years. These patients have excessive calculus, periodontal pockets greater than 4mm on almost every tooth and excessive bone loss over the entire mouth. Not only will home hygiene be insufficient to keep up with the progression of disease, but standard cleaning techniques will fall short as well. Here, we provide scaling and root planing for the the most invasive levels of calculus and plaque removal. The entire mouth is cleaned over two or four appointments, usually with an anesthetic. This type of procedure is usually recommended once to give your mouth a complete, thorough evaluation and cleaning. The goal is to set a healthier baseline for your mouth, so that it can be better managed by regular scheduled cleanings and your personal home care routine.

We recommend all of these periodontal services to a number of our patients for a number of reasons. Sometimes, unique situations will require a combination of approaches, the expertise of specialist or even surgical intervention. Only a thorough evaluation by Dr. Kari or one of our skilled hygienists will give us a true picture of your gum health. If you would like schedule an exam or cleaning, please contact our office. We are here to listen to your concerns and guide you every step of the way!

Managing Dental Fears

    A dentist’s office can be a very frightening place. The unfamiliar equipment, clinical environment and the looming “promise of pain” can all add up to quite an unsettling mental image. With this in mind, it is easy to see why so many patients are hesitant to schedule even a routine checkup. At Thousand Oaks Family Dentistry, we understand that visions of dental appointments weigh heavy in many patient’s minds. Hence, we try our best to manage and minimize fear through a number of techniques and methods.

Our welcoming waiting room. 

    One of the first things you will notice upon entering our office is our living-room style waiting room. It is decorated and designed to distract from the overly clinical and impersonal feel many patients normally associate with medical offices. A large television greets you with whatever channel you desire and our front office staff is available to provide you with water, candies or even a hot towel.

One of our Multimedia Patient TV screen. 

    After being seated in one of our exam rooms, you will be given the choice of watching TV, watching Netflix, or listening to streaming radio services. Each room also has over-ear headphones, blankets and pillows available upon request. We feel that the comforting/immersive experience of a good TV show, headphones and a blanket are enough to comfort all but the most fearful patients. These simple services have helped us treat a number of patients who felt they could never make it through an entire dental appointment.

    Beyond these services, we offer a number of medicinal methods to managing fear as well. These methods are either prescribed or offered in our office after a consultation and evaluation. We will try to address dental phobia without medication first, but we are always willing to meet you and your specific needs. If you have questions about these services, please let our front office staff know when you book your appointment.

    If you would like to hear more about our office and how we handle fearful patients and dental phobics, please give us a call. We are always happy to accommodate our patients and make you feel completely comfortable at your appointment. Our ultimate goal if for every patient to have a happy, positive experience at our office!