400 Year Old Dentures

Archaeologists recently unearthed a 400 year old set of dentures from a monastery in Tuscany. The appliance, made from the wearer's lost teeth and gold bands, is the oldest ever discovered of its type. It is thought that the denture was held in place by looping string around four holes in the gold framework. We hope that the string was tight- the wearer couldn't exactly swing by the store for a tube of Poligrip!

Interestingly enough, this ancient denture still shares some features with its modern counterparts. Today we use plastic or porcelain teeth, but removable partial dentures still utilize a metal framework for rigidity. While you won't find a denture held in with strings, many appliances have wire clasps that achieve a similar function. Overall, the similarities are striking, though we much prefer today's offerings!

With the advent of implant dentistry, many patients may think of dentures as ancient history. However, they are still an important and viable option for replacing lost teeth. If you would like to know more about your choices in completing your smile, please give our office a call!

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New Water Fluoridation Levels

You may have seen articles around the Internet noting that the United States Department of Health and Human Services recently lowered their recommended levels for drinking water fluoridation. At first, this may seem like a startling headline. Why would they need to lower their recommendations? Were the levels unsafe before? In reality, there is no reason for concern. The levels of fluoridation in the United States have always been at a safe and therapeutic value.

Previously, the DHHS recommended that fluoride levels were kept within a range between 0.7-1.2 milligrams per liter of water. Under the new guidelines, fluoride levels should be calibrated to a set value of 0.7 milligrams per liter. This change reflects improvements in dental public health services and the increased prevalence of fluoride toothpaste use across the United States. As more and more people (mainly children) are actively using fluoridated dental products, the need for fluoride in water is lessened.

At the current (and historic) levels of fluoride in drinking water, the main concern is the development of fluorosis. Fluorosis is the appearance of white marks or lines on teeth as the result of excessive fluoride exposure during the first 8 years of life. While this may sound alarming, have no fear. Fluorosis is a purely cosmetic condition. In actually, it was difficult to develop this condition before the new guidelines, and will be even tougher now. It is also important to note that the United States has never recommended fluoridation levels that could  lead to toxicity.

Fluoride has been an invaluable tool in providing large populations increased protection against tooth decay. As such, the CDC has named community water fluoridation as one of the Ten Great Public Health Achievements of the 20th Century. If you would like to know more about fluoride, its safety, or how it works, please call our office. We are always happy to keep our patients educated on current events in dentistry!

Dental Tourism

With the economy in recession, many people are (rightfully) trying to save every penny they can. From entertainment to groceries, families across the nation are looking for a “good deal.” Some have discovered the increasingly popular medical tourism industry- where individuals travel internationally for discounted surgeries, treatments and medications. While the prices may seem great, our office would like to take a moment to show you that some of these deals may be “too good to be true.”

For starters, we are addressing dental tourism as the act of traveling to a specific office in a specific country for cheaper treatment. We are not discounting the standard of dental care in any country; you can find a great dentist in every part of the world. However, when patients travel specifically to seek out cheaper treatment, they often find themselves in unsafe situations.

In the United States, healthcare is not “cheap.” Fortunately, dental treatment has remained on the lower end of the cost spectrum, where some patients may still find it viable to receive great regular treatment even without insurance. While there are a number of issues that play into this high cost, one of the most important factors is regulation.

For a dental office to open its doors in America, it has to satisfy hundreds of qualifications, standards and licensing requirements. Our dentists have to hold a valid license, which can only be renewed if they have received the proper number of yearly credits for continuing education. The instruments and materials we use have to be approved safe by the FDA. Even our sterilization systems are subject to testing and supervision from the state dental board. However, the most important part of all this regulation is that it is strictly enforced. Between HIPPA, OSHA, the California Dental Board, the local dental society and the Food and Drug Administration, there are a number of “safety nets” that keep our patients out of harm’s way. Likewise, this excellent system of care comes with a fair share of taxes, specialized equipment and additional work to meet requirements; all of which can increase the cost of care.

Beyond extensive regulation, dental offices are simply expensive to run. In an office like ours, seeing patients daily would be impossible without a complete staff of front office coordinators, hygienists and assistants. In fact, nearly 25%-35% of an office’s typical overhead goes to pay the clinical staff (excluding the dentist). When you include lab fees, utility bills, insurances and disposable products, this number grows very rapidly. As you may imagine, these costs go hand-in-hand with regulatory measures, as to assure the office runs in complete compliance.

When you travel internationally for dental tourism, think about why the office you are visiting can offer cheaper care. Are they using proper sterilization techniques? Are their instruments licensed as safe for dental use? Is their equipment subject to strict scrutiny from government inspections? At some point, there must be a “missing piece” that allows them to offer cheaper care. Maybe it is simply the result of an overall lower cost of living in that country. However, it is often difficult to discern what you are (or aren’t) getting with this type of international treatment.

Perhaps you have found a great clinic with low fees that comes highly recommended from a friend or coworker. You checked their website, where the “American standard of care” is guaranteed by the head dentist. You may travel to this clinic, receive great treatment, and make it home while saving some money. Unfortunately, dentistry (like all of biology and medicine) can be unpredictable at times. Even the most skilled practitioner using the best techniques and equipment will occasionally have imperfect treatment outcomes. With a local office, these problems can be easily remedied by the treating dentist or through close communication with a specialist or associate. However, having international treatment amended can be expensive or impossible, depending on your situation. Often times, American dentists cannot provide follow up treatment to international care, as they are not familiar with (or cannot identify) the materials or techniques used. This may require a return visit to the treating international dentist, negating any potential savings.

At Thousand Oaks Family Dentistry, we are extremely proud of the transparency and standard of care we offer our patients. We understand that some of our patients may be tempted by lower prices in international offices, but we urge you to have a consultation with us first. You may find that our fees are competitive, with the added peace-of-mind from highly regulated local dental treatment. If you have any questions regarding our fees or practices, please give us a call!

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!

Periodontitis in the United States

One of the main functions of the Centers for Disease Control (CDC) is to characterize the patterns and prevalence of diseases across the United States. Earlier this year, the CDC released a study that examined the gum tissue health of adults over the age of 30. They found that nearly of all subjects had some form of periodontitis (advanced state gum disease). That's nearly 65 million Americans!

Papers like these highlight both the importance of home care and the necessity of regular dental office visits. In most instances, periodontal disease is largely preventable. However, it requires a lifetime of proper oral hygiene and maintenance. This is one of the many reasons why we stress the importance of establishing good brushing and flossing habits starting at a very young age. Likewise, regular dental appointments allow a professional to monitor your progress and help keep you on the right track!

Like many things in life, maintaining proper oral hygiene is a collaboration between your efforts and the support of a dental healthcare team. Our office prides itself in not only treating our patient's problems, but also making sure they are equipped with the knowledge to prevent or manage further disease. If you would like to know more about gum disease, periodontitis or any other dental care topics, please give us a call. Our staff is always excited to teach the best practices in keeping your teeth and gums healthy!

Changes to Anthem Blue Cross Blue Shield's Policies

The healthcare community has long understood the importance of oral health in relationship to systemic diseases and biological changes. We now know that severe gum disease (periodontitis) plays hand in hand with many conditions, putting patients at higher risks and making them harder to treat.

Recently, Anthem Blue Cross Blue Shield has updated their dental insurance plans to better reflect current understandings on periodontitis and systemic health. As of now, their diabetic and pregnant patients qualify for three cleanings a year, as opposed to the normal two. To be eligible for the extra covered yearly cleaning, you must be actively enrolled in one of their diabetes or maternal healthcare management programs. Their system will then automatically update your profile so that you qualify for the extra cleaning. 

In the case of diabetes, research suggests that gum disease can make blood glucose levels harder to manage. Likewise, the delayed healing process brought on by diabetes allows periodontal disease to progress rapidly. For pregnancy, periodontal disease has been associated with low birthweight babies and premature delivery. In both instances, an extra preventative appointment could have a big outcome on your quality of life. 

As a reminder, this only applies to cleanings covered by Anthem Blue Cross Blue Shield. If you subscribe to another insurance company or do not qualify for this benefit, you can still utilize a third cleaning out-of-pocket. While our office is highlighting this change to Anthem's policies, we do not endorse one insurance plan over any others. If you would like to know more about dental insurance or your specific plan, please give our office a call. We have years of experience with a number of insurance providers and can assuredly help you!

Metal Fillings and Mercury

One of the most controversial topics in dentistry today is the use of mercury in dental materials. Metal fillings, known as amalgams, utilize the low melting point of mercury to create a metal substance that starts out moldable and solidifies to make a strong restoration. Knowing that mercury has harmful properties, why does the dental profession still utilize this material? We wanted to take a moment to explain how (and why) mercury is still used as a safe and predictable dental treatment. 

For starters, our office currently does not place amalgam fillings. This is not due to mercury toxicity or metal content, but rather that tooth colored fillings can now offer similar structural properties as amalgams, but with much better esthetics. All things equal, most patients would prefer a natural looking restoration over a metallic alternative. Still, many dental practices still place amalgams. The metal fillings are occasionally preferred over tooth colored materials due to location, size and user choice. Our office has a number of materials and technologies (such as the sonicfil system) that allows us to place tooth colored restorations with great predictability in a number of scenarios.

An important point in understanding mercury toxicity is acknowledging the different ways that mercury exists in our environment. Elemental mercury can be found in older thermometers, blood pressure cuffs and certain types of lightbulbs. While it is a toxic substance, it does not “stay” in our system; after exposure the harmful vapors are processed and released. This is contrasted to organic mercury (methylmercury, organomercury, etc.). Organic mercury “builds up” in ecosystems and causes health concerns associated with eating large fish, sushi and other seafood. Our bodies have a hard time clearing this compound, which can eventually lead to conditions such as mercury poisoning. 

The mercury found in amalgam fillings is unique, as it is “locked in" with other metals in an alloy. Extensive research has shown that properly maintained metal fillings leach little to no mercury into the body. In other words, while there may be mercury present in your fillings, it is largely shielded from causing any effects or systemic health issues.

The only real concerns with mercury in amalgam fillings are during placement and removal. These are the only occasions when the mercury is aerosolized or free to release vapor. However, dentists are very aware of this, and take many precautions to eliminate any potential harm. For example, our office uses two forms of isolation/suction when removing amalgam fillings, as to maximize the speed at which the vapors are evacuated.

Please do not heed the advice of television medical personalities who proclaim the many “evils” of amalgam. It is a strong, safe and effective dental filling material. Our office only removes dental amalgam due to patient preference or recurrent decay. We never recommend removing sound amalgam fillings due to mercury concerns. If you would like to know more about the mercury content in amalgam fillings, our office’s policies or why we place fillings, please give us a call. We want you to be confident and satisfied with all aspects of your dental treatment!

Fluoride- The Facts

One of the most controversial topics in dentistry (and possibly all of healthcare) is the use of fluoride in our water supplies and dental products. What is it? Why do we use it? Could it harm my family? Today, we would like to take a moment to lift the myths and mysteries away from fluoride- a safe and effective measure for remineralizing and protecting teeth.

Fluoride (F-) is a negatively charged ion, similar to chloride ion (Cl-) in sodium chloride (Table salt). As such, it needs to be bound to a positively charged ion to exist as a solid mineral. This is why the labels on toothpastes and other dental products will list “stannous” fluoride or “sodium” fluoride as the active ingredient. The first part of the compound merely serves as a safe means of stabilizing the F- ion for delivery. Like table salt, when a compound with fluoride is dissolved into a solution, some of the ions will split into two, leaving a small portion of free floating F- ions.

The chemical mechanism by which Fluoride remineralizes and repairs is quite simple. The outer enamel layer of our teeth is essentially a crystal composed of calcium and phosphate. As acid, biofilms and bacteria break down this crystal, the calcium and phosphate become weakened and dissolve into our saliva. Fluoride works by encouraging the two compounds to reunite and incorporate back into the enamel. Similarly, If teeth are exposed to fluoride during development, the enamel tends to grow stronger and more resistant to decay. Scientific studies have also shown that fluoride inhibits bacteria’s ability to produce acid and stick to the teeth. This combination of effects makes fluoride an excellent candidate for fighting tooth decay.

Since fluoride needs to be in close proximity to the teeth to work, it’s effectiveness is dependent on exposure time and the not amount consumed. For example, swishing for 30 minutes with shot glass of fluoridated water would be more effective than gulping down a glass of fluoridated water in 30 seconds. Likewise, this is the reason toothpaste is not (and should not be) consumed for it to work ideally.

Since 2007, the water supply in Southern California has been fluoridated to a level of about 0.7 PPM (parts per million). The EPA suggests that any any fluoride level under 2.0 PPM is safe for consumption, while levels between 0.7PPM and 1.2PPM are ideal for medical effectiveness. As such, our water supply is well within safe limits. Additionally, some sources of water are naturally fluoridated without man made intervention. Here, governments and municipalities will occasionally have to de-fluoridate water before it is ideal for consumption. In addition to water supplies, many dental products and supplements contain fluoride in safe levels. Typically, any product advertising “anticavity” or “helps rebuild teeth” contains some amount of fluoride.

Although the medical benefits and potential risks of fluoride are well known and documented, some individuals feel that it is unsafe for human use. Common sources of fear are over impaired glucose metabolism, pineal gland hardening, poisoning and decreased cognitive ability. It is important to note that no reputable scientific journal supports any of these claims in regards to fluoride administered or used properly.

Many websites that quote scientific studies to prove the harms of fluoride typically cite outdated or unreliable papers, or do not understand (or relay) what the paper proves. For example, some studies have highlighted that fluoridated water can be dangerous when administered in extremely high levels. This is very true; large doses of fluoride can be quite harmful or even deadly, just like too much tylenol, alcohol or allergy medication. However, when used properly, fluoride is an extremely safe method of protecting our teeth.

In reality, the main concern with fluoride use and exposure is the onset of fluorosis in young children. As the adult teeth develop, overexposure to fluoride can cause white streaks or marks to appear within the outer enamel layer. This is typically found in children who start to take fluoride supplements at a very early age or are have their teeth brushed very often with too much toothpaste. To help prevent fluorosis, we recommend that children ages three and under should only brush with a smear of fluoride toothpaste, while ages six and under should brush with a pea sized portion. Your child should always be guided or supervised during brushing, to ensure they are applying toothpaste, spitting and rinsing properly. Extra fluoride supplements and treatments should be avoided, unless recommended by a dental professional. In general, fluorosis is generally a concern only until age 8, when the adult teeth have finished developing.

At Thousand Oaks Family Dentistry, we are firm believers in the efficacy of fluoride. We offer topical fluoride treatments for all patients with active tooth decay. In addition, we recommend ACT Fluoride rinse instead of mouthwash for our adult patients who have a history of cavities.  For those with aggressive decay, we offer a range of products that combine fluoride with xylitol, calcium and phosphate to arrest further cavities before they progress. In total, our entire spectrum of preventative recommendations incorporate fluoride to some degree. If you would like to know more about fluoride, how it works or why we use it, please call our office. We want you to feel assured about all of your dental health needs and choices!

Dentistry in the News- Oil Pulling

If you turn on the news tonight, chances are you will see at least one article on harmful food additives, dangerous diets or other health scares. With so many alarming stories on the average american diet and wellness, many of our patients are trying alternative and holistic medical solutions. Today, we would like to cover one of these treatments that directly relates to dentistry and dental science; Oil Pulling. 

Oil Pulling is an ancient South-Asian practice of swishing or holding oil in the mouth. It arises from traditional Hindu medicine and is said to have incredible benefits for the entire body. In modern times, oil pulling is thought to aid in eliminating bacteria from the teeth and gums. The practice has been popularized by TV shows such as Dr. Oz and holistic medicine websites and blogs. Some believe that the oil can emulsify and trap bacteria, allowing it to be removed as the oil is expelled. Others argue that the action of swishing oil can push bacteria out of the gum tissue and hard to reach areas. No matter what proposed mechanism, the promise is a healthier mouth with lower bacterial counts.

The American Dental Association’s stance on oil pulling is that there isn’t enough conclusive scientific evidence to recommend it as a treatment for any oral condition. With papers suggesting both benefits and drawbacks, it is hard to reach a hard decision on if, how or why oil pulling works. At Thousand Oaks Family Dentistry, we feel that while oil pulling may not have any concrete medicinal benefits, there is relatively little harm in it’s practice. If you believe it can make your mouth healthier and cleaner, then feel free to try oil pulling. Our only advice is to use a quality (cold pressed) oil and to discard the oil into your trash (it can quickly harden and clog up bathroom sinks). Additionally, make sure you rinsing thoroughly after each pulling session and do not let the oil sit on your teeth for extended periods.

In short, we recognize oil pulling as a treatment many of our patients are utilizing. While you may see some health benefits, we want you to realize that there is no substitution for brushing twice a day, flossing and receiving regular dental cleanings. We know of no way to better maximize your oral health and minimize chances for disease and decay. As with any habit, if you notice oil pulling is having negative effects, stop treatment immediately. We want all of our patients to be happy and healthy. If you feel oil pulling can help get you reach that state, then feel free to add it to your existing home care regimen in a safe and controlled manner!

Covered California

As of May 1st, 2014, California healthcare insurance has undergone a significant redesign and restructuring process. Under the name Covered California, it is our state’s implementation of the healthcare marketplace system set fourth by the Affordable Care Act (commonly known as “Obamacare”). Now that open enrollment has ended, many individuals have new and unfamiliar plans and benefits.  At Thousand Oaks Family Dentistry, we want to alleviate some of the confusion and alert you as to how Covered California may change your dental coverage. Take a look at these frequently asked questions:

Does my Covered California (CCA) compliant plan include dental coverage?

-For adults over the age of 18, CCA compliant plans do not have to offer any dental coverage. Depending on your provider, dental coverage may be available, but it is strictly on an opt-in basis.

I will be signing up (or signed up) individually through the healthcare marketplace. Does it make sense for me to opt in to dental coverage?

- One thing to consider is that dental insurance is structured differently from medical insurance. While medical insurance includes features such as out-of-pocket maximums and protection against catastrophic accidents, dental coverage is typically a lowered fee schedule in exchange for a monthly premium. It is ultimately your decision if this will be beneficial to your unique needs.  Our only advice is that dental plan premiums tend to follow a “get what you pay for” model. Plans with lower monthly payments typically have higher copays and out-of-pocket costs.

Will my children have dental coverage through CCA?

- Children 18 and younger are covered under CCA. However, these dental plans are additional to any insurance plans. You must opt-in or specifically seek out dental coverage for your children. It will typically not be done without your explicit consent or knowledge. Both PPO and HMO options are available, so be aware of what you are signing up for. More information can be found on the Covered California website: https://www.coveredca.com/childrens-dental/

Will the new guidelines set forth by CCA change my experience at Thousand Oaks Family Dentistry?

- The most likely answer is no. Our insurance coverage has not changed as a result of Covered California. In addition, our average patient’s dental coverage has not changed either. If you did not have dental insurance before, you will likely still be uncovered under these new provisions. An exception to this is some children (18 and under) may now be covered under CCA. Again, if this is the case you would likely have been notified by your insurance provider.