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!

Specialist Spotlight- 1000 Oaks Childrens Dental Group

At Thousand Oaks Family Dentistry, we are proud of the network of skilled dental specialists we have created. Whether you are in our office or one of our associates’ offices, know that you will be treated with respect, kindness and experience. Today, we would like to highlight 1000 Oaks Childrens Dental Group, the office of Dr. Ahsan Raza.

As a pediatric dentist, Dr. Raza offers a wide variety of services and techniques that address the needs of younger patients. His office specializes in creating a positive experience that leaves children enthusiastic about their dental health. Dr. Raza prides himself on developing this environment through effective communication to both patients and parents. Education, personalized care and interactive treatment allow children to become relaxed and engaged throughout the dental appointment. For parents, a small office atmosphere and emphasis on safety and sterilization provide confidence and peace of mind.

Beyond communication, Dr. Raza manages children’s dental anxiety through a number of other techniques. The first thing you will notice upon entering his office is the fantastic and immersive spaceship theme. From the waiting room to the post-treatment toys, nearly every aspect of your child’s appointment will have an astronautical flavor. The extensive theming helps create a fun environment that distracts from the actual dentistry. The treatment rooms are also equipped with televisions, movies and video games to further entertain and divert attention. In addition, Dr. Raza will utilize a number of sedation methods for particularly fearful children. Nitrous oxide, oral sedation and IV sedation are all utilized to ensure the best possible treatment outcomes.

We love working with Dr. Raza because of his communication expertise and focus on prevention. This combination allows your child’s dental needs to be addressed appropriately and in a timely manner. If you would like to know more about 1000 Oaks Childrens Dental Group or any other of our fantastic specialists, please give us a call.  We want our patients to know they are in good hands, whether with us or one of our specialists.

Dental Library Review: The Tooth Book

Welcome to The Dental Library Review! In this feature, we will be reviewing and highlighting different children’s books we have collected at our office. Our staff have personally used these books with their own children and have had great reception. Today, we will be going over The Tooth Book by Dr. Seuss (with illustrations by Joe Mathieu).

Being a classic Dr. Seuss storybook, this tale is full of whimsical rhymes and colorful illustrations; Joe Mathieu does a great job of pairing the fun poetry with equally entertaining imagery. In this early reader, we learn about all the fun places we can find teeth and why they are so important. We also get a short lesson in why we have to take good care of our teeth and what happens to boys and girls who eat too many sweets. Overall, it is a great mix of silly fun and important oral health concepts for small children.

Given the simple wording, thick pages and short storyline, this book is likely best suited for young readers or as a bedtime story. In fact, it is listed as a part of Dr. Seuss’ Bright and Early Board Books. As with all the stories we review, feel free to check it out at your next appointment. We are always happy to do anything we can to get your family excited and educated about dental health topics!

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!

Facial Esthetics and the Golden Proportion

Have you ever wondered why it is so easy to spot a perfect smile? It’s something almost all of us can do subconsciously. Beyond straight white teeth, there is something that just seems to stand out on someone with a “Hollywood smile.” Believe it or not, mathematics and proportions dictate the esthetics of our teeth and facial characteristics. By following a few basic ratios and the golden proportion, it is easy to see how a great smile comes together!

When we smile, our maxillary (upper jaw) anterior teeth will show the most. Our two central incisors are flanked by slightly smaller lateral incisors and then by the canines. The premolars and molars behind the canines will show as well, which contributes to the “width” of the smile. In an ideal situation, the line between the two front teeth should run perfectly parallel to a line drawn between the eyes or ears. This measurement is of particular concern in patients with head and neck injuries or asymmetrical faces. In addition, the two central incisors should be about 80% as wide as they are is tall. That is, if the tooth is 10mm tall it should be nearly 8mm wide to look the most natural.

The most important principle to follow in facial esthetics is something called the golden proportion. This principle dictates the relative widths of the anterior teeth.  Here, the lateral incisors are used as a reference factor of 1. The central incisors should be 1.618 times the size of the laterals, while the canines should only take up about .618 of the space. These very specific numbers can separate artificial “chicklet” looking teeth from a well rounded and robust natural smile. When performing cosmetic procedures such as crowns and bonding, we always work our hardest to preserve and develop these dimensions.

These ideas and principles dictate how our office works towards creating beautiful and esthetically pleasing smiles. Most people are not born with these ideal dimensions and still have beautiful faces. What these numbers do, however, is establish a guideline for how we approach crowns, dentures, implants and restorations to the anterior teeth. Don’t measure your own smile and become disappointed! These numbers do not take into account a number of other factors that can alter your facial appearance. Everyone has a unique smile and deserves a unique treatment!

At Thousand Oaks Family dentistry, we offer a wide range of services that can create mild to dramatic changes to your smile. As with any procedure, we can only decide what treatment is appropriate for you with a full consultation and exam. If you would like to learn more about facial esthetics and cosmetic dentistry, please contact our office!

X-Rays and Radiation Safety

Although our office is full of technologically advanced tools and space-age materials, the most common conversation starter is our trusted x-ray machine.  Between hygiene checkups and emergency appointments, we are often asked "Are dental X-rays safe? Do I REALLY need another set?" The answer to both these questions is a resounding yes. After our recent post on adding the Dexis Dexsheild to our radiation safety protocol, we wanted to take a moment to explain what x-rays are, how they work and why they are some of the safest diagnostic tools available to the medical world.

Since the end of the atomic age, the word "radiation" has gained an increasingly worsening reputation. It is a scary concept; invisible and potentially harmful energy that can travel through walls. However, it is important to remember that radiation has always been around us since the beginning of time. The sun, the atmosphere and even large rocks all give off measurable radiation. This environmental exposure jumped drastically with the rise of consumer electronics. From your television to your toaster, most common household items contribute to the yearly radiation we receive. 

X-Rays are a subtype of radiation that has ideal properties for medical imaging. They have no mass or charge and travel in straight lines with fixed wavelengths. When they reach a material, they are either transmitted through, reflected or absorbed. This allows x-ray films to image biological tissues. A developed x-ray film tells us about relative densities of an object; denser materials will appear white, while empty spaces look grey or black. This allows us to visualize tooth decay, as the developed picture will indicate where the tooth structure has demineralized and become more porous.

When you receive an x-ray at our office, you are receiving a dose of radiation that is less than half the background radiation from a typical day. This equivalency falls drastically if you sunbathe or spend a lot of time outdoors without sunscreen. Our machines are calibrated to give the absolute safest dose possible to obtain a diagnostic quality image. This is not easy to achieve; both too much AND too little power can make an x-ray more harmful to a patient. Overall, dental and medical imaging (x-rays, CT-scans, MRIs) account for about 1% of the average yearly radiation a patient receives. We feel that this is an excellent trade for the incredible diagnosing power we gain from their use.

Pictured: some of the digital x-ray equipment at our office

While some products claim to match the abilities of x-rays without the drawbacks, none are as reliable, predictable or useful. For this reason, radiography machines are the gold standard in dental imaging around the world. The job of individual offices is then to keep their patients as safe as possible, to maximize quality while minimizing side effects. At Thousand Oaks Family Dentistry, we have many protocols that are focused on this idea. Our radiography system is fully electronic, from the beam timers to the digital sensors. This means we can deliver the lowest and most predictable level of radiation for every patient. This is followed up with a number of protective factors, from using lead aprons with thyroid collars, to our Dexsheilds and collimated (protectively enclosed) beam head. In every aspect, we meet or exceed the standards set out by the local and federal government.

If you still have concerns about radiation and why it is used in a dental setting, please give us a call. We know that radiography can seem intimidating or dangerous, and want to do our best to ease your mind. Our office is extremely confident in the safety and quality of the images we produce and would love to show you how and why we use them!

Dental Library Review: What If You Had Animal Teeth

Welcome to The Dental Library Review! In this feature, we will be reviewing and highlighting different children’s books we have collected at our office. Our staff have personally used these books with their own children and have had great reception. Today, we will be going over What If You Had Animal Teeth by Sandra Markle and Howard McWilliam.

This book is a great idea for any child who loves science, biology or animals. Every page covers a different creature, what their teeth look like and what they are used for. Children and adults alike will find these facts interesting and thought provoking. The book also briefly introduces the human teeth, what they do and why it is important to keep them nice and healthy!

Since the book opens with a story about losing the front two teeth, it is most appropriate for children in the 6-7 year range (when the central incisors are typically shed). However, we feel that this book would be fun and interesting for children over a much wider age range. Our only caution is that some of the pictures and illustrations might be alarming to younger children (snakes with fangs showing, children illustrated with animal teeth, etc.).

As with all the stories we review, feel free to check it out at your next appointment. We are always happy to do anything we can to get your family excited and educated about dental health topics!

Sterilization, Disinfection and Cleanliness

When choosing a dental or medical office, one of your main concerns is likely sterilization. This very understandable, with the news full of alarming stories and statistics on secondary infections, pathogens and contaminated surfaces found in medical settings. In light of this, Thousand Oaks Family Dentistry is here to show you the basics of our sterilization and disinfection methods, and why we feel they are the best way to keep our patients safe and healthy.

Cavicide comes in wipes and sprays to adapt to a variety of needs. 

When entering one of our operatories, you will notice bags, films and coverings over all commonly used surfaces. These disposable barriers ensure that there is no cross contamination between patients: as soon as one procedure is finished, every covering is replaced. Naturally, some surfaces cannot be covered or protected or might become inadvertently contaminated during a procedure. To maintain the cleanliness of these areas, we use a medical grade disinfectant called Cavicide. This incredible solution is strong enough to kill TB, Hepatitis B, HIV and even MRSA, while remaining gentle enough to be approved for use in NICUs. It is a disinfection standard in hospitals, medical offices and dental practices nationwide and we are proud to offer it as a protective measure for our patients.

Beyond our operatories, we take great care in the cleanliness and maintenance of our instruments. All of our instruments are cleaned and sterilized after every single use- with no exceptions. When possible, we also choose to use disposable products to eliminate any possibility of cross-contamination. We feel that this is the most effective way to maximize patient safety.

An example of an autoclave. Note the secure screw-latch on the left side to withstand high pressure.

In general, our sterilization practice runs in two steps. First, instruments are processed through a medical grade instrument washer under high heat. This process takes about an hour and removes debris and dental materials from any fine surfaces. After washing, instruments are then run again in one of our two autoclaves. Autoclaves work by taking a combination of high heat, steam and pressure to completely sterilize whatever is placed inside them. Scientifically speaking, it would be nearly impossible for any pathogenic (disease causing) entity to actually survive these conditions. Our autoclaves are set to meet or exceed all standards mandated by the state and federal government. In proving their efficacy, we run weekly tests to affirm the machine’s abilities to kill even the toughest bacteria.

These steps apply to roughly 90% of the potentially infectious materials we process at our office. For special instruments and tools, we have a variety of other sterilization methods to keep everything (and everyone) safe. In short, we leave nothing to chance when it comes to sterilization and disinfection. If you have any concerns about our office, how we sterilize or why we use the techniques we use, please let us know. We are proud of how we maintain our facility and it’s cleanliness!