Dental Library Review: Clifford's Loose Tooth

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 Clifford’s Loose Tooth, adapted by Wendy Cheyette Lewison (with illustrations by John and Sandrina Kurtz).

In this story, the lovable Clifford loses his first puppy tooth. Initially, he is a little frightened and confused until Emily Elizabeth explains that loose teeth are completely normal. His friends suggest various ways that he can preemptively remove it, but he decides to wait and let it fall out on his own. In the end, his patience is rewarded with a big dog bone from the tooth fairy. It really goes to show that being patient with loose teeth pays off!

We love this story because it reinforces the idea of letting a baby tooth come out on its own. While children will naturally wiggle and play with loose teeth, being overly aggressive with a not-so-loose tooth can end up in pain and injury. This story is a fun way to remind your children that their teeth will come out when they are ready! 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!

George Washington Dental Facts

Did our first president really have wooden teeth?

You may not have a perfect set of pearly whites, but chances are you don’t suffer from as many dental woes as our first President, George Washington. While he never actually had “wooden teeth,” his oral health had a significant impact on his life, political accomplishments and personal image. Our office wanted to take a moment to separate the fact from fiction, and highlight the political importance of President Washington and his dental needs!

In Washington’s time, humanity knew much less about tooth decay, gum disease and how to properly treat and prevent them. As such, many people found themselves with cavities and missing teeth. President Washington was no exception, as historical documents indicate he only had one in-tact natural tooth when he took office. He went through a number of different sets of dentures throughout his life, composed of everything from ivory to bone and even his own previously extracted teeth. It is thought that some of these dentures became quite stained with use, creating an almost “wooden” appearance.

President Washington was very conscientious of his false teeth. The poor fit of his dentures are reflected in some of his later portraits; his face has a collapsed and widened look that is associated with toothlessness and old age. Some scholars even estimate that his poorly fitting (and probably uncomfortable) dentures may have contributed to the infrequency of his public speeches and appearances later in life.

Washington’s story teaches us great lessons on the impact of oral health. Even a man as powerful and historically important as President George Washington was vulnerable to tooth decay and gum disease. Fortunately, today’s dental health care system is better equipped to treat and prevent these conditions before they become a rampant problem. We can only look towards President Washington as a man who best utilized the treatment and technologies available to him.  

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!

Announcing the Birth of Dr. Hong's Baby Boy!

Dear patients and friends,

On February 4th 2015, Dr. Kari Hong's family grew by one! Baby Duke John Warren was born at 2:18pm, weighing in at 7lbs and 12oz and measuring 21.5 inches in length. We are glad to report both mother and child are happy and healthy. Congratulations Dr. Kari! 

As a short reminder, Dr. Kari will remain out of the office until the end of next week (tentatively). However, our hygienists and front office staff will still be holding appointments in the meantime. If you have any questions or dental emergencies, we will still be available to assist you!

Case Presentation: Acid Erosion Repair

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

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

Treatment

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

Pretreatment photograph

Stone modelwork of the patient before treatment

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

Initial waxup of patient’s left side

Initial waxup of patient’s right side

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

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

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

The final crowns on a stone model

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

Results

Overall final product

Closeup of patient’s right side

Closeup of patient’s left side

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

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

Dentistry Through The Ages: Elderly Patients

Greetings and welcome to our on-going blog series, Dentistry Through the Ages. In these blog posts, we will cover age-group specific dental needs and concerns. Your life is constantly changing, and we want to equip you with the best information possible to keep your teeth healthy!

In this article, we will be covering the dental needs of our elderly patients. Current projections estimate that persons aged 65 and older represent between 13% and 17% of the current United States population. As such, the dental healthcare industry is becoming better adapted and prepared to handle the needs of an aging population. Our office wants to take a moment to highlight some predominant oral health concerns to keep you aware and healthy!

Dry Mouth (formally known as xerostomia) is one of the biggest concerns when treating elderly patients. As we progress into old age, our bodies become more susceptible to diseases, injuries and other medical concerns. These conditions will often result in new prescriptions and medications- many of which decrease saliva flow or limit the function of salivary glands. This, combined with the natural degradation of the parotid gland (a major salivary gland) with age, leaves many patients with little to no resting saliva.

Our saliva are crucial to limiting the activity and progress of cavity forming bacteria. As such, many patients will see an increase in cavities as they transition to old age. Certain biological factors put the elderly population at particular risk for root surface cavities, where decay arises in areas of gum recession or where the tooth meets the gum tissue. However, there are a number of great products to counteract the progression of cavities in old age. Fluoride products, remineralizing gels and xylitol rinses can all help keep decay and bacteria at bay. As an added bonus, xylitol products can help stimulate saliva flow to help combat dry mouth directly!

In addition to xerostomia, many elderly patients will encounter increased incidences of periodontal disease. Limited salivary flow, years of bacterial attacks and reduced immune response can all culminate to a loss of gum tissue and bone level. Many patients will be candidates for deep cleanings or a more frequent cleaning schedule to keep plaque and tartar levels down. Others with advanced periodontal disease may even be candidates for the services of a periodontist (gum tissue specialist).

For patients with very aggressive periodontal disease, teeth may need to be extracted. Depending on the extent of the condition, number of extractions needed and patient’s overall health, our office offers a number of tooth replacement options. Single teeth can be replaced permanently with bridges and implants or removably with a partial denture (depending on the location of the gap). Partial dentures use a metal framework to replace teeth and gum tissue back to a natural appearance. They benefit from using clasps to mount to permanent teeth and sit on the gum tissue.

Full dentures can provide the same esthetic results as partial dentures for edentulous (toothless) patients. Full dentures typically require about four to five appointments to take proper impressions, fabricate the denture, adjust it and deliver the final product. While this process is lengthy, it helps ensure a great fit that minimizes irritation to the gum tissue.

We hope you found our review of oral health concerns in the elderly informative and helpful. Our office is fully committed and equipped to care for aging patients and wants you to know you are in great hands.  If you have any questions about your oral health needs, our treatment options or any other concerns, please give us a call. We are always available to answer your questions!

Dental Library Review: Dear Tooth Fairy

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 Dear Tooth Fairy by Alan Durant (with illustrations by Vanessa Cabban).

This story follows interactions between Holly, a young girl who lost her first tooth, and the Tooth Fairy. Holly tries to deceive the Tooth Fairy by leaving plastic teeth under her pillow, but only receives a letter of concern in return. As the two exchange writings, Holly learns about the Fairy’s fantastic world. With a fun twist, the book includes all of their communications in separate, removable letters and envelopes. Interactive and Imaginative!

This hard bound book with fun surprises and large illustrations would be a perfect gift for a young girl losing her first tooth. We are sure it will bring your little ones hours of enjoyment with the fun letters from the Tooth Fairy! 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!

Important Announcement Regarding Our February Schedule

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

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!

The Golden Proportions: A Case Study

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

Case 1

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

Golden proportion ideal measurements based on a 2D picture:

• Central 1.618
• Lateral 1
• Canine 0.168

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

• Central 7.4
• Lateral 4.6
• Canine 2.8

Comments:

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

Case 2

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

Golden proportion ideal measurements based on a 2D:

• Central 1.618
• Lateral 1
• Canine 0.168

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

• Central 8 
• Lateral 4.9
• Canine 3.0

Comments:

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

Case3

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

Golden proportion ideal measurements based on a 2D picture:

• Central 1.618
• Lateral 1
• Canine 0.168 

Golden proportion ideal measurements, assuming central is ideal width:

• Central 9
• Lateral 5.6
• Canine 3.5 

Comments:

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