Dental Questions: Can a dentist diagnose decay in the mouth that is not evident on an x-ray?

Yes, it is absolutely possible to diagnose decay in the mouth from a visual exam with a mirror and explorer.  Decay on the biting surfaces of the teeth can often be hiding in a pit, groove or fissure of the outer enamel layer. On a visual exam, the area can look like a dark spot in the white of the enamel or an explorer can get stuck in the cavitation. The x-ray won’t show the decay in this area if is still primarily in the enamel layer. However, once decay spreads past this first layer of defense and lands in the internal dentin layer of the tooth, it will definitely show up on an xray.

Take a look at the following pictures, taken from the same patient in the same appointment:

In reviewing the radiographs, there is no apparent decay in this patient’s molars. There aren’t any suspicious shadows or defects in the enamel and the teeth generally look healthy. 

However, a visual examination reveals the beginnings of a cavity forming in the two maxillary molars. The geography of the tooth allows the decay to be hidden as the three dimensional object is translated into a 2D X-ray. Conversely, not all pit and fissure stains are cavities. Dentists can recognise unique shapes, patterns and texture changes in teeth that differentiate staining from active decay. This further highlights the importance of the entire dental exam to make a proper diagnosis. 

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!

Anterior Veneer Case

Take a look at one of our recent smile transformations! This patient came to our office with concerns about the esthetics of their anterior incisors. Wear to the incisal edges (biting surfaces) had created a "flat and sharp" appearance that takes away from the naturally contoured look teeth typically have. By using zirconia veneers, our office restored dimension and shape to the incisal edges and facial profiles of the lateral and central incisors. This allowed us to give the teeth a more youthful look and create a universally lighter shade. If you would like to know more about this process or other esthetic services we offer, please contact our office!

Tooth Fairy Fun

One of the most exciting times in a young child’s life is their first visit from the Tooth Fairy. As your little ones start to lose their baby teeth, chances are they will be expecting a special visit from the fairy herself. Likewise, you are probably looking for a way to make this event fun and memorable for your family. With all this in mind, our office has collected some of our favorite lost tooth toys and holders. Take a look at all the fun you can have!

Baby Tooth Album

While we have covered this tooth organizer in a previous article, it fits in perfectly with this list. The Baby Tooth Album is a fun way to organize all of your child’s lost teeth and turn them into a great keepsake. It's even flat enough to fit inside a scrapbook or memory box! 

Twinkle Toof

The Twinkle Toof is a fun baby tooth holder that glows in the dark. It has a secret compartment for the lost tooth and a small clip for any "Prizes." It glows quite brightly, which must make it easy for the Tooth Fairy to find at night! 

Maison Chic Tooth Fairy Pillows

From owls to robots and even sharks, these fun embroidered characters come in all sorts of shapes and sizes. You are sure to find one that your child loves! Each pillow has a little pouch to keep teeth safe until the Tooth Fairy can get to them. We are sure you will enjoy the fun fabrics, textures and colors!

We know the tooth fairy can have a hard time getting teeth out from under pillows without waking resting children. These fun toys help simplify the process and add a little pizzaz to the occasion. If you would like to see more of these tooth holders or any of our other children’s products, please stop by our office. We love getting our patients and their families excited about dental health topics!

Erik and Duke at the Office

This week, Dr. Kari's husband Erik stopped by the office for a cleaning and brought baby Duke along. Dad did great, but as you can see the appointment wore Duke out! We hope you all find some time to spend with your loved ones this weekend. Cherish these moments!

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!

Bacteria and Tooth Decay

An electron microscope image of S. Mutans, a common oral bacteria. 

As you probably know, nearly every surface of the human body is home to bacteria. In even the cleanest, healthiest individuals, bacteria outnumber human cells by a ratio of 10 to 1! Your mouth is no exception to this, as it contains one of the the highest bacterial counts and organismal diversities in the entire body. With this in mind, microorganisms play an enormous role in dentistry and oral diseases. Today, we want to take a closer look at how bacteria are major contributors to tooth decay and cavities.

Nearly every surface of your teeth are covered in a bacterial structure called a biofilm. This formation is a sticky “home” that the bacteria produce to allow them to adhere to hard surfaces. While the biofilm is still soft and removable, we call it plaque. Proper homecare can remove plaque daily and keep the bacterial count down. However, if the plaque remains undisturbed for about 48 hours, it starts to harden and turn into tartar. Once tartar forms, it creates a strong bond to enamel that needs to be removed by a dental professional.

In the dental biofilm, the most destructive bacteria is known as Streptococcus Mutans. S. Mutans likes to colonize teeth early on in biofilm formation, along with many other species of microorganisms. When we eat sugars, starches and carbohydrates, S. Mutans processes the glucose molecules to make acid. This acid, in turn, is a primary contributing factor to tooth decay. Thus, individuals with a high S. Mutans count typically have an elevated risk for cavities.

Interestingly enough, S. Mutans species are highly correlated between children and their caregivers. Even adopted children and kids who hereditarily lack teeth tend to have the same S. Mutans breeds as their mothers, fathers or nannies. With this in mind, it is important to remember not to share utensils or cups with your children (if possible). Furthermore, cleaning off pacifiers or other teething toys with your own saliva is not recommended. Ideally, you want to lower or prevent your child’s exposure to S. Mutans for as long as possible.

Fortunately, there are a number of products targeted against S. Mutans that you are likely already using. In addition to remineralizing enamel, fluoride has been shown to disable a specific bacterial enzyme and prevent it from making energy. This has a significant impact on how fast and large S. Mutans colonies can grow. Furthermore, the sugar substitute xylitol is known to interfere with how S. Mutans can adhere to tooth structure. Xylitol is a natural compound made by plants that is used in a number of sugar free gums and mints. If you are chewing Trident, Ice Breakers or Spry gum (or others), you are getting a healthy exposure of Xylitol every day!

Our office offers Dr. John's brand candies- a great treat made with xylitol!

S. Mutans represents only one of a number of oral bacteria that cause diseases in the mouth. Gingivitis and other gum problems are mediated by entirely different breeds and colonies of bacteria that survive below the gumline. But have no fear: we will be covering those (and more) in articles to come! If you would like to know more about tooth decay, how bacteria are involved and how to best prevent cavities, please give our office a call.

Laser Dentistry

A dental laser in action.

One of the biggest developments in modern dentistry is the introduction of laser technology in the treatment of patients. 50 years ago, the idea alone would have sounded like something out of a sci-fi movie. But today, lasers have many applications in the maintenance of the teeth and gums, along with promising outlooks for the future. In our office, we use lasers for a number of treatments and want to show you why they are safe and effective dental instruments!

At it’s very core, a laser is specially concentrated beam of light that produces a small pinpoint of energy. Depending on the type of material used to create the laser beam, the energy can be optimized to cut a number of materials. For this reason, lasers have long been used in precision manufacturing for making extremely accurate cuts. In dentistry, these properties allow us to use lasers in a variety of procedures, often with less time and tissue damage involved.

The most common application of lasers in dentistry is the removal or recontouring of gum tissue. In treatments where the gums need to be adjusted, a dentist would classically utilize a sharp instrument like a scalpel. While these did a great job of cutting tissue, they would induce considerable bleeding and inflammation. Lasers match the cutting abilities of standard instruments, but also stimulate healthier healing patterns from your immune system. Because the laser “seals” the tissue as it cuts, there is less trauma to the gum tissue and shorter healing times.

At our office, we particularly capitalize on the incredible healing properties of lasers in restoring dental implants. After an implant is placed and has healed in bone, it needs to be “revealed” by cutting away any gum tissue that would interfere with attaching the crown. Traditionally, we would need one appointment to trim the gums and a second appointment to allow them time to heal before taking impressions for the lab. However, our laser system allows us to reveal the implant and take impressions in the same appointment, as the gums will heal right away with minimal inflammation.

Beyond soft tissue adjustment, lasers are utilized to provide a number of dental services, ranging from stimulating periodontal attachment to removing tooth decay. Research has also shown that lasers hold even more applications for the future. Currently, experts are working on developing a system called selective ablation, where hard tooth structure is treated by a laser that only removes demineralized areas. Although this technology is still in development, it promises a new form of extremely conservative cavity removal, as only decayed tooth will be affected by the laser.

The field of laser dentistry is still new and evolving. Likewise, information and products are being introduced to the market at a rapid pace. As with all new technologies, our office likes to evaluate the research and clinical results before incorporating them into our patient treatment. If you would like to know more about dental lasers, the types of lasers we use or why we use them, please give us a call. We pride ourselves in being knowledgeable in all the current topics in dentistry and dental services!

What's In an Implant?

If you are considering getting a dental implant placed, you have probably done some research and found out there are many options and variables associated with the treatment. You may have even seen the informational video our office produced on the topic. Because of their rise in popularity, we wanted to take a moment to address some of the common questions associated with implants and how they might play into your dental treatment. Take a look!

1. What is a dental implant?

An implant is a bioengineered screw that serves as an "anchor" for replacing one or more teeth. It typically sits below the gum level and creates a mounting point for a crown, bridge or dentures. Implants come in a variety of shapes and sizes to meet a number of demands and spaces to fill. 

An illustration of an implant vs natural teeth.

2. What is it made of?

Most commercially available implants are made of Titanium or a Titanium alloy. Titanium is an incredible material in that it resists corrosion while promoting bone growth. This factor allows your body to heal around the implant and create a strong bond. Some companies now make implants made from milled ziconia as well. These offerings are marketed as beneficial since they are metal free, but long-term research still needs to be done to confirm if they are as safe and predictable as titanium implants. 

3. Who is eligible to receive a dental implant? 

Implant recipients need to be generally healthy and have one or more teeth that need to be replaced. There are also certain restrictions on bone level height, bone health and extraction healing that need to be evaluated by a dental professional prior to implant placement. 

4. Who places the implant?

At our office, Dr. Kari Ann Hong places many implants in-house. However, depending on mouth location, health complications and patient needs, the expertise of a dental specialist may be utilized. Periodontists and Oral Surgeons are both extremely qualified and knowledgeable in the placement of dental implants. 

5. How is it used to replace a lost tooth?

After the implant is placed and heals, a small metal/zirconia flange (called an abutment) is screwed into the implant. Once the position of the abutment and the esthetics of the surrounding gums are approved, an impression is taken and sent to a dental lab. They will then make a crown that both fits on the implant and looks natural in your mouth. 

How the implant, abutment and crown work together. 

6. Does your office use a specific brand/type of implant?

Our office uses Straumann brand implants. These implants are made to meet very rigorous standards with the highest quality materials available. They manufacture a number of different sized implants that allow for many unique treatment options. Straumann is a very common and respected brand in implant dentistry, assuring that your implant will be serviceable for as long as possible. 

7. How is implant pricing structured?

Implant pricing is usually broken into three fees for the implant, abutment and final crown. Each fee will be for the procedure and the delivered "part." Naturally, this system will vary slightly office to office. 

8. Do I have to wait between having the implant placed and putting a crown on it?

In almost every circumstance, you will need to wait for your bone to heal around the implant before attaching a crown. This is to assure complete osseointegration before introducing stresses from biting and chewing. Some procedures/techniques allow for "immediate loading" of implants, but overall success rates are typically higher if you wait for the bone to heal first. The time you will have to wait varies person to person and needs to be evaluated by a dental professional. 

9. Will I be "awake" for the procedure?

At our office, we offer mild forms of sedations for implant patients with who have dental phobias. However, most people find the procedure both quick and very tolerable. If you do wish to be "asleep" for the procedure, there are a number of dental specialists who can arrange that treatment option. 

10. Will it look like a natural tooth?

Yes! Implants can be some of the most natural looking dental restorations available. Unlike a bridge, you can floss between the implant and the adjacent teeth, and unlike dentures, you will not need to remove it at night or before eating. Overall it is a great cosmetic and functional choice for tooth replacement. 

We hope we answered any questions you may have on dental implants. There are a number of options available in tooth replacement, and implants represent only one of them. If you would like to know more about implants, how they are placed and if they are appropriate for you, please call our office. We are always happy to answer any of your questions!

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!