Dental Questions: What do probing numbers mean?

A periodontal probe in healthy gum tissue.

At your last dental exam, you may have heard the dentist or hygienist say numbers while scanning your teeth with an instrument. The numbers were grouped in triplets and called out after each tooth ("three-two-three, two-one-two"). These findings correspond to the space between your teeth and gums. They are typically measured using an instrument called a periodontal probe, which is pictured at the start of this article. Each color change corresponds to three millimeters, creating a sort of measuring stick for the mouth. 

The numbers you hear are the millimeters that the probe slips below the gum line. A reading from one to three millimeters is generally considered healthy. Measurements four and above indicate the presence of a periodontal pocket, where the bone has recessed away from the tooth. There are many different treatments for periodontal disease, ranging from deep cleanings to bone grafts, designed to halt or reverse increasing pocket depths. If you would like to know more about dental exams, cleanings or periodontal services, please give our office a call!

Case Presentation: Crown Delivery

Take a look at the amazing work we can accomplish with the help of our dental labs! This patient came to us needing a crown repaired in the front of their mouth. As always, our main concern was delivering a restoration that looked completely natural. After preparing the tooth and making impressions, we took a number of diagnostic photographs to capture the nature of the patient's smile. Using just the photos and impressions, our lab created an unbelievable new crown. The color, shaping and opacity are a perfect match to the existing teeth. If you would like to see more of the esthetic work we perform at our office, check out the "cosmetic dentistry" section on our blog index!

Case Presentation: Esthetic Crown Lengthening for Veneers

Today's patient came to us with complaints about the shape of their anterior (front) teeth. The teeth appeared too small or "boxy," and a large proportion of the smile was occupied by gum tissue. To correct these concerns, our office decided to utilize cosmetic veneers in conjunction with esthetic crown lengthening. 

Crown lengthening is a procedure performed by a periodontist where the gum tissue is contoured to reveal more tooth structure. Dr. Wilgus at Camarillo Periodontics worked with us to treat this patient and delivered phenomenal results. Even before veneers, the teeth have better proportions and the smile has a less "gummy" appearance. The next step will be to prepare the teeth and design a set of natural and uniform cosmetic veneers. We cant wait to see the final product!

Dental Questions: Is Dental Anesthesia Safe?

Dental anesthesia is packaged into carpules like these. The sizes and coloring is standardized to prevent any confusion between manufacturers. 

Note: In this article, we will only be discussing local anesthesia. For information on other forms of anesthesia/sedation, please contact our office.

Many patients come to our office with concerns about the safety of "Novocain" and other local anesthetics. Because these medications seem to work so quickly and powerfully, it is no wonder that they raise concerns in the general population. However, we are here to show you how and why local anesthetics are wonderful tools in dental treatment. 

First off, Novocaine is no longer used in general dentistry. Concerns of liver damage prompted pharmaceutical companies to develop a new generation of drugs. Now, we have products such as lidocaine, septocaine and carbocaine- a variety of compounds maximized for specific circumstances. They are metabolized safely and have predictable durations of numbness. Overall, these medications have very few side effects unless you are receiving large quantities (far beyond the amounts used in dentistry).

Anesthetics are frequently administered with epinephrine. This compound is made naturally by the human body and is essential to life. We use it to allow the anesthesia to better numb the intended tissue. Some patients may feel an increased heart rate or anxiety when exposed to epinephrine. However, it is impossible to have a true (medical) allergy to this substance. During exams, we take note of any contraindications or reactions you may have had with epinephrine in the past. This does a great job of minimizing unexpected side effects.

It is possible to develop an allergy to the preservatives used in dental anesthesia. However, these reactions are very rare and typically present earlier in life. By the time you are receiving dental treatment, you will most likely know if and how your body will react to these substances. As with all conditions and allergies, please inform us during your medical history/exam if you have a known problem with these substances 

In practice, most adverse reactions to anesthesia come from its method of administration. However, good technique and modern equipment (such as our wand systems) help mitigate any problems. If you would like to know more about dental anesthesia and it's safety, please give our office a call!

Operation Gratitude's Halloween Candy for the Troops

Dr. Kari and her three sons out for trick-or-treating!

Did your little ones get a big haul trick-or-treating this year? If you're stuck with more sweets than you know what to do with, consider sharing them with our troops! Operation Gratitude, a nonprofit that organizes support packages for our servicemen and women, hosts a yearly Halloween candy donation drive out of Van Nuys. Last year, we snapped a photo of a small portion of their donations: 

Just look at all those sweets! If you want to brighten a troops day (or cut back on the residual Halloween sugar in your household), click through to their website. Operation Gratitude is asking for all donations by November 15th (whether shipped or in person), so get those candies in!

Link: https://opgrat.wordpress.com/2013/07/18/halloween-candy-for-the-troops/ 

Case Presentation: Maxillary Dentures

With the rise of implants and implant dentistry, many patients assume that dentures are no longer a "modern" treatment option. On the contrary, dentures are a great way to replace missing teeth without the need for additional surgeries or trauma. Pictured above is a complete upper denture fabricated for one of our patients. It is in the wax try-in stage: this is a proposed shape for the final denture made out of adjustable wax. Once we confirm the fit and cosmetics of the prosthesis, we will have a permanent acrylic version made by our lab. 

Dentures have a number of advantages of implant supported prosthetics (and vice-versa). From a functional standpoint, dentures allow us to "replace" both teeth and soft tissue. A well made denture can create the appearance of gums in deficient areas or level out resorbed bone. Implants have a more limited range of soft tissue enhancement and frequently require other procedures to get the full effect. Furthermore, dentures have a considerable cost advantage over implants, especially for replacing full arches of teeth. 

When this denture is seated in the patient's mouth, it will be nearly undetectable during daily activities. However, some may find the idea of having a removable dental device objectionable. This is why our office offers a number of restorative services- from bridges and dentures to implants. If you would like to know more about the tooth replacement options available to our patients, please give us a call!

Sports Injuries: Basketball

Today's patient came to us with a tooth knocked in after a game of basketball. Believe it or not, basketball is one of the most oral-injury prone competitive sports (even more than football). This type of injury is called a luxation- that is, the tooth was moved but not removed from it's original location in the mouth. This is a problem that needs to be evaluated by a dentist as soon as possible. Treatment usually involves moving the tooth back into its original position, stabilizing it with minor orthodontics and monitoring it for infection. However, the long term prognosis on luxation is not great. You may find yourself needing an implant, bridge or partial denture in the future. 

Though we see numerous patients every year with injuries just like this one, they are largely preventable. Sports guards are an excellent way to minimize damage to the teeth and surrounding tissues. Our office makes custom fit guards in-house for about $55. All we need is an impression of your upper teeth and 15 minutes to fit the final product. If you would like to know more about sports guards or have questions about sports injuries, please give us a call. 

Cone Beam CT Technology

Here is a series of images assembled using CBCT technology. They are being used to visualize a tooth treated with a root canal. 

Dental X-rays are very useful in diagnosing a number of conditions. Decay, abscesses and bone structure can easily be seen using standard technology found at any dental office. However, X-rays are inherently limited: they can only show you a two dimensional image of a three dimensional object. In many instances, X-rays can visualize part of a problem, but leave out "the whole picture." How deep is that crack? Which tooth is draining to that abscess? Are there one or two canals in that root? For these questions, many dentists and specialists use Cone Beam CT technology. 

Cone Beam CT (CBCT) is based on a principle called Computerized Tomography. Here, a series of low-radiation exposures are used to take "slices" that can assemble to a 3D image. Imagine looking at a apple, cut widthwise many times. If you saw each slice consecutively, you could easily surmise the 3D shape of the original apple. This is the same idea behind CBCT- many individual images are used to create a 3D representation of hard tissue. While a traditional X-ray might miss small problems (like a cracked root) or misrepresent sizes or shapes (like superimposing two root canals as one), a CBCT excels at giving us a more complete picture.

Many of the specialist we refer to utilize CBCT technology. For example, Doctors Bollinger, Cobin and Stoop at Conejo Simi Endontics use it to diagnose cracks, visualize root canals and determine the prognosis of treated teeth. CBCT is particularly useful for endodontics, as many problems are difficult or impossible to locate, even with high powered microscopes. Likewise, Dr. Wilgus at Camarillo Periodontics uses his CBCT machine to plan implant placement. Being able to see the height and width of bone along with any associated structures adds extra predictability to his surgeries. 

It's easy to see how CBCT technology has made diagnosing dental conditions easier and more reliable. When we make referrals to our specialist network, we have these capabilities in mind- that these doctors have the technology to visualize problems that normal X-rays can't. If you would like to know more about Cone Beam technology and how it is used in dentistry, just give us a call!

Adrienne And Her Daughters

At Thousand Oaks Family Dentistry, we always love seeing our staff's children at the office. This week, our hygienist Adrienne's daughters Kamdin and Rylin came in to see their mom at work (and get some cleanings out of the way). Be sure to give us a call when you or your little ones are ready to stop by!

Cosmetic Reconstruction With Emax Crowns and Veneers

Today's case is a great example of the importance of color and translucency when designing a crown or veneer in the anterior region. This patient came to our office dissatisfied with their current dental restorations and overall smile esthetics. The crowned teeth appeared unnaturally opaque and presented with a sharp change in color where the teeth met the gum tissue. These crowns were created using porcelain fused to metal (PFM), a classic technique for fabricating tooth colored crowns. While they make very functional restorations, PFMs take away from the natural translucency of teeth due to their solid metal underpinnings. This patient's condition was exacerbated by gingival recession, which revealed contrasting natural tooth structure underneath the crown.

To create a completely natural smile, we utilized Emax lithium disilicate crowns and veneers across the maxillary and mandibular teeth. These crowns are made of a single type of translucent material, and thus transmit light like natural enamel. Similarly, the single piece construction makes these crown very strong, allowing us to replace the PFMs in the posterior region as well. By working closely with our dental lab, we created a set of crowns and veneers that are uniform in shape, color and shade. The final product is a natural and youthful smile designed to stand the test of time! If you would like to know more about crowns, veneers or any other esthetic service offered by our office, please give us a call.