Safe Amalgam Removal

I remove amalgams from teeth on a daily basis as a dentist. The reasons why I remove amalgams vary from new decay around an existing amalgam; a patient doesn't like the way the amalgam looks and would like something tooth colored; the amalgam or the tooth with the amalgam broke and the tooth needs a crown; the tooth has an existing crown with decay and the old buildup in the tooth was amalgam.

Recently I was asked the following questions by a potential new patient and I thought others might be interested in the questions and my responses.

Here are the questions:

How long have you been doing safe amalgam removal? Did you have to have special training in this procedure? Do you do any kind of health assessment on the patient before starting? Do you recommend any supplements before and after removal? Do you check the electrical potential of the fillings to determine where to start? I understand you use a rubber dam. Do you have a special vacuum or vapor control system? Do you use an electric drill or an air turbine drill? How much time do you recommend between extractions?

Here was my answer:

I have been doing safe amalgam removal since completing dental school at UCLA in 2003. I use an electric handpiece with sufficient water spray to minimize the mercury vapors when removing amalgams. I do all amalgam removals with a rubber dam and high speed evacuation. When removing amalgam fillings I do so by quadrants of the mouth and I start in the quadrant that has fillings with underlying decay or breakdown of the existing amalgam. I recommend waiting at least a week between quadrants. Sometimes a tooth can be sensitive after an amalgam is removed and a new tooth colored filling is placed. It is important to make sure the teeth have fully recovered and are feeling good before any further work is done. I leave it up to the patient to decide how they want to spread out the treatment. I recommend to all my patients that they take a multi-vitamin, but nothing in particular for amalgam removal.

I have a patient that is currently being treated for high levels of mercury and lead in her system. She only has three fillings in her adult teeth and none of them are amalgams. The patient doesn't know how she ended up with such high levels of mercury or lead in her system. The patient is seeing an internal medicine doctor that has been placing her on a drug called Dimercaptosuccinic acid (DMSA). Also, the doctor recommends taking mineral supplements, specifically Vitamin C. Prior to this treatment, the doctor recommends her patients have any amalgams in the mouths removed so as not to counteract her treatment protocol. The treatment with the DMSA is closely monitored with urine tests to see if the levels of mercury decrease.

I can be reached via the contact page on my website familycaredentists.com with any further questions.

Kari Ann Hong, DDS
1000 Newbury Road, Suite 190
Thousand Oaks, CA 91320
www.familycaredentists.com

Mouthguards and the Olympics

I was watching the Olympics last night and was pleasantly surprised to see the male ski jumpers wearing mouthguards. The sport looks inherently dangerous. The athletes speed down a ramp, jump high in the air, do ariel flips, and then must quickly look for the ground to land on their skis. According to an article in the California Dental Association journal, mouthguards are recommended for the following Olympic events: ice hockey, slalom skiing, aerials, skeleton, basketball, field hockey, boxing, martial arts, volleyball, cylcing, water polo and soccer. The type of mouthguard recommended is a dentist made pressure-laminated mouthguard.

In my dental practice I make the pressure-laminated type mouthguard for high school students participating in football, wrestling, soccer, field hockey, and water polo. It is a shame that mouthguards are not mandated in more sports. Sports like ski jumping and football have noticeable dangers that athletes are trying to protect against. The wearing of mouthguards in such sports is expected and accepted by the athletes. It is the sports like soccer and basketball where athletes don't see the need to wear a mouthguard.

I have seen the damage from two soccer related injuries, inflicted by another player. One was a nineteen year old girl that was playing soccer on the weekend with an adult league team. She had one of her front central teeth knocked out. The other one was my fifteen year old cousin. He had his two front teeth knocked inwards during a high school soccer game. An oral surgeon was able to reposition the bone around the teeth, but the teeth themselves died and had to have root canals. Both of these injuries were totally preventable.

Pressure-laminated mouthguards save teeth, prevent broken jaw bones and reduce the risk of injury to the jaw joint. If you play a sport where there is any physical contact with another person or potential contact with a moving object, then you should be wearing a mouthguard!

Kari Ann Hong, DDS
1000 Newbury Road, Suite 190
Thousand Oaks, CA 91320
www.familycaredentists.com

Happy New Year Dental Resolutions

I am back at work today after a week and a half long vacation. So far it has been a slow morning at the office. In the couple of weeks prior to the holidays the phone was ringing constantly and it seemed like everyone had a dental emergency. Today it is quiet, like the calm after the storm.

New Years is all about resolutions. I have some dental new year resolution suggestions for 2010.

1. Buy an electric tooth brush. Electric tooth brushes are the best at removing plaque and keeping gums healthy. They prevent tartar build up and give teeth a smooth polished feeling. Patients that I see six months after they have started using an electric tooth brush always have cleaner mouths. Costco has the best deals on electric brushes- they sell the Oral B and the Sonicare brands.

2. Floss once a day. I am sure you have heard the old saying that you only need to floss the ones you want to keep. Flossing helps removed plaque between the teeth and around the gum line. Daily flossing prevents cavities between the teeth and makes the gums and bone that hold the teeth in the mouth much healthier.

3. Bleach your teeth. There are so many affordable ways to have a whiter brighter smile. My favorite is ZOOM! Whitening. After about an hour of in office ZOOM! Whitening you will have whiter teeth. Current price for this procedure is $200!

4. Stop bad habits. Smoking and drinking soda are the two biggest culprits of dental problems. Smoking can lead to severe gum disease, as well as cancers of the mouth and throat. Drinking soda throughout the day can cause lots of cavities. By the way, diet soda is just as bad as regular soda. The carbonation is just as big of a problem as the sugar in the beverage.

5. Visit the dentist twice a year. It is important to have your teeth professional cleaned and evaluated. Gum surgery, root canals, and crowns can be prevented if your teeth are consistently maintained and checked for disease.

Happy New Year!

Kari Ann Hong, DDS
1000 Newbury Road, Suite 190
Thousand Oaks, CA 91320
www.familycaredentists.com

Internal Tooth Bleaching of Root Canal Treated Tooth

Unfortunately tooth trauma to the front of the mouth is a relatively common occurence. I have seen patients with trauma from going over the handle bar bike accidents, getting hit by an elbow on the soccer field, bar fights, and falling while running around a swimming pool. In some cases the teeth are completely avulsed during these accidents, but most of time the teeth are forcibly pushed into the bone or they are chipped. The teeth that are forcibly moved often die from the trauma, which means that the nerve of the tooth dies and the tooth ends up needing a root canal. In conjuction with nerve death the tooth takes on a darkened hue since the tooth no longer has a vital blood and nerve supply.

In the last month I have treated four teeth on three separate patients that had previous trauma, root can therapy, and a darkened hue. I have done an internal tooth bleaching therapy called "walking bleach." To do this treatment a combination of sodium perborate and superoxyl is placed inside of the tooth where the rooth can therapy was performed and it is kept in the tooth for two weeks. At the end of the two weeks the darkened color bleaches out and the tooth looks normal again!
Kari Ann Hong, DDS
1000 Newbury Road, Suite 190
Thousand Oaks, CA 91320
www.familycaredentists.com

Little filling can cause lots of pain

I had a patient in the office this morning that was convinced a filling I placed about a month ago had come out. The reason she felt it had come out was that the tooth was sensitive to cold and biting and she had been completely avoiding chewing on that side of her mouth. I had my assistant take an xray of the tooth which showed a very small and shallow filling on an upper second molar. The filling was completely intact and no where near the nerve of the tooth.

I had a similar experience with a filling placed in a tooth in my mouth. Sometimes the small fillings give patients the biggest trouble. The reason is that the composite materials we use today are bonded to the tooth. The composite experiences a certain amount of shrinkage after it is light cured and bonded in place. The shrinkage of material is what causes the discomfort. Since the filling is so small and completely contained by walls of tooth structure, there is lots of tooth structure to pull against.

The solution is to place a temporary sedative filling that has eugenol in it. The eugenol is very soothing for the tooth and once the nerve endings calm down, a permanent filling can be placed again. When it happened to my tooth, the tooth felt better immediately after the sedative filling was placed and I had a permanent filling placed about a month later.

Kari Ann Hong, DDS
1000 Newbury Road, Suite 190
Thousand Oaks, CA 91320
www.familycaredentists.com

Dental Digital Impressions

Do you remember having ortho as a kid and having impressions taken? Or perhaps you have had a crown done recently and had some goopy material placed in your mouth that took five minutes to set? Well there is a new wave in dentistry called chairside digital imaging that is eliminating the need for a standard dental material impression.

According to Gordon Christensen, a leading dental clinical researcher, the top effective chairside systems are:
Cerec AC by Sirona Dental Systems, www.sirona.com
E4D byD4D Technologies, www.d4dtech.com
i-Tero by Cadent,Inc., www.cadentitero.com
Lava COS by 3M ESPE, www.3mespe.com

I have had the Lava COS digital impression machine in my office since February of this year and I have been quite impressed with the results. The most impressive thing about the machine is the accuracy and fit of the crowns. I have little to no adjustment with a crown that was fabricated from a Lava COS impression. Also, the marginal fit (where the crown meets the tooth) is almost impossible to discern.

I particularly like the Lava COS technology because the impression is a real time video image that lets you know right away whether or not you have an accurate and complete impression. All of the other digital systems more of a still shoot camera technology where the images are combined to give the 3D information.

My patients like the technology because they don't have to suffer through having impression material in their mouths. In addition, on the day we cement the crown, they don't have to wait for adjustments to their new crown. I highly recommend the Lava COS machine!

Kari Ann Hong, DDS
1000 Newbury Road, Suite 190
Thousand Oaks, CA 91320
www.familycaredentists.com

The Terrible Two's

Today was my second week back from maternity leave for baby #2. My elder son is about to turn two and he is already acting like a two year old.

I had the baby at my office this morning. He is pretty calm and easy going, except for when he is hungry. I had to take one break in the middle of crown preparation appointment to feed him. The best part of the morning though was when I called my dad to say I would be home a little early for lunch. He was having quite an experience with my two year old.

While out shopping together, my dad was holding my son's hand and my son being two and having a mind of his own, tried to walk away from grandpa while they were in a parking lot. Somehow in the process my son now likely has a subluxated radius in his left forearm. I had to cancel two hours of patient appointments this afternoon in order to take my son to see the pediatrician.

Sometimes it is hard being mom and dentist at the same time.

Kari Ann Hong, DDS
1000 Newbury Road, Suite 190
Thousand Oaks, CA 91320
www.familycaredentists.com

New Dental Technology

I spent the last two days attending Esthetic Professionals 10th Annual Update course. This is the third or fourth Esthetic Professionals update course I have attended. It was highly informative on the latest and greatest in dental technology and materials. Also, I had the pleasure of hearing Dr. Bill Dorfman speak as well as a dental materials educater from Loma Linda School of Dentistry, Dr. Brian Novy.

The most exciting new technology presented at the meeting is 3M ESPE's new digital scanner called the LAVA COS. The scanner can image a tooth in the mouth that has been prepared for a crown. The scanner is a mix between a video camera and a still picture camera. It moves around like a video while at the same time plotting 20,000 picture points. These picture points are so accurate that the image can be used to fabricate a model that can be used to make the final crown restoration.

Dr. Bill Dorfman spoke about an electronic oral cancer detection system call VELscope. Apparently, the light emitted from the Velscope shows any cancerous or precancerous lesions as black tissue. Twenty-five percent of oral cancers occur in people that have no obvious risk factors such as a history of smoking or excessive alcohol consumption.

Dr. Brian Novy presented some convincing clinical work he has done to remove decalcified white spots caused by braces. The treatment for the white spots involves wearing custom plastic trays that are similar to bleaching trays, along with a calcium-phosphate-fluoride paste called MI paste. These trays are worn for about a month and the white spots nearly disappear.

It is always fun to learn about new technologies and procedures. The hard part is deciding which technologies to bring back to your office.

Kari Ann Hong, DDS
1000 Newbury Road, Suite 190
Thousand Oaks, CA 91320
www.familycaredentists.com

Conquering the two year old patient

In the past two weeks I have seen three patients in the two year old age range. The biggest challenge with patients in this age group is getting them to open their mouths and to stay open while you look in their mouth. I asked my son's pediatrician the other day why it is that one and two year olds don't like to open their mouths. His response was that the mouth is the one thing a child that age can control. Apparently you can put your fingers in the child's ears and eventually they will open their mouth to get you to remove your fingers. While this trick might work for the pediatrician that is just trying to take a quick look in the back of the throat, it doesn't work so well for the dentist that needs to evaluate 20 individual teeth.

Back to my story... I saw three such patients recently. The first one was a girl that was turning two in a couple of weeks. She didn't want to have anything to do with me and refused to even open her mouth. The second child I saw was a girl that had just turned two. I tried a different approach with her. First, my assistant found a cartoon on television for the girl to watch. Then I had the mom hold the daughter in her lap while we counted the mom's teeth. After we counted the mom's teeth, the little girl wanted her teeth counted as well. While counting the teeth I am able to evaluate each individual tooth for cavities. By two years of age nearly all twenty of the baby teeth have erupted. If cavities are present at this age, then they are either visually evident or are apparent when touching the tooth with a dental explorer (an instrument with a pin like end).

The third patient I saw was a three year old boy. In his case both the cartoon trick and counting daddy's teeth worked. As a three year old there was a little bit more comprehension of what was going on and I was able to polish his teeth as well.

Fortunately, in all three cases the children's parents were doing a good job assisting with the brushing and none of the children had any cavities. When kids this age do get cavities the only way to treat them is to either wait until the child is older (like age four or five) or to treat them while the child is under anesthesia. The best thing for the two and three year old patient is cavity prevention!
Kari Ann Hong, DDS
1000 Newbury Road, Suite 190
Thousand Oaks, CA 91320
www.familycaredentists.com

Sleep and Babies

Time Magazine online published an article today on "How Not to Get Babies to Sleep." My husband lovingly emailed me the link to the article this morning. This article is particularly poignant to me right now since I haven't slept much lately. My son is ten months old today and he has slept through the night only once in ten months.

According to the article, "Every new parent knows how difficult it can be to get a fussy baby to sleep, but new research suggests that a parent's best efforts may only be exacerbating the problem — and that inadequate sleep in childhood can have long-lasting health effects. "It is very hard to let your child cry it out when they are toddlers," says Dr. Elsie Taveras of Harvard Medical School, referring to parents' tendency to pick up their children or bring them into the family bed to help them sleep. "But if you approach it differently — 'I am not even going to start my child making these sleep associations' — it's much easier to prevent [future problems]."

It is wonderful to know that in addition to the fact I am struggling with making my son sleep in his own bed, through the entire night, I now need to worry about the long-lasting health effects of his poor sleep habits. Before my son was born I swore I would encourage good sleep habits and that he would be sleeping through the night in no time. I read Baby Wise and Healthy Sleep Habits, Happy Baby. In line with the thinking in those books I have tried to be consistent with a bedtime, nap times, and feeding times. I have tried a bedtime routine of bath time, reading, and feeding. I have let him cry himself to sleep since he was three months old.

The problem seems to be when he wakes up at 1, 2, 3 or 4 in the morning and I am totally exhausted. My first inclination is to feed him. Although at this age I don't think he is really hungry in the middle of the night. Sometimes I let him sleep with me in an effort to get some sleep myself. I feel like I am doing everything wrong when it comes to getting him to sleep through the night. At this point in time I think I am almost encouraging the night time waking because I am SO attentive to his needs.

Kari Ann Hong, DDS
1000 Newbury Road, Suite 190
Thousand Oaks, CA 91320
www.dentist4smiles.com