Another Cavity?

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Another Cavity?

There are three groups of people that tend to get new cavities on a routine basis. The first group are children under 10, the second group is teenagers, and the last group is mature adults (the 60 and over crowd). My least favorite thing to do in my office is to inform someone that they have another cavity.

On a routine basis now I am asking a couple of key questions as part of my patient health history review. The purpose of the questions is to initiate a dialog as to what causes tooth decay and how to prevent it from happening in the first place.

The risk assessment for cavities includes the following: Acidic beverages, frequent snacking, inadequate salivary flow, appliances present, deep pits and fissures, hyposalivary medications, visible plaque, cavity in the last three years, visible cavitations and radiographic lesions.

Basically in order to get a cavity, something acidic sits next to the tooth structure and eats away at the tooth structure to form a hole in the tooth. What we eat and drink and how often we eat and drink it plays a large role in how much acidity is in our mouth. Anything other than water such as: soda, juice, energy drinks, vitamin waters, and carbonated beverages are acidic. Anything dry, pasty or sugary contributes to the food particles staying in the mouth for a longer period of time. The solution when it comes to tooth decay, is to limit food consumption to meal time and only drink water outside of meal times.

Braces, inadequate salivary flow, deep pits and grooves on the teeth, and lots of plaque on the teeth are all things that contribute to the acidity having an easier time to stay next to the teeth for a longer period of time. I recommend an electric tooth brush for all of my patients, as well as a daily flossing routine in order to maximize the cleanliness of the teeth.

A cavity in the last three years, visible cavitations, and radiographic lesions are important because it means that the cavities are significant enough that they must be removed and filled by the dentist. Even though a tooth has had a filling or a crown, it can still get new tooth decay in the future. Basically any part of exposed tooth structure is susceptible to tooth decay.

Wonder why the three age groups I mentioned at the beginning tend to get the most new cavities? The under age 10 group is at risk because of drinking milk right before bedtime or other non-water beverages throughout the day, eating sugary snacks and candies like gummies or fruit rolls, and not being able to effectively brush or floss their own teeth. The teenager crowd is at risk because of braces, consuming large amounts of alcohol and not brushing before bedtime, and snacking or drinking awakening beverages while studying. The mature adult is at risk because of the medications that they take that changes their body chemistry and dries out the mouth.


Kari Ann Hong, DDS
1000 Newbury Rd. #190
Thousand Oaks, CA 91320
www.thousandoaksfamilydentistry.com

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New Website

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New Website

We are launching our new website design this week for Thousand Oaks Family Dentistry. The new site will feature patient reviews, commonly asked questions, services we provide, online appointment requests, and a video of our practice. I am excited about our latest improvements to our internet presence. I think the website gives a great snapshot of my office.


My goal in patient care is to provide personalized, individual care to each of my patients. Also, I believe in respecting people's time, so I don't double book and I do my best to run on time all day. I make treatment recommendations based on a comprehensive approach to patient care. I want all of my patients to be able to achieve optimal dental health.

Take a look at my new website and let me know what you think!


drhong@thousandoaksfamilydentistry.com


Kari Ann Hong, DDS
1000 Newbury Rd. #190
Thousand Oaks, CA 91320
www.thousandoaksfamilydentistry.com

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Baby Teeth

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Baby Teeth

With two young kids, I have baby teeth on my mind. Children usually get twenty teeth by the age of two, ten on top and ten on bottom. The first baby teeth a child gets are the lower two central incisors. The first adult teeth a child gets are the lower first molars and they come in behind the baby teeth. The first teeth a child looses are the lower incisors and that usually happens after adult molars erupt.

As a mom I worry that my kids will end up with poor skeletal/tooth/facial development and that they will get cavities. Prevention is always the best medicine in dentistry. It is always easier to stop something from happening then to fix it once it has happened. When it comes to facial development, the biggest problems are bottles, pacifiers, and thumb sucking. Any of these things by themselves can cause a significant overjet of the upper teeth over the lower teeth. I recommend stopping bottle and pacifier use by age one. Thumb sucking is the most difficult thing to prevent because as a parent you can't take that away. If a child hasn't stopped sucking their thumb by age 4 or 5, then there is a dental appliance that can be placed to prevent the thumb from sitting comfortably in the mouth.

The easiest way to prevent cavities in children is to watch what they are eating and drinking. It is important to limit milk and juice consumption to meal times. I recommend never purchasing soda for daily consumption. Foods that are sticky in consistency like gummy fruits or candies should be avoided at snack time, because chances are that sugar will stay adhered to the teeth until they are brushed next.

Kids are difficult and frequently have minds of their own where they don't want to do what we want. Fortunately, I have made it past the bottle/pacifier/thumb sucking stage with my own children. It is a constant struggle to make sure they are well fed and that I am keeping their teeth clean.

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

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Safe Amalgam Removal

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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

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Mouthguards and the Olympics

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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

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Happy New Year Dental Resolutions

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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

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Internal Tooth Bleaching of Root Canal Treated Tooth

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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

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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

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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

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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

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