CAMBRA and Preventative Dentistry

    At Thousand Oaks Family Dentistry, we tend to ask a lot of questions. Some of them are are expected (“Do you floss regularly?”), while others (“What type of water do you drink?/Do you chew gum?”) might raise some confusion. While our investigations might seem slightly tedious, they are critical to our practice philosophy and how we treat our patients. These questions are part of a revolutionary preventative dentistry strategy known as CAMBRA.

    CAMBRA, or Caries (cavity) Management By Risk Assessment is a series of weighted factors and criteria that allow dentists to quickly and effectively determine tooth decay risk. By going over your dietary habits, home care techniques and medical history, we can obtain an accurate picture of how your tooth decay will progress (or continue to stay static) in the coming years. While this isn’t a “crystal ball” looking into your smile’s future, it is the best marker we have at determining your unique oral health situation.

    This screening technique relies on a simple thought process: if your habits and lifestyle lend themselves to an acidic, dry or bacteria prone mouth environment, then you will be at a greater risk for tooth decay. While this may seem obvious, what CAMBRA does is determine which factors are the most destructive, which ones can be “treated” and which ones are based on habits or lifestyle. Using this information, we can help our patients better manage their tooth decay, ultimately resulting in fewer office visits, fillings and incidences of dental discomfort.

Once we have determined your risk for tooth decay, we can make recommend products that can help you better manage your unique risks. One of these great products is Carifree Ctx3. This mouthwash-like rinse combines pH neutralization (to minimize mouth acidity), fluoride (to rebuild enamel) and xylitol (to naturally inhibit acid-producing bacteria). We love this rinse because it targets three of the decay cornerstones outlined in CAMBRA in an easy and convenient delivery method.

    Here is an example of how CAMBRA works: A 24 year old male comes in with and is diagnosed with a cavity on one of his molars. We go over his medical history and see he is taking medications that cause dry mouth. When discussing his eating habits, we find that he is a frequent snacker and enjoys sticky, processed foods. Finally, we note that he almost exclusively drinks bottled water and sports drinks. Using CAMBRA, we can determine that his tooth decay risk is likely caused by his medication and eating/drinking habits. We then recommend that he considers cutting back on snacking and sticking to 3 meals a day, stops drinking sports drinks (when not necessary) and starts drinking more filtered water, to both counteract the dryness caused by his medication and add fluoride exposure. While we will still need to treat his current tooth decay, we have now given him the knowledge and tools to better manage his oral care in the future.

    At our office, we treat every patient as a unique individual with unique needs. This is why CAMBRA fits so well with how we perform dentistry. It is not a one-size-fits-all approach, but rather a dynamic diagnosing tool that flexes with you. We are proud to operate our office on the CAMBRA model, and are incredibly satisfied with the results our patients have seen!

Emax Lithium Disilicate Crowns

    When it comes to dental crown materials, there are many different options to suit a multitude of different scenarios. Some, like full porcelain crowns, provide excellent esthetic results. Others, such as full gold units, provide extreme durability along with desirable tooth-like physical properties. However, what options offer both beautiful cosmetic results along with enduring strength?

For many years, porcelain-fused-to-metal (or “PFM”) crowns were the cornerstone of “form meets function” in crown materials. These units are made by taking an alloy metal core and attaching a thin layer of porcelain over it, resulting in a durable tooth colored restoration. Unfortunately, this process is not without it’s downfalls. The porcelain has a tendency to crack and break between the opposing tooth and the hard metal sublayer. Additionally, the alloy substructure is extremely opaque, and prevents the overall crown from having the translucency of a natural tooth. This detracts from the overall esthetics of the final product.

While PFM crown still have a very useful place in dentistry (and are still regularly placed at our office for various reasons), modern technology has provided us with newer and more elegant solutions. Today, we can offer Emax as a means of creating a beautiful crown or bridge with long term durability.

An example of a finished Emax dental bridge (right) and crown (left)

Emax is a lithium disilicate material that combines the translucency of porcelain with incredible strength. On average, these restorations can withstand 360-400 megapascals of force before breaking. What does this mean? Essentially, you could hammer a crown made of Emax into a plywood board and pull it out without damaging the structure. This incredible resilience means that Emax can be placed in almost any location in the mouth with extreme confidence.

In terms of esthetics, Emax rivals porcelain in that it provides an incredibly toothlike translucency. One of the most obvious “tells” of a dental crown is poor transmittance of light. Crown that do not respond to ambient light like natural teeth are just as visually jarring as poor tooth shade matching. Emax offers this low opacity in conjunction with the ability to have natural artifacts “baked” into the crown’s surface. Surface lines, color gradients and staining can be added to the crown to blend it perfectly with the adjoining teeth. Overall, this step helps detract from the “chiclet gum” look that is imparted to certain crown.

Of course, Emax in only one of the excellent crown options offered at our office. While it has some great properties, it can be a poor choice of restoration depending on a number of factors. Your crown material should take into account mouth location, neighboring teeth and your personal expectations. We regularly work with a number of different materials because our patients regularly need a number of different materials. If you have any questions Emax, or any other materials we offer at our office, please let us know at your next appointment!

After Hours Phone Service

At Thousand Oaks Family Dentistry, we pledge to be committed and available to our patients. We understand that your dental emergencies and concerns may not coincide with our business hours. In fact, they typically seem to arise at the least convenient times possible. This is why we are proud to offer our after hours phone service.

Our promise to our patients is anytime you call our office number, one of our staff member’s phones will ring- any time, day or night. You will never be forwarded to a call service and any message you leave will typically be followed up in about two hours (a little longer for late night calls).

After hours callers will typically encounter our office manager, Michael. He brings years of experience in dental emergencies, insurance billing and scheduling to the convenience of your phone. Whether you have a filling fall out at 10am on a Saturday or an insurance question on an idle Thursday evening, he will be there to answer.

Our office manager, Michael. hard at work taking phone calls. 

Why do we provide this service? Simply put, our practice is a patient-centric environment. We know you have many options, and are honored that you choose to visit us at Thousand Oaks Family Dentistry. Dental care can be an intimidating endeavor, and thus we are here to make the process as easy, simple and convenient as possible.

Cosmetic Bonding

Often times, patients will be very satisfied with their oral esthetics aside from one feature. Thier teeth can be straight, white and well spaced, saving for a single tooth. In these cases, orthodontics may be impossible or unnecessary for purely esthetic results. Here, cosmetic bonding proves to be the most predictable and reliable treatment to a perfect smile.

In this case, bonding was added to compensate for a short lateral incisor (left of center).

Cosmetic bonding is one of the most underappreciated cosmetic procedures offered in dental offices. Using the same tooth colored material as fillings, we rebuild and recontour teeth to better fit and fill out your smile. This material is extremely durable, and can be used to lengthen, widen or "even out" the appearance of your front teeth. Our patients are always satisfied with the results, as the transition from natural tooth to filling material is virtually undetectable.

Here, bonding was used to close the gap between the patient's two front teeth.

Your appointment will begin with a short consultation on esthetics and a few photographs. We strive to match your expectations and desires before we start working in your mouth. Once a decision has been made on how and where to add bonding, we use high pressure air abrasion to temporarily roughen the tooth surface. This step is comparable to rubbing wood with coarse sandpaper before painting. After the tooth surface is prepared to accept composite, we add our bonding agents to the indicated area, followed by the tooth colored composite. Our composites come in a variety of shades and color, and can match practically any tooth shade. The material is added slowly, contoured to your tooth, and set solid via a high intensity curing light.

After we select an appropriate tooth color and light cure it, we begin shaping the material to resemble a completely natural tooth. The refinement process utilizes  sanding discs, polishing points and a number of sensitive techniques. The results look and feel completely natural in your mouth.

However, there are limitations to cosmetic bonding. It can generally compensate for deficiencies in tooth structure, but cannot address size issues such as overcrowding. Additionally, once structure has to be built out over 3-4mm, bonding becomes a less reliable long term cosmetic solution. For these in-depth cases, we typically recommend more involved esthetic procedures. Finally, bonding can interfere with teeth whitening or whitening results. Since bonding material does not respond to hydrogen peroxide, it does not change shade proportional to your natural teeth. Hence, we recommend you complete a bleach treatment prior to performing esthetic bonding.

Many consider veneers, orthodontics and whitening  as the standard of dental esthetics. However, we urge you to consider bonding to address your mild to moderate cosmetic dental concerns. The minimally invasive nature of these procedures makes them convenient and accessible to many patients. Feel free to call our office with any questions or concerns you have about the process, materials or results behind cosmetic bonding.

Athletic Mouthguards

Almost every physical activity carries some risk of harm or injury to your person. Bikes crash, lacrosse sticks get launched and soccerballs never go exactly where intended. We often take precaution against these injuries with helmets, kneepads and special footwear. However, we rarely consider the potential for tooth injury- unless a coach or league mandates mouthguard use.

In reality, there are a number of ways in which your teeth can be damaged during any activity. Many of these injuries can be minimized or prevented by using a custom fitted mouthguard.  These soft appliances help redistribute forces and protect the teeth from blunt trauma during athletic events.

A finished mouthguard. Notice how the material sits flush against the gums for extra support. Your personal appliance can be adjusted and contoured entirely to your liking. 

Who could benefit from using a mouthguard? A general rule of thumb is any sport or activity where you would wear protective padding (Such as a helmet) will present a risk of tooth injury. Studies show that athletes have 10% risk of sustaining an orofacial injury every year, with a total risk of injury of about 30%-50% over a lifetime. Furthermore, mouthguards protect beyond tooth injuries. Lip lacerations, TMJ trauma and tongue injuries can also prevented be via sports mouthguards. Some studies suggest that mouthguards could be protective against certain types of traumatic brain injuries as well. Additionally, many athletes feel that mouthguards allow them to feel more balanced and focused by providing a flat and even surface rest and concentrate on. 

The mouthguards we make at our office take your entire mouth anatomy into consideration. We use stone models and vacuum packing to form them not only to your teeth but up flush against your gums as well. This process eliminates the loose and flimsy feeling that comes with many “heat and bite” style mouthguards. The plastic is contoured and smoothed so that it feels natural in your mouth without losing any protective ability. The bottom side is layered with two types of protective acrylic, so that clamping injuries (such as an elbow to the lower chin) are counteracted by evenly distributed forces. The whole process only takes two appointments, firstly to take the initial impressions and a follow up to deliver and adjust the appliance.

At Thousand Oaks Family Dentistry, we want patients to be as educated and safe as possible in their daily activities and hobbies. Even if you are comfortable with your current mouthguard or not interested in having one made, please call our office if you have any questions about oral injuries. We feel that many types of trauma are preventable via education and want to be available to answer any questions you may have!

Additional Reading:

Types of Dental Trauma:

http://www.dentaltraumaguide.org/

Sports Related Dental Injuries: http://www.dentalcare.com/en-US/dental-education/continuing-education/ce127/ce127.aspx?ModuleName=coursecontent&PartID=1&SectionID=-1

Custom Mouthguards and Traumatic Brain Injuries:

http://www.traumaticbraininjury.net/custom-made-mouthguards-may-help-prevent-sports-related-brain-injuries/

ADA article on Sports Mouthguards:

http://www.ada.org/en/press-room/news-releases/2013-archive/april/play-it-safe-prevent-facial-injuries-with-simple-s

CDA Southern California Dental Convention 2014

Each year, California Dental Association (CDA) puts on a giant general dental convention with exhibitors, educators and classes. It is absolutely massive, with representatives from every oral health company and organization in existence. This year, Dr. Kari, Michael, Adrienne, Lori and Dean hit the road bright and early and had a blast at Anaheim Convention Center. Their extremely productive day was rewarded with some great Dim Sum in Chinatown!

Removal of Amalgam Fillings

One of the hundreds of beautiful amalgam swaps we have performed at our office. 

Amalgam fillings are a tested and proven dental material and have been in effective use for over 100 years. There are many aspects of these metal fillings that make them excellent candidates for tooth restoration; they are durable, easy to place and have many of the same physical properties as natural tooth structure. However, they are not perfect (there are no perfect materials in dentistry). Over time, amalgams can crack, “leak” or become surrounded with decay. Furthermore, they are not as esthetically pleasing as tooth colored materials and can tarnish from silver to black very quickly.

These are some of the compelling reasons that we remove amalgam fillings at Thousand Oaks Family Dentistry. While we recommend replacement for ALL compromised fillings (both metal and tooth colored), we only replace amalgams for esthetics upon patient request. Additionally, we do not recommend removing metal fillings over concerns of mercury exposure. The long term safety of amalgam fillings and their associated mercury content is well understood and documented. Additional information can be found at http://www.ada.org/en/member-center/oral-health-topics/amalgam or by calling our office.

The result of an amalgam replacement procedure. While amalgam fillings are easy to spot, composite fillings blend very well with natural tooth structure. However, this difference in esthetics does not necessarily make one type of filling functionally superior. 

The removal process is a simple procedure that parallels how we place fillings on decayed teeth. We start by removing the existing amalgam from the tooth by carefully cutting it with a high-speed handpiece (“drill”). While amalgam fillings are very safe, there is a slightly elevated risk of mercury exposure upon their removal, as the material becomes loosened and aerosolized. To counteract this, we rely on two forms of suction and isolation to prevent any of the metal from being swallowed. Typically, we pair an Isolite suction/bite block with our high speed suction to gather any stray metal.

Once the amalgam is removed, we eliminate any decay under or around the filling and reshape the tooth to better accept the new composite. Once the tooth is “prepared,” we proceed by bonding and curing in tooth colored material. After it is set, we recontour the filling to the natural shape of your teeth and adjust so it feels natural in your mouth. The entire process takes under an hour, and can be considerably shorter depending on the size and shape of the existing amalgam.

If you have any questions, or would like more information on how and why we remove amalgam fillings, please call our office. We regularly remove amalgam fillings under a number of different scenarios, and would be more than happy to walk you through the process.

Teeth Whitening

Teeth bleaching is one of the most common and sought out dental treatments nationwide. There are numerous options and products offering whiter teeth, from toothpastes to bleaching “strips” and even professional procedures. At Thousand Oaks Family Dentistry, we offer two forms of whitening procedures: in-office bleaching and take home trays.

Firstly, it is important to understand how teeth whitening works. In actuality, there is no bleach (sodium hypochlorite) in any whitening products. The active ingredient in almost all whiteners is hydrogen peroxide. Peroxide works by oxidizing the molecules that cause staining, which in-turn prevents them from dying the teeth. These staining compounds reside in the layer of the teeth known as the dentin. This zone sits between the tooth enamel and nerve chamber and is composed by  thousands of tiny ducts known as tubules. Whitening sensitivity usually arises from these tubules opening, allowing the peroxide to penetrate and “bleach” the teeth.

Take home bleach trays combine flexibility and enduring results of whitening strips with the speed of professional strength bleach. After you decide to whiten using trays, we will take impressions of your teeth and turn those into plaster study models. We then vacuum form plastic to your model, making a perfect relief of your teeth. After trimming the plastic, your trays are ready to be picked up and used. The entire process can be completed in as little as two days (if necessary).

(From left to right)- We start by taking impressions which are turned into stone models. These models are used to make your custom trays. We then send you home with a supply of professional strength peroxide bleach.

We will send you home with a peroxide intensity appropriate to your comfort level and desired results. Many first time bleachers will opt into a lower peroxide percentage until they understand their personal level of sensitivity. Trays are typically used for one hour a day for two weeks, followed by one hour a day, once a month. This schedule allows for deep dentin bleaching and an enduring white smile. Patients who use this method typically reach a very stable tooth shade that lasts for many years.

In-office bleaching is a great whitening solution for those who want immediate results or cannot devote the time to slower bleaching methods. We start by retracting your lips and blocking out your gum tissue and mucosa. Once we have created an effective barrier between your teeth and other mouth structures (peroxide will remove color from any tissue it contacts), we apply a 40% peroxide bleach to the facial side of your teeth. We typically leave the peroxide on for two 20 minute sessions. In the meantime, you can enjoy netflix, pandora internet radio or cable tv on our in-operatory TVs.

Top left- Blockout material used to protect your gums. Bottom left- In-office bleach, before activation. Right- Cheek retractors commonly used in our whitening procedures.

Feel free to enjoy one of our many entertainment options during your whitening procedure. 

If you have any further questions on teeth bleaching or would like to schedule an appointment, feel free to call our office. We have helped hundreds of patients achieve healthy and beautiful smiles and can accommodate all of your esthetic needs and desires.

Covered California

As of May 1st, 2014, California healthcare insurance has undergone a significant redesign and restructuring process. Under the name Covered California, it is our state’s implementation of the healthcare marketplace system set fourth by the Affordable Care Act (commonly known as “Obamacare”). Now that open enrollment has ended, many individuals have new and unfamiliar plans and benefits.  At Thousand Oaks Family Dentistry, we want to alleviate some of the confusion and alert you as to how Covered California may change your dental coverage. Take a look at these frequently asked questions:

Does my Covered California (CCA) compliant plan include dental coverage?

-For adults over the age of 18, CCA compliant plans do not have to offer any dental coverage. Depending on your provider, dental coverage may be available, but it is strictly on an opt-in basis.

I will be signing up (or signed up) individually through the healthcare marketplace. Does it make sense for me to opt in to dental coverage?

- One thing to consider is that dental insurance is structured differently from medical insurance. While medical insurance includes features such as out-of-pocket maximums and protection against catastrophic accidents, dental coverage is typically a lowered fee schedule in exchange for a monthly premium. It is ultimately your decision if this will be beneficial to your unique needs.  Our only advice is that dental plan premiums tend to follow a “get what you pay for” model. Plans with lower monthly payments typically have higher copays and out-of-pocket costs.

Will my children have dental coverage through CCA?

- Children 18 and younger are covered under CCA. However, these dental plans are additional to any insurance plans. You must opt-in or specifically seek out dental coverage for your children. It will typically not be done without your explicit consent or knowledge. Both PPO and HMO options are available, so be aware of what you are signing up for. More information can be found on the Covered California website: https://www.coveredca.com/childrens-dental/

Will the new guidelines set forth by CCA change my experience at Thousand Oaks Family Dentistry?

- The most likely answer is no. Our insurance coverage has not changed as a result of Covered California. In addition, our average patient’s dental coverage has not changed either. If you did not have dental insurance before, you will likely still be uncovered under these new provisions. An exception to this is some children (18 and under) may now be covered under CCA. Again, if this is the case you would likely have been notified by your insurance provider. 

Dentistry Through the Ages: Infants and Newborns

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!

    Today, we want to address the dental concerns of families with newborns and infants. We know this can be an exciting and stressful time, with childcare advice coming from many (sometimes conflicting) sources. Hence, we want to ease your mind with our professional and scientifically proven advice on proper newborn dental care.

    Infant dental concerns actually begin during the prenatal months. Studies have shown that women with periodontal disease are at a higher risk for low birth weight and early term infants. It is important to minimize this concern by keeping up with your regular dental cleanings before and during pregnancy. Additionally, hormonal changes, increased snacking and morning sickness all put pregnant women at a significantly higher risk for tooth decay. We recommend that all of our pregnant patients pay special attention to their oral health and consider supplementing their current home care with further preventative products, such as xylitol rinses or chews.

    You can start your newborn on the path to great oral hygiene even before their teeth start to erupt. An important fact to remember is that oral bacteria is often transferred from caregivers to their children. Avoid sharing saliva with your infant, as your bacteria can start to colonize their mouth and cause tooth decay at a very young age. In fact, studies show that the bacterial profile of mothers and children match, even before the baby teeth come in! Once teeth begin to show through the gums, you can clean them using a washcloth or xylitol wipes. After two or more teeth “touch,” you should start to floss between them.   

    Once the teeth begin to develop, it is important to never put your infant to sleep with a milk bottle. The milk will sit on the teeth all night and eventually cause rampant decay. In fact, the decay pattern of night time milk bottles is so characteristic, it has earned itself the title of “bottle mouth.”

The unfortunate consequences of "bottle mouth."

    Beyond toothcare, infancy is a period of rapid craniofacial development. While much of this will occur naturally, proper development can be encouraged. Breastfeeding has been shown to be beneficial to proper facial growth. Global studies show that breastfeeding during the first four months of infancy are particularly critical to lower jaw development.

    Your babies teeth need to stay healthy for as long as 13 years. Thus, it is very important that you protect them right from the beginning. On top of proper home care, we recommend you bring your child in for their first check up at 12 months. This can allow us to catch decay and developmental problems before they become a much larger issue. At Thousand Oaks Family Dentistry, we are prepared to see all of your family members, no matter what the age!