Dentistry Through the Ages- Toddlers and Young Children

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 take a look at the special dental needs and concerns of toddlers and young children. During this time period, your young one will undergo rapid growth and development, both physically and mentally. At Thousand Oaks Family Dentistry, we want to give you the best tools to keep up with their changing needs!

There are a number of milestones that can help you best gauge your child’s dental development. Typically, the first primary teeth to erupt will be the central lower incisors at around 8 months. These will be followed shortly after by opposing teeth, the upper central incisors at about 10 months. Likewise, the last primary teeth to be shed are the upper canines and second molars, which are lost as late as 12 years.

A chart showing the eruption and shedding ages for primary teeth. 

It becomes apparent that although the primary teeth will all be eventually be shed and replaced, they need to last a long time- from 5 to 10 years depending on the specific tooth. During this period, these teeth will serve as both mechanical tools for chewing and as placeholders for the adult teeth. It is important that primary teeth are lost naturally and not due to facial trauma or decay. If a tooth must be removed prematurely, we recommend placing a Space Maintainer retention device to hold spacing. Without this appliance, the adult teeth can come in crooked or unevenly, requiring extensive orthodontic intervention later in life.

A typical space maintainer on a model. The final appliance is gently cemented to the rearward tooth. 

Beyond the development of primary teeth and adult teeth, there are a number of ways you can give your young child the best start on their dental health. At 1 year of age, we recommend stopping the use of bottles and pacifiers. Studies show that the prolonged use of these products can cause improper oral development, including an open bite. You can limit pacifier use using the “snip” method, where a small amount of the pacifier base is cut off periodically, limiting your child’s ability to create satisfying suction with the device. Thumb sucking needs to be limited as well, although behavioral interventions required to stop this are usually unsuccessful until the age of 3.

We recommend brushing your child’s teeth as soon as the first teeth begin to erupt. You can brush with water, fluoride-free toothpaste or even xylitol wipes. However, avoid fluoridated toothpaste and supplements until age 2, as the fluoridated water in Southern California will provide enough remineralization power alone. Any extra dosage of the ion can cause a condition called fluorosis, where white spots of “over mineralization” arise on the still-developing adult teeth.

At about three years of age, adjacent teeth in your child’s mouth will begin to touch. At this time, it is crucial to start flossing once a day. Childhood diets are full of tooth decay causing foods and habits- constant snacking, sticky and carbohydrate heavy foods and milk instead of water for beverage. While brushing will manage the risk of decay on most tooth surfaces, only flossing can remove bacteria and food from in-between teeth, where 70% of childhood tooth decay occurs. Additionally, keep in mind that brushing and flossing can be difficult tasks for children. As a rule of thumb, children not possess the motor skills to brush their own teeth until they can tie their own shoes.

We typically recommend children come in for their first dental visit at 1 year of age or when their first tooth comes (around 6-12mos). This visit is less of a traditional exam, and more of a “primer” for future dental visits. We will introduce your child to our various tools and ease them into what can be a very stressful setting. Depending on patient compliance, we will do a quick check of the mouth, followed by a health history review and educational discussion (for parents). All this is conducted in our fun and imaginative children’s room!

Undoubtedly, your child’s specific developmental patterns, needs and concerns will vary from the information in this article. With this in mind, it is imperative that they come in for regular dental examinations and check-ups. Many problems- from tooth decay to some developmental issues, can be corrected easily if caught early on. We hope to see you and your loved ones at our office- to make sure everyone is on the right track for dental success!

Specialist Spotlight-Synergy Dental Lab

At Thousand Oaks Family Dentistry, your appointment is much more than meets the eye. Behind the scenes, a network of dental specialists, labs and technicians help ensure that you receive outstanding esthetic results from our office. Today, we would like to highlight Synergy Dental Lab and its owner Andy Knapp, for their efforts in delivering our patients beautiful crowns and bridges.

Synergy Lab's owner, Andy Knapp.

At Andy’s lab, a team of technicians bring together over 70 years of design, ceramic and modeling expertise. They use a combination of proven techniques and the latest CAD/CAM technology to deliver products that fit and look wonderful. This ultimately means less time spent in our office, away from your friends, family or work. Even difficult cases can be handled with ease, through the use of digital photography and shade matching. The end result is a crown or bridge that looks, feels and fits like a natural tooth.

An example of the incredible work that comes out of Synergy Dental Lab. Through a combination of time, effort and technology, the quick impressions we take at our office become beautiful crowns and bridges. 

Synergy is a locally owned and operated business. Aside from being a part of the Thousand Oaks economy, this allows them to provide quick turnarounds and immediate support. Difficult time constraints, complicated cases and other concerns can be addressed in a matter of hours or days, instead of weeks.

We love working with Synergy dental lab because they offer a high quality product with excellent customer service. The speed, accuracy and support offered by this lab allows us to provide more convenient appointments at our office, ultimately saving you time and money. If you have any questions about Andy’s lab, or any of the other offices we work with, please give us a call. We are here to make your entire dental health experience as easy and confusion free as possible!

Dental Library Review- Open Wide

Welcome to The Dental Library Review! In this feature, we will be reviewing and highlighting different children’s books we have collected at our office. Our staff have personally used these books with their own children and have had great reception. Today, we will be going over Open Wide: Tooth School Inside by Laurie Keller.

On the surface, this whimsical book is a fun collection of collage-style graphics, funny jokes and silly comics. However, it is incredibly informative and engaging for readers over a variety of ages. The book follows the antics of Dr. Flossman's class at the Tooth School, along with his 32 tooth-shaped pupils. Nearly every two pages covers a different topic on dental development, tooth care or the history of dentistry. You will find all kinds of information, from how to react to a getting a cavity to why primary teeth are important. This information is all neatly rolled together with stimulating illustrations, side jokes and fun fonts. 

We love this book for a number of reasons. Firstly, there are a lot of great topics covered by this book- beyond just being informative, it has useful and engaging facts. Topics on brushing, flossing and dental care will follow your young one for life. Additionally, the fun and animated way that this information is presented is sure to engage readers and merit multiple read throughs. Finally, the last pages of the book include a quick test with simple questions to encourage knowledge retention (disclaimer: about half of the questions are silly). With all this combined, we find this book to be a great tool for getting kids excited about their oral health. 

Open Wide is likely most appropriate for elementary school readers. For children on the younger end of the spectrum, we would advise a read through with mom/dad to explain some of the bigger words and concepts. As with all of the books at our office, feel free to stop by and take a look. We want to do everything possible to get your family excited and informed about dentistry and oral health!

Cleanings and Periodontal Maintenance

The most common and essential function of our office (and any dental office) is the administration of routine cleanings and exams. These are critical steps to your long term tooth preservation, decay prevention and gum care. However, many patients would likely be surprised to learn that there are an array of services offered under the “realm” of cleanings. In this article, we will uncover the different types of dental cleanings, who gets them, and their overall “goals” in terms of your oral health.

Before going into the different types of cleanings, it is important to understand a few key terms in diagnosing and treating gum disease. Please consider the following:

Plaque- A biofilm created by bacteria to allow it to better attach and anchor itself to the tooth.

Tartar/Calculus- The result of plaque hardening on tooth structure. This substance can cause rapid tooth decay and progression of gum disease. Additionally, it is very difficult to remove with home hygiene techniques.

Periodontal pockets- The depth of space between teeth and gums as measured by a “perio probe.” Pockets ranging between 1-3mm are considered healthy and maintainable with normal brushing. Anything deeper is the result of plaque/calculus irritating the gum tissue away from the tooth root.

Bone Loss- The loss of bone height around a tooth as a result of the body’s immune response to the long term presence of plaque and calculus.

A perio probe- The indentations show 1mm and 5mm intervals for measuring pocket depths. 

The majority of patients that come to our office receive what is called a prophylactic cleaning (or “prophy”). This is typically considered a standard cleaning that you would receive twice a year on a 6 month recall. The word “prophylactic” indicates that this type of cleaning is strictly preventative care. Here, the patient’s gum tissue is considered to be within the healthy spectrum- mild plaque and calculus, shallow periodontal pockets and no bone loss. Our hygienists will remove any buildup you have incurred since your last visit and make sure there is no progression of gum disease. The purpose of this appointment is to “prevent” your healthy gum tissue from progressing into the spectrum of periodontal disease.

Some patients fall within an in-between state of periodontal disease. While they do not have aggressive bone loss, their levels of calculus, gum recession and periodontal pockets are not within a healthy spectrum. For these patients, we usually recommend a periodontal recall cleaning. This service, usually administered in three month intervals, is a more aggressive maintenance of the teeth and gums. We are no longer preventing periodontal disease; widespread calculus inflammation and tissue detachment marks the clinical presence of disease. These patients are receiving dental scaling for multiple pockets over 4mm- much deeper than a toothbrush can clean. The ultimate goal of this appointment is to prevent moderate disease from progressing further, with the hopes that you will soon be back to normal “prophy” cleanings.

A diagram visualizing the difference between healthy and diseased gum tissue and bone. 

A final category of cleanings exist for individuals who typically have not seen a dentist in a number of years. These patients have excessive calculus, periodontal pockets greater than 4mm on almost every tooth and excessive bone loss over the entire mouth. Not only will home hygiene be insufficient to keep up with the progression of disease, but standard cleaning techniques will fall short as well. Here, we provide scaling and root planing for the the most invasive levels of calculus and plaque removal. The entire mouth is cleaned over two or four appointments, usually with an anesthetic. This type of procedure is usually recommended once to give your mouth a complete, thorough evaluation and cleaning. The goal is to set a healthier baseline for your mouth, so that it can be better managed by regular scheduled cleanings and your personal home care routine.

We recommend all of these periodontal services to a number of our patients for a number of reasons. Sometimes, unique situations will require a combination of approaches, the expertise of specialist or even surgical intervention. Only a thorough evaluation by Dr. Kari or one of our skilled hygienists will give us a true picture of your gum health. If you would like schedule an exam or cleaning, please contact our office. We are here to listen to your concerns and guide you every step of the way!

Dental Library Review- Baby Tooth Album

The Contents of the Baby Tooth Album

Welcome to The Dental Library Review! In this feature, we will be reviewing and highlighting different children’s books we have collected at our office. Our staff have personally used these books with their own children and have had great reception. Today, we will be going over The Baby Tooth Album. 

Admittedly, calling this a "book" is quite a stretch. However, it is a great educational tool that doubles as a convenient keepsake. The Baby Tooth Album is a rotating disk with spots for each of your child's baby teeth. The top cover rotates to keep one tooth chamber open at a time, preventing spillages, mix ups and lost teeth. Also included is a small baby tooth chart with some fun information on children's teeth. 

We love this product because it is a very visual way of displaying and learning about teeth. Children can clearly see the differences in tooth size and structure, gaining an appreciation and interest in their own dentition. For parents, this is an easy way to remember the excitement and anticipation of lost teeth. The device itself is small enough to fit in a photo album or scrapbook as well, making it a perfect addition to your existing documentation.

If you would like a closer look at the Baby Tooth album,  feel free to stop by our office. As with everything in our dental library, it is free for you to read and examine. We look forward to getting your family excited about dentistry, home care and oral hygiene!

Managing Dental Fears

    A dentist’s office can be a very frightening place. The unfamiliar equipment, clinical environment and the looming “promise of pain” can all add up to quite an unsettling mental image. With this in mind, it is easy to see why so many patients are hesitant to schedule even a routine checkup. At Thousand Oaks Family Dentistry, we understand that visions of dental appointments weigh heavy in many patient’s minds. Hence, we try our best to manage and minimize fear through a number of techniques and methods.

Our welcoming waiting room. 

    One of the first things you will notice upon entering our office is our living-room style waiting room. It is decorated and designed to distract from the overly clinical and impersonal feel many patients normally associate with medical offices. A large television greets you with whatever channel you desire and our front office staff is available to provide you with water, candies or even a hot towel.

One of our Multimedia Patient TV screen. 

    After being seated in one of our exam rooms, you will be given the choice of watching TV, watching Netflix, or listening to streaming radio services. Each room also has over-ear headphones, blankets and pillows available upon request. We feel that the comforting/immersive experience of a good TV show, headphones and a blanket are enough to comfort all but the most fearful patients. These simple services have helped us treat a number of patients who felt they could never make it through an entire dental appointment.

    Beyond these services, we offer a number of medicinal methods to managing fear as well. These methods are either prescribed or offered in our office after a consultation and evaluation. We will try to address dental phobia without medication first, but we are always willing to meet you and your specific needs. If you have questions about these services, please let our front office staff know when you book your appointment.

    If you would like to hear more about our office and how we handle fearful patients and dental phobics, please give us a call. We are always happy to accommodate our patients and make you feel completely comfortable at your appointment. Our ultimate goal if for every patient to have a happy, positive experience at our office!

Kerr Sonicfill Filling System

If you have had a filling placed at our office recently, you likely noticed that the entire appointment was much shorter (and more comfortable) than when you were a child. This is due to a number of wonderful advancements in dental technologies and techniques, allowing us to move more smoothly and efficiently. A great example of this progress is the Kerr Sonicfill Composite Applicator.

The Sonicfill "handpiece" and composite filling material tubes. It plugs into our chairs much like the dental polisher and "drills." 

The Sonicfill is an incredible device that allow us to place certain fillings in the back of the mouth in a matter of seconds. Previously, properly filling a large cavity in the molars and premolars required two different types of materials, which had to be carefully packed, shaped, adjusted and finally cured. With Sonicfill, The entire process is completed in a single step, with outstanding results.

This incredible device works by utilizing the air supply built into our dental chairs to create a vibrating/pushing motion against a tube of tooth colored filling material. The vibrations cause the material to flow gently and thoroughly into the shape of the cavity, leaving no gaps or bubbles. Once the vibration is stopped, the material remains firm but pliable, allowing us to shape it perfectly before curing it completely solid. The end result is a beautiful tooth colored filling placed in practically no-time!

We love this technology for two reasons. First, it has provided us with excellent functional results. The vibrating motion truly does make a difference and has given hundreds of our patients strong, long lasting restorations. Secondly, its speed-of-use means a shorter appointment time. This translates to less time in our office, away from work and/or family.

As with all of our products, if you have any questions or concerns please call our front desk. We only use new technologies when we are absolutely sure they will provide a superior experience for our patients. Sonicfill has satisfied this requirement by making your appointment smooth, quick and comfortable!

Dental Library Review- The Berenstain Bears and the Tooth Fairy

Welcome to The Dental Library Review! In this feature, we will be reviewing and highlighting different children’s books we have collected at our office. Our staff have personally used these books with their own children and have had great reception. Today, we will be going over The Berenstain Bears and the Tooth Fairy by Jan and Mike Berenstain.

Like others in the Berenstain series, this is a picture heavy story book that chronicles the antics of a family of bears. This selection follows the story of Sister Bear and the loss of her first two teeth. After loosing the first, she receives a quarter from the tooth fairy. However, she is soon shocked to find out that her friend Lizzy received a whole dollar for her lost tooth. The rest of the book covers how the tooth fairy pays for teeth and how this price can go up or down ("like the price of gas," as noted by Papa Bear).

This is book is mainly geared towards young readers around the time of their first lost tooth (around 6-7 years old). We like this book because it helps manage expectations on how much the tooth fairy pays, and how to react if a friend gets more from the tooth fairy than you do. The main focus of this story is more towards how and why the tooth fairy visits us, rather than the actual process of loosing teeth. This can really be helpful in keeping the legend alive and avoiding difficult conversations.  

As with any of the books in our library, feel free to stop by our office to take a look. We want you to have the best tools available to educate your family and get them excited about dentistry. We hope you find this book as enjoyable as we did!

Video Blog on Teeth Veneers

Greetings, my name is Dr. Kari Ann Hong, and I have a family dentistry practice here in Thousand Oaks, California. Frequently, my patients will ask me if I do cosmetic dentistry. This is an interesting question, because cosmetic dentistry defines every treatment that I provide. In fact, cosmetics are intrinsic to the very nature of dental procedures. My ultimate goal is to provide you with long term dental solutions that are both functional AND beautiful.

The most common procedure associated with the term “cosmetic dentistry” is teeth veneers.  Veneers can be used to change the color, shape, and size of the teeth.  They are an excellent solution for teeth that have been chipped in the past or that have had extensive fillings.  Also, they can be used to fill in gaps or to correct the alignment of teeth.  The process of making a veneer involves lightly removing about 0.3-1.5mm of tooth structure. Then an impression is taken, temporaries are made, and the dental lab takes about two weeks to fabricate the veneer.  

Veneers are made out of either feldspathic porcelain or lithium disilicate.  Both materials are known for their translucency and life like appearance.  Patients are often concerned that their veneers will look fake.  I work very closely with my dental lab to ensure that the final result is both natural and esthetically pleasing.

If you are interested in teeth veneers, please fill out the contact us page at the bottom of this page.

Root Canals

Root Canal- Likely the most feared of all procedures. The name alone brings up visions of pain, discomfort and dental woes. But what is a root canal? Why would you need one? What does it do? In this article, we will shed some light on the world of endodontics, dental subspecialty that encompasses root canals. Contrary to popular belief, you will find that this procedure is both comfortable and provides near instant pain relief!

A Diagram of the different parts of the tooth. 

Before explaining how a root canal works, it is important to understand the different parts of the tooth and what they do. There are three basic layers to all teeth- the enamel, the dentin and the nerve/pulp. The enamel is mostly inorganic (nonliving) material and gives the tooth its strength and rigidity (it’s the hardest material in the human body!). Dentin provides support to the enamel and contains a mix of living and nonliving materials. The innermost layer is the pulp chamber and nerve canal. This space contains innervation that provides information on biting pressure, temperature and pain to the central nervous system. It is mostly organic material and has has it’s own blood supply.

Different teeth will have different numbers of canals. The number varies between tooth types, arch location and even person to person. In general, teeth typically have between one and four canals, with posterior teeth having more than anteriors. On top of this, a tooth can have any number of accessory canals.These can range in size from easily visible to microscopic.

With this information in mind, let’s discuss root canals. In the most basic terms, a root canal is performed by removing the root/nerve from the tooth, cleaning out the now-empty space and filling it with a stable material. Why would we remove the nerve from a tooth? This is typically done because:

A) Long term decay, stress or fracture has aggravated the nerve and it is causing constant pain. This is what happening when patients come in with a “hot tooth.”

B) The aggravated nerve has now “died,” leaving a perfect alcove of organic material for bacteria to feed on. Here, patients might have very little feeling in the tooth and may notice a change in color to a grayish hue.

C) Bacteria have found the dead tissue and there is an active infection. The bacterial abscess can be seen on an X-Ray and the patient will feel soreness, swelling or even draining from the gum tissue.

Condition A will eventually progress to condition B and usually to condition C. Since active infections are both difficult to treat and potentially life threatening, we will usually treat dying nerves early-on and aggressively. Waiting can often lead to more pain and higher long term costs to our patients.

The actual root canal procedure is based on a simple ideology: If you remove the dying/dead nerve, you remove the source of pain and bacterial “food.” We start by getting you numb using standard dental anesthesia.  You should not be able to feel any part of this procedure, from start to finish. The tooth is then isolated using a dental dam to keep your saliva and the inner tooth completely separated. We access the tooth canal and begin clean out the canal. We use a system of specialized files to shape and clean the canal, along with a number of sterilizing irrigants to eliminate any bacteria. Once the canal is the right size and shape (confirmed via X-Ray), we fill it with a material called gutta percha. Modern gutta percha is engineered in a lab, and is extremely resistant to deterioration, infection or absorption.

Tooth Second from left- Before and after root canal. The gutta percha shows up bright white in the X-Ray, highlighting the shape of the canal.

Once the canal is filled, it is topped of with a filling to give the tooth structure. This final step may be done the same day as the canal filling or may be delayed to allow the tooth time to adjust to the procedure. Most of the time, the tooth will require a crown to give it long term structural stability and strength. Removing the nerve from teeth can make them more brittle, and the capping effect of a crown can help counteract this.

After the nerve is removed from the tooth, it physically cannot feel any more pain. The surrounding tissues can still feel tender, but the specific tooth will no longer have a way to relate sensory information to the brain. This is what makes root canals great at ending tooth pain permanently and instantly.

Overall, root canals are about 80% successful long term. They are an excellent way of buying time with a tooth that would otherwise need to be extracted and replaced with an implant or dentures. At our office, we evaluate root canals on a patient-to-patient basis. If we feel your specific case could benefit from the perspective of a specialist, we will refer you to an endodontist. These tooth canal experts bring a number of technologies to handle complex or difficult cases, including microscopes, CT Scanners and cutting edge materials.

If you have further questions on root canals or why we place them, please contact our office. We understand that this procedure seems intimidating, and will try our best to make it more manageable. As with any procedure provided at our office, we want you to be happy, pain-free, and satisfied with the end result!