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
Tuesday, October 6, 2009
Friday, September 25, 2009
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
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
Thursday, September 24, 2009
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
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
Monday, May 18, 2009
30 minute medical appointment vs. 4 minute medical appointment
I took my 2 year old to see an orthopedic doctor that specializes in pediatrics last Friday. The doctor spent nearly a half hour with us, confirming the pediatrician's diagnosis of radial subluxation or Nursemaid's elbow and casting my son's arm. Prior to seeing that particular orthopedic doctor, I called two other doctor's offices to inquire for an appointment. One of the other doctors didn't have any appointments available until Monday. Apparently the doctor was only working between 2:30 and 4:30 on Friday and he already had thirty patients scheduled in that time period.
I feel fortunate that I was able to get a same day appointment with an orthopedic M.D. that was able to spend a significant amount of time looking at my son's arm. The other doctor that was so booked Friday afternoon could only spend 4 minutes on average per patient. Four minutes isn't enough time to hardly say hello, let alone diagnose and treat an injury.
Both of the doctors are contracted with my insurance company, which means that they have agreed to certain discounted fees. I am sure if you asked either doctor why they decided to go into the profession that they would say they want to help people. However, being a doctor is more than just helping people. Being a doctor is a business and there is a certain overhead to having an office, staff, and treating people. When an insurance company discounts a doctor's fees, then the doctor is forced to see a larger volume of patients to keep the business running.
The quality of patient care is what suffers when a doctor only has 4-5 minutes to spend with a patient.
As a dentist I have made a choice not to contract with any specific PPO dental insurance. I employ a hygienist that sees only 8 patients a day, or one an hour. I myself only have about 8 patients on my own schedule on any given day. If I were an in network provider for PPO insurances I would be discounting my usual and customary fees anywhere from 30 to 50% percent. At that rate, I would be unable to afford to employ a hygienist, unless that hygienist saw twice as many patients. Since doing dentistry like fillings, crowns, extractions, and root canals takes a fixed amount of time, I would be unable to increase the volume of patients on my schedule. It would be difficult to have a viable dental practice if all of our patients were PPO or HMO patients. Also, patient care would suffer if my hygienist only had 30 minutes to clean someone's teeth, take appropriate x-rays, set up the room, and have time for me to do an exam.
Kari Ann Hong, DDS
1000 Newbury Road, Suite 190
Thousand Oaks, CA 91320
www.familycaredentists.com
I feel fortunate that I was able to get a same day appointment with an orthopedic M.D. that was able to spend a significant amount of time looking at my son's arm. The other doctor that was so booked Friday afternoon could only spend 4 minutes on average per patient. Four minutes isn't enough time to hardly say hello, let alone diagnose and treat an injury.
Both of the doctors are contracted with my insurance company, which means that they have agreed to certain discounted fees. I am sure if you asked either doctor why they decided to go into the profession that they would say they want to help people. However, being a doctor is more than just helping people. Being a doctor is a business and there is a certain overhead to having an office, staff, and treating people. When an insurance company discounts a doctor's fees, then the doctor is forced to see a larger volume of patients to keep the business running.
The quality of patient care is what suffers when a doctor only has 4-5 minutes to spend with a patient.
As a dentist I have made a choice not to contract with any specific PPO dental insurance. I employ a hygienist that sees only 8 patients a day, or one an hour. I myself only have about 8 patients on my own schedule on any given day. If I were an in network provider for PPO insurances I would be discounting my usual and customary fees anywhere from 30 to 50% percent. At that rate, I would be unable to afford to employ a hygienist, unless that hygienist saw twice as many patients. Since doing dentistry like fillings, crowns, extractions, and root canals takes a fixed amount of time, I would be unable to increase the volume of patients on my schedule. It would be difficult to have a viable dental practice if all of our patients were PPO or HMO patients. Also, patient care would suffer if my hygienist only had 30 minutes to clean someone's teeth, take appropriate x-rays, set up the room, and have time for me to do an exam.
Kari Ann Hong, DDS
1000 Newbury Road, Suite 190
Thousand Oaks, CA 91320
www.familycaredentists.com
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