When children get cavities they are quicker to appear and faster in their progression than cavities on an adult. Mostly this has to do with the anatomy of a baby tooth versus a permanent tooth. I recommend that children start seeing the dentist at age one and then every six months thereafter. It is much easier to fill a small cavity then to deal with a large hole on a tooth.
Yesterday I had the pleasure of seeing a six year old girl that had a hole in-between two of her baby teeth. I had seen her last week to attempt to fix the hole, but it was a no go. Yesterday I was successful in filling the cavity and it brought to mind some important points on treating children: parent selection, timing, patience, and choices.
Parent selection is a key factor. As parents we bring our own anxieties with us to the dental office and we are experts at transferring these anxieties to our children. In the case of my six year old patient, it was her father that had brought her the week prior. The dad has a severe gag reflex and previous traumatic dental experiences. While he was being supportive of getting the cavity fixed, there was an aura of "is this going to hurt my daughter?" in the room. The mom was much more relaxed and matter of fact. From the onset of the appointment yesterday the mom's attitude was that we were going to get the cavity filled.
Timing when treating children makes a huge difference. If your kid is cranky or tired at certain times of day, then that is a bad time to be doing dentistry. For instance, my four year old is exhausted by 3 or 4 in the afternoon. He is much harder to reason with at that time of day. Early in the morning my son has boundless energy and he has a hard time sitting still. The best time to treat most kids is mid morning or after lunch. Also, it is important to keep in mind that when you are numb it is hard to eat and kids are more likely to bite their cheeks when numb. Thus, is important that your child is well fed before having a cavity filled.
Patience is the answer to finishing all types of dental treatment. It is important to take the time to walk a child through the steps of the procedure. In addition it is necessary to wait for them to overcome the crying that comes with anxiety of not knowing what is going to happen next. At the beginning of the appointment, my six year old patient was crying and refused to open her mouth. Once she realized that her tooth was going to get filled no matter what and I fully explained each step, she stopped crying and opened her mouth.
Choices are a funny thing when it comes to kids. The appointment with the six year old went something like this, "we can use this white and pink Mr. Thirsty or this clear Mr. Thirsty.". The point being that one way or another I needed suction while cleaning out the sugar bugs. Then I used a blue liquid, followed by a glue that was hardened by a blue light saver light and topped off with a white liquid that filled the hole. Success!
Kari Ann Hong, DDS1000 Newbury Rd. #190Thousand Oaks, CA 91320www.thousandoaksfamilydentistry.com
Sunday, October 2, 2011
Wednesday, September 21, 2011
Sleep Apnea and Dentistry
Did you know that if you have sleep apnea that it can shorten your lifespan by 7 to 8 years? Did you know that having sleep apnea puts you at greater risk for stroke or heart attack?
Obstructive sleep apnea is defined as someone that stops breathing while sleeping. Sometimes this can be accompanied by loud snoring. The cessation of breathing is caused by muscles in the throat area relaxing and the tongue falling back in the throat, blocking the airway. The severity of sleep apnea is defined by the number of times per hour someone stops breathing in their sleep. Someone with severe sleep apnea stops breathing more than 25 times per hour while they are sleeping. The body subconsciously wakes up when it realizes it isn't breathing, leaving the person to wake up the next morning feeling unrefreshed.
My dad has sleep apnea. In his quest to treat his own condition he took a continuing education class on treating sleep apnea with dental appliances. After taking the class, he decided to invest in an airway evaluation device as well some take home sleep monitors. In the past couple of months he has successfully treated a number of mild to moderate sleep apnea patients with dental appliances. (If someone is found to have severe sleep apnea, then a continuous positive airway pressure machine is recommended.)
As a part of our sleep apnea screening we ask the following questions:
1. Are you likely to fall asleep or doze off if you are:
a. Sitting and reading
b. Sitting in a public place
c. Driving a car stopped for a few minutes in traffic
d. Sitting down quietly after lunch without alcohol
e. Watching TV
f. As a passenger in a car for one hour
g. Sitting and talking to someone
h. Lying down to rest in the afternoon
2. Have you gained 15 pounds or more in the last six months?
3. Have you ever been told that you snore?
4. Does your snoring occur almost every night?
5. Would you or someone hearing you sleep consider your snoring louder than a person talking?
If you answer yes to two or more of the above questions, then you could be at risk for sleep apnea and an evaluation of your airway opening would be a good idea.
Kari Ann Hong, DDS
1000 Newbury Rd. #190
Thousand Oaks, CA 91320
www.thousandoaksfamilydentistry.com
Obstructive sleep apnea is defined as someone that stops breathing while sleeping. Sometimes this can be accompanied by loud snoring. The cessation of breathing is caused by muscles in the throat area relaxing and the tongue falling back in the throat, blocking the airway. The severity of sleep apnea is defined by the number of times per hour someone stops breathing in their sleep. Someone with severe sleep apnea stops breathing more than 25 times per hour while they are sleeping. The body subconsciously wakes up when it realizes it isn't breathing, leaving the person to wake up the next morning feeling unrefreshed.
My dad has sleep apnea. In his quest to treat his own condition he took a continuing education class on treating sleep apnea with dental appliances. After taking the class, he decided to invest in an airway evaluation device as well some take home sleep monitors. In the past couple of months he has successfully treated a number of mild to moderate sleep apnea patients with dental appliances. (If someone is found to have severe sleep apnea, then a continuous positive airway pressure machine is recommended.)
As a part of our sleep apnea screening we ask the following questions:
1. Are you likely to fall asleep or doze off if you are:
a. Sitting and reading
b. Sitting in a public place
c. Driving a car stopped for a few minutes in traffic
d. Sitting down quietly after lunch without alcohol
e. Watching TV
f. As a passenger in a car for one hour
g. Sitting and talking to someone
h. Lying down to rest in the afternoon
2. Have you gained 15 pounds or more in the last six months?
3. Have you ever been told that you snore?
4. Does your snoring occur almost every night?
5. Would you or someone hearing you sleep consider your snoring louder than a person talking?
If you answer yes to two or more of the above questions, then you could be at risk for sleep apnea and an evaluation of your airway opening would be a good idea.
Kari Ann Hong, DDS
1000 Newbury Rd. #190
Thousand Oaks, CA 91320
www.thousandoaksfamilydentistry.com
Saturday, September 10, 2011
Cavity prevention with mouthwash
I pulled this pH scale image from the CariFree website. What is CariFree? CariFree is an entire product line of mouthwashes, toothpastes, gum, and mouth sprays that were developed to have basic pH content, xylitol, and fluoride. The most impressive part of their product line is the mouthwashes. They have a CariFree treatment rinse and a CariFree maintenance rinse. What sets apart the CariFree rinses from others on the market is that they are basic in their pH. The CariFree system of products is a relatively new product line and something that I have only had in my office since May of this year.
I have a patient that has recently been struggling with dry mouth and tooth decay. We set up an appointment so we could further discuss treatment options for prevention of future tooth decay. My patient took it upon himself to bring in some pH strips and the Biotene and ACT brands of mouthwashes to his appointment. I was surprised to find out that the Biotene rinse was a 4.5 pH which is quite acidic. The ACT brand was neutral at 7.0 pH.
It is scary that a rinse like Biotene which is marketed to dentists as a treatment for dry mouth, could actually be causing more harm due to its acidic content. It would be like rinsing your mouth with 7-UP soda. There are many other mouthwashes out there that contain alchohol which apparently is meant to kill bacteria, but it leaves the mouth dry which ultimately encourages bacterial growth.
Since we started distributing the CariFree rinse in May, I have had a number of patients use the rinses. The most common testimonial I hear is that it helps with dry mouth and it makes the teeth feel cleaner.
My recommendation to my patients is that if you are going to use an over the counter rinse, the ACT rinse is your best bet. It has fluoride and it is at least neutral in its pH. If you want a rinse that will help neutralize the mouth and stop de-mineralizing your teeth, then I recommend taking a look at the CariFree product line.
Kari Ann Hong, DDS1000 Newbury Rd. #190Thousand Oaks, CA 91320www.thousandoaksfamilydentistry.com
Saturday, September 3, 2011
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
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
Sunday, October 31, 2010
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.
Kari Ann Hong, DDS
1000 Newbury Rd. #190
Thousand Oaks, CA 91320
www.thousandoaksfamilydentistry.com
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
Monday, August 2, 2010
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
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
Wednesday, April 7, 2010
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
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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