Happy New Year Dental Resolutions

I am back at work today after a week and a half long vacation. So far it has been a slow morning at the office. In the couple of weeks prior to the holidays the phone was ringing constantly and it seemed like everyone had a dental emergency. Today it is quiet, like the calm after the storm.

New Years is all about resolutions. I have some dental new year resolution suggestions for 2010.

1. Buy an electric tooth brush. Electric tooth brushes are the best at removing plaque and keeping gums healthy. They prevent tartar build up and give teeth a smooth polished feeling. Patients that I see six months after they have started using an electric tooth brush always have cleaner mouths. Costco has the best deals on electric brushes- they sell the Oral B and the Sonicare brands.

2. Floss once a day. I am sure you have heard the old saying that you only need to floss the ones you want to keep. Flossing helps removed plaque between the teeth and around the gum line. Daily flossing prevents cavities between the teeth and makes the gums and bone that hold the teeth in the mouth much healthier.

3. Bleach your teeth. There are so many affordable ways to have a whiter brighter smile. My favorite is ZOOM! Whitening. After about an hour of in office ZOOM! Whitening you will have whiter teeth. Current price for this procedure is $200!

4. Stop bad habits. Smoking and drinking soda are the two biggest culprits of dental problems. Smoking can lead to severe gum disease, as well as cancers of the mouth and throat. Drinking soda throughout the day can cause lots of cavities. By the way, diet soda is just as bad as regular soda. The carbonation is just as big of a problem as the sugar in the beverage.

5. Visit the dentist twice a year. It is important to have your teeth professional cleaned and evaluated. Gum surgery, root canals, and crowns can be prevented if your teeth are consistently maintained and checked for disease.

Happy New Year!

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

Internal Tooth Bleaching of Root Canal Treated Tooth

Unfortunately tooth trauma to the front of the mouth is a relatively common occurence. I have seen patients with trauma from going over the handle bar bike accidents, getting hit by an elbow on the soccer field, bar fights, and falling while running around a swimming pool. In some cases the teeth are completely avulsed during these accidents, but most of time the teeth are forcibly pushed into the bone or they are chipped. The teeth that are forcibly moved often die from the trauma, which means that the nerve of the tooth dies and the tooth ends up needing a root canal. In conjuction with nerve death the tooth takes on a darkened hue since the tooth no longer has a vital blood and nerve supply.

In the last month I have treated four teeth on three separate patients that had previous trauma, root can therapy, and a darkened hue. I have done an internal tooth bleaching therapy called "walking bleach." To do this treatment a combination of sodium perborate and superoxyl is placed inside of the tooth where the rooth can therapy was performed and it is kept in the tooth for two weeks. At the end of the two weeks the darkened color bleaches out and the tooth looks normal again!
Kari Ann Hong, DDS
1000 Newbury Road, Suite 190
Thousand Oaks, CA 91320
www.familycaredentists.com

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

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

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

New Dental Technology

I spent the last two days attending Esthetic Professionals 10th Annual Update course. This is the third or fourth Esthetic Professionals update course I have attended. It was highly informative on the latest and greatest in dental technology and materials. Also, I had the pleasure of hearing Dr. Bill Dorfman speak as well as a dental materials educater from Loma Linda School of Dentistry, Dr. Brian Novy.

The most exciting new technology presented at the meeting is 3M ESPE's new digital scanner called the LAVA COS. The scanner can image a tooth in the mouth that has been prepared for a crown. The scanner is a mix between a video camera and a still picture camera. It moves around like a video while at the same time plotting 20,000 picture points. These picture points are so accurate that the image can be used to fabricate a model that can be used to make the final crown restoration.

Dr. Bill Dorfman spoke about an electronic oral cancer detection system call VELscope. Apparently, the light emitted from the Velscope shows any cancerous or precancerous lesions as black tissue. Twenty-five percent of oral cancers occur in people that have no obvious risk factors such as a history of smoking or excessive alcohol consumption.

Dr. Brian Novy presented some convincing clinical work he has done to remove decalcified white spots caused by braces. The treatment for the white spots involves wearing custom plastic trays that are similar to bleaching trays, along with a calcium-phosphate-fluoride paste called MI paste. These trays are worn for about a month and the white spots nearly disappear.

It is always fun to learn about new technologies and procedures. The hard part is deciding which technologies to bring back to your office.

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

Conquering the two year old patient

In the past two weeks I have seen three patients in the two year old age range. The biggest challenge with patients in this age group is getting them to open their mouths and to stay open while you look in their mouth. I asked my son's pediatrician the other day why it is that one and two year olds don't like to open their mouths. His response was that the mouth is the one thing a child that age can control. Apparently you can put your fingers in the child's ears and eventually they will open their mouth to get you to remove your fingers. While this trick might work for the pediatrician that is just trying to take a quick look in the back of the throat, it doesn't work so well for the dentist that needs to evaluate 20 individual teeth.

Back to my story... I saw three such patients recently. The first one was a girl that was turning two in a couple of weeks. She didn't want to have anything to do with me and refused to even open her mouth. The second child I saw was a girl that had just turned two. I tried a different approach with her. First, my assistant found a cartoon on television for the girl to watch. Then I had the mom hold the daughter in her lap while we counted the mom's teeth. After we counted the mom's teeth, the little girl wanted her teeth counted as well. While counting the teeth I am able to evaluate each individual tooth for cavities. By two years of age nearly all twenty of the baby teeth have erupted. If cavities are present at this age, then they are either visually evident or are apparent when touching the tooth with a dental explorer (an instrument with a pin like end).

The third patient I saw was a three year old boy. In his case both the cartoon trick and counting daddy's teeth worked. As a three year old there was a little bit more comprehension of what was going on and I was able to polish his teeth as well.

Fortunately, in all three cases the children's parents were doing a good job assisting with the brushing and none of the children had any cavities. When kids this age do get cavities the only way to treat them is to either wait until the child is older (like age four or five) or to treat them while the child is under anesthesia. The best thing for the two and three year old patient is cavity prevention!
Kari Ann Hong, DDS
1000 Newbury Road, Suite 190
Thousand Oaks, CA 91320
www.familycaredentists.com