Using an Old Retainer to Straighten Teeth

If you have had braces in the past, you were probably given a retainer at the completion of your treatment. For many, wearing a retainer daily is a task that usually falls to the wayside after a few years. When this happens, some may experience a slight movement of their teeth over time. Others will see complete orthodontic relapse to their previously crooked state. Either way, you may be tempted to reuse your old retainer to re-straighten your teeth.

The amount of post-braces movement your teeth will go through depends largely on the way your teeth mesh together and the amount of space on your dental arch. It is tough to predict what patient will experience the most movement after treatment. While using an old retainer to treat this relapse may seem like an easy fix, it is generally not a good idea. Retainers can correct some slight movement of the teeth, but lack the properties to actually adjust your smile. Causing serious damage is unlikely, but you always run the chances of irritating your gums, starting a toothache or chipping enamel. As with any appliance, NEVER force your retainer over shifted teeth.

If your teeth have moved significantly after braces, Invisalign can be a great option. A short treatment of clear aligners can properly straighten teeth and create a better smile line. If you would like to know more about orthodontics, retainers or Invisalign, please give our office a call!

Organic Toothpaste

If you shop at a natural market like Whole Foods or Sprouts, you have probably seen the organic toothpastes available in the cosmetics aisle. Companies like Toms of Maine and Jason all sell numerous types and flavors of toothpaste with varying promises. No matter what the packaging claims about being anti-cavity or enamel strengthening, all toothpastes have to have fluoride to protect against oral disease.

The protective factor of brushing your teeth comes from the mechanical action of scrubbing the enamel and the remineralizing effect of fluoride. Fluoride works by increasing the rate of enamel mineralization and interfering with bacteria's ability to colonize your teeth. Years of research and clinical trials have shown that using fluoride is safe, effective and significantly lowers your risk of developing cavities.  If you aren't using fluoride toothpaste, you are missing out these great benefits. Other ingredients, such as baking soda or triclosan may add to the protective factors but are not effective enough on their own to fight cavities. 

If you are interested in switching to an organic or specialty toothpaste, simply check the packaging for added fluoride (all active ingredients have to be disclosed by law). Specifically, Toms of Maine sells a version of their organic toothpaste with fluoride. If you have any more questions about fluoride, toothpaste, or oral hygiene, please give our office a call! 

Wisdom Tooth Extraction

Wisdom tooth extraction is the most common oral surgery procedure performed on high school and college aged patients. Depending on how the teeth grow in, they can be painful, irritating or harmful to the adjacent teeth. Read on to learn about wisdom teeth and what to expect at your extraction appointment!

Wisdom teeth (or "third molars" in technical terms) are the last molars on the upper and lower arches of teeth, typically coming in between the ages of 17 and 20. They are the most common congenitally missing teeth, with 10-45% of the population missing at least one. When they erupt, wisdom teeth often grow in at angles that limit their usefulness in the mouth. In fact, they can increase the risk of decay and bone loss around adjacent teeth, depending on their position. 

Most dentists will recommend extraction of wisdom teeth if there is any sign of positioning problems or pain. Even if the teeth are "questionable," extraction is usually recommended if the patient is young and healthy. If you choose to wait until the teeth become infected or painful, there could be more complications with the procedure or recovery. In many cases, wisdom teeth will be impacted, or stuck beneath the gums and/or bone. Because of this, and because they are positioned so far in the back of the mouth, wisdom teeth are usually removed by an Oral Surgeon. Surgeons have the skills and instruments to remove more complicated teeth more quickly and with less trauma to the surrounding tissue. 

When you have you wisdom teeth removed, you will likely be given the option of being sedated for the procedure. No matter what type of sedation or anesthesia the surgeon uses, you will need to have someone drive you to and from your appointment. Additionally, plan on missing work/school for the rest of that day and the following day for recovery (at a bare minimum). Your cheeks can be swollen for the first week after the procedure. Pain usually peaks at about two days after and begins feeling completely normal in about a week. As with any tooth extraction, keeping the socket clean and healthy for the first two weeks is crucial. No smoking, sucking on straws or spitting with force!

We refer all wisdom tooth extractions to our network of trusted oral surgeons. If you would like to discuss your referral or better understand the extraction process, feel free to give our office a call. We are always here to alleviate any dental concerns or fears!

Types of Implant Dentures

(Left): An Implant overdenture retained by two implants. (Right): A hybrid implant denture resting entirely on four implants. 

While we often consider dental implants as a solution to replace single missing teeth, they can also be used in conjunction with dentures to replace entire arches of teeth. Many of the aspects of denture use that patients find objectionable can be alleviated with the addition of implants. However, it is important to understand the different ways that implants are used to support dentures, and the benefits of the specific appliances. 

Most patients with “implant dentures” are using a system called implant overdentures.  Here, a fairly traditional denture rests “over” two to four implants on the top or bottom jaw. It is designed to be removable and snaps onto the implant anchors. This makes cleaning around the implants easy and convenient. When compared to regular dentures, implant overdentures have much more stability and retention on the soft tissue. This is particularly beneficial for the mandible, which does not benefit from the “suction cup” action that maxillary dentures have on the palate. It is important to note that the support for biting force with this system still relies on the gums and soft tissue. Thus, you will never be able to generate as much force as natural teeth. Additionally, some patients will still object to the removable nature and bulk of these appliances. However, they are an excellent compromise between usability, cosmetics, ease of cleaning and cost for denture wearers.

A newer system of implant dentures is the all-on-four or "hybrid" implant supported dentures. This appliance is permanently screwed or cemented on four to six implants on the top or bottom jaw. They are not designed to be removed, and thus are more difficult to clean versus implant overdentures. However, they function much more like natural teeth, as the entire arch rests solely on implants. They are much less bulky than traditional dentures and provide easier chewing and biting. Most all-on-four appliances are milled out of a single piece of zirconia. Thus, if any part of it chips or breaks, an entirely new arch of teeth needs to be created. The biggest drawback to this system is cost. Treatment for all-on-four dentures is typically two to three times the cost of implant overdentures. For this price, you are getting the best permanent replacement for natural chewing and eating.

Other factors, such as bone health, gum tissues, jaw relations and face shape will all play into your choice between implant overdentures and all-on-four implant dentures. Surprisingly, cosmetics varies from patient to patient, with some seeing more realistic results with implant overdentures. Making an informed decision relies on a thurough exam and consultation to create a comprehensive treatment plan. If you would like to know more about dentures, implants or other methods of replacing teeth, give our office a call!

Dental Questions: Can I be allergic to dental crowns or fillings?

While understanding all of your medical allergies is essential to providing safe care, reactions to common dental materials are rare. Over decades, the products we use were developed to avoid irritation and work well with the natural tissues in your body. Overall, any allergic response to a crown, filling or implant would be extremely unlikely. 

In the past, fillings and crown materials relied heavily on the use of metal. Mixtures of different metals called alloys allowed labs to create resilient structures that adapted well to the natural teeth. In the early years, many porcelain and metal crowns contained high amounts of nickel in their structure. Patients with nickel allergies sometimes developed irritation, itching and swelling around newly placed restorations. In modern dentistry, less irritating metals such as gold and palladium are now used in place of nickel. As a whole, metal plays a much smaller role in today's practice, and thus metal allergies are not a predominant concern. 

Tooth colored materials are even less likely to cause an allergic reaction. The crowns we place are typically either made of ceramic or glass and thus have almost no allergic potential. The fillings we place at our office are also non-irritating. Composite (tooth colored) materials are placed in an "uncured" state (so that they are soft/moldable) and "cured" with a light to become rigid and durable. Once the material is cured, the chemical structure is permanently altered and unable to leak or leech compounds into the body. 

Overall, the materials used at a modern dental office are extremely safe. Our patients' health and safety is of utmost importance, beyond the need to fix a single tooth. If you would like to know more about the products we use at our office or have a question about how one of your allergies or conditions might affect dental care, please give our office a call.

Dental Questions: Why does it take two weeks to make a crown?

In today's world of on demand service, it may seem strange that a dental crown takes two weeks to make. Your confusion is probably compounded by news of "same day" crowns available at some dental offices. The reality is that many crowns are created (at least partially) by hand and take time, expertise and effort. Read on to learn how dental labs recreate and help replace lost teeth. 

After your first crown appointment, there is typically a two week wait until the new restoration is ready to be cemented to your tooth. In this time, a lab has to receive the impression, create a stone model and make a wax replica of your tooth. While many offices are using computer aided design and digital scanners to simplify this process, most of it is still done by hand to some degree. Converting the wax replica to metal, zirconia, porcelain, or other ceramics involves delicate processing and layering to maintain the initial structure. Finally, most crowns are colored and glazed (textured) by hand to expertly match them to the adjacent teeth. Currently, there is no computer or machine that can visually blend a tooth color to the rest of the mouth like a skilled lab technician. 

Some dental offices currently offer "same day" or "one visit" dental crowns. Here, a digital impression is taken after your tooth is prepared and the crown is milled out of a ceramic block while you wait. You will leave the office that same day with your permanent crown cemented. While this technology is fantastic in some applications and has a very promising future, our office feels that it needs a little more refining before we offer it to our patients. Studies show that the margins (where the tooth and crown meet) can be less precise with these digitally milled crowns. Additionally, many machines require additional tooth structure to be removed in order to create a shape that is compliant with the milling process. Overall, there is nothing wrong with this style of dental crown, but we feel the benefits of using a lab created restoration outweigh the drawbacks of a waiting period. 

Dental crown placement is one of the most common procedures carried out at dental offices nation wide. At our office, we specialize in creating crowns that are beautiful, functional and feel natural in your mouth. If you would like to know more about crowns, veneers, fillings or other dental procedures, please give our office a call!

Dental Questions: Should I try to reattach a lost crown?

If you've had a crown fall off unexpectedly, you're probably familiar with the feeling of shock, confusion and horror as you gaze down at part of your tooth in your hand! While your first instinct may be to try and re-cement the lost restoration, this can come with some serious consequences. The best bet is to let your dentist evaluate and repair your tooth with the proper materials and techniques.

Temporary dental cements are available at almost every drug store and pharmacy. While these products may seem like a good idea, they can lead to a number of problems. If you don't use enough cement (or don't apply it properly), you run the risk of dislodging the crown again and potentially chipping a tooth or swallowing it. If you put on too much cement, the crown can seat too high and cause a sore jaw or excess material can ooze below the tooth and irritate your gums. Either way, it's best to have a dentist examine and recement the crown in-office. Crown usually fall off for a reason, and it is important to discern that the tooth and restoration are healthy enough to be reattached before creating a new set of problems. Additionally, never try to recement a crown with super glue, epoxy or any other household adhesives!

More common than losing a permanent crown is dislodging a temporary crown. These provisional restorations are used to save space between the first preparation appointment and delivery of the final crown. Thus, they are made and cemented with easy removal in mind. If you lose a temporary crown, it is important to return to your dentist ASAP. Waiting until the permanent crown is finished  can leave the underlying tooth vulnerable to chipping, nerve irritation or movement from the adjacent teeth. 

At Thousand Oaks Family Dentistry, we always make time for our patients' urgent problems. Wether a lost crown, tooth ache or broken appliance, we are here to help. If you would like to know more about what do to during various dental emergencies, please give our office a call!

Dental Questions: Does Invisalign work for everyone?

Invisalign (generically known as "clear aligners") is a relatively new orthodontic option for patients who desire straighter teeth. They offer a number of benefits over traditional bracket-and-wire braces, including less visible hardware, easier cleaning and less trauma to the lips and cheeks. However, Invisalign is not necessarily a great choice for everyone. While most patient have needs that can be addressed through clear aligners, it is important to note the limitations of this treatment option. 

For starters, Invisalign needs to be worn at least 20+ hours a day (ideally 22+ hours). If you are unable to adhere to this requirement, your treatment will take much longer. This is one of the primary reasons Invisalign is not recommended for young and poorly compliant kids. It is better to wait until the patient is ready to commit to treatment rather than stay in trays for additional months or years. 

While Invisalign is easier to clean than normal braces, it can pose a higher tooth decay risk for individuals who choose to eat or drink with their trays in (water being the exception). The clear plastic creates a cover that can hold in sugars and carbohydrates while blocking out the remineralizing/protective saliva. Oral hygiene is of utmost importance when considering any appliance, and Invisalign is no exception. 

Finally, there is a small subset of orthodontic conditions that Invisalign either cannot treat or treats very slowly. Severe deviations from normal dentition and drastic tooth movements may be better managed with traditional braces. Here, the wires and brackets can act as anchors on which to push, pull or slide teeth. In certain cases, a combination of Invisalign and other appliances may be needed to achieve an ideal smile. There is only so much a removable device can do in straightening teeth. 

At Thousand Oaks Family Dentistry, we offer Invisalign aligners as a treatment option to our established patients. However, we evaluate each patient individually and decide if their needs are better managed by one of the orthodontists in our specialist network. If you would like to know more about Invisalign, braces or cosmetic dentistry, please give our office a call!

Case Presentation: Premolar Crown

Premolars can be very difficult teeth to repair. They are both functional (absorbing about half the chewing force of molars) and cosmetic (adding to the "corridors" of the smile). Often times, fillings cannot satisfy all these needs when restoring tooth decay or a fracture. A full coverage crown is usually recommended to provide a solution that will both look great and help protect the underlying tooth. For today's patient, an Emax lithium disilicate crown was used to restore their right first premolar. Notice how the shade and opacity blends in with the enamel of the adjacent teeth. The result is a virtually undetectable dental treatment- good as new!

If you would like to know more about fillings, crowns, implants or veneers please give our office a call. We specialize in providing cosmetic treatments that stand the test of time and would love to discuss your options!

Case Presentation: Smile Makeover

What makes a beautiful smile? Is it the size of the teeth? The shape? Color? As this case demonstrates, the answer is all of the above! Careful details help us reconstruct a smile that is not only beautiful but appropriate for the patient's face shape, age and mouth size. The goal is to create natural appearing teeth while avoiding the "chiclet" look that can come from too little color or shape variation

For this patient, we used Emax lithium disilicate crowns to restore the cracked and decayed anterior teeth. Additionally, you can see where a bridge was used to replace the patient's missing canine on the photo right. As you study these pictures, take note of the subtle color gradient from the edges of the teeth to the gum line. This gradual darkening mimics natural teeth and creates a very convincing profile. Overall, we could not be happier with the results!

If you would like to know more about cosmetic dentistry, crowns, veneers or dental implants, please give our office a call. We are always excited to restore the natural beauty and luster to deserving smiles!