Month: February 2016

Biological Dentistry

Biological Dentist Thousand Oaks

What is a biological dentist?

Recently a few of my patients have asked me if I am a biological dentist. This is a sometimes mistakenly believed to be a specialty in the field of dentistry.  It is not a dental specialty.  It is more of a focus of philosophy in treatment. I care deeply about the bio-compatibility of all of the materials and methods that I use in my practice. So I do call myself a biological dentist.  I don’t belong to any organization but I do read and study to many of their studies and I form my own opinions and philosophies.

We, as dentists, correct pathology of the mouth and do so with foreign materials and medications. We remove tooth structure – some bad, some good, and replace it with metals, ceramics, or resins. Its not too unlike what construction teams do, but on a micro-scale. The big difference is that in dentistry the materials are going into a biologically active human body. Chewing will break down the surfaces of the fillings and crowns, enzymes will do the same.  Certainly, a very minute amount of the restorations are being slowly, slowly ingested and making the external dental work, internal and systemic.

So a huge burden is put upon dentists to research every material that is used in a practice. The material should be strong, esthetic, long-lasting, but more importantly, it must be bio-compatible.

Key Points of Biological Dentistry

Mercury in Amalgam

I spoke about mercury in fillings in last weeks blog. The main reason that I don’t use silver amalgam at all in my practice is because it contains mercury.  Mercury is a horrible poison toxic. Every reputable scientific study has shown that silver amalgam fillings are reasonably safe. That doesn’t mean that they are bio-compatible. My philosophy remains that silver amalgam should be avoided.  It is a wonderful material as far as strength, durability, cost, and ease of use.  But I simply can’t justify using it with the biological understanding we have.

Environmental Concerns

Our waste water goes into the city sewers.  Eventually everything ends up in the ocean.  I’m not an environmentalist but I do believe we need to do our parts to keep our world healthy. My biggest environmental concern has always been the ocean. I support great organizations like The Surfrider Foundation.  I can’t control issues like over fishing, but I will do my best to put chemicals into the ocean.  I have an amalgam separator incorporated into my vacuum suction system which removes the toxic chemicals from the waste so I can responsibly dispose of them.

Safe Removal of Mercury

I don’t advocate removing silver fillings for the sake of removing them.  Studies have shown that the majority of mercury exposure happens at the time of placement and the time of removal. So when a silver filling needs to be removed I advocate placing a rubber dam to isolate the tooth from the body. I also use a special suction tip that more effectively isolates the area.  This provides safe removal without the peak in mercury exposure that is too common.

Bio-compatibility Testing

I understand that what might be right for one is not right for all.  I am committed to testing the bio-compatibility of my work at follow-ups and check ups. I understand that irritation of the tissue around a crown is likely not due to poor oral hygiene but due to a bio-incompatibility. I will replace any restoration, even though I believe it is safe, if it is not individually compatible.

Fluoride

I part ways with many biological dentists on this point.  I believe that water fluoridation is safe and effective.  I have read too many studies and articles and my conclusion is that we should take advantages of the benefits of fluoride.

Pathogens

It is universally accepted that pathogens cause just about every issue common to oral health.  Historically, dentists have only corrected the damage caused by pathogens.  Biological dentistry advocates being proactive and treating the pathogens instead of their damage.

I am committed to treating each patient as a whole person and not tooth by tooth. I will do this through keeping up to date in the latest that evidence based research and technology has to offer. I look forward to any questions or discussion that anyone has on this topic!

Dr. Sycamore

 

 

Silver Fillings vs. White fillings. Which are better?

 

silver fillings in a tooth

 

I get this question asked fairly regularly.  There is a lot of difference in opinion when you ask dentists.  So I will write a little bit about my thoughts on the subject.

amalgam capsule for silver fillingsSilver amalgam fillings have been around for about 150 years.  Modern dental amalgams are made up of liquid mercury and a mixture of silver, tin, and copper in powder form.  They come in capsules which the dentists mixes together.  The metal powder mixes with the liquid mercury and you have about 5 minutes to work with it before it becomes hard.

The benefits of silver amalgam fillings are that they are very strong and long lasting.  They typically cost a little less than white colored fillings.  The negatives of silver amalgam are that they are ugly, they stain the teeth and sometimes the gums, and that they contain mercury.

There have been many studies done and the general consensus is that dental silver amalgam is safe.  The FDA has cautiously said that amalgam fillings are safe for adults and children over 6.  It is uncertain of the safety of use of silver amalgam for pregnant women.

White colored fillings are made of a composite resin.  Many people believe they are porcelain but this is an error.  Porcelain is sometimes used in crowns, onlays and inlays, but not in fillings.  The composite resin is made up of a light cured polymer which is soft and sculptable until it is cured with an ultraviolet light.  It is then hard and able to be polished.  The filling itself does not bond to the teeth so we need to prepare the teeth for the bond.  We use a bonding agent to condition the surface of the teeth and then we cure the filling onto the bonding agent.  It sounds confusing but it is really simple and forms a fairly strong bond.

The benefits of the composite resin fillings are that they blend in seamlessly with the teeth.  They are bonded to the teeth so there tends to be less initial sensitivity.  The bond strength can also allow dentists to minimize the preparation of teeth and be more conservative with removing tooth structure.  The negatives are that the white colored fillings don’t last quite as long.  I also tend to see more recurrent decay under white colored fillings.

In my office I don’t use silver fillings.  I only use composite resin.  I believe that the benefits of the composite resin fillings outweigh the benefits of silver amalgam fillings.  I don’t believe silver amalgam fillings are dangerous but I do believe they will be banned in the not too distant future. Probably for environmental concerns more than anything else.

Sometimes patients will ask me if they should change all their silver fillings to white.  My answer in most situations is that you should change them to white as the silver fillings fail.  But it doesn’t make sense to me to remove good fillings and change them to white unless you have a good reason to do so.

-Dr. Sycamore

Teeth Whitening

Teeth Whitening information by Thousand Oaks Dentist Justin Sycamore DDS

Teeth Whitening is a really interesting subject because there is a lot of misinformation out there.  Whitening is safe!  It does not damage the enamel or cause erosion of the teeth.  It does not weaken the teeth and make them vulnerable to tooth decay.  Its actually the opposite.  The whitening solution will actually reduce the number of oral bacteria, so people who regularly whiten their teeth will get fewer cavities.  It is possible to damage the gums with a whitening solution so it is important to whiten in accordance with the directions of your chosen solution.

We are a full service dental office doing a wide range of procedures but our focus in on cosmetic dentistry.  So I do a lot of whitening!  I want to go over the different types of whitening and how they effect the teeth and sensitivity.  There are 3 types of whitening that you can do.

  1.  In-Office Whitening
  2.  At home bleaching trays
  3.  Over the counter products

In-Office Whitening

This is the best way to whiten your teeth.  It takes about an hour for an in-office whitening session.  I’ve used many different whitening products over my career.   They most marketed is Zoom.  I like it a lot.  It whitens very well but in my experience it causes too much sensitivity and in some cases pain.  So recently I started using Boost.  It whitens teeth really well and with minimal sensitivity.  So that is what I am currently using.  It takes about an hour.  I cover the gums and retract the lips from the teeth to protect the skin.  I put on a very powerful hydrogen peroxide solution and it sits on the teeth for 20 minutes.  I then remove the solution and apply a freshly mixed solution for 20 more minutes.  I find that we can usually achieve the whiteness a patients desires with one session, but we occasionally will return for another hour of whitening.  The photos that I’ve attached show teeth whitened over 2 appointments.

Before and After Images of Boost Whitened Teeth

Bleaching Trays

Bleaching Trays are really great for people who whiten their teeth frequently.  It always works best to do an in-office whitening followed by at-home whitening with trays.  The custom trays are supremely important because the solution can cause damage to the gums and the lips.  So a well fitting properly trimmed tray is vital to safe whitening.  There is a upfront cost to making the custom trays but you can use them for years assuming you don’t have changes to your teeth.  My favorite type of solution for bleaching trays is Opalescence.  They make a variety of flavors and concentrations so you can choose the one that works best for you.

Custom Bleaching Trays

Over-the-Counter Products

Too often over-the-counter products exist because there is a demand for them and not because they are good products.  So you will see whitening toothpastes, mouth washes, etc.  The reality of tooth whitening is simple.  Hydrogen peroxide and carbamide peroxide will whiten teeth.  The degree of whitening depends on the concentration and amount of time the solution is in contact with the teeth.  Mouth washes and toothpastes are only in contact with the teeth for about 2 minutes so it just isn’t long enough to make a measurable effect on tooth color.  So I don’t recommend those products for whitening.

There is one type of over-the-counter product that I do recommend and that is Whitestrips.  I gave a link to Crest Whitestrips but there are a variety of manufacturers and even storebrand whitestrips which should work fairly nicely as well.  I hesitated to link to the Crest Whitestrips because it says that it will whiten as well as a professional whitening and in my experience it generally will not.  But if you consistently use whitestrips you will see a visual improvement over time.  Teeth Bleaching with White Strips

Sensitivity

All whitening products will cause sensitivity.  There is a wide variation in sensitivity among different patients and products.  But there are a few ways to minimize discomfort following a whitening.

Use a sensitive toothpaste for a few days before, during, and after the whitening treatment

I always give my patients a few sample size tubes of Sensodyne toothpaste.  It has potassium nitrate which is minimizes the sensitivity.  So brush your teeth with it and if the sensitivity is particularly bad you can actually smear the toothpaste over the sensitive teeth and leave it there.  It will surprisingly help a lot.

Take a pill

If you have no health issues that would preclude taking a pain reliever you can take your preferred pain killer.  Motrin,  Tylenol, or Aleve would all be good choices.  Again make sure that you have no health issues that would be negatively effected by taking a pain killer.  But if you can, it can really take the edge off.

Avoid cold food and drinks

Don’t even try to eat ice cream for a few days and be careful with cold drinks.  It will be annoying for a few days but it will get better.  Sensitivity is always temporary.

What’s the Deal with Wisdom Teeth?

Wisdom Tooth Removal Thousand Oaks

I get so many questions about wisdom teeth so I thought it would be a good topic to discuss.  Most of the wisdom teeth I remove are because there simply isn’t enough space!  Its so strange to remove a healthy tooth with not a speck of decay only because there is no place for the tooth but that is what happens all the time.

 

If we go back in timWisdom Teeth Skull Brain Sizee several thousand years and look at the skeletons of our ancestors we’d see that their jaws were much longer than ours.  You would also see that their skulls were smaller.  As we’ve evolved, our brains have grown bigger and extended the skull down and forward.  You can see that the increase in cranium has pushed the jaw forward.  Our faces have also flattened.  Our jaws used to be the most protrusive aspects of our faces but now it is usually the nose.   So that also limits the size of the jaw.  So simply, we’ve really benefited by our amazing, giant brains but it comes at the cost of a reduction in our mandibles.

 

Now we have a dilemma, our jaws are smaller but we still need to squeeze in the same amount of teeth.   So what do we do?  Most of the time when there is an issue we just remove the offending tooth.  Sometimes we remove preemptively.  I always recommend young people to remove their wisdom teeth before they finish their orthodontic treatment.   I have my wisdom teeth when I was 19 before they caused any problem because my dentist felt they would cause problems later.
Wisdom Teeth Swelling

Not all wisdom teeth extractions are equal!  Some wisdom teeth come out really easy.  It is usually really easy to remove a erupted/semi-erupted wisdom tooth in a 18 year old because they roots haven’t had a chance to set in.  Sometimes the wisdom teeth erupt in a position that makes them really hard to remove.  Sometime it requires cutting the gums and surrounding bone to access the tooth.  That’s why some people get their wisdom teeth removed and have no down time and others have their cheeks swell up like chipmunks!

It’s interesting to talk to dentists because there are many different philosophies to wisdom teeth.  Some dentists want to remove every wisdom tooth, others will only try save them if the patient is missing teeth and may need the wisdom tooth in the future to support a bridge.  As for myself, I’m really conservative.  I try to save all teeth, even wisdom teeth.  So if a wisdom tooth isn’t causing any problems, my recommendation is to leave it be.

-Dr. Sycamore