Author: Dr. Sycamore

A cool portrait

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I hope to be practicing dentistry here for a long, long time.  So I think it’s important to take office pictures!  We had a photo session a few months back and I really like how this portrait came out.  Sadly, we’ve already changed staff.  We’ve had to say goodbye to Mary in the front but we get to welcome Kayley.  She’s taking over the reception duties in the afternoon!

Halloween Candy Buyback 2016!

November 3rd

9am – 6pm
dentalhalloween

I love Halloween and I, Dr. Sycamore (a certified dentist), love candy.  I think having candy now and then is fine.  I’m glad kids horde candy and pig out for a day or two every Halloween.  But after a few days get the candy out of the house!  Bring your kids to the Halloween Candy Buyback at our office.

We want to give kids a chance to let go of their candy.  We weigh it and give them a dollar a pound.  They’ll also get a toothbrush and goody bag.  We collect all the candy and at the end of the week we ship it off to Soldier’s Angels who distribute the candy to military stationed overseas.

The event is fun for kids, it’s a good cause, and it stops the steady supply of sugar from causing cavities!

We will also accept candy donations all week during business hours from grown ups who just want to get the candy out of their houses.  The last day to drop off candy is Monday, November 7th.

We won the best dentist in Ventura County Award!

VCSTAR Readers Choice

Ventura County Star Winner for Best Dentist in Ventura County East

Each year the VCStar will send a survey to it’s readers to vote for who they think is the best in many different categories.  Well…we won!  We got the award for best dentist in Ventura County East. That includes Westlake Village, Thousand Oaks, Newbury Park, Moorpark, and Simi Valley.  So I feel really happy to have won!  But what makes it even better is that I wasn’t aware of the contest until they told us their readers had vote me the winner!

I want to thank all of my awesome patients who voted for me in the Ventura County Star Readers Choice Awards. When I was informed I won the contest I was shocked! I really wanted to make a practice where people would be happy and come for years and years.  It really makes me happy and honored that my patients go out of their way to write reviews, vote in contests, and just go out of their way to spread the word about our practice! We’re still new — less than a year old, but we’ve seen so much growth in the last few months.

Best Dentist in Thousand Oaks

All About Periodontal Disease

Periodontal diseasePeriodontal disease is the worst! Teeth with tooth decay or nerve problems can be treated with fillings or root canals but periodontal disease causes irreversible damage. Even if the teeth themselves are perfect, they are in danger of being lost if there is insufficient periodontal support. Periodontal disease is a term we use to describe the loss of bone and gums around the teeth. Since bone loss is irreversible, the name of the game is prevention!

What causes periodontal disease?

Periodontal disease is caused by bacteria. However, the loss of bone and gum support is not directly caused by bacteria. There are many types of bacteria found in the oral cavity. Some are actually good. They can actually assist in the pre-digestion of food as well as preventing harmful bacteria from growing out of control. That good bacteria is called normal flora. There is some bacteria that can cause harm. It can bind to teeth and cause tooth decay. It can also form plaque and tartar and cause inflammation to the gums. The inflammatory process is actually the direct cause of periodontal disease! If we can subside the inflammation, the destruction of the gums and bone will stop.

Periodontal disease progression

How do we stop the inflammation?

Since the cause of inflammation is bacteria, we have to remove plaque and tartar! Most of the time that is a really simple process. I can usually really easily remove it with a ultrasonic scaler. It’s a great instrument that uses water and vibration to loosen the tartar. It is usually painless and fast. I can usually do a full mouth debridement in about a half hour.

Occasionally, I need to do what is called a scaling and root planing. It is a similar treatment but I will anesthetize the inflamed area and clean deep under the gums to reach every speck of tartar. If I leave even a little bit we might not relieve the inflammation. The scaling and root planing is a little more involved but is a really great treatment when needed.

When the gums don’t respond to those treatments, then we may do a periodontal surgery. This involves retracting the gums and repairing any defects in the bone which are preventing the gums from being healthy. Fortunately, this is not a common treatment but it works wonders in rare cases.

Is periodontal disease contagious?

According to the American Academy of Periodontology, it is. We are often pretty lax about spread of germs within families and loved ones. Things like kissing or sharing glasses or utensils can spread bacteria from one person to another. The bacteria found in someone with active periodontitis can spread to someone with healthy gums and that bacteria can grow and cause inflammation in the previously unaffected individual.

So if one member of the family has signs of periodontal disease (bleeding gums, red inflamed gums) Then it actually benefits the other members of the family if that member goes to the dentist to get the inflammation under control.

Prevention is everything! When I am doing an exam I always evaluate the periodontal condition. Sometimes we will need to see someone with the initial signs of periodontal disease more often to prevent any future damage. The good news is that with proper professional maintenance we can control the damage that would otherwise occur. If you think you are having symptoms of periodontal disease than schedule an appointment for evaluation and then stay on top of your regular dental cleaning!

 

Being Green: Conserving Water

Conserving Water in Thousand OaksWe’re Saving Teeth and Saving Water!

I love living in Southern California. But one of the things that is engraved deep into the brains of all children growing up in California is the importance of conserving water! Especially now that we are in one of the worst droughts in recorded history, we really need to due our parts to save water. When I was designing my dental office, I knew that I wanted to make my office green! In this weeks blog I want to share some of the things that we are doing to conserve water.

Vacuum Pump System

About 90% of dental office use what is called a wet ring vacuum pump system.  This creates the suction that removes saliva and water from your mouth.  It uses water to create the suction.  They can use thousands of gallons a day. This article states that some wet vacuum pumps can use up to 200,000 gallons of water per year.  That’s an Olympic size swimming pool worth of water every month.  Even with a recycler they waster hundreds of thousands of gallons a year.  We decided that was unthinkable in Southern California and purchased a dry vacuum.  It requires no water at all.  They are more expensive and require more maintenance but the savings in water makes up for it. 

Toilet and Faucets

I believe the toilet to my building was original to it’s construction. It used a whopping 3.6 gallons per flush. A true antique that is thankfully not in use any more. The new toilet fixture is a Toto ultra high efficiency toilet that only uses 1.0 gallons per flush. It is CalGreen certified and saves a ton of water.

We have a lot of faucets in the building but all of them have regulators on them to limit the water flow and to save water.

Rain Collection

With the rain that we’ve been fortunate enough to get recently, we decided to take advantage of it and purchased a rain collection barrel.  It sits under the down gutter and collects all the rain that is collected from the roof of the building. We can use that water for watering plants and cleaning the exterior of the building.

You can actually get rain barrels for your house for free!  The Thousand Oaks Go Green website was giving out rain barrels and says it plans to give more out in the future. So be sure to check out the city’s website for that and a lot of other green info.

Saving water is something that is vital to everyone living in Southern California.  But we can only make a difference if we all conserve together!

“No Prep” Porcelain Veneers

Porcelain veneers make smiles beautiful

Porcelain Veneers: Easier than ever!

Porcelain veneers are probably the most common procedure in cosmetic dentistry. The idea is simple. We bond a layer of porcelain over the visible surface of a tooth. It’s really not too different from acrylic nails. A manicurist will glue them on to existing fingernails to cover damage and alter the shape. Porcelain veneers have become a lot more popular than you may think and a lot of your friends and acquaintances who you think have perfect teeth actually have porcelain veneers.Porcelain veneers are like acrylic nails

One of the drawbacks of placing veneers has always been that the thickness of the porcelain required to be strong enough to function in the mouth has always had to be too thick to place directly on the teeth.  This required reduction of the enamel to prevent the teeth from looking bulky. So a typical appointment was first numbing the patient with a local anesthetic, preparing the teeth (which is to say, grinding off the enamel surface of the teeth to create a space for the veneers), then pushing back the gums to hide where the veneer meets the tooth, taking an impression, and finally making temporary veneers out of acrylic.  The temporary veneers are very fragile and can be easily dislodged so a lot of care is necessary in eating until the permanent veneers are ready.

Maybe my description sounds laborious but it really isn’t too bad and we regularly do it with many patients to this day. But I do have some patients who really want veneers and they don’t want to go through all of that.
porcelain veneers

Fortunately, this is an alternative.  And it is a really good alternative. We are now doing what we call “no prep” veneers. Innovation in the custom fabrication of veneers have finally allowed us to create a porcelain veneers that is strong and beautiful, yet razor thin so that we can bond it directly over a tooth.

It’s still totally custom and just like a regular veneer. It’s just significantly thinner. So what does that mean to you? We can really simplify the process of getting veneers. The new procedure doesn’t require any anesthetic. No shots! No drilling! We need to take impressions of the teeth. Then we make the veneers. We have you back and we bond the veneers directly to the teeth. It really couldn’t be any easier. It’s really a lot more like getting acrylic nails placed.

There are some limitations that this new type of veneer has so not everyone is a candidate. But it is a great procedure for those who want veneers! The only way to know is to set up a consultation and we can walk you through the process and let you know if it will work for you!

Dr. Sycamore

 

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

What’s New at Sycamore Dental?

I want to make a quick blog entry today to share a few happenings in the office and give a thank you to a very considerate patient.

It’s 2016 and things are exciting.  The amazing whitening promotion has ended but if you still have a card or mailer then we will still honor it.  January is going to have a really simple promotion.  All new patients can get an exam, x-rays and a cleaning for only $45.   So if you have been putting off your cleaning for a while then schedule an appointment this month to get it taken care of.  At that price there is no excuse!

Every once in a while I will get an email asking me general dental questions.  Sometimes I will alter that question and make it into a weekly blog entry.  So if you have any questions, you can send me an email to sycamore@sycamore.dental.  I will answer it here on the blog.

I will be going back to Ensenada in the first weekend of February for the Thousand Smiles cleft palate clinic.  It’s a really good cause.  They provide free surgical correction to children in Mexico with cleft palate and then follow it up with extensive dental treatment.  It can include implants, orthodontics, and everything else you can think of.  There is also an orphanage which buses a bunch of kids over for much needed dental care.  I’m going to be providing all types of dental services over the weekend.  If you would like to help in some way, give us a call to let us know.SAMSUNG CAMERA PICTURES

The last thing I want to mention is a big thank you to a nice patient of ours.  He has a family run business in Newbury Park, named Alfi International.  They make kitchenware and appliances right here locally.  He sent us a set of kitchen knives which are among the best I’ve ever used.   So I suggest you try their awesome knives and support local Thousand Oaks businesses!

-Dr. Sycamore

Water Fluoridation

Tooth decay is caused by bacteria.  Bacteria exists on the enamel surfaces of your teeth in plaque.  The bacteria metabolizes sugars and simple carbohydrates from the food you eat and the byproducts are acids.  These acids are trapped in the plaque and remain in contact with the enamel for up to 2 hours.

The acidic plaque causes what is called demineralization.  This is when calcium and phosphate minerals actually dissolve from the enamel.  This leaves the enamel weakened.  But all is not lost!  The teeth can remineralize!  Once the acids are neutralized the enamel will reintake the same minerals and strengthen the enamel.  We just need a neutral environment and plenty of fluoride ions.

That’s where fluoridation comes in!

This is a great 3 minute video which goes over the basics of fluoridation:

Water fluoridation has been in practice for over 70 years!

Water Fluoridation Thousand Oaks

Drinking fluoridated water keeps the teeth strong and reduces tooth decay by approximately 25% in children and adults. By preventing tooth decay, community water fluoridation has been shown to save money, both for families and the health care system.

Nearly all water contains some fluoride, but usually not enough to help prevent tooth decayor cavities. Community water systems can add the right amount of fluoride to the local drinking water to prevent tooth decay.

Community water fluoridation is recommended by nearly all public health, medical, and dental organizations including the American Dental Association, American Academy of Pediatrics, US Public Health Service, and World Health Organization. Because of its contribution to the dramatic decline in tooth decay in the United States since the 1960s, the Centers for Disease Control and Prevention (CDC) named community water fluoridation one of 10 great public health achievements of the 20th century.

What about the water we drink in Thousand Oaks?

The drinking water in Thousand Oaks actually originates in Northern California!  Its transported from the Sacramento River Delta through the California Aqueduct to the Metropolitan Water District’s Jensen Filtration Plant in Granada Hills.  It is there where it is treated, filtered and disinfected.  It is also there where it receives the perfect amount of fluoride for optimum oral health!  It is then piped directly to Thousand Oaks through the transmission facilities of Calleguas Municipal Water District.

So have no fear!  Our water is ideally fluoridated in Thousand Oaks!

What if its not enough?

Occasionally I will encourage a patient to increase his or her fluoride intake.  One way is to use a prescription toothpaste.  Sometimes I will prescribe Prevident toothpaste to be used for a time to try to remineralize some problem spots.

Fluoride Thousand Oaks