4700 Spring St., Suite 210
La Mesa, CA 91941

(619) 464-2801

Dental Articles


Waterlase Dentistry

Waterlase Dentistry is the use of laser energy, combined with a spray of water, a process called HydroPhotonics, to perform a wide range of dental procedures more comfortably. It can be used for cutting teeth, bone and gum tissue and can also do things that can’t be accomplished with traditional tools such as the drill and scalpel. Your dentist will determine what type of treatment is appropriate for you.

Lasers have long been the standard of care in medicine for many surgical and cosmetic procedures such as LASIK, wrinkle removal, hair removal and many others. The Waterlase was approved for hard tissue procedures in 1998 and since has been cleared for numerous additional dental procedures. Thousands of dentists around the world have performed millions of Waterlase hard and soft tissue procedures with less need for shots, anesthesia and drill.

There are many advantages to using the Waterlase over conventional instruments: Patient comfort – Waterlase dentistry does not transmit heat or vibration, a major cause of the discomfort associated with the dental drill. In addition, using the Waterlase reduces bleeding, post-operative pain and swelling in many procedures. Accuracy and Precision – Dentists are able to treat targeted areas of tooth structure and gum tissue while having surrounding areas unaffected. The Waterlase eliminates damage and conserves healthy tissue.

Fewer Shots and Less Anesthesia – This means no needles and no numb lip for many procedures!

Better tooth preparation – Waterlase cavity preps increase bond strength of tooth-colored restorations for longer lasting fillings.

Fewer dental visits – Waterlase Dentistry gives your dentist the ability to perform many procedures that previously required referral to a specialist. Now you can have them done during your same appointment.

In the hands of your trained dentist, the Waterlase is a safe medical device. As a Waterlase Dentist, your doctor is committed to providing you with the best possible care and dental experience.

You know it had to happen. That someday, somebody in this high-tech world would make going to the dentist a pleasurable experience. Comfortable! That someday is now. Let our office take care of your needs.

Please call our office for an appointment at 619-464-2801.

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Teeth Whitening

In this world of cosmetics, teeth whiteness has become a very important concern for patients and their dentists. No matter how many procedures on goes through improving the different facial parts, it isn’t complete until the smile looks clean and white. When we bleach teeth, our patients have certain expectations. Many dentists absolutely agonize over what technique to use… what products to use… what results they can promise their patients… what they should realistically expect themselves. Cutting through all the hype can be quite difficult.

Teeth become discolored because of aging, consumption of staining substances such as coffee, tea, colas, tobacco, red wine, etc. During tooth formation, consumption of tetracycline, certain antibiotics or excessive fluoride may contribute to the discoloration as well.

Almost anyone may benefit from tooth whitening. However, treatment may not be as effective for some as it is for others. Your dentist can determine if you are a viable candidate for this procedure through a thorough oral exam and shade assessment. Many people whiten their teeth because a bright sparkling smile can make a big difference.

Extensive research and clinical studies indicate that whitening teeth under the supervision of a dentist is safe. In fact, it is considered as the safest cosmetic dental procedure available. It is not recommended however, for children under 13 years of age and pregnant or lactating women. Teeth sensitivity during the treatment may occur with some patients. The light we use generates minimal heat which is the usual source of discomfort. On rare occasions, minor tingling sensations are experienced immediately after the procedure, but always dissipate. It is completely reversible and will not damage any teeth or gum tissue.

After a teeth whitening procedure, your teeth will always be lighter than they were before if you do the recommended maintenance such as flossing, brushing twice daily, and occasional touch-ups with a lower concentrate of bleaching gel once or twice a month.

Our office utilizes the deep bleaching technique in conjunction with the regular chairside teeth whitening procedure. The result is so much more dramatic that our patients are truly happy and satisfied. “Deep Bleaching” was developed by a dentist in Orange County, who’s patients came all the way from the East Coast because his technique was so effective. We learned this technique and incorporated it to the teeth whitening procedure as an added service to our patients.

If you would like a free teeth whitening consultation, please call us at 619-464-2801 for an appointment.

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Let’s Talk About Halitosis (Bad Breath)

Halitosis is called oral malodor in the dental literature. The public sees it as a major dental problem and particularly so in kissing and sexual experiences. Currently, the manufacturer of a major mouthwash is spending big dollars on television advertising to picture morning grimaces and no kisses between couples with “morning breath.” It is only after using their mouth that kissing is acceptable.

Several years ago the then assistant surgeon general of the United States Army Dental Corps, initiated a study to determine what motivated army personnel to achieve good plaque control. Although most dentists probably would think of this as essential for oral health, it was of no concern to the soldiers. The survey showed that the soldiers only wanted to be kissable.

Unfortunately, some dentist do not make malodor control a major part of the patient relationship. This is, however, a major social problem, as well as a diagnostic sign of oral disease. Volatile sulphur compounds (VSC), the cause of bad breath, are a major first step in the development of periodontal (gum) diseases.

Compounds come from the breakdown or degradation of living tissues made of polypeptides. Thus, dead bacteria and epithelial cells are a major source of VSC.

Under the gums around the teeth have a rapid turnover of cells. They are replaced in 2-4 days. With swollen red gums, the rate increased eight times. Replacing the epithelium in as little as 6 hours. Sloughing millions of dead cells. The potential compounds become clinically and socially significant.

It is generally believed that by-products of bacterial metabolism are the primary factors in the cause of periodontal (gum) disease. They induce a change under the gum tissue around the teeth and permit an increase in accessibility of microbes which initiates a sequence of destructive inflammatory reactions such as swelling of your gum tissues.

The decaying activity of gums are toxic to oral tissues. They comprise 90% of the VSC content of mouth air and have been shown to increase with the severity of periodontal (gum) disease. It may also interfere with normal healing.

To sum it up, volatile sulphur compounds (VSC) are controlled by:

1)Regular oral hygiene, such as brushing and flossing, to reduce bacteria and inflammation. And..

2)Use of effective mouthwash.

Another area that most people seem to miss is cleaning the surface of the tongue.

There are different types of tongue cleaner available in the market today. One can also use a spoon by holding it upside down and scrape the top surfaces of the tongue

For more information. Please call 619 464-2801 for a consultation appointment.

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Brushing and Flossing

Typically, people say they brush their teeth daily and there’s a good chance most of them probably do. But brushing any old way just won’t do the job of removing plaque and neither will brushing without flossing.

Consult your dentist about the methods and dental aids that suit your mouth to make sure you have mastered these techniques. It takes some practice.

Proper brushing involves both teeth and gums. Dentist now advocate the use of a soft bristle brush and gentle scrubbing, better yet, a sonic brush that doesn’t create friction; the hard bristle brush and vigorous sawing motion advocated in the past can be harmful to the teeth and gums.

Place the brush at a 45 degree angle against the teeth and gums, aiming the bristles up on the upper teeth, down on the lower teeth, so that the bristles actually enter the gum space.

Then move the brush from side to side in a quick, light scrubbing motion. Brush section by section until you go completely around your mouth. When you’re finished brushing the outside teeth and gums, open your mouth wide and use the same technique to brush the inner surfaces of the teeth and gums and the chewing surfaces of every tooth.

It is important to prevent gum disease by cleaning thoroughly all around each tooth and into the gum space every day. Flossing is necessary to disrupt colonies of bacteria that regroup every 24 hours. If you don’t remove bacterial plaque, it builds up into a hard deposit called calculus or tartar. More plaque forms on top of the calculus, irritating the gums and eventually forming a pocket between the teeth and guns, which then will lead to eventual toothlessness.

To floss your teeth:

Break off a strand of floss about 18 inches long. Loop one end around the middle finger of one hand and the other end around the middle finger of the other hand.

Use your thumbs and forefingers with about an inch of floss between them to guide the floss between your teeth.

Hold the floss tightly and use a gentle sawing motion to insert the floss between your teeth. Don’t snap the floss into the gums. When the floss reaches the gum line, make it into a C-shape against one tooth and gently slide it into the space between tooth and gum until you can feel a slight resistance.

While holding the floss tightly against the tooth, move the floss away from the gum by scrapping the side of the tooth. Repeat the process on the adjacent tooth and gum space and on all the rest of your teeth, including the backsides of the last teeth.

Some dentists also recommend the use of gum stimulators made of balsa wood or rubber. These devices are inserted between the teeth to massage the gums and clean out the plaque. It tightens the tissue – healthy, tough tissue resists disease better.

For more information. Please call 619 464-2801 for a consultation appointment.

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Gum Disease

It is nothing new. It’s as old as man. The Egyptians, Greeks and Phoenicians, wired loose teeth together for support in their treatment of gum disease. But modern dental science knows enough about gum disease to take extraordinary efforts to save teeth and to try to prevent it by educating and encouraging patients to remove dental plaque by brushing their teeth properly and flossing them daily.

Dentist have gone beyond their old image s “drillers and fillers.” Dental science has progressed to the point that specialists are able to transplant teeth, re-implant teeth that have been knocked out, use titanium dental implants to replace missing teeth, repair fractured teeth, restore decayed or stained teeth with new, less painful methods and even straighten adult teeth.

Fluoridated water, fluoride treatments and improved nutrition have reduced the incidence of cavities dramatically. A recent survey by the American Academy of Pedodontics showed that 37 per cent of children between the ages of 5 and 12 have no cavities at all.

“Caries (tooth decay),” was the principal concern of dentists 20 years ago. Periodontal disease has almost replaced caries as the principal concern. People paid lip service to it for ages, but now dentists are much more attentive to the removal of dental plaque, the cause of gum disease.

So the impetus of the dental profession now has shifted from crisis intervention to prevention. “If people take care of things, they shouldn’t have any problems,” said one dentist. “Prevention is cheaper than any treatment that can be done.

Dentists often blame mouth problems on patient negligence, and, of course, they are right about the patient’s responsibility. A dentist may do everything he can do, but if the patient doesn’t follow through it doesn’t work.

A 1975 ADA survey found 23 million edentulous (toothless) people living in the United States with most of them wearing some form of dentures. But even dentures do not end periodontal problems. Wearing them eventually will result in loss of the bone that supports them and a patient needs a dentist who understands the process of bone resorption (breakdown), how to curb it and how to correct it. Each case is different, but ill-fitting dentures can contribute to bone loss in some patients.

There are probably a lot of possibilities for saving teeth – many have been available for quite some time. Now more specialists are available and dental insurance has made these kinds of treatment available to those who could not afford it otherwise.

The disease itself is treated with a combination of traditional methods of scaling, root planning and curettage – procedures periodontists generally refer to as surgical even though there’s no real cutting – and rigorous personal hygiene. Also available now are medicine in “chip” form that are inserted between your gum and teeth (pockets), to help control the amount of bacteria causing the gum disease, or the dental laser, used to de-contaminate the pockets as described. This will allow the body to heal before it has to take on a barrage of bacteria again.

There are patients who see their dentist every month because they just can’t seem to clean their teeth themselves. It all comes down to discipline. If you get in there and disrupt things (colonies of bacteria), you can prevent gum disease. Compliance is always a problem. Flossing is a nuisance. Let’s say you’ve got a family of six and one bathroom. Dad goes in and starts to floss and the kids start pounding on the door. He ends up not doing it.

For more information. Please call 619 464-2801 for a consultation appointment.

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Management of Oral Inflammation

Oral inflammation or swollen gums, caused by bacteria, initiate the destruction of gum tissue and compromise the periodontal attachment. This is one aspect of the relationship between oral inflammation and systemic conditions. It has been published that periodontal disease may increase the risk for cardiovascular disease, respiratory disease, osteoporosis, preterm delivery and low birth weight newborns, it is also known to accelerate the progression of diabetes. Because of these recent findings, the management of oral inflammation is critical not only for oral health but also for the maintenance of the general health of patients.

Adherance of bacteria to the oral surfaces aggregately produce plaque or dental biofilm responsible for building a complex and physically structured microbial communities consisting of several pathogenic (disease causing) species in large numbers. Dental biofilm is the slime around your teeth made up of polysaccharides that serves as a protection for bacteria from the effects of antibiotic, antiseptic or even host defense mechanisms – that would otherwise routinely control such infections and prevent disease. Without the host defense mechanism, inflammation occurs and contributes to gum disease and even promote the enzymes that destroy the bone.

The best strategy in eliminating dental biofilm from the mouth are as follows: Physical removal of dental biofilm (slime) on tooth surfaces by way of flossing, interdental brushes, remaining bacteria using mouthwash, routine oral hygiene habits, and patient education.

There are several risk factors that contribute to oral inflammation. In other words, people with the following factors are more likely susceptible to developing oral inflammation. These factors are: aging, frequent use of medication, diabetes, your gender, genetics, HIV infection, nutrition, pregnancy, smoking, specific bacteria found in mouth of person, stress, substance abuse and systemic conditions such as immunosuppression.

Alteration of the microbial environment surrounding the microbial flora (number of bacteria) can affect numbers, proportions and frequent occurrences of bacterial species present in the mouth. Dental restorations that are not smooth will prevent one from cleaning the biofilm effectively.

Despite frequent brushing and cleaning, the rapid growing rates of bacteria requires consistent efforts to decrease these disease causing bacteria to low levels. The use of topical mouthwashes containing antibacterial agents, such as chlorhexidine (e.g. peridex, periogard) or essential oils (e.g. Listerine) or prescription fluoride rinses or of an antibacterial toothpaste, will help to prevent or delay bacterial accumulation and dental biofilm formation.

Managing chronic oral inflammation would involve regular maintenance care by either a dentist or hygienist on a long term treatment plan for thorough elimination or removal of dental biofilm and calculus, and to do evaluation of the gum health status.

Frequent visits – every 3 to 6 months - all depends on the condition of the patient’s risk factors and the extent of their gum problem.

How gum problems is determined is by way of traditional clinical means such as observation of signs in the mouth, probing (measuring) pocket depth, gums are loose (loss of attachment), bleeding, x-ray pictures, patients complain of pain and discomfort, sores, thickness of plaque and calculus. An accurate determination of the severity of the gum disease is essential for selecting the appropriate treatment and maintenance strategy for each patient.

It is important to keep up with self care habits at home. Patient education and support are key for a successful personal management of gum disease. Daily brushing, flossing and use of antibacterial mouthwash and toothpaste is the only way to do it, as long as people expect to eat, cleaning should follow naturally. Non-compliance to treatment is a frequent cause of failure to prevent oral inflammation and gum disease. People need to understand the consequence of a lack of attention to the daily treatment regimen. Even to as far as kicking the smoking habit, which is a key risk factor for oral disease, should be encouraged and advocated.

A good plaque control program, together with regular gum maintenance by a dental professional and the reduction of risk factors (such as smoking) , can effectively manage oral inflammation in most of the patients.

For more information, please contact our office at 619-464-2801 for a free consultation appointment located at 4700 Spring St., Suite 210, La Mesa, Ca. 9194.

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How To Feel Good About Your Dentist

People have a hard time evaluating the competence of the dentist that they see. A person who doesn’t get well or has frequent relapses may begin to be suspicious about their doctor.

Sometimes careless dentistry may leave patients with a false sense of security until their dental problems escalate. Even then, they may not suspect or relate their problems to the quality of previous care.

A practical way to evaluate a dentist is to determine if he or she is performing a thorough examination. An examination should include a visual examination of the soft tissue of the mouth such as the tongue, throat, cheeks as well as the gums, checking the teeth and bite relationship of your upper and lower teeth, the jaw joint (TMJ), a periodontal examination involving the use of a probe to measure the depth of pockets that may have formed between gums and tooth (an indication of gum disease), a full set of x-rays if you haven’t had a recent set taken by a previous dentist, feeling the lymph nodes under your jaw, take notes of your existing restorations, and the color or shade of your teeth. A medical and dental history should also be taken.

If treatment is needed, the dentist should discuss the problem, the treatment options, and how much each will cost. An ideal treatment plan should emphasize trying to save tooth rather than extraction except in some cases. The best dentist are skilled in the latest techniques and, most of all, they are prevention oriented. They try to make you avoid having problems in the future instead of just fixing what is broken. They care to learn and improve their skills to provide better care for their patients. Beware of dentist who send you on your way with “everything’s all right; don’t worry” and do not discuss your diet and oral hygiene.

Even among dentists graduated from recognized dental schools, some are better than others. The better ones tend to be able to inspire their patients. Call it chairside manner if you will. It is a gift. Of course, there are some very good dentist who don’t communicate too well. If a patient doesn’t feel confident, he shouldn’t feel obligated to continue with that dentist.

Patients should expect someone who is concerned about them as a whole person, not just their teeth, and who will be tuned in to their problems and be responsive to them.

Dentist are trained to refer patients with problems they cannot handle to specialists who can, but some of them might not for fear of losing patients. This is often true with patients who discover later that they have gum disease.

Patients should not hesitate to get a second opinion if they feel unsure. A patient may not be able to pin point the problem – whether it’s approach or cost – but a second opinion certainly is appropriate. Patients should also be suspicious of dentist who are offended by their desire to get a second opinion. When a dentist is honest and supportive, it may end up making their patient become more confident about them.

Those seeking dentist for regular care may ask for referrals from universities with dental schools, hospitals with accredited dental services, the local dentist society, family physicians or friends whose judgment is reliable.

It is recommended that children be brought in for a first dental exam around the age of 2 ½, when there is no crisis and therefore no pain involved. This can be done by a family dentist who is comfortable treating children or a pedodontist (children’s dentist).

A recent trend in delivering dental care has been the growth of franchise dental centers, sometimes placed in department stores or shopping centers. Such centers may advertise lower fees and faster care than is usually available from private practitioners.

Bulk equipment purchases and shared overhead costs help to keep the price down. The big question is whether dentistry practiced in such a setting will be good as well as cheap.

There is no relationship between cost and quality of care. Some are good, some are terrible. Some dentist in high-rent districts may not give as good quality of care as in some clinics. We simply cannot relate fee and quality.

For those who can’t afford private dental care or who do not have dental insurance, good dental care can often be obtained in hospital-based dental clinics or the student clinics at dental schools, where faculty members supervise the student’s work. Some patients think that they get better care because a full complement of dental specialists were consultants on their cases.

For questions, call our office at 619-464-2801 for an appointment. We are located at 4700 Spring St., Suite 210, La Mesa Ca. 91941.

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Questions You’ve Always Wanted To Ask

Q. Recently, I broke a tooth that had a huge silver filling in it. I ended up having a crown made. Since I have a lot of teeth with large silver fillings in them, should I replace them with white fillings or crown them to prevent them from breaking on me again at a time when I can’t get to the dentist right away? Also, what causes them to break?

A. Your experience is a very common one. Upon placing these silver fillings, the material is soft (like concrete) at first, and it is packed into the cavity hole so condensed, to eliminate any trapped air, before it hardens. The downside however was that there were no ‘room for expansion’ provided. Like concrete, silver metal fillings expand when subjected to heat , such as your hot meal and drink. So they cause your teeth to crack. These fillings last for about 20 to 30 some years for most people until the natural wear and tear of the teeth weaken the cracked portion of the tooth – thus fracture occurs.

The extent of the fracture will determine how the tooth can be repaired. It can range from a simple filling to a root canal therapy (RCT) followed by a crown, to hopeless or irreparable.

Replacing the existing silver fillings with white or tooth colored fillings will not eliminate the crack or damage that is already on the tooth. It will however, help hold it together due to the bonding property of the white filling material. Silver filling is retained in the tooth mechanically – meaning, its retention comes from the undercut created in the tooth by the dentist. Another way to fix fractured teeth is to put on onlay (partial crown) or a full crown, to hold the tooth together. Many times, people want peace of mind specially if they are thinking of going on a long trip like a cruise or going out of state. They want the assurance that their teeth aren’t going to break on them. This is when it calls for a full crown. One can choose what type of material they want for their crowns such as all gold, all silver metal, all porcelain or a combination of porcelain and the metal of your choice.

It all comes down to fracture prevention if you have your existing filling replaced with either a tooth colored filling, onlay or a crown. You can also choose to leave it alone and deal with it if and when something breaks but then you are taking a chance as far as the extent of the break.

Q. What is plaque? How do I know I have gum disease? And why do teeth become loose?

A. Plaque is a sticky, transparent substance which clings to the teeth. It reforms again in 24 hours after it is removed. This substance consists of an enormous amount of live microorganisms. Since most bacteria thrive in protected areas which are inaccessible to conventional tooth brushing, they become a constant threat to the teeth and gum tissue. As the bacterial elements organize to form plaque (within 24 hours) they produce toxic acids capable of destroying the holding fibers and the supporting bone.

Signs and symptoms of gum diseases include bleeding gums, excessive formation of calculus deposits, drifting or shifting of any teeth – including fanning of the front teeth, loosening of any teeth and swelling in the gum area, possibly indicating the presence of an abscess.

Teeth become loose when there isn’t enough bone support. Compare this to a fence post. If two thirds of the fence post is in the ground, it is solid.. but when erosion occurs and a great part of the support is lost, leaving only one fourth of the post remaining in the ground, it is no longer solid. Like your teeth, it becomes loose.

Visualize the neck of the tooth encircled with a tight turtle neck sweater which represents the gum tissue. The threads in the sweater could be compared to the tough elastic fibers lacing through the tissue. Healthy tissue is so tight that bacterial action cannot affect it.

If bacterial plaque is allowed to accumulate in the space between the gum and the teeth, the toxins slowly destroy the elasticity of the fibers. Then the bacteria and toxins can slip into the deeper fiber areas. When they reach this more favorable environment, they can multiply to form more colonies and more toxins. The deepest fibers and the supporting bone receive the brunt of the bacterial attack and cause the pocket to deepen continuously – thus bone loss occurs. Then the teeth will come loose.

For questions, please call 619-464-2801 for an appointment. We are located on 4700 Spring St., Suite 210, La Mesa, Ca. 91941.

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Fact and Fiction About Radiation

The myths about radiation are almost as numerous as its beneficial uses according to Health News on Radiation.

Myth: Radiation is difficult to detect and measure.

Fact: Radiation is easily detected and precisely measured. There are a variety of sensitive instruments available: dosimeters measure dose; Geiger counters measure levels of radiation; and gamma cameras are for use in nuclear medicine studies. These devices can measure small amounts of radiation, even natural background radiation that is around us every day.

Myth: Radiation accumulates in the body.

Fact: When an individual is exposed to radiation, radiation’s energy is absorbed by the body. The energy may cause damage to cells or it may pass through the body and cause no damage. Cells typically repair damage that is caused by radiation, just as they repair themselves after other injuries. This damage, if it occurs, happens only once; it doesn’t accumulate.

As radioactive materials enter our bodies they are removed primarily through normal body functions. These materials also lose their radioactivity through radioactive decay.

Radioactive decay is measured by half-life, the time it takes for one-half of the radioactive atoms in a material to decay. Some radioactive elements have half-lives of thousands of years while others have half-lives of hours, minutes or fractions of a second.

Myth: Any radiation exposure will cause cancer because radiation is a very potent carcinogen.

Fact: The levels of duration of radiation exposure determine whether or not adverse health effects result. According to the American Association of Physicists in Medicine, radiation in sufficient dosage can cause many types of cancer, but only a very small fraction – about one percent – of the total cancer cases in the population are attributed to radiation exposure. These cancers are primarily from natural background radiation.

Low levels of radiation are not very effective at producing cancer. In fact, a single exposure of 10 millirems results in the same risk that a regular smoker takes by smoking one extra cigarette every 20 years or that an overweight person takes by gaining 0.006 ounce.

Myth: Pregnant women should refuse all medical examinations that involve radiation.

Fact: The effect of radiation on the embryo-fetus depends on the radiation dose and the age of the embryo-fetus at exposure. Just as we become less sensitive as we grow from children to adults, the embryo-fetus will also become less sensitive to radiation as it develops. Therefore, during pregnancy, the first 15 weeks of development are the most sensitive. For x-ray examinations during which the embryo-fetus receives a dose of less than 1,000 millirems, the national Council on Radiation Protection and Measurements (NCRP) states that “the probability of detectable effect(s) induced by such exposures is so small as to be outweighed by any significant medical benefit.”

The NCRP also states that the decision to proceed with abdominal radiography for pregnant women should reside with the pregnant woman and her attending physician, in consultation with a radiological expert, such as a radiologist or a health physicist.

For questions, please call 619-464-2801 for an appointment. We are located on 4700 Spring St., Suite 210, La Mesa, Ca. 91941.

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Radiation and the Sun

From HealthNews, here are some information for Summer.

Even though it is some 93 million miles away, the sun is the source of the earth’s energy. And although exposure to this energy may produce an attractive tan, it can also have health consequences.

The sun’s energy, emitted as radiation of various wavelengths, is part of a broad band of energy waves called the electromagnetic spectrum.

What is the Electromagnetic Spectrum?

The electromagnetic spectrum is composed of a variety of energy waves. Radio waves, x-rays, visible light, microwaves, gamma rays and ultraviolet radiation. These waves can be grouped into two categories – ionizing and non-ionizing.

Ionizing radiation is higher energy radiation that has the potential for causing biological change by stripping electrons from atoms in cells. On the electromagnetic spectrum, only x-rays, gamma and cosmic rays are ionizing radiation.

However, the sun’s radiation is non-ionizing radiation- radiation that does not have sufficient energy to strip electrons. But it can cause biological damage. For example, ultraviolet rays can damage the eyes and infrared radiation the skin.

About 45 percent of the sun’s energy is infrared radiation which we experience as heat. Another 49 percent of the sun’s energy is responsible for the visible light spectrum. The remaining six percent is ultraviolet radiation.

Although we can’t see it, ultraviolet radiation is strong enough to induce photochemical reactions and penetrate the skin. And while it can produce a tan, it can also result in long-term damage to the skin – sunburn, sagging and wrinkling, “sun spots” and possibly cancer.

The sun emits three types of ultraviolet radiation. The two which cause the most concern being UV-A and UV-B.

UV-B represents 0.5 percent of the total energy of the sun reaching the earth. It can penetrate the upper two regions of the skin and is responsible for immediate skin damage, such as redness, burning and peeling. It is also more dangerous than UV-A and is recognized as a direct cause of major skin and eye problems.

Although UV-A is of a much lower intensity than UV-B, it can penetrate the dermis, causing wrinkling and premature aging.

The third type of ultraviolet radiation is UV-C. Although highly toxic to human, plant and animal life, it is not a present concern as it is absorbed by the ozone layer and the earth’s atmosphere before it can reach the earth.

Risk of Exposure to Ultraviolet Radiation

According to the American Cancer Society, about 90% of nearly 700,000 cases of skin cancer that will be diagnosed this year could have been prevented by protection from ultraviolet radiation. With the wide array of sunscreens available today, and a little common sense, most individuals can reduce their risk of skin cancer.

However, a 1989 study by the National Institute of Health, concluded that no type or degree of tanning is safe and that prolonged exposure causes wrinkles and increases the risk of skin cancer.

Protection from Ultraviolet Radiation

X-ray technologists and nuclear power plant workers reduce the risks of ionizing radiation by limiting their exposure. People can also reduce risks of non-ionizing radiation, such as ultraviolet radiation.

Sunscreens, both chemical and physical, limit exposure to ultraviolet radiation. Chemical sunscreens filter and absorb specific parts of the ultraviolet radiation spectrum. Physical sunscreens are powders and opaque pigments that reflect and scatter ultraviolet radiation.

The American Cancer Society recommends the following precautions:

-Limit the time you spend in the sun. In particular, try to stay out of the sun between 10 a.m. and 3 p.m., when its rays are the strongest.

-Cover up. Just as lead aprons protect patients from x-rays, wide-brimmed hats, long sleeved shirts and pants can shield you from ultraviolet radiation.

-Use a sunscreen with a Sun Protection Factor (SPF) of 15 or greater. Sunscreens keep out the harmful rays of the sun. Apply it at least 15 to 30 minutes before going in the sun and reapply after swimming or perspiring.

-Beware of cloudy days. Skin burns from solar radiation can still occur.

-The sun’s rays can reach through three feet of water. While a swimmer may feel cool, burning is still possible.

For questions, please call 619-464-2801 for an appointment. We are located on 4700 Spring St., Suite 210, La Mesa, Ca. 91941.

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Questions and Answers

Q: Why are my teeth sensitive?

A: According to studies, 45 million people in the United States have experienced sensitive teeth, about 10 million of them chronically. Common causes of tooth sensitivity discomfort is experienced during eating very hot, cold, sweet or sour foods or drink, or as far as breathing in cold air. When gums recede and expose the root surface of the tooth, the problem occurs due to allowing hurtful stimuli to reach more directly to the nerve.

Other causes of sensitivity are gum disease, which could be responsible for pulling your gums away from your teeth; brushing too hard wears away gum tissue or cementum, which protects your roots; bleaching causes temporary sensitivity; crown placements; fillings; grinding your teeth at night causes excessive pressure and wear on your enamel, teeth, gums and roots.

To prevent tooth sensitivity, try to have good oral care to keep your gums healthy, avoid brushing too hard by paying more attention to your brushing, and avoid acidic or sugary foods. If you have to have them, drink plenty of water afterwards. If you are already experiencing sensitivity, avoid cold, sugary or acidic foods. Use desensitizing toothpaste or get a prescription strength sodium fluoride toothpaste, mouthwash or gel.

If you grind your teeth, it would help to have a nightguard made and fitted for you.

Q: What is this oral–systemic link that is being talked about today? Is it true that the health and hygiene in my mouth affects the rest of my body?

A: It has now been proven that there is an association found to exist between oral infection and systemic diseases particularly heart disease and stroke, preterm low birth weight babies, diabetes to name a few and even ties were made to pneumonia, respiratory diseases, and osteoporosis.

Gum disease causes heart disease by allowing bacteria into the bloodstream, where they attach to fatty substances and may contribute to clot formation. People with gum disease are twice as likely to suffer from coronary artery disease. Common dental problems are stronger predictors of heart disease than high cholesterol.

It is estimated that about half of all pregnant women will experience pregnancy gingivitis due to hormonal changes. If this is allowed to develop into a more serious gum infection, this may affect the weight of the baby during birth. Premature Low Birth Weight babies (PLBW), refers to any child born less than 37 weeks into the pregnancy, weighing less than 5.5 pounds. A pregnant woman with gum disease may be up to 77 times more likely to have a baby too early or too small, because the condition triggers increased levels of prostaglandin, which may cause contractions that induce early labor.

People with diabetes, are three to four times more likely to develop gum disease. Too much or too little sugar in the blood affects the provision of nourishment to all parts of the body including the gums.

Likewise, research suggests that having gum infection may make it difficult to control blood sugar. Many people with diabetes do not know they have it. A tell tale symptom like “acetone breath” may help your doctor or dentist diagnose the disease earlier. There is no clear evidence that having gum disease can put you at risk for developing diabetes but getting your gum disease under control may actually help to improve your control of your blood sugar levels.

People who are compromised by diabetes, respiratory diseases, or osteoporosis should consider gum disease to be a serious threat to them. It may now be up tp the dentist to educate patients on the meaning and significance of the presence of a bacterial infection and/or inflammation in their mouths.

For questions, please call 619-464-2801 for an appointment. We are located on 4700 Spring St., Suite 210, La Mesa, Ca. 91941.

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More Questions and Answers

Q: How can the dentist help in maintaining the health of elderly patients?

A: Right now, 13% of the general population are senior citizens and this figure increases every year. By the year 2030, more than 70 million Americans (19% to 20% of the population) will be over the age of 65. Today, the elderly are spending quite a bit of their discretionary income on dentistry. About 64% have visited the dentist last year. What this means is that the dentist/hygienist have a greater role in maintaining the overall health of this senior population by evaluating the medical conditions that may affect their dental health, according to Dimensions of Dental Hygiene (April 2005).

The National Center for Chronic Disease Prevention and Health Promotion reports that 80% of all seniors have at least one chronic condition, and 50% have at least two. Most of these patients are maintained with prescription medication and therefore be evaluated with medication in mind. Patients who are compliant take their medications properly, seek regular medical care, keep their appointments and comply with their medication regimen. Noncompliance includes not taking a medication, missing doses, taking more than what’s prescribed, improper timing of dose, failure to fill or refill a prescription and sharing medications. A good number of patients do not have prescriptions filled due to cost, cultural background, isolation and other reasons. Older patients can also be noncompliant for not asking their doctors enough questions to understand what they need to do.

The dentist/hygienist can help by identifying patients who are noncompliant with their medications upon asking them questions at each appointment. Probing questions based on their medical history can be used to assess the patient’s ability to tolerate dental treatment. Patients who skip doses of medications for diabetes or heart ailments can be at risk in the dental office. This will alert the dentist to refer the patient back to their physician until the ailment is under control. This is how the elderly patients can be kept in checked to help them become more compliant with their medications that are responsible for their health maintenance.

Q: Is teeth bleaching effective and safe for teenagers? Is it even necessary?

A: Teenagers like adults desire whiter teeth. The question is, who doesn’t want whiter teeth? We are not even talking about whiter than white here….just whiter than our current color. Our children live in a world of peer pressure and are burdened with “look good and be accepted” philosophy. We all hope that our children are being raised to feel good about themselves regardless of what other people say and to make good choices. Peer pressure coupled with a sense of dissatisfaction with their smiles may cause adolescents to want their teeth whitened. Many teenagers whiten their teeth without the knowledge of their parents and dental professionals. Over the counter whitening systems like the bleaching strip are real popular among these teenagers.

The concern we have is that the self treatment on bleaching by adolescent has not been evaluated in clinical studies yet. Although there have been case reports of vital bleaching cases, studies assessing the safety and effectiveness of peroxide whitening in an adolescent population have been very limited.

So should children whiten their teeth? There really has been no difference in the reaction of the teenagers to those of the adults as far as temporary sensitivity and oral irritation. Dentists can feel comfortable making recommendations for teeth whitening with either a strip or tray system for teenagers who have concerns about the appearance of their smiles.

For questions, please call 619-464-2801 for an appointment. We are located on 4700 Spring St., Suite 210, La Mesa, Ca. 91941.

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Dry Mouth

A common and rapidly growing problem among dental patients today is Dry Mouth or Xerostomia.

Some experts say that dry mouth is reported by 17% to 29% of the population and this figure increases to 40% of the population over the age of 55. We often overlook this condition easily during a dental exam and if left untreated, it may eventually lead to tooth decay, gingivitis (gum inflammation) and a variety of oral infections.

Dry mouth can have a significant impact on a person’s quality of life. For this reason, dentists have to be vigilant in diagnosing dry mouth, and while eliminating the condition may not always be possible, dentists can help their patients manage their symptoms and improve their quality of life.

Absence of adequate saliva is what leads to dry mouth, as it is a vital component of such everyday processes as tasting, swallowing, speech and digestion. A reduction in salivary flow can happen from a number of reasons, but medication use is a major contributor. This is the most probable reason that dry mouth rates increases with age. There are about over 400 medications that can adversely affect saliva production including common classes as antihistamines, antidepressants, and antihypertensives. Other contributors are smoking, stress and anxiety. Additionally, many cancer patients who receive radiation treatments to the head and neck may suffer permanent loss of function in the salivary glands.

People who have dry mouth often complain of trouble in speaking or eating, discomfort in wearing their dentures, oral dryness or the feeling of burning tongue, remarkably less saliva, frothing saliva, cracking lip on the corners of the mouth, and having more teeth decay. Often, patients do not tell their dentist and visual signs are not always evident. So it is then the job of the dentist to proactively question patients to identify the sufferers and those at risk.

Helpful questions to ask are: Does your mouth feel dry or uncomfortable? Do you enjoy your food as well as you used to in terms of how it tastes like? Are you constantly thirsty that you feel like taking a sip of water often? Do you have trouble eating sometimes?

Common self treatment measures and management of dry mouth is sipping on water and sucking on sugarless candy. This remedy provides short term relief only, however. Farther-reaching change and adjustment in lifestyle includes abstaining from alcohol and less spicy foods. The problem with this is that people will not be able to do this for a long time. A more ideal solution should be something that people can incorporate into their lifestyle for the rest of their lives.

There are moisturizing mouth washes available in the market today that moisturizes (similar to what artificial tears can do for the dry eyes). A real popular one to use is Oasis mouthwash from GlaxoSmithKline. It is available in spray form as well. Product like this hydrates the mouth and trapping in the moisture to prevent moisture loss for about two hours. People who suffer from dry mouth think this type of product is effective compared to merely sipping water constantly.

The prevalence of dry mouth may likely increase as the aging population continues to grow. Dentists can help their patients prevent more serious oral health problems by helping them identify early signs of dry mouth during routine dental exams.

For questions, please call 619-464-2801 for an appointment. We are located on 4700 Spring St., Suite 210, La Mesa, Ca. 91941.

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The Progress of Dentistry

The dental profession has evolved a lot in the past 60 years. Curiosity and wonderment or even the constant thinking about how to make something better, also known as research is responsible for the progress we have made in dentistry. Any dentist out there can attest that dentistry has never been more enjoyable to do than ever before because of the different options in treatment and materials available to make beautiful restorations.

We are where we are now because we understand bacteria and infection. Understanding microbiology as it relates to dental caries and periodontal (gum) disease, recognizing them as infectious diseases, has changed the way we treat both of these conditions. We were able to develop strategies of prevention based on these findings.

We have general and local anesthesia. Nitrous Oxide (laughing gas) was also discovered to be used successfully as a form of anesthesia.

Standards have been set on techniques for filling teeth, operative procedures and instrumentation and visual aids in educating the public on dentistry.

Then we have federal funding for dental research being established by President Harry Truman, who signed a congressional bill to formally establish the National Institute of Dental Research in 1948. Its mission continues today to be the improvement of oral, dental, and craniofacial health through research – a beginning of the infusion of science, technology, and public money into university based research.

The benefits of fluoride were discovered when clinical trials were conducted on the fluoridation of drinking water. This was perhaps the most significant public health measure of the 20th century by fluoridation of water to reduce tooth decay. Subsequently, it led to the use of fluoride in other forms, including gels, rinses, dentifrices and sealant.

Adhesive bonding and polymer chemistry were then developed. Obviously, the ability to do most of cosmetic dentistry today are enjoyed and benefited by the public which all goes back to the original polymer chemistry.

High–speed rotary instrumentation was invented by John Borden in 1957. His introduction of high speed drills greatly enhanced the end effect of treatments of the dental caries process. Combined with local anesthesia, high- speed handpieces make dentistry kind of painless.

Implant dentistry was then introduced by Alvin Strock for his first vitallium dental screw implant. Much later, Professor Branemark represented his first application of his discovery of osseointegration. Implants have enabled dentists to restore function in a different and simple way using biological approaches and very specialized materials.

We have better understanding on host response to infection and inflammation. How the body reacts to microbiota in the mouth and how to treat it.

The occurrence of the digital revolution dramatically and rapidly changed the way dentists manage and practice dentistry. It is the result of digital technology: computers and telephones, digital radiography, CAD/CAM chairside restorations, intraoral imaging, computerized patient records, and practice management software. High-tech products such as high intensity curing lights, lasers and laser based diagnostic tools continue to change dentistry at a rapid pace.

The link between oral and systemic disease is now recognized. With it came the understanding that without oral health, no person is truly healthy. Links between oral disease and systemic diseases such as caridiovascular disease, delivery of preterm, low-birth-weight babies, diabetes and others, enable the dentists to work more closely with their colleagues in medicine, nursing and pharmacy as an integral part of the biomedical team. The medical community realizes that dentistry has a lot to offer to the healthcare enterprise as a whole and makes them equal partners.

Where will dentistry be in the future? Stay tuned for more in the next issue.

For questions, please call 619-464-2801 for an appointment. We are located on 4700 Spring St., Suite 210, La Mesa, Ca. 91941.

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The Future in Dentistry

There is a bright future in dentistry in the next 10 to 20 years, if not sooner. According to Dr. Lawrence Tabak, director of the National Institute of Dental and Craniofacial Research, a whole new set of tools will be available to identify individuals with the greatest risk for the variety of oral diseases and conditions that the profession now faces. Diagnostic tools such as genome association studies and the identification of relevant biomarkers found in saliva.

Saliva, is said to be the widespread of research interest because it holds the potential to impact dentistry’s future position in the overall health care arena. Although this is further into the future, identifying biomarkers will allow us to create interventions that are personalized to an individual. The fact is not everybody metabolizes medicine the same way. If we can predict early on that a particular individual will need a particular medicine, we can personalize the level of the medication to best match the individual’s makeup and their ability to metabolize it. The way caries and gum disease are being handled and treated are going to be dramatically different than it is today. Prevention is still the key but there will be focus on restoration of form and function. We will have the means on identifying people who are most susceptible and the early stages of diseases. Interventions may allow us to remineralize and reverse the disease process. We will be able to alter the bacterium present to a more healthy bacteria group in periodontal (gum) disease. As for oral cancer, early stage identification would allow us to institute therapies that would help reverse the progression so it never proceeds beyond that point.

Dentistry will have an arsenal of ways to tackle the various devastating diseases and conditions requiring restorations including diagnostic and prevention measures. With the promising stem cell research and tissue engineering and even gene therapy, dentists will be able to achieve what was impossible before.

In this regard, Dr. Gerard Kugel, associate dean for research at Tufts University School of Dental medicine, sees the real future and the real breakthroughs, coming from tissue and biomedical engineering research, including stem cell research. They are finding ways to grow bone on matrix so that they can replace bone that are lost both periodontally and post-surgically. Also included are growing primitive teeth from stem cells in the hopes that someday, replacing missing teeth by regrowing them can be possible.

Although these researches may not be implemented in practice yet for another 20 years or 30 years, but its beginnings are happening now. It is all possible.

The idea of replacing any structure and tissue in the mouth damaged by pathologic disease or trauma using the regeneration techniques being studied right now is the future of dentistry.

“Today, we may be talking about what materials to use to build up a broken-down tooth,” says Dr. Kugel. “Tomorrow, you may be talking about how to regrow enamel and dentin on that broken-down tooth.”

There has also been studies being conducted in coming up with a caries vaccine. We have the science to make it possible to come up with the right vaccine that will battle the bacteria responsible for tooth cavities in the mouth. This vaccine intercepts the accumulation of bacteria thereby delaying them from colonizing in the mouth to prevent the onset of decay. This vaccine would make a monumental difference in the prevention of decay among children – particularly in populations that don’t have very good access to care.

For questions, please call 619-464-2801 for an appointment. We are located on 4700 Spring St., Suite 210, La Mesa, Ca. 91941.

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Advantages and Disadvantages of Amalgam (Silver) Fillings and Composite Resin (White) Fillings

According to the State of California Department of Consumer Affairs, dental amalgam is a self-hardening mixture of silver-tin-copper alloy powder and liquid mercury and is sometimes referred to as silver fillings because of its color. It is often used as a filling material and replacement for broken teeth.

The advantages of amalgam filling is that it is durable and long lasting, wears well, holds up well to the forces of biting, relatively inexpensive, generally completed in one visit, self-sealing, minimal-to-no shrinkage and resists leakage, resistance to further decay is high, but can be difficult to find in early stages, frequency of repair and replacement is low.

The disadvantages however are, the concerns about the safety of such a material, gray colored and not tooth colored, may darken as it corrodes, may stain teeth and even tissue (tattooing) over time, requires removal of some healthy tooth structure, in larger amalgam fillings, the remaining tooth may weaken and fracture, because metal can conduct hot and cold temperatures, there may be a temporary sensitivity to hot and cold, and contact with other metals may cause occasional, minute electrical flow (galvanism).

Composite fillings are a mixture of powdered glass and plastic resin, sometimes referred to as white, plastic, or tooth-colored fillings. It is used for fillings, inlays, veneers, partial and complete crowns, or to repair portions of broken teeth.

The advantages of composite resin fillings are that it is strong and durable, tooth colored, single visit for fillings, resists breaking, maximum amount of tooth preserved, small risk of leakage if bonded only to enamel, does not corrode, generally holds up well to the forces of biting depending on product used, resistance to further decay is moderate and easy to find, and frequency of repair or replacement is low to moderate.

The disadvantages are moderate occurrence of tooth sensitivity, sensitive to dentist’s method of application, costs more than dental amalgam, material shrinks when hardened and could lead to further decay and/or temperature sensitivity, requires more than one visit for inlays, veneers, and crowns, may wear faster than dental enamel and may leak over time when bonded beneath the layer of enamel.

Patient health and the safety of dental treatments are the primary goals of California’s dental professionals and the Dental Board of California. Components in dental fillings may have side effects or cause allergic reactions, just like other materials we may come in contact with in our daily lives. The risks of such reactions are very low for all types of filling materials. Such reactions can be caused by specific components of the filling materials such as mercury, nickel, chromium, and/or beryllium alloys. Usually, an allergy will reveal itself as a skin rash and is easily reversed when the individual is not in contact with the material.

There are no documented cases of allergic reactions to composite resin, glass ionomer, resin ionomer, or porcelain. However, there have been rare allergic responses reported with dental amalgam, porcelain fused to metal, gold alloys, and nickel or cobalt-chrome alloys.

If you suffer from allergies, discuss these potential problems with your dentist before a filling material is chosen.

By law, your dentist must provide a fact sheet to every new patient and all patients of record once before beginning any dental filling procedure.

As the patient or parent/guardian, you are strongly encouraged to discuss with your dentist the facts presented concerning the filling materials being considered for your particular treatment.

For questions, please call 619-464-2801 for an appointment. We are located on 4700 Spring St., Suite 210, La Mesa, Ca. 91941.

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Orofacial Trauma Today and How To Prevent It

In this day and age when sports is so popular and has been fast becoming people’s favorite past time activity, whether one participates in it or just being a spectator, cheerer, directly or indirectly, celebrating sweet victory or experiencing the agony of defeat, we often witness accidents resulting in injury to the face. Some sports are more risky than others in that it is safe to assume that all contact sports can be very dangerous. Health clubs and gymnasium attendance is on the rise due to more children and adult participation in events where the probability of trauma is apparent. People in general are not aware of how many of these sports can cause real damage to one’s face when inflicted accidentally or intentionally. The mouth is the focus here because this is where the teeth are located. Imagine having your teeth getting knocked off! Teeth you have been taking very good care of? Teeth you have spent a fortune on and have spent countless time trying to keep them clean and cavity free. The smile that defines you as the unique individual that you are and taking pride of its ownership. Perhaps it is the smile that belongs to your sweet child that it wouldn’t be the same without those teeth beaming at you? You get the picture.

So how do we protect this smile without giving up all these physically demanding sports and activities? Well, general dentists are now being asked about their opinions on prevention of athletic injuries. Since the inception of the Academy for Sports Dentistry in the United States ( responsible for providing insight on trauma treatment and prevention), a more viable and responsible solution for orofacial trauma prevention has been introduced. In the past, our patients would feel comfortable going to local sporting goods store to get their dentistry in the form of a mouthguard. This is no longer the case as the population becomes more educated on injury prevention and the availability of proven methods of prevention. The use and acceptance of preventive mouthguards is gaining on the general dentist’s list of priorities today. However, there is still a significant number of dentists who do not provide this service. An important issue to consider on identifying and managing is parental perceptions of mouthguards. How do they overcome objections of cost, custom made versus store bought, vacuum versus pressure and availability? Patient education is essential to the success of trauma prevention. The dental hygienist may play a critical role in this education during routine periodontal treatment.

There are basically three types of athletic mouthguards presently available, all significantly different in fit, comfort and acceptance. Type I is the stock mouthguard available at sporting goods stores – which are the least desirable and acceptable. There is no attempt at fit. It is simply remove from package and place in mouth kind of thing. Type II refers to the common Boil and Bite Mouthguard. These are also mostly store bought type of mouthguard with a little attempt at fitting by heating up (via boiling) the material and then try to mold it into the mouth. The uneven distribution of material and instability does not lend itself to proper fit and protection. The Type III mouthguard is of course, the custom made mouthguard. It is reported that many occurrences of injuries comes from wearing the Type I and Type II variety of mouthguards. A mouthguard will not be as protective if it does not fit properly. When it comes to mouthguards, the better the fit, the better the protection, acceptance and compliance. The internal adaptation of the Type III appliance makes all the difference. The role of the dentist is to determine the thickness of the mouthguard needed for the type of sport it will be used for, age of the athlete and history of trauma. The custom made mouthguard’s precise fit tends to be less bulky and more retentive in the mouth which increases the compliance of wearing it by the athlete as compared to the bulkiness and lack of retention of the store bought kind.

For questions, please call 619-464-2801 for an appointment. We are located on 4700 Spring St., Suite 210, La Mesa, Ca. 91941.

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