• Regular Dental Checkup
• Dental Sealants
• Space Maintainers
• Fluoride Treatment
• UCLA Saliva Test for Streptococcus Mutans

Regular Dental Checkup

In order to avoid lengthy procedures & maintain a healthy disease free mouth we recommend recare every 6 months. This allows us to detect early signs of disease & provide appropriate treatment, leading to a favorable prognosis.

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Dental Sealants

Sealants protect the occlusal surfaces, inhibiting bacterial growth and providing a smooth surface that increases the probability that the surface will stay clean. The ultimate goal of sealants is penetrating into the pit and fissures of the tooth and sealing them from bacteria.

Indications for Use

Traditionally, sealants are thought of as a preventive measure for children and teenagers when they are in their “cavity prone years”. Patients who have xerostomia (decreased salivation), are undergoing orthodontic treatment, show evidence of incipient caries, or who are prone to caries should be evaluated as candidates for sealant placement. Primary molars also can benefit from the placement of sealants.

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Space Maintainers

Space maintainers are appliances made to custom fit your child's mouth to maintain the space intended for the permanent tooth when it decides to come in. They do this by "holding open" the empty space left by a lost tooth by preventing movement in the remaining teeth until the permanent tooth takes its natural position in the child's mouth. This treatment is much more affordable and much easier on your child than to move them back later with orthodontic procedures. Think of space maintainers as insurance against braces.

Why are they important to children's dental care?

Well, baby teeth usually stay in place until "pushed out" by a permanent tooth that takes its place. Unfortunately, some children lose baby teeth too early. A tooth may be knocked out accidentally or be removed due to severe disease. When this occurs, a space maintainer may be required to prevent future dental problems. Space maintainers encourage normal development of the jaw bones and muscles, and save space for the permanent teeth and help guide them into position.

How can losing a baby tooth too early cause problems for permanent teeth?

Well, teeth are strange in that regard. Teeth attempt to "fill" any space available to them. If your child loses a baby tooth to early, the remaining baby teeth may tilt, drift, or move up or down to fill the gap. When this happens, they fill the space intended for the permanent tooth, and the permanent tooth can come in crowded or crooked. And this condition, if left untreated, may require extensive (and expensive) orthodontic treatment (braces or even surgery).

Space maintainers require any special care?

Yes, they do, and you as a parent can help. Make sure your child avoids Hard/Sticky foods (suckers, caramels, gum, popcorn, etc.). Teeth should be brushed after each meal and clean the teeth with bands especially well. Once a day, a fluoride mouthwash should be used to help prevent decalcification of the teeth around the band and wire. Do not try to bend the wire for any reason with finger or tongue. Notify our office immediately if the bands come loose or the space maintainer is damaged in any way. If a tooth erupts under the wire this also needs to be checked.

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Fluoride Treatment

What is fluoride?

The fluoride ion comes from the element fluorine. Fluoride, either applied topically to erupted teeth, or ingested orally (called systemic fluoride) during tooth development, helps to prevent tooth decay, strengthen tooth enamel, and reduce the harmful effects of plaque. Fluoride also makes the entire tooth structure more resistant to decay and promotes remineralization, which aids in repairing early decay before the damage is even visible.

Where is fluoride found?

Topical Fluoride is found in products containing strong concentrations of fluoride (i.e., toothpastes, mouth rinses), fluoridated varnishes and/or gels either topically applied by a dentist or other oral health professional, or prescribed as an at-home regimen (particularly for persons with a high risk of dental caries).

Systemic Fluoride can be ingested through public and private water supplies, soft drinks, teas, as dietary supplements, some bottled water supplies. Once ingested, systemic fluoride is absorbed via the gastrointestinal tract and distributed and deposited throughout the body via the blood supply.

What health risks are associated with fluoride uses?

In general, fluoride consumption is safe. Health risks associated with Fluoridation usually are limited to misuse and over concentration. To avoid misuse and over concentration: Avoid drinking overly fluoridated water - results of this may cause teeth to become discolored, and may cause the enamel of the teeth to look spotted, pitted, or stained (a condition known as dental fluorosis). Avoid swallowing toothpaste and other dental hygiene products.
Call the local water department and/or the health department to evaluate the fluoride level in your local drinking reservoir. Children are especially vulnerable to dental fluorosis as their developing teeth are more sensitive to higher fluoride levels. Consult a pediatric dentist or other oral health care professional if you notice changes in the condition of your child's teeth.

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UCLA Saliva Test for Streptococcus Mutans

Although several local environmental factors including dietary pattern, fluoride level and salivary flow contribute to the development of dental caries (cavities), cariogenic (cavity-causing) bacteria are ultimately responsible for the disease. These bacteria have the ability to make a gel-like plaque from sucrose in the diet, and then to create an acid environment deep in the gel-like plaque whenever sugars are eaten. The acid dissolves the crystalline structure of the tooth to create a cavity. Among the cariogenic bacteria, Streptococcus mutans is the principal bacterium responsible for the initiation and progression of human dental caries.

Previous clinical studies have established a close relationship between salivary S. mutans level, and the risk of developing caries. Similar relationships also exist with the disease activity state. These data strongly indicate that salivary S. mutans can serve as an index of both the state of activity and the risk or susceptibility of developing caries. Salivary S. mutans counts can also be used as an aid to patient motivation and compliance to reduce caries risk or activity, to help keep patients at low risk after treatment, and as an aid in assisting parents and infants in delaying or avoiding initial S. mutans infection.

UCLA Oral Microbiology Laboratory recently developed highly species-specific tests which detect S. mutans with nearly 100% sensitivity and specificity, and which count the number of these bacteria with great accuracy.

Dr. Dean Carlston DDS is offering these tests to the community with the hope that by identifying those with greater risk for dental disease, he and his staff can motivate them to take extra precautions in order to reduce the numbers of these acid producing bacteria, thereby maintaining healthy disease free teeth and gums.

What is the risk to the human body when teeth are allowed to decay, and gums are allowed to become infected?

Untreated tooth decay eventually leads to abscesses in the surrounding bone and gum tissue, and rejection of the tooth by the body leading to tooth loss.

Untreated gum disease eventually leads to bone loss around the teeth which allows the teeth to shift, become loose, and eventually be rejected by the body.

Bacteria in infected gums and abscessed teeth can enter the blood stream and spread through-out the body. This greatly increases the risk of stroke, heart attack, and pre-term babies.

As we loose our teeth, we become less and less efficient in the chewing of our food, which leads to gastro-intestinal problems, including but not limited to, weight gain, constipation, and acid reflux disease.


Who can receive this test for Streptococcus mutans?

Anyone capable of spitting saliva into a small cup can receive this test. Children should practice with their parents prior to coming to the office so that they will not be intimidated with the process in the dental office.

Dr Carlston has performed the test on children as young one year old. These younger patients can be held in the parents lap and the dental staff can retrieve saliva with an eye dropper. It would be a good idea for the parents to practice at home with an eye dropper so that small children will be less frightened.

The saliva sample is mixed with a preservative and delivered to UCLA for analysis. A report will be generated, and Dr. Carlston will discuss the results with the patient, parent or caregiver.


Why should adults be interested in this test?

60% of all adults are in need of some form of gum therapy! Knowing that one has a greater propensity for tooth and gum disease can be great motivation for taking the necessary steps to control disease and retain healthy teeth and gums.

Some patients present with moderate bone loss and gum disease, and are in need of considerable repairs to their teeth because of fractures, advanced decay or both. Before undertaking the gum surgeries, root canals, crowns and bridges, etc, it would be good to know how much of a factor these acid forming bacteria have played regarding the current condition of the patient’s teeth and gums. The patient at high risk may decide to extract an infected tooth with bone loss and replace it with a titanium implant. Implants are very reliable in today’s dentistry; and while the bone loves titanium, bacteria do not.


What steps should one take to control this disease condition or the risk of contracting it?

Depending on the extent of the disease, there are several treatment options. First and foremost is the need to follow conventional oral hygiene routines. Those at high risk should consider gently brushing and flossing after each meal, with greatly reduced snacks between meals, especially refined carbohydrates like bagels, cookies, soft drinks, cold cereals, etc.

Between meal snacks should include raw vegetables and fruits. A piece of cheese helps introduce some fat in the snack which does very little harm to the teeth and gums; but provides greater and longer satisfaction with these healthier foods.

Children younger than 6 years of age should use a toothpaste formulated for children which contains fluoride.

Individuals over 6 years of age should use a toothpaste that contains both fluoride and an anti-bacterial compound.

High risk patients should have more frequent teeth cleanings and fluoride treatments.

At home use of fluoride containing mouthwashes and gel containing trays will be recommended for certain patients depending on the state of the disease.

For individuals with very high initial counts, chlorhexidine rinses might be prescribed by Dr. Carlston.

Chewing gum with sugarless Xylitol offers some control as Xylitol inhibits the ability of bacteria to adhere to the tooth structure. Health food stores carry different brands of this gum.

Using salivary S. mutans counts as an index of caries risk and activity is much more beneficial to the patient than waiting for signs of cavity development. By the time the patient experiences pain, the condition is often in an advanced state; which makes treatment more time consuming and expensive.

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