Gar N. Chan, DDS, INC

Dental Infection Control through Instrument Processing

Because your patient protection and infection control are top priorities in our office, every time we see you, or any member of you family, we take special care in supporting successful instrument processing.

How do we insure your safety? 

We do so by consistently, routinely implementing and monitoring the recommended infection control policies and procedures specified by each instrument manufacturer, the United States Food and Drug Administration, those set by the Dental Board of California and CDC (Center for Disease Control and Prevention).

How do we deal with the different sterilization times and temperatures for the many different hand pieces, instruments, and accessories we use for each procedure?

We do the following:

  1.  We carefully read and adhere to the directions for use (DFU) for all of our equipment;
  2.  We group items together that require the same time and temperature and then sterilize in batches;
  3.  We correctly package and load items in the sterilizer.

How do we minimize infection control breaches?

  1. We unequivocally use only those dental hand pieces and attachments, including motors that can withstand heat sterilization;
  2. We sterilize our hand pieces and attachments between each and every patient;
  3. We have an established workflow to minimize breach risks by using a one-directional flow sequence.  This includes the following:
  • Collection and sorting of reusable contaminated items
  • Disposal of non-reusable contaminated items
  • Cleaning via ultrasonics/washer including rinsing and drying
  • Packaging
  • Sterilization
  • Storage in a clean, dry, contamination free area in a covered or closed cabinet

How do we monitor and ensure that the sterilization processes are successful and working as they should?

Our staff monitors these sterilization processes daily, weekly, monthly and yearly by maintaining records.  Our monitoring processes include the following:

  1.  Chemical monitoring – Chemical indicators, are embedded in our sterilization instrument bag pouches and change color when exposed to high temperatures, pressure and time.
  2.  Biological monitoring – Biological indicators (BI), also called spore tests are utilized weekly inside our autoclave because they are the most reliable method of monitoring the success of this essential piece of equipment.  These BI indicators are sent to an independent lab which forwards the results to us immediately, if there are any inconsistencies.
  3. Interval maintenance – Every six months all of our instruments, whether or not they have been used, are subjected to the full sterilization process.

To protect you and all of our patients from exposure to infectious diseases, we follow established best practices and manufacturer’s DFU instructions for reprocessing (cleaning, sterilization and disinfection) all of our instruments.

If you have questions, please just ask.  We are here to help, educate and serve you, our wonderful patients!


Dimensions of Dental Hygiene, July/August 2019, p. 42-45, Eve J. Cuny

Fluoride in Water Supplies – Benefits vs. Risks

Cavities risks can be minimized through the preventive effects of water fluoridation in drinking supplies.  This is achieved by exposure to optimal fluoride levels before baby and adult teeth erupt.  This public health strategy is supported by all professional dental journals, societies, research centers and educational institutions.

Currently, the US Center for Disease Control and Prevention (CDC) and the Environmental Protection Agency recommends the following water fluoridation levels be:

  1.  at an optimal level of 0.7 ppm;
  2.  no more than 2 ppm to prevent severe enamel fluorosis;
  3.  no more than 4 ppm to limit skeletal fluorosis.

Health risks reported in the media have proven to be unfounded,  due to their study limitations, including design flaws, testing and sampling errors.

The vast majority of dental professionals contend the benefit of fluoride in public water systems in caries reduction out weighs any potential adverse effects like mild enamel fluorosis (a slight  esthetic  discolored mottling of the enamel).   In addition, mild fluorosis is non-functional and  does not detract from enamel strength or structure.  In fact,  those who present with mild fluorosis are more caries resistant than the general population.

Community water fluoridation is one of the most cost effective and equitable ways to prevent tooth decay.  The CDC named fluoridation as one of the top 10 most significant public health measures of the 20th century.

Consumers need to be aware of the misinformation about water fluoridation that has  surfaced on the internet.  By  focusing on evidence based research, public concerns can be minimized and patients can be appropriately educated.

For any concerns about fluoride, please feel free to ask us.

We are here to educate you and to help you achieve optimal dental and oral health.

The choice is yours.


Source: Dimensions of Dental Hygiene 10/19  V.17, No.9. Relich & Sutton

Covid 19 – We will be closed temporarily, except for emergencies.

Our top priority at our practice, Gar N. Chan, DDS, Inc. is the safety, health and well-being of our patients, team and community. We have kept a close eye on the evolving situation with COVID-19 over the past several days, responding to changes and recommendations from the Centers for Disease Control (CDC), the World Health Organizations (WHO), and federal, state and local officials as they occur.

In response, we have made the difficult decision to close our office starting tomorrow, March 17, through Monday, March 30, 2020. We feel it is in the best interest of our community, and feel compelled to do our part to combat this virus.

For those with appointments scheduled in the next two weeks, we will be contacting you to reschedule. We understand this is an inconvenience and will be available for emergency appointments. Thank you for your understanding in this matter, and we will be available to answer your phone calls and emails to help us all work through these times, and hopefully return to our normal schedule very soon. We will continue to keep you updated with any new developments or changes.


Holiday Greetings to All!

As the winter season comes upon us,

we wish you health, peace, contentment and the excitement

of experiencing life, feelings and events.

Happy Holidays!

                                                                                       Pieced Santa quilt by Rhona T. Lee

Peri Implantitis – What is your plan?

According to the American Academy of Implant Dentistry each year over 500,000 implants are placed in the United States.  While implants are excellent missing teeth replacements, technical, esthetic and biologic complications occur.

Technical complications can include occlusal (bite) trauma, implant breakage or fracture and loosening of screws and abutments.

Esthetic complications can include exposed threads and abutments, which invites bacteria and debris to harbor in the area.

Biologic complications from tobacco use, alcohol consumption, uncontrolled periodontitis, history of periodontitis, uncontrolled systemic diseases and the inability to perform adequate plaque removal – all can increase risk factors for implant infection and eventual failure.

Implant patients need to be aware that implants are susceptible to similar gum or periodontal issues that natural teeth have and are often attacked more aggressively.   Research shows that periodontitis and peri-implantitis are similiar yet different.  Both the microbial composition and sequence of infection are similar but they are different in three major ways.  Peri-implantitis versus periodontitis is marked by the following:

1.  Higher extensive inflammatory infiltrate and innate immune response:

2.  More severity of tissue destruction;

3.  Faster destructive progression rate.

To feel more confident about your implants long term health, patients should know, prepare and practice the most current methods to maintain them.  To do so, the following are recommended:

A. Regular, consistent and professional supportive continuing care prophylactic visits with the hygienist;

B.  Use of proper home-care techniques;

C.  Use of water-irrigating devices, ie.  Waterpik’s Water Flosser used with the Plaque Seeker tip.

(The tips are inexpensive, easy to obtain and fit on all Waterpik models.);

D.  Use of an interdental brush to provide tissue stimulation and to remove plaque and debris instantly;

(Dipping the brush in an antiseptic increases the benefit.)

For all implant patients early diagnosis, treatment and home care reinforcement of implant infection

(peri-implant mucositis) are essential.

When is your next continuing care maintenance visit?



Kombucha: An Elixir Tea or Champagne?

Kombucha, a growing popular green or black tea, has been called the “Champagne of Life”, but is it really?

Over thousands of years several cultures have claimed that drinking kombucha daily promotes well-being and energy.  Kombucha starts as a tea to which is added strains of bacteria, sugar and yeast.  The mixture is fermented to produce a mushroom cloud formation, which can be ingested and then used to ferment new kombucha.  The fermentation process produces acetic acid and various species of lactobacillus strains that are purported to have positive impacts on irritable bowel syndrome, diarrhea, cancer, heart disease and Type 2 diabetes.

As the Western culture has begun to embrace this  ancient elixir,  side effects are being noted, including stomach issues, yeast infections, allergic reactions, nausea, vomiting and jaundice.  The fermented tea batches can become contaminated with bacteria and fungi which place those with weakened immune systems at risk.  Because the batches contain alcohol, alcoholics should refrain from consuming it.  Due to high acidic pH from 2.5 to 3.5, the content places the enamel of those who sip their tea at a high caries risk.

The  scientific jury is out on this elixir.  If you are a regular user or want to try it, be aware of precautions in order that you can make informed decisions on its risks and benefits.   (Reference:  Dimensions of Dental Hygiene, September 2019, Jill Rethman, RDH, BA, page 6.


Happy 4th of July!


Handmade quilts by Rhona Lee



According to Wikipedia, Independence Day (colloquial: the Fourth of July) is a federal holiday in the United States commemorating the Declaration of Independence of the United States on July 4, 1776. The Continental Congress declared that the thirteen American colonies were no longer subject (and subordinate) to the monarch of Britain and were now united, free, and independent states. The Congress had voted to declare independence two days earlier, on July 2, but it was not declared until July 4.

Independence Day is commonly associated with fireworks, parades, barbecues, carnivals, fairs, picnics, concerts, baseball games, family reunions, and political speeches and ceremonies, in addition to various other public and private events celebrating the history, government, and traditions of the United States. Independence Day is the National Day of the United States.

We are proud to be citizens of this great country.  Happy 4th of July everyone!


Welcome little Layla!


Patients come in all sizes and ages.  This is six year old Layla, who came in today for her first visit with us.

Dr. Chan checked her teeth for cavities and for spacing.  He did this to make sure that as she grows, she will have enough space throughout her mouth for her permanent teeth, which are almost always larger than her primary or baby teeth.  During her appointment Layla’s teeth were colored to show her in the mirror where the “pink colored sugar bugs” were hiding.  Layla could see where she needed to use her toothbrush to brush off those pesky bugs.

All of her teeth were then polished to make them all shiny and bright.  Every six months Layla’s teeth will be checked to monitor her growth patterns and to keep her dentition and oral condition as healthy as possible.

Layla left with a big smile, especially after picking out a toy from the toy box.   Great check-up, Layla!

Dry Mouth or Xerostomia

What is dry mouth or  xerostomia and what can be done to minimize its effects?

People of all ages can have dry mouth symptoms, otherwise known as xerostomia.  This condition may be attributed to many factors either singly or in combination, including but not limited to the following:

1. Medications
2. Allergies
3. Use of a C-pap machine
4. Snoring
5. Age
6. Other health conditions, ie. Sjogren’s Syndrome                                                                                   7. 7. Tobacco and alcohol use
8. Chemo and/or radiation therapy

When dry mouth occurs, salivary flow changes both in quantity and quality.  Saliva helps prevent tooth decay and demineralization of tooth enamel by neutralizing acids produced by bacteria, limiting bacterial growth and washing away food particles. Saliva also enhances your ability to taste and makes it easier to chew and swallow. In addition, enzymes in saliva aid in digestion.

Decreased saliva and dry mouth can range from being merely a nuisance to something that has a major impact on your general health and the health of your teeth and gums, as well as your appetite and enjoyment of food.

There are several simple strategies to offset some of these effects.  They include the following:

1. Having a fluoride foam treatment (Acidulated phosphate fluoride foam with 1.23% Fl ion)  twice a year in a dental office;

2. Application of fluoride prescription strength toothpaste on your teeth overnight and, if you have one, under your retainer.  You will need a prescription from your dentist to fill this at the pharmacy.  The difference between a prescription strength fluoride toothpaste and an over the counter (OTC) fluoridated toothpaste is that the prescription strength is much more concentrated and effective than the OTC. ;

3. Use of dry mouth products, ie. Xylimelt tablets overnight and/or All Day Spray and/or Biotene gel (lubricating gels), mouthwash products, and sugarless oral lozenges.   All of these products are effective, low cost and readily available on-line. ;

The first two procedures will re-mineralized your teeth. With time fluoride applications will decrease sensitivity to cold temperatures and protect your teeth against acids and cavity formation.  The third procedure will help to maintain a neutral oral environment against the increasingly acidic environment.

We encourage everyone to maintain their overall health, especially their oral health!