Archive for the ‘Children’ Category

Teeth Healthy Snacks for Kids

Monday, January 6th, 2014

By Dr. Andrea Beltzer

Happy carrot chomping girl

Feeding my kids isn’t always easy.  As parents, we are constantly bombarded with information about what is healthy and what is potentially harmful for our children’s little bodies.  As a parent, I take these decisions very seriously knowing that the choices I make for my kids now will likely impact the choices they will make for themselves when they are older.

I have two children, Lucy who is five and Charlie who is two.  They couldn’t be more different in their eating preferences and habits.  Lucy has a major sweet tooth.  We were recently at her friend’s birthday party at OaksPark.  There were lots of treats being served, including lemonade, fruit punch, cotton candy, chocolate cupcakes, and cups of ice cream.  The kids were sitting at a long picnic table, and the adults were chatting at another table.  It was crowded, and I wasn’t really keeping a close eye on what Lucy was choosing to eat at the other table.  As the kids’ table emptied out, Lucy was still sitting there finishing her chocolate cupcake after having a cup of lemonade, most of her cotton candy and the cup of ice cream.  Most of the other kids had abandoned their treats half-eaten, but not Lucy.  This was her chance, and she was going to consume as much sugar as possible in one sitting, since I wasn’t right there to monitor what she was eating.  I went over to her, and we had a little conversation about making good choices, and how eating all of those treats so quickly was probably going to make her feel a little sick later on.   Then I proceeded to try to wipe off all of the gooey chocolate and sticky cotton candy that was all over her face and hands and have her drink a cup of water to try and neutralize some of the acid that was being produced by those sugar-loving bacteria in her mouth.  Some of the parents who were standing around us chuckled with me knowing that I am a pediatric dentist, and it’s my kid who is the last one sitting at that picnic table trying to devour every last gram of sugar that she can.  Parenting fail?  No, not really.  I was more amused by the situation than embarrassed.  I know that what really matters in the long run is the every day choices that we make, not the very occasional big treat that sometimes happens during special occasions and holidays.

Charlie, my two-year old, is the exact opposite of Lucy in many ways, including his eating preferences.  He enjoys something sweet here and there, but will typically have a few licks of a popsicle after dinner in the summertime, and then decide he’d rather get down and play instead of finishing his treat.  My challenge with him is that he’s a grazer.  He is two years old and easily distracted, so unless he is starving, mealtime can take a very long time, and sometimes can result in him not eating much at all.  As a result, he likes to snack or “graze” in between meals.  His top choice of snack would be crackers or chips, and he could graze on chips and crackers all day long if we let him.  We know though that a diet of chips and crackers is not good for his body or his teeth!

Many parents are surprised to learn that even snacks like crackers can contribute to tooth decay.  Any snack that is rich in carbohydrates can lead to tooth decay, even it’s not necessarily considered a “sugary” snack. This is particularly true for kids that tend to graze all day long on carbohydrate-rich snacks, including crackers, chips, cereal bars, fruit snacks, raisins and dried fruits.  Studies have shown that it is not only the quantity of sugar consumed that can lead to decay, but it is also the frequency with which the sugars are consumed.  It is much worse for a child to sip on juice or snack on crackers if they are sipping or snacking over a long period of time, than if they were to have a few ounces of juice with their breakfast.  I’ve alluded to the role that bacteria play in tooth decay.  We all have bacteria in our mouth and some of these bacteria are responsible for contributing to decay.  The bacteria consume the sugars that we consume, and then produce acid which breaks down tooth enamel causing cavities.  If the bacteria are fed all day long by those who graze on carbohydrates throughout the day, they are constantly producing acid, and the mouth remains at an acidic pH for long periods of time which results in tooth decay.  Preventing your children from grazing throughout the day on carbohydrate-rich snacks is important for the health of their teeth.

Limiting juices, flavored milks, and other sweetened beverages, as well as encouraging your children to drink a lot of water in between meals can go a long way to prevent cavities.  Chewy snacks that are high in sugar, such as fruit snacks, raisins and dried fruits should be avoided in general, but especially for children with deep grooves on their molars.  These snacks really stick to teeth and are hard to remove from teeth even with good tooth brushing.

I have discussed a lot of things to avoid, so now I will talk about some of my kids’ favorite “teeth-healthy” snacks.  My kids love avocado, and that makes a great snack all on its own or sliced lengthwise with sliced turkey or ham rolled around it.  If your child is old enough and doesn’t have any nut allergies, nuts are a great snack food too.  My kids love almonds and cashews.  Whole fruits (not dried) and veggies are great.  My kids really started taking more of an interest and were more adventurous with trying different fruits and veggies when we planted a vegetable garden.  They love picking strawberries, cherry tomatoes and yanking carrots from the ground in their own backyard!  Other favorite fruits and veggies in our home are celery sticks with cream cheese, apple slices, Satsuma oranges, and carrot sticks.  Bananas are always a good portable snack when you are on the go.  They are nutritious and filling.  For kids that can tolerate dairy, cheese sticks are another easy “tooth-healthy” snack.  My kids also really love hummus, and almost any veggie tastes good dipped in a little hummus.  Costco sells boxes with individual servings of hummus that are very convenient for snacking.  Olives are popular in my house, not only because you can have fun putting them on your fingers but because they taste good too.  I also try to ask Lucy for ideas when I think she is getting bored with our usual lunches and snacks.  She often sees her friends at school eating things that I would never think to pack for her!  One of her school friends often enjoys red peppers stuffed with tuna salad for her lunch.  I would never think that a 5-year-old would enjoy something like that, but Lucy was interested in that because she saw her friend eating it.  Now she loves red bell beppers!  For some reason, kids always think their friends’ lunches look better than their own, so ask your kids what their friends are eating, and if they are interested in trying some new things!  You might just be surprised at what your kids will eat!

 

090725PTTBBELTZNERA11Dr. Andrea Beltzner received her certificate in Pediatric Dentistry from the University of Connecticut in 2007, and became board-certified in the specialty of Pediatric Dentistry in April 2008.  Along with her husband, adorable children and  two adorable dogs, Dr. Beltzner lives and works in Portland, Oregon. Passionate about helping underserved children receive the dental care they so desperately need, Dr. Beltzner volunteers regularly at Creston Children’s Dental Clinic, on the Tooth Taxi, at the annual Children’s Health Fair along with being a co-lead for the pediatric department at Oregon Mission of Mercy, and a volunteer on the Emanuel craniofacial team.

Dental Emergency First-Aid

Thursday, December 12th, 2013
By Dr. Weston Heringer, JrTooth First aid

Dental emergencies, especially with children, can happen any time.  Listed below are the most common types of emergencies and what action to take following the emergency.   It is always better to be prepared!

  • TOOTHACHE Clean the area of the affected tooth thoroughly.  Do not place aspirin on gum tissue or aching tooth. If face is swollen, place cold compress to the outside of the cheek.  Contact a Dentist.
  • CUT OR BITTEN TONGUE, LIP OR CHEEK If there is bleeding apply firm but gentle pressure with a clean  cloth or gauze. If swelling is present, apply cold compresses. If bleeding doesn’t stop readily or bite is severe, contact a Dentist.
  • BROKEN TOOTH If center nerve of tooth is exposed or center shows pink color contact a Dentist immediately.  For comfort, the injured area may be covered with a moist warm cloth.  If edge or corner is broken seek care at your convenience.
  • KNOCKED OUT PERMANENT TOOTH   Time is critical, find the tooth.  Quickly rinse the tooth, if possible, and reinsert it in the socket.  Have the patient hold the tooth in place. A tooth that cannot be reinserted should be kept moist.  The patient must see a Dentist immediately.
  • KNOCKED OUT BABY TOOTH  Primary teeth are not reimplanted, if you have questions about the injury, contact a Dentist.
  • BLEEDING AFTER BABY TOOTH FALLS OUT  Have the child bite on a folded gauze placed over the bleeding area for 15 minutes.  If bleeding persists contact a Dentist.
  • BROKEN BRACES AND WIRES  If a broken appliance can be removed easily take it out.  If it cannot ,cut it off.  Cover the sharp or protruding portion with cotton , chewing gum or wax.  Loose or broken appliances do not usually require emergency attention.
  • POSSIBLE FRACTURED JAW If suspected, contact a Dentist immediately or take the  individual to Hospital Emergency Room.
  • COLD/CANKER SORE  Over-the-counter preparations often give relief. Stay away from salty or acidic foods.  If sores persists over two weeks contact a Dentist.

 Editors Note: Please consider this non clinical advice and always consult your dentist with any questions or concerns.

Dr Weston Heringer

Dr. Heringer is a retired pediatric dentist and has served on 19 overseas dental trips. He operated a private practice in Salem for 30 years with a satelite office in Lincoln City for 26 years. For the last two years of his career he was the full time dentists on the Tooth Taxi, a mobile dental van providing free care to children in Oregon. Dr. Heringer is a past president of the Oregon Dental Association and is a board member of the Dental Foundation of Oregon.

 

 

Dental X-Rays

Monday, August 6th, 2012

By Dr. Medhi Salari

Benefits of Dental X-rays

Dental X-rays help us detect cavities, infections, gum disease, cysts, tumors and developmental abnormalities much sooner than waiting for these problems to get large enough to become evident to the naked eye; or painful enough to become uncomfortable and noticeable to the patient.

Dentistry has led the healing professions in preventive care since the 1940’s and x-rays help us each and every day in finding and treating dental disease in its earliest and easiest to treat stages.

Patients who receive regular exams and x-rays tend to retain their teeth for life, while patients who go without exams and x-rays tend to have more extensive dental work, such as root canals and extractions.  By the time the problem has become uncomfortable or noticeable to the patient, the decay or problem has already progressed too far.

Risks of Dental X-rays

A large number of patients cite exposure to radiation as a concern in consenting to regular dental x-rays and exams.  We gathered the following information from the American Nuclear Society website to put the amount of radiation from Dental X-rays in perspective.

Source of Radiation

Estimated Exposure (mrem)

Air Travel

0.5 per HOUR

Dental Bitewings (4 films)

2

Dental Complete Series of X-rays

10

Medical Chest X-ray (1 film)

10

Natural Radiation from the ground

30 per year

Natural Cosmic Radiation in Central Oregon (elev. 3,000 – 4,000 ft.)

41 per year

Medical X-ray – Mammography

42

Medical CT Scan – Head

200

Internal Radiation from food & air

268 per year

Medical Upper GI X-rays

600

Medical CT Scan of Abdomen/Pelvis

1000

 As you can see from the table above, radiation exposure from dental x-rays is extremely low, in comparison to other forms of radiation that we are routinely and often times naturally exposed to.  We also take the added precaution of routinely covering our patients with a lead apron and Thyroid collar to further minimize the already low exposure levels.

International standards have recommended a maximum amount of radiation for humans working with or around radioactive materials at 5,000 mrem per year.  The average accumulated amount of radiation per person is approximated at 620 per year.  You can calculate your own annual radiation dose by visiting the American Nuclear Society website (www.ans.org), and clicking ‘Public Information’, ‘Resources’ and then ‘Dose Chart’.

General Recommendations & Protocol

Our goal is to take the very best care of your teeth and mouth as possible.  In order to do that, we need periodic x-rays to properly diagnose and treat conditions that might exist or arise in your mouth.

We realize that different patients and different dental conditions require different protocols.  We have always strived to minimize our patient’s x-ray exposure and at the same time reduce the costs associated with necessary x-rays.

We do not have a one-size fits all x-ray routine in our office, but have tailored our X-ray Protocol to benefit each specific patient’s dental and medical conditions.

Patients who have a higher risk of decay, multiple existing restorations or more complex treatment plans require more frequent and regular dental x-rays.

Patients who have experienced fewer cavities and restorations in their past, and have exhibited a smaller risk of dental disease, will continue to have less frequent dental x-rays recommended to them.

Our X-ray Protocol also takes into account numerous other important factors; such as pregnancy, patient’s age, list of medications and concurrent medical conditions (dry mouth, acid reflux, concurrent radiation therapy, …).

We will continue to honor the trust that our patients have placed in us, by taking the necessary steps to properly diagnose and treat their dental problems, while remaining respectful of our patient’s wishes for a protocol that caters to each patient as an individual.

With our X-ray Recommendations and Protocols, we hope to provide the right balance between our patient’s wishes for reduced exposure to radiation and the Oregon Board of Dentistry’s Standard of Care for dental practices.

Excerpts from  American Dental Association (www.ada.org) and American Nuclear Society (www.ans.org) 

 

Dr. Mehdi Salari is a 1993 graduate of the OHSU School of Dentistry.  He has been in private practice in Bend, Oregon for 19 years and along with his wife, have three kids under the age of nine.  He is a Past President of the Central Oregon Dental Society.  He has been actively involved in the Central Oregon soccer community through coaching, playing and officiating.  He also volunteers with the Central Oregon Community College Dental Assisting Program, Healthy Beginnings, Volunteers in Medicine and the Kemple Children’s Clinic Give Kids a Smile program.

 

Dental Volunteerism Abroad

Monday, June 18th, 2012

By Dr. Sean Benson

 

After the New Year holiday passes, and the cold and snow are permanent residents in Baker City, I start to focus on a warm tropical climate. Before you think I am describing some time off with relaxation at a luxurious resort I should clarify that the warm tropical climate is in Honduras, and it is hot, muggy, and malaria ridden. I start to think about if my typhoid, hepatitis, tetanus vaccinations are up date. Reminding myself to start taking my doxycline for malaria prohylaxis the few days before we hit San Pedro Sula. Double and triple checking my supply list. Do I have enough anesthetic, antibiotics, and analgesics? Do I have all my instruments, and disposable supplies. Will they all make it through customs? As you read this your first thought might be why?

I started to going to Honduras because of my good friend Jon Schott, MD. He had been going for several years and he had been providing basic medical care. He was frustrated by his lack of ability to treat emergent dental infection beyond antibiotic intervention. He believed almost all of the people he was treating needed some kind of basic dental intervention, and most had been suffering from an unchecked, and untreated dental infection for years. For several years I listened, empathized,  but was unsure if I could help. How would I provide care in the remote settings, and poor conditions that I had seen in pictures, and heard about in stories?

 

 

I enlisted the help of dentists who had done this type of thing in other countries, and came up with a plan. Dr. Weston Herringer Jr. was my mentor. He had been everywhere, and had done several trips to various countries. I borrowed, begged, and cajoled colleagues, dental supply companies, and honorary organizations. The first trip was hard, and tiring, and had its share of technical, and logistical problems…but was one of the most emotional rewarding experiences I had in long time. I was hooked.

 

 

These trips have become a part of my year. A chance to put things in perspective for myself, and take time to realize how truly fortunate I am.  I know everybody who volunteers says this, but it is true. The purity of doing volunteer dentistry is a recharge to myself professionally, and keeps me coming back for more.

I encourage everyone to volunteer for the profession in some capacity. Where, and how do not matter as much as the doing. The rewards will benefit the patient, the profession, and yourself, and provide unforgettable memories, and experiences that will make your time in practice complete.

 

Sean A Benson, DDS, graduated with his Doctorate of Dental Surgery from Ohio State University in 1998.  He currently is practices in Baker City and is an active member of the ODA, ADA and OHSU. In addition to volunteering his time abroad, Dr. Benson helps out with Northwest Medical Teams, Donated Dental Services, Give Kids a Smile Volunteer Day and is an Eastern Oregon Red Cross Advisory Board member.

 

The Dental Foundation of Oregon Tooth Taxi

Monday, April 30th, 2012

By: Mary Daly

The Tooth Taxi is a 38’ state-of-the-art dental office on wheels with two dental chairs, a full-time dentist, two dental assistants and a program manager. It visits schools and community sites throughout Oregon to provide free dental care and oral health education to uninsured and underserved children.

The van spends up to a week at a school/site providing dental screenings, cleanings, sealants, X-rays, fillings, minor oral surgery and in-classroom oral health education. Each child receives oral hygiene instruction, a toothbrush, toothpaste, floss, mirror, and a brushing timer.

Site partners and schools are selected based on high percentage of students qualifying for the free & reduced lunch program, limited or no access to dental care and a dedicated project coordinator from the site to prepare for the Tooth Taxi visit.

The Tooth Taxi was created through a partnership with OEA Choice Trust, ODS, and The Dental Foundation of Oregon, the charitable arm of the Oregon Dental Association. The van is funded by leading foundations, corporations and individuals who care deeply about improving the oral health of Oregon’s children.

The Tooth Taxi team is charged with implementing the Dental Foundation of Oregon’s mission, “Improving oral health for Oregon’s children.”

In our fourth year of service we continue to modify and evolve the program to enhance services rendered.  We have instituted repeat site visits that account for 40 percent of our visits, decreasing the introduction time necessary with the site partner and allowing us to complete treatment on many students.  Our program can be a bit intensive for some schools, especially in light of diminished budgets and staff. Return visits allow us to make more of an impact both with education and with treatment rather than just reaching the tip of the iceberg.

At the end of each site visit a list of students identified as uninsured and still needing dental treatment is given to the site partner to refer students to The Children’s Program.  This not only provides a follow up resource but is a reminder to school staff that they have a referral option for students with dental needs throughout the year.

In 2011 we ran our most successful summer program partnering with school migrant programs and community non-profit centers.  Establishing relationships with dedicated site partners ensured a steady stream of patients and kept the Tooth Taxi on the road.

Tooth decay is preventable and that is a message we try to get across to students through our in classroom oral hygiene program.  Teachers are invited to sign up for a presentation from one of our staff members while we are on site.  With a focus on offering the education each week we have increased the number of students that receive the oral hygiene news.  This also prompts discussion in the classrooms and reaches the teachers who often share their own dental care stories.  Each student receives a bookmark that reinforces the oral hygiene message and each school receives a Tooth Taxi library bookpack, four books that provide invaluable oral health education information for teachers, parents and children.  How do we know the presentations have made a difference?  Checking out of the hotel Friday morning the desk clerk told us her kindergarten daughter came home from school all excited about the Tooth Taxi staff visit to her classroom.  She’s excited to take care of her own teeth and told her Mom “if you don’t brush them you get holes in them.”  She really liked the BIG toothbrush and the fake teeth.

Our ongoing goal is to keep the Tooth Taxi staffed (first things first).  It is a challenge to recruit and retain staff when the van is on the road three weeks a month, away from home Monday through Friday.  We modified our schedule so that we are within 60 miles of Portland during the summer and we spend every 3rd week within 60 miles of Portland (so staff can sleep in their own bed at night).  These changes allow staff to have a bit of a home life, take care of personal business, and stay in the position longer.

We give kids a positive experience and teach them to be good patients.  Acknowledgment from schools and parents reinforce that we are doing the right thing.

Dental professional volunteers are a key component of our program.  Volunteers are asked to give ½ or full day of services.  If we have two dentists in the van we set up our portable unit in the school for hygiene services by a volunteer hygienist. Volunteer hygienists provided cleanings and sealants to students that don’t need restorative care from the dentist.

Since the Tooth Taxi launched in late fall 2008 we have visited 157 schools/sites all over the State of Oregon, and served over 10,000 children while delivering $2,734,557 in donated dental services.  The Tooth Taxi services provide immediate relief of dental pain and infection for thousands of children who lack access to basic dental care, in addition to preventive services and education.

 

Mary A. Daly is the Program Manager for the Dental Foundation of Oregon’s mobile dental van affectionately known as the Tooth Taxi.   Mary has spent the past year criss-crossing the state of Oregon with the new mobile dental van, as close as she can get to her childhood dream of running a book mobile.    Mary may be contacted at 503.329.8877 or Mary.Daly@SmileOnOregon.org

 

ODA Celebrates the Passage of HB 4128 and the Expansion of Children’s Dental Health Coverage

Tuesday, April 17th, 2012

By: ODA Staff

Over the last two years, the Oregon Dental Association has worked with our partners  to help families of those born with craniofacial abnormalities to overcome some of the challenges associated with these types of birth defects  through legislation. Craniofacial abnormalities are the most common birth defect in the United States. In Oregon, 68 cases of cleft lip/palate amongst newborns were reported in 2007. These children are faced with real and potentially lasting challenges associated with oral clefts such as breathing, social integration, hearing, speech and language abilities.

HB 4128  helps the  families of patients with craniofacial abnormalities by preventing the costs of dental care from being prohibitive, which often forces the family to delay needed treatment for a child.  HB 2148 requires health benefit plans to cover medically necessary dental and orthodontic services for the treatment of craniofacial abnormalities.  A child born with a cleft frequently requires several different types of services over a number of years with treatment often beginning in the first months of childhood. In the treatment of oral clefts, timing is critical and delaying due to cost can impede or permanently stunt the development of a child. But with proper and timely treatment, a child with an oral cleft can develop on a normal arc.

ODA member dentists, Dr. Daniel Saucy and Dr. Judah Garfinkle along with ODA Lobbyist, George Okulitch and Dean Hale (father of a cleft palate patient) watched as Governor Kitzhaber signed HB 4128 in to law after unanimously passing both the Oregon House and Senate.  Our sincere thanks go out to Rep. Val Hoyle, HB 4128 chief sponsor, for all her hard work and dedication to improving the oral health of Oregonians and to Regence Blue Cross Blue Shield, Oregon Dental Services, Children First for Oregon, and the Oregon Medical Association for supporting the bill.

 

Protect Your Teeth, Wear a Mouthguard!

Monday, April 9th, 2012

By Dr. Teri Barichello

Soccer players don’t question wearing shin guards, football players their helmets, volleyball players their knee pads. Clearly shins, heads and knees are worth protecting. Why then don’t we place the same value on our teeth? Why isn’t the use of mouthguards just as routine as other protective measures?

Millions of children and adults participate in sports and recreation activities, and depending on the activity, they are at an increased risk of sustaining dental injury. When teeth sustain a traumatic blow or injury, the damage can often lead to permanent alteration in appearance or irreversible changes to its function. A single accident can create the need for lifelong follow-up care and maintenance.

April is National Mouthguard Month. The intention is to draw attention to the increasing and serious issue of oral trauma and injury as a result of sports and recreation activities. One in six sports related injuries is to the craniofacial area. Football, boxing, basketball, lacrosse and hockey are obvious examples of high contact, high risk activities but injuries aren’t confined to these sports. Often participating in non-contact sports results in dental trauma. Some of the most traumatic injuries have been reported as a result of baseball, bicycling, gymnastics or skateboarding. Studies show that while young boys show a slight higher prevalence of dental injury than girls, that gender difference evens out as they enter young adulthood.

The great news is that we can all easily protect our smiles by wearing a properly fitted mouthguard.

There are three types of athletic mouthguards, two of them are available over the counter and one is custom fabricated by a dentist. The over the counter versions offer convenience and are lower cost but have limitations in their comfort and level of protection. The first over the counter type is a pre-sized, stock version. They are generally available is sizes S-L and there is no customization for fit. They often don’t fit comfortably and wearers usually need to hold their teeth together to keep them in. For this reason, this type is considered to be less protective. The second over the counter type is commonly called a “boil and bite”.  The guard is warmed in boiling water then self adapted to the users mouth. This type has better retention than the stock version but is often bulky which can make it hard to speak or breathe. For optimal protection, there needs to be certain thickness of material in key areas.  This is a concern with the boil and bite due to the self adaptation process which often leads to dangerously thin areas. In addition, lab impact tests have shown that the boil and bite mouthguard has less adequate cushioning and shock absorption than that available with a custom fit. A custom made mouth guard is by far the most protective and comfortable type of guard. This version requires a visit to your dentist who will take impressions and either fabricate it onsite or send it to a laboratory for a precise, customized fit. Custom versions tend to be more expensive, but offer superior protection, are far more comfortable and are more easily adaptable to orthodontic appliances. The expense incurred to have a proper mouthguard made could save a person thousands of dollars if there is damage from an accidental injury.

Mouthguards for All!

The use of a mouthguard is not age dependent. It is recommended for all people, young and old, who participate in activities with the risk of injury to the face or teeth. When parents consider enrolling a child in an activity, they are recommended to have a conversation with their dentist to discuss the level of risk and whether a guard is appropriate. Good habits start young, so there will be increased acceptance and compliance by young adults if wearing a mouthguard has been part of their routine all along.

 

Dr. Barichello is a 1998 graduate of the OHSU School of Dentistry.  She was a private practicing general dentist in Oregon City for 13 years before taking her current position as Vice President and Chief Dental Officer at The ODS Companies.  She is a Past President of the Oregon Dental Association and trains in the high contact martial art, Poekoelan, for which she is an avid proponent of the use of mouthguards.


The Creston Children’s Dental Clinic of Portland

Monday, April 2nd, 2012

By Dr. Kurt Ferré

 

Creston Children’s Dental Clinic is the only school-based dental clinic in Multnomah County, Oregon.  It has a long history dating back more than 50 years when the Assistance League of Portland (ALP) opened the doors to the clinic.  Due to capacity limitations, the ALP could no long sustain its operations, and the clinic was scheduled to close in early 2010.

In January, 2010 Dr. Dale Canfield, Lora Mattsen, Executive Director of the Multnomah Dental Society, and I met with one of Dr. Canfield’s patients, Duncan Campbell, who started a successful non-profit organization, Friends of the Children years ago, and Mr. Campbell outlined a template on “how to” set up a non-profit organization.

Thus, in February, 2010, a new non profit took over stewardship and operations for the clinic as the “Friends of Creston Children’s Dental Clinic” (FCCDC).  Easier said than done, however, because the IRS moves at it’s own speed, and it took almost 1 year to receive our official determination letter designating us as a non profit organization.  In order for us to be able to go out and do some immediate fundraising, we had to find a non-profit organization that could act as our fiscal sponsor.  Enter the United Way of the Columbia-Willamette.  Then president/CEO, Marc Levy, helped facilitate the process.  In a word, they were “great”, and they totally supported FCCDC without charging us any administrative costs.

So,  fund raising was our immediate task.  To keep the clinic open for the remainder of the school year (February to June 15th), we needed at least $30,000.00.  The Multnomah Dental Society donated $10,000.00, Lora Mattsen and I approached Multnomah County for $20,000.00 of emergency funding, and with the help of Commissioner Jeff Cogen and his chief of staff, Marissa Madrigal, the county commissioners voted 5-0 to grant our request.

Thus, with some breathing room, we began the task of building a sustainable model for FCCDC.  We wanted to return the clinic to a completely all volunteer clinic as regards to dentists and hygienists to reduce the clinic operating expenses.   Our first two recruits to board of director membership were Barry Rice and Sue Sanzi-Schaedel.  Mr. Rice is past executive director of the Oregon Dental Association, and now retired from his positions as an executive in ODS Company and Advantage Dental.  Ms. Sanzi-Schaedel is a retired public health hygienist with a MPH, having worked with Multnomah County Dental Health Department for over 30 years.

As Mr. Rice told me early on, our core quality that we wanted in any board members or future employees is that “their head bone has to be connected to their heart bone”.   Essentially, anyone directly involved with Creston has to believe in its mission.  Thus, we have recruited 3 addition board members, David Novitsky of the Daisey Company, Catherine Kittams, RN, a retired MESD school nurser in Multnomah County, and Jay Ward, a retired area sales manager with the A-Dec Company.  Our board is a working board, and they all bring long-time connections in the dental community to the table for the benefit of the clinic.

We have hired 3 wonderful employees:  1) Erica Soto, Administrative Director; 2) Annette Rotrock, lead dental assistant, who keeps everything running in the clinic area; and 3) Jenny Poach-Gagnon, our front desk extraordinaire (believe me, she does more than answer the phone and make appointments).  Both Ms. Soto and Ms. Poach-Gagnon are fluent in Spanish as our patient base is over 50% Hispanic.  While all the children are fluent in English, most of the parents speak little English, and it is wonderful having that resource to bring the families into the preventative picture to combat oral disease.  Lastly, we have an incredible grant writer, Eli Levine, who has helped the clinic obtain over $300,000.00 in grant funding.

In two years, the clinic has had a complete makeover.  First, we had the clinic completely painted and new furniture in the waiting area and back professional work area is all donated. We have 5 operatories, new A-Dec chairs, fiberoptic handpieces, and digital radiography, including panorex.  Again, much of this equipment was donated to FCCDC.  We have been amazed with the generosity of the dental community to help sustain the clinic.

With a good clinic infra structure in place, our focus is on the care of the low-income children in the Portland Public School System, ages 5-18, who lack adequate access to dental care.  We know that oral disease is a 100% preventable disease.  However, for this to be a reality, one needs education, prevention, and access to care.  We know that there are just too many holes to fill in our patient population.  Treating a disease and filling holes are not necessarily the same thing.  We need to go to the root causes of dental decay, and educate our patients in prevention.  This also means educating the parents of our patients in prevention.  We encourage every child in elementary school to sign up for the King Fluoride supplement program that is offered free to the children in Multnomah County schools (hopefully, someday soon we will see Portland’s public water supply fluoridated).

Our results have been most positive.  We now have a bulletin board full of patients’ photos who initially showed up with cavities, but at their next recall visit, they were cavity free, and now they are members of the “Cavity Free Club”.  It’s heart-warming to see how excited the kids are to get their photos on the wall.  We are looking to add additional bulletin boards, because we are almost out of space.

I’m embarrassed to say that I practiced 23 years before I did my first volunteer dental care.  I can honestly tell you that I get back in return from these children more than the sevices that I have been trained to deliver.  To break down the barriers for these children, to see a child, who was initially fearful about going to the dentist, and now love coming to Creston with a smile on their face……..priceless.

For those of you who are in a position to volunteer at Creston, try it.  I believe we’ve created a clinic and atmosphere that you will want to come back again.  If you are at a stage in your life when you cannot volunteer the time, please consider a cash donation in the form of a “Smile Scholarship”.  To learn more about Creston, visit us at www.crestondental.org

 

Dr. Ferré is a 1976 graduate of Northwestern University Dental School in Chicago.  He retired in December, 2008, after a 28 ½ year career with Permanente Dental Associates in Portland. He is past-president of the Multnomah Dental Society, and he currently serves on the board of directors for the Oregon Oral Health Coalition, the Oregon Dental Association’s Government Relations Council, and the dental advisory board for Medical Teams International (MTI).

 

How to Manage An Apprehensive Child Before and During a Dental Visit

Monday, March 19th, 2012

By Dr. Jane Soxman

Apprehensive children may create many concerns and anxiety for parents, dentists and staff. The following recommendations offer some tips for behavior guidance.

  • Parents should not offer presents or rewards for good behavior prior to the visit. This may prompt additional fear that something really difficult is about to occur. A surprise to be given just after the visit may be more appropriate.  Do not tell a child to be brave or that nothing will hurt.  The idea that dental care requires bravery or that pain may be involved may have never occurred to the child.  Positive preparation may include a story about going to the dentist, placing the child in a reclining chair to experience the sensation of moving backward and brushing with a battery powered spin brush to experience a sensation similar to the rubber cup used to clean teeth. Minimizing comments or explanation by parents is advisable. Parents may unintentionally create more anxiety in the child with their silent cues, especially if there is any parental fear regarding dental visits.
  • Only one parent should accompany the child for the visit and that parent should be the one who is more comfortable with dental treatment.  Consistency is very important. The dentist, parent and child function as a team.  If the visit went well with Dad, he should be the parent who returns for subsequent visits.
  • Morning appointments are always recommended for apprehensive children. The children are more rested in the morning and morning appointments usually have less waiting time. Also, the child may worry about the appointment throughout the school day and being tired after school will result in reduced coping skills.
  • In the reception room, the parent should sit closely beside the young child, reading a story. This not only provides distraction but also places the child in a more relaxed frame of mind. Free play should be avoided.
  • Parents may share their primary concerns regarding their child’s anxiety or fears with the dentist or staff prior to taking the child to the examination area. Some advice or reassurance may help to ease the parent’s concerns and the child may be eased into the dental chair with a slightly different approach. Parents must understand the child’s behavior may impose limitations on dental treatment, but most apprehensive children can be treated with empathetic guidance.
  • Parents should not attempt to describe the events of a visit for restorations (fillings).  If the child asks, the response should be that the dentist or his helper will carefully explain everything planned for the visit. Parental tone of voice or body language could accidentally create a sense of fear or apprehension in an unsuspecting child.  The dentist should determine how much and what should be said prior to the visit. The child’s perceptions and level of anxiety are strongly influenced by his parents, particularly by Mom.
  • If local anesthesia (a shot to numb the teeth) is to be used, this should never be discussed prior to the appointment. “Shots” are universally the most feared aspect of the dental visit for children, however most often injections can be performed painlessly, without the child being aware of the occurrence. A child who comes to the appointment already intensely worried about the “shot” is much more difficult to calm. Studies have shown that anxiety may reduce the efficacy of the local anesthetic. Because some procedures may be performed without local anesthesia, parents should not assume that an injection is necessary.
  • Expectations of a child’s behavior must be age-appropriate. By four years of age, an emotionally and physically healthy child should be able to separate from the parent for an examination and possibly treatment. Opinions vary amongst dentists regarding parental presence for treatment.  Parents should agree with the dentist’s philosophy regarding parental presence for treatment and this should be discussed and clearly understood prior to the visit.
  • Most children under four years of age are not yet emotionally capable of separating for treatment, and a parent should be present. Some parents and children over age four insist on parental presence.  If the parent is present for treatment, he or she must be the dentist’s silent partner.  The parent must remain calm and quiet. The mere presence of the parent provides support for the child. Children are very aware of silent cues from parents; body posture and facial expressions may speak volumes to a child. The dentist must give the child undivided attention and the parent should not divide the child’s attention between herself and the dentist.
  • Prior to reclining the dental chair, the dentist should place his or her hand on the child’s shoulder, while informing the child that the chair is going to move backward. Both the dentist and staff should ask the child, “Do you know my name?” Make sure the child has been re-introduced with a smile and comforting attitude.
  • Voices should be low and soft, never attempting to speak louder than the child’s crying. The parent (only one present) may need to be reminded of this. A small hand mirror may offer good distraction after the local anesthesia has been administered. The dentist may count backward, tell a story, sing a song or ask about pets, requesting a “yes” with the child showing one finger or  “no” with two fingers. The dentist and assistant can guess what kind of pet, boy or girl, color and name. Always very distracting, humorous and incredibly successful for calming an upset child after treatment has begun.  Just an occasional pat on the shoulder may be adequate for some children, offering some non-verbal assurance from the dentist.
  • If a child is crying, listen to the sound of the crying. Compensatory crying does not change in pitch and is a means for the child to cope.  The parent should not become the “court of appeals”, permitting the child to delay treatment by reaching for one more hug or to tell the parent one more thing.  The dentist must direct the treatment, not the child.
  • If unable to gain the child’s cooperation with parental presence, the parent may be asked to leave the operatory. This would occur only if the child is four years of age or older. The door to the operatory is left open so the parent can check on the child.
  • Parental love must permit age-appropriate independence.  A parent’s permitting his or her child to undergo treatment without being present sends two messages. First, “It is ok. I really do not need to be right beside you for this.” Second, “You Can Do It! I have confidence in you.”  This child has been given a very positive message and a sense of empowerment.
  • Some parents prefer not to be present, but if a child becomes extremely upset or borderline hysterical during the procedure, the parent should be present to possibly assist in calming the child and to be assured that the child is not being harmed.
  • Age-appropriate expectations, individual temperament, previous experiences and social influences must be considered for each child. Parents also should be guided with insight and recommendations to gain an understanding of the dentist’s treatment goals and the limitations imposed by behavior. This preparation provides a positive influence for not only the parent and child, but also the dentist and staff, assuring a less stressful and more successful visit for all.

 

Dr. Soxman is a diplomat of the American Board of Pediatric Dentistry, a Fellow in the American College of Dentists, on the board of advisers for General Dentistry and is a seminar instructor for two General Practice Residencies.

Dr. Soxman presented at the 2012 Oregon Dental Conference and is from Pennsylvania.

 

 

The Best Age for Your Child’s First Dental Visit

Monday, March 12th, 2012

 By Dr. Michelle Stafford

The American Academy of Pediatric Dentistry (AAPD) and the American Academy of Pediatrics (AAP) both recommend that children be seen at Age 1 for their first dental visit. At the first visit, your pediatric dentist will generally complete a lap-to-lap exam to ensure there are no abnormal development issues or pathologies that you need to be aware of, and as we all understand, catching health issues early is often the key to successful treatment and lowest cost.

The first visit is an excellent time to ask questions of your pediatric dentist; anything from the best toothbrush to use, to flossing tips, and even ideas on nutrition for your small one. Your pediatric dentist will discuss with you appropriate timing for bottles and sippy cups and even when to leave the pacifiers to the “Paci-Fairy”. A fluoride treatment may be recommended to help your child’s natural tooth development, and regular 6 month visits are encouraged to promote a positive routine and catch problem areas quickly.

Having a dental home that both you and your child feel comfortable in is key, particularly during a time of emergency. Children are naturally curious and rambunctious, and often will chip or hit their mouth during bouts of walking, crawling, running, and playtime. For a first time parent, a traumatic injury to the mouth involves a rushed search to call the pediatrician or ER triage, only to find they recommend seeking care with a pediatric dentist to ensure no permanent injury has been sustained.

When a dental home is a regular part of a child’s routine, the comfort level of seeking emergency care with their dentist gives peace of mind to the family and can turn an otherwise chaotic event into one of comfort and support.

For more information on what to do in a pediatric emergency, click here!

 

Dr. Stafford is the owner dentist of World of Smiles, Pediatric Dentistry, located in Portland, Oregon.  Her love for dentistry started as an intern in her childhood orthodontist’s office. She continues to pass it forward by offering this experience in her own practice to area high school and college students.To schedule your child’s first dental adventure with World of Smile, Pediatric Dentistry visit us on-line or call us at 503.626.9700.