Archive for the ‘Parents’ 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.



There is No Excuse for No Dental Care – Overcoming Dental Phobias

Tuesday, April 2nd, 2013

Scared girl at Dentist's teeth checkup

By Harvey Levy, DMD, MAGD

I have been practicing clinical dentistry and been on this planet long enough to have heard every reasonable excuse for avoiding dental care. I have yet to hear a good one.

Our dental practice has successfully treated thousands of phobic, anxious, mentally challenged, autistic, and medically compromised patients. We’ve been able to accommodate infants through Alzheimers patients. What I have learned is whatever the reason given for avoiding the dental office, there’s always a way to overcome the problem.

Are you afraid of the dentist? Perhaps a dry-run walking through the office will calm you down, or learning more about the treatment using videos or demo models will make you less afraid. If it doesn’t, we can prescribe pills or liquid drugs that you can take right before your appointment. If you’re even more apprehensive, you can also take an oral sedation pill before going to bed the night before your appointment, and be treated with nitrous oxide (laughing gas) to relax you during treatment. Other options to deal with anxiety include behavior modification, hypnosis or acupuncture.

If your loved one is an infant, or is mentally challenged, autistic, or suffers from Alzheimers, they can and should still receive effective dental treatment. Intravenous sedation can be offered in an office setting, or these patients can be treated in a hospital or surgical center operating room. There, the patient is totally asleep while all the needed work is being performed, and has no recollection when they wake up.

An extremely anxious patient can also be treated in this manner, with the advantage that work that would typically require multiple office visits can be successfully performed in only one visit to the O.R.

If you cannot come to the office due to mobility issues, age, or medical complications, dentists with portable equipment can come to you, be it in a nursing home, private home, institution, or in-patient facility. Mobile vans are fully equipped to handle most dental problems. Mobile teams use hand-held x-ray units with self-developing films or laptop instant imaging systems to diagnose problems. Portable x-rays with protective radiation barriers, are coupled with mobile dental carts, and provide the same dental procedures available at the office.

Whatever reason kept you or your loved one away from the dentist, the road back is readily available and easier than you think! Over the past 38 years our practice has successfully performed over 32,000 oral sedations in our office. Three percent of the time, oral sedations at our office couldn’t be done, or failed due to autism, severe combativeness, or major medical concerns. All those patients were able to receive treatment, safely and successfully, with the help of an anesthesiologist in a hospital operating room.

Whatever excuse I hear for someone not going to the dentist, know that there’s always a way to overcome it. What is not acceptable are the complications resulting from the lack of dental care – from bad breath to infections that start in the mouth and threaten your health.


LevyHarvey Levy, DMD, MAGD is a 1974 Tufts Dental graduate who practices general and hospital dentistry in Frederick, MD. He holds eight fellowships, four diplomats, Board certification in Integrative Medicine, and has earned Mastership and three Lifelong Learning Service recognition awards from the Academy of General Dentistry. He is a recipient of the ADA Access to Care Award, the AGD Humanitarian Award, the Maryland Governor’s Doctor of the Year Award, and ran the 2002 Winter Olympic Torch in honor of his dental care for special-needs patients in Maryland. He has written and lectured extensively on management of anxious and special-needs patients. For more information, visit or contact him at

An Analogy of Tooth Decay – How our Teeth Stay Strong

Monday, January 7th, 2013

Dr. Terri Baarstad

I have a little analogy that I use with my patients that seems to help them understand. I say something like:

There are bacteria in your mouth that “eat” carbohydrates. These bacteria have waste products and those waste products are acidic. Acid “dissolves” our teeth and makes it so we get cavities.

Imagine that your teeth are brick walls. They have all these bricks going in and out of the wall all the time- they are not static, they change. So when your mouth is at PH7 –that is neutral- the bricks go in and out at the same rate- there is no net change. Teeth stay healthy. But, when you eat or drink anything that has carbohydrate (sugar, bread, pretzels, even croutons) the PH of your mouth drops and the environment becomes acid. When your mouth is in acid- more bricks go out than come back in, so there is net loss of tooth structure. It takes about 20 minutes for your mouth to return to neutral after eating, so, if you are snacking, taking a bite or a sip of a soda pop every few minutes over an period of time, say 2 hours, then your mouth will be in acid for 2 hours and 20 minutes. If this occurs regularly over time, there is more net loss of “bricks” and eventually there begins a cavity. Once the cavity begins there is more acid because the bacteria have multiplied and they make more acid, leading to more cavities. The cure for the cavity is to have it treated with a filling or a crown. But the cure for not getting more cavities is reducing “exposure” to the acids. Fluoride on and in the teeth is like having mortar for those bricks- it makes it so much more resistant to acid.

Knowing the way that teeth “dissolve” you can understand what might help slow down this process

If you brush your teeth, chew sugarless gum, or rinse vigorously with water after eating, the Ph raises to neutral more quickly. Conversely, a dry mouth doesn’t return to neutral very quickly. The dry mouth patient is also at a higher cavity risk because the acid is that much more concentrated. Water, mints and gum, or even a change of medications might be in order.

Since it is all about acid, and acid comes from bacteria, and the bacteria live in plaque, reducing plaque (by brushing and flossing) reduces acid and therefore cavities. Xylitol (gum and mints) reduce bacteria and increases saliva flow, thereby minimizing acid exposure. Eating your food less frequently (eating the entire candy bar or drinking the entire soda all at once) will decrease exposure time, thereby reducing the risk.


Dr. Baarstad appreciates the value of community service, and devotes herself to improving the dental health of those who live around her.  After attending the University of Oregon, Dr. Baarstad graduated as a DMD from the Oregon Health Sciences University in Portland. She is an active member of the American Dental Association, the Oregon Dental Association and the Academy of General Dentistry, and a recipient of the Dr. William Howard Award for Excellence in Fixed Prosthetics. She donates services to charitable organizations and sponsors many community events, including high school fundraisers. Dr. Baarstad expresses a special interest in helping young men and women explore a career in dentistry through volunteering at local high school career symposiums.

Cavity Management by Risk Assessment Improves Access to Care

Monday, October 1st, 2012

By Dr. V. Kim Kutsch, DMD

Recently PBS broadcast a Frontline special report entitled “Dollars and Dentists”. The report presented a “broken dental system” in the US, amidst a rising epidemic with decay. PBS actually did a very good job describing the current issues facing dentistry today: rising healthcare costs, increasing decay rates in children and adults, limited access to care, an entitlement system that doesn’t adequately reimburse private practitioners, and corporate America seeing a profit opportunity in treating (mistreating) these children, and the concept of mid-level providers to help solve the access issue. However, the report failed to examine the real issues at play, and missed a huge opportunity to report the truth.

Here are the facts: the decay rate in our small children is rising at epidemic proportions, there is limited access to care, but the focus of the system is still in the wrong place. The Medicaid system will reimburse for crisis care for a child in a hospital setting to the tune of $12-18,000, and again when the same child needs the same procedure 20-24 months later, but won’t adequately reimburse a private practicing dentist to provide the necessary preventive management to avoid the crisis in the first place. What part of this expensive, out-dated system should we consider successful?

Corporate America got involved and suddenly there is an increase in the number of stainless steel crowns being placed on these children and less preventive services. Is anybody really surprised by that? The system rewards placements crowns but doesn’t adequately compensate a private practitioner to provide real preventive care and counseling. What might happen if the system paid $300 for fluoride varnish, professional therapy products, and nutrition counseling and $30 for a stainless steel crown?  There would be a lot fewer stainless steel crowns and there might also be fewer $18,000 crisis scenarios and better treatment outcomes.

Organized dentistry provides a lot of free care to help with the epidemic, take the success of the MOM program for example, or Donated Dental Services. Or consider the fact that individual dentists routinely provide pro-bono care to people in need. This was never mentioned in the report, but we all donate care as best we can. Unfortunately it still isn’t enough for the crisis we’re in.

Dr. Bob Barkley summed it up pretty accurately over 40 years ago. The problem we have is the house is on fire, and we’re trying to solve the problem with carpenters. We need to send in the firemen. The bottom line is dental caries is a multifactorial, complex, pH-specific biofilm disease. Too late we’ve learned that the drill has little to do with actually treating the disease. Increasing the number of Pediatric Dentists, operating suites, corporate dental practices, or mid-level practitioners isn’t going to solve this epidemic. We can’t drill and fill our way out of this crisis, regardless of who is running the drill. We don’t need more carpenters. We need to put the fire out.

To solve the healthcare crisis we face in dentistry today, we need to move from a treatment model to a healing model. CAMBRA, or caries management by risk assessment identifies and addresses the cause of the disease for each patient. By understanding the cause of dental caries we can focus on targeted strategies and effectively manage it. Armed with this knowledge we can coach patients back to long-term sustainable health. Through real preventive management of this disease we can provide the treatment outcomes we are looking for. The system we’ve got is truly broken and not functioning. The decay epidemic is direct evidence of that. But the solution won’t be found incarpenters, we need to change the “system” so that it fairly rewards firemen. That would reduce the decay epidemic, reduce the cost burden, improve access to care, and provide a genuine long-term solution. We need to fix the system. That’s the real story, and Frontline missed it completely!



Dr. Kutsch received his undergraduate degree from Westminster College in Utah and then completed his DMD at University of Oregon School of Dentistry in 1979. He is an inventor, product consultant, internationally recognized speaker, in past president of the Academy of Laser Dentistry, and WCMIID.  He has also served on the board of directors for the WCLI and AACD.  As an author, Dr. Kutsch has published dozens of articles and abstracts on minimally invasive dentistry, caries risk assessment, digital radiography and other techonologies in both dental and medical journals and contributed to several textbooks. He also acts as a reviewer for several journals.  Dr. Kutsch also serves as CEO for Oral biotech, as a clinician.  He is a graduate and mentor in the prestigious Kois Center and maintains a private practice in Albany, 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)


Dental Complete Series of X-rays


Medical Chest X-ray (1 film)


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


Medical CT Scan – Head


Internal Radiation from food & air

268 per year

Medical Upper GI X-rays


Medical CT Scan of Abdomen/Pelvis


 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 (, 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 ( and American Nuclear Society ( 


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.


Fluoride – Nature Thought of it First

Monday, June 4th, 2012

By Dr. Kurt Ferre

Fluoride is the natural cavity fighter.  It is the 13th most common element in the Earth’s crust and is found at varying concentrations in all drinking water and soil. Dr. Fredrick McKay, a young dentist, discovered the miracle of fluoride in the early 20th century.   He had recently moved to Colorado Springs and observed that although many of his patients had unsightly spots on their teeth, they had far fewer cavities than his patients back in the eastern United States where he was trained.

With the help of dentist pioneer, Dr. G. V. Black, they discovered that the decay rate was related to the naturally occurring fluoride in the water.  The problem was that in Colorado Springs the concentration was 10 parts per million, which caused the unsightly spots called fluorosis.  Dr. McKay and Dr. Black hypothesized that if the concentration were lower, then, the protective benefit of fluoride could still be achieved without the unsightly spots on the teeth.  After years of observational studies of water supplies around the country, they arrived at the concentration of 1 part per million.

In January, 1945 Grand Rapids, Michigan was the first city in theUnited Statesto add fluoride (called fluoridation) to its public water supply.  The results were dramatic.  In 10 years the cavity rate dropped 65% for 12-year old children!  It is estimated that fluoridation has saved over $40 billion and countless hours of pain and suffering for Americans.

So, how does fluoride work?  Studies have demonstrated that fluoride has both a pre-eruptive (systemic) effect and a post-eruptive (topical) effect.  Therefore, after teeth have erupted into the mouth, the primary action of the fluoride is topical for both children and adults.  When consumed in optimal amounts in water and food, and used topically in toothpastes, mouth rinses, and dental office treatments, fluoride: 1) increases tooth mineralization; 2) reduces the risk of cavities; and 3) promotes enamel remineralization throughout life for all individuals.

Sadly, Oregon is ranked 48th out of 50 states in percent of its public water supplies that have controlled amounts of fluoride added to the water.   In communities without fluoridation, the American Dental Association and American Pediatric Society recommend dietary fluoride supplements for children from the ages of 6 months through 14 years.  Parents should talk to their pediatrician or dentist about getting a prescription for their children.

With education, prevention, and access to care, cavities are a preventable disease, and fluoride will benefit everyone, not just children.

Remember, “Got teeth, get fluoride”.


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). In addition to his volunteer work at the Creston Children’s Dental Clinic, he is a regular volunteer on a MTI mobile dental around the Portland metropolitan area.


How to help our Parents, Grandparents and other Elders keep their teeth

Monday, April 23rd, 2012

By Dr. Janet Peterson

My grandfather lost his first permanent tooth at the age  of 89.  A lifetime of wear and tear on this upper canine had resulted in a crack that split the tooth and it had to be extracted.   He was lucky, though, in that a lifetime habit of brushing  twice a day and little or no snacking  between meals, in addition to good memory, allowed him to keep his oral  health.

My aunt was not so lucky.  In her mid-eighties she began to experience some memory problems.  Living alone, meals disappeared and she snacked on cookies and milk throughout the day.  She pretty much forgot to brush her teeth.  Her six month cleanings were followed by more and more repairs as decay encircled her teeth and  they broke off.  It was finally decided that a complete denture was the only reasonable solution.  Because of her frail health, two teeth would be extracted every two months to allow for healing.   Unfortunately, she passed away before the treatment plan could be completed – with only three teeth left and with  considerable embarrassment at the demise of her smile.

Memory loss is a big factor in the catastrophic increase in tooth decay  that so many elderly people experience.  It can be difficult to determine if this is a factor as elders  learn to “cover” memory lapses and we tend to respect their assurances that everything is all right.  Asking when their next dental appointment is may give a clue as to whether they are keeping up on dental check-ups.  If they have no appointment scheduled, getting an appointment is the first step.  Having someone go with them can be a good way of getting information from the dentist or hygienist as to whether there is an increase in the rate of decay in their mouth.  Because of the privacy rules of  HIPPA ( Health Insurance Privacy and Portability Act) ,  staff may be unwilling to discuss an elder’s health over the phone or by letter, whereas it is easy to have a three way conversation with the elder and their dentist or hygienist in person.  If there is an increase in rate of tooth decay,  it is necessary to find out what are the contributing factors and to start trying out possible solutions to slow this rate of decay.

The usual contributing factors and some first steps to mitigate them are:

Change in dietary habits with more frequent  snacking,  more sweets.

  • Provide balanced meals that require little or no preparation
  • Try to group sweets with a meal and decrease snacking between meals

Physical difficulty with brushing with weakness or uncoordinated hand movements or pain

  • Try an electric toothbrush,
  • Adapt the manual brush by bending the handle or enlarging it with foam

Apathy or depression – the attitude of “why bother?”

  • Engage the professional services of a psychologist or counselor
  • Discuss the benefits of good oral home care, and the downside of neglect – pain or missing teeth

Memory  problems leading to the forgetting of established daily habits

  • Place the toothbrush by the bathroom  sink in plain sight
  • Tape a note on the bathroom mirror – “Brush Teeth”
  • Remind the elder daily to “ go right now and brush your teeth”
  • Have staff at assisted living residence or nursing home remind the elder or brush for them

Problems of calling for a dental appointment or transportation to the office 

  • Have family or caretaker make appointment and arrange for transportation
  • If necessary, have office front office staff call to make appointment and arrange transportation


Dr Janet Peterson is a 1983 graduate of the Oregon Health Sciences University School of Dentistry and just recently retired after practicing as a general dentist in the Salem area for over 25 years.

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.