Archive for the ‘Prevention’ Category

Portland City Council Unanimously Votes to Fluoridate Water!

Tuesday, September 18th, 2012

Over the past year and half, the Oregon Dental Association, as a member of the Everyone Deserves Health Teeth Coalition, has been working on a new effort to fluoridate the Bull Run water system. The Bull Run system serves about 900,000 people, or almost one-fourth of Oregon’s population. More than 74 percent of the United States is served by optimally fluoridated community water supplies to protect dental health – and Portlanders will soon join them.

Last week, after a colorful public hearing on September 6th, the City Council unanimously voted in favor of fluoridation. Portland is no longer the largest city in the U.S. that has yet to approve fluoridation to combat tooth decay. The ordinance calls for the city water to be fluoridated by March 2014.

Oregon Dental Association has long been an advocate of community water fluoridation and we were not alone in the fight this time. As a founding member of the Everyone Deserves Healthy Teeth Coalition,  made up of dental and medical professionals, children’s advocates, business leaders, and Portland citizens, we called on the Portland City Council to fluoridate Portland’s water as a safe, effective and affordable way to increase the oral health of our community.

One in three Oregon children has untreated cavities, jeopardizing their health and educational success. Financially, dental decay accounts for 30 percent of all health care costs for children. Dental–related emergency room visits by Oregon’s Medicaid enrollees jumped 31 percent in the past few years, causing a tremendous increase on healthcare costs.

Fluoridating Portland’s water is affordable and will save money. Initial start-up costs are estimated to be about $5 per person with an annual cost of $0.61 per person, based on average water use.That is less expensive than providing fluoride treatments in dental offices and schools. The return is very high: every $1 invested in fluoridation saves over $30 in decreased treatment costs for fillings and more serious dental work. Cheers to healthier teeth!

Visit to learn more.

William E. Zepp, CAE, is the Executive Director of the Oregon Dental Association. Bill previously served as Executive Director of both the Virginia and Montana Dental Associations and has been involved in association management for twenty five years. Bill is also active with the American Society of Association Executives, serving as a past chair of the Small Staff Associations Committee. He has given presentations on non-dues revenue and management at several ASAE Annual Sessions. He is a past-president of the Oregon Society of Association Management.




African American Health Coalition

African Partnership for Health

African Women’s Coalition

American Medical Student Association, OHSU Chapter

Albina Head Start

Asian Health & Service Center

Asian Pacific American Network of Oregon (APANO)

Capitol Dental Care


Center for Intercultural Organizing

Central City Concern

Children First for Oregon

Coalition of Communities of Color

Coalition of Community Health Clinics

Component Dental Societies

Dental Foundation of Oregon

Familias en Acción

Friends of Creston Children‘s Dental Clinic

Health Share of Oregon (Tri-County CCO)

Kaiser Permanente Northwest

Knowledge Universe

Latino Network

Legacy Health

Lutheran Community Services Northwest

Native American Youth Association (NAYA)

Northwest Health Foundation

Medical Teams International

OEA Choice Trust

OPAL Environmental Justice Oregon

Oral Health Outreach

Oregon Academy of Family Physicians

Oregon Community Foundation

Oregon Dental Association

Oregon Dental Hygienists’ Association

Oregon Dental Services Companies

Oregon Head Start

Oregon Health & Science University

Oregon Latino Health Coalition

Oregon Latino Agenda for Action

Oregon Medical Association

Oregon Nurses Association

Oregon Oral Health Coalition

Oregon Pediatric Society

Oregon Primary Care Association

Oregon Public Health Association

Oregon Public Health Institute

Oregon School Nurses Association

Oregon School-Based Health Care Network

Pew Center on the States

Philippine American Chamber of Commerce of Oregon

Physicians for a National Health Program, OHSU Chapter

Portland African American Leadership Forum

Providence Health & Services – Oregon


Regence BlueCross BlueShield of Oregon

SEIU Local 49

Urban League

Upstream Public Health

Virginia Garcia Memorial Health Center

Willamette Dental

The Truth about Fluoride – Debunking the Myths

Monday, August 27th, 2012

By Dr. Weston Heringer, Jr.

Fluoride is natures cavity fighter with small amount present in all water sources such as lakes, rivers and wells. Communities fluoridate their water supply as a cost-effective public health measure to help prevent tooth decay and cavities in both children and adults. According to the best available scientific evidence, water fluoridation is safe and effective. Thousands of studies and more than 65 years of experience tells us that water fluoridation is effective in preventing tooth decay and is safe for children and adults. Even with all the science, there are still a lot of misconceptions about community water fluoridation so let’s talk through them.


1. Fluorosis. Fluorosis can occur before teeth erupt from the gums if teeth are exposed to too much fluoride. The vast majority of fluorosis is very minor, barely detectable white spots on the teeth, that does not affect how they function or a person’s overall health. There are studies that suggest that fluoride occurs more frequently in African American children, however more research is needed on the topic. Fluoridation is implemented because dental decay is widespread, the burden of which falls unfairly  among some  population groups.  The National Dental Association, representing African American dentists, and the Hispanic Dental Association both endorse community water fluoridation as safe and beneficial.

2. IQ. According to the best available scientific evidence, there is no association between fluoridation and brain development or lower IQ. The studies often cited are from China, India, and Mexico where environmental conditions are significantly different than those in Oregon. The vast majority of these studies have never been published in peer-reviewed journals and the quality of these studies does not stand up to scientific scrutiny.

3. Osteosarcoma. In 2011, a team of researchers from Harvard University, the Medical College of Georgia and the National Cancer Institute published a study that analyzed hundreds of bone samples from nine hospitals over an 8 year period from patients with osteosarcoma and a control group to measure fluoride in levels in the bone. Considered the most extensive study to date, the results indicated NO CONNECTION between fluoride levels and osteosarcoma. All the other organizations and agencies that have looked at this issue – including the FDA, National Cancer Institute, California EPA Office of Environmental  Health Hazard Assessment – have concluded the same thing.

4. Infant Formula. Although we encourage all parents and caregivers to talk to their dentist of physicians about their child fluoride intake, community water fluoridation has been proven to be safe for children, including babies. Babies who are fed powdered or liquid concentrate infant formula mixed with optimally fluoridated water might develop mild enamel fluorosis, which is a cosmetic condition and has no effect on how they function.


Water that has been fortified with fluoride is similar to fortifying salt with iodine, milk with vitamin D and orange juice with vitamin C. Community water fluoridation saves more than it costs. Studies show that community water fluoridation prevent at least 25 percent of tooth decay.

Want more information on fluoride? You can find extensive information in Fluoridation Facts, the ADA’s comprehensive publication with facts from over 350 scientific references.


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)


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.


ODA Dental Health and Wellness Committee

Monday, July 16th, 2012

By Dr. Todd Beck


As dentists we manage the stress and anxiety of our patients every day.  We have developed a rich and complex skill set that allows us to provide much needed treatment to people who are not always appreciative and most often fearful, anxious and even sometimes angry.  We do all of this with the self imposed need for perfection and under the backdrop of a troubled economy; a combination which, as best, makes owning and running a small business a daunting task.  Add to all of that the unique challenges of managing employees and it is no wonder why most of us choose to work only four days a week.

We have CE courses and study clubs for everything from practice management to placing gold restorations.  But where do we turn for help with the emotional and personal issues we face?  Where do we go to get tips on how to better cope with our fear, anxiety and depression?  How do we get help when our coping mechanisms include drugs and alcohol?  Who do we turn to if we are suffering the anxiety of a board complaint or a lawsuit?  This is where the Dentist Health and Wellness Committee might be able to help.

I have been involved with the DHWC for over 12 years now.  In 2000 I reached out to the committee for help.  I was struggling with an addiction to narcotic pain medicine and my world was falling apart.  What I received was an ear to listen, a shoulder to cry on and excellent advice and direction.  It was a phone call to this committee that started the process of getting my life back on track.  At that moment I decided the rest of my career would involve “paying it forward”.

The work we do is most often anonymous; and for good reason.  We are dealing with very sensitive and personal issues.  We get referrals from the Board of Dentistry, concerned staff and family members, attorneys and dentists themselves.  The issues range from general stress to suicidal thoughts.  The ages range from dental students to retirees.  The request is always the same; “I just need someone to listen, I don’t know what to do”.  The response is always the same; “I’m glad you called; let’s see how we can help you”.

I need to be clear.  None of us on this committee have the training nor are we able to solve these problems by ourselves.  What we do have are the resources to point people in the right direction.  We are often the first step in the journey to healing and a better life.  We are an ear and a shoulder, and sometimes that is all that is needed.

If you or someone you know might need our help, please don’t hesitate to call our anonymous hotline at 503-550-0190


Dr. Beck graduated from OHSU in ’94 and completed a two year GPR at St. Anthony Hospital in Oklahoma City, OK in ’96.  After practicing and teaching for a few years in Oklahoma, Dr. Beck returned to Portland in 1999 and purchased Mt. Tabor Dental.  Dr. Beck opened a second location at South Waterfront in 2010 and for the past decade has been an Assistant Professor at OHSU in the departments of Community Dentistry, Restorative Dentistry and Urgent Care.  Dr. Beck has served as Chair of the Dentist Health and Wellness Committee for the past seven years, is on the Board of Directors for the OAGD and is currently President of the Multnomah County Dental Association.

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.

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.