Tuesday, May 2, 2017

Is mouth rinse the answer?

“Kills germs that cause bad breath” (Listerine)
“For longer lasting fresh breath” (Colgate)
“Kids love it, cavities don’t” (ACT Kids)
“Healthy, beautiful smiles for life” (Crest)

Those are a few famous slogans from the most popular mouth rinse brands on the market today. Mouth rinses have always been a go-to supplementation to tooth brushing and flossing for fresher breath, a whiter smile and a cavity free dentition for decades. Per the American Dental Association, “Children under the age of 6 years should not use mouthwash, unless directed by a dentist, because they may swallow large amounts of the liquid inadvertently.”

Important components of mouth rinses are fluoride and pH. The fluoride ion incorporates into the biofilm of the teeth and helps to remineralize the tooth structure. pH is equally, if not more important, to the decay process.

Tooth structure will start to break down around a pH of 5.5, or what we consider the “danger zone”. When a person eats or drinks, the bacteria in the mouth secrete acid and bring the oral pH into the “danger zone”.  It typically takes 30 minutes for a person’s saliva to buffer against the acid attack, bringing the pH of the oral environment back to health. 

Similar to eating, when a person swishes with an acidic mouth rinse, the potential for an instant pH drop is present. The acidic liquid is being washed over all surfaces of the teeth, potentially keeping the oral environment in the “danger zone” longer than ideal. Our office has tested the pH of several over-the-counter mouth rinses: ACT, Listerine, Dr. Bite and Toms of Maine.  All resulted in a pH of 3-4, the “danger zone”. 

(pH table listed from “Balance, a guide for managing dental caries for patients and                    practitioners” V.Kim Kutsch, DMD, Robert J. Bowers)
We furthered our research to find a basic mouth rinse called CXT3 Carifree Rinse, which we carry in our office and can also be found on Amazon.com. The pH of the Carifree rinse is neutral (8-9).  It also contains fluoride and xylitol. Xylitol is a natural sweetener, which has a 5-carbon sugar ring versus a 6-carbon sugar ring (like table sugar) therefore bacteria can not break it down and secrete acid.

Along with pH, there are many different risk factors that can contribute to and ultimately lead to decay. Diet (frequent drinks and snacking), medications that cause dry mouth, oral appliances (braces), medical history, family history, bacterial transmission, or the wrong home care routine are examples of how complex this disease process is. 

No patient is alike. We encourage you to have an in-depth conversation with your dentist and dental hygienist regarding any decay concerns. Our goal is to always work with our patients and their families to come up with a plan that works best for you, your family and ultimately keep the oral environment healthy and happy!

Sarah – Registered Dental Hygienist

(pH table listed from “Balance, a guide for managing dental caries for patients and practitioners” V.Kim Kutsch, DMD, Robert J. Bowers)

Tuesday, April 4, 2017

Tell-Show-Do, An Empowering Tool for Dental Health

Tell-Show-Do is a basic but important tool to help children feel comfortable in our office. We explain to the patient, step by step, what is about to happen as well as give them the opportunity to feel each tool first on an area of the body other than the oral cavity. For example, we will touch the patient’s fingernail with the explorer (“sharp instrument”) prior to touching the teeth, or we will allow the patient to hold the instruments themselves prior to use so that they can have a deeper understanding that our tools are safe and gentle. It is important for us to communicate in ways that the child will understand, so for our younger age groups we like to use more kid-friendly terms.  To make it fun and exciting, we may use the term Water Squirter, and replace the term “suction” with “Mr. Thirsty”, and “prophy brush” with “Tickle Toothbrush”.  As dental providers we firmly believe we need to earn the patient's trust by doing exactly what we have explained to the patient with no surprises.

As a Registered Dental Hygienist working in pediatrics, I find the Tell-Show-Do technique very valuable. One of the most common fears in young patients is a loss of control and by using this technique we are able to reduce patient anxiety for a more enjoyable visit.

In addition to Tell-Show-Do, we have a wide range of behavior guidance techniques to meet the needs of each individual child. Our distraction techniques are also very important to help relax an anxious child. Our reception area has a room especially made for your child to enjoy. The room contains I-Pads, books, puzzles, and a bead maze to help children unwind and take their minds off their appointment before they go to a treatment room. Once in the treatment room, we have Netflix ready for your child to pick their favorite show to watch during their exam. We provide headphones for them to listen, as well, which has the added benefit of blocking out background noise in the office.  Anything from the sound of our dental instruments to a vocal patient in a nearby room can be a distraction, so having headphones and a favorite show to focus on is a great tool to keep your child relaxed and content.

An extremely important factor in your child's success during an appointment is our consistent positive attitude.  This provides a happy environment regardless of the situation, day, or time. Above all, we have found that body language, tone of voice, and facial expressions play a very big role in reducing anxiety and encouraging patient cooperation. Consistent positive reinforcement is something we implement to help guide the child to have a good time during their appointment. At the end of every visit the patient earns a token they can use to pick a special prize from our prize tower.

From Beginning to end, we use our empowering tools and distraction techniques to provide a relaxing positive, and rewarding experience to ensure your child will enjoy their visit with us.

Amber - Registered Dental Hygienist

Thursday, March 2, 2017

An Important Treatment Option

Not all parents are aware that we offer in office IV sedation.  It’s an important tool that is ideal for patients with issues or concerns such as strong dental phobia, extensive treatment needs, a strong gag reflex, infection, children with special needs, and/or very young children who are not yet able to sit still long enough to have their treatment completed.

If ever a child presents with one or more of the situations above, we will always discuss the treatment options available to you and your child.  If sedation is appropriate to help us to eliminate your child’s dental disease, it offers several benefits.  All dental work can be completed in one visit.  We greatly reduce the potential of worsening any dental anxiety or phobia during your child’s treatment.  If you have a super wiggly little one our office finds it offers better outcomes and success rates for their care.

During your child’s IV sedation appointment the medications work quickly and reliably.  This form of sedation is less invasive than the type we use in the hospital under general anesthesia requiring no tubes be inserted into your child’s throat.   Your child will be breathing on their own which allows for a quicker recovery as compared to general anesthesia in the hospital setting.  Typically, within 20-30 minutes.  All of this is done in the familiar setting of our office.

Our staff does not perform the sedation services.  We work closely with Pediatric Dental Anesthesia Associates (PDAA) as we feel this option offers the highest level of care that we can provide in our office for your child's dental sedation needs.  A pediatric anesthesiologist is a medical doctor who has completed 4 years of college, then 4 years of medical school, followed by 4-5 years of training in anesthesiology including specialty training in pediatric (infants and children) anesthesiology. This typically includes more than 12,000 hours of clinical training. PDAA’s anesthesiologists receive some of the highest level of training available, so you can be assured your child receives the safest care.  Our office works primarily with Dr. Hector Vila from PDAA who has been certified by the American Board of Anesthesiology since 1994.  He is considered an expert in the area of patient safety.  All anesthesia services are billed directly through PDAA and they have a wonderful team to help you with that process.

Please click the link for a brief IV sedation tour from PDAA.  

The cost of an in office IV sedation appointment is, on average, about 80% lower than that of an in-hospital sedation.  These services are not typically covered by dental insurance but may be covered by your medical insurance depending on your plan.  With that said, some insurances favor in hospital general anesthesia over in office IV sedation.  Your out of pocket costs could vary depending on your medical plan.  We can help you with the information you would need to allow you to have a meaningful conversation with your insurer to help you make the choice that is right for you.  PDAA is your primary resource for any questions you may have about coverage for their services.

Whatever your child’s dental needs we will always look at ways to help you prevent further decay in the future.  There are many causes of decay beyond the consumption of obvious forms of sugar like candy and sugary drinks.  Some foods convert to sugars after consumption, the pH of your child’s mouth can contribute to decay.  There are also medical conditions we can help to identify that influence your child’s dental health.  We can review and advise you on ways to adjust your home hygiene routine.  Our main concern is preventing new decay where ever possible.  Whatever you child’s dental needs may be, we are here to help.

Michelle - Certified Dental Assistant

Tuesday, February 7, 2017

Children's Dental Health Month

Each year, American Dental Association chooses a new theme for Children's Dental Health Month to spotlight preventative measures for oral health. This year's campaign slogan, “Choose Tap Water for a Sparkling Smile” promotes drinking water over less healthy options like sports drinks, soda, juices, and other sugar-laden beverages. The added bonus of fluoridation in most public water sources adds to the benefit for oral health, but the message of making tap water your beverage of choice stays the same even if your water comes from a well. If you have questions on how fluoride impacts oral health, Dr. Scholl would be happy to review your child's individual preventative treatment plan at their next visit.
The celebration of children's dental health has grown since the first, single day observance on February 3, 1941, to be the month-long American Dental Association event we know today, and what we know about children's dental health has grown right along with it. Coastal Maine Pediatric Dentistry is committed to helping our patients achieve and maintain a beautiful, healthy smile by providing the most up to date clinical information, and we extend that commitment to our community especially during our Children's Dental Health Month.
This year, we will be visiting 15 day cares and preschools, 3 elementary schools, and 3 public libraries reaching nearly 600 children with our message of healthy food choices and dental hygiene. With the valuable input from our participating caregivers, we have cultivated our program to empower our child audience to take charge of their oral health. Dr. Scholl understands that there is no perfect world without sugar and that chocolate cake will eventually cross your child's lips, so we use a successful combination of an informative story and an interactive critical thinking exercise of choosing between which foods are best for our teeth. Some choices are easy- carrots are obviously healthier than chocolate bars, but we also introduce variations in foods like grapes vs raisins and cheese vs cheeseballs. It's a silly way to encourage thinking about the foods they choose as well as the effect it has on their oral health. We top the experience off with giving everyone a turn to brush our flossosaurus, Elvis's teeth with his giant toothbrush before getting their very own toothbrush to take home. A child's food options are not always in their control, so the message we hope resonates is the importance of daily dental care and the importance of building a positive relationship with dental health.
Children's Dental Health Month is also an opportunity to connect with and support our fellow members of Merrymeeting Bay Dental Society in an effort to make sure every first grade student in our area has the opportunity to see a dental professional. This is our fourth year organizing this program on behalf of MMBDS, with the height of participating schools at 16 and over 3,000 students served in that time. We provide first grade classrooms with a classroom presentation, home health supplies, dental health posters for their school, and optional dental exams, all free of charge from area professionals. It's quite a feat of coordination, but so important to extend our professional service beyond our individual patient lists for the betterment of the community.
To incorporate American Dental Association's Children's Dental Health Month in your child's day, visit ada.org for more program information and printable activity pages, and if your child is suddenly giddy about their gums and proudly yells, “BRUSH YOUR TEETH!” after they have a snack, you'll know they had a date with Elvis in February. If your preschool or daycare would like a complimentary visit from our office to encourage dental health throughout the year, please contact our office and we will be happy to add you to our calendar!

Tessa Kingsley
Professional Relations Coordinator

84 Baribeau Drive
Brunswick, ME 04011

Thursday, January 5, 2017

We Are Thinking About You

Poster: Mike - Practice Manager

As we enter 2017 we have been giving a great deal of thought to how we can better serve our patients and their families.  There is a lot we have done over the past year to continuously improve things you may never know or see, and to make sure you and your child's experience is better at every visit in ways you will appreciate.  As we move through the year we would like to stay in better touch about what we are working on and what we have already done.  So you will see posts from a number of different staff members on topics as diverse as -  what we do in the community to further children's dental health, more information on topics parents often have questions about, the steps we take to make sure everything we use to treat your child safe, clean and sterile, information on insurance and how you can get the most from your benefits and a number of other topics that are of interest to us because we feel they will be of interest to you.

I have the honor of writing our first post of 2017.  Looking at your child's dental home I get excited about things that may seem strange to the casual observer.  For example, we recently had a standby generator installed.  It was a significant investment for our office, but based on the experience we have had here at our new location we felt it was incredibly important.  In our old office we occasionally lost power and it's a fact of life living in Maine with the rain, snow and wind we experience here.  With that said, here in our new location we have found the power supply to be much less reliable.  We still have not been able to figure out why.  At the same time, we know and appreciate the fact that finding time in your and your children's busy schedule to come to the dentist can be a challenge.  We feel it's really important to honor your commitment to your child's dental health by making sure that we have done everything we can to be up and running when you get here no matter what is happening in the outside world.  Further, we want to always be sure we can finish your child's visit no matter the weather or situation.

Your convenience is important to us so we do things like keep backup computers setup and ready to put in place in the event a techno-gremlin finds its way into one of our critical computers.  It is also why we have worked to install HIPAA compliant on and off site backups for our patient records that allow our system to be up and running again within the hour if we have a catastrophic technical issue.  We take our responsibility of housing your child's dental information very seriously. We are always looking at the key elements of our practice that allow us to serve you and your family and trying to place ourselves in the position where we have backups for our backups.

Dr. Scholl, our hygienists, dental assistants, and business office staff work hard to make sure we keep your child's dental health, safety and comfort at the center of everything we do.  Along with that we focus on making visits convenient for parents and fun for kids.  We hope we will have a chance to see your little ones this year, and we promise to continue to strive every day to make your next visit better than your last.  If you ever have a question we can help you with please don't hesitate to give us a call.  Have a safe and happy 2017.

Mike - Practice Manager

Tuesday, February 14, 2012

Children's Dental Health Month

February is Children's Dental Health Month and its a great time to get the word out there as to why seeing a dentist is so important at an early age.  Both the American Academy of Pediatric Dentistry (AAPD) and the American Dental Association (ADA) recommend a child see a dentist by their first birthday.  There are many reasons for this but here is one that many parents don't think of until it happens.  Typically, a child's first tooth comes in around 7 months.  This is also the time when children start crawling and practicing on those two feet.  That means lots of falls.  If you're a parent, you remember those first shaky steps.  It's exciting and fun but you feel like you need to follow them around constantly!

Now picture your family playing in the yard.  Your toddler goes to take a step onto the pavement and trips and falls.  There is some blood in their mouth and you start panicking (I remember my son getting his new teeth and bouncing them off of the garage floor on his first birthday when his new walking skills were not quite keeping up with his brain's enthusiasm!)  You notice that there are a couple of holes in your child's lips and the two front teeth are broken!!  Your child stops crying and you get the bleeding under control.  Now what do you do?

This is a situation we see ALL the time, and one where most parents are relieved to have a dental home to come to.  Your child is familiar with the office and knows the familiar faces they will see.  Their first visit to a dentist isn't one after a trauma which eases everyone's anxiety.  Even better, you are comfortable with the dentist and your dentist is comfortable with your child.  We have already gone through the initial paperwork and medical history so there are minimal administrative steps to complete.  We will have already examined your child's teeth so we know what their status was before this little mishap.

This is just one of many situations where you will be happy to have established a dental home for your child.  The age one visit typically consists of an exam and Fluoride treatment as well as a lot of talking.  We teach you how to care for those pearly whites and what you can expect during teething and development.  We also talk about habits your child may have and oral hygiene recommendations.  (We have lots of tips to make brushing easier!!!)

Tuesday, December 6, 2011

Why should I worry about these baby teeth?

I am often asked why we should bother filling baby teeth, the most common follow up is - "Aren't they just going to fall out?"  The answer to whether or not you should fill baby teeth is yes and no.  The first thing to realize is that not all baby teeth fall out at 6 years old like the front teeth do.  Some front teeth don't even make their way out of the mouth until 8 or 9 years old!  It's funny to think that we all lost our baby teeth but nobody remembers losing them.  In fact, the molars do not fall out until 11-13 years old!  Therefore if a child is 11 and the radiograph (x-ray) shows a primary tooth (baby tooth) with a small cavity but that tooth is going to fall out in the next few months, we typically don't treat it.  Averages are averages, however, so it depends on the dental age of your child, not the chronological age.

The truth is, the baby teeth play several key roles in developing the mouth while they are present.  Primary  teeth are not just there to practice with, they guide the permanent teeth into the mouth and provide an important space holder for the permanent teeth.  They also allow your child to chew which impacts nutrition and digestion.  Without proper nutrition, physical and mental growth are impaired.  Without their primary teeth children are often lacking in appropriate bone to house their permanent teeth.  Chewing affects the growth and remodeling of the temporomandibular joint (TMJ) as well.  Primary teeth also help to develop speech and language, which, if lost, can affect speech patterns.  (You have all heard the Christmas song, "All I want for Christmas is my two front teeth".) 

The biggest reason to fix primary teeth is that these teeth have less enamel and dentin (the second layer of tooth).  This means that cavities can progress much faster than they do in permanent teeth.  This can lead to pain and infection which can threaten the health of the permanent teeth growing in the jaws.  It happens rarely in the United States, but children die yearly due to dental infections spreading into the brain and neck starting from a primary tooth.   This is why the Department of Health and Human Services considers untreated primary teeth serious enough to charge a parent with child neglect.

The good news is that cavities are 100% preventable.  We want your child to be healthy so make dental appointments a priority.  If your child is unfortunate enough to suffer from dental caries (cavities) we can fix them when they are still small and prevent further damage or problems.  Overall we look at is as a team effort between our office, the parent, and other healthcare providers to keep your child happy, healthy, and comfortable as they go through their daily life.