Authored by Kayla, RDH/Myofunctional Therapist

Over 4 years ago a patient came into our practice with the chief concern of multiple areas of decay. After their initial exam with Dr. Roper, I found the patient in my hygiene chair for a cleaning. We began discussing solutions for the patient’s recurrent decay and generalized plaque associated gingivitis. We also discussed the patient’s long history of decay. At the conclusion of their appointment the patient left with a tube of Enamelon toothpaste, a fluoride based toothpaste that I recommended to help strengthen the patient’s enamel.

A few months later the patient returned stating that the Enamelon wasn’t the right fit. I then recommended the patient try CariFree toothpaste to help with decay prevention as well as an oral probiotic to eliminate some of the bad bacteria in the patient’s mouth. The patient also modified their homecare routine and become more diligent about brushing and flossing regularly. Three months later the patient stopped by the office to purchase more CariFree toothpaste and another 90 day supply of the oral probiotic. At the patient’s next appointment things had improved. Although they still had areas of generalized plaque build up, no new areas of decay were present.

The patient was pleased with their progress and kept purchasing CariFree toothpaste and oral probiotics over the nex t few year. Eventually, the patient decided to start using an electric toothbrush to further maintain their cavity free status. The patient was doing everything that I recommended to stop the amount of plaque that was building up on their teeth between cleanings, and yet the patient was still reporting to the office every six months with a significant amount of plaque build up and areas of bleeding even though they weren’t experiencing active decay.

Three years later, despite the patient’s diligence and consistency, they were once again sitting in Dr. Roper’s chair for fillings. A dental fitness report from early 2021 indicated that this patient only had 39% plaque control. For nearly 4 years the patient had been compliant and consistent, and yet they were still struggling with plaque control, bleeding, and, once again, decay. At the same time I was taking courses to become a myofunctional therapist. As I was working through my program this patient came to mind several times as someone who would be a good candidate for myofunctional therapy. The patient struggled with mouth breathing in addition to the bleeding and plaque build up in their mouth.

A few months ago I began seeing this patient for myofunctional therapy sessions. Our primary goals were to improve the lip seal, tongue posture, and minimize mouth breathing. I provided the patient with a new set of exercises at each session and immediately began to notice improvement with their lip seal and tongue posture. The ability to breath through their nose was slowly starting to improve as well. After seven myofunctional therapy sessions the patient came back for another hygiene appointment. Their plaque control was now at 77%! The patient’s homecare remained the same and they continued using the same oral hygiene products–the only thing that had changed in the last six months between appointments was the implementation of myofunctional therapy. With the improved ability to breath through their nose the patient was able to reduce the amount of plaque and decay building up between hygiene visits. Breathing through the mouth can dry out gums and change the bacteria levels in the mouth, which both lead to decay and periodontal disease. Through myofunctional therapy, this dedicated and compliant patient, was finally approaching a healthy level of plaque control!

When we meet new patients for the first time we often discover that many people are not thinking enough about the future, or don’t realize that the trajectory they are on doesn’t line up with the goals that they would like to achieve. In our office, we like to look toward the future and help our patients change their trajectory so they can achieve their oral health and wellness goals, but we also spend a lot of time looking into the past. We emphasize prevention as a way to eliminate oral health problems in the future, and we dig deep into the past as a way to determine a root cause of presenting issues. Many of the issues we discover can even develop before birth, in utero. We like to collect each patient’s dental history because it is the foundation for their current state of oral health. We also like to set goals with our patients and learn about their ideal wants and needs for the future. We do these things with a focus on the present state of each patient’s teeth, mouth, and oral health. Outside of conversation, we do this is by taking photographs. We take photographs for both adult and pediatric patients and review them with the patient or the child’s parent.

The photographs we take help us educate our patients about inflammation, decay, occlusion and bite, the jaw joint, wear on the teeth from clenching and grinding, palate size, and tongue placement. We are able to spend time with each patient evaluating the current state of their mouth so they can see what we see during the diagnostic process. We have realized that few people are able to read dental xrays in the way that dental professionals can, however people are able to identify what they see in photographs with ease!

Below are a few examples of photographs we have taken and what the patient learned from them.

The next two photos are of a pediatric patient and an adult patient who both have a deep bite.

_{^{This patient is 12 years old with no previous orthodontic treatment and several primary teeth remaining.}}

^{_{This patient is in their 70s with no previous orthodontic treatment. They have several posterior cracked and broken teeth.}}

For the pediatric patient, we were able to compare the child’s bite to a properly aligned jaw joint and determine that the occlusion and alignment would lead to problems in the future. Addressing the deep bite early on will prevent the child from developing into an adult with cracked and broken teeth, and airway issues caused from the facial muscles collapsing. The pediatric patient is now undergoing a form of non-traditional orthodontic treatment to correct their bite. For the adult patient, treatment is much more complex. The early intervention being offered to the pediatric patient will ensure that the child is not undergoing complex restorative dental work in their 70s, or experiencing airway issues throughout their life.

Below are examples of a healthy bite, a crossbite, and a bite with a hyperocclusion.

The healthy bite is not applying an excessive amount of force or pressure to any of the teeth. The force is distributed evenly and the patient is not clenching or grinding. The airway is not restricted and the patient is able to maintain proper tongue placement. The crossbite and hyperoccluded bite apply excessive pressure to the teeth, lead to clenching and grinding habits and can result in cracked and broken teeth if the bite is not altered. Both the crossbite and hyperoccluded bite can also cause airway issues and are often accompanied by an improper tongue placement and weak orofacial muscles. These problems do not correct themselves, they worsen over time. The photographs help us explain the concerns and risks of an improper occlusion to our patients.

Authored by Angela

We often hear from our expectant and post partum mothers that they experience bleeding and gum inflammation during pregnancy. Many women even believe that they are doomed to have decay and inflamed gums during pregnancy. As a woman currently experiencing pregnancy for the very first time, I’ve also read multiple pregnancy books, articles, and information on pregnancy tracking aps telling me that I will be experiencing bleeding gums as a result of pregnancy. Contrary to this belief, here I am nearly 35 weeks pregnant and I have yet to experience bleeding gums and I’ve found great satisfaction in disproving the theory that pregnancy will destroy my teeth and gums. I’ve also never had a cavity!

Over the years I have paid close attention to my oral hygiene routine, even long before I began working in the dental office. Growing up I had parents who emphasized oral health and wellness. Effective teeth brushing was a high priority in our household. Even though I brushed and flossed, going to the dentist was always a stressful event because I feared learning that there would be a decline in my oral health. One of my greatest fears in life is getting a cavity, however after spending the last 4.5 years working in the dental field I have become more fearful of having bleeding gums or periodontal disease. It is never normal for your gums to bleed, even during pregnancy. Bleeding gums is a sign that there is inflammation in your mouth that is most often caused by a bacterial infection or periodontal disease.

When I discovered that I was pregnant I decided to conduct a longitudinal study on myself that would prove that it is possible to maintain oral hygiene and gum health during pregnancy. I wanted to be able to confidently tell our patients that it is possible to have healthy gum tissues and also remain cavity free while pregnant. Fortunately, for me, I work in an office where we measure plaque and bleeding control during our hygiene visits.

During the 10th week of my pregnancy Johana checked my dental fitness scores and measured the plaque and bleeding levels in my mouth. I had 100% bleeding control and 91% plaque control. I was thrilled to learn that my gums were in perfect health early on in my pregnancy since early pregnancy presents many challenges and changes to our daily routines. In the early weeks of my pregnancy I felt very nauseous, I experienced some vomiting, the exhaustion was unlike anything I’ve ever felt before, and my diet was terrible. I had a lot of food aversions and I found myself eating a higher volume of acidic foods and an increased amount of carbohydrates. For example, I cannot stop snacking on tomatoes and peanut butter sandwiches. Tomatoes are very acidic and excessive amounts of acidic foods can wear down tooth enamel. Peanut butter sandwiches can get stuck in the grooves of your teeth and cause plaque to quickly build up if it is not removed properly. I understand why and how dental hygiene can be impacted by pregnancy, however I also know the importance of making it a priority. During pregnancy everything you do feels exhausting and almost anything, including brushing your teeth can, at times, make you feel nauseous. The challenges are imminent, and yet what I have determined, from my experience, is that oral health remains within your control during pregnancy.

Our office focuses on educating our patients about the links between oral bacterial infections and the rest of the body. I know that bleeding, inflamed gums can be extremely dangerous and detrimental to my health. Knowledge is power and the knowledge that I have gained about oral systemic health gave me the power to take control! At my hygiene appointment at 10 weeks pregnant I told Johana my plan to maintain my oral health throughout my pregnancy and disprove the theory that bleeding gums during pregnancy is normal.

My dental hygiene routine hasn’t changed since becoming pregnant. I brush my teeth with an electric toothbrush, floss with coco floss, and brush again with a manual toothbrush. No matter how terrible I have felt I made sure to brush my teeth every morning [after breakfast] and every evening [ after dinner]. Both times, followed by flossing. Most days I also brushed my teeth after lunch, especially days I ate peanut butter sandwiches. As time consuming as it may seem, my dental hygiene routine helped me continue to have good oral hygiene habits during my pregnancy because it was already established. No matter how terrible I felt or how tired I’ve been I have made it a priority.

This week when I had my hygiene appointment Kayla checked my dental fitness scores again. I hadn’t seen any bleeding when I was flossing and brushing at home so I had a good feeling going into the hygiene appointment. I STILL had 100% bleeding control and my plaque control was 90%, one percent lower than last time. Though I was frustrated with my minor decline in plaque control, I was thrilled to learn that I had disproved the idea that if you become pregnant your gums will become inflamed and bleed.

I recognize that each individual person has their own challenges and each pregnancy also has it’s own challenges, but like anything else in life there are always ways to overcome those challenges. I am fortunate to work in a dental office that values education and helps patients establish excellent home care routines specific to their individual needs. Having an established oral hygiene routine helped me maintain my oral health throughout my pregnancy because it has become a habit, making it easier to maintain and prioritize.

If you are pregnant and your gums are bleeding we can help! Let your hygienist know at your next hygiene appointment and she will help you establish oral hygiene habits that will reduce the bleeding and keep you healthy.

If you have been following our office for a while or you are a patient of record, you’ve likely heard about the oral bacterial tests that we offer and the microscope slides we create to show patients the bacteria in their mouths. Recently, we have been using the BANA-Zyme Test System. The BANA-Zyme Test System is a chairside test that provides rapid, in office results to the patient. We utilize the test when the patient presents with periodontal disease or symptoms of periodontal disease. The test specifically identifies the riskiest members of periodontal biofilms known as Treponema denticola, Porphyromanas gingivalis, and Tannarella forsythus. These three bacteria produce a specific enzyme that will react with the peptide coating the testing strips.

Bana-Zyme Testing lets patients know their risk level immediately and it helps them make a decision about further testing and treatment. A diagnosis of periodontal disease can be overwhelming and terrifying. Many patients are still uncertain what that diagnosis means even after going through treatment, and few patients understand the risk factors that accompany that diagnosis before entering our office.

The microscope slides we create coupled with the Bana-Zyme testing provide answers and a high level of understanding to our patients. Both are tools we can use to look beyond the diagnosis and provide customized treatment and care to our patients.

You can learn more about BANA-Zyme Testing here.

For the last year our office has undergone many changes as a result of COVID-19. A year ago our office was closed. We were uncertain about the future of the world, our patients’ safety, and our own safety. We researched how to make our office safer and followed all of the recommended protocols. We purchased surgically clean air units for each operatory and our providers began to wear extra PPE. We created a touch free check in and check out process and masks became required to enter the building. We take temperatures and check oxygen levels on each staff member before the work day begins, and we do the same for each patient all day long. Once we were able to reopen we began limiting the amount of people in the office, and all of our surfaces are continually disinfected. Additionally to eliminate the spread of unnecessary and excess aerosols, our hygienists followed the recommendation to stop polishing patients’ teeth at the end of hygiene appointments.

Of all of the safety measures we implemented, not polishing teeth at the end of a hygiene appointment was the one that made the largest impact on our patients. This is because of a common misconception that the polishing portion of a hygiene appointment is the “cleaning”. Over the last year we have had patients make it through an hour long hygiene appointment and ask the hygienist why she didn’t clean their teeth. We’ve done our best to guide these patients down a path of understanding by explaining how the scaling the hygienist does to remove tartar and plaque that have built up between visits is actually what is “cleaning” their teeth. Beyond removing built up plaque and tartar, your hygienist will evaluate your gum tissues and remove any bacteria that is hiding in the pockets. She will also take the time to help you identify areas of concern and help you reach your oral health goals. Your hygienist is a healthcare provider, coach, educator, and watch guard. She is cleaning your teeth even if she isn’t polishing them, and more importantly she is teaching you how to properly clean your teeth.

When we were able to reopen our hygienists were very excited to get back to work even though they would no longer be able to polish. Polishing makes the tooth surface shiny and provides a smooth, glossy feeling; it is a tangible result that patients can see, feel, and immediately enjoy! Our hygienists recognize the value that patients place on polishing, and they understand the disappointment patients experienced when they didn’t get their teeth polished, however they had to follow the guidelines. Aerosols generated by polishing have the potential to present an infection control hazard, particularly in the COVID era. Our hygienists utilized this last year as an opportunity to help patients see the true value of a hygiene appointment by replacing the time that they previously spent polishing teeth with goal setting and education. For many patients, plaque levels have decreased and their oral health has improved between visits because they learned that polishing wasn’t the key to oral health and wellness.

As a kid I would spend my recess time wandering around the playground looking for four-leaf clovers. They were challenging to find and I was told that they would bring good luck. Finding a four-leaf clover wasn’t an everyday occurrence, however the hope that I’d find one kept me searching for them. I looked for four-leaf clovers every recess because I was determined to find them. The more time I spent looking, the more four-leaf clovers I found.

Some people may believe that visiting the dental office and leaving without getting “bad news” is as rare as finding a four-leaf clover. Visiting the dental office can be very stressful and scary for many of our patients. Many patients actually believe that they have bad luck when it comes to oral health. You could say these patients are looking for a four-leaf clover and leaving with an ordinary three leafed clover, or sometimes even leaving with a weed.

So, how can a patient ensure that they are leaving our office with lucky four-leaf clover news? The patient has to be dedicated to the search and determined to find what they are looking for. It takes a lot of commitment and an excellent oral hygiene regimen; it is possible to have good luck upon entering our office at every visit! The more time you spend caring for your teeth and gums at home the more “good luck” you will have at your dental exams!

There are four components that we focus on at your dental visits: gum health, tooth structure, the jaw joint, and your body’s overall health. We will investigate each one of these components at your routine visits and provide you with the tools and information to keep bacteria and tooth decay away. The gums are the foundation of your oral health. Healthy gums, without plaque and bacteria lingering below the surface, hug the teeth tightly and keep the teeth rooted into the jaw bone. If teeth begin to decay that decay spreads to the jaw bone. A patient might begin to notice a change in their jaw joint and their bite as a result of missing or shifting teeth. Removing plaque and bacteria prevents decay, cavities, tooth loss, and a disease called dental caries. Healthy, bacteria free teeth and gums keep the mouth and body healthy and make your dental visits a positive experience. We are here to help you find your own good luck the next time you come for a visit!

Think of all of the ways you spend your time. Think of the things you enjoy doing, and the things you don’t enjoy doing. Think of the moments when you feel rushed, stressed, or short on time. In a perfect day, in a perfect world our time would be managed to our own uniquely ideal specifications. It would be enjoyable. There wouldn’t be traffic, your children would wake up with ease and make their way to school without a struggle, fresh coffee would be brewing as your alarm went off, and the meetings and appointments on your calendar would stand firm. At the end of the week, you wouldn’t feel like you survived a whirlwind of chaos.

_________________________________________

We live in a world marked by days on a calendar and hands on a clock and in order for us to take back control of our lives we have to start owning our time.

Owning your time eliminates chaos and stress. Owning your time means that you are managing your time so that your specific, individual needs are met. Owning your time means that you are prepared. It means that you are setting boundaries and creating expectations for yourself and the people that you interact with. It also means that you are holding yourself and the people you interact with accountable for respecting those boundaries.

Establishing boundaries and being prepared starts with identifying your chaos. Chaos for you might be when people cancel appointments last minute, it might be rushing to gather information before entering a meeting or an appointment, it could be cranky kids in the morning, someone nagging you about what to eat for dinner, or lunches that are getting packed as you walk out the door. Chaos can be running late and needing to stop for gas. Chaos might be saying yes when you should say no, or offering understanding and forgiveness when what you really need to offer is a boundary that protects you and your time.

Once you identify your chaos it becomes relatively easy to establish boundaries, make preparations, and manage your time in a way that is uniquely yours. It takes time to sift through the chaos, however once you sift through it, you’ll see how you can become more prepared and manage your time to meet your needs. You’ll demand respect when it comes to your schedule, and rather than always offering forgiveness and understanding you’ll begin to offer a boundary. You might set out your kids’ outfits and pack their bags and lunches the night before to cut down on the morning stress of getting them ready. You might preset your coffee pot the night before. A very ambitious person might plan out a weekly dinner menu to post up in the kitchen. Maybe you’ll always fill your gas tank on the way home in the evenings. You might consider dedicating time in the day or evening to review notes from meetings and appointments, create follow ups, and prepare questions and discussion topics for the meetings the next day. You are managing your time. You are preparing by planning ahead and circumventing problems and chaos. You are taking ownership of your time.

In managing chaos and setting boundaries you’ve also honed in on the art of preparation. Within our office, we thrive when we are prepared and when we have clearly defined boundaries. Prior to your appointment, a member of our team will thoroughly review each patient’s chart. She will review upcoming treatment, medical and dental history, allergies, letters from other providers, any notes or requests from the patient, and any educational information that we would like to share with each patient. Our hygienists and Dr. Roper will discuss each patient’s planned treatment to make sure that their periodontal treatment plan and restorative treatment plan align. This process is ongoing, however typically it begins a week before the appointment. Each morning we have a brief meeting to review our schedule and each team member shares relevant information for their corresponding patients. Your one-hour appointment isn’t just a one-hour appointment, in many cases it takes 2-3 team members several hours to prepare for this appointment. We have chosen to be prepared to the best of our ability for you.

When people show up late for appointments, cancel at the last possible moment, or even worse don’t show up at all they are causing a chain reaction of chaos. If someone shows up late and we ignore their tardiness and see them as planned without adjusting their appointment we will be behind for the rest of the day. This appointment will run into the appointment with the next patient. Every patient we meet with after the tardy person will also feel the effects of having their life turn to chaos. Their schedule will be skewed. They now have the potential to run late for other obligations throughout their day. What we do on an individual level impacts the world around us. We have to be aware of our actions and the chaos that they will cause. We also have to be aware of our inactions and the chaos that they will cause.

It isn’t harsh or unreasonable to hold each other accountable when it comes to time management. It’s easy to be understanding and ride out the wave of frustration to keep the peace, but unfortunately sometimes this sets us up for disaster and chaos. Sometimes people misinterpret understanding and forgiveness as an invitation to disregard how valuable time is. This is why boundaries are essential. Establishing a protocol requiring a 48-hour notice for a cancellation is a boundary. In many professional establishments a cancelation fee may be charged for not providing adequate notice. This is also a boundary.

Professional and medical establishments often get pushback for enforcing cancelation policies, when in reality they are setting healthy boundaries for their patients that will not create chaos in the lives of other patients and employees. We need to protect our time. If someone isn’t going to show up for a 10 am appointment on a Tuesday we’d like to know by 10 am the Friday before. Think of how much chaos we could resolve if we kept firm boundaries. Appointments would run on time. Staff members wouldn’t be working late. More people would have time to get gas on the way home, pack lunches the night before, and set their coffee pot. Let’s all do our part to help eliminate some of the chaos.

February is American Heart Month and National Children’s Dental Health Month. There is a plethora of important knowledge to be shared in the short month of February. Twenty-eight days simply isn’t enough time, especially when everything we see, hear, and read is propagated with the idea that February is the month of love and Valentine’s Day. Celebrating with cards and flowers and eating candy and fancy dinners can be fun, but creating a healthy lifestyle for yourself and your family is a gift that will last forever.

We focus on preventative care because prevention is the foundation for a healthy lifestyle. If you focus on prevention you likely will not discover recurring issues in the future. The sooner preventative care is implemented the sooner it will become a lifestyle. We serve a lot of families in the community with young children. Dr. Roper, Kayla, and Johana want to help teach your children how to brush and floss their own teeth effectively. They know the challenges of caring for young toddlers, especially when it comes to brushing their teeth! They will spend time teaching your child how to brush effectively each time you bring them to our office. They want to teach your child how to properly brush their own teeth so that you can confidently send your child to the sink to brush their teeth and have confidence that they did an excellent job removing plaque. They only want your child to visit the office for routine exams and educational hygiene appointments. They will do everything they can to prevent your child from ever needing restorative dental treatment.  

Learning to have a strong oral hygiene routine at a young age will ensure that your child’s heart is healthy and happy as they grow up. There is a connection between heart disease and the bacteria in your mouth that contributes to dental caries, periodontal disease, and tooth loss. The problems in your mouth can and will inevitably impact your overall health, and we don’t want to see that happen. We want to keep you and your children happy and healthy.

We love what we do and we love working with families to create a lifetime of health for their children. This February give your child the gift of an educational dental exam.