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Managing Dental Anxiety - Part 1 (Source: Local's Guide, Ashland)


Managing Dental Anxiety - Part 1 (Source: Local's Guide, Ashland)

The following is Part 1 of an article that appeared in the January 2018 issue of the Local’s Guide. Dr. Kivel was honored to be interviewed on this topic he is so passionate about.


Hi Aron, I thought we’d catch up on what's new for you and for your dental office, Soulsmile.

Hi Shields. Great to talk to you and congratulations on pulling off living and working from the rainforest of Costa Rica!

Thanks. It sure has been an adventure and after two years we are really getting into our groove. So, tell me what’s new with you.


Well our daughter, Siena, will be two in the spring and is more fun that I ever imagined. Her head-back, arms-out greetings are pure joy for my wife and I. As for Soulsmile, we are almost to our four-year anniversary and grateful as ever for the continued support of the Rogue Valley community, as well as residents of towns from Yreka to the Coast.

As for what’s new, for the first part of 2019, we’ll be expanding our hours and maybe even bringing on a partner. We are - and will always - accept new patients, see them within one week, and work emergencies into our schedule on the same day.

Sounds like great growth plans. What’s new from a services standpoint?

Well, since we offer such a wide array of services, one of the biggest recent shifts in our paradigm is realizing the contribution we can make for anxious patients - a large group of Rogue Valley residents for whom dentistry really brings out fear or a feeling that they are not in control. We seem to be sought out by many individuals who feel this way and it’s been some of the most rewarding work of my career.

I hear that from people so often, they are afraid of going to the dentist, but hadn’t really thought of what it actually means for them.

Yeah, like others fears or phobias, dental anxiety hides in the shadows but really gets in the way. After all these years practicing dentistry, I’m still moved by these wonderful folks who come in and really start opening up about it and then allow us to help them on the journey to dental health and relief from dental anxiety. And I’m not talking about using drugs or sedation. I’m talking about good old-fashioned person-to-person trust and normal dental services. It really goes to the heart of why a healthcare provider does what they do.

Treating anxious patients and having a successful outcome is a big emotional deal for me, too. After treatment, there are usually hugs and glassy eyes all around. It’s impactful for everyone and a core reason that someone suffering from dental anxiety should feel confident in taking the first steps to a new beginning.

I love this topic! So tell me, what does dental anxiety look like?

Good question. Well, there is a massive barrier between patients and dental health when they have dental anxiety. It’s almost unthinkable for many. It can present as a guarded smile, sweating, pacing, overly quiet – the expressions are varied and personal, but the source is clear. I start off by congratulating them for even picking up the phone. To call, make an appointment AND show up… that takes courage! I let them know that I get it. It isn’t long into dental treatment that the smiles start to show up, the sentences become longer, the conversations fuller, the shoulders broader, this sort of thing. So I know the signs just from having seen hundreds of people show me their true personalities within days of getting started with treatment. It’s incredible.

So what happens when they are at the dentist for the first time, what should they look for? What should they say?

A patient with dental anxiety seeks trust in the entire dental team and office. The good news is that most dentists, and certainly the dentists and their teams in this town, are really good people. If at all possible, an anxious patient should try to say what it is that most causes them fear. Ideally the entire team will allow this conversation to build naturally. Just call an office and offer a hint of your fear and see how it goes! Call another office if you feel like finding just the right connection. There is nothing to lose in that and meeting the dentist for a free consultation is a great way to find out if it’s a good fit.

What if someone is afraid but feels uncomfortable or uncertain about how to express it?

It’s true that it might help to identify a fear so to get the conversation started. Anxious patients come in four big categories with some subtle variations within each.

First, some people fear pain. This usually relates to an earlier dental experience or maybe even stories of a family member who spoke of feeling discomfort while having treatment. They may also have more sensitive teeth and gums or have a fear of needles. Talking to a dental team about this fear allows them to share ways that the patient can remain in control along the entire path, including making sure they are completely numb before and during treatment.

Can you give me an example?

Sure, here’s an easy one. Many people with a square jawline report being difficult to get numb (picture Michelle Pfeiffer or google “celebrities with square jaw”) as the reason they are afraid of dental treatment. This is one of the easiest situations for a dentist to address with slight technique changes since really the nerve serving the teeth is just a little more hidden around the corner of their slightly flared out jawline. Try an appointment just to get numb if you’d like to feel reassured. Maybe try one easy filling to get started. In this case, pain is managed through technique, patience, and a patient’s ability to stop treatment at a moment’s notice by raising their hand at the slightest sensation.

I never even thought about how someone’s anatomy might change their perceived ability to get numb. Great example! How about the second category of anxious patient?

Being judged. Some people fear being judged for their dental problems. They just want to stay home and be left alone. If they tell a dental team this on the phone, or in the chair, I can assure you that everyone will respectfully discuss what relatively affordable and easy things can be done and zero about how the teeth got in this condition.

For example, I can see plenty in x-rays and may suggest to a patient that we just shoot the breeze about what they would like to accomplish and that we take our first small step on the next visit, lightly touching on our final goal of say dentures, implants, cosmetics, etc. In other words, let’s place something in front of us that feels like a small positive step and begin the practice of not looking back.

On that note, if a person has had a history of drug use that has led to their dental condition, they should know that this doesn’t really need to be discussed. You will probably feel comfortable talking to your dentist about it a couple visits down the road, but for now just focus on getting out of discomfort, saving teeth, and coming up with an affordable immediate solution to restore your self-confidence. This goes hand-in-hand with recovering from drug abuse and is one of the most rewarding type of cases I get to treat. I can tell you with certainty that no one at Soulsmile will ever talk about “how did your teeth get like this?” No way. We are totally focused on looking down the road into your future.

Stay tuned to read Part 2 of “Managing Dental Anxiety”


6 Surprising Habits That Can Wreck Your Teeth


6 Surprising Habits That Can Wreck Your Teeth

We know all the list of things that can be bad for your teeth - soda, gummy candy, smoking, etc. But there are a handful of habits with the potential to wreck your chompers that may not be quite as obvious. Here's the low down ...

1. Chewing Ice

Ice can easily be thought of as harmless - its juts H20 after all. But crunching down on hard, frozen cubes can cause cracks, chips and wear on your teeth. If you chew ice regularly enough, you may even cause aches in the soft gum tissues around your teeth. Often times a habitual ice-chewer gets "shorter" tooth appearance from all the wear. Dr. Kivel can fix this cosmetic issue but will only do so after the patient has curbed their ice habit!

2. Playing Sports (Without Proper Protection)

We love sports! All of us here at Soulsmile not only grew up playing many sports, but still take part in a myriad of outdoor sports including biking (motorized and non-motorized, running, surfing, kayaking - you name it! But we are also huge proponents of mouth protection! Mouth guards are a piece of molded plastic that protects your teeth. Without it, contact sports can easily result in chips or even a full tooth knock-out. We can make these for you or your whole team. Just contact us to schedule an appointment. 

3. Bottles Past Bedtime

Just like adults, a baby's teeth should be cleaned before bed. Putting a baby to sleep with a bottle of milk, formula or juice can put new teeth in harm's way. This can basically bathe the baby's teeth in sugars overnight. Its best to keep them out of the crib and establish a good hygiene routine. 

4. Tongue Piercings

Dentists have long lamented tongue piercings. Accidentally bumping a metal stud along teeth for years can definitely pose a risk to your teeth. In a study published by the Journal of Periodontology, "nearly half of the participants who wore either long or short barbells for four or more years had chipped teeth." The study also found receding gums in up to 50% of participants who had worn long-stemmed barbells for two or more years. Furthermore, the mouth is a haven for bacteria, making tongue piercings a likely candidate for infection and sores. Bottom line - research the health risks before you decide on a tongue piercing. 

5. Grinding

Bruxism (the fancy name for teeth grinding) wears teeth down over time. It is most often caused by stress and sleeping habits, making it a hard habit to control. We just wrote a whole blog on teeth grinding if you want to find out more about diagnosing an treating this condition. 

6. Cough Drops

We'd like to think that anything you find in the medicine aisle is healthy, but that's just not the case. Most cough drops are packed with sugar. We still love them, but recommend that after you sooth a sore throat with a lozenge, break out the toothbrush. Think of them like hard candy! 

Have any questions for us about habits that you suspect may be compromising your oral health? Feel free to write them in the comments section below or feel free to make an appointment with our Ashland, OR dental team here at Soulsmile. We'd love to have you in as a new patient! 



Maximize Your Dental Benefits Before January


Maximize Your Dental Benefits Before January

The end of the year is quickly approaching and with it, the end of another dental insurance benefit year. You're probably thinking more about stuffing and cranberries than dental benefits, but we'd recommend putting aside a bit of time in between your holiday plans to make sure you are maximizing benefits which will be lost as of January 1st. 

1. Don't Throw Away Money,!

Going into a new year with unused benefits is like tossing hard earned dollars you worked for all year. If you're like a majority of people, your insurance plan expires each calendar year. Unfortunately, your remaining benefits do NOT rollover - they expire! Trust us, your insurance company won't remind you of this. In fact, they bank on millions of Americans overlooking this and benefiting them instead of you. 

2. Find Out About Your Annual Maximum 

Each year, your insurance plan sets an annual maximum of dental work they will pay for. This is called the annual maximum. Each plan is different, but this amount is usually $1000-2500. You'll also want to find out how much you've already used this year (if you're a Soulsmile patient here in Ashland, call us - we can tell you!).

3. Consider Pending Treatment 

You may already have a tooth that's nagging at the back of your mind and you know needs to be fixed. Other times, patients may forget about treatment that is not a huge priority (like preventatively replacing old amalgam fillings that are prone to leaking). Give us a call or come in for an exam if you'd like to find out if you have any pending treatment we can put towards your benefits. 

If you have any questions, please call us at 541-482-4995. You can also call your insurance provider directly for more details regarding your unique plan. Our end-of-the-year schedule fills up quickly, so call us today to use up your benefits before its too late!




Q&A Spotlight: Periodontal Maintenance vs. Prophylaxis

Often times, we get asked by patients, “What’s the difference between a normal cleaning a periodontal maintenance, and why does it cost more?” This is a great question and the answer has a few parts to it. 

First, let's establish that a “normal” cleaning (prophylaxis) is for a healthy mouths. This includes procedures that address plaque, calculus and stains on the coronal portion of the tooth. “Coronal” means relating to the crown of the tooth, above the gumline. The typical patient who should receive prophylaxis comes to routine (every 6 months) hygiene appointments, exhibits excellent home care habits and has healthy tissues with no bleeding when probed or flossed. When they have a periodontal evaluation and charting session, probings are measured at 4mm or less. 

Next, let’s cover periodontal maintenance and scaling. This is an ongoing therapeutic procedure to treat periodontitis, which is a chronic and incurable (but controllable) bacterial infection. The primary objective is below the gumline - removal of dentin that is rough and/or permeated by calculus and contaminated with toxins and microorganisms. Some soft tissue removal also occurs. This type of procedure requires more skill and expertise than a prophylaxis. 

Periodontal disease overwhelms a patient’s defenses and spurs the immune system to initiate a breakdown of supporting tooth structures (bone loss). It is also episodic. These type of destructive episodes can be triggered by stress, disease or other problems unbeknownst to the patient. The three-month interval recommendation for perio maintenance is not arbitrary. It is based on the behavior of the bacteria. After periodontal maintenance therapy, periodontal pathogens aggregate on the biofilm and become the predominant species of bacteria again in three to 12 weeks. This means that by the 12th week, or 3 months, the periodontal “bugs” are flourishing again. That’s when we should reduce their numbers again. After discovery of periodontal disease, it is important to stay vigilant in controlling and monitoring through periodontal therapy. 

To value a periodontal maintenance it is necessary to understand that it is different from a regular cleaning because you are controlling disease with therapy versus simply cleaning teeth. 


The Importance of Athletic Mouth Guards


The Importance of Athletic Mouth Guards

The benefits of sports and athletic activities are numerous – they improve strength, coordination and reduce stress. Many of these activities also carry with them a bit of physical risk – including potential damage to your mouth. When we think of protective gear, items like helmets and shin-guards come to mind, but athletic mouth guards are just as important when it comes to negating physical risk.

The Journal of the American Dental Association (JADA) reported that as many as 39% of all dental injuries are sports-related, resulting in nearly $500 million spent on replacing teeth due to injury each year. We encourage you to evaluate your sports activities and related risks and consider having a mouth guard made.

The American Dental Association recommends mouth guards for the following sports:

Peter helping create custom mouth guards for our SOU Women's Wrestling team members!

Peter helping create custom mouth guards for our SOU Women's Wrestling team members!

  • Acrobatics
  • Football
  • Martial Arts
  • Skiing
  • Volleyball
  • Basketball
  • Gymnastics
  • Racquetball
  • Skydiving
  • Water Polo
  • Boxing
  • Handball
  • Rugby
  • Soccer
  • Weight Lifting
  • Discus Throwing
  • Ice Hockey
  • Shot Putting
  • Squash
  • Wrestling
  • Field Hockey
  • Lacrosse
  • Skateboarding
  • Surfing

This list is not exhaustive – in fact, we feel that Mountain Biking is an obvious one to add to the list. The point is that many of the sporting activities we all enjoy should be included. Studies show that athletes are at a much higher risk of sustaining orofacial injuries when not wearing a mouth guard. These type of injuries are not just cosmetic. Injuries to the teeth and soft tissue can be very serious, whether it’s nerve damage or eventual periodontal disease.

It just makes sense to protect your teeth. But not all mouth guards are created equal. There are three main types:

1. Stock

These mouth guards are non-custom. They can be purchased at a store for immediate use. For most patients, they feel bulky and uncomfortable, which can affect the willingness of a patient to wear the guard.

2. Boil and Bite

Just as the name implies, these guards can be purchased at a store, then boiled in hot water (to make it more malleable) and then fit into the mouth and bitten down on to form. These guards are usually more comfortable than a stock guard, but they can be hard to get just right. 

3. Custom

Custom mouth guards are creating by a dentist to fit the unique shape of your teeth, which makes them most comfortable and most effective. Even if a patient is in braces, these guards can be formed to fit comfortably around orthodontia. The process is quick, easy and inexpensive.

If you are a patient or a parent of a child involved in any activity with the potential for injury, let us know. We’re happy to create a custom mouth guard to keep those pearly whites protected! Contact us to book an appointment for your fitting. 



Insurance Update

Today's blog post is brought you by a special quest author, our office coordinator, Nikki Kirkland, to keep you updated on our insurance information. Here's Nikki ... 

As a service to our patients, we are happy to submit dental claims and maximize insurance benefits to reduce out-of-pocket expenses.  Our office accepts all major insurance carriers, including most employer-sponsored group plans and many individual plans. Currently, we are a Delta Premier Provider, which means our Delta Dental and MODA subscribers benefit from our in-network agreement and fee schedule. We are also a participating provider with Regence Blue Cross Blue Shield, which includes LifeMap, HMA and RGA dental plans. To better serve our patients and community, several additional carriers are being considered for our participation.

As the end of the year approaches, it is important to keep in mind that most dental plans renew on January 1. Dental insurance is unique in that patients have an annual maximum allowed, and any unused benefits at the end of the year are lost. Now is an ideal time to schedule pending treatment and use those remaining insurance dollars. The same concept applies to flexible spending and healthcare savings accounts.

Many of our patients do not have dental insurance, but will still benefit from fair and competitive fees, treatment plan discounts and monthly payment plan options. Our experienced and knowledgeable staff is here to assist you with any questions you may have.

> Please don’t hesitate to contact our Office Coordinator, Nikki with any financial or insurance related concerns.



Toothbrush Selection

There are so many toothbrushes on the market – how do you choose? Angled heads, electric brushes, ergonomic handles, biodegradable, etc. All these choices can make it tough to decide which brush is right for you. In this article, we’ll decode some of these options and help steer you in the right direction.  

What’s the Difference Between Hard and Soft?

When we talk about “hard” or “soft” toothbrushes, we are referring to the stiffness of bristles on a toothbrush. In theory, stiffer bristles are designed to better remove plaque, food bits and staining. However, our recommendation is to always go for a softer brush. This simple fact is that most people actually brush too hard! Brushing too vigorously is compounded when using a hard-bristled brush and can cause damage to sensitive gum tissue - especially near the gum line.

So next time you come across a hard toothbrush, save it for cleaning the kitchen grout instead!

Natural or Synthetic Bristles?

Most toothbrushes are made from a synthetic material. However, recent advances have been made to promote the production and usage of natural material toothbrushes – for both bristles and handles. Popular materials for these types of brushes are plant or wood fiber. In our opinion, either is fine for your pearly whites, but we love the idea of toothbrushes which are better for the environment! Try a natural toothbrush out when you have the opportunity.

Heads and Handles

There are almost infinite possibilities in brush and head styles. Rather than take too much time describing them all, we’ll get down to business. Here’s what you need to know: It doesn’t matter much. Instead of getting weighed down by the choices, just choose one that’s comfortable to use and inspires excellent hygiene (cheetah print anyone?).

Electric or Manual?

This is where we’ll make our strongest recommendation. We are huge fans of electric toothbrushes! They are powerful and easy to apply the right pressure with. Another great benefit is that many models come with a timer, encouraging people to brush for a full two minutes more often than they normally would. A study by the American Dental Association found that most people brush for only a minute and half.

In addition, the sonic waves emitted by the vibrating brush are proven to be more effective at loosening food and plaque. We had a patient in Invisalign treatment compare brushing her aligners with a manual toothbrush after forgetting her electric brush on a two week vacation. After the experiment, she claimed she would never use a manual toothbrush again! She said the difference, when she could actually see what she was brushing (opposed to the teeth in your own mouth), was an obvious one.

Finding “The One”

Still wondering which toothbrush is best? Don’t worry about it too much. Consistency in your dental hygiene makes a bigger impact on your dental health than any style of toothbrush. Brush two times a day, floss daily and keep your regular hygiene appointments.

If you still have questions about choosing a toothbrush or any other dental care topics, feel free to drop us a line. 


The Link Between Gum Disease and Prostate Issues


The Link Between Gum Disease and Prostate Issues

Ashland, OR – For many years now, we’ve known about the unique link between gum disease and other ailments such as increased risk of heart disease. A new discovery points to the likelihood that treating gum disease may also lessen symptoms of prostate inflammation.

“Western Reserve University School of Dental Medicine recently released research that this may be the case,” says Ashland dentist Dr. Aron Kivel. “In the report, participants who suffered from prostatitis experienced fewer symptoms while also seeking periodontal (gum) treatment.” 

This isn’t the first time the correlation between the two have been studied. Previous research also proved the link between prostatitis and gum disease, but this new study shows proves the effectiveness of treatment in helping patients with prostatitis.  For those with inflammation of the prostate, urinating can be painful and laborious.  27 men with both prostate inflammation and gum disease were studied and after gum disease treatment. Even though these men received treatment for their gum disease only and not for their prostate issue, most showed significant improvement. Specifically, 21 of the 27 participants displayed decreased prostate specific antigen (PSA) levels, which indicate a lessened likelihood of inflammation. Men with the highest levels of inflammation also exhibited the most improvement following periodontal treatment.

So How are the Two Linked?

Gum disease develops when plaque and calculus isn’t properly removed and with time, the bacteria can spread and grow below the gum line. This toxic bacteria can then stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. If left untreated, the bacteria can also spread to the bone, causing further infection and possible bone loss.

Our bodies’ systems are intimately related. The bacteria that cause periodontitis can travel to other organs of the body. While a definitive answer has not been reached for why gum disease is linked to so many other issues, inflammation is the strong common denominator.

Research continues to be conducted around the world exploring the link between gum disease and other serious medical issues, but the consensus is obvious – even without an exact reason why, the evidence points to the fact that periodontitis has an effect on your body as a whole. Undergoing proper treatment for gum disease can very well improve people’s overall health and well-being.

You can prevent gum disease before it becomes and issue by following a thorough home hygiene routine which includes daily brushing and flossing, and regular check ups at your dental office. Because periodontitis is often painless, you might not even be aware you have it until it is too late. By discovering and treating gum disease as soon as possible, your dentist can lessen its effect on your gum health as well as the rest of your body. If you’d like a thorough evaluation of your own gum health, make an appointment with us today. 



Electronic Cigarettes and Oral Health

Ashland, OR – Since their introduction to the market in 2004, electronic cigarettes have seen significantly increased popularity. E-cigarettes are battery-powered devices that convert nicotine into vapor. Publicized as a “healthier alternative” to regular cigarettes, many users have switched to help them quit smoking. The negative health effects of traditional cigarettes are well-know, but many people are now wondering what risks might be posed by e-cigarettes.


The main issue is electronic cigarettes have not been fully studied. “E-cigarettes are so new that long-term effects of their use are not yet know,” says Ashland dentist Dr. Aron Kivel. “Recent research does show that el- cigarettes can negatively impact oral health due to the presence of nicotine. Another concern is that they aren’t regulated by the FDA. “

The products are sold over the counter and are not subject to the same regulation as actual cigarettes. In fact, the FDA does not regulate them at all. Studies have shown that nicotine, delivered by traditional cigarette or other, does harm to the gums, mouth and tongue.

A report published by the Journal of the Indian Society of Periodontology stated that nicotine may contribute to the development of gingivitis and periodontitis, which can cause inflammation and bad breath. Nicotine is a vasoconstrictor, meaning it narrows the blood vessels and reduces the amount of blood that can flow. Without proper blood flow, the gums do not get the enough oxygen.

This constricted blood flow can also hide the symptoms of gum disease, making it harder to be diagnosed. When gum disease is present, it’s the increased blood flow to the gums that alerts your dentist or hygienist to the fact. Diseased gums are irritated and typically swell with blood, and when brushed or flossed, they bleed. This false positive caused by nicotine can fool you into thinking that things are going better than they are.

Nicotine can also be detrimental to people who grind their teeth as it is a stimulant. This fires up the muscles, which makes you grind your teeth more intensely. It may even prompt non-grinders to start grinding their teeth. 

The vaporizing liquid used in these cigarettes contains dangerous chemicals, restricts vital blood flow and more studies need to be conducted to further study the implications of e-cigarettes. Our final verdict? It is safe to say that the only safe alternative to smoking is quite simply not to smoke at all.