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

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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.

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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.

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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”

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The Link Between Childhood Obesity and Poor Dental Health

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The Link Between Childhood Obesity and Poor Dental Health

Lots of studies in recent years have been proving the connection between dental health and overall health. But a study released at the end of last year explored the link between dental health and childhood obesity. The study researched the habits and stats among 271 Swedish children. They found that children with a higher amount of carries bacteria (which is responsible for cavities) also had significantly higher body mass index (BMI) and unhealthier eating habits. Their eating habits more frequently and consumed more foods rich in sugar. 

Because weight can be a sensitive subject, registered dietitian Louise Arvidsson advises focusing the conversation on dental health and the type of foods that can help or harm your teeth. Foods high in carbohydrates (starches and sugars) contribute considerably to the production of plaque and acids that break down tooth enamel which can eventually lead to cavities. 

Food suggestions for dental health AND overall health:

  • yogurt
  • leafy greens
  • apples
  • celery
  • carrots
  • almonds
  • lean sources of protein such as lean beef, skinless poultry, and fish
  • dry beans, peas, and other legumes
  • plenty of water

Tooth decay is actually the single most common chronic childhood disease, but the good news is that we can prevent it and impact children's overall health when we educate them and teach them healthy hygiene habits. Remember to teach children to brush twice a day, floss daily and visit their dentist regularly. If you have any questions or would like to make an appointment for your own child, please contact us or give us a call at 541-482-4995.

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LocalsGuide Article: The Evolution of Soulsmile

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LocalsGuide Article: The Evolution of Soulsmile

We are always so grateful to Shields and the LocalsGuide crew when they want to interview us and help people get to know Soulsmile and the people behind it. This is the full transcript of the article that ran in the December 2017 issue of the LocalsGuide in Ashland, OR ...

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Hi Aron, it’s been a year since we last spoke. Tell us, what’s new with Soulsmile?

Shields, thank you for this interview opportunity. This type of support from the community has helped Soulsmile get its message out and boosted it beyond the business startup phase. Having moved mid-career from the Bay Area three years ago to start anew - I can’t express my thanks enough! We are committed to providing one patient at a time, high-tech, high-touch general dentistry with an emphasis on complex dental conditions and cosmetics. We deliver this service at a great value by really listening to our patients to come up with a treatment plan based on the patient’s wishes, and then performing in an efficient, predictable manner to achieve excellent results.

New for 2018 will be a monthly membership plan for uninsured patients, laser-assisted hygiene at no additional charge, cone beam 3D imaging for critical diagnostics, and 3D printing of diagnostic models for accurate planning and enhanced patient communication.

And personally? Congratulations on your baby girl. How is fatherhood?

Thank you! Siena is six months old and it has been absolutely wonderful. I’m most blown away by motherhood. My hat is off to my wife, Ryann, and moms everywhere. Second, I’m in love. I think about Siena all of the time and can’t wait to see her. I’m a softie already!

Starting a business brings about unexpected challenges. Would you share yours?

Right, these challenges are lifelong learning in an organic sense, as opposed to more academic learning. The two most significant areas where this has occurred for me with Soulsmile have been, first, the earning of trust in a new practice and in a new community, and, second, the development of my leadership skills.

I see that, as your “Modern Dentistry - Classic Values” slogan touches on trust.  

Yes, absolutely. That motto is eight years old now, stemming from our San Francisco office.  It’s easy to write a strong message into a vision statement, but trust is earned the old-fashioned way in dentistry. It doesn’t matter to a new patient if you’ve been practicing for a dozen years.  Making a solid connection with everyone walking through the door who values our services is at the heart of earning that trust. So I have spent a good amount of thought on earning and maintaining trust rather than assuming years of service, academic background, technology or past success will speak for themselves.

How has leadership become a learning opportunity for an experienced dentist?

To get Soulsmile where we want it, I need to become a better leader. Simple as that. Podcasts and audiobooks, which were already in my regular diet, have been perfect for improving my shortcomings in this area. Of the ten or so audiobooks I have listened to this quarter, Extreme Ownership, written by a couple of Navy Seals, was my favorite. In a nutshell, it’s about taking full responsibility for every condition, situation, and outcome.

Beyond the application of building and maintaining a high-performance team, I now see what an amazing dynamic my team members bring to our business since taking full ownership of training, working through our vision, being vulnerable to them about my own dreams and concerns, giving them a safe and fun place to work, and allowing them to express themselves and own their personal connection with patients. It’s really exciting for me to see this team becoming one of our greatest strengths.

Those points make sense, as your patient reviews often mention being very trusting of you and your team.  Do you have a particular philosophy to credit?

We feel lucky to have such great reviews from patients and humbled by their generosity. The patient experience is always on our mind. We actually have a six-star goal: a five-star review plus a willingness to refer a friend. Our patient exams are at the heart of this trust, I believe. A quote from the famous martial artist, Bruce Lee, might shed light on our approach: “No way as way, no limitation as limitation.” Lee’s philosophy rejected the idea of a preconceived response (in our application, a predetermined dental treatment plan) and mandates an open mind with no perceived limitation of what is possible. I can’t tell you how many times being open-minded, curious and communicative has uncovered a wide range of really important dental considerations, from a patient’s unexpressed desires to big life events - good or bad, to finances, to hidden dental conditions. We believe that every patient has a unique view of their dental health. Safety, comfort, dignity, beauty ... whatever the objective, it is in flux depending on a person’s situation. So our sincere goal is to have patients feel (“soul”) these positive ways (“smile”) about their dental experience.

So trust stems from focusing on listening before the big-picture plan?

Exactly. We combine what we have learned from our patients with a myriad of dental solutions - from simple to complex- to come up with an ideal plan for that patient at that specific point in their life. Sometimes the plan is even to do nothing; whatever fits the patient’s desire. Each team member is highly trained and crossed-trained so we can be nimble, often pivoting to a patient’s request while plugging in the relevant standard operating procedures that apply. This feels flexible, understanding and compassionate to the patient. But there is also an efficient and methodical backbone which gives the feeling of safety and comfort.  It also allows us to see one patient at a time and to keep fees at a good value. A patient leaving a review may not directly notice these things. Such is the case with many of our favorite businesses.

You barely mentioned technology, yet many reviews comment on this as a strong characteristic of the practice.

As Jim Collins stated in his business book, Good to Great, technology can accelerate a business beyond good, but it will not in and of itself make a business great. People will. I love technology in dentistry. It’s great for patients and the progress keeps us all engaged. Using new technology is a state of mind; it keeps you in the loop.  At Soulsmile, we don’t use technology before it is practical, tried and true. But we do continue to look for the slightest application for affordable technologies in order to stay in the mental game so that when the application of use say, 3D printing, comes full circle, we are on the train instead of looking for the station.

In your opinion, what is the least understood area of dentistry?

Dental implants. Implants are actually a group of components that are combined to create the part that the patient cares about: the tooth. Understanding the parts, prices and prognosis can be confusing. Also, a natural tooth is still the best implant. Implants are a fantastic solution for an empty space or a completely empty dental arch, but I think we need to respect mother nature and the patient’s desire to keep their natural teeth when possible and practical to do so.

What’s a question people don’t usually ask, but you wish they did?

“Here is my budget today and here is my projected budget, can you make me a three step treatment plan that will allow me to look and feel my best and keep my teeth healthy forever?”

Any particular observations from this mid point in your career?

It’s a great view from which to look around. I’ve been thinking about how my “n=” is getting high enough that what were anecdotal observations as a younger clinician have now become a large enough sample size to amount to bona fide professional experience. As mentioned, I like entering each exam and treatment with an open mind, a “beginner’s mind” in the yoga sense, and yet good clinical judgment and planning stems from solid experiences from which to confidently draw diagnosis and treatment proposals.

Lastly, I know you are an outdoor enthusiast and adventure athlete.  Any new projects?

My wife and I love the Rogue Valley as a base for outdoor activities. The dirt is perfect for riding bikes right now and there will certainly be a good amount of backcountry and Mt. Ashland shredding in the months to come. We love paddling performance stand-up paddleboards and rowing at Emigrant Lake. There are fantastic adventure motorcycle routes all around. The list goes on, and yet, I have to say, that taking Siena for simple walks in the woods might be my new favorite outdoor pursuit.

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Visiting Soulsmile: Your Questions Answered

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Visiting Soulsmile: Your Questions Answered

ashland dental office

Hello and happy summer! We hope everyone has been enjoying the weather here in the Rogue Valley. We're particularly fond of afternoons at Emigrant Lake. Coming from the crowded state of California, we are always surprised at how few people are out on the lake, even in the middle of summer. Oh well - more fun for us!

We've noticed that we get asked a lot of the same questions by prospective patients when they first call in. We thought we'd gather a list to answer them in a blog. 

Do you accept ______ insurance?

The easy answer is that we accept any insurance that allows you to choose your own dentist. My advice to friends and family when they have questions about their dental insurance is to request a copy of their benefits and become familiar with them. It is surprising how many patients are never given a copy of their benefits! Unfortunately, there are HUNDREDS of dental plans out there and they change yearly. A dental office will usually know the basics of your plan, but knowing the nuances yourself can answer a lot of questions. Most likely, you're looking for a section of your benefits titled "Out of Network". A lot of people are surprised to find that going to an out-of-network dentist may only cost them $20 more, but can mean a HUGE difference in the quality of care they receive. 

Currently, we are IN network with Delta (aka Moda), Regence (aka Blue Cross Blue Shield) and Cigna. However, there are even some plans within those companies where they do not let you choose your own provider. So check out your benefits for the best answers! Feel free to ask us your questions too. 

How much does _______ cost?

We are as transparent with costs for our services as possible and are certainly able to give you an estimate. The only problem is, without seeing what's going on in your mouth, its hard to know exactly what you need. Here are some common services we get asked about:

  • A crown is usually $1,100. But in some cases, the tooth has worn down enough or has had a root canal and needs a $200 build up too. This is so the crown has something to secure it to.
  • Fillings cost between about $100-300 depending on how many surfaces it needs to cover.
  • Invisalign is $4700.
  • A cleaning is $111. Unless you have periodontal disease and need a deeper cleaning called Periodontal Maintenance, that is $160. 

Sometimes the best price to ask about is your initial exam (we usually run great specials!). From there we can see what you need and discuss costs. There are ways to work within any budget!

Do you offer payment plans?

Yes! We work with a third party service called CareCredit. They allow you to finance healthcare service, similar to using a credit card. They even offer no interest plans if its paid off within a certain time frame, usually a year. You can learn more or even apply on their website. We can also help you with the process in our office.

What will happen at the first visit?

First, you'll be greeted by our friendly team. Then, you'll be seated in our conference room to fill out welcome forms. We've had them laminated to eliminate paper waste. They are scanned into our computer when we're done and then erased for the next guest. You'll then be escorted to a treatment room by one of our awesome dental assistants. There, they'll take records. Most commonly this consists of not only xrays, but also digital images. Patients love that high resolution photography allows us to show you what we see. This way you can make more informed decisions about your dental care. Our assistants are highly trained and will often start the conversation about your dental health - if anything is bothering you, what they are seeing, your goals for your oral health, etc. Dr. Kivel will then do an in depth oral examination and review of records. He will present a comprehensive overview of your teeth and gums and if there is any recommended treatment. The main goal of this appointment is to give you any information you might want to know about your mouth, but most importantly - find out what you want and how we can help. Sometimes this means nothing at all! Other times, it means simply addressing any obvious decay or how your smile can look its best. It really is all up to the patient and what they want. 

I just need a cleaning. Can I make an appointment for that only?

The state of Oregon actually requires that dentists perform an oral exam on a patient before assuming care for them. It makes sense! How can we even provide the best type of cleaning for a patient before we know what they need? So at Soulsmile, you'll first have an exam with Dr. Kivel and his assistants to see how things are going before booking a cleaning with our fantastic hygienists. 

Do you offer consultations or second opinions?

Yes and yes! Anyone with more general questions about bigger treatment plans, cosmetics, treatment proposed by another dentist, etc, is welcome to come in to meet Dr. Kivel and an assistant for a free 15 minute consultation. This type of appointment is also useful for patients with dental anxiety who simply want to meet the team and check out the office before making their first appointment. 

Have any other questions? You can contact us directly or leave it in the comments if you'd like us to add it to the blog article. Thanks for your interest in Soulsmile. 

 

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Latest Dental Trend: Charcoal Toothpaste?!

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Latest Dental Trend: Charcoal Toothpaste?!

You may have seen some pictures on Instagram or YouTubers posting videos of the latest, greatest dental trend - charcoal toothpaste. Move over oil-pulling ... this DIY whitening trend consists of smearing a charcoal-derived black mixture on your teeth and brushing with it. 

Proponents of the technique claim that because these mixtures are highly absorbent they can naturally solve surface stains. In fact, there are already medical applications for charcoal, like absorbing poisons in an accidental poisoning. Many "reviewers" online brush their teeth for 3-5 minutes with the mixture and then have seemingly whiter teeth afterwards. 

Currently, the American Dental Association has not evaluated or approved of charcoal toothpaste. In fact, a representative for the ADA has commented saying the trend is concerning because its abrasiveness is not yet known and could be causing damage to people's teeth. Did you know, teeth are the only part of our bodies that does not replenish or heal itself. Once they are gone or damaged, it's a done deal. Of course, we can help correct any problems, but we'd rather see them avoided in the first place. But this means your teeth are usually not where you want to do any experiments. Fun new hair color or crazy nails? Yes! They grow back. Your teeth - not so much.

Whitening your teeth can happen in two ways. One, by scrubbing surface stains. Or two, by bleaching to actually change the color of the dentin. The later method is many times more effective. Charcoal tooth paste only claims to affect surface stains anyway, so if you're looking for real results, consider a professional whitening systems. These penetrate the enamel making teeth 3-8 times shades whiter, with effects that last years. 

We've concluded that there is not enough evidence available yet to know if the supplement is hazardous, beneficial or benign. Our vote: wait until there are more studies (if that even happens before it falls out of favor). In the meantime, there are plenty of proven techniques and products for whiter teeth. Ask us at your next appointment about whitening options. We offer three levels to meet your needs and budget. As always, if you have any questions feel free to contact us or leave a comment below. 

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Is Mouth Rinse a Must-Do?

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Is Mouth Rinse a Must-Do?

Walking the aisles of an Ashland drugstore will reveal a plethora of mouthwashes and rinses. These products tout dozens of features like germ eradicating ingredients, fluoride or even teeth whitening. Many of our patients wonder about the benefits and if they should make mouthwash a part of their daily routine. 

Our short answer is that brushing and flossing are the two most critical habits that will affect your dental health. If you're doing a good job of these two, mouth wash is not a necessity. 

On the other hand, it simply doesn't hurt to add an additional aspect to your routine, like mouth wash. While it may not live up to every promise advertised, it can be beneficial. We like to advise mouth rinse after flossing to help wash away any excess particles of food which may have been dislodged during your flossing. 

One thing to keep in mind is that mouth wash will not necessarily help with bad breath. Often, bad breath is a result of dryness and the harsh alcohol content of many mouthwashes can worsen this condition. If fresh breath is one of your primary goals, we'd recommend selecting an alcohol-free variety. Plus, its easier to handle! Additionally, chronic bad breath is often a result of plaque build -up. Ask Jordon (or your own fabulous hygienist) at your next cleaning if she thinks this may be contributing to bad breath. If so, improving your brushing and flossing is much more likely to help. 

The bottom line is that you should never substitute proper flossing and brushing with mouthwash. But feel free to supplement your routine with a little rinse! If you have any specific questions, feel free to contact our Ashland dental office. If you want to make an appointment for a check up, you can call us at 541-482-4995. 

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Teeth Grinding and Nightguards

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Teeth Grinding and Nightguards

Do you ever wake up in the morning with headaches or soreness in your jaw? Have you or your dentist ever noticed chips or small cracks in your teeth? If so, you may be grinding your teeth while you sleep. Don't worry - you're not alone. Its estimated that about 30 million people in the US do the same. 

This condition, known in dental as bruxism, is not life-threatening, but it can definitely cause damage to your teeth. It is probably also disrupting your sleeping habits. In this blog we'll discuss the causes, symptoms and solutions for bruxism and how the latest dental products can help you. 

Diagnosing Bruxism

Bruxism is not typically hard to spot. Most people suspect they grind their teeth. They usually either looked up their symptoms online or have been told by friends or family that they're grinding. 

During a dental exam, we can usually tell a patient has been grinding. We look for chips and damage to the tooth enamel as well as smoothly worn surfaces. We will also ask questions about jaw pain and/or headaches. One of the most significant concerns related to bruxism is that it often is an indicator of a sleep apnea - a very serious condition. 

Identifying Signs of Bruxing and Clentching

Treatment with Nightguards

The most common way to treat bruxism is with a nightguard. In fact, up to 70% of our regular patients use a nightguard. It's one of the easiest methods of prevention! This appliance is worn in the mouth during sleeping hours to prevent grinding. Nightguards are similar to athletic guards, but thicker and more rigid. These custom appliances are made with acrylic using a professional impression, ensuring a perfect fit. 

Another advantage of a custom-made night guard is the material. Acrylic is hard (opposed to store-bought "boil and bite" type of nightguards that are soft) and discourages further biting, clenching and grinding. These are the behaviors we're trying to eliminate! An over-the-counter biteguard isn’t made specifically for you, it’s meant to fit a wide variety of jaw and mouth sizes. Unfortunately, it will never fit perfectly. 

Ask Us About It!

If you suspect that you’re grinding, ask your regular dentist for help. He or she can confirm a diagnosis and work with you to develop a treatment plan. If you're in the Ashland or Rogue Valley area, contact us at Soulsmile. You can call us at 541-482-4995 to schedule an appointment. We'd love to help you sleep better. 

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The Reasoning Behind Wisdom Teeth Removal

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The Reasoning Behind Wisdom Teeth Removal

Most people's "wisdom teeth" (which we call third molars) begin to erupt around the late teens or early twenties. These will be the third and final set of molars to come in. Occasionally third molars can come in correctly aligned and offer more chewing power. In this event, you may decide to keep your wisdom teeth as long as you can maintain proper hygiene. More often, they are misaligned and can crowd other teeth. 

Why Do We Have Wisdom Teeth?

A popular theory suggests that the human diet used to consist of more rough food like leaves, meat and roots which required better chewing power. There has also been a size reduction in the human jaw and face over the past 20,000 years.

More and more people born today never develop third molars. 

Why Remove Wisdom Teeth?

While not every patient needs to have their wisdom teeth removed, the common situations will likely warrant their removal. 

1. Impacted Wisdom Teeth

When a third molar is "impacted" it means that gum tissue is completely covering the tooth and preventing it from erupting successfully through the gum. This is usually the result of a mouth that is too small to allow the room the teeth need. At times, this leads to bacteria or food getting lodged under the gums covering the wisdom tooth and can create an abscess. 

2. Partially Impacted Wisdom Teeth

Partial impaction means the tooth is only partially emerged from the gums. In this case, we almost always advise removing the tooth. Again, bacteria can be lodged underneath and because of the location in the very back of the mouth, a wisdom tooth is more susceptible to cavities and decay. 

3. Additional Reasons for Wisdom Tooth Removal

The following dental issues may also increase the likelihood that we recommend removal for your third molars.  

  • Pain at or surrounding the third molar(s)
  • Pain or swelling in the jaw or cheek area
  • Infections of the soft tissues
  • Gum disease
  • Tooth decay
  • Tumors or Cysts

If you are considering having your third molars removed, we are happy to consult with you on the topic. Dr. Kivel can address the health of your wisdom teeth, whether they have erupted and your overall oral health to determine the best next steps. Contact our Ashland, OR dental office to schedule an appointment with our friendly team. 

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What the floss?! Soulsmile Weighs in on Recent News

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What the floss?! Soulsmile Weighs in on Recent News

Let's Talk About Flossing

Surely you've seen the headlines - "Flossing is Nonsense and My Laziness is Vindicated" or "Flossing: Government's Latest Piece of Bad Advice". All this press about flossing stems from an article published this month by the Associated Press (Read it here). Their report points out the weak evidentiary basis for floss as a method of reducing plaque and tooth decay. The American Dental Association responded saying: Trust us, flossing helps.  

In reality, the AP article is less about floss and more about evidence-based medicine. They are correct in that the published and proven evidence for the benefits of floss is poor. One reason for this is that floss has been around since the 19th-century! Recommendations for flossing are based on pretty obvious assumptions: it removes plaque from in between teeth and because plaque leads to gum disease and decay, flossing will improve these conditions. But because our medical standards have risen so greatly in the last centuries, assumptions are not enough - and understandably so. 

Anecdotal evidence and long-standing traditions have been replaced with evidence-based medicine. This approach is dependent on well-designed, controlled studies. Thus far, nobody has tackled a flossing study with the academic rigor we now expect. Why? We can only speculate. Studies like this are expensive and there is no fame or monetary reward to be found in proving out flossing. Flossing is cheap, easy to adopt and no-risk. This leaves us with anecdotes and weak evidence. Two of our leading dental associations — the American Dental Association and the American Academy of Periodontology — cited other studies as proof, but most of these studies used outdated methods or had relatively small sample size. 

Despite our agreement regarding poor studies and evidence around flossing, this does NOT mean it has been proven ineffective either. Each of your teeth have six surfaces and brushing can only clean four of them. You simply need a method for cleaning in between your teeth to properly remove all plaque causing substances that are proven to cause decay.  

We always hoped more people would talk about flossing - but not like this! At the very least, we hope this exposure will inspire researchers to conduct better studies and counteract these claims made by the AP. Oh, and by the way - even the author of the article admits he still flosses. If you have any questions, feel free to contact us directly or leave a comment. We'd love to hear from you. 

For Further Reading

This 2006 study titled, “Dental Flossing and Interproximal Caries: a System Review,” recruited 808 children age 4-13 and split them into three test segments: kids who were professionally flossed 5 days/week; kids who were professionally flossed once every 3 months; and kids who reported self-flossing at home. The research lasts 18 months and unsurprisingly, the participants who were professionally flossed 5 days/week saw a 40% decrease in the risk of cavities. 

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Are Dental X-rays Safe and Necessary?

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Are Dental X-rays Safe and Necessary?

One of the great things about the Ashland, OR community is the level of health intelligence. Its evident by ready the local publications or driving around town and seeing the many natural food stores and health care providers. We’ve come to realize that concern around x-rays is even greater here than many parts of the country – and rightly so! We hear questions regarding the safety and necessity of x-rays on a daily basis. This is a great question and the answer differs from patient to patient. Let’s dive in a little deeper – we think you’ll be surprised to leave just how safe today’s x-ray practices are.

First of all, there is an ever-changing landscape when it comes to dental x-rays. The American Dental Association (ADA) together with the Food & Drug Administration (FDA) routinely revises their guidelines when advances in technology provide new methods of reducing exposure to radiation. In fact, today’s dental X-ray is already far superior to those of just a decade ago. This is due largely to the advent of digital technology.

The following guidelines come from the ADA and are supported by our practice:

New Patients: 

Full X-rays are generally suggested for new patients to provide us with a full history of your prior oral care and current needs. If you’ve recently had x-rays taken at another office, we’re happy to obtain those on your behalf.

Continuing Care Patient:

One set of X-rays every 6-18 months. We generally aim for 12 unless a patient is at a higher risk or is presenting with an issue.

Continuing Care Patient with Periodontal Disease: 

Dependent upon the professional judgment of Dr. Kivel.

Patients with, but not limited to, Proposed or Existing Implants and Root Canals:

Also dependent upon the professional judgment of Dr. Kivel.

In conclusion, it’s important to realize that exposure to all sources of radiation - including the sun, home appliances, minerals in the soil, X-rays - can damage the body's tissues and cells. Fortunately, the dose of radiation you are exposed to from dental X-rays is tremendously small, especially with our use of digital x-rays. Our recommendation is to follow the ADA guidelines. This is because allowing a major dental issue to go undiagnosed can be much more damaging to your health than a small amount of radiation. Please feel free to ask us any questions or voice your concerns regarding x-rays and we will do what we can to accommodate your preferences.

You can also check out our great FAQ Page on Digital Xrays.
 

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Dental Care: Under the Microscope

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Dental Care: Under the Microscope

The introduction of microscopes has revolutionized dental care. A microscope is the best visualization tool available in modern medicine. This advanced machine allows Dr. Kivel to work under a magnified scope of up to 20x that of normal vision.

The benefits of dental procedures completed with a microscope include:

Magnified Image: With the simple turn of a dial, microscopes offer a deeper and wider field of view than traditional dental loupes.

Conservative Treatment: Increased magnification allows better precision and access into small, narrow openings without unnecessary removal of tooth structure.

Illumination: Typically, when magnification is used, the light is spread out and an image field would appear darker. Mounted to our microscope is an integrated, through-the-lens, fiber optic light. This light source completely eliminates shadows because it incorporates a coaxial (line of sight) light path.

Ergonomics: With a microscope, it is no longer necessary for dentists to contort and bend their bodies to obtain proper visualization, enabling more comfortable operation for longer periods of time. This efficiency also means more treatment can be provided in fewer visits for the patient.

Imaging: With an added camera (even a cell phone camera!), a scope can fulfill the purpose of an intra-oral camera mid-treatment. With a scope, there’s no stopping in the middle of the procedure to get a wand, find the area, focus, and capture the image. It’s there already!

How Much Extra Does it Cost?

We charge no additional cost to perform treatment using a dental microscope. A microscope is simply the best modality for accurate visualization and diagnostics and we believe this is essential to providing the best care possible for our patients.
 

A Different Kind of Dental Experience

Overall, microscopes give Dr. Kivel increased precision and a higher level of confidence that all decay has been removed. Most importantly, however, the microscope enables us to better diagnose problems early, and in turn, communicate these issues to patients so that they are better informed in making decisions related to their care.  

Please let us know if you have any questions about dental microscopes or are interested in becoming a patient of our Ashland dental office and experiencing the difference yourself! 

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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. 

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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.

ecigarette

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.

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