I just finished a “Lunch and Learn” by our Rep from Crest/Oral-B on all the new products from this renowned company. While eating a Greek salad, I listened as he extolled the virtues of the new IO electric toothbrush that they have offered for sale. They have the top of the line, the IO-8 with all the bells and whistles on down to the IO-6, IO-4 and their entry level IO-2, which is offered at Costco at a pretty good deal.

The IO-8 retails for almost $300 on Amazon and features technology that is far quieter than its predecessor. The electronics are quite novel, featuring differing lights and modes and a red light that comes on when you press too hard. The timer expires at two minutes and gives you a “frowny” face if you cut short the brushing time. There are modes for regular brushing, sensitive brushing, whitening mode (which is increasing and decreasing in frequency) and full-on all-out power mode, etc. There is a traditional charger and a “power” charger, a black and white interface on the handle, and a travel case.

The basic unit does not have the electronics and fancy features, just an on-off button, but it has the same great technology as the power toothbrush.

Years ago, I saw an article on trials that showed that manual vs. electric brushing is the same. I asked my Rep that question, and he responded that recently, those clinical trials have shown that it is not the case. Today I looked it up and sure enough, he was right.

The electric toothbrush is shown to reduce plaque in one to three months by 11% compared to a manual toothbrush. After three months, there was a 21% reduction in plaque levels, so there is something to that. Our elderly patients and younger patients who do not have manual dexterity benefit from the electric toothbrush, as well as our periodontal patients who just need more help with their oral hygiene routine to improve it and change things up.

Our staff have purchased the high-end unit for themselves and also to give away to children and family members, and there is nothing but high praise for the unit. I have used both the Oral-B and the Sonicare in the past, and my personal preference is the Oral-B, by far. I ordered a bundle of three of the entry-level electric brushes that are offered at Costco for sale in our practice for a very reasonable price. They also offer the “water flosser,” which, in my opinion, is false marketing because it really does not floss your teeth or mechanically remove the plaque.

A better term for a water flosser would be a “water jet,” which is great for debriding around bridges and dental implants, and reducing the inflammation and bleeding of the gums, along with removing the heavy food debris as an adjunct to brushing and flossing.

The manual brushes we are giving out to our patients are my favorite, with the Orab-B indicator brush, which shows a blue marking that, after three months, goes away, indicating that it is time to replace the toothbrush. We are also getting half our order in the new “sensitive” toothbrush with a smaller head and silky, extra soft nylon tufts or bundles in it.

This toothbrush is great for anyone, but especially those with exposed tooth roots, sensitive roots, erosion areas or anywhere there is wear on the teeth. We are still recommending the Reach waxed floss by Johnson and Johnson, which, in our opinion, is better than the Oral-B Glide floss brands, although they are coming out with a new nylon floss that does not shred as easily.

The toothpaste we are giving away is the Crest Complete with 3D white technology and the Crest Gum Detoxify for those with gum issues. We also love to give out the Sensodyne Pro enamel with Active Shield technology when it is available.

It is sometimes a hard decision to decide on which brush, floss and toothpaste to use–but for those without a caries (cavities) issue that need a prescription-strength toothpaste with the 5000 fluoride and the Nanohydroxyapatite technology–these are great options. If you have any questions about these products, call us at 360-256-1202 or email me at teuscher@tworiversdentistry.com, and we will respond to any questions you might have.

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At Two Rivers Dentistry in Vancouver, Washington, our dedicated dentist, Dr. Vaughn Teuscher, along with the rest of our team is here to help you achieve a healthy, vibrant smile!

The post Better Oral Health: Evaluating The Manual Vs Electric Toothbrush Conundrum first appeared on Two Rivers Dentistry.

Many of my patients ask what they can do to help fight cavities. We go over their diet to make sure they are not ingesting sugary products and acidic beverages on a daily basis. We look at their family history, genetics and their environment and risk factors.  In addition, one of the best ways to protect their teeth is the use of fluoride which is nature’s cavity fighter.

Fluoride is a mineral found in nature that combines with the calcium in the enamel of your teeth to make it more resistant to decay. We can get fluoride in two ways. One way is in our water supply when it is swallowed and the other is when applied to the tooth surface, such as with fluoride toothpaste. Many communities add fluoride to their tap water at a very low dose of 0.7 milligrams of fluoride, per liter of water, which is the recommended level for drinking water.  This strategy has a 75-year track record of safe and effective prevention of cavities. Before this, children had about three times as many cavities. If someone lives in a more rural environment, they can get fluoride supplements or over-the-counter fluoride products to help lower the risk.

Many of our patients require prescription-strength fluoride toothpaste with hydroxyapatite, which helps utilize the calcium and phosphate demineralization in addition to the fluoride topically. The fluoride varnishes we apply after the maintenance cleanings also help to prevent the epidemic of root caries and decay that is rampant.

We just received a new batch of varnish from 3M that is water soluble, so it does not have the “thick, gummy feeling” of the traditional varnishes and a person can eat and drink in 15 minutes, instead of one hour. It is four times the cost for us compared to the regular varnishes, but we do not charge extra for it because our patients love it so much and not one person has ever complained of the taste. These revolutionary products can dramatically reduce tooth decay and remineralize the teeth, saving both time and money in replacing old restorations and placing new ones.

For small children under three years of age, place no more than a grain-of-rice-sized amount of fluoride toothpaste on the brush and make sure children do not swallow it.  For ages three to six, a pea-size amount is sufficient and for older children more is not better, make sure they get the proper amount and are spitting it out after brushing.  Fluoride pills, drops or lozenges can be prescribed for children between six months to 16 years old who live in areas where there is no fluoride in the water.  They should take a daily dose until the child is 16 years old.  These supplements are only available by prescription.

We are seeing tremendous success with these fluoride products in addition to the Cari Free products and Closys Oral Rinse we carry in our office.  It is one of the best methods we have for reducing tooth decay and preventing a lot of problems over time.  Most of our patients are keeping their teeth into their 90’s and beyond which provides a lot of satisfaction to see that these methods and products truly do work.  If you have any questions about fluoride or fluoride products please do not hesitate to call us at 360-256-1202 and let us know your concerns.

The post Pioneering Dental Breakthrough: Fluoride In A Nutshell first appeared on Two Rivers Dentistry.

Let’s just say it wasn’t a very conservative way of practicing dentistry. When the composites and bonding came to the forefront years later and amalgam placement and use started to decline, we began to be more conservative in our preparations of the teeth because we could seal the grooves with flowable resins and preserve the healthy tooth structure.

In the mid to late 1990’s when I was working for my father in his old dental office, we purchased a state-of-the-art air abrasion unit called the KCP 1000 kinetic cavity preparation unit for over $16,000, pretty expensive at the time. It was the “Mercedes” of air abrasion units and still is, although they stopped making them years ago. It features two warmed brass holders to contain two different sizes of particles, at 50- and 28-micron sizes of aluminum oxide powder. Many of the smaller pit and fissure caries we see can be handled with this unit in a very minimally invasive way, saving healthy enamel and tooth structure and avoiding the dreaded fear of the “shot and drill”.

We only use our electric handpiece after the fact to smooth, polish and adjust the bite. Without exception, all of our patients invariably say it is the least painful and easiest filling they ever had. While some powder gets in the mouth (and all over) and it can all be a bit messy, we use water and suction to lessen the effect, and that is the only disadvantage that I can think of. The sandblasting provides a really good bond for our adhesives and resins, strengthening the bond and providing a long-lasting restoration.

Recently, our unit gave out and I had American Dental AirSonic Technologies in Texas completely refurbish the unit “like new”. We have been using it now for a few weeks and it really is like new, performing flawlessly. We are only one of maybe 100 dental offices in the entire US that have had one of these since they stopped making them years ago, and I had been just scavenging parts to keep it going. Now, it is like brand new and I am practicing minimally invasive dentistry like never before and my patients are very pleased.

At Two Rivers Dentistry, we are also pleased we can offer this very important service to our patients–as it isn’t even offered in 99% of dental offices. If you have any questions about air abrasion and minimally invasive dentistry in Vancouver, Washington, please call our office at 360-256-1202 or send us an email or text from our website at www.tworiversdentistry.com. Dr. Vaughn Teuscher, our dedicated dentist along with the rest of our team is here to help you with all of your dental needs!

The post Minimally Invasive Dentistry Using Air Abrasion first appeared on Two Rivers Dentistry.

The state Dental Quality Assurance Commission and the ADA, along with other state regulatory boards, have come up with the latest guidelines which generally state that it is recommended to take dental X-rays in a timely manner which generally is one year for bitewing X-rays unless the patient is high risk (six months) or low risk (two years). These timelines can be fudged a little according to the doctor and patient’s discretion. We try to inform the patient of the benefits and risks associated with refusing treatment and the potential risks of X-rays. I would like to address a few of the reasons for refusal.

1-Cost

A series of 4 bitewings may cost up to $60 or less depending on the area in which you live. Since we can’t see decay many times hidden in the mouth, nor can we see changes to the bone levels or any other aspect prior to operating in the mouth, we need X-rays to visualize this, track the bone levels, see the calculus missed, see the decalcification of the enamel and decay into the enamel and other problems. Simply put, diagnosing and finding these earlier saves a ton of potential costs in the long run. We are a preventative-oriented practice. We like to catch things as early as possible to prevent the future high cost of restoring a tooth, with a dental implant or root canal/build-up and crown, which could cost up to $5,000 or more for one tooth replacement.

2-Radiation

The new digital X-rays have reduced radiation down to almost zero. We placed a radiation badge on our assistant for three months recently and it came back at zero radiation. A series of 4 bitewings is 0.3 millisieverts and the normal background radiation from the sun and other things when you go outside is 300 millisieverts. Eating a peanut butter sandwich releases 0.12 pCi/gram of radiation from radioactive potassium-40, radium-226, and radium-228 or flying on an airplane gives you multiple times more than a dental X-ray. The recent ADA guidelines state that no person of any age or health status, including pregnancy, should wear a lead apron as it has been shown to not help, but actually make things worse by trapping the minimal scattered radiation and not allowing it to “fly off” but bounce back into the body. Europe was further ahead of us and stopped this practice years ago.

3-Complaint of Discomfort

We do our best to mitigate discomfort by using the sensors which are rounded, and using cotton and cushions and other things to help. We also have the phosphor plate X-rays which are thinner and more comfortable, and we can use the panoramic machine to take bitewing X-rays as a last resort, which we rarely have to do. So, there really should not be a reason to not follow the dentist’s recommendations and the latest guidelines from the ADA.

Signing a Consent Form 

In the past, if a patient refused, we would have them sign a consent form for refusal of dental X-rays. But even if they signed a release of X-rays, the courts do not accept this release. A patient is not an expert in the field. A doctor cannot accept supervised neglect. In other words, if a patient chooses to neglect themselves by refusing X-rays and the doctor allows it, the state considers it neglect by the doctor. If it has been three or four years and the patient refuses, we will need to make a notation in the patient record regarding the discussion and refusal. It may be that their needs would best be met in another office which would be at the discretion of the doctor and patient.

Call To Learn More

The good news is, that the new digital X-rays have made it possible to prevent and care for our patients in such a profound way and we use them as needed and not more, according to the latest guidelines, for the best care possible. If you have any questions about this or X-rays in general, please don’t hesitate to ask your dentist.

We welcome you to call Two Rivers Dentistry at 360-256-1202 to speak with one of our team members or schedule a visit with Dr. Vaughn Teuscher, our dentist in Vancouver, Washington.

The post Preventative Diagnosis: The Conundrum of Dental X-Rays first appeared on Two Rivers Dentistry.

That was a healthy person on no medications and is a rare occasion that can happen with no ill effects. However several other of my elderly patients came in with large areas of bone sloughing off and not healing and it was determined that the antiresorptive/ anti-osteoclastic drugs they were taking were the cause of this. One of my patients lost an implant and another almost all the teeth on one side due to this, so it is a real cause for concern.

We try to find out all the medications a person is taking and ask clearly if they are on any of the following drugs or bisphosphonate medications: Prolia, Forteo, Xgeva, Avastin, Eylea, Suninat, Nexavar, Rapamune, or Sutent. If so, we are very careful to avoid doing any extractions or implants or anything affecting the bone as it will not heal and there is a real risk of future complications associated with dental treatment. It is worse the longer a person is on them and how frequently and by mouth or injection etc.

Bisphosphonate and these other drugs appear to adversely affect the ability of the bone to break down or remodel itself thereby reducing or eliminating its ordinary excellent healing ability. The risk is increased anytime there are invasive procedures such as oral surgery that might cause mild trauma to the bone. Osteonecrosis may result, which is a smoldering, long-term, destructive process in the jawbone that is often very difficult or impossible to eliminate. I will usually recommend an oral surgeon to manage this problem and usually, he will be forced to put the patient on a drug “holiday” for the time before and after surgery, or permanently thereafter.

Your dental and medical history is very important. We must know the medication and drugs that you have received or taken or are currently receiving or taking. Providing an accurate medical history, including the name of your physician, is important. The complication of not doing anything to prevent this is loss of bony or soft tissues, pathologic fracture of the jaw, oral/cutaneous fistula, or other significant complications.

If osteonecrosis does occur, treatment may be prolonged and difficult, involving ongoing intensive therapy including hospitalization, long-term antibiotics, and debridement to remove non-vital bone. Reconstructive surgery may be required, including bone grafting, metal plates and screws, and/or skin flaps and grafts. Even if there are no immediate complications, the area will always be subject to possible breakdown even with minimal, gentle trauma from a toothbrush, chewing hard foods, or denture sores could trigger more problems. Long-term monitoring is required and regular dental maintenance and exams with your dentist are important to monitor and prevent problems from developing.

If you have any concerns or questions about your bisphosphonate or other medications, don’t hesitate to discuss them with your doctor and dentist. In this case, as in most cases, prevention is always the best medicine. Dr. Vaughn Teuscher and our Two Rivers Dentistry dental team in Vancouver, Washington, are here to help! We welcome you to give us a call at 360-256-1202 if you have concerns about your smile.

The post Osteonecrosis of the Jaw: A Real Problem first appeared on Two Rivers Dentistry.

Recently this past week we have been upgrading our server and many of our workstation computers as they were getting to be almost 10 years old.  That’s the problem with technology; it is constantly getting better and better and you are always needing to upgrade. These new 27-inch monitors we purchased are wonderful and show an incredible, crisp clear digital image and are a far cry from trying to look at an old washed-out one-inch X-ray under a small light of a view box or holding it up to the overhead light.

But, the problem with technology and information is that there are bad people always trying to take advantage and steal it and hold it for ransom.  I received a letter from my IT person who said, “In 2023, 43% of ransomware attacks were on small businesses. Only 14% of these businesses were prepared to face such an attack.”

Your money is the only priority for the bad guys and it doesn’t matter how big your business is, they don’t care.  I have noticed a huge increase in these attacks.  Just last weekend I found out that the United Healthcare/Change Healthcare clearinghouse ransomware attack affected almost all the dentists in the U.S. and caused them not to get any insurance payments for who knows how long.

I was relieved to find out that my electronic claims provider used a different clearinghouse for most of my claims so I wasn’t affected.  I couldn’t order products from my Henry Schein dental supplier recently due to a cyberattack and last year my supplier Burkhart Dental Supply was hit and was affected for quite some time. Due to this trend and problem, I have decided to invest in a monthly cyberattack prevention software program called Threatlocker, which my IT person says is the best one out there. This will increase my expenses, but the cost and pain of having it happen and losing everything is totally worth the added cost.

I just want you to know that as my clientele, and I consider you like family, you can rest assured that your personal health information is safe and secure from everyone and everything, and especially, all the hackers out there. I also feel adding this service and protection will help my IT person, who is responsible for my data, and me, to sleep at night knowing we are fully protected.  Yes, technology has changed, and yes, along with it all the problems associated with it, but it is still wonderful to live in the digital age and enjoy all the blessings of it.

If you have any questions or concerns regarding the Health Insurance Portability and Accountability Act (HIPPA), or your personal health information stored on our computers, don’t hesitate to reach out to me at any time.  Oh, and by the way, we are also here for all your dental needs, including your family and extended family and friends.

If you would like to schedule a visit with our Two Rivers Dentistry team in Vancouver, Washington, please call 360-256-1202. I look forward to helping you create your best smile!

Best Regards,

Dr. Teuscher

The post My How Technology Has Changed! first appeared on Two Rivers Dentistry.

Elderly seniors have a host of issues to deal with, including the fact that they can’t brush their teeth like they used to, or floss due to arthritis or dementia, or whatever their health care concern is.  That lack of good oral hygiene combined with many who take a host of medications that cause dry mouth creates an epidemic of caries, and particularly root caries.

When the cavity starts destroying the root of the tooth next to the bone, it becomes a heroic endeavor to try to save or restore the tooth.  It also becomes quite expensive when you have to replace crowns or have to resort to root canals or implants.  Gum disease, lack of care, bone loss, and the inability to clean down the infected areas also make seniors more prone to tooth loss. Seniors are usually on a fixed budget which makes it hard to pay for the needed care. In addition, many seniors have diabetes, high blood pressure, obesity, and are prone to pulmonary infections such as pneumonia, and heart issues. The infection in the gums can complicate and worsen their entire health condition.

Keeping the mouth free of infection and healthy is one of the keys to preserving the oral health of this category of patients.  In addition, the best way to prevent root caries is with fluoride and the best time to apply the new varnishes we have is right after the dental cleaning.  It typically isn’t covered by insurance, but it can be so effective.  The prescription toothpaste we provide our patients, such as ClinPro 5000 and Prevident, allow the person to apply the fluoride at home on a daily basis, helping to prevent root cavities.  We also love the Carifree products, such as the treatment rinse and maintenance rinse, to bring the pH of the mouth back up out of the acid zone and kill some of these unhealthy bacteria.

Additionally, if the patient would avoid sucking on lozenges and drinking acidic beverages and such they can prevent a lot of these problems on their own.  Many of our elderly patients (including my own mother) benefit by coming in every three months for a cleaning to help debride the mouth of the unhealthy biofilm that causes dental problems.

In short, we have found that preventative in-office care can help seniors avoid losing their teeth and impact their ability to chew effectively. Also, many seniors go downhill after losing teeth. Preventative care can also be a lot cheaper in the long run, thus saving them a lot of money.

If you are a senior or know someone in your family who could benefit from a preventative care approach to dentistry, please give us a call at 360-256-1202.  We can do a lot to help keep your mouth healthy and avoid the epidemic of root caries and periodontal disease that we are seeing. At Two Rivers Dentistry, our dedicated dentist, Dr. Vaughn Teuscher and his team are happy to serve our senior patients in Vancouver, Washington.

The post HELPING SENIORS GET THE QUALITY DENTAL CARE THEY NEED first appeared on Two Rivers Dentistry.

But now, imagine not having to go to the dentist for a shot or to have your tooth drilled on. We simply clean off the tooth, etch it, then paint on a liquid for 4 minutes and it’s done, quick and painless. What’s more, there is no staining or discoloration of the teeth, it is tasteless and odorless, and can be done on all ages 4 and up with virtually no side effects or contraindications.

Many of these early lesions appear like white chalk on the teeth and the liquid contains a peptide or protein that penetrates the lesion and sets up a ladder-like scaffold inside which allows the body to leverage amino acids, calcium and phosphate ions to help new hydroxyapatite crystals grow in the enamel. It can then be tracked over the next 6 months and beyond to make sure it is healing and getting better.

They have been using this product in Switzerland over the past 10 years and the studies show it has a 95% success rate and 13 times higher probability of success versus fluoride varnish alone. Of course, if the person never brushes their teeth or exhibits poor home care or prevention by not coming in for regular check-ups, it may start to form a hole in the tooth and require a filling, but this intermediary treatment is a game changer.

Using ClinPro 5000 or Prevident or any of the prescription strength home fluoride kinds of toothpaste will aid in the remineralization process as will a fluoride varnish treatment in the dental office after the cleaning or maintenance appointment and or after the Curodont Repair Fluoride Plus repair treatment process.

There will be a new ADA code beginning in January 2024 for this procedure titled hydroxyapatite remineralization of the tooth/per tooth. We hope insurance companies will start to help with the costs of this which typically is not covered by insurance. But, at only one-third of the cost of a filling currently, it will be well worth it not to have your tooth drilled on or have to endure filling replacements, crowns, root canals, implants or loss of the tooth over the life of the person.

We are excited to now offer this amazing new technology and look forward to seeing the benefits it provides our dental family. If you have any questions about this new treatment or would like to schedule an appointment, don’t hesitate to call us at 360-256-1202 or email us at office@tworiversdentistry.com. We look forward to assisting you with all of your dental needs in Vancouver, WA, and the surrounding areas!

The post CURODONT™ REPAIR FLUORIDE PLUS REMINERALIZES EARLY CAVITIES first appeared on Two Rivers Dentistry.

If there is periodontal bone loss over 50%, it may be better to extract the tooth, especially if there is active infection or the person isn’t coming in regularly for their periodontal recare. If there is deep decay near the bone or extensively throughout the tooth, it may not be worth the additional surgical procedures and loss of bone to do crown lengthening procedures or root canal  procedures with posts and cores, etc.

If there are cracks that are located within the confines of the tooth, then many times a crown and build up can be placed and will solve the problem or a root canal if there are symptoms. But, if the crack extends down onto the root, then the prognosis is generally hopeless and it will be better to extract the tooth as it cannot be saved no matter what we do. This is the main criteria for removing a tooth with a crack and it is sometimes a difficult diagnosis and a hard decision to explain to our patients. Many of these also have the telltale sign of active infection along the crack extending down the root, but some do not.

Our 3D cone beam X-rays can help in the diagnosis and decision making. We are seeing many more of these “cracked tooth syndromes” in our practice as people are under a lot of stress and tend to bruxism, the clenching and grinding, of their teeth. The best approach is prevention and trying not to place any fillings in the tooth if possible so as to weaken it.

Regular preventative maintenance hygiene visits, check ups and dental X-rays go a long way to accomplishing this. When the decision arises of whether to save or not to save a tooth, many times the decision will be obvious (and many times it won’t) and a discussion with your dentist as to the short and long term prognosis, advantages, disadvantages, cost, labor and time will go a long way to help in this difficult decision making process. If you would like to schedule a consultation with Dr. Vaughn at Two Rivers Dentistry in Vancouver, Washington, we welcome you to call us today at 360-256-1202. Your smile will thank you!

The post TO SAVE (A TOOTH) OR NOT TO SAVE…THAT IS THE QUESTION first appeared on Two Rivers Dentistry.

“Adults have fond memories of walking into their grandparents’ bedroom as children, only to see grandma’s teeth in a cup by her bedside table. This common scenario leads to many interesting questions from young children, but it also hides a serious health concern. While dentures can be common in some older adults, they are more than just a funny family story. They’re a sign that older adults are at greater risk for oral health problems like tooth decay and loss.”

“Oral health is about more than just aesthetics and the ability to eat. Gum disease and tooth decay actually increase the risk of other health problems, including cardiovascular disease and bacterial infections. Sadly, over half of all older adults, 68% to be exact, suffer from gum disease, and nearly 20% have untreated cavities. Oral health and the resulting health problems are serious risks for older adults.”

“This guide explores some of the reasons seniors are at such high risk for oral health problems. It also looks at solutions to some of those problems, while giving tips on dental hygiene for older adults. Finally, it provides a list of low-cost resources for seniors who cannot afford dental care.”

Seniors and the Risk for Oral Health Problems

“Older adults face unique challenges that make it harder for them to keep their teeth and gums healthy. Yet without proper dental care, they’re at higher risk for serious medical issues beyond just the teeth and gums. Understanding these risk factors may help you find ways to overcome them as you assist the senior in your life in embracing good oral health.”

Full Article:
Seniors and Dental Health: A Comprehensive Guide to a Healthy Mouth

The post A COMPREHENSIVE GUIDE TO BETTER DENTAL HEALTH FOR SENIORS first appeared on Two Rivers Dentistry.