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.

Recently, we just purchased a product called a phaser warmer gun by Vista-Apex that reminded me of those Star Trek days gone by. Initially, I wasn’t sure about it, but since using it for the last couple of weeks I almost can’t do without it. It allows us to place our composite compule for our restorative material into a gun that really does look like a “phaser.” We push a button and in 45 seconds an LED light heats up the composite material in the gun. When the cool blue light stops flashing it is ready to go. This allows it to be injected more easily into the area without voids or the dreaded bubbles that often get trapped there. What I have noticed is the adaptation is so much better creating a filling that is more harmonious with the tooth and has a much better finish than placing it cold.

I learned this technique from Dr. David Clark of Tacoma, WA, who mentors dentists on his Bioclear method. I adapted it to my situation and so far I feel this technology will improve our outcomes and create a better restoration. We are excited to offer this new technology to you which I’m certain very few other dental offices are using. If you have any questions about our office or about your current situation, don’t hesitate to give us a call at 360-256-1202.

The post BEAM ME UP, SCOTTIE first appeared on Two Rivers Dentistry.

The analogy reminded me of our mouths. As we age, our roots get exposed and are more prone to decay. Dr. Tom Orent has shared one of his “gems” to many of us dentists that I can relate to and I’d like to share it with you.

“Recent research has helped us to uncover one of the most devastating adult dental problems. The problem is known as “root cavities.” All adults are susceptible to root cavities.

One of the most respected dental researchers in the world says that once you get a cavity on your root surface, it’s like the beginning of the end of your tooth. Sure, we’ll try to fix it, but even after we think we’ve removed all the cavity or decay, it often creeps up again right under the filling or crown, and we have to cut it out further and further up under the gum near the bone.

The problem is, your roots are 1000% softer than your enamel! As an adult, you tend to have some recession of the gums — that’s when your gum drifts higher up the tooth and exposes some of your roots. Often early recession is so small it’s not immediately apparent and unfortunately, recession doesn’t have to be visible to put your tooth at risk!

The best prevention for root cavities is fluoride, and the best and most reliable fluoride delivery is immediately after your cleaning — due to the natural film layer (plaque) the body coats your teeth with within 24 hours after your cleaning. Again, the best time for fluoride is at the end of your cleaning as this natural film layer, a sticky substance, decreases the ability of the fluoride to penetrate into and protect your teeth.

In fact, we recently had a patient only 40 years old who lost a tooth due to this disease. The fact is that we had effective fluoride for many years, but they were so incredibly acidic and bitter-tasting that most adults refused to use them, myself included! The old fluoride took from five to seven minutes in your mouth and was pretty close to intolerable.

We are fortunate today to have fast-acting, high-strength fluorides that are extremely effective, but also taste great and require only 60 seconds to apply. I wouldn’t allow my family or myself ever again to have a cleaning without immediately afterward having the fluoride treatment as well.

Insurance doesn’t cover fluoride for adults but it’s like having your own insurance policy to help ensure you can keep your natural teeth for life. The charge is less than a third of one surface filling and we have several flavors to choose from.”

In summary, adults can benefit from topical fluoride treatment just as much as children. Fluoride treatments are an important part of keeping your teeth healthy and they help repair teeth in the very early stages of the disease. Existing restorations, poor oral hygiene or diet, or tooth enamel damage can all increase the risk for cavities. Soda and sports drinks also have a high acid content that can damage teeth.

The best way to prevent these risks as well as the biggest risk of all — root cavities — is a topical fluoride varnish application immediately following your dental cleaning. One of the many prescription-strength 5000 toothpaste at-home fluoride daily regimens is another great way to prevent this most unfortunate problem. If you have any questions about topical fluoride prevention treatment, ask your dentist or hygienist.

The post THE BENEFITS OF TOPICAL FLUORIDE TREATMENT first appeared on Two Rivers Dentistry.

At Two Rivers Dentistry, we do everything possible to preserve and protect your tooth enamel.  Enamel erosion leads to the eventual loss of this important protective layer. Its deterioration exposes the inner yellow layer of dentin, leading to rapid erosion, wear, sensitivity, cavities, bacterial invasion, and the loss of tooth structure–among other complications.  If damaged, you’ll need your dentist’s help to repair it so it doesn’t wear away more.

The proliferation of acidic beverages is a major culprit in the loss of tooth enamel today.  Because many of our most popular drinks are so acidic, most patients who consume acidic beverages on a regular basis will experience the dissolution of the enamel layer in a fairly short amount of time. In moderation, however, and with a vigilant home care routine, they may be fine–it is the frequency and quantity of consumption that becomes critical in dental care

It is relatively common for people today to think that because a beverage claims to have no sugar, it will not cause long-term damage. Yet, even flavored sparkling waters can cause tremendous damage. Within twenty minutes of consumption, studies have shown that bacteria already present on your teeth produce acid from the byproducts of the carbonated water. For comparison purposes a handy chart may be of benefit

The more we consume acidic beverages, the more prone we are to acid erosion. Those hoping to avoid yellow teeth, tooth sensitivity, cavities, extensive wear, and other painful or embarrassing outcomes should educate themselves on the effects of acidic beverages.  Those with sensitive teeth experience acute pain when they drink or bite into hot, cold sweet, acidic or spicy foods and drinks, and consequently, enamel erosion can have harmful effects on their long term diet. Acidic citrus juices are indeed packed with the ever-helpful Vitamin C, but one must exercise caution and moderation. Their PH levels–especially lemon and lime juice–rival the acidity of stomach and battery acid.

So, how can we protect our teeth and keep our enamel safe? First, reduce any frequent, repeated intake of acidic beverages, replacing them with water, milk, or a milk-substitute. Second, drink acidic beverages with food rather than sipping them between mealtimes.  If at all possible, after your meal rinse with water to further dilute any remaining acid in your mouth. Wait at least thirty minutes to brush your teeth after mealtime as toothpaste can damage newly sensitive areas. Baking soda or rinses we carry at our practice (like Cari-free CTX Maintenance) can bring your mouth’s PH back up to healthy levels after drinking highly acidic beverages. If you are concerned about your enamel and experience any problems stemming from the consumption of acidic beverages, call or visit your dentist right away.

The post DO YOU KNOW THE DANGERS OF ACIDIC DRINKS? first appeared on Two Rivers Dentistry.