Fisher Jones Family Dentistry

Panoramic What’s that?

Dr. Matt here, Panoramic imaging, A “Pano” is a very important diagnostic tool. The x-ray called a Panoramic is a two dimensional capture of the entire mouth in a single exposure, including the teeth, upper and lower jaws, and surrounding tissues. Pano’s allow us to evaluate for the presence of cysts, tumors, cancer, trauma, third molars, large lesions, and generalized disease. It can be used as an alternative to intraoral x-rays and to assess surgical procedures during surgery. In addition we can see impacted teeth, temporomandibular joint disorders, sinus problems, carotid artery blockage, and bone differences. It is highly recommended to have a Pano every five years.

X-ray imaging (radiograph) exposes you and a Phosphor Plate to ionizing radiation.  The exposure to you is very small however it is cumulative over your life time. The Plate significantly amplifies the low dose exposure into a big useful picture image. Background radiation in nature is 6.2 mSv (microsievert) per year.  A Pano is .01 mSv.

It is easy to do.  You stand or sit in an enclosure and bite on a disposable plastic stick.  You swallow put your tongue into the roof of your mouth, close your eyes, hold very still and wait approximately 20 seconds. The image is immediately visible.

Next time you are in to FisherJones Family Dentistry ask about your Panoramic.  If you don’t have one, get one. It is always good to keep a “Good Image”.  Thank you.

Health History and HIPPA

Dr. Matt here, FisherJones Family Dentistry (FJFD) says, “It’s time to update your Health History form”. You, “I did that last time”. FJFD, “I know but that was more than five years ago”. You, “Well there are no changes………….
Did you know that most of your insurance carriers will not help you with your benefits unless we have a currently signed Health History?
Did you know that the mouth is the gateway to your entire body and well being? We are often the care givers that notice subtle changes in your head and neck region that indicate that something may be going on in your other organ systems.
Did you know that routine Local Anesthetic (people refer to it as Novocain but Novocain has not been used in dentistry since 1965) may contain the most powerful cardiac drug on the planet Epinephrine? We use an assortment of “Cain’s” that can be kind on your Heart and Nervous System when we have a current Health History.
I once said to a patient, “Any changes in your health since last time I saw you?” They said “no”. The older man needed a tooth out and was in pain. We got the tooth numb and pulled it out. I spent the next two hours trying to establish a clot; he just kept on bleeding. He said, “You know I take blood thinners since my open heart surgery last month”. I believe that filling out an updated Health History would have prevented this potential life threatening emergency even though an update was sought verbally. When you go through the systematic Health History form it allows you to pause and really think about your current health situation. We have methodically assembled it to try and discover every possible Dental Implication.
You primary care Physician will not see you until you fill out a new one every time you go in for anything; so why is it so strange that FJFD is asking. We verbally ask you at every visit, “Have there been any changes in your health?” The verbal update works well for awhile but after five years we need a fresh start.
To update your Health History go to the internet and enter Click on the Patient Registration Tab. Then Click on Patient Health History Form. The Form is two pages and it took me about 10 minutes to complete. Press the submit button. When you come in to the office we will have you sign and date it electronically. Thank you for being proactive in your health.
In addition to a current written Health History every five years you will need to Acknowledge and Authorize your HIPPA (Health Insurance Portability and Accountability Act) form. We want to protect your medical information and keep it private. This form tells how your information may be used and disclosed. HIPPA started in 2003 and should sound familiar. The document is 7 pages, large print. You will see the Tab (HIPPA Notice of Privacy Practices) directly below when you do your Health History Form. You do not submit anything but sign and date it electronically when you are in the office. It took me 4 minutes to read it. If you want to print it and read it at your leisure; click on Patient Information, select Privacy Policy and click on HIPPA Privacy Policy Notice. Wallah! Thank you for helping us be in compliance with the Federal Government Department of Health and Welfare.

Child Dental Trauma

What do you do when your child has broken or knocked out a tooth? Following these guidelines will help lessen your child’s discomfort and prevent infection.

Nearly 50% of children will suffer dental trauma during childhood. Injuries to the mouth and teeth include falling accidents and sports injuries. In all mouth/dental traumas, the first priority is to make sure the child has not suffered a serious head injury. If he is unconscious or has signs of a concussion, immediately bring to the Emergency Department for an evaluation.

If A Tooth Is Chipped Or Broken
If your child chips his tooth, clean any blood from the mouth and surrounding soft tissues. Applying a cold compress will also reduce any swelling. Contact your pediatric dentist immediately. If you can find the tooth fragment, it is important to also bring it with you (in a zip top plastic bag, for example).

If A BABY Tooth Is Knocked Out
Again, clean any blood from the mouth and surrounding soft tissues. Applying a cold compress to reduce any swelling and contact your pediatric dentist. It is NOT recommended that a baby tooth be replanted, therefore, spend time comforting your child instead of looking for the tooth. The pediatric dentist will do an evaluation and if it is indicated, can make an appliance to replace the missing tooth until the permanent one erupts.

IF A PERMANENT Tooth Is Knocked Out
It is important to find the tooth so the pediatric dentist can replant the tooth. If you are comfortable in replacing the tooth back in the socket, first gently rinse the tooth (less than 10 seconds) in cool water, but do not scrub it or use soap. After you replant the tooth, hold it in place with a gauze or cloth as you transport your child to the dentist. If you are unable to put the tooth back into the socket, place the tooth in a clean container with cold MILK. Do not transport the tooth dry or in water. Take your child to the dentist immediately. If it is after business hours, call the emergency number for the dental office or if that is not available, bring your child to the emergency room.

Remember, your quick action and a treatment by a pediatric dentist can help prevent infection and increase the prognosis of the tooth. In many cases, these dental emergencies can be prevented. Here a few tips in preventing dental trauma:
• If your child plays a contact sport, encourage him/her to wear a professionally mouth guard.
• Always use a car seat for young children and seat belts for all other passengers.
• If you have toddlers (2 to 3 years old), child proof your home to prevent mouth injuries.

You can always contact us or visit the American Academy of Pediatric Dentistry ( for more information on preventing and treating dental injuries.

Happy New Year 2015

Happy New Year from all of us at Fisher Jones Family Dentistry.
We wanted to confirm that we are not changing our name. We have only just moved our sign off of our old building next to Pacific Avenue and replaced on the west facing wall of our current building. We had to make room for the new tenants in our previous space.
We have been in this building, 2415 Pacific Ave, for six years now! Did you know That Dr. Don Fisher opened this dental practice in January of 1972?! Our team has been serving this Olympia/ Lacey dental community for 43 years! Dr. Don started with 2 procedure rooms, one receptionist and one dental assistant. We have grown since then but we are still committed to the same values of care and dentistry that began in 1972.
We are so pleased to be able to provide you with great dentistry and an awesome experience. In addition to traditional restorative procedures we offer one appointment “CEREC” crowns, we offer Invisalign ( “invisible” braces), TAP III ( sleep appliances), and we offer sedation for many dental procedures, including third molar extractions.
We are in our places with bright shining faces ready to brighten up your smile. We all hope this year is good to you. We’ll see you soon!

Movember 2014

It is once again our favorite time of year…moustache growing season is upon us!  At Fisher Jones Family Dentistry, we have made it an annual tradition to grow out our ‘staches to raise awareness for men’s health.  Last year I wrote a detailed blog talking about the statistics behind our motivation.  Click here to see that blog.

If you would like to join our annual cultivation of upper lip caterpillars, please join our illustrious group called the Olympia Moustache Militia.  Click here to be directed to our page where you can sign up and join the squad.  It’s a  fun way to raise funds and awareness for a very worthy cause.  Tell your wives, girlfriends, significant others, bosses about the cause and there’s no way they can stop you from growing that glorious moustache!

Here are a few pictures from last year’s Movember fun:

Why Should I Brush My Dog’s Teeth?

Brushing your dog’s teeth isn’t just about fresh breath, but hey, isn’t that reason enough? Although most people aren’t aware of it, periodontal, or gum disease, is a common and serious problem in dogs. Yet brushing your dog’s teeth can prevent it! Veterinarians estimate that 85 percent of dogs over 5 years of age suffer from periodontal disease!

What is the percentage of humans with periodontal disease? 50 percent ! And it is preventable and treatable! Just ask our hygienists for some tips!

When deciding to take on your dog’s oral health, choose a tool that you are comfortable using. Pet stores carry toothbrushes for dogs as well as small, plastic brushes that fit on your finger and special dental sponges. If these products don’t appeal to you and your dog, just wrap a thin cloth around your finger instead.

Purchase a toothpaste made for dogs from a pet store or veterinarian. Avoid using human toothpaste on your dog. Keep in mind that our pet will end up swallowing a lot of the paste during brushing sessions, and ingesting paste made for people may upset their stomachs. The pet formulations are sure to be tastier to your best friend as well! Pet toothpaste comes in a variety of flavors. Experiment with a few flavors to see which taste your pet prefers.

It is ideal to brush your dog’s teeth daily, just like you brush your own.
1. Take it slow. Introduce tooth brushing in small steps so that your dog doesn’t get overwhelmed and upset.
2. Teach your dog that good things happen when he/she gets a toothbrushing. Give treats and love as incentives.
3. Apply a small amount of paste, use the brush, sponge or your finger in circular motions by the teeth and gums. Try to get the tongue side and cheek side areas. Just like you would your own mouth!

The goal to a healthy mouth is the prevention of periodontal disease, better overall health and the decreased needs of sedation and necessary tooth removal. BTW, Dr. Garrett Barker does these procedures on humans!

Does your dog snore? Ours does, perhaps it is her underbite! We have joked about taking impressions and having Dr. Jim Jones straighten her teeth with invisalign!

Then Dr. Matt Fisher would be able to create an appliance, like the TAP III appliance, to reduce her snoring!

Ha! That would never happen!
Enjoy your pet,
-Michelle R Fisher
Fisher Jones Family Dentistry 360.943.4644

Obstructive Sleep Apnea, a summary

Hey there Dr. Matt here, here is an update on Obstructive Sleep Apnea. First off Dentists cannot diagnose OSA but Physicians can. Second Physicians cannot make mouth appliances to treat OSA. Having said that, here is a current summary.

OSA affects approximately 20% of the US adults. 90% of whom are undiagnosed. There is a well-known link between obesity rates and sleep apnea. A quick guide is the Mayo Clinic BMI (body mass index)

There exists a vicious cycle: sleep deprivation from OSA causes people to eat more and feel too tired to exercise, which leads to weight gain, which can exacerbate existing OSA or bring on new occurrences.

In people with OSA breathing stops repeatedly for 10 seconds or more during “sleep”. It occurs because the muscles in the back of the throat collapse, and cause the airway to narrow and close. Your bed partner will know because of choking or gasping sounds when this occurs, not just snoring.

Medical histories often indicate chronic snoring, excessive fatigue, difficulty concentrating, depression, irritiability, headaches, learning difficulties, and memory loss problems. Risk factors include being overweight/obese as mentioned above, smoking, drinking alcohol, being 40 or older, having a large neck, and having a small airway to begin with.
Take the “STOP-BANG” questionnaire and see for yourself.

If you score poorly then there are other questionnaires your Dentist will use to refer you to a sleep center Doctor who can diagnose you. The Doctor will order a Sleep Study with a Polysomnogram. A Polysomnogram measures physiological changes during sleep, such as rapid eye movements (REM sleep), electrical activity in the brain (what levels of sleep you reach), muscle activity, heart rhythms, blood oxygen levels, and air flow in and out of the lungs. The results are reviewed and a diagnosis of mild, moderate or severe OSA is made.
Often mild OSA can be managed with weight loss, non smoking, no alcohol, sleeping on the side, using nasal sprays or allergy medications, anything to open up the airway.

Moderate to Severe OSA discussions center around Apnea-Hypopnea Index (AHI mild 5-15, moderate 15-30, over 30 severe) and the blood oxygen saturation levels (96% normal, below 80% horrible, and inbetween). Simply number of sleep interruptions and how oxygenated you are.

The gold standard of treatment for OSA is CPAP (continuous positive airway pressure). Less than 50% of patients continue to use CPAP therapy even though it is potentially lifesaving. For those that cannot tolerate a CPAP a Mouthpiece (MAD: madibular advancement device) can be made by a Dentist).
A second sleep study can be made with the use of CPAP and/or MAD (mouthpiece in place). This is useful since it tells all the true quality of the treatment intervention.

I hope that this was helpful and you will let us know at your next appointment if you need help.

Does Red Wine Prevent Tooth Decay?

Dr. Jim here! A recent study conducted at Pavia University in Italy suggests that, indeed, red wine can help prevent tooth decay. the study used wine that had its alcohol removed so that they could verify the antibacterial of properties of wine without the influence of ethanol.
The study involved using extracted teeth, saliva, the main bacteria that causes decay, strep mutans, and red wine. When the de-alcholoized red wine was mixed with saliva and strep mutans, it was found the red wine prevented the bacteria from adhering to the surface of teeth and saliva.
Researchers determined that the active components that protect teeth are proanthocyanidins, naturally occurring flavonoid compounds previously found to have antioxidant properties. The compounds are found is edible plants such as apples, cinnamon, cocoa and teas. So imagine the double benefit of having some dark chocolate with your wine!
It seems every year we find more benefits from wine, which is just fine with us. But this news can add a whole new dimension to a dental practice. If we could figure out a way to put a wine bar in our reception area we just might give more people a good reason to come and visit us!  So the next time you have a glass of red wine, toast to the prevention of tooth decay and enjoy!

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Dr. Matt here, XYLITOL. What is it? Xylitol is not new it has been around forever. It is in animal and plant metabolism. Xylitol is a sugar alcohol, a low-calorie carbohydrate made from birch bark, fibrous vegetables and fruit. Xylitol has no known toxic levels (in humans) and was approved by the FDA in 1963. Xylitol is even produced naturally in OUR bodies, up to 15 grams daily during normal metabolism. Because it metabolizes without using insulin, there is no blood sugar spike, making it ideal for a diabetic choice. It is as sweet tasting as Sucrose (table sugar). Beware Dogs are deathly sensitive to it just as they are to Chocolate since they have no way to fully metabolize it.
Why is XYLITOL important in Dentistry? Because dental decay (cavities) are transmissible from one person to another just like the common cold and flu through casual contact. So if you hang out with someone with nasty teeth you may get their decay germ pathogens and be susceptible to getting holes in your teeth. To interrupt the transmissibility you can chew xylitol gum, use xylitol toothpaste, and/or suck on xylitol lozenges. We recommend children ages 0-5 use xylitol toothpastes, and people 6-adult use the gum and lozenges. As adults take more saliva depleting medications they develop dry mouth and xylitol lozenges can help them dramatically by moistening tissues and protecting against dental decay. My favorite brand of lozenge right now are Ice Chips ( ). They come in a metal container and there are twenty plus flavors. They can be found readily in stores. They are made local in Yelm Washington. My favorite line of xylitol products is SPRY. Most health food stores have many choices and the food Co-op has bulk xylitol. Spry products can also be found on line ( ) Many parents with infants can dip a small wet toothbrush directly into the white xylitol granules for brushing. The SPRY toothgel works too if you like something more contained or Squigel toothpaste( ). How does xylitol stop the transmissibility? The bacteria in our mouths that cause the cavities eat the xylitol and it stops them from being mobile. They cannot move around. The scientific term is “significant decrease in motility”. Another benefit of using xylitol in young children is the elimination of ear infections. Using the xylitol tooth gel at bedtime helps to teeth but also protects against ear troubles (Otitis media). We found this to be very helpful with our kids. So there you have it. When you are at the grocery store next time look around and read labels for xylitol. Trident brand sugarless chewing gum has it too.

Platelet-rich Plasma for better healing


Dr. Garrett here!  I recently added a very exciting new treatment to procedures that involve the grafting of bone and/or tissue.  It is called platelet-rich plasma (PRP for short) and it is a revolutionary way to improve healing in areas undergoing surgery.

Our blood is composed of many cells that perform numerous functions throughout our body.  The cells we’re interested in for helping our bodies to heal from injury are called platelets.  Although the main role of platelets is causing our blood to clot, the reason we’re interested in using it for healing is due to its’ role in inflammation.  When an injury occurs in our body, blood is rushed to the area to help start the healing process.  This rush of blood is what causes the bruising and swelling we often see.  The platelets in our blood release inflammatory mediators (called cytokines and growth factors) that aid in the actual healing process.   There are a multitude of different growth factors released by platelets, including one’s that aid in the healing of soft tissue and bone.  By including PRP in bone grafts and tissue grafts, the surgical site is immediately infused with all the necessary growth factors to help create new tissue and bone.  As a result, the inflammation caused by surgery is less.  In turn the pain and discomfort is decreased as well…and the bone and soft tissue heals at a faster rate.  It’s pretty cool stuff!!

So how do we get this PRP?  The day the patient comes in for surgery, blood is drawn and placed into a test tube with an anticoagulant.  It is then placed into a centrifuge where the blood is spun around at a high rate to separate the red blood cells from the plasma.  What you’re left with is a test tube that has the yellow plasma layer on top and the dark red blood cells at the bottom.  In the middle of these two layers sit the platelets.  We draw this layer up into a syringe an infuse the bone or tissue with the PRP. It’s that simple!  There’s no risk of rejection, because it’s the patient’s own blood.  The blood draw only takes about 30-60 seconds and the pain is minimal.  I have been using this now for the past few months and the results have been very promising.  Patients are reporting less pain, they appear to be healing at a faster rate, and the surgical area appears much less inflamed.  Currently the procedures PRP is used in our office include: bone grafts, sinus lifts, soft tissue grafts, some dental implants, and some complex extractions.  There is no added cost to have PRP added to your treatment at this time.  You just get the benefit of using your own blood to heal faster and with less pain!  It’s a new technique that I am very excited about and would be happy to discuss it further if there are any questions that this blog did not satisfy.

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