A better way to brush

Dentist suggests rethinking dental hygiene as something tied to eating, not sleeping

  • Gabriel Bloniarz, 8, brushes his teeth with brothers Jacob, 5, and Noah, 2, after dinner in their Easthampton home. Typically, their mother, Jenny Bloniarz says she and her husband, Ed Bloniarz, let the boys brush a first time themselves. Then the parents follow up right after for a more thorough cleaning. Staff Photo/Andy Castillo

  • Jenny Bloniarz supervises her three boys, Gabriel, 8, Jacob, 5, and Noah, 2, as they brush their teeth after dinner in their Easthampton home. Typically, Bloniarz says she and her husband, Ed Bloniarz, let the boys brush a first time themselves. Then the parents follow up right after for a more thorough cleaning. Staff Photo/Andy Castillo

  • Jenny Bloniarz supervises her three boys, Gabriel, 8, Jacob, 5, and Noah, 2, as they brush their teeth after dinner in their Easthampton home. Typically, Bloniarz says she and her husband, Ed Bloniarz, let the boys brush a first time themselves. Then the parents follow up right after for a more thorough cleaning. Staff Photo/Andy Castillo

  • Dr. Sue Keller demonstrates how to brush a young child’s teeth. She recommends brushing from behind using a small toothbrush to help hold the child’s mouth open in coordination with a special finger brush. Staff Photo/Andy Castillo

  • KELLER

  • A selection of specialty toothbrushes are designed for children. Staff Photo/Andy Castillo

Staff Writer
Published: 2/22/2019 7:35:15 PM

Dr. Sue Keller, a dentist at Modestow Family Dentistry in Florence, spent nearly 25 years telling middle-aged adults to take better care of their teeth. No matter how many times she shared the same information, nothing seemed to change.

“At some point, I recognized that I’m still teaching 60-year-old people how to brush effectively,” said Keller, 51, of Deerfield. “I came to realize the only way we can prevent disease” — like tooth decay, gum disease and oral cancer — “is to go back to the pregnant women, teach them how to take care of themselves, and teach them how to take care of their baby in the first year.”

According to recent data from the Massachusetts Pregnancy Risk Assessment Monitory System, while 65 percent of women in the state reported getting their teeth cleaned before becoming pregnant, less than 50 percent went in for cleaning during their pregnancy. Another study from the Journal of the American Dental Association concluded the “mother’s oral health status is a strong predictor of the oral health status of their children,” either good or bad.

To that end, Keller, who went to Harvard University for her undergraduate work and then studied dentistry at the University of Connecticut, has taken it upon herself to educate young and expecting mothers about the importance of taking care of their teeth. Starting in 2002, Keller began giving lectures at Baystate Franklin Medical Center. More recently, she’s been trying to reach families who might not hear the information otherwise — she even made a cameo appearance as a dentist in a PaintBox Theatre play last year.

One of her suggestions to improve oral health in children is to re-frame brushing as something to do right after eating, as opposed to something tied to waking and bedtime routines. And if it’s not possible to brush after meals, she said it’s important to at least rinse with mouthwash or even water.

“If you brush after meals, drink water in between, floss the sides once a day, scrape the germs off the tongue, you’ve done everything you can to have a disease-free mouth. And that’s in your hands. You don’t need insurance, you don’t need a lot of money,” she said.

Typically, Jenny Bloniarz of Easthampton said she and her husband, Ed Bloniarz, allow their three boys — Gabriel, 8, Jacob, 5, and Noah, 2 — to brush their teeth on their own the first time. Then the parents follow up right after for a more thorough cleaning.

Before her first pregnancy, Jenny Bloniarz said she hadn’t been to the dentist in nearly a decade. She started going regularly when she was pregnant and has been getting regular dental care ever since. These days, Bloniarz actively teaches healthy dental habits to each of her children.

Inside their home on a recent evening, Ed Bloniarz helped his wife herd their boys to the bathroom where they retrieved toothbrushes from behind the mirror.

Tonight, Ed Bloniarz said their oldest boy, Gabriel, will have an easier time brushing.

“He has a few less teeth. He just lost two last week,” he joked.

Once their teeth were clean, the boys raced off to play.

“Three teeth brushings today. They’re extra clean,” Jenny Bloniarz said.

Keller began focusing on the oral health of pregnant women for two reasons: First, pregnant woman are particularly at risk for dental issues themselves, she said. But also, Keller believes that if she can teach healthy habits to mothers, they will, in turn, create healthy habits for their children.

“If you teach a pregnant mom how to take care of her own and the baby’s teeth, and they do it from day one, and it’s always part of cleaning up from the meal and not a struggle, it’s just what (they) do. Game-changer,” Keller said.

Researchers from the Journal of the American Dental Association came to a similar conclusion. “Pregnancy is a ‘teachable moment’ when women are motivated to adopt healthy behavior,” noted the study, which was conducted in 2013 and then reaffirmed in 2017.

A baby’s first year is a critical time to establish healthy dental habits, Keller stressed — tooth decay was the most common chronic disease among children and young adults ages 6 to 19, according to a 2018 report from the Centers for Disease Control and Prevention. Daycare facilities, which are required by state law to brush children’s teeth after meals, can help reinforce these habits, she said.

During pregnancy, said Keller, who has two teenaged children of her own, women are particularly at risk for dental issues. One of the reasons for this is because women are encouraged to eat small meals throughout the day to ward off nausea. But while their eating habits might change, their brushing habits usually don’t.

“Her whole body environment is changing, she’s eating more frequently, and she’s vomiting and trying to knock down the vomit by chewing on Tums, which have a lot of sugar. Now you’ve got this trifecta — increased carbohydrates, increased frequency, sugars and then the acid,” Keller said. The Journal of the American Dental Association study also found that 59 percent of women surveyed “did not receive any counseling about oral health during pregnancy.”

Most people are born with a healthy set of teeth, Keller explained. Cavities are formed when saliva breaks down carbohydrates into acid, which in turn erodes teeth. If there was no food for the saliva to turn into acid, teeth would be healthy indefinitely.

“Acids could be in the foods you eat or the drinks you drink, or they could be from your own stomach from things like acid reflux or vomiting,” she said.

With babies, Keller noted that it’s common to nurse or bottle-feed an infant to sleep. While that practice is harmless before they have teeth, trouble comes at around 6 months when they get their baby teeth. And if infants continue that habit of drinking milk until they fall asleep without brushing, tooth decay can occur.

“Are (parents) going to wake the baby up and clean the baby’s teeth before they go to sleep? They are not. They’ve created a pattern of feeding they’re not going to change,” Keller said. “All night long, the natural sugars in the milk are on your teeth, the bacteria is using them for food and making acid.”

One practical way to help children learn brushing habits is to tie dental health to dinner cleanup by brushing their teeth at the table immediately after a meal. When they’re really little, Keller said to put a small dab of fluoride-free xylitol toothpaste on a wet cloth or finger brush, and wipe down their gums while standing behind their high chair. Xylitol is a natural substance that has been shown to reduce bacteria.

Once they’re a little bit older, give them their own brush at the table and then, after they’ve tried it themselves, brush their teeth more thoroughly and help them floss once per day.

“Would you leave your kid without wiping their face after the meal? So why wouldn’t you clean their teeth?” Keller said. “If we can establish good habits, we can make real change.”




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