Dental Health


Common Questions about Pregnancy and Dental Care

by Laurena Marques, BSDH, RDH

In honor of Dr. Zeller and his wife Catharine’s new baby arriving next month, let’s chat about pregnancy and oral health!

Oral health is a very important part of prenatal care. Pregnancy can cause an increased risk for dental problems so taking care of your teeth and gums can help you have a healthy pregnancy and baby! Here are some of the most common questions we get from our pregnant patients:

“Does the baby take all the nutrients from my teeth?” 

This is a common question but fortunately a misconception! However, the body’s hormonal changes can cause an exaggerated response to bacteria in the mouth, as well as tooth decay from an increase in acids from vomiting (especially in the first trimester). A change in dietary habits can also lead to an increase in acids that cause tooth decay.

“Why are my gums sore and bleeding during pregnancy?”

Increased hormone levels allow an increased response to the bacteria in the mouth that causes gums to bleed easily and can lead to pregnancy gingivitis. There is also an increase of specific bacteria that use these hormones as a source of nutrition. Gums can bleed easily when brushing and flossing and new lesions can appear on the gums between the teeth. When chronic inflammation is untreated, it can lead to periodontal disease, which is common during pregnancy.  When gums are unhealthy or an untreated tooth infection is present, this can lead to a slightly higher chance of premature birth and low birth weight babies.

“Are dental x-rays safe during pregnancy?”

Yes! It’s important to diagnose decay and gum issues during pregnancy, so we recommend routine x-rays at your dental visit. Digital dental x-rays pose minimal radiation exposure to the uterus, and we provide a lead apron for additional protection.

Read more about the type of x-rays we take at Five Pines and the safety of dental x-rays.

“Can I have a dental work aside from cleanings during pregnancy?”

Dental care should be prioritized during pregnancy due to the higher likelihood of tooth decay and gum issues. We recommend delaying restorative work (fillings, crowns, etc.) until after the first trimester. The best time to have dental work completed is during the second trimester, while you are more comfortable in positions for long periods of time. Dental cleanings can be performed throughout the entire pregnancy if you are comfortable in the chair. 

“What are some things I can do to help my teeth and gums during pregnancy?”

  • If you notice an increase in bleeding when brushing, it’s important to have early intervention – come in to get a checkup and dental cleaning. Many of our patients like to have additional cleanings during their pregnancies to ensure good oral health. Some insurances will even cover an “extra” cleaning during pregnancy! Dental visits are also important if you have a chronic health condition or have a high-risk pregnancy. 
  • If vomiting, wait at least one hour before brushing your teeth to avoid enamel erosion. Use a pH balancing mouth rinse or swish with water to reduce the amount of acids in your mouth.
  • Use toothpaste with fluoride to strengthen your enamel.
  • Choose low sugar foods that are less damaging to your teeth such as raw fruit and vegetables. Avoid soda and juice.

If you have additional questions about pregnancy and your oral health, please reach out to us. And if you are reading this and currently expecting – congratulations!


American Dental Association (2021) Oral Health Topics – Pregnancy.

B Rai, J Kaur, S Kharb. (2008) Pregnancy gingivitis and periodontitis and its systemic effect. The Internet Journal of Dental Science. 2008 Volume 6 Number 2.


Ask a Hygienist: At-home Oral Cancer Screenings

The month of April is Oral Cancer Awareness Month.

A misconception with oral cancer is that it is only found in people who use tobacco. However, while that is a common risk factor, oral cancer is also found in people who drink excessive amounts of alcohol, with certain types of HPV, and even in those with no risk factors at all!

According to the Oral Cancer Foundation, an estimated 54,000+ people will be diagnosed with oral cancer in 2021:

“Of those individuals, 43 percent will not survive longer than five years, and many who do survive to suffer long-term problems, such as severe facial disfigurement or difficulties with eating and speaking. The death rate associated with oral and oropharyngeal cancers remains particularly high because the cancers routinely are discovered late in their development.”  

Oral Cancer Foundation, March 25, 2021

At Five Pines, we perform oral cancer screenings at every routine exam. We also check your neck and thyroid during this examination. But just as you should be aware of your body and doing self-exams for other cancers, we thought it would be appropriate to share how you can do an oral cancer screening yourself at home!

First, grab yourself a flashlight. Following these steps, you’ll be looking for sores or ulcers that have been persistent for more than two weeks, lumps, areas of white patches, or areas of redness that are noticeably more red than normal areas of your mouth.

  • Feel your neck for painless, fixated lumps on the outside of your neck that have been there for more than two weeks.
  • Check the outside and inside of your lips. Pull your lip down as far as you can and check the tissues down the bottom of your lip. 
  • Look at the inside of your cheeks. Feel around with your fingers for lumps. 
  • Check underneath your tongue and the floor of your mouth for any discolorations. Also stick out your tongue to check the back and sides of your tongue. It helps to grab onto your tongue with gauze or a washcloth. 
  • To see the back of your throat, say “aaah” and look for any unusual spots in the back of your throat. 

If you find something suspicious or aren’t sure about something, let us know. You should also inform your dentist if you have difficulty swallowing (as if you have something stuck in your throat), a hoarse/sore throat that doesn’t go away, or difficultly moving your tongue or jaw.

As Dr. Zeller says, it’s important to know what your mouth looks like normally so that you can detect any changes! We hope you’ll add at-home screenings to your routine and as always, feel free to reach out with any questions.


Do you have a dental question for Laurena? Email and let us know what’s on your mind.


We’re Vaccinated!

We are happy to announce that the entire Five Pines team is now vaccinated against COVID-19!

We know there are still uncertainties even after being vaccinated (protection against variants, long-term immunity, etc.) but the team felt the best way to protect ourselves, our patients, and the community is by getting vaccinated.

We also want to emphasize that none of our COVID-19 safety procedures at the office will be changing. We’ll still be wearing masks, conducting daily screenings, keeping up with our strict disinfecting protocol and monitoring state and federal guidelines for PPE usage.

Since many in Portland are still waiting for their turn in the vaccine rollout, let’s chat about mRNA vaccines! We love reading about science, particularly when it’s broken down by health professionals, doctors, and scientists. We’ve compiled a helpful list of links that explain how your immune system works, what viruses do, and how the SARS-COV-2 virus vaccination was created: 


Ask a Hygienist: Stress and Your Oral Health

Lately we’ve been seeing a wave of new oral health concerns from patients.

“I’ve been so stressed that I feel like I am clenching my teeth all the time.”

“I have been working from home and sometimes I forget to brush my teeth in the mornings”

“My self-care has been lacking due to depression.”

So many of us are far from our “normal” and out of our regular routines. We are stressed, tired, and just trying to make it through this strange time.

Our body responds to stress down to a molecular level. Stress affects the immune system and can cause an imbalance in inflammatory reactions in the body and increase vulnerability to illness, oral ulcers, infection, and decreased wound-healing.

Stress can also cause people to neglect their oral health, especially since poor mental health often correlates with a lack of self-care. Eating habits are often altered, with an increase of sugar and snacking which can increase your risk for cavities. Alternatively, one may be eating less often or eating softer foods – taking away the mechanical movement of chewing and therefore increasing plaque accumulation. Many people cope with harmful habits such as smoking (which increases your risk for periodontal disease, cancer, and cavities), nail-biting (causing wear and chipped teeth), cheek and lip biting (resulting in painful sores or ulcers), and teeth clenching (causing tooth wear and fatigue in the TMJ).

Okay, so now that I have thrown all these stress-inducing scenarios out there, what can you do? Do your best. Meticulous oral care might be the last thing on your mind lately, we get that. Make an appointment for routine, preventative care – especially if you have seen an increase in bleeding gums, tooth sensitivity, or have increased jaw pain.

It’s our job to assist you in finding ways to personalize your oral hygiene regimen during these unprecedented times.  We understand, and we’re here for you.

Do you have a dental question for Laurena? Email and let us know what’s on your mind.


Hygiene at Home: Water Flossers

If flossing has been your New Years Resolution for the past 30 years and you still haven’t got it down, but you also care about your teeth, we’ve got a solution for you: flossing with a water flosser!

A water flosser uses pressure and water to get in and around the surfaces that your toothbrush won’t reach. The most well-known and studied brand of water flossers is called the Waterpik.

Some studies have shown that a Waterpik is even more effective at reducing bleeding and removing plaque from treated areas vs traditional flossing. Now, we’ll note here that traditional flossing is effective if done correctly and consistently. Traditional flossing is also very technique sensitive and may be extra difficult if you have issues with hand dexterity, have a lot of dental work that shreds and breaks your floss, aren’t using an effective product, or because, well, you aren’t flossing at all. In that case, a Waterpik could be a potential game changer.

The very first use, you’re probably going to make a mess. A video of your first attempt at a Waterpik would be good content for TikTok if you’re into that. In all seriousness, you’ll get the hang of it – start on a low power and work yourself up to a comfortable pressure. Slowly follow your gumline along all front then back surfaces of your teeth. The Waterpik website also has a helpful how-to video here.

The Waterpik models our hygienists typically recommend are called the Aquarius and the Sidekick:   

  • The Aquarius comes with a standard tip in addition to a variety of interchangeable tips of different sizes indicated for specialty use. The Pik Pocket tip is great for those with diagnosed periodontal disease and deep gum pockets. The Plaque Seekers tip is for people with large fillings, crowns, implants, bridges, or braces.
  • The Sidekick is excellent if you need something compact for travel and have limited sink space. It only comes with a standard tip and unfortunately the other tips do not fit on this model. If you do have extensive dental work or gum disease to maintain, we recommend the Aquarius!

If you purchase a water flosser, we’d love to hear about it at your next appointment. Although you probably won’t even need to tell us – your hygienist will take one look at those healthy gums, gasp and say, “Wow! Your teeth look incredible!” and you’ll say, “Yes, thank you” but then you’ll go home and into your bathroom and whisper to your water flosser, “No, thank YOU.”


Ask a Hygienist: Coping with Dental Anxiety

Dental anxiety often keeps people from scheduling dental work and regular preventative checkups; perhaps it’s the smells and sounds of the dental office, previous trauma, treatment anticipation, embarrassment, or simply an unexplainable fear. No matter the reason, please know we won’t judge you for it. It’s important to speak up to your clinician about any dental anxiety so we can work with you to ease your stresses and provide a comfortable environment for you.

Here are a few tips to help with your dental anxiety prior to and during your dental appointment:

• Arrive early and relax. Rushing to get to your appointment can cause your heart rate to increase and cause additional emotional stress. We have a variety of books and tea for you to enjoy in our waiting room prior to your appointment!

Avoid caffeine. Caffeine can exacerbate your feelings of anxiety in the dental chair.

Bring or ask for a blanket! A weighted blanket can often have a calming effect in the dental chair. We can also provide a blanket or two while you’re in the chair. (We also have a seat warmer and massage feature our dental chairs – the combination of all three amenities is often very helpful).

Have your earbuds ready. It is often helpful to listen to music, an audiobook or podcast during your appointment to distract yourself and help drain out the sounds of the dental office. Additionally, each room in our office can play its own music and we can play tunes of your choice!

Bring a fidget spinner! Sensory toys can often help with stress and anxiety (and this tip works great for your kiddos as well!) We have a fidget cube in our treatment rooms if you’d like to borrow one.

Ask about nitrous oxide/”laughing gas”. Our office is equipped to provide nitrous oxide (often called “laughing gas”) to patients for all appointments. Nitrous is a safe, odorless gas that is given through a mask that covers your nose for the duration of the appointment. Nitrous can help you feel relaxed and tired, but you will still be responsive for your appointment. The effects of nitrous are completely gone within several minutes so it is safe to drive and return to work after your appointment. Feel free to call us prior to your visit to discuss whether nitrous would be a good option for you.

Be open about your fears and expectations. We understand that dental visits can often be overwhelming. All of us are here to discuss your expectations and help plan your appointments so that your treatment plan is manageable.  

Above all else, we hope you have a provider you trust – whether that’s here at Five Pines or somewhere else. You should always feel comfortable communicating your needs during your appointment. And remember to think long-term… when you are comfortable during your visits, future appointments can be less anxiety-inducing!

Do you have a dental question for Laurena? Email and let us know what’s on your mind.


Ask a Hygienist: Plaque vs. Calculus

Dental Dictionary – Plaque and Calculus
by Laurena Marques, BSDH, RDH

Through years of discussions with patients about oral hygiene, I have come to realize that most people use the words plaque and calculus (or tartar) interchangeably. But in fact, they’re totally different! So let’s chat about the stuff that builds up on our teeth, why it’s relevant to oral hygiene, and how to keep it off of our teeth. Plus, who doesn’t love to talk about germs? (Okay, maybe most people don’t… we’re just nerds).

Plaque is the sticky, soft, film that we brush off with a toothbrush. Although it is difficult to see, under our magnifying glass it is usually a white substance with the consistency of cottage cheese. Plaque is what makes our teeth feel like a “sweater” in the morning before we brush our teeth. Plaque is a harmful biofilm that causes inflammation, gum disease, and cavities. The makeup of plaque is around 1000 microorganisms, including streptococcus mutans, a large contributor to tooth decay.  Plaque builds up on our teeth naturally with our diet and saliva and is exactly why we brush our teeth at least twice a day. 

As plaque absorbs minerals from food and saliva, it begins to harden within as little as 48 hours, turning into a substance called calculus (sometimes referred to as tartar). Calculus is made up primarily of calcium phosphate deposits and is formed in incremental layers. Calculus varies in color- white, green from stain, or even dark/black deposits from iron (bleeding) in inflamed gums. How and why calculus forms has many variables including oral hygiene, the type of bacteria in your mouth, drugs, medications, and tobacco use. Calculus can no longer be removed with a toothbrush and can only be removed by a professional dental cleaning using specific dental scalers and ultrasonic instruments. 

Our mouths alone contain over 700 species of microbes (not including what’s under our gums and the bacteria that make up plaque and calculus – another 1200 species). Some of these microbes are good, and some are bad. Your mouth is basically it’s own ecosystem. Oral bacteria and inflammation (bleeding gums) is related to a variety of systemic issues in our body such as heart infections, cardiovascular disease, pregnancy complications, pneumonia, and Alzheimer’s disease. It is important to keep a good balance of the good bacteria in your mouth through low-sugar diet, brushing twice a day, flossing (or using a water flosser), avoiding tobacco use, and of course, visiting your dental hygienist!


Cate, J. (2006) Biofilms, a new approach to the microbiology of dental plaque.  Journal of Odontology. 94: 1.

Dr. Tungs (2017) [Image] Germs. Retrieved from


Ask a Hygienist: Dental X-Rays

Dental X-Rays! Why and When?
by Laurena Marques, BSDH, RDH

Today I’m giving you the scoop on dental x-rays – why we take them and what exactly we are trying to find. Radiographs are an integral part of diagnostics during your dental examination.  In order to provide you with the highest standard of care, we need to see the entire picture… no pun intended. 

What are you looking for when you take x-rays?

Dental radiographs are used to look for a variety of issues – even letting us see problems before painful symptoms begin. Here are some of the oral concerns the dentist can identify with diagnostic imaging:

  • Cavities: When we look at your mouth, we are only able to see the top and side surfaces of your teeth. Cavities often form on the in-between surfaces, and radiographs will allow your dentist to see cavities or the beginnings of cavities forming.
  • Existing fillings: An x-ray will show re-developing decay or areas breaking down around existing dental work.
  • Bone structure surrounding the teeth: Looking at the bone levels surrounding the teeth will identify bone loss caused by gum disease.  X-rays can also identify jaw problems, cysts, tumors, or abscesses.
  • Infection: X-rays will show abnormalities at the tip of tooth roots, indicating an abscess or infection. An infection may show up in an x-ray before it shows symptoms that you can see or feel. Sometimes, infections can form years after prior injury.
  • Fractures: An x-ray can show a fractured tooth or jaw.
  • Check the location teeth:  X-rays help us evaluate teeth that are not forming in the right place or are too crowded to grow in properly, such as impacted wisdom teeth. The doctor can also evaluate crowded or overlapping teeth.  In children, x-rays also monitor tooth development and evaluate the need for orthodontics.

But if I have a cavity or other problem, won’t I feel pain?

Typically, you will not feel pain unless a cavity has become larger and approaches the nerve of the tooth. Some people will not feel infections at all! When decay reaches the nerve of the tooth, you are at a higher risk of needing a crown or root canal. It is recommended to treat a cavity while it is small to prevent more extensive dental work.

How safe are x-rays? What about pregnancy?

At Five Pines, we use digital technology which is up to 70% less radiation than conventional radiographs! The technology has improved so much that lead aprons are no longer required for exposure. However, we still recommend a lead apron for pregnant patients, children, and those who would still like to use the apron as a precautionary measure.

We still recommend regular check-up x-rays for pregnant patients to identify problems that may need treatment. According to the American College of Radiology, no single diagnostic x-ray has a radiation dose significant enough to cause adverse effects in a developing embryo or fetus.

This infographic compares a dental x-ray with other sources of radiation – it is a helpful comparison!

How often do I need x-rays?

We base the frequency of x-rays on a variety of factors that vary from patient to patient. Risk factors such as dental history, medical history, age, medications, diet, and oral hygiene all play a part in the collaborative decision of radiograph frequency.  We generally recommend a full set of x-rays every 3-5 years, and limited check-up bitewings every 1 to 2 years.

I saw this sign on the wall of a chiropractic office that was the perfect illustration of radiographs: “To see is to know. Not to see is to guess. And we won’t guess about your health!” It’s important to us that you know exactly what we are looking at when we are evaluating your teeth and want you to be involved with understanding your health.

Do you have a dental question for Laurena? Email and let us know what’s on your mind.


Ask a Hygienist: Activated Charcoal

Activated Charcoal – Should I Use It?
by Laurena Marques, BSDH, RDH

Activated charcoal is a manufactured product that has benefits such as water filtration, binding with intestinal gas, and is used by doctors to treat poisoning and overdoses. If you’re a science nerd and want to read up on how activated charcoal works, Dr. Anne Marie Helmestine (2019) breaks down the mechanism in which activated charcoal is created and its effectiveness here. Activated charcoal is currently all the rage in skincare products, at the smoothie bar, and now… in toothpaste!

First, let’s talk about how whitening pastes work. Generally, whitening toothpastes remove stain through the action of abrasion – “scratching” stains off of the surface of the tooth (think: sandpaper!). Common mild abrasives you may see in toothpaste are hydrated silica, calcium carbonate, and baking soda. These products are recognized by the Food & Drug Administration (FDA) as being Generally Recognized as Safe (GRaS).

Currently, charcoal pastes are gaining popularity due to its claim that it can brighten your smile though its abrasiveness and “detoxing” mechanisms. But what evidence do we have that it works? Unfortunately, there is not a lot of scientific studies to back up the claim. The Journal of the American Dental Association posted a literature review stating little to no evidence of the safety and effectiveness of charcoal as a whitening agent. In 2017, the Journal of Physics released a study that concluded that brushing with a charcoal paste nearly doubled tooth roughness after three months of use – suggesting that it may be too abrasive to use and suggests reconsidering the use of toothpastes containing charcoal for the long term.

Additionally, the United States Center for Disease Control stated that charcoal powder is as carcinogenic as cigarette smoke, and that mixing a powder into toothpaste form at home can pose a dangerous risk.

However, reputable dental companies are following the trend for charcoal pastes. Crest released a toothpaste with charcoal, claiming to gently remove surface stains and remineralize weakened enamel through fluoride. The brand HELLO released a charcoal paste claiming to be less abrasive than charcoal powder and well within the safety limit for toothpaste abrasiveness as suggested by the International Organization for Standardization (ISO).

So, the short answer: There has been very little evidence that charcoal has any effect on tooth whitening. Charcoal also has minimal studies on the negative effect and abrasiveness on enamel. We recommend that if you do decide to use charcoal toothpaste, purchase from a reputable toothpaste brand as a pre-mixed paste, and do not use it long term.

Keep in mind with any whitening toothpaste – whether or not recognized as “safe” by the FDA or within ISO standards– whitening pastes may cause sensitivity, weaken enamel, or further damage exposed root surfaces (called gum recession). While we do find that most side effects are temporary, please consult your dental professional. We can help you find the products that are best for you!

Do you have a dental question for Laurena? Email and let us know what’s on your mind.


Brooks, J., Bashirelahi, N., Reynolds, M. (2017). Charcoal and charcoal-based dentrifices. Retrieved from

Food & Drug Administration (2018). Generally recognized as safe. Retrieved from

Hello (n.d). Frequently asked questions. Retrieved from

Helmenstine, A. (2019). Activated charcoal and how it works. Retrieved from

Pertiwi, U., Eriwati, Y., and Irawan, B. (2017). Surface changes of enamel after brushing with charcoal toothpaste. Retrieved from