Dentistry for Kids at Great Grins for KIDS
Portland, OR

Happy dental patient at Great Grins for KIDS - PortlandA lifetime of healthy teeth starts with good brushing habits, good nutritional choices and trust in the dentist. By teaming up with you, we can ensure that your child has a vibrant smile all the way into adulthood.
Preventive Dentistry Restorative Dentistry Sedation Dentistry
Brushing & Flossing ◢
Cleanings & Exams ◢
Fluoride Treatments ◢
Sealants ◢
Space Maintainer ◢

Brushing & Flossing
Happy little girl after some brushing and flossing tips from Dr. MutschlerBrushing and flossing your teeth are the best ways to have your be teeth sparkling white and cavity free, your gums look good, and your breath smell swell.

How does brushing and flossing work?

Dental disease is caused by germs, many types of bacteria and yeast, to be exact. The bacteria stick to teeth by making a sticky waterproof glue that surrounds the germs and holds them tightly to the tooth. This combination of germs and glue is called dental plaque. Bacteria are present in every mouth and they multiply and grow by eating the same food that you do. The problem is that after they eat, they make wastes – germs poop! Their waste is lactic acid and this acid will dissolve tooth enamel and make a hole (cavities). Once there is a hole to hide in, the germs are much harder to clean off the tooth and they grow even faster, making more acid, and making the cavity even bigger. Over months and years, the cavities can grow big enough to cause tooth aches and even dissolve the whole tooth right down to the gums. Wow.

To prevent this disappearing act, we need to brush and floss to remove the dental plaque. Because the plaque is waterproof, just swishing with mouthwash does not work. It is like a bit like Vaseline petroleum gel on a mirror; throwing water at it just smears it around. You have to physically wipe it off with a wash rag or paper towel to get the mirror clean. For your teeth, we use a toothbrush to rub the top and sides of teeth and we use floss or a toothpick to rub clean between the teeth. To do a complete cleaning job, you need to use BOTH.

Flossing is one of the most important oral health activities that you can teach your child. In fact, flossing is more important than brushing. Our kids would sometimes go to bed late and to save time with the bedtime routine, we would have “Floss and Fluoride” nights and skip the toothbrushing. Now this was rare, but it demonstrates that we choose flossing over brushing in importance.

Floss comes both in boxes of long strands that you use your fingers to hold or you can buy the disposable floss handles. Floss handles make flossing much easier for parents because some small children can bite your fingers if you try to floss using fingers. Our office gives out floss handles that are reusable (so there is less plastic waste than the disposable ones) and it is cheaper too. Whichever type of floss you use, just USE IT.

If you have any questions please feel free to give us a call at (971) 470-0054
Cleanings and Exams
 Happy little girl and her dental hygienist at Great Grins for KIDS in Portland, ORProfessional cleanings performed by a hygienist or dental assistant are important to your child's dental health, as are daily brushing and flossing. Using specialized tools and kid-friendly language, we will:
•  Remove plaque build-up from the surfaces of teeth. Bacteria in the mouth form plaque, which collects on teeth and causes decay, gum disease and gingivitis
•  Remove tartar from teeth surfaces. Tartar, or calculus, is plaque that has become so hardened on the teeth that its removal requires special procedures. Tartar below the gum line is also an indicator of gum disease, and generally appears on older children and adults
•  Help with brushing and flossing techniques, and encouraging healthy eating habits at home to promote good oral development
•  Remove surface stains from teeth through polishing


Regular examinations help detect and prevent health issues before they become serious. Twice yearly dental check-ups help catch problems when they are small and easier to treat. Left unattended, small treatable problems become worse and may require more extensive, expensive procedures to repair. Dental examinations in our office generally include the following:
•  Digital x-rays to assess proper tooth development and healthy eruption of primary and permanent teeth
•  Thorough examination of the teeth, looking for areas of decay, teeth that will be exfoliating (coming out soon), future orthodontic needs, and any treatment diagnosis
•  Head, neck, and mouth visual examination

X-rays (Radiographs)

Dental x-rays are a primary tool for early identification of dental problems. X-rays are primarily used to detect tooth decay between teeth, dental infections, cysts (fluid-filled sacks), tumors, impacted teeth, and teeth that not erupting properly. Your Portland / Oregon City pediatric dentist uses x-rays to detect these issues early, saving you money in the long run by preventing the need for more expensive procedures or surgeries.

Some people are concerned about radiation exposure, and we agree that we should always use the least amount of x-ray exposure possible. Luckily, most dental radiographs are a tiny fraction of the amount of medical radiographs and are more comparable to a few hours in the sunshine. The benefit we get from a radiograph x-ray that can prevent serious dental problems more than makes up for the risk from a tiny amount of x-ray exposure.

We invite you to call us at (971) 470-0054 with any questions about your child's first visit!
Fluoride Treatments
Happy young man after his fluoride treatment at Great Grins for KIDS in Portland, ORFluoride is a natural mineral that has been proven to strengthen teeth and prevent the incidence of tooth decay. The American Dental Association recommends fluoride treatment for children as soon as teeth emerge. This simple preventive measure of applying a fluoride varnish to a child's first teeth can strengthen teeth at risk for decay and create a tooth surface that is more resistant to decay.

Applying a fluoride varnish protects a child's primary (first) teeth from decay. Fluoride is applied twice a year from ages one to six or seven when the child gets their permanent teeth. Fluoride varnish works by repairing gaps in the tooth enamel, protecting teeth from plaque forming bacteria that likes to colonize in small pits and gaps.

Fluoride is easily applied to teeth. It dries almost immediately upon contact with clean dry teeth and will not be removed by saliva. The procedure is quick, painless, and often included in dental insurance coverage, but you will want to check with your provider to be certain.

To schedule an appointment please call (971) 470-0054

Dental Sealants to Ward Off Cavities
Portland, OR

Cavity free young man thanks to dental sealants from Great Grins for KIDS in Portland, OR

Looking to Boost Your Child's Chances of Remaining Cavity Free?

For optimum dental health, the ADA and CDC recommend that children and teenagers receive a plastic coating on their back teeth called dental sealants. In fact, placing dental sealants on molars is the dental procedure with more evidence of preventing decay than any other dental procedure! Dental sealants are a thin, plastic coating painted on the rough chewing surfaces of your child's premolars and molars that harden with a bright blue light. Sealants cover the hard to clean pits and fissures present on the back molar teeth, preventing food and plaque from forming cavities. Dental sealants reduce cavities by an average of 75%, often protecting teeth for more than 10 years.

Sealants are typically applied to the first permanent molars about the age of 7, as soon as they fully erupt. Sealants are then applied once the child's permanent premolars and second molars erupt, around age 12. Sealing permanent teeth helps protect them through the most cavity-prone years, ages 6–14, but adults can also benefit from sealants if they have permanent teeth with no decay or dental work. Although dental sealants should be placed before any decay starts, research shows that even if a small amount of decay has started, sealants can actually prevent the decay from progressing once the sealant is properly placed and maintained. Sealants are checked at each cleaning and should be repaired or replaced as necessary. Most dental insurances cover the application of sealant in children. Make sure that your child's teeth are properly protected with dental sealants.

To schedule an appointment, call (971) 470-0054
Space Maintainer
Happy child with a healthy smile thanks to Great Grins for KIDS - Portland, ORIt is a rare day in my pediatric dentistry and orthodontic practice when I do not think about having enough space available for permanent teeth to grow in and line up properly. There are two situations when we worry about space in kids’ mouths:
1.  Naturally crowded teeth
2.  Prematurely lost primary teeth


If teeth are crowded, sometimes teeth must be extracted to make room for the others to line up. Usually braces are needed after all the permanent teeth erupt, but extractions make the orthodontic treatment easier. Before all the permanent teeth erupt, maintaining the remaining space can be very helpful. We use a space maintainer called a Lower Lingual Arch for lower teeth and either an Upper Palatal Arch or a Trans-Palatal Arch for upper teeth. These appliances will stay in place until the permanent teeth erupt.

Lost Primary Teeth

Adults need to have an artificial tooth made to replace missing permanent teeth because the teeth on the other jaw can over erupt and disrupt the jaw function. Children are growing so much and their adult teeth come in soon enough that this is usually not a problem for kids. An artificial molar is not needed to replace missing primary teeth, just maintaining the space.

The primary (baby or milk) teeth are important for chewing and biting and speaking and especially for holding open the space needed for the permanent adult teeth to grow in. If a front baby teeth goes missing, we do not lose space very much so we do not have to replace missing front teeth or even make a space maintainer. Luckily, a gap-toothed grin in a kid is much cuter than in an adult!

But when a primary back tooth molar is lost by infection or trauma, the gingival gum fibers and the angle of the jaws closing together make for a strong tendency for the adjacent teeth to move into the newly open space. In other words, the space for the permanent tooth will be lost.

While initially the loss of a primary tooth does not seem like such a terrible thing, the future consequences could be the loss of a permanent tooth, extensive and expensive orthodontic appliances, and even an uncomfortable bite that causes abnormal wear on the poorly positioned teeth.

To avoid these problems, we routinely make a small appliance that spans the gap to keep the space open. This is called a band-loop space maintainer. It is made with a metal orthodontic band soldered to a wire stretching across the missing tooth’s space.

If more than one tooth is missing, another way to save the space is to use an appliance that goes from a permanent tooth on one side to one on the other side of the mouth. These are called a lower lingual arch to replace bottom teeth or a transpalatal arch to replace upper teeth. Often a lower lingual arch or transpalatal arch can keep the room that remains or even press the teeth to gain space.

Taking care of a space maintainer is easy; just don’t play with them and keep them clean.

To summarize, there are several types of space maintainers:

•  Band-loop space maintainers – the most common space maintainer, it is most useful for replacing a single tooth. They consist of a metal orthodontic band soldered to a wire that spans the missing tooth space.
•  Lower lingual arches (LLA) – also very common, are used to hold space open for more than one missing tooth or to help keep the lower incisors straight. Bands are placed on molars on both sides of the mouth then a soldered wire extends, on the tongue side, from one side to the other, touching the front teeth.
•  Upper lingual arches – these are just like the lower lingual arches but on the top. They also make nice retainers to help keep the upper incisors straight after early orthodontic treatment.
•  Transpalatal arches – metal bands on molars connect to each other with a wire that goes directly across the top of the mouth. These are useful for keeping molars in position without getting in the way of the front teeth.
•  Nance appliances – metal bands on upper molars are soldered to a wire that has a plastic pad touching the roof of the mouth (palate).
•  W-arches – these have metal molar bands soldered to a wire that rests against the inside of the molars and a large loop across the palate. These are useful for widening the upper dental arch.
•  Distal shoe space maintainers – these have a band around the tooth closest to the missing one. A bar extends back and digs into the gums to guide permanent tooth eruption. I avoid these whenever possible.

Each of these have different uses and each doctor has their favorites. Give us a call today at (971) 470-0054 to schedule an appointment.

Fillings ◢
Root Canals ◢
Extractions ◢
Teeth Whitening ◢

Kid with a Great Grin thanks to Dental Fillings - Pediatric Dentist Portland, OR

Composite Fillings

What are they?

Composite fillings are a mixture of glass or quartz filler in a plastic resin that produces a tooth-colored filling. They are sometimes referred to as composites or filled resins.

What limitations are there?

Composites might stain or discolor over time. Composite fillings are more difficult to place because they require a cavity that must be kept clean and dry during filling and so it generally takes longer to place a composite filling than an amalgam filling. The cost is moderate; more than a silver filling but much less than porcelain crowns or inlays.

What is good about them?

Composites can be "bonded" or adhesively held in a cavity, often allowing the dentist to make a more conservative repair to the tooth. Because the dentist removes less tooth structure when preparing the tooth, this results in a smaller filling than that of an amalgam.


Composite fillings cost a little more because they mimic natural tooth color and the natural translucency of enamel, they provide excellent appearance, and they have good durability and resistance to fracture in small-to-mid size restorations in patients with normal chewing pressure.


What are they?

Resin Ionomers and Glass Ionomers are translucent, tooth-colored materials made of a mixture of acrylic acids and fine glass powders that are used to fill cavities, particularly those on the root surfaces of teeth.

What is good about them?

Ionomers release a small amount of fluoride that may be beneficial for patients who are at high risk for decay. Because the dentist removes less tooth structure when preparing the tooth, this results in a smaller filling than for an amalgam.

What limitations are there?

1.  Glass ionomers release more fluoride and tolerate moisture better than resin ionomers. Because they can fracture, glass ionomers are mostly used in small fillings in areas not subject to heavy chewing pressure or on the roots of teeth.
2.  Resin ionomers release less fluoride and are not as tolerant of wet conditions as glass ionomers. They also are used for small fillings and on the root surfaces of teeth: they have a better resistance to fracture but wear down.


Ionomers work better than composites in wet areas but experience high wear OR fracture if large fillings are placed on chewing surfaces. Both glass and resin ionomers mimic natural tooth color but lack the natural translucency of enamel or composite

Amalgam Fillings

What are they?

Dental amalgam is a stable alloy made by combining elemental mercury, silver, tin, copper and other metallic elements. Although dental amalgam continues to be a safe, commonly used restorative material, its mercury content has raised some concern. However, the mercury in amalgam combines with other metals to render it stable and safe for use in filling teeth.

What is good about them?

Because amalgam fillings can withstand very high chewing loads, they are particularly useful for restoring molars in the back of the mouth where chewing load is greatest. They are also useful in areas where a cavity preparation is difficult to keep dry during the filling replacement, such as in deep fillings below the gum line. It remains a valued treatment option because it is durable, easy to use, highly resistant to wear and relatively inexpensive in comparison to other materials.

What limitations are there?

Disadvantages of amalgam include sensitivity to chewing metal foil and possible short-term sensitivity to hot or cold after placing the filling. The silver-colored filling is not as natural looking as one that is tooth-colored, especially when the restoration is near the front of the mouth, and shows when the patient laughs or speaks. Moreover, to prepare the tooth, the dentist may need to remove more tooth structure to accommodate an amalgam filling than for other types of fillings. Long term, there is a higher chance of breaking cusps off teeth if the amalgam fillings swell up.


It has a long history of use and it wears well. It can be placed in wet areas better than composite and it is cheaper because it is easier to place. However, amalgam is dark colored, it can fracture teeth after many years, and can be sensitive to temperature and chewing metal foil, and usually more tooth must be cut away to place it.

If you have any questions, or if you'd like to schedule an appointment, please give us a call at (971) 470-0054.
Tooth Pulp & Root Canals

Tooth Pulps & Root Canals
Portland, OR

“Root canal? Ouch!” That is what most of my Portland patients tell me, but luckily root canal treatments take away toothaches to make you feel better.

Usually dentists prefer to treat infected root canal pulps before they start to hurt because this is the most comfortable way to go. Waiting for a tooth to hurt before starting root canal treatment is usually less comfortable.

Permanent teeth are alive with nerves and blood vessels located in the middle of the tooth in the area called the pulp. Bacteria infected pulps or teeth that have been traumatized may have damaged pulps that cannot heal. If the pulp cannot heal, the tooth will become painful and may cause serious health problems. To avoid these problems, the tooth must be extracted or receive root canal treatment.

The steps of permanent tooth root canal treatment:

•  Numb the tooth with local anesthetic, usually 4% articaine or 2% lidocaine (usually with 1:100,000 epinephrine).
•  Stretch a rubber dam over the tooth to keep bacteria in saliva from re-infecting the cleaned root canal.
•  Remove any decay with a handpiece drill and remove the infected pulp.
•  Use extremely small wire files to scrape the tissue from the canals in the roots.
•  Measure the length of the files to know exactly how far it is to the end of the root.
•  Rinse the infected material from the root canals with disinfectants, often sodium hypochlorite.
•  Soak triple antibiotics in the cleaned, shaped, and smooth canals to fight infection.
•  Pack pink, rubbery gutta percha into the root canals all the way to the tip, with runny sealer to fill in any gaps.
•  Place a filling in the hole and plan on a crown to hold the weakened tooth together.

Primary teeth with infected pulps are treated differently than permanent teeth.

Primary molars last until about age 11 or 12 so we like to save them with root canal treatment, if we can, instead of pulling them out and placing a space maintainer.

Because primary teeth roots need to dissolve away when the permanent teeth start to grow in, the root canal material used for baby teeth should be dissolvable or not go all the way down the root canals.

Most of the time, primary teeth with infected pulps are treated with a partial pulp removal called a pulpotomy.

The steps of primary (deciduous or baby) tooth pulpotomy procedure:

•  Numb the tooth with 4% articaine or 2% lidocaine (usually with 1:100,000 epinephrine).
•  Stretch the rubber dam around the infected tooth to seal out infected saliva.
•  Use a handpiece to drill away infected tooth and cut the infected tooth pulp in the top coronal pulp chamber.
•  Stop any bleeding with ferric sulfate, then swab out the chamber with diluted formocresol.
•  The infection is often only in the top of the tooth so using medicines like formocresol or ferric sulfate will treat painful nerves and kill the germs in the remaining pulp tissue.
•  Fill the pulp chamber with zinc oxide and eugenol filling to form a tight seal and prevent bacterial entry.
•  Place a tightly fitting stainless steel crown or a composite filling.

These pulpotomies are very successful for teeth that have not infected the bone supporting the tooth. If the bone around a tooth gets infected, then all the pulp tissue must be removed, even the root canal tissue. This complete pulp removal is called a pulpectomy.

A pulpectomy procedure is similar to the adult root canal treatment in that files are used to clean and shape but the material we use to fill the root canals is much different because the roots are supposed to be dissolved away as the permanent teeth erupt.

The root canal filling material for primary teeth must be resorbable or dissolvable. I use a material called Vitapex (a mixture of calcium hydroxide, iodoform, and silicone lubricant) with great success healing abscessed teeth.

Pulpectomy treatment for primary teeth is mostly reserved for only the most important teeth: the second primary molars before the eruption of the permanent molars.

When faced with the options of a painful toothache, a root canal, or an extraction, most people will be pleasantly surprised that those root canals are the best option and not an “OUCH!” after all.


Extractions are easier than pulling teeth

The phrase "It was like pulling teeth" usually means that something is very difficult. Lots of people are worried about getting a tooth extracted. They usually think that they will have to go to sleep or that it is very difficult.

This is just not the case for almost every extraction that we do. A little numbing, a push, a squeeze, and you are done in a few minutes.

Sedation is an option for the faint of heart, but most do not need it. Often we amaze the little ones when we take the tooth out “magically” with a magic mirror and sleight of hand because they do not know the tooth was already pulled out. See our section on sedation for more information.

Today a girl from Gladstone needed several teeth out for her braces. After rubbing her gums with a powerful anesthetic gel, the shot was so comfortable that she did not know what I was doing. Once the anesthetic was working well, we discussed the difference between a push and a pinch and explained how teeth are connected to ears through the jaw bone so touching teeth is louder than normal. The gums were gently pushed away from the tooth and then the tooth is rocked back and forth. Shaking her whole head a little bit helped distract her from the sensation of firm pressure. Once the tooth was out, a gauze pad stopped the bleeding. And a prize brought out a smile. She was surprised to learn that the teeth were out – she did not even know!

This story demonstrates how young kids often worry about the numb feeling or they confuse pressure with pain. Explanations of what to expect using carefully chosen words make kids much more comfortable. We joke with the children that it was "Like pulling teeth - very easy!"

For more information, or if you'd like to schedule an appointment, please give us a call at (971) 470-0054.
Teeth Whitening

Teeth Whitening at Great Grins for KIDS in Portland, OR

Teeth whitening (or bleaching) is a simple, non-invasive dental treatment used to change the color of natural tooth enamel, and is an ideal way to enhance the beauty of your smile. Tooth bleaching is included in the price of our orthodontic treatment so every newly straight smile has a chance to really light up a room!

Because having whiter teeth has now become the number one aesthetic concern of most patients, there are several ways to whiten teeth. The most popular method is using an at-home teeth whitening system that will whiten teeth dramatically. Since teeth whitening only works on natural tooth enamel, it is important to evaluate replacement of any old fillings, crowns, etc. Replacement of any restorations will be done after bleaching so they will match the newly bleached teeth.

Teeth whitening is not permanent. A touch-up may be needed once a year and more often if you smoke and/or drink coffee, tea or wine.

Reasons for Teeth Whitening

•  Naturally yellow or brown stained teeth
•  Normal wear of outer tooth layer
•  Stained teeth due to diet
•  Just want a brighter, whiter grin

What Does At-Home Teeth Whitening Involve?

Whitening systems provided by our dental office usually require two visits. At the first appointment, impressions (molds) will be made of your teeth to fabricate custom, clear, plastic trays.

At your second appointment, you will try on the trays for proper fit, and adjustments will be made if necessary. The trays are worn with special whitening solution either twice a day or overnight, depending on the degree of staining and desired level of whitening. It is normal to experience tooth sensitivity during the time you are whitening your teeth, but it will subside shortly after you have stopped bleaching.

You will receive care instructions for your teeth and trays, and be encouraged to visit our office regularly to help maintain a beautiful, healthy, white smile.

To schedule an appointment call (971) 470-0054 today.
At Great Grins for KIDS - Portland, dentistry for kids is more than bright, healthy smiles; it's also about making the trip to the dentist a calm, pleasant experience so there's no fear of "next time." We take pride in seeing our patients grow into their adult teeth, so we're committed to earning the trust of everyone who visits our practice—both children and parents. That's why we take extra time to build rapport and earn confidence; it makes the experience easier for everyone. As a part of our care, we use pleasant, simple explanations to answer your child's questions and calm any anxieties. Of course, we're also happy to address any concerns or questions you might have as a parent.

Young girl who knows how to take care of her teeth

Superior Service Starts Before Your Child's Appointment.

We know that your child's perception of his or her visit starts well before he or she climbs into the dentist's chair, and that's why we proudly offer a warm, kid-friendly waiting area. We keep a wide variety of storybooks and toys for all ages, so they can have fun while they wait. Also, when your little one goes in for his or her appointment, you'll have access to wi-fi, so you can make the most of your time. Read more about your child's first visit.

At Great Grins for KIDS - Portland, we believe in the power of education. Our dental team uses kid-friendly technology and easy-to-understand language to help you and your child understand what you can expect next as your child grows.

We're Here for You!

Have a question about something you've seen on our website, or heard on a popular talk show about kids and their teeth? Our team of dental assistants, office staff and our dentists are all here to answer your questions and help you navigate through your child's oral development. Give us a call today at (971) 470-0054.
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