Mrs. Smiley

smiley face

by Dr. Cameron, D.D.S.

We often will ask a 7 year old if they brushed their teeth today? But we almost never ask a 70 year old this same question…





I started this article with the above question, because unfortunately more and more these days I often find myself asking both these groups and their care takers this question.

About 8 years ago in my practice, I saw a regular long-term patient of mine, she was 71 years old. She had been coming to me for her dental care for close to 20 years. She always had great teeth. She had been very fortunate to receive very good dental care through out her life and her oral hygiene and dietary habits were excellent.

During this one particular exam, this patient, who I will call Mrs. Smiley, seemed just a bit off to me, while I was talking with her before I started my examination. It was during her actual examination where I noticed a huge difference. Mrs. Smiley who had always had immaculate oral hygiene and nice teeth presented with a very different mouth then I was used to seeing. She had plaque and food debris all through out her mouth. Her gingival (gum) tissues were extremely inflamed, very swollen, red and bleeding. She was starting to get decay especially on exposed root surfaces she had on her teeth. After seeing Mrs. Smiley just about every 6 months, for the past 20 years, this came as quite a shock to me. I couldn’t figure out what had caused this change. I immediately sat up Mrs. Smiley, and started to ask her a few questions about her oral hygiene … but she seemed a bit confused and did not quite seem to understand what I was trying to ask her.

I then went out to the waiting room and I asked her husband (Mr. Smiley) if could come into my private office to speak with me. When I started explaining to Mr. Smiley what I saw during my examination, he was very surprised.

So I asked him, “When was the last time you saw your wife brush her teeth?”

He told me, Why she brushes her teeth 3 to 4 times a day, she has done this her whole life.”

Then I had to stop him and ask him again, but this time I asked him, “No, when was the last time you actually saw your wife physically in the act of brushing her teeth?”

When he took a few minutes to think about it, he told me, he can’t remember actually seeing her brush her teeth, but she must have been doing this. Sadly, I had to tell him that she was not, she looked like she had not brushed her teeth in over a week or so.

Even though I am certainly not an expert in dementia, one of the things I do know is that in the early stages of the disease, one of the traits that is noted, is that individuals will sometimes stop performing everyday basic hygiene tasks. Often times these traits start happening so gradually, that the people closest to them do not notice them at first. We are finding that members of the dental team, hygienists and dentists, can sometimes be the first health professionals that can spot some of these early changes that are associated with dementia. We know that cognitive decline has a very significant negative effect on oral health, which of course leads to a decline in the patient’s overall health.

Sadly, Mrs. Smiley did go on to develop dementia, and she was in the very early stages when I first noticed the decline in her oral hygiene. Due to the fact she was diagnosed rather early, and with a very good support system in place (her husband and her adult children), we were able to put into place an oral health plan which would greatly aid her in her oral health care. This plan included increasing the frequency of her routine dental recall visits, so we could provide better and more frequent cleanings and catch any small problems, i.e. cavities, early and treat them easier. She had her support group help her with her home care, brushing and flossing. But still… every now and then, someone has to ask Mrs. Smiley, “Did you brush your teeth today?”


dr-paul-cameronDr. Cameron is a full time General dentist who practices in Antigonish. He is a past president of the Nova Scotia Dental Association, and a past Board Member of the Canadian Dental Association’s Board of Directors, and he has served on a provincial working group dedicated to the Oral Health of Seniors in our province.

By the same author:

First Tooth, First Dental Visit

by Dr. Paul Cameron, D.D.S.

“When should I bring my child for their first dental visit?”

As a full time family dentist, I get asked this question a lot.  The answer I give these days is based on recommendations from the Canadian Dental Association, and that is…

“I see infants by age 1 or within 6 months of the eruption of their first tooth”


When I started practicing dentistry 27 years ago, this was not the case. Dentists usually did not see a child until they were 3 to 3 ½ years old, because it was very challenging to get an infant to co-operate well enough at any age earlier.

During my career I started to notice that I was seeing a significant number of 3 year olds that already had lots of cavities, which concerned me.  I thought there must be something we can do as dentists to prevent this from happening.

In 2001, I attended a Continuing Education course in Halifax put on by Dr. Ross Anderson, who is the Chief of Pediatric Dentistry at the IWK Hospital.  He was starting an initiative to encourage dentists to see infants at an earlier age, by their 1st birthday.   I started to follow this philosophy almost right away ever since that course.    Dr. Anderson taught me how to do a thorough proper Knee-to-Knee oral examination” of an infant, and he taught me the important things to discuss with a new parent during that visit.


Knee-to-knee examination performed by Dr. Jennifer MacLellan, Paediatric Dental Specialist, IWK

Here are some of the key points

  • The child is facing the parent
  • The parent stabilizes the child’s arms and legs
  • The dentist stabilizes the child’s head on a comfortable flat surface (e.g. pillow)
  • There is constant communication between the child, the parent and the dentist

A complete video of a knee-to-knee oral examination can be viewed here.


Since that time, Dr. Anderson along with a number of other Pediatric Dental Specialists, have made this a National Issue, which the Canadian Dental Association has gotten 100% behind it and is actively promoting to all dentists across Canada.

One of the biggest challenges that I faced at first, was to actually convince the parents that the oral health of their infants was important and how poor oral health could really diminish how a child will grow and learn.  As I mentioned earlier, I was often surprised and dismayed when I saw how much dental disease was already present in my 3-year-old patients.   So now by seeing an infant at 1 year old, it gives the parent and myself an excellent opportunity to discover any issues very early stage and to have a healthy discussion on proper oral health care, including nutrition and home care.

The greatest reward from these early visits is to see the infant with their new parents get onto the right path to oral health at a young age.

There is a lot of information available to young parents on the Internet about oral health, but almost “way too much information”, and it is difficult to determine what information comes from credible sources.  Your dentist should be your “Go-To Expert Resource”, and there is nothing that compares to sitting down one on one with your dental professional to discuss the individual oral health of your child.

firts-tooth-full-pageEven after practicing for 27 years, I still get very excited to see a new 1-year-old patient on my day’s schedule.  To me, I know that is going to be a very productive and rewarding appointment with keen parents who want to do the best for their child, and as well it will be a fun appointment!



Paul Cameron, B.Sc., D.D.S. Antigonish, NS

Dr. Cameron is a full time General dentist. He is a past president of the Nova Scotia Dental Association, and a past Board Member of the Canadian Dental Association’s Board of Directors.