Maggie McKay (Host): Welcome to To Your Health, presented by Jefferson Healthcare. I'm your host, Maggie McKay. Today, we're going to talk about something very exciting, Jefferson Healthcare's Mobile Dental Clinic, where healthcare comes to you with dentist, Dr. Pavel. Doctor, it's so good to have you here. Thank you for joining us. You have a beautiful background.

Pavel Vasilyuk, DDS: Hi, I am Dr. Pavel. It's nice to be here today as well, Maggie.

Host: So, give us an overview of Jefferson Healthcare's Dental Services and how it's unique from other places.

Pavel Vasilyuk, DDS: So, Jefferson Healthcare is a critical access hospital that is located in Port Townsend, Washington. Back in like 2016, Mike Glenn, the CEO of Jefferson Healthcare saw that there was a need for dental services in Port Townsend. And so, he modified the rules in terms of working with the state representatives and senators on allowing a rural health clinic to open up a dental clinic. And that was to bring about access to care to Jefferson County. And so, this clinic is different from other clinics in that it works with a rural healthcare clinic in order to provide care to Jefferson County residents.

Host: So when was it started, just that you offered dental care in general?

Pavel Vasilyuk, DDS: So, we started seeing patients for dental care in 2019. And I've been with the organization since the beginning of seeing patient care.

Host: And tell us about the dental service line at Jefferson Healthcare.

Pavel Vasilyuk, DDS: So with the dental service line at Jefferson Healthcare, we're providing the community members with exams, which includes evaluation of their gum tissue, of their tooth health, of any sort of dental diseases and abscesses of any sort of oral pathology. And we work closely in order to maximize their oral health by working in conjunction with their primary care providers. So, we're doing cleanings, we're doing extractions, we're doing fillings, and other services as well in order to maximize the oral health of our communities.

Host: It's amazing to me that they didn't have that before. Not Jefferson Healthcare, but in the area that they did not offer that at a hospital. So, other critical access hospitals don't offer dental care still. So, why was it a priority for Jefferson Healthcare?

Pavel Vasilyuk, DDS: So, it was a priority for Jefferson Healthcare because looking over county by county, Jefferson County was ranked last to second to last, in some instances, in terms of Medicaid accessibility for dental health. And so, what that meant was that the adults and the children living within this county, just didn't have access to see a dentist. And as a result of that, we saw dental problems become medical problems, which then affected their quality of life. And so, Mike Glenn, being the visionary CEO that he has really worked hard in terms of bringing about this clinic. So, that way, we can integrate both dental and medical together and make the community healthier as a result.

Host: So, this summer is very exciting for Jefferson Healthcare and the community, I imagine, because you have a new mobile dental clinic. And when is that going to roll out, so to speak?

Pavel Vasilyuk, DDS: So, we've been working for the last almost year on establishing a way to provide dental services and expand on dental services in Jefferson County. Jefferson County is unique in that when you look at the map, it spans from Port Townsend all the way down to Brinnon, and the distance between them is about an hour's drive.

At the same time, that's just East Jefferson County. If you look at the map, the county then goes westwards to Forks. Our focus right now is on East Jefferson County and being able to provide quality dental services and making sure that each resident that is Medicaid has access to those dental services. And so, we know that the challenges our community members face with transportation, with taking time off work in the southern towns of Brennan and Quilcene. And so, I worked closely with Mike Glenn, Jake Davidson, and the other hospital administrators in order to acquire the funding necessary and get this project going. So, that way, instead of them coming up to us in Fort Townsend, we're going to come down to them and really provide them with high quality dental services and dental care.

Host: And how do you get the word out? How do they know you're coming?

Pavel Vasilyuk, DDS: The podcast that we're doing here is one way to get the word out. I'll be walking through the roadie parade this upcoming Saturday. And then, I'll be working closely with the administrators as well as the marketing team at Jefferson and meeting with the community members down in Southern County.

I know when we first initially started the dental project in 2019, the previous dentist that was here as well as myself, we would go down to the food banks, for instance, meet with the local people down in Quilcene, as well as in Port Townsend as well. We would go down to the schools and do like an oral hygiene event with the kids. And so, I'm hoping that there'll be certain things that I can do, such as those events, and really start integrating myself into the community down there. I already have patients that are from Quilcene and Brinnon. And so, it's going to be nice to see their familiar faces as well as see their family and friends, and just excited to be with them and see how I can help them with their oral health.

Host: That's so great. You mentioned transportation as a challenge, which I imagine it would be. I also have to think that this is great for the elderly who maybe don't have any people or family to take them to the dentist. So, what does the mobile clinic offer? Can you, like, fill cavities, do teeth cleaning? What's the goal?

Pavel Vasilyuk, DDS: The mobile clinic is going to be just like the regular clinic up in Port Townsend. So, we'll be able to evaluate patients for cleanings. We'll be able to do oral cancer screenings. We'll be able to do some pathology and biopsy services as well. But then, the focus of the mobile clinic will be expanding a way that we can integrate our services to improve the oral health of the communities down in Quilcene, Brinnon, and then surrounding communities around that area, down the Hood Canal. So, making sure that we're restoring teeth that have cavities, for instance, extracting teeth that might be painful, that might be abscessed.

Working closely with the families and applying fluoride varnish to the kids and making sure that the kids are having their fluoride application. I know fluoride has been a very hot topic in the news lately. But as dentists, we strongly believe that a little bit of fluoride goes a long way in terms of protecting teeth in kids and adults. And so, placing sealants another way to protect their teeth. But the overall goal would be to work closely with the community and just increase the dental IQ of the community, and increase the oral health of the community.

Host: What's the response been from the community?

Pavel Vasilyuk, DDS: Oh, fantastic. I mean, allowing us to go down to South County with this mobile project is going to further allow us to expand our clinic and hire on another full-time dentist. And so, that will help us address the big magnitude of need that we've been facing in this community when it comes to providing dental services. But we have a thrilled patient base in the Port Townsend Clinic, and I'm excited to see that grow with this mobile clinic as well.

Host: That's amazing. Good for Jefferson Healthcare for putting this together and you. And all the people involved. I mean, it sounds like there's a critical need for it. So, is there anything else you'd like to add in closing?

Pavel Vasilyuk, DDS: Yes. So right now, we're coming on to summer season. Before I'm able to see you for cleanings and exams and so forth, I want to make sure that you're dialed in to have a healthy mouth. And so, things that I look for with regards to healthy mouths, especially being a father and having two kids, is making sure that, one, we're using a fluoride toothpaste when brushing our teeth. It helps defend our teeth from cavities. So, there's a reason why fluoride toothpaste has been designated with the sign anti-cavity and non-fluoride toothpaste typically don't have that anti-cavity sign on there. It's because fluoride is effective in reducing the risk of child decay and adult decay when used properly.

And then, two, oral hygiene practices to make sure you're brushing your teeth appropriately. And so, I usually recommend for an adult, a pea-sized amount of toothpaste. For a child, it's going to be a little bit different. Usually for a child, I'll take the toothbrush. And then, you just make the toothpaste go a little bit higher, and then you just smear it. And then we call that a rice-sized amount. And then, what you want to do is when you're brushing your teeth, you want to go ahead and angle the toothbrush for the upper teeth a little bit up. So, you don't want to go completely sideways. You want to go a little bit up. And you want to go along the gum line. Just make sure you're brushing your teeth right along the gums. And you want to start at the front, and then just gently back and forth all the way around. And then, the important part is when you get to the molars there, the back teeth, what you want to do, especially for the upper teeth, is you want to bite down halfway. Then, move your jaw over to the side that you're brushing your teeth on. So, the reason being is the anatomy of your jaw is such that you have your jaw joint, but then you have a muscle attachment right over here called the coronoid process. And you want to get that out of the way so you can get that molar really nice and clean. So, bite down halfway, move your jaw, and you really get to that last molar and around it as well. And you want to feel those bristles right along the gum line. And so, just give it a little brush. Use your tongue afterwards. Go in the back, make sure it feels clean, and then afterwards go over to the other side.

Then, the chewing surfaces of your teeth, the back of your gum tissue. And then, when you get to the front teeth, you want to slick out to really get everything nice and clean on the top there. Then, you want to repeat the process on the bottom. You can see with the toothbrushing, I'm not brushing the upper and the bottom teeth together like this. I'm focusing my attention on the top by angling the toothbrush, and then I focus on the bottom by angling my toothbrush down. And so, do the same thing on the bottom. On the bottom, because it doesn't have that coronoid process, you don't have to move your jaw side to side. It's only for the top molars when you're keeping those areas clean. It should be about two minutes that you're able to brush your whole mouth. So, that's one way, that you can just maintain your oral health before I see you.

Another thing that's really important-- and I keep these everywhere-- I grab one of these baggies, they're called plackers. Usually, they sell them at Costco, but I keep these in the car. I keep these around the house, but you have these little floss sticks with a U-shape. And if there's traffic, I'm driving, I haven't flossed my teeth in the morning or I'm running late, it's nice to have one in the car, you can just take it. You can go between your teeth.

The important part about using floss is when you put it between your teeth, you want to push it on one side of the tooth and kind of just scrape up and down, and then push it on the other side of the tooth and scrape it up and down, and then just kind of go between every tooth. Ideally for adults and kids, any tooth that does not have a gap you want to floss between. And then, don't forget flossing on the back of your last molars as well. That's an area that people usually don't floss. It develops a lot of plaque. That plaque over time, hardens up, develops into tartar and calculus. And then, in that case, you can predispose that tooth to gum disease and periodontal disease and bleeding and infection, and we don't want that to happen. I want you to have healthy teeth.

When it comes to healthy teeth as well, the important part is sugar consumption and the frequency of sugar consumption. As a dentist, we don't recommend consuming sugar frequently. It's not that I am like anti-sugar. I personally love sugar. I love chocolate chip cookies. I love cakes. But I want to keep it specifically with like my meals. So, breakfast, lunch, dinner, okay, to have sugar. But then, between meals, you want to eat healthy snacks.

And so, with healthy snacks, it's summertime, I would recommend these sort of things. Bananas, very good snack. Dentist approved. Meat sticks, fantastic. They have protein, no sugar. It's going to make your kid energized for a longer period of time. It doesn't give that sugar rush and it doesn't cause cavities, fantastic snack. Cheese, a good source of calcium and phosphates, those are the building blocks of your teeth. Nice to have kind of floating into saliva. Really good snack for kids as well. Things that parents don't really realize that are bad snacks sometimes though, it doesn't have to be cookies, doesn't have to be candied necessarily, but say like the fruit jerky, it's natural, it says organic on it. But when you look at the label, there's a lot of sugar in these. And not only is there sugar, but they're also very sticky. And so if a parent gives it to their kid, the kid gets their sugar rush, but also they have this sort of sticky, sugary substance on their teeth, it's just as bad as candy when it comes to snacking. If you're going to give one of these, give it with a meal, either a lunch or dinner. And then, don't forget to check the child's teeth. Or if you're eating one, check your teeth with your tongue. And make sure you don't have any sticky substance on your teeth, like 10 minutes afterwards. So if you eat one of these, just check your child's mouth. Just make sure they don't have it sticking right in between surfaces of the teeth or on the chewing surfaces. That's where cavities usually develop. And so, not dentist-approved snack.

Another thing would be like gently dried strawberries. Same theme, they seem healthy, but because they're dried, a lot of times that sugar is just more sticky and more conglomerated within the substance itself. So for this bag, for instance, total sugar's 23 grams per serving. And so if you're using this as a snack, maybe you're on a road trip to go camping, for instance. You're snacking on this, it sticks between the teeth as a constant source of sugar, not a good snack to have. Keep it with the meals and then, at the same time, after the meal, just make sure it's not stuck between your teeth. Another common one is potato chips. The potato chips tend to be sticky, tend to be refined sugars, carbohydrate-rich, not a dentist-approved snack. Keep it with your meals and then afterwards just make sure the teeth are clean.

With regards to healthy mouths and healthy teeth, what we're trying to do is just minimize the risk of sugar on causing cavities. And so, we do that by reducing the frequency and also making sure that the mouth is clean afterwards. In terms of gum disease, it's practicing the proper oral hygiene technique, making sure the toothbrush is angled against the gum tissue, and making sure you're practicing appropriate flossing where you're not just going up and down between teeth, but really focusing on cleaning the teeth on the in-between surfaces. And then, in doing that, you make your mouth healthier and then at the same time you make it so when I come and visit you, there'll be less fillings, there'll be less extractions, less hopefully decay, and a better experience as a result.

Host: Wow. That's all such good practical advice. Thank you for all those visuals, really. That's a good idea. I just had my teeth cleaned and, poor gal, she kept having to tell me to like close my mouth because of what you're saying to get back there. Because I was like, "Ah." And she's like, "No, do it like that." I'm like, "Okay." So, I get it now.

Pavel Vasilyuk, DDS: Yeah. People usually are not aware of the anatomy of the face. And so, part of it is like kids, for instance, they know that if they put their toothbrush in the back there, it hurts. They don't understand why it hurts, and so I have to a lot of times explain to them, "Hey, you have this sort of muscle right here on your temple. When you look at a skull, for instance, you notice that there's a hole, your cheekbone. Well, that muscle goes through that cheekbone and has to attach to your jaw. It's a closing muscle. It's called the temporalis. And so, that jaw muscle attachment is just like any other attachment. You have your funny bone, which is a muscle attachment to your arm. If you hit it, it hurts. And so, it's just a reminder that you do want to keep those back teeth clean. You do have back teeth in many cases. And so, the way to do that is bite down halfway, move your lower jaw to the side, move that muscle and the muscle attachment over to the side. Now, there's adequate room to practice or proper oral hygiene around that area.

Host: Well, thank you so much for sharing your expertise, Dr. Pavel. This has been great and very useful and educational.

Pavel Vasilyuk, DDS: Well, thank you so much for having me here, Maggie. I hope you enjoy the rest of the beautiful day and have a wonderful Friday. And then, to the folks down in South County, I look forward to seeing you here soon.

Host: You as well. If you would like to find out more, please visit jeffersonhealthcare.org. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to To Your Health, a podcast from Jefferson Healthcare.