Pediatric Dentistry with a Mission

At Montshire our mission is to educate families and prevent tooth decay, rather than to “drill and fill” the youngest members of our community.

Believe it or not, cavities are reversible. Up until a certain point, tooth decay can actually be stopped and reversed. Once the bacteria causing the cavity is killed, the affected area can then remineralize or, depending on age, the tooth will naturally be replaced when the adult tooth comes in.

Our office specializes in silver diamine fluoride treatment, or SDF. SDF is a liquid that is painted onto the tooth and painlessly kills the bacteria causing decay. We then apply a covering over the site to keep the antimicrobial paint protected and active.

SDF is a state-of-the-art, minimally invasive process, and our Dr. Jonny was the first in the state of New Hampshire to submit it to Medicaid for reimbursement in conjunction with fillings. We know this because our billing was promptly denied. But we didn’t stop there. Our office sent the government reams of scientific journal articles that showed the efficacy and improved outcomes of SDF for pediatric patients. Thanks to Dr. Jonny’s fight, we—and all other pediatric dentists around the state—now have full Medicaid endorsement for the treatment.

Unfortunately, our pragmatic, scientific approach with SDF is unique due to the perverse incentive that insurance companies have created for drilling and filling young children’s teeth. While our office is reimbursed $15-30 for treating a tooth with SDF, another dental practice would earn $300 for drilling that same tooth to resolve the cavity. But, again, our mission guides us. Whenever possible we choose the less-invasive approach for our community’s children, even though it is less profitable.

We believe that to serve the children in our community, we need to protect the world they will inherit. This piece of our mission stands above our profit, as we choose ecofriendly options in every aspect of our practice.

We’re proud to send children home with toothbrushes made from sustainably sourced and decomposable bamboo. Though these toothbrushes are 15 times more expensive for our office to provide than traditional plastic toothbrushes, they ensure we’re not adding to the growing global trash epidemic our children will grow up to face.

And when we send children home with their bamboo brush, floss, and toothpaste, we drop them into recyclable paper bags. Plastic bags take 1,000 years to fully degrade, during which they continuously release toxic chemicals in to our environment. It’s important to us that we stop the poisoning of our soil.

Our flooring is made from locally sourced maple and renewable cork; we use non-toxic, green cleaners in our office; and we take numerous other steps to ensure that our patients will grow into adults with great smiles and a healthy environment.

We are here to serve our community. This means investing in cutting-edge equipment, technologies, and practices - without charging cutting-edge prices.

Montshire uses digital radiography rather than conventional radiography equipment, resulting in 3-4x’s less radiation exposure for your children - an important step in preserving their lifelong health. This equipment also creates better imaging, allowing for more accurate assessments of our patients’ dental condition.  Wealso use only sealants made from a natural glass ionomer that are more durable and offer better protection against decay for patients.

We use hospital-grade sterilization in Keene, rather than standard dental sterilization equipment. In standard sterilization, only heat is used. At Montshire, we use a heat and vacuum combination that distributes more heat and kills microbes more effectively than heat alone. This is the highest standard.

Our doctors communicate weekly with researchers and leaders in minimally invasive dentistry from around the world. Our research partnership with the University of Washington enables our practice to evolve with the latest literature and findings, while also contributing to the leading edge of minimally invasive dentistry.

As one example, a new Micro CT technology in Germany just began to use X-ray imaging in 3D to visualize what happens at the histological level when using Silver Diamine Fluoride. This will be better resolution than anything that has been published in the literature so far, and Montshire regularly provides these researchers with teeth treated with Silver Diamine Fluoride so we can learn what is going on with these teeth at the micro level.

An estimated 75% of adults experience some kind of fear associated with seeing a dentist. A portion of them suffers from dental phobia, a fear so strong that they postpone or avoid dental visits altogether and to the great detriment of their tooth and overall health.

At Montshire, we are committed to stopping this trend for the children in our community. We structure each patient visit to instill a calm confidence in the children and families.

Our doctors have seen firsthand the impact that traditional pediatric dental practices can have on a sensitive, developing psyche. In his time in the Air Force, Dr. Jonny had the privilege of treating thousands of airmen. He worked on men and women who were willing to get into a fighter jet and put their lives on the line in active battle but were shaking in front of him during a routine dental checkup. Due to the dental experiences that they had as children, they were literally more comfortable having bullets or missiles fired at them than visiting a dentist.

We value the child’s emotional health as much as their dental health. If we can contribute to positive experiences with doctors and dentists, we can create an individual that is not only “okay” with going to the doctor or dentist, but actually likes it!

First, we encourage parent involvement. For children of all ages, we urge parents to stay with their children during the entire visit to provide them with a sense of security in an unfamiliar environment.

Second, we prioritize communication and education. We walk through our findings with the family, review imaging together, and spend time evaluating the pros and cons of each potential solution.

Third, we schedule visits to allow for longer time spent between doctors and patients. Our doctors are the ones who explain findings and options to the family. Our doctors stay with patients and their families for as long as is needed, rather than stacking appointments in a way that only permits short conversations.

Fourth, we have purposely created a calming environment in our office, avoiding the bright and overly stimulating environment you find in many pediatric dentist offices. Our office is designed with gentle art, soft toys, and calming colors. These are all deliberately introduced to aid in the calming effect of our office on your child, creating an environment of playfulness while still being soothing.