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Preventing Dental Problems In Kids

Dr. Nana Odoom

If you’re a parent, you likely have a lot on your calendar – doctor’s appointments, kids’ activities, school projects and more. It’s easy to put off taking your child to the dentist when they aren’t having any problems. However, helping your child get in the routine of caring for their teeth each day, including regular visits to the dentist, is a very important step for their future.

Dr. Nana Odoom, Pediatric Dentist at Keystone Dental Care, and her colleague, Dr. Victor Amarteifio, often see children who have dental conditions which could be prevented. In today’s article, she shares what parents can do to help their children have healthy teeth and avoid painful, and sometimes costly, dental problems in the future.

What conditions do pediatric dentists treat?

Pediatric dentists primarily focus on treating toddlers, adolescents and all special needs patients. After four years of dental school to treat not only growing children, but children with additional medical needs and special needs patients of all ages, we receive two to three years of extra training with a great focus on orofacial growth and development. Our training focuses on enhancing our skills to best address all forms of behavioral challenges that a child or a special needs patient may present at a dental office. Those skills include advanced behavior guidance and management techniques, and sedation and treatment in a hospital setting depending on the needs of the patient.

Some of the most common procedures we perform are routine checkups and cleanings, treating caries (cavities), abscesses and swelling. We also see patients for traumatic injuries that may sometimes include needing stitches to the mouth and face as well.

What can parents do to help prevent childhood dental problems?

The best thing you can do is to establish a dental home as early as possible – find a pediatric dentist to see your child for regular care as soon as your child has their first tooth. This dentist will be able to establish a relationship of trust with your child from an early age and get to know them and their needs.

With my patients, I try to remember their hobbies and interests so we have something to talk about when they visit. If your child feels comfortable around his or her dentist, appointments are more enjoyable and less intimidating. If an emergency situation would ever arise, children usually feel much more comfortable being treated by their regular dentist instead of someone they are meeting for the first time.

Nutritional counseling is a major part in preventing cavities from the standpoint of a pediatric dentist. We encourage discontinuing bottle-feeding at 12 months of age.  Not putting your child to sleep with a bottle with anything other than non-flavored water is also beneficial to limiting the rate at which your child can get cavities. Also, cleaning your child’s teeth after night-time feeding is highly recommended. Children should definitely not share utensils with siblings, parents and other caregivers who have had cavities before or have active cavities. Minimizing processed carbohydrate food products helps to decrease your child’s ability to get cavities. Limiting frequent snack intake as well as sugary drinks (flavored water, juice, soda, sport drinks and flavored milk products) during the day will decrease cavity formation in your child.

Cleaning your child’s teeth twice a day with a fluoride-containing toothpaste, especially at night time, will help prevent cavities from forming in their teeth.

Parents can check with their county about water fluoridation in their neighborhood and have a conversation with their dentist to determine if further fluoride supplementation is necessary for their growing child.

What dental habits should parents teach their children?

Parents should start cleaning their child’s teeth as soon as the first tooth appears. They can use a toothbrush or washcloth, or can buy a finger brush which is a small, soft brush designed to fit on the parent’s finger. Even if your baby only has one tooth, you should still clean it. Be consistent with brushing every day.

After brushing their teeth at bedtime, they should not eat anything else and should drink nothing other than water.

As your growing child becomes more independent, parents should follow up afterwards to check if the brushing has been properly done.

What should parents know about taking their child to the dentist?

Contrary to popular belief, you should not wait until your child is 2 years old for their first dental appointment. You should schedule your child’s first dental appointment when his or her first tooth appears, or no later than 12 months of age.

Don’t wait to see a dentist until problems arise. Instead, be proactive. Make caring for your child’s teeth a regular habit, and make time to see their dentist twice a year. By getting into good dental routine, many problems can be prevented.


This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.

111 Chambers Hill Drive Opening

Starting Monday October 28, Keystone’s newest facility at 111 Chambers Hill Drive (on the corner of Norland and Fifth Avenues in Chambersburg) will be open for business!

The first floor of the building will be operational at that time. The practices on this floor are:

  • Keystone Urgent Care
  • Keystone Pediatric Therapies including Audiology and Speech (which will be renamed Keystone Pediatric Developmental Center) and
  • Keystone Infectious Diseases, HIV/STD Services, and Keystone Community Outreach (these practices will be combined into one office named Keystone Community Health Services)

In November, Keystone Administration and Keystone Pediatric Dental will move into the second floor of the building.

If you have any questions, you can contact us at 717-709-7900.

111 Chambers Hill Drive

Diabetes Health Fair!

Join us for this FREE event on November 16th, 2019!

Protect Yourself From The Flu

Join us and Keystone’s Dr. Tirupathi on October 10th for this educational presentation!

Battlefield Acupuncture

People who live with chronic pain know the impact it can have on their daily lives. Not only does it affect the quality and enjoyment of life, but it can make everyday tasks difficult or impossible. With the opioid crisis continuing to grow, many people are looking for alternative treatment methods.

Dr. Michael Gaudiose of Keystone Family Medicine has seen first-hand the improvement acupuncture, specifically Battlefield Acupuncture, has made in many people’s lives.

Dr. Gaudiose learned Battlefield Acupuncture while serving as a Family Physician at Dunham U.S. Army Clinic and received additional training at Womack Army Medical Center in Fort Bragg, NC. He answers some frequently asked questions about the subject in today’s Take Care article.

What is Battlefield Acupuncture?

Acupuncture has been around for more than 5,000 years. While researchers are still studying to find the exact way acupuncture relieves pain, we do know that all pain is processed in the brain. There is evidence that acupuncture works by suppressing pain transmission signals and by releasing endorphins into the brain to suppress the feeling of pain and disrupt the pain signals.

Battlefield Acupuncture was developed in 2001 by Dr. Richard Niemtzow while on active duty in the United States Air Force. He was looking for an effective way to be able to relieve pain on the battlefield without having to carry a lot of supplies with him. He discovered that a specific sequence of needles, when inserted into the ears, could relieve many types of pain quickly and effectively.

How does it work?

In this type of acupuncture, instead of inserting needles into the part of the body that is in pain, needles are inserted into the surface of the ear. There is scientific evidence that the regions of the ear have a connection to distant body functions, and that that pain relief can be achieved through using ear acupuncture in the correct areas.

Very small needles are inserted into five specific areas of the ear. These needles have a flat head, (similar to a very small nail head), and will stay in your ear until they fall out on their own, usually in two to five days. Pain assessments are taken before and after treatment.

How long does it take to see results?

Some people get results immediately, while others notice their results in the hours and days after treatment. Data shows that 80% of people get at least a 50% reduction in pain level.

How long do the results last?

While some patients receive long-term relief after just one treatment, many require repeat treatments. Most patients will have several days of relief after the first treatment, and after multiple treatments their relief period often becomes longer. Most people report having pain relief for a few days to a month after treatment.

Is it painful?

The needles are so small that pain is not an issue for most patients. You may feel a slight pinch or minor discomfort, but this feeling goes away quickly.

When you leave the office the needles are usually not bothersome, but can become uncomfortable during certain activities such as talking on the phone or sleeping on your side. If they are causing discomfort you can remove them with tweezers or your fingernails.

What have patients said about their experience?

Some patients say they feel better than they have in years, and some have been able to reduce the amount of opioids they take.

I witnessed one patient who walked into the office bent over because of back pain, leaving the office walking upright due to the relief of acupuncture. It is important to note that this treatment does not work for everyone. A small number of people experience no relief after treatment. But in my experience about 90% of patients get at least some results from Battlefield Acupuncture.

Who is a good candidate for Battlefield Acupuncture?

If you experience any type of chronic pain, including migraines, you may benefit from it. People who are pregnant (or might be pregnant), or have a fear of needles are not recommended to undergo this treatment. If you have a bleeding disorder you should discuss this with your provider before deciding to try Battlefield Acupuncture. People who are on active military special mission programs (such as Flight Status) may have restrictions as well.

This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.

October is Breast Cancer Awareness Month

Arthritis Of The Foot And Ankle

Dr. David Pagnanelli Jr.

Having arthritis can result in a great deal of pain and can affect the quality of life for those who have the disease. When arthritis is in the feet and ankles it can present a variety of challenges during day-to-day life, including an impact on mobility. The good news is that treatment is available.

Dr. David Pagnanelli Jr. of Keystone Foot and Ankle Center shares some information about how podiatrists can help patients with arthritis, and why seeing a doctor sooner rather than later is so important.

What is arthritis and what causes it?

Arthritis refers to a group of diseases that causes joint pain and swelling. There are more than 100 types of arthritis, but the most common form is Degenerative Arthritis, also known as Osteoarthritis. This arthritis comes into play when your cartilage, which should be smooth and slick to help your joints glide, becomes worn down.

A variety of factors affect one’s risk for developing arthritis and these factors include age, excessive weight, previous injuries and a family history.

How does arthritis affect the feet and ankles?

Everyone wants to walk, but arthritis can make walking difficult. All of your weight is transferred through the bones and joints of your ankles and feet. The excessive strain on these small joints can cause the cartilage to break down and can result in pain with every step you take. The bone on either side of the joint then starts to rub together, causing pain, swelling, stiffness and spurring.

How is arthritis in the feet and ankles treated?

Different types of arthritis are treated in various ways. Early treatment for osteoarthritis of the foot or ankle joints consists of specialized custom orthotics (shoe inserts). These hold your joints in an upright, aligned position during each step to reduce excess pressure and weight in one location on the joint surface. This helps create a more normal and functional walking pattern. We also use NSAIDS (pain relievers) and steroid injections to reduce inflammation and pain as well as bracing and taping to help stabilize the joint.

Surgical intervention is also an option for end-stage arthritis. Depending on the severity of the arthritis, we surgically treat these joints by either simply cleaning up the arthritic spurring, or completely fusing the joint. By completely fusing the joint you eliminate the micro-motion and the sliding of the bone on bone and therefore eliminate the pain. We also can place joint implants for certain joints like the toe joints and the ankle joint. These can only be placed in certain patients who qualify for them.

When is surgery recommended?

When the pain becomes constant and non-invasive treatments have not been sufficient, and/or when there is no more cartilage left in the joint and you begin to create large bone spurs as a result, surgery may be recommended.

Is it important to keep your joints moving when you have arthritis of the foot or ankle?

Although arthritic pain is caused by moving your joints, if you completely stop moving you will add to the stiffness and you will get muscle fatigue and atrophy (loss of muscle mass and strength). It is good to have an exercise program to keep your joints moving but not to the excess that it produces pain. Most patients find that aquatic exercises are the best to alleviate pain and keep joints moving.

What are some tips for living with arthritis of the foot or ankle?

Know your limits and don’t overstress your joints. Try and find a healthy balance of exercise and rest. Also, it’s important that you don’t wait to see a doctor until your pain gets so bad that it hurts with every step. If treated early, your doctor may be able to help you manage your symptoms before they become severe. If you wait until your pain becomes constant, it might be too late for non-invasive treatments and surgery could be needed.


This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.

Signs of Autism Spectrum Disorder

Kyle Ducey

While most people have heard of Autism, there is still a lot of misinformation about the subject. Not all people affected by Autism have the same characteristics, and many people on the spectrum go on to lead productive, independent lives. However, identifying traits of Autism as early as possible is very important.

Kyle Ducey, Certified Registered Nurse Practitioner at Keystone Pediatrics in Chambersburg, sheds some light on the topic in today’s article.

What is Autism Spectrum Disorder?

Autism, or Autism Spectrum Disorder (ASD), refers to a developmental disorder with a wide range of characteristics with varying degrees of severity. The characteristics that define ASD are difficulty in social interaction/social reciprocity, difficulty with communication and restrictive or repetitive patterns of behavior or thoughts. There is not just one classic textbook presentation of Autism, but rather many different subtypes that are affected by a combination of genetic factors and environmental factors.

The characteristics that define ASD run on a spectrum of severity, giving each individual their own unique presentation of strengths and challenges. The ways an individual with ASD learns, thinks, problem-solves and socializes range from highly skilled to severely impaired. Some individuals require significant support to complete their daily activities, while others may need less support and may even eventually live independently.

Autism symptoms are treatable but not curable. Autism is five times more likely to occur in males than females. A diagnosis of ASD is made every 11 minutes in the United States, and 1 in 59 children will be diagnosed with Autism Spectrum Disorder.

Autism is often accompanied and sometimes complicated by conditions such as sensory sensitivity/processing difficulties, gastrointestinal disorders, seizures, sleep disorders, anxiety, ADHD and depression.

When do signs of ASD first appear?

In the United States the most common age at diagnosis is 4 years old. However, the American Academy of Pediatrics recommends screening for Autism at ages 18 months and 2 years at well child exams, using a verified screening tool. A diagnosis of Autism can typically be made by the age of 2 if identified early enough.

One of the most important ways to identify risk factors for Autism is to have your child seen by their health care provider regularly.

Why is it important to identify Autism as early as possible?

Identifying Autism early has been shown to be one of the key predictors of positive outcomes for individuals with Autism. Research has shown that intense early applied behavior analysis (ABA) therapy has shown the best improvement in the child’s core symptoms of Autism. ABA is based on the science of learning and behavior. ABA is considered an evidence-based “best” practice treatment by the US Surgeon General and by the American Psychological Association.

What are some of the common early signs of Autism?

Given that an individual’s outcome has been linked to early diagnosis and early treatment, it is important to know what some of the early signs of Autism may be which parents and providers need to be aware of. These include but are not limited to the following:


These signs can include:

  • Delays in development of spoken language
  • Repetitive language
  • Lack of useful language
  • Inability to initiate or maintain language
  • Responding to a question by repeating the question rather than answering it
  • Difficulty communicating needs or desires

Social Interactions

These signs can include:

  • Displaying inappropriate verbal and/or non-verbal behavior
  • Difficulty developing peer relationships
  • Lack of social and emotional exchanges
  • Preferring not to be touched, held or cuddled
  • Trouble understanding feelings or talking about them
  • Not sharing interests or achievements with others (such as drawings or toys)

Behavior Patterns

These signs can include:

  • Restricted and/or repetitive patterns of behavior
  • Difficulty in motor control
  • Peculiar attachment to inanimate objects
  • Distressed by a change in routine
  • Lining up toys
  • Head banging
  • Rocking back and forth

What are some common signs of Autism in older children?

It is common for an individual with high academic functioning to receive a late diagnosis of Autism. Particularly in girls more than boys, due to girls more often being able to copy neuro-typical behaviors, including verbal and non-verbal communication which may mask their other symptoms of ASD.

Some of the signs an older child could have that may be concerning for Autism are the following:

Difficulty with social interaction and communication. These signs often include problems forming friendships, mistaking social cues or body language, misinterpreting conversations, finding it easier to form friendships online, displaying poor eye contact and expressing that they don’t fit in.

Inflexibility or rigidity of thoughts (‘black and white’ thinking).

Sensory processing difficulties. These often include experiencing sensory overload (finding the noise of school overwhelming), being unable to cope with lines or crowds, sensitivity to touch and having difficulty planning or organizing their work, bag or school day.

Emotional difficulties which often include low self-esteem, difficulty or reluctance to express or label their own emotions, levels of anxiety which seem excessive compared to the situation triggering them, low mood or depression and a desire to withdraw from the outside world.

Having any one of these symptoms by itself does not automatically indicate Autism Spectrum Disorder, but rather, as the name implies, it is a spectrum of multiple symptoms that when combined together can indicate a potential diagnosis of ASD.

What should you do if you are concerned about your child?

If parents are concerned about their child’s development, they should schedule an appointment with their primary care provider’s office to further discuss their concerns. One way that parents can be proactive with their child’s development is to bring their child in for routine physical exams and their provider can perform developmental screenings at that visit to monitor for any areas of concern. And if there is any concern, your provider can refer your child to the appropriate specialist for further evaluation and further intervention and treatment.

This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.

Keystone Foot and Ankle Center

Keystone Foot and Ankle Center is accepting new patients! Click here to learn more.

Don’t Diet – Tips for Making Healthy Eating a Lifestyle

Dr. Rebecca Patterson

In America, healthy eating is not a top priority for most people. The vast majority of Americans are carrying extra weight, and even those who are in a healthy weight range often don’t have the best eating habits. A poor diet can contribute to a variety of health conditions including high blood pressure and cholesterol, heart disease, stroke and even some cancers.

In today’s article, Dr. Rebecca Patterson of Keystone Family Medicine gives some tips for avoiding diets and making healthy eating a part of your everyday lifestyle.

What’s wrong with dieting?

I don’t recommend traditional dieting as there are no quick magic fixes. Most diets promise rapid results by eliminating food groups or having rigid rules that will not be maintainable long-term. Instead, I encourage my patients to make healthy eating part of their lifestyle, and to find a balance they will be able to sustain long-term and feel good about.

One eating plan that I do recommend is the Mediterranean style of eating. It is high in fruits, vegetables, fish, olive oil, nuts and whole grains, and recommends that dairy, red meat and added sugars be consumed only occasionally or in smaller amounts. There is good evidence that following the Mediterranean eating style increases longevity and helps keep inflammation controlled, which is an important part of overall health.  Another eating plan that shows great evidence for longevity and controlled inflammation is a whole-foods, plant-based diet. Studies show that 60% of chronic diseases could be prevented by diet changes that lower inflammation.

Are juices and diet sodas OK to drink?

Juice, even 100% juice, isn’t the healthiest option. Juice has concentrated sugar as the fiber has been removed from the fruit. Many juices have similar amounts of sugar as sodas. Eating a piece of fruit is a much better option than drinking a glass of juice. Diet sodas also aren’t healthy. While they may have no actual sugar, they are loaded with artificial sweeteners which spike insulin. The body has the same reaction to artificial sweeteners as it does to sugar, and the more of it you consume, the more the dopamine centers in your brain will crave it. There are also concerns about how artificial sweeteners affect the body long-term, and studies are currently underway.

No sweetened drinks are healthy, including sweet tea. Instead, opt for water or unsweetened tea. Most people are not drinking enough water. I do not recommend the water flavoring packets or liquids which are available at grocery stores as they contain artificial sweeteners. If you want to add flavor to your water, try a fruit or cucumber slice instead.

Is sugar or salt worse for you?

For most people, lowering their sugar intake is most important. Sugar has been linked to cancer, diabetes, hypertension and more. It is also highly addictive. In research, mice have shown higher levels of addiction to sugar than to cocaine.

Excess salt or sodium intake is not recommended, but unless you have heart conditions, high blood pressure or some other medical concerns it is generally not as big of a problem. However, you should still be mindful about how much salt you are eating. Don’t buy pre-salted foods, limit processed foods (which are often high in sodium) and add salt to meals after cooking instead of before.

What’s the microbiome?

The microbiome, in short, is the bacteria in our guts. This is an exciting area of research showing that proper nutrition may not only be about what we consume, but what our bodies absorb. Everyone’s body absorbs nutrition differently and can be affected by many different factors. In the future, the research that is currently underway may help us better craft eating plans specifically designed for individuals.

What should I keep in mind when trying to change my eating habits?

Healthy eating should focus on what options are available, instead of focusing on restrictions. It’s best to eat fewer foods that are processed and more whole foods that are recognizable without changing their forms. Processed foods do not give our bodies the nutrients we need, and nutrition is the most fundamental part of health and is used for everything our bodies do. Increase your intake of fiber and healthy fats (such as vegetables, fish and nuts), and decrease the amount of sugar, high fructose corn syrup, pre-packaged foods and simple carbs that you eat. (Examples of simple carbohydrates include bagels, donuts, white bread and white pasta). High fructose corn syrup, a type of added sugar, has been linked to the obesity epidemic and like sugar is highly addictive. Foods with preservatives also have a negative effect on many people, and can lead to gastrointestinal issues.

It’s important to keep in mind that it takes a long time to change your eating habits. If you are used to eating a highly-processed or sugar-filled diet, many fruits and vegetables may not taste very good to you at first. It takes a while for your taste buds to adjust, and adding them into your diet gradually may help the transition be easier. Don’t feel like you can never eat your favorite treats again. But keep them as that – an occasional treat – as opposed to eating them every day.

What if I don’t have the time or money to cook healthy meals?

We live in a culture of convenience, and finding the time to eat healthy can feel overwhelming. In today’s society, many people work long hours at multiple jobs, are busy with kids and often have little support. Most people feel they do not have enough time or energy left to prepare healthy meals. However, making small changes can make a big difference. Limiting junk food at home and replacing it with healthier options is a great place to start. Drink water instead of juice or soda and eat real fruit instead of fruit snacks. Instead of sugary breakfast cereals, try yogurt with granola and fruit (make sure you are buying low-sugar products – many yogurts and granolas have added sugars). Swap white pasta for whole-grain pasta. Instead of reaching for cookies, try veggies with hummus or an apple with peanut butter. When you buy fruits or vegetables, it’s helpful to cut them into bite-sized pieces that same day so they are easy to take on-the-go.

As a working mom myself, I find it helpful to plan my meals for the week ahead of time, and to set aside a specific time each week to cook. Those meals can then easily be reheated for a quick, healthy dinner. Allowing your children to be part of this process may encourage them in your new habits. Let them pick which vegetable you’ll have, or assist with simple cooking tasks.

If money is tight, it can be extra tempting to opt for a cheap drive-through meal instead of one with fresh ingredients. However, you don’t have to spend a lot of money to eat healthy foods. Watch for good deals at the store and stock up on foods that you can freeze or can. When you have a day off, cook a large amount of food in advance. Dinner leftovers make great lunches! Frozen fruits and vegetables are often more affordable for produce that is not in-season. For produce that is in-season, farmers markets offer good prices and allow you to support the local economy. Chambersburg has a great outdoor farmers market on Saturday mornings – North Square Farmers Market – which even offers kids tokens to exchange for free produce each week! There are other great markets in Chambersburg and our surrounding towns well, some of which offer weekday and evening hours.

Making the adjustment to healthier eating is crucial to your and your family’s wellbeing. Children often carry their childhood habits into adulthood and eat the same foods they ate growing up. Make time to enjoy your meals together (never in front of the TV), and focus on which healthy foods you really enjoy instead of those which you should limit. If you are looking for some support on your journey to eating healthier, check out a local program called Healthy Eating Adventure (www.healthyeatingadventure.org), a 28-day program which helps people transition to making better nutrition choices.

By gradually changing your eating habits and making a few good choices each day, you can have a healthier and happier tomorrow.


This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.