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Two Keystone Physicians Receive Honor

Two of Keystone Health’s doctors have been honored with a statewide award! Each year The Pennsylvania Medical Society selects a panel of Top Physicians under 40, and Dr. Jagdeep Kaur of Keystone Behavioral Health and Dr. Raghavendra Tirupathi of Keystone Infectious Diseases have been selected among this year’s honorees! Winners were nominated by colleagues and ultimately selected by a statewide committee of Pennsylvania Medical Society members. They will be presented with their awards during a ceremony in October. Congratulations Dr. Kaur and Dr. Tirupathi!


Dr. Jagdeep Kaur

Dr. Jagdeep Kaur, a psychiatrist with Keystone Health, is fellowship trained in addiction psychiatry. She serves as Medical Director for medication-assisted treatment of opioid use disorder at Keystone Health. Dr. Kaur is actively involved with her community, including by participating in the Franklin County Drug Taskforce. Her colleagues note her compassionate patient care for mental health and substance use disorder.

Dr. Raghavendra Tirupathi

Dr. Raghavendra Tirupathi, a practicing doctor and Medical Director at Keystone Infectious Diseases, is a fellowship-trained infectious disease physician. He has brought infectious disease care, including HIV and hepatitis management, to the community. Dr. Tirupathi plays vital a role in quality improvement projects, such as working with local hospitals to implement the meaningful use of antibiotics through antimicrobial stewardship. He is a member of the Chambersburg Borough Board of Health.

HIV – Free Testing Event & FAQs

Dr. Raghavendra Tirupathi

National HIV Testing Day is on June 27. According to the Centers for Disease Control, more than a million people in the United States are living with HIV, and one out of five HIV-positive Americans are unaware of their infection. Dr. Raghavendra Tirupathi, medical director of Keystone Infectious Diseases and the Keystone Health HIV program, says learning about HIV and how it’s acquired is the best prevention.

What’s the difference between HIV and AIDS?

HIV, or Human Immunodeficiency Virus, damages a person’s body by destroying specific blood cells which are crucial to help the body fight disease. If left untreated, HIV can develop into AIDS (Acquired Immune Deficiency Syndrome). This stage of HIV leaves person’s immune system is severely damaged and those affected have difficulty fighting disease and certain cancers.

What are some myths about HIV?

There is a lot of misinformation about this virus. People need to know that HIV is not spread by saliva, kissing, shaking hands or sharing utensils. It is not spread through insect bites, air or water. It is completely safe to have close contact with people who are HIV-positive, as long as you are not having unprotected sex or sharing IV drug needles.

How can I protect myself from HIV?

It is important to make sure you practice safe sex. HIV is transmitted through sex with either a man or woman without the use of condoms. Never share needles as HIV can also be spread through using IV drugs or having a partner who uses IV drugs. Pregnant women can pass HIV to their baby by pregnancy or through breastfeeding, so HIV-positive women need to receive extra medical care during pregnancy. When getting tattoos or body piercing, make sure you are getting them from a licensed facility as there is a potential risk for HIV if procedures are done in an unsterile way.

Do I need to be tested?

Everyone between the ages of 13 and 64 should be tested at least once in their lifetime, even if you don’t think you are at risk. For those who have had more than one sexual partner in the last six months, have a history of sexually transmitted disease in the last year or have a history of IV drug use, you should be tested at least once every year. For those who have high risk-sexual behaviors, multiple partners, have sex in exchange for money or use injection drugs, testing is recommended every three to six months.

Where can I go to get tested?

In Franklin County, free and confidential HIV testing is provided on a walk-in basis at the following places and times. No appointment is needed; you can simply walk in during business hours:

Keystone Internal Medicine at 830 Fifth Avenue Suite 201, Chambersburg from Monday – Friday 9 am – 4:30 pm

Keystone Community Outreach 455 Lincoln Way East, Chambersburg from Monday through Friday 9 am – 4:30 pm, and on Tuesdays from 9 am – 5:30 pm

The testing is very quick—it only takes a few minutes and results are ready in less than half an hour. This non-invasive test is done by simply swabbing the gums—no blood is involved. No appointment is needed; you can simply walk in during business hours.

Free Testing Event

In honor of National HIV Testing day, a free event will be held at Chambersburg Walgreen’s (949 Lincoln Way East) on Thursday June 27 from 10 am – 7 pm. In addition to free testing, counselors will also be in attendance to answer questions about HIV awareness and prevention.

Getting tested is the only way to know your status. There is help available in our community for those who are HIV positive. The Keystone Health HIV Program provides medical and support services to HIV positive individuals. If HIV is detected early and treated, you can expect a higher quality of life and a longer life


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.

What You Should Know About Measles

If you’ve been following the news in recent months, you have likely heard reports about the growing concern over measles. Measles was declared eradicated from the US in the year 2000 due to the efforts of health agencies spanning several decades by practicing widespread vaccination. However, more recently, a decrease in vaccination rates in several communities has led to a rise in cases.

Dr. Raghavendra Tirupathi, Medical Director of Keystone Infectious Diseases, gives some insight about the disease in today’s “Take Care” article.

How is measles spread and what are the symptoms?

Measles is a highly contagious disease caused by a virus that lives in the nose and throat mucus of an infected person. It can spread to others through coughing and sneezing.

Most of the American cases since 2000 have been the result of people traveling to or from countries where measles is an endemic because there is little vaccination. When those non-immune travelers return to communities with decreased herd immunity, they tend to spread the infection to others. Because measles is so contagious, between 93 percent and 95 percent of people in a community need to be vaccinated to achieve herd immunity. 2019 has been the worst year so far with 971 cases since Jan 1, 2019.

The symptoms of measles generally appear about seven to 14 days after a person is infected. Measles typically begins with a high fever, cough, runny nose and red, watery eyes. Two or three days after symptoms begin, tiny white spots may appear inside the mouth. Infected people can spread measles to others from four days before through four days after the rash appears. Three to five days after symptoms begin, a rash breaks out. It usually begins as flat red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs and feet. Small raised bumps may also appear on top of the flat red spots.

While most patients recover from the infection, sometimes it could cause fatal complications including pneumonia, encephalitis and death.

Am I protected against measles?

You are considered protected from measles if you have written documentation (records) showing at least one of the following:

  • You received two doses of a measles-containing vaccine
  • A laboratory evidence that you had measles at some point in your life
  • A laboratory evidence that you are immune to measles
  • You were born before 1957

People who have received two doses of a measles vaccine as children, according to the U.S. vaccination schedule, are protected for life and do not need a booster dose.

What should I do if I’m unsure whether I’m immune to measles?

You should first try to find your vaccination records or documentation of measles immunity. If you do not have written documentation of measles immunity, you should get vaccinated with the measles-mumps-rubella (MMR) vaccine. There is no harm in getting another dose of MMR vaccine if you may already be immune to measles. Another option is to have a doctor test your blood to determine whether you’re immune.

How effective is the measles vaccine?

The measles vaccine is very effective with 97% efficacy at preventing measles if exposed to the virus. People are usually fully protected about two or three weeks after vaccination. When you get the measles vaccine, your immune system makes protective virus-fighting antibodies against the virus.

How safe and effective is the measles vaccine?

It is extremely safe and effective. The MMR vaccine, which was first licensed in 1963, causes no side effects in most children. Small numbers may get a mild fever, rash, soreness or swelling, according to the Centers for Disease Control and Prevention. Adults or teenagers may feel temporary soreness or stiffness at the injection site. Multiple large studies have essentially ruled out any link between the measles vaccine and autism.

If I have been exposed to someone who has measles, what do I do?

Immediately call your healthcare provider. If you are not immune to measles, the MMR vaccine or a medicine called immune globulin may help reduce your risk of developing measles. Your doctor can advise you, and monitor you for signs and symptoms of measles.


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.

Employee Spotlight – Trond Harman

The Keystone Health Employee Spotlight for June shines on Trond Harman, Licensed Clinical Social Worker at Keystone Pediatrics Chambersburg!

Trond has been employed at Keystone since October 2016 and spends his days providing therapy to children, teens, and their families.

While many people would view his occupation as difficult or stressful, Trond views it as rewarding.

“I am proud to be able to have a gift of helping others,” he said. “There are many times that I hear people say, ‘I could never do what you do.’ I have never viewed my job as a social worker in this way. I have always just done the job to the best of my ability and did everything I can to help people with being the best they can be no matter what they have been through in life.

“I was previously studying to be a teacher in undergraduate school and then had a family tragedy that deeply affected me. I realized then that I could not help these kids with problems by giving them more homework. I needed to be able to do something more.”

Trond is glad he made that decision as he enjoys watching the improvements his clients make each day.

“My favorite part of my job is when I see children and their families making progress and reaching their goals,” he said. “As a social worker, there is nothing more satisfying than watching this growth. It is good to be able to tell the kids that you are proud of how far they have come and how hard they have worked to make their own progress happen.”

Not only does he find his line of work rewarding, Trond also feels fulfilled by working at Keystone Health.

“Keystone is definitely the best place I have ever worked at and I wish I would have found them much earlier in my career,” he said. “They support you as an employee and as a person. I have worked for so many places that are quick to find ways to say you did something wrong and never look at what they may have done or not done that lead to this problem. These types of places make you feel like someone who is expendable and can be easily replaced. Keystone values you as a person and they are appreciative of what you give to the company. If there is a problem, they work through it with you and discuss how both sides can work to make things go better in the future.”

Those who work in healthcare know there is a growing need for therapists in the community, and Trond takes pride in helping as many clients as possible.

“I am normally quite busy,” he said. “Most of my days are booked with sessions. I have a few openings here and there, but on average I see about seven or eight kids per day. It keeps me busy, which I like, and I know that I am making the most of my day by seeing as many kids who need support as possible.”

Trond also keeps busy in his personal life. He lives in New Oxford, PA with his wife Angela and their children – Aaron, 16, Jack, 13, and Elsie, 7. They also have three dogs and “too many cats to count.”

“The cats, other than three of them, live outside and help to keep the mice away since we live in the country and tend to have a lot of them around,” Trond said. “We live about 10 minutes from Gettysburg and love it there because we are big Civil War buffs and we like going to the battlefield and town even if it is just to get ice cream. We love the atmosphere and nostalgia in Gettysburg.”

In addition to being a Civil War buff, Trond also enjoys the subject of true crime and enjoys listening to podcasts during his commute to and from work.

“I think it relates to me on a number of levels,” he said. “I think the first part is a desire to better understand the human psyche and why people think and behave a certain way. I also have a desire for justice and to see that everyone is treated appropriately.”

What people may be most surprised to learn about Trond is his love for running, and his daily work-out routine.

“Most people think I am crazy but it makes me feel better to run,” he said. “I am currently running 11 miles every day. I normally run inside on a treadmill, but I do get outside for races if we are out of town. The running helps me to focus in the morning. It clears my mind and prepares me for the day. On the rare occasion that I miss a day of running before coming to work, I can honestly say that I have less energy. I would also say that I did not wake up one day and decide that from here on I am going to run 11 miles every day. It has taken me years to work up to where I am at today with my running.”

Thank you, Trond, for all that you do for Keystone and our patients!


Mental Health Treatment Options

One in five adults in the United States will experience a mental health disorder in a given year. While 20% is a significant portion of the population, many people are still unaware of the variety of treatment methods that are now available for mental health conditions.

Dr. Irakli Mania, Psychiatrist and Medical Director of Keystone Behavioral Health, shares some treatment methods which many people are unaware of in today’s article.

Psychiatric Developments

Psychiatric treatment has come a long way in the past 100 years. In the early twentieth century, scientists were trying to figure out which regions of the brain were responsible for psychiatric problems. In the 1950s, antidepressants and antipsychotic drugs were accidentally discovered, allowing for treatment of what is called “chemical imbalances” in the brain. This discovery has been a very important breakthrough in the field of psychiatry allowing treatment and better quality of life for many people. However, the availability of these medications has steered the field away from the physical problems that could trigger psychiatric disorders.

In recent years there has been more interest in looking at physical abnormalities leading to different symptoms and disorders. The brain is an “electro-chemical” organ and its function can be influenced not only chemically but also with brain stimulation methods. We are able to map out circuits in the brain that are involved in various disorders and we can affect that particular circuit with brain stimulation methods.

We have now entered era of interventional psychiatry. Interventional psychiatry uses brain stimulation techniques or rapid-acting medications to treat symptoms that are not responding well to standard treatments with medication and/or therapy. There are many treatment methods that are being used by clinicians, but the ones I will discuss have been approved the U.S. Food and Drug Administration (FDA), meaning they have been approved as safe and effective.

Transcranial Magnetic Stimulation

Transcranial Magnetic Stimulation (TMS) is a non-invasive treatment for Major Depressive Disorder, Obsessive Compulsive Disorder (OCD), and migraines when medications have not been working well or are causing side effects. TMS involves placing a magnetic coil on a patient’s head while they remain awake and alert. The treatment is not painful and patients are able to resume their daily activities immediately after. There are very few side effects from TMS compared to antidepressants, and those who do experience side effects usually describe them as mild and short-term. TMS is available in Franklin County for people with Major Depressive Disorder, and we plan to soon have this treatment available in the area for those with OCD. The use of TMS has been increasing and it’s likely that it will soon be approved to treat Post-Traumatic Stress Disorder, Tobacco Use Disorder, Alcohol Use Disorder and Opioid Use Disorder. These disorders have a significant impact on our society and I believe that TMS can make a big difference.

Electroconvulsive Therapy

Electroconvulsive Therapy (ECT) has received a lot of bad attention through the media and some movies and is often referred to as “shock therapy.” Much of the stigma attached to ECT is based on early treatments in which high doses of electricity were given without anesthesia, leading to memory loss, fractured bones and other serious side effects. ECT is much safer today and it is one of the most effective treatment methods we have for severe depression including for those who have suicidal thoughts and psychosis. It is done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions. ECT may still cause some side effects.

Vagus Nerve Stimulation

Vagus Nerve Stimulation (VNS) involves the use of a device to stimulate the vagus nerve (one of the nerves that connect the brain to the body) with electrical impulses. An implantable vagus nerve stimulator is currently FDA-approved to treat epilepsy and depression. In conventional VNS, a device is surgically implanted under the skin in the chest, and a wire connects the device to the left vagus nerve. When activated, the device sends electrical signals along the nerve to the brainstem, which then sends signals to certain areas in the brain involved in depression. Dosage of stimulation can be adjusted depending on a patient’s need. New, noninvasive vagus nerve stimulation devices, which don’t require surgical implantation, have been approved in Europe to treat epilepsy, depression and pain. A noninvasive device that stimulates the vagus nerve was recently approved by the FDA for the treatment of cluster headaches in the United States.

Neurosurgical Interventions

Surgical procedures have been done over the years in severe and debilitating cases. Today, a new era of neurosurgical intervention for psychiatric illness is emerging. These procedures are much more focused and much less invasive and destructive. Deep brain stimulation is an established and FDA-approved treatment for people with movement disorders such as refractory epilepsy, essential tremor, Parkinson’s disease, and dystonia, and also for psychiatric conditions such as Obsessive Compulsive Disorder. Although deep brain stimulation is minimally invasive and considered safe, any type of surgery has the risk of complications. Also, the brain stimulation itself can cause side effects. Deep brain stimulation involves creating small holes in the skull to implant the electrodes, and surgery to implant the device that contains the batteries under the skin in the chest.

External Trigeminal Nerve Stimulation

The most recent FDA approval has been External Trigeminal Nerve Stimulation (eTNS) for children ages 7-12 who have Attention Deficit/Hyperactivity Disorder (ADHD). This is the first non-drug treatment option for ADHD. This treatment is intended to be used in the home under the supervision of a caregiver. The cell-phone sized device generates a low-level electrical pulse and connects via a wire to a small patch that adheres to a patient’s forehead, just above the eyebrows, and should feel like a tingling sensation on the skin. The system delivers low-level electrical stimulation to the branches of the trigeminal nerve, which sends signals to the parts of the brain thought to be involved in ADHD. While the exact mechanism of eTNS is not yet known, neuroimaging studies have shown that eTNS increases activity in the brain regions that are known to be important in regulating attention, emotion and behavior. One should consult with a behavioral health provider in order for this to be recommended.

New Medications

Another area of development is new medications. This is important because Treatment Resistant Depression is common and available medications, in addition to being ineffective at times, may take a long time to work or find the correct dosage. One medication which has been given fast-track FDA approval is Esketamine (Spravato). This is used as a nasal spray and can be effective within hours of administration. Unfortunately, it still has significant side effects and administration can only happen in a licensed facility under observation.

With all the above developments we have to increase awareness of these treatment methods in our society. I see the need for a center for interventional psychiatry across the country including in our community. For more information about any of the treatments mentioned above, consult a behavioral health specialist.

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.

For more information about Keystone Health’s TMS Program, click here.

Chambers Hill Construction Progress

You may have noticed ongoing construction over the past year for Keystone Health’s newest facility. Construction will be completed this summer, and we expect to occupy the building in early fall.

The 68,000 square foot building will be located at Chambers Hill, on the corner of Norland and Fifth avenues in Chambersburg. Several of our current practices will relocate to the new site to allow for expansion so we can better serve the community.

The sites planned for relocation are:

  • Keystone Urgent Care
  • Keystone Pediatric Dentistry
  • Pediatric Therapies including Audiology and Speech
  • Keystone Infectious Diseases and HIV/STD Services
  • Keystone Community Outreach
  • Keystone Administration and Billing

Keep an eye out in the coming months to see the completed project, and for information about a community open house!

Keystone Health’s newest facility, a 68,000 square foot building, expected to be completed in September.

Better Speech & Hearing for Kids

Communication is much more than only spoken words and sentences. From early infancy, parents and caregivers can begin to encourage and promote their child’s overall communication and speech-language skills.

Laurie Kaufman, Speech Language Pathologist at Keystone Audiology and Speech, gives some important tips that all parents and caregivers should know about making sure children are on track with proper communication development.

When do speech and language skills start developing?

Beginning at birth, infants communicate with their cries, smiles, laughter, facial expressions and body language. Before children begin to use words, one-on-one interactions with the important people in their lives significantly influence their language learning. They imitate the speech models provided by their caregivers including gestures (waving, giving kisses), sounds (mama, moo) that evolve into words, and strings of words that evolve into meaningful language. Children who are provided with strong language stimulation develop strong communication and language skills. Research has shown that during the first years of life, children who are talked to, read to and played with have better language skills than their under-stimulated peers. Children with strong language skills are also more likely to enter school ready to learn, are less likely to have difficulties learning to read and are more likely to have academic success.

How can I help my child develop these skills?

From birth, parents and caregivers can encourage the development of a child’s communication and language skills. Caregivers can begin by simply responding to babies’ vocalizations – their cries, coos and babbling. Gaining a baby’s attention by responding to them with eye contact, facial expressions, sound play and commenting encourages turn-taking and promotes positive communication interactions. Even when children are too young to respond with words, it is important for caregivers to provide language stimulation by talking to and engaging their child in “conversation.” Parents and caregivers should consider themselves to be the “narrators” of their child’s life, providing ongoing models of spoken language through labeling, commenting on and describing objects, daily routines and play-based interactions. Children are more likely to imitate first sounds and words when they are used repeatedly within routine activities and play. During play routines, caregivers can pair actions with sounds or words which promotes imitation of both the action and the spoken sound or word, such as saying “Pop” as you pop bubbles or saying “Beep beep” as two toy cars collide. Additionally, singing favorite songs, repeating nursery rhymes and performing finger plays also encourage imitation and language development. Reading books with repetitive text patterns or reading the same books over and over also encourages imitation. Additionally, limiting screen time in favor of personal interactions and play-based opportunities greatly enhances a child’s chances for social and language development.

What are the milestones for speech development?

If you are concerned about your child’s speech, language or hearing, it’s important to know what is considered developmentally appropriate. Every child develops skills at his or her own pace; however, most children acquire certain communication skills within an expected age range. A child who has not yet demonstrated an expected communication milestone, within the expected age range, may have a problem. It is important for caregivers to be aware of communication milestones in order to recognize signs of a delay or disorder, and consult the child’s healthcare provider with any concerns. Below is a list of basic communication milestones within the expected age ranges.

From birth to 3 months, infants should smile, coo and show interest in others. From 4-7 months, babies should babble and engage in sound play. Babies 7-12 months should make a variety of sounds and sound combinations, including early words (mama, dada, etc.), use gestures like waving or pointing, and follow routine commands.

From 12-18 months, they should use 5-10 words, combine words and gestures, imitate the speech of others, point to objects/people in pictures, consistently follow simple directions, and understand and respond to yes/no questions. Toddlers from 1 ½ – 2 years should use approximately 50 words and combine them into two-word phrases, follow two-step directions (pick up your cup and bring it to me), and enjoy listening to stories.

By three years old, children should be able to consistently use three or four word phrases with longer sentences noted, use early grammatical markers such as plurals and present progressives (dogs, walking) and have most of their speech understood by a caregiver. They should enjoy playing and talking with other children, ask and answer questions, follow two-step unrelated directions (give me the ball and go get your coat), and have emerging understanding of concepts including color, space and time.

Can having chronic ear infections impact my child’s speech?

Yes. During ear infections, children can have mild or even moderate hearing loss which makes hearing speech difficult. Speech will sound muffled or indistinct. As your child learns new words he or she may not know how they are actually pronounced. With continued ear infections, your child may not hear all the words in a sentence or not hear the ends of words and therefore not use those sounds or words.

What can I do to protect my child’s hearing?

There are several ways that you can protect your child’s hearing. The most obvious is to use hearing protection when exposed to excessive noise at sporting events, concerts, races and around power tools or mowers. Children that use earphones or headphones should use volume limiting versions until they are able to learn to moderate the volume to safe levels. In addition, maintaining overall ear health can prevent hearing loss. Some tips are: consult a physician if ear infections are suspected, eat a healthy diet that includes lots of vegetables and fruits but limits empty calories, avoid second hand smoke and get exercise to build a strong circulatory system.


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.


Employee Spotlight – Geetha Potineni

The Keystone Health Employee Spotlight for May shines on Geetha Potineni, Network Security Administrator in our Information Systems Department!

Geetha started working at Keystone in January 2016 after completing her master’s degree in Computer Science.

“I was in search of a job in the area when an opportunity became available at Keystone,” she said. “My husband was already working for Keystone and I had heard many great things about the organization, so I was naturally excited to become a part of it.”

Geetha’s daily job responsibilities include checking on the servers and making sure they are backed up, monitoring computer systems and servers for potential threats and preventing them from happening, responding to threats when they do happen as part of the IT team, and maintaining logs for compliance. She can also be found helping staff through the Keydesk when they encounter issues with their computers, logins, websites, emails, pagers, etc. and also provides IT security awareness training to new employees and providers.

“I enjoy every aspect of my job,” Geetha said. “As a Network Security Administrator, I am responsible for continuous monitoring of some of the IT systems and servers and it gives me a sense of pride when I find something critical early and can address it in time so patient care is not interrupted.”

She’s also glad to take part in Keystone’s overall goal.

“I’m proud to be part of Keystone Health, which is driven by the mission of providing access to healthcare for everyone, irrespective of one’s ability to pay for the services.”

In her free time, Geetha keeps busy with her family life.

“I live in Greencastle with my husband, Venkat, who is a Pediatrician at Keystone, and our two daughters, Sindhu and Shriya. My daughters keep me busy, but I love to cook and travel, and I run whenever feasible.”

While she and her husband are not Franklin County natives, they are glad they chose this area to raise their family.

“Franklin County is really beautiful, especially during spring,” she said. “Also, neither I nor my husband likes a long commute to work, so we both enjoy shorter commutes and the area’s relatively slow-paced lifestyle. Its proximity to Washington D.C is also another thing that we love.”

Thank you, Geetha, for all that you do for Keystone and our patients!


Free Mental Wellness Event

We hope you will join us on May 28 for an informative discussion on mental wellness and self-care by Dr. Jagdeep Kaur! Light refreshments will also be provided. Don’t forget to RSVP as space is limited.


Caring For Your Child’s Teeth

While most parents are diligent about taking their children to the doctor for routine medical visits, many people don’t treat their children’s teeth with the same importance. Developing a proper oral hygiene routine, including regular visits to the dentist, is one of the most important habits parents can pass on to their children to help them have healthy teeth for life.

Dr. John Palm of Keystone Dental Care shares some information about how to properly care for babies’ and children’s teeth and how to prepare for their first dental office visit.

How and when should parents begin caring for their baby’s teeth?

Begin cleaning your baby’s mouth during the first few days after birth by wiping the gums with a clean, moist gauze pad, teeth wipes or washcloth. Gently wipe his or her gums after each feeding.

For children younger than 3 years, start brushing their teeth as soon as they begin to come into the mouth by using fluoride toothpaste in an amount no more than the size of a grain of rice. Brush teeth thoroughly twice per day with a small, soft-bristled toothbrush or finger brush. Supervise children’s brushing to ensure that they use the appropriate amount of toothpaste and remind them not to swallow the toothpaste. When your child has two adjacent teeth that touch side-by-side, you should begin cleaning between his or her teeth daily with flossers.

Introduce a pea-sized amount of fluoridated toothpaste for children 3 to 6 years of age. Do not do this until the child is old enough to spit out the toothpaste after brushing. Use only the recommended amount of toothpaste and tell your child to spit out—not swallow—the toothpaste.

Until you’re comfortable that your child can brush on his or her own, continue to brush your child’s teeth twice a day with a child-size toothbrush and a pea-sized amount of fluoride toothpaste. Allow the child to watch you brush, and follow the same brushing pattern to minimize missed spots. Typically around age 8, most children are able to brush on their own with minimal supervision.

Prevent baby bottle tooth decay: Don’t give children a bottle of milk, juice or sweetened liquid at bedtime or naptime. Don’t allow children to walk around with a sippy cup filled with sugary beverages all day long. Encourage water between meals, and limit milk and other drinks that may contain sugar to mealtime.

Avoid foods and treats that increase tooth decay: hard or sticky candies, gummy fruit snacks, multi-vitamins that are high in sugar and sweetened drinks and juice. Offer fruit rather than juice; the fiber in fruit tends to scrape the teeth clean, whereas juice just exposes the teeth to sugar.

When should the first dental appointment be scheduled?

The American Dental Association, American Academy of Pediatric Dentistry, and American Academy of Pediatrics all recommend that the first dental visit should occur within six months after the baby’s first tooth appears, but no later than the child’s first birthday. Baby teeth are vulnerable to tooth decay from their very first appearance, on average between six months and one year of age. Being proactive about your child’s dental health today can help keep his or her smile healthy for life. It is important to have his or her teeth screened by a dental professional at medical well-child visits. This service is offered at both Keystone Dental and Keystone Pediatrics Chambersburg.

What will be done at the first dental appointment?

Most initial office visits are to help acquaint the child with the dental professional. The first visit usually lasts 30-45 minutes. During the visit, you will be seated in the dental chair with your child on your lap if your child isn’t able to — or doesn’t want to — sit in the chair alone. The dentist will check the teeth, jaws, bite, gums and oral tissues to monitor growth and development. Once the exam is over, the dental professional will gently clean the teeth, which includes polishing teeth and removing any plaque, tartar and stains. The dentist will give you tips for good oral hygiene practices for your child’s teeth and gums. At this time, the dentist can provide or recommend information on baby bottle tooth decay, infant feeding practices, teething, pacifier habits, and finger-sucking habits.

If you have dental anxieties, be careful not to relate those fears or dislikes to the child. If your child cries a little or wiggles during the exam, don’t worry. It’s normal, and your dental team understands this is a new experience for your child.

How can parents prepare their child for their first dental visit?

Start early! To get your child ready for the visit, talk to him or her about what’s going to happen and be positive. Have your child practice opening his or her mouth to get them ready for when the dentist counts and checks their teeth. Reading books or watching videos about first dental visits may help your child be less fearful and more confident. Explain why it is important to go to the dentist. Build excitement and understanding.

Moms and dads can prepare, too. When making the appointment, it can’t hurt to ask for any necessary patient forms ahead of time. It may be quicker and easier for you to fill them out at home instead of at the office on the day of your visit.

Make a list of questions as well. If your child is teething, sucking his or her thumb or using a pacifier too much, your dentist can offer some advice.

Tips for a great visit

Be sure to schedule all dentist appointments for times when your child will be comfortable and in a good mood. Don’t schedule an appointment during naptime. Instead, pick a time your child is usually well-rested and cooperative. Make sure your child has had a light meal and brushes their teeth before their appointment so they won’t be hungry during their visit.

Think of the appointment as a happy and fun experience. If your child becomes upset during the visit, work with your dentist to calm your child. You’re on the same team!


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.