Clinical Options

At Blue Whale, we offer our families options regarding the care they receive. We maintain an honest, no-nonsense approach to communication with parents. We are happy to respect your wishes, and we prefer to openly discuss whatever you need to feel comfortable.  

Cleanings and Exams

Cleanings remove bacteria and debris from teeth, and allow for the careful inspection of teeth and surrounding tissues. Cleanings are quick and physically easy for most patients.  If repeated regularly, the process can inspire confidence and trust at the dentist office. We recommend children begin having these positive learning experiences from a very young age – as early as 1-year old, or the eruption of the first teeth, whichever is sooner. 

Digital X-Rays 

We follow the ADA’s recommendations on prescribing x-rays based on the individual needs of each patient. We use digital radiography sensors, which allow the lowest radiation exposure. Our policies are designed to use x-ray technology in ways that are safe for your child.


We always weigh any health risks and benefits for any treatment we recommend, and we are respectful of individual choices regarding any treatment, including fluoride. The conversation about fluoride has polarized some communities here in Hawaii. Our opinion is that for children who are not immediately facing cavities, and who maintain a low-carbohydrate diet, fluoride provides less benefit. For children that have cavities, or maintain a high-carbohydrate diet, we consider low doses of fluoride to be safe and beneficial for total wellness. Unfortunately, many families maintain a diet with high levels of carbohydrates, and therefore may benefit from fluoride use. We will always respect your preferences.

Cavities and dental treatment

We may recommend minimally-invasive therapy to attempt to stop or reverse the cavity process for some areas of early tooth decay. This may include attentive home care, or a variety of re-mineralization approaches, silver diamine fluoride (SDF), or in-office Ozone therapy.

If cavities warrant restorations, we prefer to treat them while they are still small.  Allowing cavities to grow in size leads to the loss of more tooth structure, physical pain, and deeper infection - allows bacteria to multiply and infect other teeth with more cavities. We use white composite/resin fillings. We never use amalgam/mercury fillings. White fillings require more time and skill by a dental team, yet they allow for more preservation of natural tooth structure, and have zero risk of mercury toxicity.  White fillings are also far more visually pleasing. White fillings may be only partially covered by insurance, and a co-payment is often required.  

Large cavities may require pediatric crowns, and we offer stainless steel, and Zirconia options. Stainless steel crowns are safe and strong. They are often well-covered by insurance plans. Zirconia crowns are made of ceramic glass, and are very esthetic, yet are more expensive, and require certain clinical conditions. Zirconia is often not covered by insurance plans. Some teeth with large cavities also require treatment of the nerve in a tooth, to remove any internal infection. In baby teeth, this is a relatively fast and comfortable procedure, and should not cause additional worry for patients or parents. 

If cavities are very large, or if teeth are due to fall out very soon, the early extraction of teeth may be the best treatment option to rid the body of the infected tooth.  Sometimes it is wise to accompany the extraction of baby teeth with the placement of retainers that prevent remaining teeth from shifting. 

Nitrous Oxide, aka "Laughing Gas" 

Nitrous Oxide, known as “laughing gas” is a very safe, and very effective aid to reduce anxiety and nervousness, and allows patients to stay alert and communicative.  It has been used in pediatric settings for decades, and it can successfully assist in creating a calm, safe, and emotionally constructive dental office experience.  

Other pediatric dental offices may automatically recommend nitrous oxide for every child. This recommendation often comes at financial cost to families. At Blue Whale, rather than quickly recommending laughing gas, we view it as our professional responsibility to first coach a child toward cooperative behavior by establishing fundamental trust and communication, and to promote children learning self-control of their emotions and behaviors. We view this as in our patients' best interests, because it helps build a long-term behavioral foundation. It also saves families money. Yes, we do have laughing gas available, but we are happy that at Blue Whale we are able to actively coach most children to build confidence and self-control at our office, without simply turning to sedatives and drugs to promote good behavior. 


Lip Ties (and Tongue Ties) 

A labial frenum is a normal anatomic feature that everyone has. It’s the tissue near your two front teeth that connects your lip to your gums. Most people never have problems with it.  Some people have a labial frenum that is especially thick, or positioned exceptionally close to the teeth.  Whenthis occurs, it is referred to as a “lip tie.” Many people with a lip tie never need any treatment, because they are able to function well, in spite of the thick tissue. Other people develop problems that may be solved with surgical removal of the tie, called a “release”. 

  • For newborns and infants (before age 1): a strong lip tie may prevent a baby from latching well onto a bottle or nipple. This may create problems with feeding. For these kids, a lip release may improve latch. 

  • For young children (age 1-4 years): a strong lip tie may prevent proper toothbrushing of the front teeth, because the tight lip prevents the toothbrush from cleaning the teeth. The process of brushing can be painful for the child. Some children with strong lip ties quickly develop cavities on their four front teeth. A release may improve the ability of the child or parents to brush the front teeth well. 

  • For older children: a strong lip tie can create a wide gap between the two front teeth. This is rarely a health problem, and is mostly of aesthetic consequence. If desired, treatment of the lip tie should be coordinated together with an orthodontic plan. 


At Blue Whale, we encourage parents to consider non-surgical solutions to these problems first. If all non-surgical solutions have been examined, then release of the tissue can be considered. The surgical release of the tie is a fast procedure that is completed in-office without sedation or serious medications. We invite one parent to be present during the procedure. Bleeding is minimal, and healing takes about a week.   

Open Conversation 

Any dental procedure possesses risks, benefits, and financial costs that should be discussed and understood. We call attention to the fact that the most comfortable and conservative treatments are preventive and early interventions, so please bring your child to the dentist early, long before any obvious problems develop.



Appointment Center

808-735-BLUE (2583)

(we return missed calls promptly, so please call and leave a voice message)

Office Hours

By appointment, including: EVENINGS & WEEKENDS


Kaimuki Office
3660 Waialae Ave.
Suite 201
Honolulu, HI 96816

Waimea Office
64-5191 Kinohou St.
Waimea, HI 96743