General dentists don't know enough pediatrics

2008 10 21 14 53 23 614 Helaine Smith Thumb

Editor's note: Helaine Smith's column, The Mouth Physician, appears regularly on the advice and opinion page, Second Opinion.

I have to admit that until I met a pediatric dentist in my master track program for the American Academy of General Dentistry, I was not aware of the new protocols and updates in pediatric dentistry.

First and foremost, since 1991 the Academy of Pediatric Dentistry recommends that children have their first visit to the dentist at age 6 months. What an eye opener! Most pediatricians and general dentists do not know this, and some even scoff at the idea.

Yet there are valid reasons for the notion, and I agree that a child should be seen at a very early age. There is new research in the process and prevention of caries. For example, every person's oral flora is established by age 3. A diet high in sucrose before age 3 increases the chance of early childhood and lifetime caries.

Pediatric dentistry is now using the medical model: Identify who is at risk. The child who is at risk is the one who has had caries before age 3. As a result, educating the parent on nutrition and at these early visits is essential. It is estimated that an average child older than age 5 eats 3 lb of sugar a week!

I made a decision, as I was branding myself as a cosmetic dentist, not to see children and have an adult practice only. Earlier in my career I did see children, and struggled with behavior management and what to do with interproximal caries. I did not like working on children and found it very hard to control saliva, keep their mouth open, and keep them entertained.

I have to admit, I did not know what I did not know. For example, according to the chief of pediatric dentistry at Geisinger Hospital, Lance Kisby, D.M.D., 82% of all "stain" on primary molars is actually caries. Interproximal decay must be treated and not "watched."

Radiographs should be taken on 3-year-olds to properly diagnose caries. When interproximal decay is ignored, the arch length is lost, crowding of permanent teeth occurs, and proper growth and development of the face can be effected. The argument that some would make -- "Well, they will have ortho anyway" -- is ridiculous and lowers us to the status of a tooth plumber. Caries is an active disease and must be treated early. Would a physician ignore a bacterial infection?

To learn more about the updates on this topic, take a good pedo course. The Academy of Pediatric Dentistry offers a great two-day course annually in November on a specific topic in pediatric dentistry, open to any dentist.

Also, dental schools often have good courses. There are many new treatment modalities for trauma, early interceptive orthodontics, and sleep disorders. It is difficult to keep up with all the advances and be a master of all areas of dentistry. But it is a disservice to our patients if we are going to treat them and we do not know the latest protocols.

The newer materials for restorations make it easier to restore the primary teeth. Even if you are a dentist who decides not to treat children, then it is a disservice not to be able to educate a parent on what needs to be done and why.

There is a shortage of pediatric dentists, and many have a waiting list for OR cases of 18 months or more. They would welcome questions from a general dentist who wanted to provide proper care to a child. They need us and want us to be on the team.

The rule I abide by is: When I cannot provide care at the level of a specialist, I do not treat and will refer. I know in nonurban areas it is difficult to find specialists. Hence, it is even more important to keep up to date. Our dental license only allows us to practice; it is a first step. It is our duty to always be improving and learning.

Please make it a goal for 2009 to raise your level of knowledge in at least one specialty area. The rewards will far outweigh the effort, and it is our responsibility to act like mouth physicians.

The comments and observations expressed herein do not necessarily reflect the opinions of, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.

Copyright © 2008

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