Editor's note: Helaine Smith's column, The Mouth Physician, appears regularly on the DrBicuspid.com advice and opinion page, Second Opinion.
A couple of years ago I had a patient come in on an emergency basis for a crown. She saw that I had the Cerec system and needed a crown quickly because she was heading to China to bring home another child she had adopted.
She has adopted four children and has a loving spirit. The children were seeing a pedodontist in Boston, and the mother asked me if he was doing unnecessary work because he wanted to fill her daughter's deciduous teeth. I said absolutely not, and explained about the arch space when interproximal decay is not repaired and infection, etc.
Although I do not see children in my cosmetic practice, she managed to get me to agree to have her kids come into my practice. Her 7-year-old daughter was in this week for an appointment and has decay on numerous posterior teeth. The mom wanted to blame her early years in China and lack of milk.
I explained the etiology of caries and said we would keep a close eye on her daughter's teeth. But the truth is I felt inadequate and slightly upset that I had to deal with a child and decay. Let me explain.
First of all, I am very fortunate to be in a city where many pedodontists are within a 10-mile radius. I feel children should see a specialist. Why do dentists think we can be everything to everybody and handle every case? The age of family medical practitioners is long gone and it should be in dentistry too. Unfortunately, the lack of pedodontists often leaves the general dentist caring for children.
Educating parents is as important as making sure the child had a good visit and the restoration was completed properly. The American Academy of Pediatric Dentistry (AAPD) considers a child with one smooth surface area of decay severe. Yes, one surface. They also recommend that children see the dentist at 6 months of age. Do you endorse this as a general dentist, or are you uncomfortable with a 9-month-old in your chair?
In my practice, I tell the "hover mothers" not to let their children have sugar until the age of 2. When it comes to this kind of oral care advice, they do not listen, while they insist that their precious little Einstein Jr. go to school at the age of 9 months and use sign language to say please. But they do not take their child to the dentist often until they are 2 to 3 years old, despite being told a first visit should be between 6 months and 1 year of age. Pediatricians do not even know the recommendations.
I am not saying that parents or pediatricians are bad. I am just saying that general dentists have an overwhelming task to educate the parents, and often this is not accomplished properly as we have so much going on in a general practice. Also, many of us operate under an old treatment model for decay. It is not because we want money but because we feel defenseless and resigned to the fact that all we can do is fill the holes and tell the child to brush better.
Spending the time to educate parents about prevention, providing fluoride treatments, talking about home care, and implementing CAMBRA (caries management by risk assessment) and the use of xylitol takes time and energy, and often does not become part of the way we approach caries. We should be utilizing microbiology and culturing our patients' mouths, and showing them lab reports to raise the knowledge of the public. It is not just a matter of brushing better. We need to talk about caries as a bacterial disease with biofilms and pH levels.
In medicine, they have invented many vaccines, and there is still a huge need for medical care. I do not worry that if science invents a vaccine for caries, I will be out of a job.
As a general dentist, it is my obligation to treat a child at the level a specialist would. I know I fall short on this when I do have the rare occasion to treat a child.
If you are in an area where there are no pedodontists, take at least 50 hours of continuing education given by the AAPD. Find a pedodontist who you can talk to and discuss cases via the telephone. When you don't know what you don't know, it seems like a simple restoration, but with children there are many factors at play.
I encourage everyone to step up and be true mouth physicians, not just tooth plumbers.
Helaine Smith, DMD, owns and operates two dental offices -- a cosmetic dental spa and a family dental practice -- in the Boston area and is a passionate advocate for educating consumers about dentistry. A fellow of the Academy of General Dentistry, Dr. Smith writes and lectures about dentistry frequently and is actively involved in several volunteer organizations, including Operation Smile, Cape CARES, and Give Back a Smile.
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