In a dental utopia, all children would only be seen and treated by pediatric dentists. No exceptions.
The reality, however, is that many general dentists have what it takes to see children of all ages in their practices. Also, with the lack of access to care for pediatric patients in many areas of the United States, it is imperative that general practitioners open their practices for children seeking a dental home.
So what do we as pediatric dentists want to share with our general dentist colleagues? Here’s the top 10 list.
You don’t have to wait until the child is “X” years old to schedule that first dental visit!
Don’t postpone the initial visit until the child needs to have a kindergarten school form completed. Use the guidelines set forth by the ADA and the American Academy of Pediatric Dentistry.
The first visit should coincide with the child’s first birthday or when the first tooth erupts. Many parents are already aware of this first visit guideline, so be the practice that is ready to accept the one-year-old for a first exam.
While that visit may only be a quick visual exam, it will give you the opportunity to speak to the parents and impart preventive guidelines for their child. We are all looking for practice builders and where to find new patients. This one is built-in.
When you do refer a patient to the pediatric dentist, don’t promise the parents that we can treat the child with just nitrous oxide.
When a patient is referred to us, it’s because of a number of complicating factors including age, expected cooperation, actual behavior, difficulty of treatment needs, and quadrants of dentistry.
Nitrous oxide might be an option. But often due to behavior or the negativity of multiple office visits, oral sedation or IV sedation or even general anesthesia provided in a surgical center would be indicated. Properly preparing parents decreases the confusion and disappointment that they often feel when they are told that nitrous oxide is not enough.
Before you treatment plan for a traditional dental restoration for decay on a primary tooth, how about doing something conservative?
Today, the paradigm in pediatric dentistry is minimally invasive dentistry. From the more accepted use of silver diamine fluoride and glass ionomers to the more prevalent acceptance of no-prep Hall crowns, there are so many ways to buy yourself some time with those patients with limited cooperation. Arrest decay and consider the definitive treatment when the child is a little older and more accepting of treatment.
Consider interim cosmetic treatment for your young patients.
Have you ever seen a four- or a five-year-old with visible caries of the maxillary incisors? Pediatric dentists feel that “watching” these teeth and simply waiting for exfoliation is not good enough given the climate of bullying that is ever present in schools. Why not avoid the social stigma that arises because of one’s appearance by simply removing decay and restoring with composites or glass ionomers?
The same holds true for post-ortho patients and white spot lesions. The conservative use of DMG’s ICON with resin infiltration to remove the unsightly enamel scarring could make a world of difference to a teen with self-esteem issues.
Before you refer to a pediatric dentist, try not to give the parent a definitive “number of cavities,” especially if you didn’t take diagnostic dental radiographs.
This goes hand in hand with promising that the child can be treated with only nitrous oxide. For pediatric dentists, this number game is the kiss of death. Imagine the parent’s horror when we do take the x-rays and say that there are interproximal caries with all of the molars.
Parents often doubt our diagnosis and will go back to you, the referring general dentist, who gave them a smaller number. Avoiding the number game saves parents a lot of disappointment and instills the trust in your pediatric dental referral.
When you refer, please send us diagnostic films!
One time, I actually received a set of x-rays via fax! If you are unable to get the x-rays because of behavior or a strong gag reflex, don’t stress over it. We are equipped to work with little mouths and small sensors or size 0 phosphor plates!
Don’t treat children as if they are mini-adults.
It goes without saying that maximum dosages of local anesthesia, antibiotics, and analgesics are major considerations, but a child’s attention span and ability to sit still in a dental chair also should be kept in mind. Schedule shorter visits for children and remember that they do better when they’re not sleepy or due for a nap. Typically, early morning appointments for preschool-age children are the best.
Don’t allow parents to overshadow your professional standards and judgement.
We have all been there when a parent begs you to try treatment again because Johnny promised to behave this time. Begging a non-compliant child to sit in the chair or open his mouth is disruptive to your schedule.
We live in a world where helicopter parents and even lawnmower parents are a daily reality. They ask us not to take x-rays because of their fear of radiation. They request no fluoride treatments because they think it’s poison. And they ask you if your sealants have the “bad carcinogenic plastic.”
We are dictated to on a daily basis because of the availability of information on the internet. Armed with Google searches, today’s parent is that much more difficult to please. Stand your ground and impart your knowledge and experience for the child to receive the best possible care.
Don’t underestimate that emergency call.
The call comes in and the mom says that the child fell and the baby tooth is a little loose. Does it warrant an office visit? In most cases, the tooth will firm up within a day or two, so many practices don’t even schedule a limited exam visit.
Pediatric dentists always want to rule out the worst case scenario with any type of trauma. Fractured incisors with pulpal exposure, intruded teeth, extrusion with interference when occluding—we want to be able to give a definitive diagnosis and provide treatment if needed. Schedule that limited exam and take a radiograph!
Don’t be afraid to reach out for help when you need it.
This is the number thing we as pediatric dentists want you to know. We have your back! We understand how disruptive it might be to have an uncooperative child in your dental chair when you have an implant case in one operatory and another patient awaiting 14 veneers in the next room.
Develop a working relationship with a board-certified pediatric dentist who is receptive to your calls and can collaborate with you with challenging pediatric patients. It’s a win-win for all involved!
Dr. Meliton is a Diplomate of the American Board of Pediatric Dentistry and a Fellow of the American Academy of Pediatric Dentistry. She earned her DMD at the University of Pittsburgh School of Dental Medicine and completed her pediatric dental residency at the Eastman Institute for Oral Health. She is on the active staff at Penn Medicine-Lancaster General Health, Department of Surgery, Dental Division. She also maintains a fee-for-service private practice, M2 Dentistry for Children & Teens, with two offices in Lancaster County, Pennsylvania. She is a member of Catapult Education as a product reviewer and speaker as well. She can be reached at melitondmd@aol.com.
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