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The sooner, the better, and with the right information

Feb. 1, 2008
This Viewpoint is in response to the recent article, “Dr. Ross’ children’s crusade,” (December DE®, Page 110).

Jeffrey N. Brownstein, DDS

This Viewpoint is in response to the recent article, “Dr. Ross’ children’s crusade,” (December DE®, Page 110). The article states that the American Academy of Pediatric Dentistry recommends initiating dental visits for children between 12 and 24 months of age to prevent the decay that can begin as soon as teeth emerge. Unfortunately, this information is incorrect. The American Academy of Pediatric Dentistry, American Dental Association, and the American Academy of Pediatrics all agree that infants should begin visiting the dentist around the time the first teeth begin to erupt (typically about six months old), and no later than six months following the eruption of the first primary tooth (usually around one year old).

Many uninformed general dentists would say, “What’s the real difference if a child is six months old, a year old, or two years old – they’re all young, right?” Despite great efforts by the AAPD during the past several years, a majority of general dentists continue to be completely unaware of important milestones associated with the development and eruption of primary and permanent teeth, the psychosocial implications of visiting the dentist prior to the development of negative dental feelings, and the positive effects of providing early dental education to parents of infants. In my pediatric dental practice near Phoenix, Ariz., parents commonly bring their children in with active decay – after being told by their general dentist that they didn’t need to begin regular visits until age two, three, four, or even six years old! I agree that the Ross article supports early visits for children, but I simply wish that this specific information was accurate, as many readers will now believe that the AAPD recommends waiting until age two to begin seeing or referring these children.

In fact, most two-year-olds have already begun to develop negative feelings about visiting the dentist and many, because of a lack of early parental education, have already begun to develop decalcifications or the onset of dental decay. It is extremely important that dental professionals, regardless of whether they treat children or not, understand that initiating educational visits at or around six months old has a long-term impact on a child’s lifetime dental experiences. These parents receive education on nursing, nighttime feeding, use of the bottle and sippy-cup, proper nutrition, fluoride use, hygiene instructions, anticipated response to trauma, dental development, and several other pertinent areas before a problem begins. A child with anterior cervical decalcifications, secondary to nighttime bottle feeding, presenting at age two for his or her initial dental visit will most likely require invasive dental care at a very early age, will probably require multiple restorative visits throughout childhood, and ultimately will develop into an adolescent and young adult who has negative feelings toward our profession. It is hoped that general dentists realize that poor management of these infants will eventually affect their practices and the practices of future dental providers once these individuals become adults who avoid visiting the dentist because of fears developed during early childhood.

Nevertheless, much like Dr. Ross, it is my true desire to help educate my dental peers on the need to better understand the long-term benefits of these very early visits. I can tell you from personal experience that spending endless amounts of time reprogramming parents who have received incorrect information from nurses, pediatricians, and general dentists becomes extremely frustrating and even overwhelming at times. It sometimes feels as if most dentists provide information to parents to avoid confrontation and to make their job easier, rather than presenting scientific facts.

I sometimes find myself arguing with a parent who was misinformed by an uninformed dentist, but the parent has taken this misinformation as the “holy word” because it provided him or her with a reason for the problem and ultimately took all responsibility off the parent. It is time that these professionals begin to take note and educate themselves and staff for the benefit of their patients and community. This starts by correcting literary pieces, such as the Ross article, that convey incorrect information no matter how minor.

I also want to touch on the fact that, though there is a great benefit to having general dentists provide education to parents and children (as dental care for children is drastically underserved in the U.S.), it is important for these professionals to understand their limitations, as they should not feel that they have to provide 100 percent of a child’s care. Referring children who require extensive restorative procedures to a skilled pediatric dental specialist will help these individuals manage more difficult patients and will help to insulate these children from many of the fears commonly associated with undergoing extensive invasive dental care.

General dentists providing care to children must not feel that they need to treat every child who enters the office. In fact, in an ideal situation, general dentists should provide dental care to all children over the age of nine or 10 and to younger children with low caries risk assessments (CRAs). Pediatric dentists should be providing care to the youngest children, the medically compromised, and those with special needs. This pattern would offer greater opportunity of care to children throughout the U.S., were currently more than 25 percent of children have never visited the dentist by age six.

In my observation, dentists without postgraduate training in pediatrics –

  • tend to be much less skilled in providing safe and effective care, especially in using oral conscious sedation
  • are not trained in the delivery of dental care in a hospital setting, especially for children with extensive health issues
  • rarely treat children at the standard of care established by the AAPD.

General dentists also are much more conservative in their treatment recommendations, sometimes watching active proximal decay in primary teeth because of personal fears stemming from providing invasive care to such young and mysterious individuals. Obviously, these patients eventually require more invasive treatment because of this negligence.

Much like learning to fabricate and prepare for a porcelain veneer, general dentists who want to be primary care providers for children should obtain additional CE training in this area. However, since all dentists receive some training on children while in dental school, most dentists feel that obtaining additional CE in pediatric dentistry is a waste of time.

Nevertheless, I am here to assure these dentists that without a solid understanding of a child’s anatomy, physiology, and psychology, they can actually be detrimental to a child’s long-term dental career. In fact, a majority of intraoperative complications and medical emergencies involving children occur in general dental offices – simply due to a lack of education. The AAPD allows these dentists to become affiliate members of the Academy, while sponsoring numerous CE courses throughout the country where general dentists can obtain training specifically focused on a child’s individual needs. This way, these providers can be assured that their efforts are paralleled with their righteous and well-meaning objectives.

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Dr. Jeffrey N. Brownstein is the senior partner at West Valley Pediatric Dentistry, providing dental care exclusively for children and individuals with special health care needs in Phoenix, Arizona. He is a past President of the Arizona Society of Pediatric Dentistry, Diplomate of the American Board of Pediatric Dentistry, Fellow of the American Academy of Pediatric Dentistry, and completed a fellowship in the College of Oral Conscious Sedation within the American Dental Society of Anesthesiology. He completed his pediatric dental residency at the University of Florida and dental school at the Medical College of Virginia. Dr. Brownstein can be reached at [email protected].

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