I write another blog for dentists on Dr. Bicuspid.com and was shocked to read last week that one dentist is advocating that all dentists should treat children on Medicaid.
I’m not a pediatric dentist nor have I received the specialized training required to be one, so when my patients ask me to treat their children as well, I have to tell them no.
However, the dentist that made this statement does have a point. It’s been well-documented that parents on welfare do not take their children to the dentist. It’s also well-documented that poor oral hygiene and oral health lead to other complications in children.
Children, whether they’re on Medicaid or live in $1 million dollar homes, need good dental care from the time their baby teeth begin coming in.
What this country really needs are dental clinics where low-income people can go for good basic dental care — i.e. routine check-ups, fillings, etc. These clinics could be staffed by newly minted graduates of dental schools and hygienists who earn a salary versus subsisting on Medicare reimbursements.
These clinics would help lower the abuse low-income people receive at the hands of dentists whose practices are based on seeing high numbers of Medicaid patients. They would also help lower the incidence of caries and other oral health problems in children — saving money in the long run as children would then not have to visit the doctor for complications due to poor oral health.
It’s that time of year again when dentists across the U.S. send out press releases announcing they will buy back candy from children after Halloween.
This is a noble activity but it doesn’t really help reduce cavities, especially among children whose diet consists of soda on a daily basis — soda being the real culprit of tooth decay in children.
In our office, we keep a bowl of candy corn in the waiting area during the month of October — and let me just say that we replenish it often! I wish you could have seen one patient who wanted to put a candy corn on each canine tooth (so that he looked like he had fangs) and walk down to the exam room. He cracked me up!
So please, enjoy your candy (in moderation!) and don’t forget to brush and floss your teeth — especially before going to bed.
Great blog post from Dental Blogs about a new study out from Eastman Institute for Oral Health Researchers. The researchers wanted to compare the hydrogen peroxide in teeth whitening products with the acid in orange juice.
The results were astounding. According to the press release:
Unlike never before, researchers were able to see extensive surface detail thanks to a new focus-variation vertical scanning microscope. “The acid is so strong that the tooth is literally washed away,” said Ren, whose findings were recently published in Journal of Dentistry. “The orange juice decreased enamel hardness by 84 percent.” No significant change in hardness or surface enamel was found from whitening.
The press release goes on to talk about how fruit juice and soda do a real number on your teeth. And since children are the main consumers of these products, it’s the one reason why tooth decay is on the rise in children.
Which brings me to a topic that is quickly becoming near and dear to my heart (in addition to getting tested for oral cancer!) — and that is, ensuring young children see the dentist on a regular basis.
I bring this up because my office manager has a new nephew and the pediatrician told her sister that her son didn’t need to see the dentist until he was four years old — well after teeth have come in and caries (cavities) begin to form. I was incensed!
According to the CDC, tooth decay affects children in the US more than any other infectious disease. Untreated tooth decay “causes pain and infections that lead to other problems such as eating, speaking, playing and learning.” I’ve also read that children with advanced tooth decay end up missing school.
In addition to ensuring your children use a fluoride toothpaste and instilling healthy diets that are low in juices and sodas, the CDC recommends that you bring young children in for their first dental assessment between the ages of one and two — and every six months thereafter.
The fact that a pediatrician didn’t know this simple fact is appalling — one reason why our health organizations need to do a better job at educating consumers.
My office manager’s sister did take her young son to the dentist — as you can see in these delightful photos!
Today is the last “I Love My Dentist” story. I saved this one for last because it’s written by Aidan Thomas Hornaday, age eight. According to Aidan’s mother, Aidan talked about his dentist at a media event and even handed out some of his cards — which he keeps in an harmonica case!
Writes Aidan:
“My dentist, Dr. Ashish Patel, is the happiest dentist on the earth. His office is full of happy people and I love to go there. I feel good about my teeth there. And I feel good about myself there.
“I get my teeth cleaned and then I see Dr. Patel smiling and so happy to be looking in my mouth. He is the best dentist and has cool things in his office like headsets to listen to my favorite DVDs.
“I can tell he cares about me and my family. Even with hard stuff, like my mom’s new crowns he was sweet and his machines are awesome. So if someone got a mouth full of cavities, I would say to go to Dr. Patel because he cares and he loves his patients.
“Even in the waiting room I watch amazing nature shows on his big screen. So it’s not bad going there, it’s great. They have done everything great that you can think of. It’s all there. I am his happy patient.”
Aidan, I’m glad you’ve found a wonderful dentist who knows how to give you exceptional care — and that you won’t grow up fearing the dentist. Dr. Patel should be proud that he has a patient like you.
As a dentist, I was mildly distuburbed after watching the David After Dentist YouTube video that’s making the rounds of Twitter and the blogosphere. As of this writing, the video has over 9 million views.
My friend, Dr. Lance Kisby, director of Pediatric Dentistry at Geisinger Hospital in Pennsylvania, however, was more than mildly disturbed — he was downright mad.
Here are his comments about why this video is so bad with regard to children’s dentistry — and why it gives completely inaccurate information about the role of pediactric dentists (or pedodontists, as they are known).
The 2006-2007 Pedodontic Sedation Guidelines are REALLY clear regarding sedating children. The guidelines state that before the patient is dismissed from the office he/she must be:
1. verbal
2. alert
3. awake
4. able to walk under their own power
5. given verbal tests (say the alphabet or count to 20) to determine level of recovery.
The guidelines are crystal clear on this: if the patient is none of the above (you really need all five to send the patient home), the patient must stay in office until FULLY recovered.
And, according to Sedation Guidelines, parents are not allowed to premedicate kids at home before dental appointments. Once you premedicate a child and put him or her in the back seat of a car, you run the risk of the child falling asleep, having his head fall forward and dying due to:
a)Seat belt on the neck
b)The anatomical variation in kids’airway anatomy . . . it is conical, narrow at the cricoid cartilage (adults are wide and parallel).
In addition, sedating young children is not as simple as giving a kid nitrous. When doing sedation on children using nitrous, the tragus of the ear HAS to be parallel to the sternum. If not, the airway gets blocked due to anatomy.
And, most important when it comes to sedation — kids are not adults!
Here is an equation:
Cardiac output = Heart rate X stroke volume
or
CO= HR X SV
Children, unlike adults, cannot vary their stroke volume. Thus, in the equation, stroke volume is a constant. Thus,
CO = HR
That means, blood pressure is heart rate dependant.
Decreased O2 causes bradycardia (in adults it causes tachycardia). Bradycardia (decreased heart rate) causes decreased blood pressure.
Decreased blood pressure in a child is dangerous. This is because children go FAST — as in, they die.
In the 4-day simulation course I took last year on Sedation, we found out all too well that decreased PG means decreased 02 and then it spirals out of control. Big time. In our course on the $1 million dollar dummies we worked on, and which are true to live, the “child” was dead in 30 seconds.
Adults have 02 levels that go like this: 100-99-98-96-93 . . . etc.
A child’s 02 levels go like this: 100-92-88-70. Yup, that fast.
Now, here is the kicker. Since children’s heart rates are higher, here is the rule: if a child’s HR is 80, you must start CPR immediately.
Let me put it in real life terms for you. You’re a dentist with a child in the chair. You are talking and he is talking about your good looks, your dress, the Patriots, and the weather. His heart rate is 80. He is lucid. He is talking. No problems noted. You immediately level your chair, insitute CPR with chest compressions and breathing and call 911. I am not kidding!
Here at the hospital, we have a sedation team and they sedate kids for me in the PICU rather than me worry about all this stuff. Last Thursday, a child’s O2 went: 100-99-82 . . . that fast. I had to stop and the sedation team did their thing.
I get aggrevated when dentists and parents say ‘Aw, just sedate the kid.’ I have been doing children’s dentistry forever, and I don’t sedate.
Now you know why I find this David After Dentist video highly aggraviating.
Well, I guess that sums up why dentists are truly health care professionals, why modern dentists keep up to date with technology and advanced techniques, and why really good dentists leave advanced procedures, such as sedating children, to real experts.
The reason it’s ok for kids to eat candy, as I stated in the release, is because lactic acid is produced when chewing food. This acid decreases the pH of the mouth, creating an acidic environment, which can leave the teeth vulnerable to cavities. However, studies have shown that as long as children and adults practice good oral hygiene, which includes brushing twice a day, eating candy isn’t a problem.
What is a problem is nursing a sugary soft drink or sucking on hard candy all day. Coating the teeth in sugar for extended periods of time will cause cavities, but letting your child eat candy as a special treat will not do any harm – except to their waistlines if they over-indulge.
I’m glad Halloween is approaching — even though I’m a dentist, I love to eat candy!
Every year at this time you see a number of dentists who promote that they are accepting candy from kids in exchange for a gift or toy of some sort.
Candy, which has sugar as one of its main ingredients, is supposed to cause cavities. Technically, this is not accurate — and here’s why. Lactic acid is produced when chewing food. This acid decreases the pH of the mouth, creating an acidic environment, which can leave the teeth vulnerable to cavities. However, studies have shown that as long as children and adults practice good oral hygiene, which includes brushing twice a day, eating candy isn’t a problem.
What is a problem is nursing a sugary soft drink or sucking on hard candy all day. Coating the teeth in sugar for extended periods of time will cause cavities.
So enjoy your candy. Personally, I prefer candy corn!
