Do kids need special dentists?
Sunday, February 01, 2004
Pediatric dentistry is a growing profession dealing with kids' specific needs By Laura BayardPhoto courtesy of the American Association of Orthodontics Some feel that pediatric dentists provide a more comfortable environment for children.
As a child, Leslie Winter visited the same dentist office as her parents-a sterile, drab and frightening environment. When her own daughter, Alison Haymes, now 9, went for her first tooth cleaning at age 3, Winter, a Chicago mom, chose a more child-friendly dental option.
"I went to a pediatric dentist because I felt like they understood children better," she says. "I just think the whole experience of dentistry is frightening for kids anyway. When you go to a dentist that's geared towards kids, it's not such a scary place."
Indeed, many pediatric dentist's offices are outfitted with all the comforts of the child's play room.
According to Dr. Marvin H. Berman, a pediatric dentist with Dentistry for Kids Ltd. in Chicago, "We're not going to be freaked out if a kid starts to cry. It gives the parent and the child a greater level of comfort."
Pediatric dentists have their own niche in the dentistry world, similar to the special branch of general medicine that pediatricians occupy. Two years of additional training is required of pediatric dentists. In those years they learn about children's issues, including psychology and child development.
"A child is not a small adult," says Dr. Mary J. Hayes of Pediatric Dental Health Associates Ltd. in Chicago. "I think more and more people are becoming more aware of the skills a pediatric dentist offers, and like it."
Pediatric dentistry is by no means a new phenomenon. The field has been evolving and expanding for more than 60 years. And dentists say recent years have brought a large demand for a pediatric dentist's expertise. Unlike a general dentist who may focus on adult problems, a pediatric dentist is a specialist who works solely with children and may be better equipped to diagnose a problem.
"I really trust Dr. Hayes and her experience," says Winter, whose daughter is still cavity-free. "She works with kids all day."
"The reason people go to a specialist should be just that-specialists can diagnose the problem," Berman says.
The American Academy of Pediatric Dentistry recommends children visit a dentist when their first tooth comes in or by their first birthday. Pediatric dentists usually see children until they turn 11 or 12, says Berman. However, he says some may stay on through their teenage years because they develop a certain level of attachment and comfort around the dentist.
Early visits to the dentist are best, to pick up on problems while they are still fairly simple to treat and before more invasive procedures-such as nerve treatments or fillings-are needed.
Education is key
"The most important function of a pediatric dentist is really more education," Berman says. He explains that parents must first learn the importance of baby teeth. Today, if cavities or decay become severe enough, a dentist may actually perform nerve treatments on baby teeth or put in a filling or crown.
But is so much work really necessary for temporary baby teeth?
"They're not going to fall out tomorrow morning," Berman says. "The baby teeth help guide the new teeth into position." If a tooth falls out prematurely, the other teeth can shift around, changing the spacing in the mouth. This may create major problems, such as crooked teeth or overcrowding, when the permanent teeth come through.
"We want to keep the integrity of the baby teeth because those are the patterns for permanent teeth," Hayes says. Missing baby teeth can also lead to other social problems, including late speech development. Hayes adds that many baby teeth are not as temporary as parents might think. For example, some molars may not fall out until a child is 12 to 14 years old.
According to the Chicago Dental Society, tooth decay is five times as common as asthma and seven times as common as hay fever. If decayed baby teeth are not repaired, the bacteria could also spread to the permanent teeth that have already grown in. Pediatric dentists teach parents how to avoid decay by emphasizing good hygiene techniques, proper tooth care and balanced, healthy diets.
"Twenty percent of 3-year-olds have decay," says Hayes. However, she adds because both dentists and patients have a better knowledge of dental care, "I don't see as much rampant, nasty decay."
One source of tooth decay is sugar. The Academy advises parents against allowing children to fall asleep with a bottle or letting a baby nurse for too long. If the sugars in formula, juice or breast milk sit on teeth too long, they may form an acid that mixes with bacteria to form plaque. Regular exposure to sugars can lead to decay, creating a condition known as baby bottle syndrome.
"Baby bottle syndrome is very, very common," says Berman. In fact, he says the majority of babies he treats are there for that reason. Pediatric dentists can help parents reverse the effects of baby bottle syndrome before extensive dental care is required.
Bacteria may also come from the primary caregiver, most often the mother, Hayes says. "It's critical that the mother also has good dental health," she explains. Between the ages of 6 and 24 months, teeth are most vulnerable to infection and bacteria in an adult's mouth can easily be transferred to a baby. For this reason, Hayes advises against sharing an eating utensil with a child or placing anything else in your mouth before you give it to the baby, such as a pacifier or bottle.
Still, decay can be caused by problems beyond parents' control. "The quality and type of saliva you have makes a difference, too," Hayes says. Saliva can help minimize the effects of bacteria, and those lucky enough to have better saliva, may be less likely to have tooth decay.
Dentists have found ways to prevent decay before it reaches the point of surgery. The first step is teaching the family how to brush properly. However, if teeth need more than improved brushing, a pediatric dentist may use fluoride to make a tooth stronger-a treatment known as Atraumatic Restorative Technique (A.R.T.).
Besides cavity prevention, pediatric dentists also evaluate teeth for orthodontic problems, such as cross bites or space problems. Some pediatric dentists may even perform orthodontic procedures. "That is actually part of the skill set of a pediatric dentist," Hayes says.
Orthodontic evaluations should happen as soon as possible, Hayes says. She has seen possible jaw problems as young as age 2. "There are certain kids where if you wait, you lose the opportunity to do things in an easy way," Hayes says.
Generally, orthodontics is divided into two phases. In the first phase an orthodontist may fix a cross bite, correct protruding teeth, expand the palate, or straighten the jaw in children between the ages of 5 and 7. The second phase is braces, between ages 10 and 12, when permanent teeth are in place.
Alison Haymes' mouth was too small for her tongue, a condition Hayes found when Alison was still very young, says her mother Leslie Winter. When she was 7, Alison had to wear something called an expander for a few months to open up the sides of her mouth. Winter says she believes this simple procedure prevented later difficulties.
"I think a regular dentist probably wouldn't think of that," she says. "They'd probably want to wait and put braces on."
However, others argue against doing too much too soon. Dr. Ralph Robbins, an orthodontist in Niles, says dentists and orthodontists have been debating for more than 10 years whether starting earlier actually works.
"It depends on your philosophy," Robbins says. "I don't like to do it too much unless it will decrease the severity of later problems."
Which is why it is very important for parents to get a second opinion before having a costly procedure done.
Robbins says every orthodontist will begin treatments at different ages. He says he will not put braces on baby teeth. Instead, he prefers to wait until permanent teeth are in, or at least the first molars.
All said, children's dental health rests largely on the caregivers, even more so than the dentist. Parents will be there for the brushing and for meals and can learn how to make the most of these times to best improve the quality of those young teeth.
Most pediatric dentists agree brushing is a top priority for young teeth. But that is easier said than done. Here are a few tips for parents to help kids with that tedious task.
• "Make it fun. It should not be a chore," says pediatric dentist Marvin H. Berman. However, watch out for those novelty toothbrushes. "When the novelty wears off, you're back to where you started. That's why the basic brush is still very important."
• Parents should supervise the child. Move the brush together. "Most kids don't have the fine motor skills to do this until they're 6 or 7," says pediatric dentist Mary J. Hayes. "Manipulating a toothbrush and floss is a very high motor skill activity, and it's definitely not acquired overnight. I always tell the kids it's a two-person job."
• In very young children, "brushing is more important than the flossing," Berman says. Kids do not need to start flossing until two teeth touch or are tight together. This usually occurs around age 2, according to the American Dental Assocation's Web site. At that time parents should floss their kids' teeth until they are able to do it themselves without hurting their gums.
• Use a pea-sized amount of toothpaste. And teach kids that just because it may taste good, they should not eat it. "Toothpaste is not a food, and it's not a treat," Hayes says.
Resources American Academy of Pediatric Dentistry www.aapd.org
Chicago Dental Society www.chicagodentalsociety.org
American Dental Association www.ada.org
American Academy of Pediatrics www.aap.org
Laura Bayard is a student at the Medill School of Journalism at Northwestern University and a former Chicago Parent intern who is currently studying in Paris.