Pediatric Dentistry

[dreamsicle]

Hi all,
Sorry if this is a stupid question lol, but can a general dentist limit his/her patient base to only children, or is a pediatric dentistry specialization required to do this? Can a general dentist safely and effectively carry out dental procedures on a child?
Thanks.

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[dexadental]

I'm pretty sure a dentist can treat whoever he/she wants. They can make their practice exclusively geriatric serving as far as I know. I know pediatric dentists are better trained and educated to deal with treating children, and I assume patients get referred over to them...
Also I think a good number of pediatric dentists work in hospitals.

 

[Demeter]

There are some dentists who are limiting their practice to treating children without completing a residency program. Without the additional knowledge and training in sedation, interceptive ortho, behavior management, space maintenance etc... you are limiting your abilities in treating children. Although, I believe that the papoose board still has a place in comtemporary pediatric dental treatmen it can have traumatic effects and ought to be implemeted judiciously.
I believe that if you are going to limit your practice to children you should complete a pediatric residency; just like if a general dentist is going to limit his practice to ortho he really should be an orthodontist.

 

[Dr. Pedo]

(see below---double post---sorry)

 

[Dr. Pedo]

A general dentist can limit his/her practice to any specialty of dentistry. The difficult problem is they are held to the same standards of the specialist and the specialty board-----on top of that they can not charge specialty fee and in pediatrics that is tough since the fees for procedures are typically low.

The complexity of disease and orthodontic intervention (growth and development) knowledge of children in need can be difficult to learn on-the-job in the early years as a general dentist. Pediatrics would be a very difficult area to limit your practice unless you are mentored or partnered with someone in the specialty. A two-year residency is not that long and is necessary to prepare you for the difficult behavior management/treatment cases you'll be seeing. The exposure in dental school is not able to prepare you adequately for a life in pediatric dentistry. Check-out a residency for a day and see the cases that pedo docs deal with.

Can one survive: definitely. Would it be difficult and stressful to take on kids with the knowledge learned in dental school (being nearly zero): absolutely. A typical pediatric dentist seeing ~35-50 patients a day. The hand-speed skills necessary for operative procedures on a two-year old is something that needs to be developed typically in a residency. The knowledge a parent requires of a "specialist" is 2-fold and the likelihood of a case going wrong in your practice is high------where will you send the kids you don't know what to do with or can't handle? what will you have to stand-on in court against the specialty board expert witness? What will be the image of you in the eyes of the generalists: will they refer you "their" kids knowing your not a specialist or will they call the specialist? Will the specialist invite you to their inner circle? What academy meetings will you attend and only having~ 3000 pedo docs its pretty small group. Parents and society are way too lawsuit happy not to be the best trained you can be when dealing with society's kids.

Whatever one decides is up to them but make a educated decision; if you like kids treat them in your general practice. Heck, do 50% kids. But have adults as well and leave the option to refer the complex and difficult cases to the specialist. You'll enjoy life more, the parents will respect you more, and you'll have a booming family dental practice. 👍 Nothing would be worse than having a case go bad-----your name gets smeared---you have no special education to stand-on--and the generalist don't support you and the specialist want to make an example out of you. 😱

To the other poster: there are few pedo/to none in hosptials other than the select residency programs.

Feel free to PM me anytime to ask questions.

 

[dentalman]

Wow, great answer.

 

[ek_dds]

Dear Dr Pedo,

Hi,

I am a Foreign student interested in Pediatric dentistry.
I have tried for nearly 2 years to get into DDS/Ped residency but didnt quite make it.

I understood that I need to gain a better resume,even to think of applying to pedo residency.I gained admission into an MS biomaterials program.And I intend to try pedo residency after completion of this program.

My question to you is-How far do you think an MS would help in pedo admission.And have u seen any international students being accepted into pedo residency.

Any input is greatly appreciated.

Thanks

Eswar

 

[GuidoPedo]

Dear Dr. Pedo,

I think my wife of 14 years is having an affair. She comes home smelling like cheap cologne and is always too tired for sex.

Have you ever heard of this? What can I do to get my woman back?

Thanks,

"Worried Willy"

 

[Narcissist]

Dear Dr. Pedo,

I think my wife of 14 years is having an affair. She comes home smelling like cheap cologne and is always too tired for sex.

Have you ever heard of this? What can I do to get my woman back?

Thanks,

"Worried Willy"

....................thats freaking hilarious.

 

[Dr. Pedo]

Dear Dr. Pedo,

I think my wife of 14 years is having an affair. She comes home smelling like cheap cologne and is always too tired for sex.

Have you ever heard of this? What can I do to get my woman back?

Thanks,

"Worried Willy"

Silly Willy,

Just bring it up over dinner--- though don't make your sister defensive, just ask her why she would do that to you?

 

[ItsGavinC]

Keep it on the original topic, please. 🙂

 

[drhobie7]

I was talking with someone recently about general dentists dedicating most of their practice to 'specialty' cases. It seems to me pedo would the the easiest specialty with which to do this. Perhaps this just shows my lack of knowledge about the scope of practice of pedodontics. However, there are many pediatric dentists that do zero IV sedation and even some who do not use N2O. Regarding ortho, you could take some CE courses or just know when to refer to an orthodontist. The dentistry is fairly simple. It seems to me behavior management is the most critical skill.

 

[ItsGavinC]

It seems to me behavior management is the most critical skill.

I'd agree with that.

 

[Dr. Pedo]

Perhaps this just shows my lack of knowledge about the scope of practice of pedodontics.

When broken-down---nearly all of dentistry is fairly simple especially on adults; can't imagine having a patient sit still, open their mouth for 45 mins and be able to tell you what's wrong in their mouths. Man, I miss that

 

[DDSwithAplan]

Hi all,
Sorry if this is a stupid question lol, but can a general dentist limit his/her patient base to only children, or is a pediatric dentistry specialization required to do this? Can a general dentist safely and effectively carry out dental procedures on a child?
Thanks.

GP's by design are meant to 90 % of their time in all areas of dentistry and if they acquire skills or interest in a particular specialty, increase their patient load in that discipline with the other 10, this is not a hard and fast rule or law until you get to specialties, specialists must spend 90 % of their time doing their specialties for accreditation purposes, I have met many GP's who decide to devote all thier time to one specialty or another, usually endo, oral surgery or implants but just can not say they are a specialist in that field, limiting your GP practice to childrens probably can be done but I have never seen it 🙄

 

[drhobie7]

GP's by design are meant to 90 % of their time in all areas of dentistry and if they acquire skills or interest in a particular specialty, increase their patient load in that discipline with the other 10, this is not a hard and fast rule or law until you get to specialties, specialists must spend 90 % of their time doing their specialties for accreditation purposes, I have met many GP's who decide to devote all thier time to one specialty or another, usually endo, oral surgery or implants but just can not say they are a specialist in that field, limiting your GP practice to childrens probably can be done but I have never seen it 🙄

No matter how much a GP wants to do specialty work I can't imagine one routinely doing connective tissue grafts, orthognathic surgery, calcified canal RCT and apicoectomies, or making his/her practice exclusively ortho. I can however imagine them doing SSC, strip crowns, pulpotomies, sealants, prophies, amalgams, composites, LLHA, and simple ortho. This is probably because pedo is the only specialty, aside from pros, where you're actually doing restorative dentistry. This was the basis for my claim that pedo would be the easiest specialty for a GP to adopt. But like I said earlier, maybe day to day pedo has a lot more to it than I'm aware of.

 

[drdavedave2000]

I know of a couple of general dentists who see kids exclusively in Utah. One owns his own practice and the others work for a pedodontist who has three offices. The general dentists work out of his office and see his patients. As far as being a GP you do anything out of the relm of day to day operative or pros (i.e. RCT, exts of WST, braces) IF YOU ARE TO BE SUED YOU WILL BE HELD TO THE STANDARD OF A SPECIALIST. So as the extra training it certainly would be helpful however not necessary especially for a GP acting as a pedodontist. So be careful out there just use your best judgement. Here in Utah we can do oral sedation as long as you take a class to train you. Even on children we are allowed to do oral sedation with nitrous.

 

[NileBDS]

I was talking with someone recently about general dentists dedicating most of their practice to 'specialty' cases. It seems to me pedo would the the easiest specialty with which to do this. Perhaps this just shows my lack of knowledge about the scope of practice of pedodontics. However, there are many pediatric dentists that do zero IV sedation and even some who do not use N2O. Regarding ortho, you could take some CE courses or just know when to refer to an orthodontist. The dentistry is fairly simple. It seems to me behavior management is the most critical skill.

Once you have your (pedo) patient under nitrous/medicated sedation (oral sedation) you're already past behavior management. In addition, you have mouth props, papoose and the “no McDonalds for you today!” grin on moms face to your aide.
I have to disagree that the behavior management aspect is more difficult than the one involving dental treatment. I am not implying that the behaviour management part is easy either.
Other than having high pulp horns almost like live land mines, I think it’s fair to say that pedo teeth and cases are often more complex than adult ones. Not to mention space management and ortho intervention.
Every specialty has it's tweak. If you think any of the specialty branches are "easy", then you probably missed something in dental school.
They require further training/education for good reasons.
But that's just me ...

 

[ItsGavinC]

Once you have your (pedo) patient under nitrous/medicated sedation (oral sedation) you're already past behavior management.

That's ridiculous in my opinion. What happens when you need 45 minutes to complete a day's treatment and the oral sedation doesn't work? You can only give so much ketamine...

You make it sound as though you flip a switch and the kids behave. Medicating for sedation is fine and dandy, but there are steps leading up to that that must be addressed. That's as much a part of behavior management as is the management during the procedures.

 

[NileBDS]

That's ridiculous in my opinion. What happens when you need 45 minutes to complete a day's treatment and the oral sedation doesn't work? You can only give so much ketamine...

Your opinion is your opinion. And I respect it. However, what exactly do you mean by a sedation not working ?
If you are talking about something you read in a book, than I really can not do anything about it until you get more first hand experience.
If an oral sedation does not work, then you may refer the patient for GA. Simple as that ... what's the behavioral management involved in that.

You make it sound as though you flip a switch and the kids behave. Medicating for sedation is fine and dandy, but there are steps leading up to that that must be addressed. That's as much a part of behavior management as is the management during the procedures.

If you know what you are doing, yes, it is as simple as that (for us).

I'm just curious, what is your clinical background on this subject ? I personally had the privilege of full-time assisting a board certified pediatric specialist over the course of the past 2 years, in which I have been in and out of an excess of 10 oral sedations per month. At least 4 times that number in nitrous sedations.

I know exactly what I am talking about, whether you've learned about it yet or not.

On a different note, your referral to "ketamines" for oral sedation only points out your inexperience in regards to this whole matter (broad & vague). If I were you, I would listen up to what other more experienced people have to say.

Let me let you in on a small pedo secret;
In most cases;
Assistants do most of the behavior management with kids (except maybe for hand over mouth "technique"), not the doctors.
Assistants place the patients on nitrous, not the doctors.
Assistants administer the oral sedation "cocktail" one hour prior to the treatment, not the doctor.
Assistants deal with nitrous-gone-wrong, being mostly unexpected fresh vomit, not the doctors.
In short, by the time you walk in the operatory, the sedation switch is set to "on", and all the steps you are talking about have been executed already.
Your job is mainly of monitoring the patient while under the nitrous/sedation, calculating and dispensing the drug dosage (per lb-kg) and finally dealing with complications if any, as much as you would like to think otherwise.

 

[ItsGavinC]

Your opinion is your opinion.

Good, then we can all recognize that everything you've written is also your opinion. And, technically, it's the opinion of the doctor that you've been ASSISTING.

My opinion is based on the peds patients that I myself have treated under nitrous, oral sedations, IV sedation, and in the OR under general anesthesias.

I know exactly what I am talking about, whether you've learned about it yet or not.

Once again, I'll point out your methods are you own opinions. I happen to be of the opinion that there is much more to proper behavior management than you are willing to admit. Your mention of the hand over mouth technique futher down your post goes quite a ways to show your understanding of behavior management. We'll agree to disagree.

On a different note, your referral to "ketamines" for oral sedation only points out your inexperience in regards to this whole matter (broad & vague).

Ketamine and Versed is a great combo for oral sedations. No need to wait "the hour" that you mention below. Most docs will have some drugs they favor and then roll with those. Like many things in dentistry, we don't rely on evidence but rather on experience. What works is great and we continue to use it.

Assistants do most of the behavior management with kids (except maybe for hand over mouth "technique"), not the doctors.
Assistants place the patients on nitrous, not the doctors.
Assistants administer the oral sedation "cocktail" one hour prior to the treatment, not the doctor.
Assistants deal with nitrous-gone-wrong, being mostly unexpected fresh vomit, not the doctors.
In short, by the time you walk in the operatory, the sedation switch is set to "on", and all the steps you are talking about have been executed already.
Your job is mainly of monitoring the patient while under the nitrous/sedation, calculating and dispensing the drug dosage (per lb-kg) and finally dealing with complications if any, as much as you would like to think otherwise.

Once again, we disagree. Some docs practice like that, and some don't. It doesn't make it right or wrong. It seems your goal is to complete the work whereas my goal would be to complete the work and create a positive dental memory for the child.

 

[NileBDS]

And, technically, it's the opinion of the doctor that you've been ASSISTING.

Until I got into dental school. Beats the hell out of flipping burgers at some fast food joint. Wouldn't you say ?

My opinion is based on the peds patients that I myself have treated under nitrous, oral sedations, IV sedation, and in the OR under general anesthesias.

Dude, you're still in school ! (rolls eyes)

....Your mention of the hand over mouth technique futher down your post goes quite a ways to show your understanding of behavior management. We'll agree to disagree.

Look it up in a book rookmeister. Under behavior management.
I did not say that I invented it, nor did I sate my opinion on implementing it. Furthermore, if you go back and read that line, you will find that I put technique in quotation marks.

It seems your goal is to complete the work whereas my goal would be to complete the work and create a positive dental memory for the child.

Gosh darn it, you got me again.

We'll agree to disagree.

I don't see this discussion arriving to any constructive conclusion soon.
Let's just leave it at that until you hopefully engage in productive specialized practice someday and maybe then have some real patient responsibilities and/or hands-on experience to fall back upon.

 

[toofache32]

Let me let you in on a small pedo secret;
In most cases;
Assistants do most of the behavior management with kids (except maybe for hand over mouth "technique"), not the doctors.
Assistants place the patients on nitrous, not the doctors.
Assistants administer the oral sedation "cocktail" one hour prior to the treatment, not the doctor.
Assistants deal with nitrous-gone-wrong, being mostly unexpected fresh vomit, not the doctors.
In short, by the time you walk in the operatory, the sedation switch is set to "on", and all the steps you are talking about have been executed already...

I'm not sure why you're proud of these things. You don't even have to be a high-school graduate to do these things. You can train a monkey to follow directions and push a syringe.

Your job is mainly of monitoring the patient while under the nitrous/sedation, calculating and dispensing the drug dosage (per lb-kg) and finally dealing with complications if any, as much as you would like to think otherwise.

Exactly. This is what being a doctor is about....making decisions. I'm still confused that you think it's a bigger deal to push the drugs in the vein when you don't even have to know what the drug is for.

 

[ItsGavinC]

Dude, you're still in school ! (rolls eyes)


... and maybe then have some real patient responsibilities and/or hands-on experience to fall back upon.

Do you guys not treat patients at UOP? I've got plenty of patients that I'm responsible for.

 

[ItsGavinC]

Let's just leave it at that until you hopefully engage in productive specialized practice someday and maybe then have some real patient responsibilities and/or hands-on experience to fall back upon.

It's funny that you remind me that I'm in school. Especially since I'll graduate from an ADA-accredited program one year before you do. You do graduate in 2008, right?

Like we've said, we'll agree to disagree. Nothing wrong with that! 🙂

 

[toofache32]

Let's keep it civil. Don't make me shut this thread down. Oh, wait....

 

[ItsGavinC]

Let's keep it civil. Don't make me shut this thread down. Oh, wait....

Everything I know I learned from you. If only I could find me some good p0wned images. Hmmm....

 

[NileBDS]

I'm not sure why you're proud of these things. You don't even have to be a high-school graduate to do these things. You can train a monkey to follow directions and push a syringe.

Although I don't fully agree with that statement, I get what you mean.
However, I think you missed the point I was trying to make toofache. No pride here.

The original topic under discussion was whether the behavior management aspect in pedo was more challenging that the actual 'dentistry' part.
What I was trying to argue here is that by the time you "(doctor) walk into the operatory, most of the behavior management is already taken care of (mostly by your assistants), hence the dentistry aspect of your job would prove to be more challenging.
Working as an assistant has helped me gain a lot of insight into the work and practice, if you may, of dental auxiliaries. Although I agree that some may be, not all assistants are "trained monkeys".
There are dental assistants (DA), registered dental assistants (RDA), certified dental assistants (CDA), expanded function dental assistants (EFDA)-which one day will be running most of our back office- and then there are nitrous/oral sedation certified assistants, whom yes, have completed a humble yet informative training on topics such as nitrous oxide, sedations and even effects/side effects and complications of some pharmaceuticals.
Classification requirements differ depending on which state you decide to practice, ranging from CE courses to regional clinical and written tests (similar to the NBDE and the NBDHE).

Sorry for the unnecessarily long post.

 

[NileBDS]

Do you guys not treat patients at UOP? I've got plenty of patients that I'm responsible for.

I'm sure you'll make some 3 year old happy one day.
I start at the Pacific in July. I am not even there yet.

 

[NileBDS]

It's funny that you remind me that I'm in school. Especially since I'll graduate from an ADA-accredited program one year before you do. You do graduate in 2008, right?

It was not a reminder, but a reality check. You have not even seen a patient out of training, was my point, and you're claiming to be in the OR doing GA's and oral sedations like it's no ones business.
I graduated 2001. And yes, I will be graduating hopefully 2008 from PACIFIC, for my second time.

Like we've said, we'll agree to disagree. Nothing wrong with that! 🙂

Agreed.

 

[toofache32]

...I graduated 2001. And yes, I will be graduating hopefully 2008 from PACIFIC, for my second time.

We call that remediation here.

 

[scalpel2008]

You can train a monkey to follow directions and push a syringe.

they all start off like this...first it's hash, then they learn to inject...before you know it they get involved with monkey business.

http://www.primates.com/monkeys/cannabis.html

 

[DrReo]

Let's keep it civil. Don't make me shut this thread down. Oh, wait....

 

[monreal]

Until I got into dental school. Beats the hell out of flipping burgers at some fast food joint. Wouldn't you say ?



Dude, you're still in school ! (rolls eyes)



Look it up in a book rookmeister. Under behavior management.
I did not say that I invented it, nor did I sate my opinion on implementing it. Furthermore, if you go back and read that line, you will find that I put technique in quotation marks.



Gosh darn it, you got me again.




I don't see this discussion arriving to any constructive conclusion soon.
Let's just leave it at that until you hopefully engage in productive specialized practice someday and maybe then have some real patient responsibilities and/or hands-on experience to fall back upon.

Hope you've grown up since then.

 

[capisce?]

It's funny that Nile had access to 1 pediatric dentist and can now tell the rest of us how 'it is'.

I can tell you as a privately practicing pediatric dentist that while the list of things may be a reality in his office it is not in ours.

And by the way, the first time a kid puked in this office I was the one on my hands and knees cleaning it for my assistant while she helped the child. Not because I'm that great but because I'm a good person. I later found out it was a good way of winning the loyalty of my staff as a doctor.

 

[drphannie]

It's funny that Nile had access to 1 pediatric dentist and can now tell the rest of us how 'it is'.

For the ppl that replied to this post this January (2009)...you've also got to realize that this thread was from 2006, so just drop it and let them be.

 

[JamesOSU]

For the ppl that replied to this post this January (2009)...you've also got to realize that this thread was from 2006, so just drop it and let them be.

Oh trust me, Reo knows 😛