Pedo?

[clc8503]

Okay, so it is a given that a Pediatric Dentist mostly see's younger individuals. That's crystal clear. However, I was wondering if someone could tell me exactly what procedures pedo's typically perform? Do they do any surgical procedures? Also, I've heard that there is a great deal of ortho involved in pediatric denistry? Is this true?

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[CorneliusFudge]

1. Pulpotomy
2. Stainless Steel Crowns
3. Fillings
4. The occasional extraction

 

[Jediwendell]

1. Pulpotomy
2. Stainless Steel Crowns
3. Fillings
4. The occasional extraction

I actually do quite a fair amount of impacted mesiodens extractions, lingual and maxillary frenectomies, and a ton of ortho extractions. I do your random single tooth crossbite corrections (I hate ortho....) But yes, most of my life revolves around pulps and crowns, resins and sealants.
Jedi's wife

 

[clc8503]

1. Pulpotomy
2. Stainless Steel Crowns
3. Fillings
4. The occasional extraction

Oh ok. I was just curious. If this is mainly all they do then why is pedo so lucrative? I distinctively heard someone say that ortho was involved. Maybe they were wrong.

 

[CorneliusFudge]

Oh ok. I was just curious. If this is mainly all they do then why is pedo so lucrative?

Volume, baby. Volume.

 

[clc8503]

Volume, baby. Volume.

I don't mean to sound rude but that's an very vague answer.

 

[CorneliusFudge]

Jedi's wife will be better able to answer your question, but most pedos see a TON of patients every day. A busy general dentist will probably see 10-15 patients a day for the dentist and another 8 for the hygienist. Some pediatric offices will see 50+ patients per day.

Pedos don't really do a lot of high dollar procedures but they do TONS of more basic procedures.

I think the going rate around here for pulpotomy/SSC is about $250-275. A good pedodontist will knock that out in 20 mintues or so. Add in exam fees, x-rays and multiply the total by two with no lab fees, and you are looking at a pretty good hourly production. And there is still some time left over for some fillings or extractions here and there.

To answer your question about ortho - I think the amount of ortho training pedos get varies from program to program. I'm pretty sure they all get some exposure, but some get more than others. It's not really the back door to orthodontics that a lot of people with average stats hope it is, though.

 

[ItsGavinC]

I'm working in a pedo practice right now and I see 10-12 patients each day. Each of those appointments lasts 20-40 minutes and I usually do a quadrant of tx. at a time. Usually involves pulps and crowns, fillings, sealants, some PRRs, occasional extractions and space maint.

Some pediatric dentists do ortho, but others choose not to. Some programs teach quite a bit of ortho, while others teach very little. It depends on your comfort but also your time. A doc may be able to do some limited ortho, but that doesn't mean that it would be financially beneficial for him to do so.

 

[Jediwendell]

OK my day today:
checked about 15 recalls throughout the day
In the morning: I saw 2 recalls, 2 emergencies, 2 new patients
then did 2 Nitrous - a) 1 resin, b) 1 resin (10 minutes each)
then did 4 sedations a) 2 pulp/ssc, 1 ext impress for spacer (30 min) b)4 sealants (assistants do them) 3 SSC, P&F (40 min) c) 1 EXT impress for spacer (15 min) d) 4 white faced ssc, 3 pulp, 2 resins (40 min)
In the afternoon: 3 new patients, 1 emergency, 5 recalls
went home about 2:45
My real money making days are when I am in the OR. I see about 7-8 kids and do 60+ crowns, 20+ pulps etc, etc. I go every Tuesday. Wears me out, but still usually done by 3:00.
Pedo is definitely about volume, but I'm not one of those 50 patient a day type of people.
Ortho is all personal preference. I don't enjoy it so don't do it. I have friends from my residency who do a ton.
Jedi's wife

 

[gryffindor]

double post

 

[gryffindor]

I don't mean to sound rude but that's an very vague answer.

It's a pretty good answer. Have you ever done a cleaning & exam on a good kid versus one on an adult with good oral hygiene? The kid can be done in 15 minutes versus the adult can take at least 30. So in 1 hour, you could see 4 kids vs. 2 adults, and since the fees are roughly the same, you've just made double the amount in one hour.

 

[capisce?]

I'm working in a pedo practice right now and I see 10-12 patients each day. Each of those appointments lasts 20-40 minutes and I usually do a quadrant of tx. at a time. Usually involves pulps and crowns, fillings, sealants, some PRRs, occasional extractions and space maint.

So you're going to tell me you do a quad of P/SSCs and operative in 20-40 minutes? Yeah right, lets keep the exaggeration to a minimum here. So lets say you sit and chat for 3 mins (who needs behavior management?), crank up the N20 to 50% in 3 mins, topical for a minute, anesth for 2 mins, let it cook for 3 mins, 1 minute for rubber dam. So you've got 28 mins left. Say you do 2 pulps/crowns and an MO. You must be using ferric...who's got time to wait 5 minutes for formo to cook...gavin needs to pump up the production. Maybe you take 4-5 minutes to prep, 5 minutes to let the formo do it's magic...why are you even applying to pedo? You're already the man! 20-40 minutes for a quad of P/SSC and oper? Probably more like 30 mins to seal the 6s.

 

[CallMeAl]

I'm working in a pedo practice right now and I see 10-12 patients each day. Each of those appointments lasts 20-40 minutes and I usually do a quadrant of tx. at a time. Usually involves pulps and crowns, fillings, sealants, some PRRs, occasional extractions and space maint.

Some pediatric dentists do ortho, but others choose not to. Some programs teach quite a bit of ortho, while others teach very little. It depends on your comfort but also your time. A doc may be able to do some limited ortho, but that doesn't mean that it would be financially beneficial for him to do so.

How can you work in a pedo office and do all that work when you are not even an actual dentist yet? You're signature says Class of 2007.

 

[ItsGavinC]

So you're going to tell me you do a quad of P/SSCs and operative in 20-40 minutes? Yeah right, lets keep the exaggeration to a minimum here. So lets say you sit and chat for 3 mins (who needs behavior management?), crank up the N20 to 50% in 3 mins, topical for a minute, anesth for 2 mins, let it cook for 3 mins, 1 minute for rubber dam. So you've got 28 mins left. Say you do 2 pulps/crowns and an MO. You must be using ferric...who's got time to wait 5 minutes for formo to cook...gavin needs to pump up the production. Maybe you take 4-5 minutes to prep, 5 minutes to let the formo do it's magic...why are you even applying to pedo? You're already the man! 20-40 minutes for a quad of P/SSC and oper? Probably more like 30 mins to seal the 6s.

I've never done a full quad of pulps and crowns (nor did my post ever say that I did). Tx. in a quad involves any range of those things I mentioned. My apologies if I wrote it to sound as though I do all of that in each quad--which is obviously impossible. That statement was to let the OP know what procedures a pediatric dentist focuses on.

The assistant does the nitrous and the kids are already under for 5 minutes when I meet them. I administer anesthesia then leave while the assistant places the rubber dam. I haven't spent 3 minutes giving anesthesia yet. Many of these kids are getting 1/2 carp of Lido in an IA, or perhaps 1/2 in an infiltration. I'll let an IA sit for a bit before testing the tissue, but it seems the infiltrations are good to go after 30 seconds or so. If the assistant has trouble placing the clamp then we give more anesthesia. So far that has happened only twice.

The office I'm at does use ferric sulfate, so it takes about 10 seconds to acheive hemostatis of the pulp. Two pulps/crowns and an MO does take about 25 minutes in this situation. We're also using IRM to cement, which I think adds quite a bit of time due to clean-up. Cementing with a glass ionomer would save 2-3 minutes on clean-up time. I'm not super fast, but I'm getting quicker. I'm at this office with another classmate of mine (we go 2 students to each rotation) and she is getting quicker each day. Nothing special to it.

I'm applying to pedo because I love doing it and can't imagine doing anything else. I'm fair at it, but I've got lots to learn. I'm at this rotation for the next three weeks, so I'm sure I'll learn lots here before my time is up. More than anything I'm a dental student that's very excited to finally be in a new environment.

I'm assuming that you are a resident? Where are you at? Any tx. tips for me?

 

[ItsGavinC]

How can you work in a pedo office and do all that work when you are not even an actual dentist yet? You're signature says Class of 2007.

My school has us do a month of external rotation, every other month for our D4 year. I'm on my first rotation, in a pedo clinic.

 

[Sommy]

My school has us do a month of external rotation, every other month for our D4 year. I'm on my first rotation, in a pedo clinic.

Gavin,
This seems like it gives your students a huge advantage. Legally our students can't do anything outside of the school clinics besides assist. Do you have to have every step for every patient checked by the dentist? (This is what takes up all our time in clinics).

 

[ItsGavinC]

Gavin,
This seems like it gives your students a huge advantage. Legally our students can't do anything outside of the school clinics besides assist. Do you have to have every step for every patient checked by the dentist? (This is what takes up all our time in clinics).

It is up to the attending dentist. After they see your work for a day or two they typically don't check much, unless you request their help. Of course, they're welcome to check whatever they want, but they are usually seeing their own patients so they pretty much leave you on your own.

In this sense, it does build a lot of confidence as well as critical thinking skills. At this pedo rotation my fellow student and I each have 5-6 patients in the morning and 5-6 patients in the afternoon to see. The tx. plans are already done, so we pick a quadrant and get to work. The assistants are great, which helps out a lot.

 

[3rdMolarRoller]

It is up to the attending dentist. After they see your work for a day or two they typically don't check much, unless you request their help. Of course, they're welcome to check whatever they want, but they are usually seeing their own patients so they pretty much leave you on your own.

In this sense, it does build a lot of confidence as well as critical thinking skills. At this pedo rotation my fellow student and I each have 5-6 patients in the morning and 5-6 patients in the afternoon to see. The tx. plans are already done, so we pick a quadrant and get to work. The assistants are great, which helps out a lot.

Wow man, that dentist signing off your work has some HUGE balls!!!

You are a student doing volume work under his license. Wow man, I'm floored

You are a D4, you do not know $hit yet. I'm sure you are good at the basics, but how is this even legal?

 

[ItsGavinC]

Wow man, that dentist signing off your work has some HUGE balls!!!

It's legal in the same way that working in the school clinic is legal. Every rotation site contains calibrated faculty. LOTS of dental schools have their students go on external rotations. Nothing new there.

You are a D4, you do not know $hit yet.

Don't jump the gun and think that every D4 is having the same experience that D4s at NYU are having.

True, I have lots to learn, but after this year I'll essentially have 6 months of private practice experience (procedures, speed, etc.) under my belt when I graduate. It's a phenomenal way to learn. Students from other schools that complete external rotations can attest to this.

 

[Sommy]

All of our external rotation sites are accredited through the ADA. It's no different than working in a school clinic. LOTS of dental schools have their students go on external rotations. Nothing new there.




True, I have lots to learn, but after this year I'll essentially have 6 months of private practice experience (procedures, speed, etc.) under my belt when I graduate. It's a phenomenal way to learn. Students from other schools that complete external rotations can attest to this.

Well, they didn't let me do anything at either pedo externship I did (at other schools' grad pedo programs). However, these were not assigned rotations, just voluntary (pursued them on my own). At one I THOUGHT they would let me do maybe something, because they required me to prove that I had liability insurance that would cover me on their premises. I would have been great though, if it was like your experience. The only problem though is that as a parent, I might kind of want the specialist, not the dental student doing the work. I am sure you did a great job, but how do they know...

 

[unlvdmd]

Wow man, that dentist signing off your work has some HUGE balls!!!

You are a student doing volume work under his license. Wow man, I'm floored

You are a D4, you do not know $hit yet. I'm sure you are good at the basics, but how is this even legal?

No kidding. This surprises the hell out of me. I don't care how many you have done, at the level of even a 4th year I still think it is 100% necessary to check STUDENTS off at each step. How do they know what is under that restoration is even 100% correct??? Not every situation is the same. Sounds pretty sketchy to me. I would in NO WAY sign off a STUDENT on a procedure in MY OFFICE without checking each step. HUGE balls? Talk about balls the size of Asia!!!

 

[capisce?]

It's legal in the same way that working in the school clinic is legal. Every rotation site contains calibrated faculty.

Who needs calibration when there won't be checks.

 

[ItsGavinC]

No kidding. This surprises the hell out of me. I don't care how many you have done, at the level of even a 4th year I still think it is 100% necessary to check STUDENTS off at each step. How do they know what is under that restoration is even 100% correct???

This actually brings up an interesting philosophical discussion, because right now there is (apparently) no way that I can do a simple prep correctly, yet in 9 months there won't be any question of it.

This clinic serves only children, and accepts donations only. When I explain to the parents that my fellow classmate and I are students they are very excited to see us there working with there children. Also, other than the head doctor, the clinic uses volunteer dentists to treat patients. Having us there allows some children to be seen through Headstart programs and other programs that may not be seen if we weren't there to provide some assistance. These patients return every 2-3 weeks until their tx. plan is completed.

You can bag on it all you want, but the a simple class 2 prep just isn't that difficult. I fully agree that I'm still a student (and as I've said in each post have a lot to learn), but I also value this experience because without sole reliance upon the attending it allows me to develop skills and traits that simply aren't fostered in dental school. Prior to doing any procedure I confirm it with the doc and explain to him *why* I'm doing it. If the quad is a mess and time won't allow it then I'll choose a different quad. Sometimes I don't make it through a quad. Last week a pt. was scheduled for RCT on a molar, but the doc requested that I do something else. We did sealants instead. It varies from patient to patient.

My thoughts are that the experience is unreal and goes a long way to building some of the character that dental schools are notorious for knocking down. Right now I have classmates in various parts of Arizona, Colorado, Florida, Utah, etc., and I hope they are having similar experiences.

In any event, I appreciate all these comments and different viewpoints!

 

[unlvdmd]

Gavin- I see your point. Completley. I am just totally shocked that this is allowed to be done, considering how strict my school, and I assume most others are on our procedure protocol. If we don't stop at each step: automatic failure. No matter how many times we have done it. I get that doing a class 2 isn't that hard, its just the principle of working on live patients as a student without "supervision." But I am happy for you that you are getting to work on the little rug rats for your residency! Good luck to you!

 

[ItsGavinC]

Just a quick update. The clinic doctor was on vacation last week (we had a substitute filling in for him), but he's back today. He checked every prep and every fill.

 

[toofache32]

Yes Gavin has large pendulous balls. I have seen them with mine own eyes.

 

[toofache32]

... But yes, most of my life revolves around pulps and crowns, resins and sealants.
Jedi's wife

Hmmmmm. My wife and I are just too mischievous for her to know my password. She would start posting crazy things in my name. Of course, I would do the same to her.

 

[pedo 2thDR]

I'll jump on the surprised band wagon for Gavin's externship. I understand that these children may not be able to afford dental work but it makes me nervous that someone with little experience but with what seems to be a lot of "confidence" is allowed to work on them without closer supervision.

In dental school, we had many lectures on pediatric dentistry but the experience on primary teeth was limited. Even in my three week externship at childrens in DC, I only did a few pulp/SSCs and those were done in the OR where i could learn without dealing with behavior mgmt issues! Maybe that is different at Gavin's school but I seemed to meet residents with very similar experiences during the interview process.

To be honest it sounds like he is doing more work than many first year residents (speaking from experience)! Assuming Gavin has gotten to do this much work, I think his attitude is bad! He should be trying to get the most out of this experience by getting checked as much as possible! In residency (at least mine), the attendings are very hands off in the clinic so I have found myself wishing for more supervision. At least in my case, I dont want to develop bad habits from the start. Sure, I can get a procedure done... but am I doing it with good form and efficiently?

So my advice to you, Gavin, is you shouldnt be assuming that you are "fair " at pedo, that a "simple class 2 prep just isn't that difficult" and that there is "Nothing special to it". You are missing out on a huge learning experience if you dont ask for guidance now - you wont feel as comfortable asking if and when you get into a program. While you may "value this experience because without sole reliance upon the attending it allows <you> to develop skills and traits that simply aren't fostered in dental school" you will have plenty of time to do that in a residency program b/c you wont be asking for guidance as much then!

Also, just a reminder that current pedo residents may still be reading this forum (ok i have no life yet since i just moved to a new city!) and have some say in the application process. Just another suggestion to watch your post attitudes It's very competitive!

Good Luck!

 

[kato999]

Just to let you know, I am on a rotation in Colorado similar to Gav's except we treat adults as well. I get checked after the prep and after the fill everytime. It still is way better than dental school because we have assistants and I can get going right away.

 

[unlvdmd]

The other thing I didn't mention in my previous post is the thing that I think is most important here: the lack of standardized checks for EVERYONE. So even the people who don't have a special interest (and therefore are probably less knowledgable and suck more at it) are just going at it??? Crazy!! In all likelyhood, Gavin is probably top notch in his class at pedo. But he is only ONE in that class. What happens to "Hackaway Harry" on his rotation?

 

[kato999]

The other thing I didn't mention in my previous post is the thing that I think is most important here: the lack of standardized checks for EVERYONE. So even the people who don't have a special interest (and therefore are probably less knowledgable and suck more at it) are just going at it??? Crazy!! In all likelyhood, Gavin is probably top notch in his class at pedo. But he is only ONE in that class. What happens to "Hackaway Harry" on his rotation?

You're giving Gaving waaay too much credit here.

 

[capisce?]

Also, just a reminder that current pedo residents may still be reading this forum (ok i have no life yet since i just moved to a new city!) and have some say in the application process. Just another suggestion to watch your post attitudes It's very competitive!

Good Luck!

You shouldn't clue them in Doc, we like the applicants to be themselves. I'd hate to think they'd alter their behavior on our behalf (coming from one of the aforementioned residents currently in a pedo program). Even if they do it's pretty transparent so it's pointless anyways.

My quote of the day from my 7 yr 10ms old patient this afternoon...I had to ext #I because of recurrent decay that lead to abscess formation/root resorp. Anyhows I popped on some N2O and anesth. I asked her how it was. She said she didn't feel a thing. I had described the pinch to her as is standard.

Two minutes later she spits this out:

"Actually, I'll be honest. It did pinch a little bit, but I told myself I'll just have to get over it and deal with it."

She had me, my assistant and her mom in cahoots. It's stuff like that which makes me love our job! If only she could spread that attitude to some parents of our patients. Like the one today that said, as I'm 3 cm from infiltration..."YOU ARE GOING TO STICK THAT NEEDLE IN THERE".

 

[ItsGavinC]

You are missing out on a huge learning experience if you dont ask for guidance now - you wont feel as comfortable asking if and when you get into a program. While you may "value this experience because without sole reliance upon the attending it allows <you> to develop skills and traits that simply aren't fostered in dental school" you will have plenty of time to do that in a residency program b/c you wont be asking for guidance as much then!

I agree with all of that, and I ask for assistance all the time. As my previous posts mention, I have a lot to learn.

I will note, however, that a good portion of dentistry (in general) comes with sheer experience. The more you see the more you know and the more you can do. I've seen things on this rotation that have left be befuddled and I had no idea how to handle them. After this rotation I'll at least have some inkling in the back of my brain how a situation *could* be handled.

I did 6 SSCs today and each one had a different obstacle for me. I had trouble with crowns on K and L because there had been space loss. Adjusting the crowns gave me trouble because they were still too high and the occlusion was off. Each time today the attending sat with me and explained to me what he would do and why, and then asked me if I had any other ideas. It was a great learning experience. Had I been alone or without assistance I would have stunk it up today. I have no doubt that each of those crowns took twice as long today as they should have, but the learning was tremendous for me. Once again, I have A LOT to learn.

I still vote that the experience I'mm getting has a tremendous worth for me personally. Am I a pediatric dentist? Not at all. Am I a dentist? Once again, no. Am I a student? Yes, and I finally feel as though I'm *really* learning.

 

[ItsGavinC]

Just to let you know, I am on a rotation in Colorado similar to Gav's except we treat adults as well. I get checked after the prep and after the fill everytime. It still is way better than dental school because we have assistants and I can get going right away.

How's the weather and are they working you like crazy up there?