pedodontics

[nug]

what exactly is pediatric dentistry? I've heard that it's not like a pediatric MD where you are a "child doctor", but rather, you get the incorrigible kids that a normal dentist can't handle.

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[JoeyJo]

Not true. A lot of parent's take their children just to a pediatric dentist since that person specializes just in kids. True, some dentists might refer 'bad' kids to a pediatric dentist, but overall, a ped. dentist gets to work with decent, fun kids.

 

[UBTom]

Yep, pedodontists do more than treat incorrigible kids.. They tend to be much more familiar with situations particular to kids like certain oral conditions, the use of anesthetics (particularly the dosing of kids with NO2), the differences in head and neck anatomy in growing kids, certain techniques like stainless steel crowns, etc.

I just came off of a 1-week pedo clinical rotation at the Childrens Hospital here in Buffalo NY, and it's definitely a different kind of dentistry..

Definitely much more than meet the eye!

 

[gryffindor]

A pediatric dentist treats kids and adolescents. They have at least 2 years of specialized training after dental school. A practioner told me that 90% of the kids you see in a pedo office are the good kids. The other 10% are either the incorigible kids the general dentist can't handle or are patients with special needs or developmental disabilites. A lot of pediatric treatment is geared toward preventive dentistry such as cleanings and sealant. However, pediatric dentists also do operating room cases under general anesthesia at the hospital to treat the child with rampant decay and oral problems. During their residency, the pediatric dentist receives training in behavior management, treating special children, and doing OR cases.

Check out the Amer Assoc of Pediatric Dentistry website. It has a lot of good info about this specialty as well as a thorough list of the pediatric dental residencies throughout the country.

www.aapd.org

 

[Frank Cavitation]

> During their residency, the pediatric dentist receives training in behavior management, treating special children, and doing OR cases.

which is exactly the reason I don't know why a pedodontist would have such a high proportion of well-behaved, dentally unremarkable kids. I would expect that lots of parents think it is convenient to book dental appointments together with their kids, in terms of saving time and having to remember separate appointments. If I were a dentist and I knew a patient of mine was going to have a kid I might in fact take the initiative and get them to bring the child for a checkup at MY office when his first teeth appear (thereby eliminating the pedodontist from the equation).

I haven't completed my dental education of course, so can somebody give some insights as to how a new grad GP might be ill-prepared to handle even a normal child? thanks.

 

[UBTom]

My class is presently taking the pediatric dentistry course at my school so my understanding is still incomplete at the moment.

Anyway, if your office is properly equipped to treat kids and you are comfortable doing it, then there isn't any reason you as a GP shouldn't (just keep in mind that your standard of care will be held to the same level as the pedo specialists if you do so).

When I enter practice I probably will be very selective about treating kids and the procedures I'm willing to perform, because most kids are afraid of needles and local anesthesia will not be easy to administer. I would probably send them to a pedodontist who has more experience in dosing kids with NO2 (which can cause permanent injury or death if the dentist doesn't know what he is doing) and are more familiar with the differences in head-and-neck anatomy from an adult. Plus I don't have the personality to deal with kids like some other people can.

As it is with many other aspects of dental practice and life in general, you should know what your capabilities are and what you are comfortable with before proceeding with a case!

 

[gryffindor]

As a GP, you can go ahead and get the parents to bring their kids to you, the "family dentist." But, there are many GPs out there who actually don't like treating kids and refer them all out. Kids have little mouths, smaller teeth with different anatomies, and you have to be quick with them. UBTom mentioned you have to have the right personality to handle kids, meaning you have to CONSTANTLY reassure them with phrases like "you're so good!" and "you're awesome" and "wow, look at how nice you keep open" and "stay open honey, so we can finish taking care of you." Some GPs just don't like it so they don't treat them. My friends who assisted full time before coming to dental school have said the particular GPs they worked for saw almost zero kids. The pediatric dentist often works together with the pediatrician to establish their patient base.

Frank Cavitation, I too was confused during my first two years of dental school by what the pediatric dentist did that was significantly different from the GP. So I decided to actually go to a couple of private offices and see. They are busy! Most of the kids were good kids, there were lots of recall appointments. Any operative they did was done FAST. Throughout the course of my day, I only saw them encounter between one and three screamers who they handled so efficiently. The doctors also had either one day or a half day each week set aside when they went down to Children's Hospital to do OR cases.

 

[JML1DDS]

I cannot speak for all pediatric dentists, but in my program we were trained to see the medically compromised children and MR adult patients. We have a far better understanding of the child patient. Most general dentists wouldn't want to work on a child with biliary atresia that is awaiting a liver transplant, or the child with ALL, or a child who is taking coumadin for an artificial heart valve. General dentists CANNOT obtain privilages at a hospital to admit the child on coumadin to have then switched to heparin in order to do an extraction and then switch them back to coumadin. Most general dentists have no clue as to oral sedation of the child patient, and even fewer can perform submucosal sedation. In my opinion NO general dentists should attempt to sedate a child in their office due to the liability if something were to go wrong. Pediatric dentists go through 2 months of general anesthesia rotation. I am curious how many general dentists have actually intubated a child?????? or started an IV on a child or have written orders for IV fluids for a child under your care after day surgery??????? Primary teeth differ greatly from the adult dentition especially in the pulp. The primary tooth pulp is responds differently than a mature adult pulp. All pediatric dentists are required to have a minimum number of hours in orthodontics. So even though the average pediatric dentist may choose not to practice orthodontics, he/she still knows more about orthodontics than the average general dentist. I would be surprised if a general dentists knew how much clindamycin to prescribe a 30 kg child or even amoxicillin. I see so many children who have been treated by general dentists and God love 'em the general dentists try their best, but they treat the baby teeth the same as they would an adult tooth and I just end up RE-DOING their work when it fails 1 or 1 1/2 yrs later. I can take a child to the O.R. and put them under GA and do the work....a general dentist CANNOT. Even if they could obtain privilages at a hospital...They could not do 18 pulpotomies and stainless steel crowns in less than an hour!!!!! The largest age group that sees the dentist is 5 to 17 yrs of age. There are not enough general dentists to see all these patients anyway. You should get on your knees and thank God that you have pediatric dentists to refer to......

 

[JML1DDS]

Frank Cavitation, Get a few more feathers on your wings before you try to fly.... Ask all your parents to bring in their little darlings for check-up. Ask every single one. I would love it if you did that....Because 5 or 6 out of ten are going to have cavities and the moms are going to expect YOU to fix them 'cause YOU told them to bring the child in.....Therefore how ill-prepared or incompetent are you going to look when you try to sit 4 year or little Johnny in your chair and he FREAKS out when you give him an injection and you CAN'T get him to calm down and YOU CAN'T get the work done and YOU HAVE TO REFER TO A PEDS. IN THE END ! ! ! ! Now mom leaves your practice on a negative note and you just caused little Johnny to go through a crappy experience for no reason.....You think mom will refer more patients to you???? Then you will realize that you can avoid all that and tell parents you don't see kids or you can see kids and then when you see those who are over your head you can refer them out and avoid the negative experience altogether. Dental schools don't not allow dental students to see really young kids unsupervised and they limit the amount of exposure to youngsters for a reason. Wait until you have had a taste before you decide you are an expert. Frank Cavitation, have you even started clinical yet???? Have you started working on patients??? Have you seen a pedo. patient yet ???

 

[Frank Cavitation]

JML1DDS, thanks for your useful input, and apologies if my comments somehow irritated you because that was certainly not intentional. You're right that I haven't started clinical, but I did do some dentist shadowing last summer and the GP I followed regularly saw children between the ages of 3-10. However, through the 2 months that I did the shadowing there was not one case requiring anesthetic (they were all check-ups and cleaning), and not a single referral. When I was doing database maintenance I had the impression that in his practice of over 1500 active patients there were only about 10-20 that were referred to pedodontists. Therefore my (incorrect) deduction was that little kids rarely need fillings if their parents were given adequate dental education, and unless they had an existing physical/psychological problem there would be no reason to refer.

So, JML1DDS your point of view has been an educational experience for me, and I'm sure I'll know how right you are next year when my peds clinic starts. Thanks again!

 

[haircut]

Hello all! I've enjoyed your discussion on the merits of pediatric dentistry very much. I'm a 3d year student who is convinced that pediatric dentistry is for her--although I'll be honest, I've only seen a couple kids in the clinic so far...and things could change! (although I doubt it--I love dealing with kids--even the screamers)

What I want to know is more about the residency programs that are available. I've been on the AAPD website and read their descriptions of the various programs available, but I'm looking for something a little more tangible. What's -really- important in choosing a peds program? Is it the ammount of hospital experience? Lots of research opportunities?

Any and all information you guys could add would make me very happy. My dental school (WVU) is in the middle of Appalacia, where the level of dental education is extremely low. I've seen about 15 peds cases in the clinic and already seen 4 patients with rampant nursing bottle decay. As a result, the peds clinic here runs much differently from those in larger, more affluent places. It would be nice to know more about the 'average' experiences of a peds dentist!

Thanks

 

[UBTom]

Hey there, a fellow 2004er!

I salute you. For the life of me I don't know how to handle kids. We get three hour sessions to work on one patient and it seems to take me two of the three hours to just persuade a kid to cooperate so I can put on the rubber dam.

I think I'll go into removable prosthodontics and work with easy-going retirees. j/k

 

[haircut]

Oh, you can have all of my retired folks!! They make me so stressed...they're never happy with anything ("Erica, this denture doesn't cut steak like my old teeth, can you fix that?") and they aren't afraid to tell you so. ("Don't give me that needle again like last time, you hurt me a lot when you did it before, I don't think you know what you're doing!")

Give me a crying kid over that anytime!

 

[DrJeff]

I can take a child to the O.R. and put them under GA and do the work....a general dentist CANNOT. Even if they could obtain privilages at a hospital...They could not do 18 pulpotomies and stainless steel crowns in less than an hour!!!!!

While I'll agree with alot of stuff that JML1DDS says, as a GP, I take a bit of offense at this one. First off, I don't know what the regualtions are in your state, but in my state, not only can I obtain hospital privileges (I currently have them at 3 hospitals in CT), but I'm also credentialled to work on ANY age of patient that I care to take to the O.R.. Do I take kids to the OR, I haven't in 2 years. Have I taken kids to the OR, yes, and at last count it was over 50 cases. Did I have a different type of residency where we took ALOT of kids to the O.R. so that I could become credentialled, once again yes.

Now, about the 18 pulpotomies/Stainless steel crowns in an hour, hey one pulpotomy/crown every 3 minutes and 36 seconds, that's impresive, myself I top out at about 13 pulps/crowns in an hour.

I greatly respect the pediatric dentist, and send quite a few kids there. But JML1DDS with a attitude like that you're going to irritate alot of the G.P.'s that you'll be looking to refer liitle Johny and little Sally to you, and they will send kids to other Pedontists. I would expect an attitude like that from an Oral Surgeon, but not a Pedodontist.

 

[Centrum]

Dr. Jeff! Where have you been? Another great post, and I am really glad to see you back on the boards.

-Centrum

 

[JML1DDS]

Dr. Jeff, the fact that GPR's allow their residents to take children to the O.R. is absolutely WRONG ! ! ! ! In a GPR you will spend a short amount of time in the O.R. compared to a Pedo. resident...AND No matter what your state allows you to do... A GP SHOULD NEVER EVER TAKE A CHILD TO THE O.R. If anything were to happen that GP would not have a leg to stand on. Same thing goes for GP's sedating kids. Not that I have an attitude, but If a GP could do Pedo. as well as I, then what the heck AM I doing????? The fact that you have taken children to the O.R. saddens me......You have a limited knowledge base of Pedo. to draw from and you may have done those children a disservice by not referring them. How do you know your treatment is up to the standard of care ??? Are you a member of the AAPD ? Do you go to the annual meetings ?? The continuing education on Pedo. in the GP circuit is very very limited. GP's must see kids....I agree with that. There are not enough Pedo. out there, but under no circumstances should a GP take a child to the O.R. nor should they sedate them. The Pedo. experience at most dental schools is poor at best, and the amount of Pedo. experience you gain from a GPR is minute. Lastly, I am curious where people get the idea that Pedo. is a referral based specialty. Pedo. should be viewed as a service. I do not need ANY referrals. IN FACT ! GP referrals are the worst. GP's usually NEVER refer "good" patients, GP's usually Bill for an Exam on the patient, then the GP takes X-rays and charges for them even though they are not of diagnostic quality, does the prophy and then decides they don't want to do the restorative and they refer the child out leaving the pedo. with nothing to bill for. So, we do the exam for free, re-take the x-rays FOR FREE !!!! There is a waiting list at both of my offices of 4 plus months.. I do not need referrals. I am not trying to upset anyone or take an arrogant attitude, but I have yet to see a GP do Pedo. as good or better than I. AND THIS IS AS IT SHOULD BE....I would not try to do veneers, or RPD's or even Endo. cuz I don't do that day in day out and there are plenty of GP's or specialists to refer that to, but PEDO. is what I do EVERYDAY. If I need a crown done or a Root Canal you can bet I will be seeing a GP or Endo. Most GP's are excellent dentists, but they are not specialty trained in any one facet. Same as GPR trained GP's...they just tend to be more complete GP's. Again, You are correct in that a few GP's that did GPR's can obtain privileges at hospitals, but why does a GP need privileges at a hospital. They should never take kids to the O.R. So, maybe they will take their adult CP patients, or adult Down's patients, etc. to the O.R., but again Pedo. covers the disabled and handicapped. So why does a GP need hosp. privileges and Especially why do you need privileges at so many hosp. I can't imagine that you go to the O.R. so much that you would need to be credentialed at so many places. How much primary pulp research did you do in your GPR ?? Can you describe the dynamics of the systemic distribution of Formocresol ??? The differences and success rates of Formocresol pulpotomies vs. ferric sulfate vs. CaOH2 vs. laser vs. electrofulguration etc. etc. when to do a pulp. vs. IPC. What is the actual mechanism of CaOH2 ? What happens under the layer of coagulation necrosis in a DPC after application of CaOH2 ?? How long is too long to do a Cvek pulp. after a traumatic exposure on a perm. tooth. What should be done to a primary tooth with internal resorp. What is anachoresis ?? When to do serial extraction ? When does canine to canine width stop increasing ? etc. etc. Hopefully, the only children you treated in the O.R. were the ones during your residency while you were under the supervision of a faculty member (hopefully trained in Pedo.) It would amaze me if you have taken kids to the O.R. on your own. I would never attempt something on another person's child that I was not absolutely 100% confident and FULLY and COMPLETELY trained to do. The fact that you would take a risk with another person's child staggers me. I have nothing against GP's, but I see their work day in day out. I REPLACE their work DAY IN DAY OUT. Pedo experience in most dental schools is like ortho. ya just don't get enough !!!! GP's try their best, but they don't know enough. Most are wise enough to refer, but others don't. Who has done the disservice when the child comes to me and I have to work on a "baby" tooth for a SECOND time, because someone did not do the proper treatment, or I open up a pulp to find that the GP has left the formo pellet in the primary tooth. Enough of me being a LOUD MOUTH (no pun intended). I have opinions just like everyone else. If you took offense to what I said that was not my intent. I wasn't aiming to offend anyone, but to let the people on the thread know why Pedo. exists, and that contrary to what their experience was like in dental school....Most Pedo. residents gain more medical expertise than GP's, even GPR trained GP's. I was also letting them know that treating kids is not just treating little adults, etc. etc. Primary teeth are different than adult teeth in many more ways than many GP's realize. Perhaps, I have been less candid on this subject, but I am not trying to cop an attitude, or demean GP's in ANY WAY!!!! I have great respect for GP's ESPECIALLY those that do truly practice everything.

 

[DrJeff]

I have great respect for GP's ESPECIALLY those that do truly practice everything

How hypocritical is that statement after you basically tried to tear every GP out there a new one for even considering looking at a kid. Different contexts and situations require different situations. I'm sure that you've done some work in the past that others have looked on as less than perefct, but under the circumstances that you placed it, it was as good as possible. Remember, since there are so few pedodontist's out there, in many areas going to a pedodontist just isn't a geographic option. Are you so against a GP having hospital privileges in those areas where the nearest pedodontist that is accepting patients is over 100 miles away?? Or how about my situation where the local pedodontist in my town is suffering from a Parkinson's like disorder where all of his work needs to be replaced when his patients come to my office. BTW, he had his privileges revoked by one of the hospitals that I have my at. And, as for the 3 hospitals that I have privileges at, one is my local hospital, one is the hospital where I am a teaching faculty at, and the third is where I di my residency. The third one I plan on not appllying to have them renewed when the next review period is up.

Frankly, if you want to turn this into a flame war, then so be it. But at the end of the day, if we really think about it, everything that we do in dentistry really isn't that difficult. And the bottom line is that as long as the patients are receiving competent care, it doens;t matter whether they're in your chair, my chair, or Dr. So and So's chair and/or OR.

 

[JML1DDS]

No intent for a flame war. I hope you know that I have no ill feelings. Just discussing an issue. I still feel firmly that GP's should not take children to the O.R. Even if there is no Pedo. around. The reason I chose the residency I did, is because the residents, at the time I was interviewing, said "they had seen it all." They felt more than comfortable with sedation/O.R. etc. I would never want to take another person's child to the O.R. or sedate them in my chair unless I had done it hundreds of times. I have children of my own, and I would never want someone to do anything to them that they were not trained to do, but that they had some experience doing. GPR's do not train their residents to take kids to the O.R. however they may give them some experience....Ask any GPR and they would never tell you that they are training their residents to do Pedo. O.R. cases. I believe you said you have done 50 cases in the O.R. I do roughly 48 cases a month. 6 cases on Mondays and 6 cases on fridays. Most GPR grads realize their limited experience and don't envoke their hospital experience. I believe once before you said you were ACLS trained, but we Pedo. do PALS. ACLS doesn't really have much use with Kiddos. Many subtle differences make a big deal. This is not intended to be personal. I am just giving my opinion. You may not even care about my opinion....Even more you have to do what you feel right doing, no matter what I think. Anyway, a hospital trained GP is not a replacement for a Pedo. That thinking would be the same as an MD doing dentistry bec. the closest dentist is 100 miles away. I would not agree with that either. You are right though. It is not what we DO that makes us doctors, but what we KNOW. A monkey could be trained to do what dentists do, but a monkey doesn't know what to do when something "wrong" happens. Exactly why GP's should not take kids to the O.R. they don't know as much as Pedo. (about kids). Life goes on though. Too many kids to be seen and not enough people to see them!!!!! There in lies the dilemma. We probably could debate this issue for years....I also don't want to create a turbid relationship with you either....From listening to you post you seem to be a very ethical and professional person, and I don't want to hint in anyway that you are not. All the aforementioned chit chat is just opinions, that's all. It is good food for thought for both of us and many others.