By: Allen Vean, DMD

A few years ago, I wrote about the technologies that transformed treatment and improved outcomes, innovations like the high-speed handpiece, ultraviolet curing light and chemical bonding. (Today, many would gasp at the sight of a belt-driven slow-speed handpiece in use.) The pace of advancement with new technologies and treatment modalities is evolving at warp speed. And, as MDDS Co-Editor Dr. Amisha Singh pointed out in her recent Reflections, the significant role artificial intelligence will continue to play in the future.

While our profession has become highly skilled in treating the prevalence of dental disease, the incidence of dental disease, specifically dental caries is still the number one chronic disease in the U.S. and throughout the world. As a young pediatric dentist, I had the vision of owning a preventive practice. Without caries, children have a positive experience and outlook on dentistry as they transition from a pediatric practice to a general dental practice. Unfortunately, my vision quickly turned into a bad dream. I began to see more patients with Early Childhood Caries (ECC), full mouth dental disease with fistulated abscess and other related concomitant issues. I made bi-monthly visits to Children’s Hospital Colorado to provide treatment under general anesthesia due to the extent of decay and patient inability to cooperate in an outpatient setting due to their early age. Unfortunately, in this respect, it seems not much has changed. To the credit of the profession, treatment modalities have become more efficient with in-office sedation and anesthesia as a viable alternative in select cases.

As a pediatric practice, my office’s emphasis was centered on oral hygiene and diet. It is well documented that while dental caries are multi-factorial, proper nutrition and oral hygiene can reduce the risk. For me, it was disheartening to provide comprehensive treatment for a young patient, only to see a sibling present with similar needs 12 to 18 months later. It raises important questions: Where might the disconnect be? Are there challenges within family routines, education, access or cultural perspectives the profession and we, as providers, need to better understand and support?

For now, I’ll set aside a broader conversation about public health initiatives and access-to-care programs related to caries reduction. Instead, I’d like to share a few everyday interactions from my pediatric dental office that many of you may recognize.

“My child won’t let me brush their teeth.”
While no one can sympathize with this better than a pediatric dentist, it is imperative we educate parents to step in as guides for their children. Oral hygiene must be a supervised parental responsibility. It is either two minutes, twice a day or costly and uncomfortable dental care down the road.

“I let my 4-year-old brush on their own.”
While it’s great to encourage independence, children at this age simply don’t yet have the dexterity to clean effectively by themselves. They can practice, but caregivers still need to finish the job.

“We are skipping x-rays/fluoride/disclosing solution today.”
When families have concerns about preventive or diagnostic tools, it’s important to empathize with the instinct to be cautious, especially in the age of misinformation. Explain that recommendations are based on data-backed standards of care and are meant to protect a child’s long-term health.

Obviously, I could go on, and I’m sure you could add many more examples of your own. At some point, personal responsibility must be part of the conversation; our profession can only do so much on its own. We are working hard to bring whole-body health into dentistry, and for pediatric dentists, pediatricians are a key part of that integration. Strengthening communication and collaboration with our medical colleagues must be a priority.

While dental caries and tooth loss have declined over the past 50 years, due to community water fluoridation, improved preventive care, and advancement in restorative materials, as stated previously, dental caries stills remain the number one chronic disease. But paraphrasing Winston Churchill, “We will continue to fight the fight.” Thank you for all you do for your patients.

Pythagoras once said, “The world is built on the power of numbers.” Your support for organized dentistry is appreciated and needed.

Your comments are always welcome!