Monday, February 15, 2010

Is Your Child's Dentist a Pediatric Specialist?

Many parents take their children to the Pediatrician for their expertise and training in the treatment of children and adolescents. This is also the idea behind the Pediatric Dentist. A Pediatric Dentist has completed additional education beyond dental school in an officially recognized specialty program. They are the Pediatricians of Dentistry.

If a dental practice says they treat children, are they "Pediatric Specialists"? Well, maybe --and maybe not. If you saw an add for these practices, wouldn't you think they are specialists in Pediatric Dentistry? Fact is, you cannot tell by the name or the advertisements:

Kids-R-Us
Little Smiles
Wee folks

I have run into an increasing phenomenon of practices "pretending" to be specialists in Pediatric Dentistry. They are usually general dentists who have set up a business model to emphasize the treatment of children. The most common manifestation is the clinic or practice treating mainly Medicaid insured patients. Now, a general dentist can legally treat children usually as part of a family practice. In fact, some general dentists do a good job, but do not have the additional specialty training and education of a Pediatric Dentist. In most states it is illegal to call onself a Pediatric specialist if one is not. These practices usually do not offer the full range of services as the specialist. Marketing can easily decieve the public. Don't assume that, if a practice looks like a kid's dentist, that they really are specialists.

Make sure your child's dentist is really a specialist in Pediatric Dentistry. If you are not sure, ask. Ask specifically if the dentist is a specialist in Pediatric Dentistry. Listen for the answer. If they say, "our dentists treat children" or "yes, we see children" or, "our practice is dedicated to treating children", they really did not answer your question. You need to be specific and get a specific answer. You can even research on where they did their specialty residency after dental school. Some states requre a specialty license. Now, sometimes there is a group practice that does actually have a Pediatric specialist on staff. However, is the dentist that is treating your child the specialist?--or, is that Pediatric Dentist retired, or only come in every other Friday? It could be that most of the dentists seeing your child are actually general dentists. Ask.

41 comments:

Joy Page Manuel said...

The 'dilemma' in our family is that most pediatric dentists in our area (if not all) only take PPO patients and not DMO, and that could get pretty expensive. If we are taking our child (3yrs old) for routine cleaning, would it be alright if we take him to a regular dental office that treats toddlers his age?...as opposed to taking him to a pediatric dentist?

Marketing for Dental Specialists said...

This will probably occur even more during tougher times to attract new clients.

Dr. Dean Brandon said...

Ask yourself, do you take your child to a Pediatrician? Why? Because they are experienced and trained to a higher level.

There are simply not enough Pediatric Dentists out there to see all children. I want parents to be aware if thier child's dentist is a Pediatric Specialist or not. Financial considerations, etc have to be evaluated. General dentists have very little training in behavior management and growth and development upon graduation from dental school. They learn from limited experience trial and error. Pediatric Dentists see a lot of two and three year olds every day and catch things early. The young children get used to visiting and enjoy the dentist. If something pops up that needs treatment, they are in a familiar setting. I am not saying a really good general dentist cannot do a decent job. However, I have seen the way Pediatric Dentists do things from a very early age lead to a life of good dental care, good dental habits and a good attitude towards dentistry

baby trevor's mommy said...

Two questions...

I have an almost 3 year old with a history of seizures. This past October he had a hemispherectomy to control them. He's been seizure-free since. But he does have global developmental delay. Functions around 12 months of age. Soooo...can I take to a regular pedi dentist? Or do I need to seek out someone even more specialized?

Also...my daughter took a nasty fall last summer. Knocked a tooth right out! Another was abscessed and pulled. Now...all these months later I am noticing small dark spots on her front two bottom teeth...which also happen to be loose? Could it be related to the accident?

Thanks for opening yourself up to fielding our questions!

...danielle

Dr. Dean Brandon said...

Trevor's Mom:

I cannot comment on your children's dental conditions, other than to say sounds like yes, you should get a Pediatric Dentist to take a look.
--might be trauma related or might be something else.

All Pediatric Dentists (specialists) are used to seeing children with special medical needs such as your son. Good Luck, I think he will be well cared for.

Dr. Dean Brandon said...

Oh, Trevor's Mom, I checked out your blog. Great blog--He certainly should get the "cute" award for the day.

baby trevor's mommy said...

I appreciate your input Dr. Brandon!

And also your compliment. Trevy is THE cutest kid I know. But I'm mom. :)

...danielle

Angela said...

I wonder if this is what my problem is or if I just need to see an orthodontist! My 6 year old starting getting her first sign of a loose bottom tooth last Oct. Two weeks later her permanent teeth came in behind. Freeking out I brought her to the dentist to see if her baby teeth needed to be pulled. He said no, come back when they are even. So, the first week in Feb. I brought her back when they were even. One of the baby teeth isn't loose, the other one is a bit loose. He said the permanent teeth will start to move forward and dissolve the roots on these two baby teeth. He did not recommend pulling them. I am worried though, will she end up needing braces? Should I see an orthodontist for a second opinion or drive 45 min. to where the nearest pediatric dentist is?

Dr. Dean Brandon said...

See my post on Permanent teeth coming in behind baby teeth

Dr. Dean Brandon said...

Angela, a pediatric dentist sees this kind of thing every day.

Nova Scotia Dentist said...

This is great advice and the message needs to be out there that general dentists aren't always the best answer to a child's needs. There are numerous issues that can be caught early and corrected if early diagnosis is possible. Sometimes that early diagnosis can only come from a specialist in the field. Thanks for posting and spreading the word.

Dentist Roseville said...

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Melanie said...

Wonderful post, but I do know that in many areas pediatric dentists do not take patients with Medicaid type insurances so many children miss out on their great expertise

David said...

I read your blog and I'm wondering if you're saying that because I'm a general dentist, I shouldn't be seeing kids?

Or are you saying that difficult cases (kids that scream the moment they step in the office, kids so scared they become turtles, or kids with dentinogenesis or amelogenesis imperfecta) should be referred to a pediatric dentist?

Dr. Dean Brandon said...

David, No I am not saying general dentists should not see children. As stated in the post here, many general dentists are quite good with children and see them as part of a family practice for instance. However, I do have a concern with practices that can possible decieve the public into thinking the practicioners are specialists when they are not.

By the way, I do think there is an important place for our specialty and it's not just kids with difficult to manage behavior. Pediatric Dentistry is an age related specialty, not a procedure related one. I will admit I will refer a patient (and often do) to a general dentist to do certain procedures like a porcelain crown and bridge work. Although I can do them, I simply do not do them enough to be efficient or as proficient as I would like in certain cases. In addition, we need general dentists to see children. There are not enough of us to see them all. Those dentists with interest and the desire to become educated and gain experience in treating the growth and development issues and knowledgable about when to refer, well, that is a good situation for all.

Mary Johnson said...

Very informative article!

Check out my dentist in Goodlettsville and the information at Rivergate Dental Care

http://www.rivergatedental.com

Mary Johnson said...

Very informative article!

Check out my dentist in Goodlettsville and the information at Rivergate Dental Care

http://www.rivergatedentalcare.com

Robert said...

i wish you had a practice in atlanta, GA (alpharetta, to be exact) :-)

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Dr. Dean Brandon said...

Good grief that Western Dental Group is HUGE. That comment is basically an "add" but I find it amusing.

Anonymous said...

Dr Brandon,
Does 50 mg (single dose) of hydroxyzine seem excessive for a 4 y/o girl? I am a pharmacist and occasionally see these high doses prescribed. I can't find any literature to support this. Thanks

Dr. Dean Brandon said...

Anon pharmacist--
See my post here:
Sedative Drugs Used in Pediatric Dentistry

Hydroxyzine is relatively mild (as far as sedative effect). It can be useful. Of course, all dosages should be made based on weight, health status, behavior, procedure, etc. Some 4 year olds weigh a whole lot, others are rather frail. I don't usually just raise the dosage to get the desired effect. It's often better to add additional drugs or try something else.

Dosing is something of an art as well as a science. I tend to see oral dosing about 1 mg/kg. That might be ok, but also might be rather wimpy in some circumstances. I can't say if 50 mg is ok or not, but hydroxyzine alone is relatively "safe". I say safe compared to other medications in higher doses like Demerol. Of course, no drug can really be called "safe". It's all how they are used. High doses of most anything can be a problem. It's always good to be cautious with higher doses. Basically, 50mg is two tsp (10cc) of Vistaril which has since been discontinued in that form--so Atarax is 10mg/5cc I think. My gut tells me 50 mg in an average 4 year old is high, but would likely not overly sedate them. It is likely more effective if it were 25 mg in two seperated doses. I do not use it much as a stand alone drug. One advantage is they hydroxyzine can be administered at home before an appointment. "Stronger" drugs like Demerol, Chloral Hydrate, Versed or combinations should not be given at home but under supervised monitored conditions in the office or hospital.

Sorry to go on so much. There is no simple answer to a dosing question without considering many factors.

Dr. Dean Brandon said...

Oh, one more thing--it's kind of weird, but you ask for literature that supports dosing in children--there really is very limited info on this. Why? Because these days it is very difficult to do research studies on children for any kind of medication. Drug effects are often extrapolated from adult studies, case reports and anecdotal information. Pediatricians know what I am talking about.

Anonymous said...

Dr Brandon,
Thanks for your prompt reply. The child is on the small side so we're approaching about 3mg/kg. The lack of literature for pediatric dosing is indeed a problem for us pharmacists. Sometimes it's hard to balance patient safety with interfering with their treatment.
Thnaks again for the reply.

George said...

Yes, we must make sure that our child's dentists are great and are specialists on the field, to ensure great service. And we must choose the right Pediatric Dentist. Great point you have here.

Anonymous said...

Our daughter is 11 months old and her two front teeth are concave. Other than that, she appears to have no issues. Should we see a pediatric specialist about that or is there someone else who would specialize in this? I couldn't find much mention of this issue online--is it truly a problem?

Dr. Dean Brandon said...

A Pediatric Dentist is the most likely professional to be able to address such issues. A clinical examination (taking a look) will let them know if this is unusual or not. There are many causes for tooth malformation (if that is what it is)--let them take a look.

Dentists Edinburgh said...

Parents should be greatly thankful that pediatric dentistry has actually evolved. Thanks for such an informative post.

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Anonymous said...

Hi. My son has stainless steel crowns with white coating. One year past and the white staff is breaking on his four teeth. I don't know what I can do. Is there any way to fix them? Maybe just to put some white staff there? It looks bad: half of the tooth white and half silver. And my son feels uncomfortable, something is wrong in his mouth with his teeth.

Dr. Dean Brandon said...

You can read more here on the blog about white and silver crowns for baby teeth. If it is in the front sometimes you can open upvthe front of the crown and put white filling material in there. Spmetes its easier to replace the crown Still there will be some silver around the edges. Kind of depends on what kind of white material it was. On back teeth. Well as you can read those almost always have the white stuff come off. That's why we almost always use only the silver ones back there with no coating. Like I said there are a few posts over there in the sidebar under fillings and crowns that might be of interest.

Dallas Pediatric Dentist said...

It's really important to know who are our kid's dentists and their expertise coz its our kid's health at stake.
Thanks that I've seen your article, I've learn something from it.

Anonymous said...

My children's new dentist is not a pediatric specialist but he's got 30 years experience and is very good. I'm so happy I found him after we moved to our new place. Unlike our previous pedo and family dentist, our new dentist doesn't limit his treatment based on financial budget or insurance limit. To be honest with you, I did not feel comfortable with him at first because he literally lectured me for more than an hour about my children's teeth. I deserve it though because I should have been tougher. My 3 1/2 year old daughter had 12 cavities before and now all her teeth are still intact with no cavities.

1/2empty 1/2full said...

My 8 yr old son was diagnosed with detinogenosis imperfecta last year. He had been seen by a dentist since he was 3 yr old. I changed dentist because I thought, how did the dentist not notice that before. Literally, one his dental presentation fell apart. No cavities. To a mouth full and DI. Since, changing dentist. I am realizing they don't have a clue how to treat host mouth. Lost in Atl, Ga. Referral greatly appreciated.

Dr. Dean Brandon said...

As big as Atlanta is, I don't know any of the pediatric dentists there well, but I definitely suggest seeing a specialist in pediatric dentistry.

There is a huge group practice here with lots of locations: http://www.dentistry4children.com/

Children Dentists said...

Children also need for their teeth to be cared for. In fact, the moment children develop their teeth, parents should think about taking their children to children's dentists to assess their teeth and also administer proper care to them.


Anonymous said...

I just want to say thank you for helping me feel at ease about my child's next appointment.
My 3 yo needs surgery because her 1st dentist tried to work through her kicking and screaming and all 4 of her fillings fell out. She is a little overweight I feel she was under medicated. My new dentist is not a pediatric specialist and wants to sedate her to fix the initial work. this means possible crowns. I called and got a pediatric specialist and I am hoping it all turns out great. Thanks!

henderson_tj said...

Can a general dentist practice orthodontics in Alabama?

Dr. Dean Brandon said...

IN Alabama, as in many states, a general dentist can do orthodontic treatment (braces), but cannot call himself an Orthodontist, or a specialist in Orthodontics.