Written by: Christina Carter, DMD
We are all dentists first. While we may specialize in one discipline or another, we all work together for the patient’s best interest. The latest trend of specialties joining together is pediatric dentistry and orthodontics. The co-location of the 2 specialties for total management of growth and development is on the rise. Not only does it create a cohesive location for parents to coordinate their child’s care, but it also provides patients with a dental home for all their dental needs. It allows increased communication between doctors for coordinated care and makes treatment more efficient and easier. The workflow becomes more streamlined as patient care and monitoring improve. We are building healthy foundations for bright futures.
A co-located office has many risks and benefits. It can be hard to find a single software solution that meets the needs of providers and addresses the scheduling and billing needs of an office. It may be challenging to find a design style to appeal to all ages. The selection of music throughout the office or the content on televisions may be different. One-size-fits-all is never easy.
We designed our office to be zero-entry (no stairs or obstacles) for stroller and wheelchair accessibility. The dentist affects every sense—taste, sound, touch, sight, and smell. From the moment you enter, we try not to overwhelm you with loud sounds, blaring screens, or sensory overload from playgrounds and décor. Warm, friendly colors and interior design create a calm environment with playful artwork and style. We believe in starting the dental home at 6 months after the eruption of the first tooth or 1 year of age, whichever comes first.
The First Visit
In our exams, especially for those under the age of 3, we do far more than just clean teeth. While we are always providing home care instructions and cleaning teeth, we also discuss parental questions ranging from pacifier or finger sucking habits to fluoride and braces. The internet is filled with ideas that can lead parents in many directions. We discuss habit cessation advice, trauma guidelines, dietary guidelines, and caries risk associated with feeding. In addition, we provide anticipatory guidance on growth and development, as well as evaluation of the airway and the shape of the palate. Habits such as pacifier use, finger sucking, and other non-nutritive habits can have negative effects on developing teeth and bones. Finger sucking habits are harder to stop than pacifiers. Oftentimes, this cannot be reduced until the child is mentally ready to stop. This might be around age 6, but could be much later, such as age 10 or 12. This can have a much greater impact on the developing dentition as the duration of the insult increases. At this appointment, we begin discussing the possibility of a correction in the mixed dentition to restore skeletal harmony. Parents appreciate learning the “power of the habit” in development. We work with the patient and parent to create a plan to stop the habit that also empowers the child and builds confidence.
Anxiety in children is sometimes organic, and other times it is transferred from the parents’ previous experiences. We strive to help patients and parents overcome their fears and learn that dental visits do not have to be scary. Once in the operatory, we have many ways to reduce fears and anxiety. Starting with tell-show-do and other ways to teach our patients, we make every effort to make visits fun and have parents saying, “I wish my dentist were like this when I was a child!”
Our Solutions
We built our office with our patients’ senses and concerns in mind. We have quiet handpieces and a selection of mild flavors to make our visits easier. They range from no-paste prophy angles to Directa USA’s ProphyCare prophylaxis paste. Parents who have concerns about fluoride have great options with ProphyCare HAp, which has a mild taste. By being open to parents’ concerns and patients’ sensitivities, we are able to create a strong doctor-patient-parent relationship, which makes recommendations and treatment easier.
Other little things we do to help ease patients’ concerns, increase comfort, and make us feel better about the environment include using things that look more appealing. The Hygoformic BIO (Orsing) suction is the perfect example. The curly-q shape is whimsical for even the most timid of patients and keeps the field dry. Changing the way things are presented can make the difference between a scary and a successful visit.
The use of handheld portable x-ray systems has made the process of taking radiographs much easier. Smaller sensors and holders, such as the Kimera Bio system (Directa USA), increase speed and patient comfort. Excellent diagnostic images are obtained, time is not wasted, and the patients find it quite easy.
Pain and Anxiety Control
If cavities are detected, we have many ways to make treatment painless. Parents and patients are often afraid of needles. The Dental Pain Eraser (DPE) (Synapse) is a neuromodulation/TENS-based device that works via the gate-control theory of pain, using electrical stimulation to reduce nociceptive signaling. Restorative treatment can be completed in a routine fashion with the DPE. Class I, II, III, IV, and V restorations are all possible. In conjunction, Class II restorations can be completed precisely and swiftly by using the FenderMate Prime and FenderMate (Directa USA). It provides a barrier so the adjacent tooth remains intact. The Fendermate is a wedge-and-matrix all-in-one system that enables quick insertion and quick establishment of contour and contact. Faster, better fillings are the key to a successful pediatric practice.
Sleep Considerations
When patients are screened every 6 months, we ask if their child has been sick often in the last 6 months and how they are sleeping. We evaluate and record the size of the tonsils and inquire about any sleep issues or snoring. Sometimes parents report that patients are terrible sleepers, wrestle with sleep, and snore terribly. Having CBCT imaging in our office allows us to look beyond the teeth and evaluate if there are physical obstructions, such as large tonsils or adenoids. If these are present, we refer to the ENT for evaluation. We send the CBCT to the ENT prior to their appointment. This helps guide the specialist to a better diagnosis. This interdisciplinary screening helps patients identify obstructive sleep apnea.
Collaboration
Having the pediatric dentist and orthodontist under the same roof increases collaboration. If there is a treatment plan question, it can be answered quickly by the 2 providers, and parents can save time between the 2 offices. In addition, hygiene can be better calibrated and monitored between providers. Prevention plans are essential for all patients, especially those in orthodontic treatment. Both disciplines are aware of the recommendations from the other. However, the orthodontic team is seeing the patient more frequently than the pediatric team, so they become the eyes and ears for home care. They are the first to detect developing white spot lesions, which are sometimes common during treatment. Braces and aligners do not cause white spot lesions. Poor home care and biofilm create white spot lesions. Therefore, our team should monitor the dentition and provide shifts in home care to stop the progression. We should be proactive in the medical management of caries at all times, but especially during orthodontic treatment.
As we learn how interrelated pediatric dentistry and orthodontics are, we can see how co-location not only saves time and scheduling for parents, but also allows parents to be more informed, offices to share resources such as the cost of technology (CBCT and intraoral scanners), and to better identify and integrate developing problems. We can help nervous patients feel at ease by seeing familiar faces in a familiar location and build the inner confidence to know they can do it.
Editor’s note: In this article, Dr. Carter explained her philosophy of practice. Please watch her upcoming webinar, where she will demonstrate and discuss all of this with clinical cases.
You can CLICK HERE to sign up for the FREE CE WEBINAR on August 20th.
ABOUT THE AUTHOR
Dr. Carter earned her BS in molecular biology from Haverford College in Pennsylvania and her DMD from Rutgers School of Dental Medicine, where she was honored with earning the American Academy of Dentistry for Children Award, the Pierre Fauchard Award. She completed specialty training in pediatric dentistry, orthodontics, and craniofacial orthodontics at New York University College of Dentistry and NYU Langone Medical Center. A Diplomate of the American Board of Pediatric Dentistry, she lectures internationally and serves as assistant professor at NYU while maintaining a private practice in Madison, NJ. She can be reached at [email protected].
Disclosure: Dr. Carter reports no disclosures.
