Specialty selling: pediatric dentistry
Prevention is the focus of early childhood dentists
Most kids go to a pediatrician several times in their first year of life. But how many visit a pediatric dentist? Not many. And even fewer if they’re from low-income, underprivileged families. But the American Academy of Pediatric Dentistry (AAPD) is trying to change that. And partly because of their efforts, the specialty of pediatric dentistry is enjoying something of a renaissance.
"There is a growing crisis - a pandemic - of early childhood caries," says Joel Berg, DDS, professor, Lloyd and Kay Chapman Chair for Oral Health, Department of Pediatric Dentistry, University of Washington School of Dentistry. He also serves as a spokesman for the American Academy of Pediatric Dentistry. The issue was brought to light in 2000, with publication of "The Surgeon General’s Report on Oral Health," by then-Surgeon General David Satcher, M.D. The report focused on the link between oral diseases and craniofacial disorders and total health and well-being, and it discussed the huge unmet need in pediatric dental care.
It wasn’t the first time that the issue had been raised. One year prior to the Surgeon General’s report, the American Academy of Pediatrics formed a Section on Pediatric Dentistry and Oral Health to improve communication between pediatricians and pediatric dentists, and to provide an educational forum for the discussion of problems and treatments related to oral health.
Then, in 2003, the AAP published a formal policy for its members on oral health, titled "Oral Health Risk Assessment Timing and Establishment of the Dental Home." In it, the Academy stated that "an oral health risk assessment before 1 year of age affords the opportunity to identify high-risk patients and to provide timely referral and intervention for the child, and allows an invaluable opportunity to decrease the level of cariogenic [cavity-causing] organisms in the mother with a significant caries risk before and during colonization of the infant."
Desirable field
Pediatric dentistry is defined as "an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral healthcare for infants and children through adolescence, including those with special healthcare needs." To become a pediatric dental specialist, the dentist must satisfactorily complete a minimum of 24 months in an advanced education program accredited by the Commission on Dental Education of the American Dental Association.
There are fewer than 5,000 practicing pediatric dentists in the United States today, says Berg, who is co-author of the recently published Early Childhood Oral Health (Wiley-Blackwell). "We’re trying to grow that number," he says. And the industry’s efforts are succeeding. "About 10 years ago, we graduated about 250 pediatric dentists per year. Now we’re nearly up to 350. We’d like to go higher, but the training is expensive."
Right now, it’s a desirable field for young dentists. "Over the last several years, the number of applicants has dramatically gone up, whereas [applicants] in other specialties have gone down," says Berg. Part of the reason is the Surgeon General’s report. As awareness of the need for early dental checkups has grown, so too has the need for pediatric dentists. Another boost has been Title VII, a government program designed to expand access to primary care, including primary dental care.
Yet the opportunities for growth in the specialty are enormous, says Berg. Despite the growing awareness of the need for childhood dental visits, a relatively small number of kids actually see a pediatric dentist. And of those who do, more than two-thirds are being treated by a general dentist, while only 30 percent are treated by a pediatric dental specialist.
Parents: Don’t put off the first visit
AAPD strongly advocates early childhood dental visits for one simple reason: To delay is harmful. Kids whose first visit is delayed until, say, age 3 can manifest very severe early childhood caries, says Berg. They can have as many as 10 to 15 cavities, some of which can extend all the way into the pulp. The result may be facial swelling to the point where the child needs oral surgery. In fact, among the country’s children’s hospitals, dental care is one of the top three reasons for outpatient general anesthesia. Kids ages 2 through 4 years old may have to wait up to six months to receive restorative care.
That’s why it’s important to get kids in by age 1, so the pediatric dentist can determine whether they are at high risk for more severe dental conditions. They’re particularly watchful for the 20 percent of the pediatric population who account for the lion’s share of the disease.
Medicaid covers pediatric dental care, but reimbursement is problematic, because much of what the pediatric dentist does is evaluating and counseling. Pediatric dentists spend much of their time counseling parents on how to brush their kids’ teeth, how to establish a proper fluoride regimen, and how to ensure good dietary habits. "We can offer anticipatory guidance, talking to parents about preventing disease," says Berg. "It’s a paradigm change." Indeed, while internists on the medical side are rewarded for their knowledge rather than for performing procedures, dentists are expected to repair damaged teeth. "Most of dentistry is fixing cavities," says Berg. "But we’re going to see a shift toward more early intervention and disease prevention in high-risk children."
Part of that shift is evident in the state of Washington, which instituted the Access to Baby and Child Dentistry (ABCD) Program about 13 years ago. Dentists can receive continuing education in early pediatric dental techniques and are certified by University of Washington Pediatric Dentistry staff. This qualifies them to receive enhanced reimbursement from the Department of Social and Health Services for selected Medicaid preventive service codes for enrolled children.
"One of the big things that needs to change in dentistry - and it will - is that dentists need to be paid for their knowledge and advice, like internists," says Berg. The need is greatest for pediatric dentists, whose greatest value lies in counseling, evaluating and disease prevention, rather than treatment and procedures.
Berg is particularly excited about a project for which he is the director - the Washington Dental Service Building for Early Childhood Oral Health (ECOH). Scheduled to open in September 2010, the building - which is a converted naval base air traffic control tower - will serve as a regional center for pediatric dentistry. The 28,000-square-foot facility is a collaboration of the University of Washington School of Dentistry and Seattle Children’s, and it will house 31 dental chairs and three operating rooms. The emphasis will be on teaching, education and prevention.
"Our main objective is to demonstrate the problem of early childhood caries," says Berg. "We can study best practices and come up with creative solutions for managing the disease." Those solutions can help the people of western Washington, and can then be shared with caregivers around the world.
Berg recently traveled to Peru to study dental disease in children there, as part of the First Lady of Peru’s Project Sembrando. Upon returning, he reflected, "Dental disease in children is one of the few conditions that is just as severe, if not more severe, in developed parts of the world as in developing parts of the world. This fact enables the ECOH program to study and create solutions locally, and assist in their delivery both locally and internationally."
|
|
|
