(Dr. Katherine Fleming, Dr. Michaela Matos, Courtney Chandler, Chris DeFrancesco, February 2023)
Chris: If oral health is part of overall health, then the formative years are a good time to establish and reinforce healthy habits. Today on the Pulse we talk about the importance of pediatric dental care.
This is the UConn Health Pulse. A podcast to help you get to know UConn Health and its people a little better, and hopefully leave you with some health information you’ll find useful with Courtney Chandler. I’m Chris DeFrancesco. Now most parents understand it’s a good idea for kids to brush their teeth twice a day. But there’s probably a little more to maintaining good oral hygiene habits.
Courtney: And February is Children’s Oral Health Month. And today we have two experts from the UConn School of Dental Medicine to discuss some best practices. We welcome Dr. Katherine Fleming from the Division of Pediatric Dentistry, and Dr. Michaela Matos, a first- year pediatric dental resident. Thank you both for joining us today.
Dr. Matos: Thank you for having us.
Dr. Fleming: Thanks for having us.
Courtney: So what are some common oral health issues you see with children? .
Dr. Fleming: Thanks, Courtney. So definitely the most common oral health issue that we worry about in kids is similar to what we worry about in adults, and that is cavities. Unfortunately, cavities are the most common chronic oral health condition in kids, and it, it’s something that we see every day in practice. Children can also have other issues similar to adults like gingivitis and other things, but cavities are really what we spend a lot of time focusing on.
Chris: The saying of “oral health is overall health.” How receptive are your patients or your parents to that, and how do you have that conversation with parents and families, understanding that in the nature of your practice, you’re speaking not only to a child who might not really process the big-picture concept, but also the parent who ideally is going to help reinforce that?
Dr. Matos: I think when it comes to children, parental education is one of the most important things. If you’re talking to the child about different oral health habits, it’s really important to use age-appropriate language, but parental education is really one of the most important things because the parents are going to be modeling those healthy habits at home with the child, brushing their teeth with them, explaining things to them at home. So educating the parent is really the most important, one of the most important parts of our job.
Dr. Fleming: We like to look at parents as partners in this as well. It’s really important that we’re all working together, that we’re all on the same page, doing what we can to not only make sure that their child has oral health as a child, but teach them the habits that they’re going to carry throughout their entire lives.
Chris: And could it be an extension too, if you make good habits, like with your teeth brushing and your dental care, that it kind of maybe lays a foundation for other preventive health measures, not even related to dentistry down the road, just kind of build up that muscle?
Dr. Matos: Absolutely.
Dr. Fleming: Definitely. We often will tell parents, especially if kids are resistant to toothbrushing at home, think of it as another hygiene habit. Think of it as bathing or changing a diaper. It’s something that needs to be done every day to teach your child these important foundational hygiene habits.
Dr. Matos: And the earlier you start, usually the child’s more receptive. So starting at a young age, with these toothbrushing habits or flossing, it becomes a habit that they do every single day. So they go take a shower, they brush their teeth at night, so they become less resistant to wanting to do it the more often you do it and the earlier you start with those healthy habits.
Courtney: Can you talk about the issues that kind of require immediate medical attention versus the issues that should be addressed during routine checkups?
Dr. Matos: Yeah, so anything that’s life-threatening, something such as difficulty breathing, difficulty swallowing, if the child has any excessive bleeding, from either a dental trauma or a recent extraction. Also if the child’s experiencing any dehydration, maybe from not eating or drinking anything for a couple of days due to pain, or a fever, of usually around 102 over a couple of days, those definitely require some immediate attention. But things such as, if you notice the first time when you notice your child might have a cavity or some pain, that’s when it’s really important to contact your dentist for them to be able to see them in an appropriate time.
Courtney: How can a parent spot a cavity?
Dr. Matos: That’s a great question.
Dr. Fleming: That’s a good question.
Dr. Matos: Good question. So sometimes you actually will see a cavitation or a hole on the tooth. So if you’re looking in your child’s mouth, you might notice that either on the top of the tooth or sometimes it’s in between the teeth. You might also notice some staining. That doesn’t necessarily mean that there’s a cavity there, that’s important to note, but it is something that you’d want to bring up to your dentist and maybe give them a call. Let them know that you’ve noticed that, and they’ll bring you in to take a better look.
Dr. Fleming: I think that all this really plays so well to the importance of having what we call a dental home. And this is why we recommend, and our professional organization, the American Academy of Pediatric Dentists recommends, that every child has a regular dentist by the age of one. And a lot of parents are like, “Wow, that’s really early. My kid just has a couple of teeth,” which makes sense. But the reason for that is, we want to have a relationship with the patient, and not just so that we’re checking their teeth and we’re catching cavities before they turn into a bigger problem, but also so that we’re getting the child and the parent comfortable with what it means to go to the dentist. So that’s one of the reasons it’s so, so important that you have a dentist that you’re working with that your child’s familiar with, so we can share with you guys what a cavity looks like and, and hopefully treat it before it turns into a bigger issue.
Chris: When is it time to start that relationship with establishing dental care for your child? How old should the child be and how far in advance do you need to kind of make those arrangements?
Dr. Fleming: That’s a great question. So our guidelines are that we would like to see all children by the age of one, or as soon as their first teeth erupt. Most kids, and there’s a huge variation in normal, but most kids get their first teeth around six-ish months of age, so we’d like to see them somewhere between that six-months-to-one-year age range. In terms of making an appointment, that’s a great question and it definitely depends on the office, but I would definitely recommend calling probably six-to-eight weeks before you’re hoping to see the dentist, just to make sure that you can get in.
Chris: OK. Well this is a UConn podcast. You see patients at the, where is the pediatric dental clinic, in West Hartford?
Dr. Fleming: Our pediatric dental clinic, yep, it’s in West Hartford, 65 Kane Street.
Chris: OK, so using that as an example, six-to-eight weeks, is that what that’s based on?
Dr. Fleming: Yes. So we like patients to call about six-to-eight weeks in advance to get an appointment. Sometimes we’re able to squeeze patients in and see them with less notice, but it’s always easier to plan ahead if possible.
Chris: OK, and is that West Hartford location the only pediatric dental site for UConn Dental School’s practice?
Dr. Fleming: Correct. Yes. So that’s our main clinic site. We do also offer treatment in the operating room here at John Dempsey Hospital as well as at CCMC, Connecticut Children’s Medical Center.
Courtney: So let’s go back to emergency dental situations. How do you calm a child’s nerves? I mean, I guess you could also talk about a routine dental appointment as well. But especially in like an emergent situation, how do you reduce anxiety?
Dr. Matos: Yeah, that’s a great question. I think in an emergent situation, the children kind of adopt the fears of anxiety that the parent or guardian might have with them at that time. So it’s really important for the parent, or whoever’s with them, to try to stay as calm as possible. Maybe if they enjoy reading books or watching a certain show, just to keep the child as calm as possible in those situations, it could be really difficult.
In terms of just the dental office there’s a couple things that you can do to kind of reduce or prevent anxiety or fear that a child may have. Similar to the emergent situation, it’s really important to talk at home about the dentist in a very positive light. Because children can adopt the fears of anybody in the house. It could be siblings that have gone to the dentist, parents that might be talking about it in a negative way. Then the child might fear going to the dentist.
Another really important thing that you can do is have books at home, that might be a book about going to the dentist, so the child can really familiarize themselves with what they might expect — “We’re going to count your teeth, we’re going to use a mirror, you’re going to sit in this chair.” — and so the situation, the environment of the dental office, will become more familiar to the child.
Another thing that you can do that children actually really like doing as well is role-playing. So you and your child, you can say, “Let’s pretend like we’re going to the dentist,” and you could pretend to count their teeth or do it on their favorite stuffed animal, or even siblings back and forth, and the child will get really excited about doing it. So you can say, “Now why don’t you do it to your stuffed animal,” or “Why don’t you do it to your brother?” And so that when they come to the office, now when the dentist does it, they know exactly what to expect and they’re excited about it.
Chris: We all very unique approaches of parenting. Have you encountered the theory that, “I want you to fear the dentist a little bit, because if you don’t have good oral health habits, then you’re going to have to go to the dentist and get a cavity filled, and that’s not a pleasant experience”?
Dr. Fleming: I mean, we do our best to make it a pleasant experience. This is probably not our preferred approach. I always tell parents, “We’re very nice people. I promise you. We want to do everything we can to make this as easy as possible for everyone involved.”
And I think you’re right though. I think you hit on something that’s true, which is, it’s a little scary to go to the dentist as a child or as an adult. It’s an invasive thing to have someone’s hands in your mouth. And so, like Dr. Matos said, it’s really important that we prepare kids, but that we do it in a neutral or positive light, so they understand what’s coming, but they also know that it’s not something to fear, that we are there to help them. And really our goal, as we mentioned earlier, is to have built this relationship with the patient ahead of time. So if we’re seeing them when they’re little, typically the first few visits, we can avoid having to do any invasive dental care and build that relationship so that they know that they can trust us and that they’re safe with us. And then hopefully avoid needing to do any care for years. But our goal is always to have built out foundation first.
Chris: Before we go, and we do have a couple minutes left, but I wouldn’t mind hearing just a little bit about the arrangement, the pediatric dentistry program, what you’re learning, are you one of the mentors or one of the residency directors for that, and that’s how we ended up with both of you here together today?
Dr. Fleming: Yeah, absolutely. So I’m a faculty member in the Division of Pediatric Dentistry. I work with the predoctoral dental students as they learn the foundational pediatric dentistry skills. And then I’m also a preceptor or an attending in the pediatric dentistry residency clinic.
Chris: Dr. Matos, are you seeing patients in West Hartford with Dr. Fleming and others?
Dr. Matos: Yes, we are. So we’re seeing patients at the West Hartford Clinic, and then, like Dr. Fleming mentioned, we’re also taking patients to the operating room at a couple different locations as well.
Chris: And how long is the pediatric dental residency program? You’re in the first year, right?
Dr. Matos: Yes, I’m in my first year and it’s two years long.
Chris: OK. And then after that is, is she ready to go out into the world or is there additional training after that?
Dr. Matos: Hopefully. I’ll be ready. I’ll be ready.
Dr. Fleming: I think our wonderful Dr. Matos is ready now, but she’s definitely, after two years training, we have a board certification process similar to many other specialties. So we complete that usually after another additional year of practice.
Dr. Matos: There is actually something that I wanted to mention. We mentioned a couple of emergencies and, and one that I should have mentioned earlier is, what if your child loses and the tooth actually comes completely out of their mouth? We have this fancy term, it’s called avulsion of the tooth. With baby teeth, it’s not an emergency. There’s a couple other things that we’d like to check for, but with a permanent tooth, it’s really important. It’s very time-sensitive. So if your child does — in any sort of, a lot of times it’s like sports or falling — if they actually lose that permanent tooth, it’s very time-sensitive. And there’s actually a solution that you could buy at CVS and Walgreens, it’s called Save-A-Tooth. Or if you don’t have that readily available, you can actually place it in milk. You want to make sure that you’re not touching or tampering with the tooth too much. And it’s really important that you call your dentist or go to the emergency room, where we can reimplant that tooth to try to give it the best possibility of being able to save that.
Courtney: So going back to like a baby tooth though, say I have a toddler, he’s 20 months old, he’s very rambunctious and he falls and like cracks a baby tooth. So that’s not as bad of an emergency, but could that have potential consequences down the line for where that tooth was?
Dr. Matos: So, I mean, with any dental trauma, there’s some unfavorable outcomes that you’d wanna watch for. This could kind of range from, and it depends on the trauma of course, but it can range from it potentially becoming infected in the future. Even with fractures, you can have different types of fractures. The tooth has a couple different layers. If it’s a very superficial fracture or chip of the tooth, it’s not as emergent as, for example, if it might have fractured into the center of the tooth where your nerve is, that might transmit pain to the child. So of course, if it fractures to the center of tooth and the child’s having some pain, you definitely want to contact your dentist to be able to get in as soon as possible and for them to be able to triage from there.
Courtney: Yeah. This is also a good reason why it’s important to have a dentist lined up so early.
Dr. Matos: Exactly.
Dr. Fleming: Exactly. Yeah. Unfortunately it’s not uncommon, as you know, with a 20-month-old, as toddlers learn to walk, we do see dental trauma in kids fairly frequently. It’s not uncommon. And most of the time, as Dr. Matos said, it’s not always an emergency with the baby teeth. But again, like you said, another plug for having a dental home, having a dentist office that you can call and let them know what the situation is so that they can give you individualized recommendations.
Chris: Dr. Katherine Fleming and Dr. Michaela Matos from the UConn School of Dental Medicine. Any final tips for parents before we say goodbye?
Dr. Fleming: My favorite tip is always to have a two-minute timer, just to help remind yourself how long to brush your kids’ teeth for.
Chris: All right. And that goes for grownups too, I happen to know.
Dr. Fleming: Yes. Absolutely.
Chris: Very good. And at what point does the conversation about orthodontia happen? At what age generally?
Dr. Fleming: So it depends. There are issues, sometimes we see issues in younger kids that we recommend orthodontics a little bit earlier, but typically I believe the American Academy Orthodontics likes to kind of have a general check of kids around age 7, and a lot of kids are not ready for actual orthodontics until all of their permanent teeth are in, which is usually somewhere in the range of 12 to 14 years of age.
Chris: That is our time for today. For Dr. Fleming and Dr. Matos, and Courtney Chandler, I’m Chris DeFrancesco. Thank you for listening to the UConn Health Pulse. Be sure to subscribe, so you can catch us next time, and please share with a friend.