Among the most troubling problems in dentistry is the tiny number of doctors trained to care for children, for whom the caries rate is exploding around the world. According to the Centers for Disease Control and Prevention, tooth decay affects more than one-fourth of U.S. children aged 2 to 5, and the number swells to one-half of those between 12 and 15. By their 17th birthday, 80 percent of American adolescents will have caries. Altogether caries present a greater public health threat to kids than such chronic diseases as asthma and diabetes. And just as those conditions have alarming outcomes when ignored, so do untreated caries, sometimes culminating in emergency services—and bringing the calamitous expense of that kind of care. Experts predict the problem of deferred care to continue, along with its financial and health consequences, as more people lose access to both insurance benefits and government-funded care. No matter the economic climate, the need for more pediatric dentists is compelling—only 5,000 practice in the country out of 183,000 dentists overall. So why do so few doctors choose to enter the field? One reason is the simply the small number of educational spots. Current post-doctoral programs in pediatric dentistry graduate only around 300 specialists annually. Another factor is financial incentive: pediatric practices are perceived to be less remunerative than those concentrating on adults. Then there's also the practical complication of caring for patients with behavioral issues. In the past physical constraint was the only tool dental staff possessed when faced with petrified, squirming children. That approach was not only traumatizing to the patient and parent it distressed the doctor as well. "I remember coming home and thinking I just didn't want to practice dentistry anymore if I had to do it this way," recalls Roger Sanger, DDS. Dr. Sanger is a pediatric dentist in California. The availability of relief for pain and anxiety—in both the medical and dental fields—has historically been uneven. For children progress has been even slower. That's because myths persist about children's experience of pain. Experts say the long-debunked notion that kids simply don't "feel" pain as keenly as adults do frustrates both their assessment and treatment. If anything, researchers think children may actually be more sensitive to pain, perhaps because of still-developing inflammatory response and nervous systems. They further theorize that feeling pain at a young age—while only dimly understanding the reasons for it—can make dentistry even more traumatic when the same patient presents for care as an adult. The American Pain Society and American Academy of Pediatrics have jointly urged that pain be recognized and treated more aggressively in children. The American Academy of Pediatric Dentistry also recognized the need for sedation in more settings. Several years ago it revised sedation guidelines, in part to "unify" care provided by medical and dental practitioners. Dr. Sanger's Central Coast Pediatric Dental Group—which operates several offices and a surgicenter in and around Salinas, California—has performed over 6,000 oral sedation cases. He discovered that its safe application served a two-fold purpose. First, he says, pediatric sedation offered a humane option to an underserved group. Secondly, it reinvigorated the practice. Along with his partners Drs. Peter Chiang and Kenji Saisho, Dr. Sanger teaches pediatric oral sedation to dentists around the country. He's the Director of Pediatric Sedation for DOCS Education. Despite the solid track record, misinformation continues about the wisdom of oral sedation for children. According to Dr. Chiang, who performs an average of 20 oral sedation cases each week, innovations in pharmacology, patient monitoring and emergency preparedness continue to elevate the safety profile. "Careful patient selection and adherence to protocols are also important, and we cover these areas carefully in our classes." Providing sedation won't by itself end the caries crisis or the shortage of pediatric dentists, but it will expand the number of places where children can receive care, believes Dr. Sanger. "We really need the help of the general dentist to make sure all children get the help they need and deserve. It's time for all of us to step up."
