The Changing World of Pediatric Dentistry by Joel H. Berg, DDS, MS

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There are many new and exciting things in the world of pediatric dentistry. As the primary caregivers for children's oral health, pediatric dentists are in various leadership roles, along with the American Academy of Pediatric Dentistry (AAPD), in working with various governmental and other entities as the inevitable changes in health care unfold as a result of the Affordable Care Act. Although it remains unclear exactly what those changes look like, the leadership of the AAPD and its members are working hard to make sure that, first and foremost, more children get access to the best dental care possible, and in particular, the most vulnerable children.

Other than in the regulatory and political world, there are several changes going on that are affecting the way dentistry for children is being practiced, bringing improvements to our ability to treat children in the best possible way. First, in the diagnosis of dental caries, the most prevalent disease in children, and the largest unmet need (in terms of its identification and treatment), each day brings new information regarding early caries lesion detection. We live in a world where treating all children the same is no longer acceptable. We must do whatever we can to assess the individual risk of each child and ascertain that the care we provide, as well as the frequency of encounter for that care be adjusted to meet the demands of the risk level. Children at the highest risk for early childhood caries (ECC) must be identified at the earliest possible time in their lives, and aggressive intervention means that many of these children need to have multiple encounters each year to avert disease progression. New technologies and tools are evolving each day, and many are beginning to undergo clinical testing to determine their sensitivity and specificity in predicting which children have the highest risk for disease as evidenced by the "microscopic" presence of disease, determined by a validated risk assessment tool. The cost and devastation of ECC can only be reduced by careful attention to early education of caregivers and other health-care providers, early identification of risk and early intervention to avert disease presenting in the form of cavitation.

In the restorative dentistry arena, there are many inventions that are now established into practice, making practitioners' and patients' lives better. In the anterior aesthetic dentistry for children, zirconia crowns in pre-fabricated form of varying sizes are now available for use in primary incisors, canines and molars. Whereas these durable devices are likely to achieve long-term success in allowing restoration, health and longevity for decayed primary teeth, practitioners must learn a new technique that requires some additional skill, at least initially. New cements that are self-adhesive can also be used to cement these zirconia crowns, allowing a sealed and durable result. In the case of other restorative care, improvements in glass ionomer materials, resin composites and other materials continue to make dental practice for children better and easier while improving the health and well-being of child patients.

Whereas pediatric dentistry is the only specialty that treats a population and not a specific condition, it is clear that every invention in dentistry has implications on the practice of dentistry for children. We must only take the time to assess the suitability of various techniques and products as they are adapted for use in children and ensure that appropriate testing and other considerations are made.

Author's Bio
Dr. Joel H. Berg, AAPD Immediate Past-President, has been a member of the AAPD for 26 years. He attended dental school at and received his pediatric dentistry certificate from the University of Iowa. He most recently served as president-elect (2011-2012), vice president (2010-2011) and the AAPD's District VI trustee (2006-2009). Berg is also a past president of Healthy Smiles, Healthy Children: The Foundation of the American Academy of Pediatric Dentistry. In addition to his leadership roles with the Academy, he is a diplomate of the American Board of Pediatric Dentistry, a fellow of the American College of Dentists and a fellow of the International College of Dentists. Berg is the dean at the University of Washington School of Dentistry. He previously served as Chair of the Department of Pediatric Dentistry and also the Director of Dentistry at Seattle Children's Hospital, and the holder of the Lloyd and Kay Chapman Chair for Oral Health. Berg resides in Bellevue, Washington. He has lectured in more than 35 countries and enjoys studying the viticulture of Washington State. Berg is a national media spokesperson for the AAPD.
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