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Bright Futures by Dr. Ashley Lerman

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Categories: Pediatric;
Bright Futures 

3 considerations for general dentists when it comes to pediatric patients

by Dr. Ashley Lerman

When it comes to pediatric patients, a few key considerations can make a significant difference. Understanding the link between childhood and adult cavities, emphasizing early prevention for those often overlooked 6-year molars, and utilizing innovative tools and resources can help us provide better care and set our young patients up for a lifetime of healthy teeth.


1 Understanding the correlation between childhood and adult cavities
Let’s start with a scenario many of us encounter: the young patient with their first cavity—or, more commonly, parents bringing in their children and being completely unaware of decay present in their mouths. It’s easy to dismiss a single cavity in primary teeth as a minor issue, but research shows that a single cavity in those teeth can triple the likelihood of cavities in adult teeth.

I recall a 5-year-old girl who came in for her first set of radiographs and had cavities between all of her posterior molars. Her parents were initially unconcerned because they thought primary teeth didn’t matter much, so we discussed how primary teeth are placeholders for adult teeth and how cavities in primary teeth can set the stage for future dental problems. We also discussed that the primary molars tend to fall out between ages 9 and 13 and that decay, once in the dentin, spreads faster in primary teeth. Early intervention is crucial; treating that initial cavity and instilling good dental habits early on sets up our patients for healthier smiles later to ensure decay doesn’t progress to the point of pain or infection.

Talking to parents about the importance of early dental care can make a significant difference. Explaining how primary teeth aid in chewing, speech development and guiding permanent teeth can help them see the bigger picture. So the next time you see that incipient cavity, consider it an opportunity to educate and set the foundation for long-term oral health. Discussing that decay is a process and can be stopped is important. Once treatment is completed, decay can return if habits, diet and behavior do not ameliorate.


2 Emphasizing early prevention for 6-year molars
The 6-year molars—the first posterior permanent teeth to break through—are notorious for getting cavities. They’re hard to reach and have deep grooves that trap food. Surprisingly, many parents are unaware that these molars are adult teeth and not just another set of primary teeth. They come in behind the existing primary teeth, making them easy to overlook, yet they are the teeth most commonly affected by decay. Making parents aware that these teeth will come into the mouth and be there for the rest of the child’s life is an important first step: awareness!

One strategy that has worked well in my practice is the application of dental sealants. Sealants act as a protective barrier against decay, and I’ve seen that kids who got sealants early on have significantly fewer issues with cavities later.

Fluoride treatments are another effective preventive measure. I had a 6-year-old patient whose parents were vigilant about his fluoride treatments and home care. His 6-year molars were in excellent condition, even a year after they erupted. Fluoride can fortify young teeth effectively and hopefully maintain them throughout adult lives.

Diet is also crucial—limiting sugary snacks and drinks can go a long way. Often simple-carbohydrate snacks like chips, crackers and pretzels, which are salty, aren’t thought of as being “bad for the teeth,” but they can pack into the grooves of the molars and be cariogenic to susceptible surfaces of teeth. Encouraging a diet rich in fruits, vegetables and dairy can help keep those 6-year molars healthy. Regular checkups are essential for catching early signs of decay and providing professional cleanings and fluoride treatments.

Equipping parents with the knowledge and tools to properly clean these hard-to-reach molars is vital. I often recommend angled toothbrushes or electric toothbrushes designed for kids, which can make it easier to reach the back of the mouth. Parents and caregivers should help kids brush their teeth until the kids can tie their own shoes, and the parents should still check once this milestone is reached. We all know when kids rush to get the chore of brushing their teeth done! Demonstrating the right technique during a dental visit can also empower parents to help their kids maintain better oral hygiene.


3 Using innovative tools and resources
In today’s digital age, we have numerous tools at our disposal to support our young patients’ oral health. Educational tools, digital apps and personalized health insights can transform how we approach pediatric dental care.

Take digital apps, for example. I regularly recommend to parents some excellent apps that turn brushing into a game. One app I particularly like uses a virtual “brushing buddy” that guides kids through the brushing process. It’s fun and effective, and I’ve seen improvements in my patients’ brushing habits because of it.

Habit logging is another useful tool. I had a family who struggled to keep track of their child’s brushing routine. We started using a habit logging app and it made a huge difference: The parents could see patterns and areas where their child needed more encouragement, and I could use that information during their visits to tailor my advice.

Digital trauma guides are also incredibly helpful. Imagine a parent calling after their child has knocked out a tooth. Having access to a step-by-step guide can help them manage the situation calmly and effectively until they can get to the office. It also allows them to store their “dental home” in their phones so they can contact their dentist ASAP if an accident occurs. FAQs for parents are invaluable. I often get the same questions about teething, thumb-sucking and dental sealants. Having a well-curated FAQ section on your website or as a handout can save time and provide reliable information to parents.


Conclusion
Whether it’s applying dental sealants, recommending the latest brushing app or having that important conversation about diet with parents, every bit of effort contributes. By staying proactive and informed, we can have a substantial impact on our patients’ oral health. Sharing what works and learning from each other in our field can enhance the care we provide. And, of course, refer patients to one another if in doubt on a case, to have another set of eyes take a look!
Author Bio
Dr. Ashley Lerman Dr. Ashley Lerman—a pediatric dentist, mom and diplomate of the American Board of Pediatric Dentistry—earned her DDS from Columbia University and specialized in pediatrics at Columbia- New York Presbyterian. Driven to enhance oral health and education, particularly for pregnant women and kids, Lerman founded Firstgrin, an initiative that collaborates with OB-GYNs and pediatricians to promote early oral health and connects parents to providers. She is an active member of the American Academy of Pediatric Dentistry and the American Dental Association.
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