Introduction

Treating Children in the New Millennium: Current Issues and Future Trends

As dentistry approaches the new millennium, it is with the hope that our practices are successful and that we continue to receive enjoyment from treating the different patients who utilize our services. For many of us, whether we are general dentists or specialists, a significant number of our patients will include children and adolescents. This population presents many unique challenges that make it timely to explore issues that relate to treating children today and in the future.

Although much has been accomplished in our efforts to reduce dental caries in children, it still remains "a common childhood condition in the United States; the vast majority of children are affected to some degree by the time they reach adulthood."¹ We have learned that in studying the demographics related to dental caries, they are disproportionately skewed toward children with higher risk. Approximately 25 percent of the children have approximately 80 percent of the need.² According to Waldman, this population is expected to increase significantly in California by the year 2020.³

In critically looking at the current paradigm for preventing dental caries, it becomes apparent that we still need to improve and refine our methods. If we now consider caries to be a transmissible disease and focus our efforts in prevention at a much earlier age (and with a somewhat different armamentarium and philosophy), then perhaps we may better prevent the destruction it causes. The paper, "Newer Approaches to Preventing Dental Caries in Children," discusses these considerations and offers a somewhat different way of looking at prevention in young children.

The issue of the increasing numbers of children in California is one that will affect the profession -- both general practitioners and pediatric dentists. How we are able to accommodate these additional children, many of whom will be from lower income families, will largely depend on our available resources. According to Waldman’s projections, we may be facing a relative shortage of pediatric dentists in California in the next 20 years.³ In dealing with the changing demographics, new strategies will need to be considered. These may include the involvement of more general practitioners who are willing to treat this population, changing the California licensing laws, and/or encouraging the training of more pediatric dentists in the state. These issues have been visited by the California Society of Pediatric Dentists as well as the American Academy of Pediatric Dentistry on the national level. "Workforce Issues in Pediatric Dentistry: Recommendations of a Recent Conference" provides a discussion of these issues and the results of a recently held conference.

Another issue that affects the delivery of dental care to children is one of treating the reluctant or difficult child in the dental office. Many offices utilize oral conscious sedation during the process of performing dentistry on children. For the most part, this is a safe and effective means to facilitate dental care for this population, if provided by a well-trained and "cautious" practitioner. However, following recently reported deaths of children in dental offices and corresponding coverage by the news media, the California Board of Dental Examiners and the state Legislature have introduced changes to the dental practice act (Assembly Bill 2006) that will have a significant effect on our practices beginning Jan. 1, 2000. These changes are intended to better safeguard the well-being of children undergoing oral conscious sedation, whether in a general or specialty office, but will impose stringent requirements on those who continue to offer this service. The article, "Pediatric Oral Conscious Sedation: Changes to Come" is intended to provide information regarding the development of these changes and to outline the new requirements involved in obtaining oral conscious sedation certification.

Also of interest to those who treat children are the many dental materials that have been borrowed or adapted for use on primary teeth from their use on permanent teeth. We have utilized some of these materials for many years, with good clinical success. We’ve been eager to try some of the newer materials that promise improved handling, esthetics, wear, etc. Sometimes, medicaments that work well in the permanent tooth do not perform as well in the primary tooth, and many of our decisions are based on empirical information. The article, "Effects of Materials Used in Pediatric Dentistry on the Pulp" revisits some of the materials that we used in the treatment of primary teeth and provides a rationale for many of our clinical findings.

Finally, an important consideration in the treatment of children in our practices relates to their vulnerability. Child abuse and neglect are realities in our world, with approximately 3 million cases reported each year. One-third of these cases are eventually substantiated.⁴ As mandated reporters, we have a moral and legal obligation to report suspected cases. The number of cases actually reported by dental professionals is small, considering that many of the signs and symptoms can be noted periorally.⁵ In an effort to educate the profession, many states have set up coalitions, such as Prevent Abuse and Neglect Through Dental Awareness. "Reporting Child Abuse and Neglect: Responding to a Cry for Help," provides a practical discussion of the mechanics of reporting suspected child abuse and neglect and can be used to help train the dental team.

The material included in this issue of the Journal was chosen both to be clinically relevant and to stimulate discussion. It is hoped that the material will provide the reader with some useful information in treating children today and in the future.

Contributing Editor/

Richard D. Udin, DDS, is the chairman of the Department of Pediatric Dentistry at the University of Southern California School of Dentistry.

References/

1. Vargas CM, Crall JJ, Schneider DA, Sociodemographic distribution of pediatric dental caries: NHANES III, 1998-1994. J Am Dent Assoc 129:1229-38, 1998.

2. Kaste LM, Selwitz, et al, Coronal caries in the primary and permanent dentition of children and adolescents 1-17 years of age: United States, 1998-1991. J Dent Res 75(Spec Iss):631-41, 1996.

3. Waldman HB, Planning for the children of your current pediatric dental patients. ASDC J Dent Child 62:418-25, 1995.

4. National Child Abuse and Neglect Statistical Fact Sheet. National clearinghouse on Child Abuse and Neglect Information. Washington DC, July, 1999.

5. Ramos-Gomez F, Rothman D, Blain S, Knowledge and attitudes among California dental care providers regarding child abuse and neglect. J Am Dent Assoc 129:340-8, 1998.