D: Dan Goldberg / J: John (Radio Host)
J: Welcome back. My guest today is Dr. Goldberg of Go Dental in Calgary, Alberta. Doctor, it has been a fascinating conversation; we are learning about the importance of diet and about chocolate and high cocoa content. We talked about how going to the dentist can prevent of heart disease, so this has been a wide-ranging conversation – one of things you have talked about in a previous section of the conversation was the chewable vitamins and how they are bad for children’ teeth. I was wondering if you could talk a little bit about the importance of children to see dentist on a regular basis and how you work with children in your practice?
D: I am just going to clarify, you actually said “chewable vitamins.” Chewable vitamins are good, the gummy vitamins that are my concern. I just wanted to clarify that.
J: Oh OK. Talk to us about the importance of children going to the dentist.
D: The Canadian Dental Association recommends that the first time a child should come to the dentist is at the age of one. And you might be thinking yourself “One!?”, “They can’t even walk at one!” (Laugh)
J: Yeah, that’s what I am thinking, like “Wow, they might not even have teeth!”, right?
D: Generally speaking, the first tooth comes up at 6 months, so, the Association recommends that six months after that tooth comes in they should visit the dentist, and so usually it’s about aged one. The reason for that is primarily for educating the parent. You know some kids they are born with cavities. And…
D: Not born with cavities, let me clarify. When the tooth comes in, they are prone to get cavities. There are also some genetic conditions that the teeth are weak and that are not protected well and that is probably the number one reason why a one year old can get a cavity. Also the main thing is just getting the child used to come into the dentist. You know, so they don’t have that fear. It’s like a fun thing. We give them toys, we make it a fun experience and at the end if they do that on a six months basis, you know, by the time they are four, hopefully they love the dentist.
J: I have a question for you. I know it’s going to sound bad, but I am sure it goes through people’s mind. They are kids, they are baby’s teeth, they are going to fall out anyways; why worry about the cavity in a baby tooth?
D: You know that’s a valid question and sometimes we don’t have to worry about if there is a cavity in a baby tooth. It’s fine, it’s going to fall out but it’s usually when they get to the age of 11 or 10. If the tooth is loose, there is a cavity in it, there is no point fixing it that point, although there might be a reason to take that tooth out ahead of time.
D: You know, a lot of things can happen when, you know, if a child gets a cavity at the age of four and we see that all the time, that tooth has to last another eight years. And so, if they just leave it like that, there is going to be an infection, a lot of pain, it’s going to cause a lot of problems and so you can’t just leave it like that.
J: It matters and I guess it’s also important to get into the habit of going to the dentist on a regular basis.
D: Definitely! And the other thing I did not mentioned was, children's teeth are very different that adults’ teeth.
J: How so?
D: Well, children’ teeth are much smaller so the top layer of a tooth which is called enamel is a lot thinner compare to an adult. So when a child gets a cavity it spreads much quicker than it would with an adult. So, time is of the essence with children.
J: Can it cause damage to the adult teeth that grow in?
D: Absolutely. There are a lot of things that can happen, but the two most common things: is if there is a big infection on a baby tooth, this can cause trauma to the adult’s tooth. It can cause discoloration, it can cause the tooth from not coming in properly, and it also causes massive infection through the body.
J: So, what other things do you do to work with children in your practice?
D: We believe in just making them feel really comfortable. The one strategy, the main strategy that I use to make children comfortable, and we call it “Tell, Show and Do.” It’s a very basic principle, but John, it works great. So what is “Tell, Show and Do”? This somehow also plays into my psychology background as well. So, “Tell,” it’s pretty obvious, we just tell them what we are going to do. It sounds easy, but a lot of people don’t do that. They just get right into it and the child has no idea and gets scared. And it’s really important you tell them what you are going to do, so they know what to expect.
J: That makes perfect sense.
D: But you don’t stop there because if you just tell them, they don’t really necessarily understand all the things we do; we have to show them. It’s really interesting, we have all these different types of terminology that are not complicated to explain to the patient and show them what we are going to do and so, for example, just run through a scenario if we are going to do. If a child has a cavity, the first thing we will do, I take my drill, I press it, I turn it on and water sprays out. And I tell the child, “OK, well this is my water gun and what we do is we need to clean your tooth because it has a sugar bug. So, with this water we will clean the bug inside your tooth.” And I take their fingers and I spray their fingers with water and I say “That did not hurt at all. Did it?” and they are like “No, that was fun!” and they start laughing usually. After that part, we have something that cleans the tooth, we call it the blue shampoo and we use that, we put it on my finger and I show them, that’s how it looks like and I rinse it off and I said “It tastes a little bit sour so you don’t really want to taste it”, and after that we show them then we use this brush here and I’ll have them feel the brush with their finger and I’ll say “Does that feel hard? Soft?” and they’ll say “No, it feels soft”, so I am like “Yeah, let’s put some on your tooth.” And next part, we show them the filling, what the filling is and then I take the finger and put the filling material right on there, fingernail. That’s the part kids love, OK. The filling material comes out like a liquid, in a gooey type of way. And so I mould it onto their fingers and they are feeling with their hands, and then I’ll say, “Now we are using this special light, OK. There is this curing light that will change the filling from soft to hard.” And they see the blue light going on their finger and I say “hey, now, can you feel your finger? What does it feel now?” And they are like, “Oh! It’s hard now!” and I am like, “Yeah, is it not like really cool?” and they are like, “Yeah, it’s great.” And I am like, “OK. Now, you understand what we are going to do? Now, we have to do that in your mouth.” And if they get anxious at any point, I would be like, “Remember, when we put the blue shampoo on my finger?” and they would be like, “Yeah.” That’s all we are doing right now. They feel way more at ease and relaxed, and I am usually like, “Remember I said it will only take two minutes to do this, well that’s how much time we have left.” And so, you constantly check in with them and I always tell them, “if anything bothers you, you need to raise your hand and I will stop right away.” And they are really good. Because you know when you have your mouth opened, you can’t talk at all. The last thing I want to do is to have someone move around because it’s dangerous and we want to keep things safe. So I say, “Raise your hand and we will stop right away,” and we try that before we do anything: “Remember I told you to raise your hand. Why don’t you use raise your hand to show me how that works?” And we sort of do it, just pretend and… you know, we spend of lot extra time going through the all process but it works, it’s such a great tool to use and in fact, it’s such a great tool. I don’t use the same all terminology but I even use it on some adults!
J & D: Laughs.
J: OK. That probably works.
D: So, there is one time I am going to mention. Recently I was working with a child and I was using that technique, and I will be honest, it does not work for everyone. I’d probably say it works 99% of the time, but there are some children who have been traumatized in the past. We haven’t done anything to them, and they actually walk to the reception room crying. They know what’s going to happen and they don’t want to be there. Sometimes, they don’t know what’s going to happen and they have never been to the dentist but they just see a doctor’s office. Maybe at some point they got immunized and they were traumatized by the needle, and they have historically had bad experiences in a medical office. There are a lot of times we could not even get them into the chair. Sometime we have to consider sedating the patient. And that’s another option too. But with children, you definitely can sedate them, but it adds another dimension of a risk to the procedure and we really want to avoid that if we can. So, one thing I want to mention, there is a time, not too long ago, I was working with a child and it was not working out. We just could not get the procedure done unfortunately. So, I was ready at that point to suggest, we maybe should sedate the patient and luckily, I have another dentist working with me. Her name is Dr. Moussa. I stepped out of the room and discussed with Dr. Moussa if she wants to try to help me out to see if she can help the patient and fix her tooth. And, that’s maybe a story Dr. Moussa can talk about.
J: OK. We need to take a quick break but when we come back, we can talk to Dr. Moussa for a couple of moments.
D: OK. That sounds great.