Pediatric dentists take away pain of visit

By Suzanne Monson
Special to The Seattle Times

	STEVE RINGMAN / THE SEATTLE TIMES Pediatric dentist Dr. John Liu jokes with 5-year-old Maggie Fagan of Bellevue after giving her a checkup at his Issaquah office.

Dr. Jon Dallman has a stash of toys most kids would drool over.

The toys, plus "Mr. Thirsty" and the lobby aquarium stocked with tropical fish, are just part of what Dallman calls his "bag of tricks" — the strategies he uses to ease anxiety among even the youngest patients he sees at his Bothell clinic.

Like other pediatric dentists — often called pediadontists — Dallman is a dental-school graduate who completed an extra two or three years of specialized training to treat children.

The American Academy of Pediatric Dentistry (AAPD) forecasts this health-care specialty will see a shortage of providers in many pockets of the country in the face of growing patient needs.

Indeed, reports one AAPD study, of the 142,000 dentists in the U.S., fewer than 4,000 are pediatric dentists. Hardest hit: rural and remote areas.

"We don't have a problem here or in places like Spokane," says Issaquah dentist Dr. John Liu, a national spokesman for the AAPD. "But when you talk about places like Wenatchee, it's a different story."

This employment need is compounded by a surge in young patients. Nearly 50 percent of all children entering school have cavities, the AAPD report indicates. Maintaining good dental health is especially tough for children with special needs and those from low-income families.

This need is what prompted Liu to continue beyond general dentistry into this specialty.

"The big eye-opener for me — what really made me choose my work — was when I was doing hospital dentistry and I was in on the case of a child with 15 cavities," he says.

"For the majority of kids, seeing a general dentist is probably going to be just fine," says Liu. "But for those with a medical condition or those who have apprehension about having any procedure done, pediatric dentists have the additional training to deal with the more complex cases that kids can present.

"One of the biggest problems most general dentists have in treating kids is assuming that they're just little adults," Liu says. "They're not."

In some cases, he says, general dentists place fillings too large for baby teeth, and the fillings later fail.

In other cases, just getting a child relaxed enough to open his or her mouth for an exam requires the understanding of juvenile behavior that pediadontists have. Other cases require experience working with special-needs children, including those with autism.

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"Classes we take are technical — things like child growth and development — but child psychology is important, too," says Dallman.

"Pediatric dentists are trained to have lots of tricks in their bag to take care of different patients with different needs," he says. "There's a big difference between a child who is 3 and a child who is 15. Our language needs to be appropriate for a 3-year-old, and there are different words we use for teenagers."

That's why Liu tries to stay up-to-date on all the hot kid trends.

"Sometimes my wife accuses me of being a kid myself," he says. "I see all the latest Disney movies so I'm able to speak to them on a level they understand."

The right words aren't the only things filling a pediadontist's bag of tricks. A clinic and its support staff are important, too.

"My office is set up for kids, with toys and prizes on a kids' level, with tools set up at a height that's right for children," Dallman says. "And my staff is highly trained. With new patients, for example, we follow a specific program where they move through prescribed phrases and actions — "Let's count your toes, let's count your fingers, now let's count your teeth' — so the child is comfortable even before I come in and sit down to look at their teeth."

Many of those jobs belong to Dallman's pediatric dental-hygiene staff, including Barbara Otter.

"We try to defuse the mystery of the dentist's office by letting them touch the equipment," says Otter, who spent 11 years in general dental hygiene before switching to a pediatric clinic eight years ago. "We let them squirt the water with 'Mr. Thirsty' and then act surprised — 'Where did the water go?' — when they use the suction."

This approach makes a dental visit easy, says Otter's daughter Brittany, 13. "It's fun — not scary at all. "What's really cool is there are always decorations hanging from the ceiling and books around for you to read. ... It's like, ohmigosh, I'm not scared at all."

With more parents taking children to pediadontists, demand in this field is expected to rise. When forecasts began predicting an employment shortage, dental schools. including the University of Washington, beefed up their pediatric residency programs.

With their advanced degrees, most pediadontists set up their own practices; about 20 percent work in other health-care settings.

Typically, about half of a pediadontist's workweek is spent in restorative procedures, including fillings.

Another 20 percent is spent reviewing patients' oral hygiene with parents after the exam.

The remaining hours are spent reviewing charts, corresponding with pediatricians or orthodontists and handling office administration and staff development.

In 2000, the median annual salary for the nation's general dentists was $129,030. Earnings vary for pediadontists, depending on where and how long they've been practicing and how many hours they work.

"The most important thing is that you have to enjoy working with kids," says Liu.

"You have to have a personality that is childlike. I love the way kids express their appreciation; most adults will be more timid, but kids will bring me drawings just because they knew they were coming to see me. They send me a note and bring me cookies, saying 'Thank you.' "

Copyright © 2003 The Seattle Times Company