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Special Treatment

Local professionals weigh in on the benefits of taking children to a pediatric dentist and the recent advancements in both dentistry and orthodontics.

Dr. Domenic Aloise did not exactly set out with the goal of devoting his professional life to working with children. But once he felt drawn to pediatric dentistry, it was impossible to change his mind.

“Out of all the aspects of dentistry, I felt pediatric dentistry was the most personally rewarding and impactful, while being fun too,” he says. “I enjoyed learning about pediatric dentistry more than any of the other subjects in dental school—especially learning about behavior management, pediatric dental treatments and materials, special needs, and growth and development. I just liked it the most.”

Fortunately, Central Florida is home to quite a few compassionate and experienced pediatric dentists just like Dr. Aloise, of Maitland Pediatric Dentistry. While general dentists are also capable of treating young patients, the specialized training and education that pediatric dentists undergo makes them uniquely qualified for the task.

“Pediatric dentists do a two-year specialty program,” says Dr. Lissette Bernal of Winter Garden Smiles. “The two years are spent studying baby teeth (primary teeth), mixed dentition, child development, behavior, psychology, pharmacology, special needs patient care and sedation. Pediatric dentists have special training and education that make them more qualified to work with kids.”

As parents with young children know all too well, it can be challenging to get kids on board with a visit to the dentist and to be on their best behavior while receiving treatment. Pediatric dentists enjoy being around children, however, and understand how to relate to them while putting them at ease and explaining any procedures they are doing.

Many pediatric dentists also have experience in working with special needs patients. Dr. Aloise, for example, completed a one-year fellowship in special needs dentistry at Helen Hayes Hospital and Columbia University in New York.

“I often reflect on what I learned during that year,” he says. “In a nutshell, it teaches you to think outside the box sometimes, because children with special needs, or even adults with special needs, aren’t always able to do things in the same way as others. You can still accomplish those goals, but, for example, some children with special needs don’t want to sit in the dental chair, so we stand up and brush their teeth.

“Knowing what aspects of dentistry might be viewed as adverse to the child or fearful for the child allows you to minimize those things, so you can have a more effective relationship. It’s not always traditional, but you can still accomplish your goals—it might just take longer or require you to use different material or a different instrument.”

Speaking of different instruments, technology has given pediatric dentists many more tools to work with in diagnosing and treating various ailments. Dr. Aloise points to the philosophy of “minimally invasive dentistry” and addressing issues before they develop into something serious, while Dr. Bernal notes the many advancements that have become common at most practices.

“[With] digital radiography, dentists can obtain detailed images of a child’s teeth with significantly lower radiation exposure compared to traditional X-rays,” she says. “Digital scanning and 3D printing technology allow dentists to create custom-fitted dental appliances such as braces, retainers, dental restorations and mouth guards. Sedation dentistry involves using medication to help children relax during dental procedures. It is becoming more popular for children who are anxious or have special needs.

“Painless injection techniques have been developed [as well]. The Wand is a tool that provides a pain-free and less fearful option to the traditional syringe. The pain from infections comes not from the infection itself but the delivery of the anesthetic into your tissue. There is also sedation dentistry for those patients who are very young or anxious.”

Dr. Lauris Johnson of My Family Orthodontics believes technology has made treatment more convenient for patients.

“Digital scanning and 3D printing are two recent advancements in the field that have positively impacted the dental industry,” she says. “We are now able to provide quality dental appliances faster to our patients without multiple visits.”

The field promises to evolve even further with the use of artificial intelligence (AI) in the future.

“AI is becoming an effective and powerful tool for assisting pediatric dentists,” Dr. Bernal says. “It shows high accuracy in diagnosis. There are a lot of dental software imaging programs that are being developed to detect early caries or detect caries that are not easily detected radiographically.”

Dr. Johnson adds: “I believe there is a place for AI to assist providers with formulating a more informed treatment plan and to facilitate selection of superior dental materials to provide better treatment results.”

Dr. Breck Brewer of Fravel Brewer Orthodontics has not seen AI develop into an effective tool for diagnosis in his field as of yet, but it is assisting with orthodontic treatment. He explains that one company, DentalMonitoring, provides a device that patients use along with their smartphone to take intraoral images monitoring their progress with Invisalign or traditional braces.

“Then artificial intelligence would be used to analyze those photos and determine if things are proceeding accordingly,” Dr. Brewer says. “What I mean by that is, does the alignment look good? Do the Invisalign trays fit like they should at this point? It would give automatic feedback to patients that says, ‘You’re not tracking along very good, you need to add two or three more days to your trays before you switch to the next one.’ Or, for a braces patient it might say, ‘You need to keep wearing rubber bands.’ It might also tell a patient they’re not doing a good job of brushing, or maybe that a bracket is loose and they need to call the office.”

Of course, supporting these technological advancements with traditional care and good habits enforced at home goes a long way, which is why Dr. Aloise recommends parents bring their child in for a first dental visit by age 1, even if they only have one tooth.

“It’s good for the dentist to have a positive relationship with parents and create what we call a ‘dental home’—creating home awareness of oral health and reinforcing it with the dentist at each appointment,” he says. “The younger, the better: It’s important to create a healthy dental habit, which should benefit the patient as they grow.”

Dr. Brewer agrees, stressing the importance of parents taking their children for regular dentist and orthodontist visits to ensure that teeth are coming in properly.

“My job as an orthodontist is to evaluate the bite and the alignment and give you a really good snapshot of what that looks like, and more importantly, what it might look like in the future,” he says. “Is it going to stay like this? Are there things in your mouth that are not stable? Are you putting too much pressure on this side versus that side and that’s going to make things worse? We give you a lot of information so you can make an informed decision on whether to get braces.

“A lot of people don’t need braces; a lot of them choose it because they want to see the teeth well aligned and as ideal as possible. But other times it’s not necessary, and getting that information to see how important orthodontic treatment could be makes a lot of sense.”