LITTLE ROCK — Going to the dentist is still not most youngsters’ idea of a good time. But kids these days have the benefit of gentler treatments, better pain and anxiety control - and even video games - that weren’t available when their parents were growing up.
Childhood dental visits for Tammy Lee a generation ago were matter-of-fact ones. She got the same kinds of exams in the same chair in the same office as the grown-ups in her family. And when she needed dental work done, she got shots to numb her mouth by a dentist who, for the most part, treated her the same as he did her parents.
Her son, 6-year-old Gray, has had a vastly different experience.
Everything in the office of the pediatric dental clinic where he goes is geared toward making kids less anxious and ensuring they get treatment designed for their growing mouths and changing smiles.
Pediatric dentists have two to three years of training beyond dental school, covering issues like child psychology and growth and development. That gives them the skills to gain the confidence of children and to make those patients feel secure.
Props can help that process along.
Kelly Wood, who works at Pediatric Dental Associates and Orthodontics of Fayetteville, hired a graphics design team from Canada to make their building more kid-friendly.
“Even before they walk into our doors, the front of our building has a giant elephant and a jeep and everything bursting out of our bricks, and the kids love that,” Wood says. “Then we have animals on our roof that are overlooking the parking lot. Then as soon as they walk in the door, it’s just like a giant jungle, and there are huge life-size trees and elephants and monkeys and meerkats.”
The waiting room contains handheld video games as well as toddler-appropriate video games and a huge saltwater fish tank that holds the cast of Finding Nemo, all there to keep kids’ minds off where they are - and why.
Headphones attached to televisions at each exam station help block out typical dental office noises - even the high-speed drills with quiet motors. The aim is to channel children’s attention away from the work being done.
As for patients’ demeanors, Wood says, “We get everything - there’s the apprehensive, high anxiety where they’re verbally anxious. There can be crying and of course we try to console them.But they can also be giggling because it’s a ‘tickle toothbrush.’”
Often, even the most anxious child is calm by the end of the visit.
“Obviously I’m biased because I work here,” Wood says, “but I have worked in the medical dental field for 13 years and I had never worked in an office before where I had seen children who were like crying a meltdown at the end of the visit because they don’t want to leave. That’s a first for me, because usually it’s the opposite.”
Dr. Andy Kitchens at Kitchens Pediatric Dentistry in Little Rock likes to hear that patients, like Gray, want to stick around rather than running for the door when they get out of the dental chair at his office.
“When we built this office we wanted to make it as easy and child-friendly as possible and try to relieve the anxiety as much as possible,” says Kitchens, in practice with his son, Dr. Michael Kitchens. “With all the features in the waiting room and all the rooms, that’s what we’re striving for. We’re just trying to make it easier on everybody - and that makes the parent more relaxed and it makes us better. It’s just better for everybody.”
Gray has been going to the dentist regularly for a few years now, but he was frightened of the prospect until he had three crowns placed when he was 4.
“He’s not afraid anymore,” his mother marvels. “Now he just goes in there and everything is fine.”
Before Gray had his crowns put on, he was given some “silly juice,” a mixture of Demerol and Versed, for a conscious sedation that would help him relax while the dentist worked on his teeth. The youngster spent about an hour waiting for the medicine to take effect, hanging out in the waiting room where there are not only the standard books and magazines but also tow trucks and a seesaw, several video game stations set back in kind of a cave with tree stumps as seats, and a big tree with a movie playing inside.
When the time came, Gray was led down a hall overhung with tree branches to a room with paintings of animals on the walls and a television on the ceiling above the childsize dental chair. He was offered a choice of movies before getting a little nitrous oxide through a mask to further relieve his anxieties.
He was in and out of the dentist’s office in about two hours, including the time he spent in the waiting room - or at least he could have been if he hadn’t stopped by the treasure chest for a reward while his mother settled things at the front desk and then he begged to return to the waiting room on the way out.
The American Academy of Pediatric Dentists recently changed a recommendation that children first visit the dentist at age 3 to a recommendation that children first visit a dentist before age 1. They should return every six months for routine checkups and cleanings, says the organization.
MAKING IT PLEASANT
Orthodontists, too, want early childhood visits to be pleasant.
Dr. Andy Vondran of Little Rock wishes more parents were aware that all kids should have orthodontic evaluations at age 7, the goal being to catch and address problems that might crop up a few years down the line.
“You need to go in and make sure their jaws are growing properly,” he says. “Not only are you looking at what’s present now, but you’re also looking at X-rays to see how their 10-, 11-, 12-year-old teeth are forming. You can look at those Xrays and even though they may only be 7, 8, 9 years old you can see those 10-, 11- and 12-year old teeth developing and you can begin to see and deal with problems that will occur at the age of 11, even though they’re only 8.”
Only one in 10 7-year-olds will need orthodontic interventions, says Vondran. But the one who does will benefit from having jawbone growth problems addressed.
Just a few years ago it was standard to wait until all permanent teeth were in - as late as ninth grade - to put braces on teeth, he says. Now it’s not unusual for even for third- or fourth-graders to wear a first set of braces for a year or so.
This earlier treatment can cut down on the length and intensity of treatment needed later on. Early treatment also cuts down on the necessity of extracting permanent teeth from crowded mouths, says Vondran.
Alison Melson’s 10-year-old son, Sam, has an orthodontic appliance in the roof of his mouth designed to help his mouth grow and make more room for his yet-to-emerge permanent teeth.
“My family tends to have large teeth and a lot of them,” Alison Melson says with a laugh.
She has to turn a key in Sam’s spacer once a week, making it spread just a fraction more.
It caused some pain when he first got it a little over a year ago, but it doesn’t hurt anymore, she says.
When his orthodontist removes the spacer, he will get his first phase of braces.
For Sam, it’s all a rite of passage.
“He was so excited about getting the appliance,” says Melson. “But the disappointing thing about the appliance is that no one can see it. He has a lot of friends who have those, and he also has a lot of friends who are not having to have those and who are going straight into braces, so he is ready to get this out and go on to the braces.”
The second phase of braces is often warranted after the permanent teeth come in, between 11 and 13 years old.
“That second phase is typically 12 to 15 months, and then they’re finished with braces before they get into eighth or ninth grade,” Vondran says. “So you don’t have to be a high school senior or sophomore with braces anymore. For kids and their social life - self-esteem, self-confidence, dating, all that stuff - that’s nice to not have braces in high school.”
FINANCIAL BENEFITS
There are financial benefits, as well, for taking a twostep treatment approach.
“It will help you save money, too,” he adds. “A year in braces now and a year of braces later is less expensive than three or four years of braces. Not only is it easier on the patient but it also makes sense from a cost standpoint.”
Kids in braces today do have the same dietary limitations as kids of yesteryear. Foods like caramel candies and corn on the cob are forbidden because they may damage brackets and wires.
Dr. Jason Landers, the orthodontist at Pediatric Dental Associates and Orthodontics, also tells his patients to stay away from food or beverages that can damage their teeth.
“The thing that we try to focus on these days is that the kids drink a lot of those energy drinks, like sugary Gatorades and sodas,” he says. “And we really have to stay on top of them about that because, me as an orthodontist, if I get straight teeth at the end and we take these braces off and we have all these cavities or decalcifications on the teeth, the parents are not going to be happy, their general dentist is not going to be happy. So we’re looking at it more like an overall oral health situation.”
The clinic rewards patients who take care of their teeth by giving them tokens during their orthodontic visits. If they save up their tokens, by the end of their treatment they can trade them in on Xbox games, iPods and other popular gadgets.
As far as the cost of braces, the total bill depends largely on the severity of the case.
“Early treatment is a lot less because it’s a shorter period of time,” Landers says. “Traditional adolescent treatment - I would say it can range anywhere from $4,000 to $6,000. Insurance definitely can help with that.”
Vondran says the cost is all relative.
“Back in 1975, the cost of braces was the exact same cost as a Volkswagen Beetle,” he says. “Back then, only the wealthy kids had braces. Since then everything else has gone up in cost. But braces, relatively speaking, have not. And that’s why you see so many kids with braces these days, because it’s relatively more affordable.”
Family, Pages 31 on 02/23/2011