Paediatric patients: could we do more?

  Posted by: manpreet.boora      15th January 2018

Student dentist CHARLOTTE GENTRY reflects on her course…

Ibegan my paediatric speciality teaching in September. I was incredibly apprehensive about starting. The idea of drilling such tiny teeth in such tiny mouths and giving anaesthetic to (stereotypically) very anxious children gave me nightmares! However, my experience so far has been a pleasant one and it’s my favourite part of the course.
Paediatrics is taught as a speciality – we get a set period of time on the dedicated clinic and we see one or two children every two weeks. I can’t help but think, is this really enough? I’ve never understood why we get such a relatively small amount of time treating children, when a large proportion of our patients will be children once we go out into general practice. Paediatrics is a speciality in its own right – of that I have no doubt. When I began the teaching, I realised how different our approach to almost everything is wihen it comes to treating children – from their medical histories to looking out for safe-guarding issues. I feel more time should be given to dental students in paediatric teaching in order for us to be able to do our utmost best when we get into the big wide world.
Many of the patients we see have been referred to us by their GDP for us to assess and treat them. This allows students like me a great chance to experience hands-on rarer and more complex cases. I can’t help but think, though, that if we are able, as undergraduates, to treat these patients surely qualified GDPs should be doing more paediatric work, too? Or are they not treating paediatric patients because of a lack of confidence due to the limited training they received at dental school?
From my experience in practice before starting at dental school, there was one paediatric treatment possibility I had never seen or even heard of – a Hall crown. We’ve been taught a great deal about these and their efficacy, and from what I’ve learnt they are an excellent treatment option that are clearly not utilised enough. No anaesthetic is required, the crown itself needs minimal adjustment and it just snaps into place. It prevents progression of and arrests the caries underneath whilst preventing a new lesion from being able to form on that tooth. They are technically easier and quicker to do than a direct restoration on a child’s tooth, which require anaesthetic and far more compliance from the child. I just have no idea why they aren’t used more frequently. Perhaps a lack of training or the cost is the answer, but, in the long term, surely utilising hall crowns would reduce costs further down the line?
I appreciate that resources – and lack of them – is a huge hurdle in practice that we do not have to such an extent at dental school. However, if Hall crowns were used more frequently, if diet sheets were used and education in oral health was more frequently imposed, in the long term it would save money and time for many dentists. Children wouldn’t need to be referred for general anaesthetic – a huge cost and time consuming treatment in itself.
There is an awful lot to fit into a five-year course at dental school and time is already a constraint. Nevertheless, I feel that paediatric teaching should be a core part of our learning, up there with our clinical practice teaching. After all, we will see kids on a daily basis and by improving the dental health of children, we can improve the future dental health of the country.