Handling Pediatric Patients


Pediatric Patients

Even super-heroes should be handled with kid gloves

By now, you may have heard about the potential impacts of the Affordable Care Act (ACA) on dentistry. One interesting likelihood: an influx of pediatric patients, as the ACA provides for dental coverage for children under 19. According to the American Dental Association (ADA), approximately 8.7 million children could gain extensive dental coverage by 2018. This means that more general dentists will have the opportunity to see younger patients. However, there are several things to consider when treating this population.

Chemical Sensitivities

Children aren’t just little adults. Their bodies are still developing, so chemicals that might not have much of an impact on an adult can have a larger impact on a child. A case in point: BPA.

Bisphenol A (BPA), a chemical compound found in everyday plastic products, can also be found in many dental composites and sealants. Unfortunately, BPA acts as an endocrine disrupter, and studies have linked it to a plethora of health maladies in children, including heart and kidney disease, emotional behavioral problems, and even an increased risk of obesity in teenaged girls.

In addition to these generalized health issues, BPA has also become a dental concern: research from France has suggested that BPA exposure in children can adversely affect cells that produce tooth enamel, making it fragile or brittle. This Molar Incisor Hypomineralisation (MIH), which occurs selectively in permanent incisors and first molars, affects about 18% of children between the ages of 6 and 8. Children with MIH are highly prone to dental caries and are very susceptible to tooth sensitivity and pain. Importantly, the age at which children develop their first molars and permanent incisors is the age at which studies show that humans are most sensitive to BPA.

The Asthma Link

Most recently, asthma – one of the most common childhood diseases – has been linked to BPA exposure, according to a recent study at the Columbia Center for Children’s Environment Health at the Mailman School of Public Health (Donohue, 2013). This is important to dental healthcare professionals because another study has linked asthma to an increased risk of dental caries (Alkali, 2013). Asthma medications were shown to reduce the salivary flow rate and buffering capacity in the mouth, leading to a potential for increased caries and gingivitis. Asthmatic children also had higher levels of Strep mutans and Lactobacillus bacteria, compared to healthy children.

Alternatives for Improved Health

Since dental caries is the most prevalent disease in children, it’s important to be on the lookout for increased caries risk factors, like asthma. Fortunately, dental healthcare providers have a number of tools available to help reduce the prevalence of caries in their pediatric patients, without exposing them to additional doses of BPA.

For example, for patients with increased caries risk factors, dentists might want to consider a chlorhexidine varnish. A relatively new product, chlorhexidine varnish addresses the undesirable side effects of chlorhexidine rinses and gels, while still reducing the presence of Strep mutans (Sijjan, 2013).

BPA-free versions of many products are also available. The Venus Pearl and Venus Diamond lines of composites from Heraeus Kulzer are not only BPA-free, but highly durable and well-suited for both anterior and posterior restorations.

Manufacturer Pulpdent produces the BPA-free ACTIVA and Embrace product lines, the majority of which are especially well-suited for pediatric patients as they are hydrophilic (i.e., they work well in a moist environment). These products include the innovative ACTIVA BioACTIVE Restorative and ACTIVA BioACTIVE Base/Liner, as well as the Embrace Wetbond Pit & Fissure Sealant and Embrace Wetbond Resin Cement.