Merhoff Pediatric Dentistry: 0:11
My name is Melissa Blake, and I’m a pediatric dentist practicing in Winston-Salem North Carolina for the last six years, and now here at Merhoff Pediatric Dentistry.
Host: 0:38
What made you decide to go into pediatric dentistry?
Merhoff Pediatric Dentistry: 0:51
Well, my love for children was the start of my desire to want to practice pediatric dentistry. Dentistry was my second love, I always say. But I think children are just so fun to be around; they’re fun to interact with. You’re creating a legacy with each interaction you have with them. You’re inspiring minds, and hearts and changing the future with everything you do.
Merhoff Pediatric Dentistry: 1:16
When looking for a career that I could pour myself into and be passionate about, I always knew that children would be a part of that. Dentistry came along out of looking for a career that would allow me to exercise all of my talents. A lot of you know I’ve got a science mind. I’m also very artistic. I love interacting with people. It’s hard to find a career that encompasses all those facets of myself, all those different aspects.
Merhoff Pediatric Dentistry: 1:46
So dentistry was kind of that very unique, perfect fit that I couldn’t find with other fields, and so I just developed that love, and pediatric dentistry was the funnest discipline I could think of.
Host: 2:03
Oh, that’s terrific. Well, one of the topics we wanted to talk about is sedation dentistry, especially when it comes to kids. I’m sure could be challenging. I mean, parents have questions. Children, you know, worry about what’s going to happen. So how does this practice approach sedation dentistry for children?
Merhoff Pediatric Dentistry: 2:28
Well, I would say that, as a mother myself, I think that anytime you’re treating a child, you want to put yourself in that parent’s shoes.
Merhoff Pediatric Dentistry: 2:38
So when we talk about sedation, some children just need a little bit of something more than your normal local anesthetic and nitrous oxide.
Merhoff Pediatric Dentistry: 2:49
They need something to help to take the wind out of their sails so they can have a positive experience and be a great patient for a lifetime. But anytime we recommend sedation, we try to look at the big picture and assess that risk-benefit and make sure we’ve exhausted all measures before getting to that stage. As a parent myself, I try to take the approach of being more conservative but also doing what’s in the best interest of the child. So there’s always a balance between that when we decide, and we select those cases as we try everything we can doing behavior management techniques tell, show, do, talking a child through showing them the instruments, just making their experience as calming and as child-friendly as possible. And that’s the most rewarding part when your behavior management techniques work. If you have a child that has had a negative experience or is very anxious, they finally trust in you that everything will be okay and you’re successful. That’s the win.
Merhoff Pediatric Dentistry: 4:00
We live for those days, but that’s not always the case. So we try to make sure that we take an approach where we’re doing things as safely and as efficiently as possible. We make sure that our staff are highly trained and also comfortable with sedation so that we have the support we need through those more technique-sensitive procedures. We continue to prepare ourselves by continuing our education. We take pediatric advanced life support. So I feel like our doctors are well supported, we’re well trained, our staff is well trained, so we take that trust very seriously and make sure that we’re giving the highest level of care that we can well.
Host: 4:44
Just like you pointed out a moment ago, sometimes it’s needed, maybe at different levels for that child to continue to have a positive experience because they’re not going to need it every time they’re here. They’ll come in for cleaning, and you want that to be a good experience. But when they have to have something a little more invasive or something that lasts longer, depending on the child, I guess that’s when you determine what’s appropriate.
Merhoff Pediatric Dentistry: 5:12
Right. We look at their eligibility in terms of whether they meet the criteria from a medical standpoint, so healthy patients that are at very low risk of any complications, and we also want to look at the temperament of the child. You know, when we’re looking at the correct level to choose mild, moderate or deep and the amount of dentistry that they need to have completed. So we take all of that into account when we’re determining which level would be most appropriate. We take all of that into account when we’re determining which level would be most appropriate.
Host: 5:46
So what are those levels and what are some of the common things that you would do for the level the anesthesia level.
Merhoff Pediatric Dentistry: 5:55
So the mildest sedative is nitrous oxide, which is laughing gas is the normal term for that, and that will keep a child conscious, but it will help. It’s an anxiolytic, so it’ll help to reduce anxiety. It’s great for children who have a strong gag reflex because it actually helps to minimize that reflex. But that’s for accomplishing more basic restorative needs for children that are mostly cooperative but may have some apprehension, some mild apprehension, in cases where the dentistry is more complex and we’re doing more than just composite restorations or white fillings then. So we’re doing more involved treatment like crowns or restorations in the anterior region of the mouth, where that’s more technique sensitive because we are striving for great aesthetics in that area. Then, we may have to move to a higher level of sedation, such as oral conscious sedation. That’s where we will give a child a pre-sedative that keeps them in a twilight state. It’s not a general anestheti,c but it’s a little bit stronger than the nitrous oxide and that allows us to accomplish much more, especially if our patient has a difficult time tolerating treatment with nitrous oxide alone.
Merhoff Pediatric Dentistry: 7:16
General anesthesia we like to reserve for children who may have severe apprehension and extensive dental needs. So dentistry that would take four or even five visits to accomplish. Sometimes, children just can’t tolerate that because that’s about six hours of chair-side time, and children have shorter attention spans, and even when we break that up they get fatigued towards those that fifth or sixth visit. They just can’t give you any more than what they’ve given you. So general anesthesia helps us to accomplish high quality dentistry in a short period of time, restores that child back to health, or they can just the parent and the family can maintain that their child’s oral health you know, consistently over time and that child hasn’t had a negative experience. They’ve had their dentistry taken care of, and they’re happier to see us every six months.
Merhoff Pediatric Dentistry: 8:15
They they skip through the little door instead of being fearful because they remember the five, six long visits that they had to have done I mean, no one wants to do that. No one wants to do that. I don’t blame them, especially our little ones. So general anesthesia is great for that. It’s great for building up their confidence and their trust in us that they can come and um know that everything is going to be okay.
Host: 8:39
Yeah, when I know you work a lot with pediatricians, they would refer in sometimes. What role do they play as far as sedation is concerned?
Merhoff Pediatric Dentistry: 8:51
Pediatricians. We rely on them greatly to give us a comprehensive medical history on the patients that we’re planning to sedate. They provide for us a recent physical history, and that helps us to fill in any blanks that may have happened in our record keeping. So they help us determine eligibilit,y and we take the information that they can provide very seriously. We really look deeply at that.
Host: 9:19
Yeah, I mean, it’s just like any other specialist. A primary care provider would be the one to refer out to the specialist or have the line of communication because they’re dealing with the patient more on the general health and right right.
Merhoff Pediatric Dentistry: 9:33
They typically will have such a much broader wealth of knowledge about that patient because, they’ve been following them from birth until when we’ve seen them when we’re meeting them for the first time. So, we really treasure that relationship and as a pediatric dentistry office.
Host: 9:52
I mean that’s different than general dentistry and I know there are adults who have different levels of sedation. A lot of offices general dentist office don’t even offer what your office does. What is the unique role that you play with children? I mean this as opposed to them going to a general dentist and having maybe needing some more in-depth procedures or something like that. What’s the difference between here and, say, a general dentist?
Merhoff Pediatric Dentistry: 10:25
The biggest difference between a pediatric office and a general office is always going to be the training and the capabilities of all the staff, including the doctor that is caring for your child. It’s going to be their level of training and familiarity with the unique needs that children have. A general dentist has had very minimal training on the issues that can be encountered during the dental development of a child, and their approach is going to be a little bit different in pediatrics. Number one is going to be we’re geared towards prevention. We want to see our patients right at the first birthday, six months after the eruption of the first tooth, so that we can detect any early signs of dental cavities, pre-cavitated lesions, which are decalcifications or white spots on the teeth, where we want to be able to do a diet assessment.
Merhoff Pediatric Dentistry: 11:22
We want to be talking about oral habits that can affect the orthodontia or the position of teeth and the shape of the arch form. We want to catch issues that can affect children early on so we can intervene, and that intervention is going to set our patients up for success further down the line. In a general office, where they’re not as familiar with the specific dental needs of children, they may overlook some of the things that we would catch early on. There have been many instances where our patients will come to visit us for the first time a little bit later than ideal and they’ve got some pretty extensive needs, such as know rampant caries or things that you know we’re we’re. The parents are sometimes disappointed because they didn’t have a chance to learn what they needed to to be able to prevent those issues we’re always happy when we get to see that child eventually, but we like the message to be that oral health is important from year one.
Host: 12:24
Yeah, so I know um pediatric dentists go through additional training than a general dentist does. So what are some of those things that you do in those extra years that you’re spending training?
Merhoff Pediatric Dentistry: 12:41
That’s a great question and I love that question because, um, I feel like the world should know and understand the value of having a specialized pediatric dentist, someone who’s had that advanced education in pediatric dentistry.
Merhoff Pediatric Dentistry: 12:55
That’s the certificate that we all earn. We go through a board certification process where we stand before a group of our peers, and we are tested on cases in a live setting, which is um. It’s challenging, but when you rise to the occasion and you pass that board certification, it’s a rite of passage that we all earn so that we are practicing at a certain level of standardized care, um. So, having a board-certified pediatric dentist who’s gone through training and additional training is huge. So the residency program is usually two to three years, and during that tim,e you are instructed by a faculty who are practicing pediatric dentists, and we get additional training learning about the growth and development of a child, how we expect their dentition to develop from year one until 18, that we find out about the common orthodontic issues that may be encountered during that development when’s the best time for intervention when to make appropriate referrals to an orthodontist. We learn how to manage simple interceptive ortho cases, so we actually learn a little bit of orthodontics, placing braces, correcting cross bites with expansive appliances..
Merhoff Pediatric Dentistry: 14:19
And I think one of the key things, too, is with all that extra training, is that you come in knowing I’m treating children. Today there’s no adults that are being treated here, unless they’re, you know, in high school or you know, some that keep wanting to come back because they’re 18, 19 years old.
Host: 14:38
But typically you’re prepared every day to deal with children which a lot of people don’t realize, and I think that takes a special kind of person, a special team, to do that. But I’m sure that’s part of your training too, that you know that you have to think what are they expecting, what do they see? You put yourself in the place of a child or a parent. Coming into the situation for the first time, I’m trying to think what?
Merhoff Pediatric Dentistry: 15:09
We get additional training on certain topics like orthodontics, special needs, dentistry, and how to manage patients that have special health care concerns. We will round. I guess we do a hospital rotation where we round with medical providers and in the inpatient unit and we get to see very, very sick children and the syndromes and complex medical issues that are specific to children and see how they’re managed. So we learn about a lot about the basic medical science, that is, pediatric medicine, the science behind that which you would need to know in terms of treating a child as well, and what their special needs are when they come into a dental office, and we learn.
Merhoff Pediatric Dentistry: 16:00
All of our advanced behavior management techniques are really refined during residency and for patients that our techniques are not enough for. We learn how, the various levels of sedation. We learn oral conscious sedation, how to use different sedatives, how to select a regimen that will be appropriate for the child we’re treating, taking their medical history into account, and the dentistry needs that they have.
Host: 16:26
Do you think most parents feel comfortable with sedation? If you can manage a situation where the child is okay in the chair without having to have it, that is one thing. But you would think what do you hear from parents?
Merhoff Pediatric Dentistry: 16:44
Some parents are comfortable They see, you know the way we work, they trust us, and they’re not anxious at all.
Merhoff Pediatric Dentistry: 16:52
But we do have a few families that need some time to process that recommendation if sedation is the most appropriate next step. I think that that just stems from all of us, as humans, having that natural fear of the unknown, and so, without much knowledge of the public of what goes into sedation, the criteria that we follow, the monitors that we have in place, you know I understand that concern. The question I get asked the most by parents was well, if this was your child, would you sedate them? My answer is always yes because I never recommend a treatment I wouldn’t do on my own child, and I know my skills, I know the ability of my team, and I would never recommend anything that I wouldn’t do for my own child.
Merhoff Pediatric Dentistry: 17:59
Just what does that all entail? And are we going to be able to manage a situation if one does arise because we have all of the advanced technology that we’re required to have and beyond? We have things that work well in our hands, even though they’re not required by our board or state regulations. We care that much about children that we are over-prepared.
Host: 18:29
Yeah, well, you’d rather be over-prepared, and that’s a great message for parents to know. And the other thing is that all of you are moms. All the pediatric dentists here are moms, so you do think about that, we do think about that.
Merhoff Pediatric Dentistry: 18:45
I think once you enter motherhood working in this profession, we always say I think I became a better pediatric dentist once. I had my own child, because that empathy really grows. So when you’re here in this office, you are part of our family.
Merhoff Pediatric Dentistry: 19:04
We always try to empathize with whatever unique needs your family has or whatever unique concerns your family has, and that’s because we’ve held our child for the first time. We know how much love goes into that first moment, those hugs as the child gets bigger. Those hugs don’t get colder, they just get warmer. And you just look back on that history. I hugged my son this morning, and I remember saying if I couldn’t do this tomorrow, I wouldn’t be okay. So we would never want to. We would take care of that child like they’re our own.
Host: 19:39
Yeah, yeah that’s fantastic. So if a parent, I mean maybe they have an older child that does have a need and they’re not currently a patient, that’s okay, right, they can come and they can schedule an appointment and have a consult and talk to you about their needs. Because maybe they already know that they’re going to need something a little more extensive, and they want that sedation for their child’s comfort?
Merhoff Pediatric Dentistry: 20:07
Absolutely, yeah, it’s all children of most ages. What we encounter sometimes with teenagers is that they may have some dental needs that cross more into the realm of adult dentistry, and if we encounter those unique scenarios we make the appropriate referral.
Merhoff Pediatric Dentistry: 20:25
But we’re happy to see all children of all ages that fall fall into our scope of care well, the thing is, if all children had that kind of care going into adulthood they wouldn’t be worried going to their adult dentist right they would know that they didn’t have to be afraid of those things. That’s the day, that that’s the moment that we live for, is just gaining the trust.
Merhoff Pediatric Dentistry: 20:54
I’m a Dr. Tina Merhoff, (the founder) pediatric dentist at Merhoff and Associates Pediatric Dentistry.. I just wanted to comment on something Dr. Melissa was saying. When we’re going over sedation options with our parents, we have found very often a child is referred to us for sedation from a general dentist, and once they come in here, they just love it, and we can accomplish their treatment with a mild sedation. That happens more often than not, and we’re able to use nitrous oxide instead of general anesthesia or a deeper, moderate sedation to a deep sedation. So that’s comforting whenever we see that, we’re excited when we can do that.
Merhoff Pediatric Dentistry: 21:39
Our goal is the mildest type of sedation. So I wanted to reiterate what Dr Melissa was saying that we treat every child as if they were our own. Would I want my child to be under general anesthesia for this dental treatment? Can we try to buy time, so to speak, by educating the family, having them come more frequently and take more preventative measures, and over time maybe we can help them be more cooperative in the chair? So we want to exhaust all measures with a family, starting with the mildest on up. So I love how you mentioned that about treating children as if they’re our own.
Host: 22:19
So I have to say that you all use your first names Dr Tina, Dr Melissa, so the kids like that, I imagine.
Merhoff Pediatric Dentistry: 22:29
Yes, we don’t want to have any white coat syndrome here in our office. We wear pink because we want a child to feel welcome. Then, the first name basis is it just helps to make a child more comfortable. We don’t want any barriers between us and our patients.
Host: 22:39 So if someone’s interested in scheduling an appointment,, they should call the office or they can visit the website and request an appointment. Is that correct?
Merhoff Pediatric Dentistry: 22:55
That is correct. They can visit dentist4kidscom, our website, or they can call our office, and the number is 336-659-9500, to schedule an appointment, and we sure look forward to meeting you and we’ll also include that information in the show notes so that someone can just click to call.
Host: 23:16
All right, thank you both. Thank you.
