Q&A on the history of pediatric dentistry
Dr. Joel H. Berg (DDS, MS), has been taking care of children and their teeth for nearly 30 years. He is the current President of the American Academy of Pediatric Dentistry, making him the ideal person to answer our questions about the history of pediatric oral care.
Who are your dental icons from the past and why?
Of the past, G.V. Black—the "father" of modern restorative dentistry. However, he is an icon also because of his less known work—he is the first to significantly talk about what is now finally emerging—the trend toward dental disease management via medicinal approaches.
Also, those who brought product dentistry into the medical arena originally, including William Morton, the first to deliver anesthesia for surgery to a patient—by himself, a dentist in Boston in the mid-1800s.
What did you learn in dental school that is no longer taught or that has been transformed in understanding?
I learned that a parent’s presence in the treatment room with the child was never allowed or indicated. Now, it is typical and preferred in most circumstances for parents to be present during dental visits. It adds to a positive experience during prevention encounters.
What are the most common things a dentist probably would have encountered in 1900 or 1950 in children? How does that compare with today?
In 1900 a dentist would have encountered cavities as we see today in children, but extraction as often the only treatment. In 1950, with the growth of sugars in our diets, there was a much higher decay prevalence, and restorative dentistry techniques were emerging.
How has the profession changed in your lifetime?
The profession has changed immensely, mainly due to developments in technology, materials and disease patterns. We are currently witnessing a revolution of ideas, technologies, and products where the goal is to manage the disease that causes cavities, and not only to treat them with restoration (fillings). Implants have become so successful, that the idea of saving a failing tooth "at all costs" is at least questioned.
The patterns of practice have also changed, and whereas 30 years ago, nearly all dentists practiced solo, today, the largest growth area of dentistry is in large group practices. There is a similar "consolidation" occurring in the dental industry. This is being driven by some of the same forces that have led to overall healthcare reform and the Affordable Care Act. There is a need to control cost, improve quality, and improve access. Dental Service Organizations (DSO) are rapidly developing and growing in size to provide care in a manner consistent with governmental and societal demands.
What one or two instruments or tools would be the hardest for you to live without in your practice?
I love my 330 carbide bur–a great tool for preparing cavities in primary teeth. A bur is a very small drill bit that spins within a handpiece (drill). The 330 carbide bur is the most versatile one for treating children because it is very small and allows for minimally invasive approaches to treating primary teeth.
Also, I am grateful for the mirror—it allows examination of all surfaces of the oral hard and soft tissues while maintaining good posture for a lifetime. By using a mirror, the dentist and team can preserve their own health better because it forces them to sit up correctly in their chair as they treat patients. Without a mirror, one will have the tendency to lean over—and, over a career, this causes back and neck problems.
What is the biggest myth or misunderstanding in pediatric dentistry and how do you think it got started?
That some teeth are "soft," that a person who has "soft" teeth will get cavities for no other reason... It likely started as an explanation of the fact that some with the same apparent risk factors get more cavities than others.
What got you interested in dentistry in general and in pediatric work in particular?
I have always been interested in children and the ability to shape behavior and health for a lifetime. Also, Pediatric Dentistry offers comprehensive care; one can practice all aspects of dentistry on a population where one can influence their overall health forever.
At what age did you know this would be your career?
I planned to be a career academic pediatric dentist around age 16 while in high-school in Des Moines. In Iowa, I was a camp counselor for children and loved the technology and science surrounding dentistry.
If you were to collect dental objects, what would you collect and why?
I would collect old and new instruments used to extract teeth. The evolution of instrument types reflects advances in technology and understanding of anatomy.
This post is part of our series on The Tooth Fairy File.