Pediatric dental home: Not just a concept

Jed M. Best, DDS, MS

In 2001, the American Academy of Pediatric Dentistry (AAPD) adopted a policy on the "dental home." The concept of the dental home was similar to that of the "medical home" adopted by the American Academy of Pediatrics in 1992. Specifically, the dental home, first and foremost, is the ongoing relationship between the dentist and the patient to provide comprehensive, continuously accessible, family-centered, coordinated, compassionate, and culturally effective care for children. This article will highlight the terms "compassionate" and "family-centered."

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Pediatric dentists use the concept of a dental home in an attempt to educate everyone in the family that caries is a preventable disease. It is, in fact, a collaboration of the dental team, child, care providers, and family. This interaction took an interesting turn when the Great Recession hit the United States. While many families had dental insurance, there were many who did not and had to face a grim reality that paying for dental services during those tough economic times was a major hardship. One, if not both, of the parents lost their jobs and with it their ability to pay for their children's dental care. While mostly not a life-threatening situation, caries is the most common chronic childhood disease and also is a cause for missing school. So what were my fellow pediatric dentists to do about this situation?

Independent of one another, many practitioners did what the public would not expect. They waived their fees yet continued to care for their patients. This was not a case of delaying payment or putting the parents on a payment plan, but of providing dental care free of charge until the affected families were back on their feet. The Recession was not just a circumstance of the lower socioeconomic classes. In fact, corporate executives were also laid off, often for the first time in their careers. Parents were embarrassed to discuss this situation with their pediatric dental care providers, yet felt horrible about not coming in for recall checkups.

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I am proud to say that I was one of those dentists who waived my fees. In discussion with my colleagues, I was not at all surprised that my friends did the same, but rather, at how many did it without fanfare. To me, this is the best definition of what a dental home is meant to be. The definition mentions that it should include compassion and be family centered. I cannot imagine what is more compassionate than waiving treatment fees so that all children of a particular dental practice can continue to come in for care.

This type of scenario was similar among all of us. A parent would often ask to speak privately, away from his or her children. Frequently, it was the mother who initiated the conversation, and it was not uncommon for her to have tears in her eyes. She would say that the family would need to change dentists, or worse yet, avoid having any dental checkups for the foreseeable future. As the conversation would unfold, the reason for this would be a loss of long-term employment. If it wasn't for loss of a job, it was a retrenchment of the company with a significant decrease of benefits. I think most of the families anticipated it was the end of a very strong relationship between the parents, their kids, and their pediatric dentist. To their surprise, we would say that we would continue to see their children without fee until they were able to get back on their feet financially. Not only that, but once on solid financial grounds, there would not be any retroactive fee; payment would only be required from that date on.

This wasn't something done in a widespread fashion; we just did this discretely for families that were long-term patients of the practice. When I began discussing this with my fellow pediatric dentists, I found that they did the same thing in their practices with no ballyhoo . . . no pats on the back. It was just another example of us believing in the concept of the dental home, as well as being compassionate on a private scale.

It made no difference what the patient needed-recall exam, extractions, sealants, or operative treatment. To see the relief on the parents' faces that they could continue in an office where they and their children were comfortable and where they believed they received quality care was payment in itself. There is an old saying that giving gives more pleasure than receiving. I, for one, can attest to this fact.

I had heard as a child that doing a good deed was "building castles in heaven." Well, it seems that many of my fellow pediatric dentists were in the "construction business." While this is an example of what we did during tough economic times, it is not something we did only then. We are often flexible in our approach to children, depending on what is going on in their lives. It could be a divorce, a significant illness of a parent, or loss of a job within the family. I think that empathy and compassion are two terms that well define a pediatric dentist-a group of individuals of whom I am proud to be considered a member.

Jed M. Best, DDS, MS, is a graduate of Case Western Reserve University School of Dentistry. He obtained his training in pediatric dentistry and his MS degree at the University of Minnesota. Board-certified, he is the past president of the College of Diplomates of the American Board of Pediatric Dentistry. He holds academic positions at Case Western Reserve University School of Dentistry and Columbia College of Dental Medicine. Dr. Best is currently a national spokesperson of the American Academy of Pediatric Dentistry.