Dr. Marvin Berman
Click here to enlarge imageby Jeffrey B. Dalin, DDS, FACD, FAGD, FICD
Dr. Dalin: Dr. Berman, you have always been one of my favorite lecturers. There are never any dull moments during your presentations! Let’s begin by talking about kids, and how important it is to treat them properly. Through the years, I have come to realize that kids often come to a dental practice first for treatment. Then, once parents and other relatives see how dentists can make their children feel comfortable in the dentist’s chair, they follow as new patients.
Dr. Berman: Child patients are the seeds for growth of a new practice, and a lifeblood transfusion for the revitalization of an established one. The problem is that many dentists imagine a young child in their dental chair, and a feeling of fear grips the dentist more so than the child. Most general practitioners would rather struggle for an hour trying to extract a horizontally impacted wisdom tooth than spend five minutes dealing with a reluctant or apprehensive 3-year-old.
Jimmy Pinkham, one of my favorite colleagues, made the following tongue-in-cheek observation: “If I told you there was an alligator in your waiting room with a toothache in the last tooth in the back of his mouth, and I was going to give you a million dollars to fix it ... you would find a way.” If you develop the competence and confidence to treat children, your image will be elevated 10-fold in the eyes of adults.
Dr. Dalin: I love it when adult patients ask how soon they should start taking care of their child’s teeth. How can we get parents motivated about caring for their children’s teeth? How early should dentists tell parents to bring their children for treatment?
Dr. Berman: Ideally, it would be wonderful if we could speak to expectant moms and show them how primary teeth are developing during pregnancy. Then we could explain the importance of proper diet, offer advice on managing the breast-feeding interval, and how to limit the use of baby bottles and pacifiers. Unfortunately, we often do not see children until they already have evidence of poor hygiene and bad habits that result in neglected caries and malocclusions.
Despite the wishful thinking of the American Academy of Pediatric Dentistry about scheduling children for the first visit at age one, it seems that two years of age is the logical and practical time frame for the first dental exam. With all the consumer-oriented information available, it is amazing that parents seem so bewildered that their 2-year-old has baby molars, cavities, or that they should be brushing their children’s teeth. This is why a dentist’s most important obligation to children and parents is education. Otherwise we are just tooth-fixers.
Dr. Dalin: Let’s talk about prevention. I am excited with the new products in our profession, such as fluoride varnishes and amorphous calcium phosphate products. What is your opinion of these products? Can we expect to see more in the future?
Dr. Berman: Fluoride varnish has been a most helpful adjunct in my practice, especially for special children in which tooth isolation can be problematic. Digital radiography has revolutionized the way we perform and organize the diagnostic portion of checkup visits. It is much easier today to present clinical issues to parents with visual clarity and dramatic emphasis.
My experience with calcium phosphate compounds, thus far, is limited. But, on a related subject, I still believe in amalgam restorations in primary molars. I say this even though we are using composite materials more often as they become more reliable and predictable. Nothing in the scientific literature has persuaded me that amalgam restorations pose any threat to the well-being and health of patients.
Dr. Dalin: Dentistry is getting some newfound respect from the medical community with ties between good dental and good systemic health. For years, you have been a media spokesperson for dentistry, trying to get the public to view dentists in a positive light. Also, would you discuss public relations and how dentists should work with the media?
Dr. Berman: There is no question that clinical dentistry is interwoven with systemic medicine. This has long been a neglected topic. Almost everything we do in oral medicine has ramifications in some way to general medicine. In fact, it is often the dentist who - when performing a thorough routine oral examination - discovers some condition of a more serious medical nature such as blood disorders, diabetes, developmental anomalies, and even precancerous lesions.
As pediatric dentists, who shun mind-altering drugs in the management of child behavior, we relate to children on a one-on-one, face-to-face basis. So we are often the first professionals to discover and call a parent’s attention to behavioral disorders as well as symptoms of autism, Asperger’s disease, or even deafness.
Dr. Dalin: As one of the originators of the Give Kids A Smile program, I first brought the concept to the American Dental Association. In St. Louis, we annually deliver free full-service dentistry to more than 600 kids in two-day clinics in February and October. In 10 clinics, we have delivered more than $1.6 million of dental care to more than 5,100 children. It is depressing to look in the mouths of many of these children who finally receive access to dental care. How important do you think it is to get the message out regarding access to dental care?
Dr. Berman: As much as we speak about access to dental care, and given that the ADA and the Give Kids A Smile programs have had some modest success, it is a drop in the bucket. Jeff, it can be very frustrating for dentists, such as yourself, who devote their time and energy in an effort to make a difference only to realize that it is a never-ending struggle.The message is there but the solution is still forthcoming.
Having been in practice 46 years, I have some observations in regard to access to care and volunteerism. First, there are people who are givers and people who are takers. Givers give to everything. They give to charity. They give of their time. They are on everybody’s “givers list.” Then there are the takers. They mostly think first of themselves, and how they can benefit or what giving will cost them.
Unfortunately, there are a limited number of givers. In Tennessee Williams’ play, “A Streetcar Named Desire,” Blanche - in desperation - says, “I’ve always relied on the kindness of strangers.” Can we teach someone to perform an act of kindness? Can we teach others the joy of giving? Can we inject moral empathy and make people caring individuals?
Here is a major point about dentist volunteerism. It is much easier to give your time when you can treat patients gratis in the atmosphere of your office with your dental assistants and your instruments. We carry hundreds of child patients a year in my office on a cost-free basis. But, if you asked me to volunteer a day in a clinic, I would have to say that I do not have time.
The bottom line is that education, medical care, medicine, medical research, and charity take a back seat to the more mundane focus of human nature - buying cars, waging war, pursuing personal pleasure, and entertainment. How do you justify the phenomenon of a teacher earning $50,000 a year and paying for his or her art supplies, and a Major League Baseball catcher who does not even bat his own weight yet earns $5 million a year?
Until priorities are rearranged and serious scientific effort and money are directed toward discovering the cause of diseases and social ills that plague mankind, there can be no global solution for access to anything. If you look at places in the world today that are inundated with poverty, disease, hunger, and discontent, then look at the billions and billions of dollars devoted to endeavors that destroy rather than build, you can see the disconnect.
Why should any child in the world today go to bed hungry? When this question is answered, we will have the answer to access to dental care. Until then, each of us has to do the best we can to make a difference no matter how small.
Dr. Dalin: Thank you, Dr. Berman, for taking the time to visit with me. Is there anything else you would like to discuss?
Dr. Berman: I would like to make a plea to our colleagues to spend more time treating special children. The “special child” is no longer a rarity. Autism, for example, occurs in one of every 170 births. For some reason, birth defects and attention span disorders are becoming more and more common. There is no “special” dental office for special kids. It falls to all dentists to be actively involved. The satisfaction you will feel from treating a child who is physically or mentally compromised is indescribable.
