Bright-eyed & enthusiastic, my classmates and I began our journey as dentists in 1991.
The fortunate few amongst us, got the much coveted one year job as clinical assistants in
my alma mater, GDC & H, Mumbai. While my peers complained during their pediatric
dental postings, I noticed that I enjoyed cajoling the scared child, while successfully
accomplishing the task at hand. Kids seemed to take to me as I to them! So it seemed
like a natural transition, to pursue pediatric dentistry for a career. As luck would have it, I
made it to the only seat available then, to an all-India candidate, at the prestigious NHDC,
Mumbai under Dr. SG Damle. And in 1995, I was ready to take on the world of childhood
tooth decay, once again bright-eyed and enthusiastic!
Cut to 2025! If I were to make ‘treating childhood tooth decay’ my sole identity, it might
invite scorn amongst colleagues. The scope of pediatric dentistry has become so much
wider. A pediatric dentist today, might help a family struggling with enuresis or attention
deficit in their child, by diagnosing symptoms of sleep disordered breathing. A pediatric
dentist may not only release tongue ties but also provide therapy that helps the child
maintain the right tongue & face posture. A pediatric dentist may suggest an assessment
by a developmental pediatrician thus leading to an early diagnosis of neurodiversity. The
list goes on.
And yet, I maintain that even today, the one constant in a pediatric dental practice is early
childhood caries. It is unfortunate that we haven’t seen a decline in dental caries and
managing the disease continues to be our mainstay! How we understand & treat the
disease however, has changed. What has also changed dramatically over the decades is
the families we work with. Parenting techniques have undergone transformation as also
the relationship between doctors and the families they treat. The sooner we understand
and adapt to this change, the better we will serve the kids who need our care.
What makes us different
I have always looked at pediatric dentistry as age focused general dentistry! This brings
with it, endless challenges & possibilities! Our skills have to encompass every branch of
dentistry while simultaneously ensuring that treatment plans are appropriate to the child’s
age and ability. We have to be proficient in the understanding and efficient use of
pharmacological methods of behaviour guidance. We have to be adept at performing
dental procedures on the dental chair and on an operation theatre table. We have to
perform treatment in awkward positions to accommodate a child on a wheelchair,
caregiver’s lap or a waiting room sofa! And we are expected to deliver quality, state-ofthe-art care even in reluctant children and patients whose age, cognitive or physical
abilities override their capacity to cope with demanding dental procedures. All this
requires not just our expertise but also our ability to team up with the constantly evolving
parent & family, so that the child receives the best possible care.
Keeping Abreast
Back in the day, with no internet, access to ‘up-to-date’ information was challenging. I
was able to incorporate new techniques and materials into my pediatric dental practice
because of my constant interactions with astute clinicians, who were experts in other
specialities of dentistry. I was very fortunate that the leader of that pack was my own
spouse, Dr. Udatta Kher. I consider those friendships a valuable asset even today.
But the world has shrunk, access to knowledge is a click or a webinar away and how
current our knowledge and techniques are, depends entirely on how interested we are in
updating ourselves. The younger generations of our pediatric dental community in India
need a special mention here. I am proud and grateful for the constant knowledge sharing
we enjoy on social media platforms!
Learning, Unlearning & Relearning
Who would have thought, when I first learnt the science of dental cariology and the art
and science of treating it, that I would need to unlearn what I knew to be the
unquestionable truth? The understanding of dental caries and how we treat the carious
tooth and the pulp has undergone a paradigm shift. We have now adopted minimally
invasive techniques to treat the carious tooth and to treat teeth that are pulpally involved
due to trauma or dental caries. These techniques preserve tooth structure, increase tooth
longevity, are less challenging to undergo, reduce anxiety for the patient, decrease the
need for pharmacological techniques of behaviour management, reduce the burden of
care for the family and are less stressful for the pediatric dentist to perform. It is a win-win
for all the stake holders, provided the dentist has an open mind to unlearn the old and
relearn the new!
The Parent
Today the pressures of being an ideal parent raising an ideal child are immense. Social
media experts share accomplishments and set goals that seem impossible for parents to
achieve. Stressful lifestyles leave parents with a constant dearth for time. Coupled with
poor knowledge and attitudes towards child oral health, pediatric dental appointments in
India are constantly left to compete for attention with tuition classes and other activity
classes. There are parents who are excessively anxious that their child not experience
discomfort. Others are anxious to record the perfect reel of their child’s first dental visit
and cannot concentrate on what you are communicating to them. Still others may be
confused because of the information they have gathered online.
Instead of being annoyed that they tried to seek answers on the internet, we must
acknowledge a parent’s need to keep themselves informed as also their right to correct
information. Today, parents ask questions and know that they deserve answers. At the
same time they respect our advice with regards to their child’s oral health. When we
communicate clearly and answer their concerns and questions, it ensures that the child
who is everyones focus, gets the best possible care. We are the health care professional
that they sought out over many others, for their child’s needs. Acknowledging this with an
attitude of gratitude and mutual respect, goes a long way in developing a comfortable
relationship with the family.
And frustrating as it may be sometimes, understanding a parent who is ‘gentle parenting’
or ‘unschooling’ their child will only make us better at our jobs! After all, we need the
parent or care giver to partner with us in their child’s care.
The Private Pediatric Dental Practice
Very few had trodden that path when I established an exclusive pediatric dental practice
in Mumbai, 30 years ago. That made it easy since competition was scarce, but difficult
because awareness even in the medical fraternity, was extremely poor. Pediatric dentists
routinely practiced general dentistry back then and most in the medical profession did not
know we existed. Dr. Hema Kapadia deserves a special mention, for leading the way in
India with an extremely successful pediatric dental practice. I remember visiting her clinic
on Peddar Road, Mumbai to invite her to my new practice. She came out to the waiting
room, rushing to greet and hug one of her patients and I was surprised at the casual
warmth. I had thought that the dentist was supposed to sit in their chamber and await the
patient’s entry. You learn so much from the little things! I remain eternally grateful for the
encouragement and support of my family and the many general dentists and pediatricians
in Mumbai city who opened their minds to the need for a pediatric dentist to look after
their child patients.
Fortunately, exclusive pediatric dental practices are common place today as they should
be, and parents understand the value we add to their children’s health. Pediatric dental
practices however, need to adapt and evolve constantly, in tandem with the evolving
parent. When we first got our clinic website up, I thought our job online was done. I was
so wrong! If families search online for ‘the best pediatric dentist near me’, we need to
ensure our practices appear on that search. Requesting a parent to rate us professionally
and write a review about their experience, would have felt insulting even a decade ago.
We were the ‘doctor’ and our word was final. The dynamics have changed and when we
develop an attitude of mutual respect, requesting for that review becomes easy too. Our
practice has grown in the last three decades. We are now a team of four pediatric
dentists, each bringing to the practice their own skills and expertise. Team work does
justice to the breadth of the subject after all!
Indian pediatric dentistry has grown even more majestic with time! The expertise and
contributions of Indian pediatric dentists and pediatric dental entrepreneurs is being
acknowledged world wide today. The future looks exciting for our fraternity and I can’t
wait to see what’s next!
I did not use AI to write this blog! But I can’t help wondering how much artificial
intelligence will influence the way we practice pediatric dentistry in the years to come. Will
AI make our work easier? Will AI take some of our work away? I look forward to the
coming decades with wonder and excitement!