Pediatric Dentistry, my journey of three decades!

Dr. Meenakshi S. Kher

MDS, FIAPD

Happy Tooth Clinic , Mumbai

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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!

Author

Dr. Meenakshi S. Kher

Dr. Meenakshi S. Kher

MDS, FIAPD
Happy Tooth Clinic , Mumbai