For those who think today’s kids have it too easy, with their cell phones and social media and apps that do all the work — this story might be just too much.
A somewhat trendy procedure allows dentists to treat kids’ cavities without using a drill.
Nor is a needle with painkiller required.
Dentists are using silver diamine fluoride, or SDF, a liquid substance used to help prevent tooth cavities from forming, growing or spreading to other teeth.
It’s important to note SDF does not cure a cavity. But it can be used on baby teeth — or on children who have an intense fear of drilling.
This year, Delta Dental of Arizona began reimbursing for SDF treatments. According to a press release, “Reports through June 30 show 151 dentists within the Delta Dental network have used the trending treatment with more than 1,200 applications to patients.”
Dr. Jeanette MacLean is no trend-follower. She is practically a pioneer in SDF treatment.
MacLean, 43, has been at the same practice in Glendale since 2005.
A few years ago, she started using SDF on children, primarily for two reasons:
• As an alternative to children who would have to be put under with anesthesia to sit still for drilling;
• Because SDF is far less expensive than drilling.
MacLean said the second reason benefits parents who don’t have insurance —and social network helps cover low-income families.
“I’m saving Medicaid hundreds of thousands of dollars,” the Glendale dentist said. “It’s a huge benefit to taxpayers.”
The saving is striking, she added, when one considers a child terrified of a drill, who would need to undergo costly anesthesia to be treated. Instead, MacLean can painlessly paint SDF on the child’s tooth.
An undesireable byproduct: The treatment is not aesthetically pleasing.
“SDF turns teeth jet black,” MacLean said.
And the color does not fade away. “It’s permanent until it gets covered with a filling or crown or the baby tooth falls out.”
However, she added, there is no coloring in some cases. MacLean said she treated herself and her daughter with SDF.
“It doesn’t stain healthy enamel,” she said. “My tooth has no stain. My daughter’s tooth only got one tiny little black dot in a groove that you could barely see. When she was a little older I placed a glass ionomer sealant over it so you can’t even see it anymore and now food can’t get stuck in the grooves so there’s no need to keep reapplying the SDF.”
MacLean lives in Phoenix with her husband and two children, 7 and 9. The kids led her, though indirectly, toward SDF.
“My daughter had surgery as an infant and had to go under general anesthesia,” she said. “That made me better empathize with parents.
“Before I had children of my own, it was almost annoying - ‘Why are they questioning anesthesia?’ Then, I became the person with all the questions.”
Though she is a proponent of SDF, for her it’s a tool in her kit, but by far from the only option for every child.
“It’s not a silver bullet. It’s another option for treating cavities,” MacLean said. “What’s unique is it’s non-invasive. Patients I treat (with SDF) are young children who are unable to cooperate with typical surgical treatment of tooth decay.
“They would have to be sedated or have a scary experience. They don’t have the coping skills of adults, so having something non-invasive for children is something that’s great to have. It’s also good for special-needs patients. And another patient population are geriatric patients; often they’re on so many medicines or medically compromised or have difficulty with surgical treatment.”
Eager for that non-invasive option to surgical treatment (read: drilling), MacLean had been doing following SDF’s entry into the marketplace.
“It wasn’t available until 2015. I purchased it as soon as it was available,” she said.
The following year, the New York Times featured MacLean in an article on SDF.
Since then, she has become something of an SDF guru, giving lectures “all over the place.”
The publicity and her speaking engagements had parents of dentist-fearing kids tracking her down.
Success stories? Oh, yes, she has a few.
Tasahli was 2 when his mother flew him from Oklahoma to see MacLean.
“No other dentist in her state would offer anything but general anesthesia to treat him,” MacLean said. “His name in Chickasaw, his tribe, means ‘scream.’
“I feel his mother’s actions are a scream for change in the way we manage caries in young children.”
Speaking of screamers, Wyatt Montgomery was one of my MacLean’s first patients she treated with SDF in 2015, “to help him avoid general anesthesia.
“He used to scream and cry even for a simple exam. We’re now BFFs.”
MacLean often uses the “bridge” approach, using SDF to stop a cavity’s growth, then treating it after establishing a trusting relationship with the young patient.
She referred to a 3-year-old she treated with SDF for a year to avoid sedation.
“She finally decided that she wanted ‘white teeth,’ and sat like an angel, no sedation, no shots and let me place glass ionomer fillings,” MacLean said.
Another success story: “The pregnant mother of a 2-year-old drove him four hours round trip from Yuma, multiple times, for SDF, SMART (silver modified atraumatic restorative treatment) and Hall Technique (another non-invasive treatment) to avoid IV sedation.”
She only wishes she could get more kids — sooner.
“Unfortunately, many kids get to us when it’s too late for minimal interventions, and the decay is already into the nerve or infection is present and sedation may be necessary. That is why it is critical for parents to bring their babies to the dentist no later than their first birthday, brush twice a day as soon as the first tooth erupts, and practice good feeding habits and a healthy diet, limiting sugary and processed foods and beverages. Sipping and snacking all day and night, even on organic foods and breast milk, can contribute to severe early childhood caries,” MacLean said.
She noted one-third of children in Arizona have cavities by their third birthdays. “So waiting until they’re 2 or 3 or will ‘sit still’ is simply too late. The earlier you come, the better, and more likely to learn how to prevent problems in the first place,” MacLean said.
“We recommend see us before the first birthday.”
Dr. Jeanette MacLean seems to be solidly in the right line of work. She loves talking teeth, sees “difficult children” as an interesting problem to solve and delights in seeing smiles — the beaming baby teeth on her young patients’ faces as well as the relieved grins of parents, finding out they don’t have to figure out how to come up with a few thousand dollars for sedation and drilling.
A curious thing about MacLean’s use of SDF to save parents money: It’s been a financial boon.
“The irony is it’s made us so much busier,” MacLean said. “If you do the right thing, good things happen.”
Dr. Jeanette MacLean is at 6320A W. Union Hills Drive, No. 280, Glendale. For more information, call 623-362-1150 or visit kidsteethandbraces.com.