New York City Edition VOL. 3, NO. 4

Dr. Deborah PillaAn Adult Look at Pediatric Dentistry

Dr. Deborah PillaAn Adult Look at Pediatric Dentistry

NEW YORK CITY DOCTOR OF DENTISTRY

coverstory

Any parent knows that a routine visit to the dentist with a young child is anything but routine. Some visits can be one of the most stress-filled and terrifying events a parent can ever experience, and for the child as well. For this reason, it takes a real measure of the right stuff to successfully practice pediatric dentistry. This fact became clearly evident in my interview with Dr. Deborah Pilla of Park Avenue Pediatric Dentistry.

Dr. Pilla’s journey into the field of dentistry in 1976 began as a detour. While attending Hobart and William Smith College, Dr. Pilla’s career goal was to become a child psychologist while her female roommate was planning to practice dentistry. This captured Dr. Pilla’s attention, since few women practiced dentistry back in the ’70s. As irony would have it, Dr. Pilla’s roommate decided not to pursue dentistry, but she did. “I decided that if I wanted to do den-tistry that I definitely wanted to work with children,” says Dr. Pilla. She later went on to receive her D.D.S. from the State University of New York at Buffalo in 1981. She later completed a fellowship in special patient care at Columbia University School of Dental and Oral Surgery in 1982 and her specialty certificate in pediatric dentistry at Montefiore Medical Center in 1984.

THE EARLY CHALLENGES“Prior to the early 1970s, nearly all practicing dentists in

the U.S. were males,” states Lynn D. Carlisle, D.D.S., of the ADA Survey Center. It’s no wonder then that Dr. Pilla was among a small handful of women who were enrolled in dental school when she attended. “When I started dental school in the late ’70s, there were only 10 women out of a class of 100. The next challenge was setting up a practice. In the mid-80s, there were really very few pediatric practices in Manhattan and they certainly weren’t any women. A female friend of mine and I decided that we really wanted to have our own office and we were going to open cold in New York. Everyone told us that we could not do that and

we would never make it. We felt we had something special to offer because we were women and we were mothers.”

Highlighting some of the key factors responsible for the eventual success of the practice, Dr. Pilla explains, “When mothers brought their children to us, we, as mothers, could really empathize with their needs and understand their concerns. At that same time, Chase Manhattan Bank had a program for new doctors — they don’t have it anymore — where they would lend you money with no credit history at all. They lent me all the money to open the first practice and now we’re here 25 years later.”

THE MOTHER FACTOR“Dentistry itself is not really complicated,” comments

Dr. Pilla. “It is really dealing with the child, getting them to trust you, getting them comfortable and easing their fears

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Dr. Deborah PillaAn Adult Look at Pediatric DentistryBy Mark Ellis

Dr. Deborah Pilla

NEW YORK CITY DOCTOR OF DENTISTRY

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and anxieties. Getting them just to sit in the dental chair can be most of the office visit. So, it’s really not the dentistry that matters most but it’s the interaction with the child.”

While some dentists would have no trouble performing basic dentistry on a child, there are occasions when even a simple procedure can take on gigantic proportions. This is especially true in the case of children with special needs. “In pediatric dentistry, we also work with children with unique needs such as handicapped children, autistic children — children who the general dentist does not want to treat, doesn’t have the time or specialized staff to accomplish the proper dental treatment,” says Dr. Pilla. “We also treat children who are ill, children with leukemia, children who need special care and children who are on special medications or need a dentist to take the time to talk to their doctor or oncologist about special pretreatment with antibiotics or certain medications. It is a part of dentistry that is a really about caring for the patient and not just about fixing teeth.”

When asked if her early training and education in child

psychology has helped in her practice she said, “Absolutely! I also believe my early experiences as a babysitter, camp counselor and a mother have also helped me in my profes-sion.” She added, “I have always liked children and this has been a perfect way to be a health care provider and engage my love of children.”

Aside from the advantages of being a mother, there were other benefits to being a woman in pediatric dentistry. “Women’s hands are generally smaller than a man’s, which makes it a lot easier to work in a child’s smaller mouth,” explains Dr. Pilla. “Another point that I have observed is that when children walk in, they ask me, ‘when is the dentist coming in?’ They [the children] don’t even realize that I am the dentist. This is great because there is a lack of anxiety when I come in the room, which makes it easier for me to interact with them.”

THE CHALLENGES OF TREATING CHILDREN

Oddly enough, one of the biggest hurdles in pediatric dentistry is not treating children. “One of the biggest challenges in treating children is their parents,” confesses Dr. Pilla. “This is because the parent is frightened, too, and

Mission statement displayed in the waiting area

A mother and toddler enjoying a storybook in the waiting areaA curious toddler plays with a wall-mounted toy

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NEW YORK CITY DOCTOR OF DENTISTRY

if Mommy is frightened, the child is frightened. Very often we have to spend time getting the mother comfortable and walking them through the procedure, not only the child.”

What other challenges can you expect to encounter when treating children? “Children often don’t have a concept of time. If I was working on your tooth and said, ‘Just give me one more minute and we will be done,’ you would just sit there for another minute. You can’t say that to a child. Children don’t have a concept of time or understand what one minute is, so you have to work very quickly. This means we have to keep appointments very short. Probably our longest appointment is 20 minutes to do a filling.”

In addressing all the special needs of children in den-tistry, it becomes apparent that you need a highly trained staff to operate a successful practice. Commenting on this fact, Dr. Pilla said, “The staff has to be highly trained with children and be willing to help them when they cry, vomit or when they wet their pants. You have to remember they

Above: A mother looks on as the condition of her toddler’s teeth is examined

Left: Comfortable, child-friendly operatory

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are children, some of them are babies and some of them have diapers on. It is very difficult to find good staff will-ing to work with children while they are crying, jumping or playing. It’s a noisy office with a lot of activity but it is also a fun environment.”

APPROACHING A CHILDIs there a special approach or technique you need to use

to perform treatment on a child? “Any dentist can treat a cavity, that’s not the challenge,” comments Dr. Pilla. “The real challenge is determining how I am going to complete this procedure with this child. How am I going to get them to sit still during the treatment? What can I use or what can I say to reassure the child? Is the child good with cartoons or will Mommy need to be in the room? Will the child need laughing gas or do they need a sedative? Will they simply need to come in and just sit in the chair and go up and down in it? So, it’s really a question of trying to figure out how you are going to be able to do the dentistry and that’s what makes it challenging and interesting.”

THE AGE RANGEWhat is the age range of the patients you treat here in the

office? “The age of the patient at their first visit is usually about 1 year old. At 2 years old is when I start their regular dental checkups every six months. So, the age range of our patients span from 1 to 18 years old. We do all our babies in the mornings and I have all my teenagers come in the afternoons. We purposely do it like that because I don’t want teenage boys stepping on babies.”

When asked if she thought teenage boys would be embar-rassed about going to a pediatric dentist, she said, “I would think so, but I have a son, 19, and a son, 16, and I find that more and more of the boys that age want to come here be-cause if they go to a general dentist they have to be a man and be strong. Here they can act a little childish and they can say to me like I’m their mother, ‘ow, it hurts!’ I guess there’s some truth to the adage that men are big babies. They like coming here, some of them are now growing beards.”

At what age do you stop treating your older patients? “We do have a cut off. I tell my patients that I will carry them through

Dr. Pilla uses a toy to interact with a patient before beginning treatment.

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college. I do this because I want to keep the flavor of the office pediatric and that’s important to my practice. What I also find is that the 18-year-old patients we treat have no cavities so they don’t really need complicated dentistry. They just want to come here to have their teeth cleaned. So, my goal really today is to have children grow up through their teens with

beautiful, straight teeth and no cavities. We refer our patients to an orthodontist if their teeth require straightening. It is an incredible new generation that’s coming out there that, like it or not, is not going to need a lot of adult-type dentistry. This is especially true when we treat the patient from infancy.”

TREATMENT TECHNOLOGIES

“Our goal in our mission statement is to provide our patients with preventive dental care using the latest technol-ogy,” says Dr. Pilla. “One treatment technology that we use very often in pediatric dentistry is sealants. We use sealants to cover the pit and fissure areas of the teeth that are more susceptible to possible decay since the fluoride they receive

Above: The young patient shown here is getting a full-mouth scan.

Left: Flat-screen monitors enable patients to see digital X-ray results instantly.

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in drinking water is more effective on the smooth, nonbit-ing surfaces. One sealant we use which we have found to be very effective is by Ultradent and it does not contain bisphenol-A dimethacrylate.”

Since preventive dentistry is the main thrust of your mission statement, how do you go about treating cavities? “When we detect a cavity early, we can actually make it go away,” explains Dr. Pilla. “Since decay starts by demineral-izing the tooth, we can reverse the process by remineralizing the tooth. We use a product called CavityShield, which is a type of fluoride that is very sticky and gooey and we can paint it or floss it between the teeth. It has actually been shown to remineralize the tooth enamel and help prevent decay in the early stages. Another product I like which is an at-home treatment that kids can use is fluoride gel toothpaste called Just For Kids by Omni. We have had good success with this product in resolving incipient caries when children used it once a day for brushing their teeth.”

CAVITIES ON THE RISEIn a recent report from the CDC, there has been a 28%

increase in cavities in baby teeth of children ages 2 to 5 years. Commenting on this alarming trend, Dr. Pilla had this to say: “Children today eat so much more processed food snacks. Where your mom may have given you an apple and some grapes, the kids today are getting gummy fruit snacks, granola bars, breakfast bars, etc., and everything has so much sugar in it. Early diet studies done in 1950 have shown that the most important meal to have sugar free is a snack. If your child’s snacks are sugar free and healthy like yogurt, cheese, apples and bananas, your kids will have a lot less cavities than the kids who are eating ice cream, cookies, candies and these processed foods. If you want to give your child a cookie, it should be a dessert with a meal and not a snack and not before bed. Another reason which I think is more upsetting is that children are not drinking tap water anymore and they are not getting fluoride because they are drinking bottled or filtered water.”

ON THE HORIZON“One of the very interesting things that I think is very

promising that will have a major impact on pediatric

Dr. Pilla is shown here consulting with a teenage patient on a treatment plan.

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dentistry is stem cell research,” comments Dr. Pilla. “There are two facets to this research. One area is growing oral structures from stem cells. So, rather than getting a fake tooth or an implant, in the future we would be growing you a new tooth. If you break your jaw and there is part of your bone missing, we would grow you the new bone. Some say that this area of dentistry is so revolutionary that some are comparing it to when silver fillings were first introduced.”

Dr. Pilla went on to explain the other area of stem cell research by adding, “They are a group of researchers that believe that they can get stem cells from a baby tooth. What they want to do is have parents with a child that is losing their baby tooth to go to a dentist who would remove it and mail it to StemSave, where they would extract stem cells and then place them in a vault. The stem cells could then be later used to help repair and replace organs like your liver, kidneys or your heart. This process can only be done with baby teeth that are about to come out. Imagine, one day it may be possible to repair your liver with stem cells that were taken from your baby teeth.” ■

Dr. Pilla and staff

Park Avenue Pediatric Dentistry870 Park AvenueNew York, NY 10075(212) 879-6518www.parkavepd.com

Training• William Smith College, Geneva, NY, 1976 — B.S.• State University of New York at Buffalo, Buffalo, NY, 1981

— D.D.S.• Montefiore Medical Center, 1984 — Specialty Certificate

Pediatric Dentistry• Columbia University School of Dental and Oral Surgery,

New York, NY, 1982 — fellowship, special patient care

Technology• Gendex — digital X-ray• Ultradent — cavity prevention• Omni — cavity prevention• Sunstar — oral health care• Oral-B — oral health care• WaterPik — oral health care• Cologate — oral health care• Unitek — restorative• Televox — doctor/patient communications• Tanner’s Tasty Paste — oral health care

Deborah Pilla, D.D.S.

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