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It's good that a lot of dentists "have no interest in pedo…it's job security for us pediatric dentists!"
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AUDIO - HSP #223 - Jeanette MacLean
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VIDEO - HSP #233 - Jeanette MacLean
Jeanette MacLean, DDS shares why kids have so much tooth decay, how to prevent it, and why kids should have their first appointment by their 1st birthday.
Dr. Jeanette MacLean is a private practice pediatric dentist and owner at Affiliated Children's Dental Specialists in Glendale, Arizona. A 2003 graduate of the University of Southern California School of Dentistry and 2005 graduate of Sunrise Children’s Hospital pediatric dental residency program through the University of Nevada School of Medicine. She is a diplomat of the American Board of Pediatric Dentistry and her clinical research has been published in Pediatric Dentistry, the official publication of the American Academy of Pediatric Dentistry. Her article "Pediatric Dentistry, Parents, and Spoiled Kids; Tips for Dealing with Parents in an Era of "Everyone Gets a Trophy!"" was recently published in the August 2015 issue of Dentaltown magazine.
Howard Farran: It is a huge honor today to be Podcast interviewing a rock star pediatric dentist from Glendale, Arizona who just had an article in Dental Town Magazine, "Pediatric Dentistry, Parents, and Spoiled Kids: Tips for Dealing with Parents in the Era of Everyone Gets a Trophy". My God, it was awesome. Everybody is talking about it.
Jeanette M.: Thank you!
Howard Farran: Your name is Jeanette MacLean, and the most famous MacLean was the lady in the Poseidon adventure.
Jeanette M.: Yes, Shirley.
Howard Farran: Shirley Maclaine. I did not think at your age you would be old enough to have seen that movie. I know I was a kid when I saw it.
Jeanette M.: I remember watching it as a kid on TV and just being totally freaked out by it. Maybe that's why I love Halloween so much is that I do love a good scary movie.
Howard Farran: Your teeth are so perfect and gorgeous. You could have been a cosmetic dentist. The question I hate to ask the pediatric dentist, because I don't want to hurt their feelings ... You know there's 9 specialties by the American Dental Association. I love root canals. I love re-treats. I love extractions. I love everything in dentistry, but if I had to have your job, I'd quit. I'd turn in my license, and go back to my first job. My first job was 10 years working with my father who owned a Sonic Drive-In. I would go back to working foot long cheese dogs ...
Jeanette M.: With the cherry limeade.
Howard Farran: With the cherry limeade, before I would go to work as a pediatric dentist. I don't mean that in a rude way. It's the only thing that it's just like there's no money enough in the world to work on a 3-year-old, even though I love kids. I have 4 boys, and I have a 3-year-old amazing granddaughter, but man. I'm going to say this, and this sounds so rude, but it's almost like you're a veterinarian when you're working on a 3-year-old. It's not like they can tell you what's going on.
Jeanette M.: Sometimes they make animal sounds actually. We had someone meowing yesterday in the office.
Howard Farran: What made you pick pediatric dentistry? Were you just a glutton for punishment?
Jeanette M.: You know what it actually started in college. I went to Northern Arizona University, and my last semester of school I was an assistant for a pediatric dentist up there, and that's really where my love of it began. I just knew "This is what I want to do. This is what I could do all day." I guess it's good that people like you have that reaction, and have no interest in pedo, because I guess it's job security for us pediatric dentists, that other dentists don't have any interest in treating the kids. I am more than happy to treat them. I think the reason why I enjoy it so much is because I'm really just a big kid myself.
Howard Farran: You're just a big child yourself?
Jeanette M.: I am. I still have a baby tooth in fact.
Howard Farran: That's something that you just learn from doing dentistry for a few years. You notice that all the people that took all my advice in '87 "Well, there's no permanent tooth underneath that baby tooth, so we're going to have to extract that, or do an implant or a bridge or whatever," and then all the people who couldn't afford that treatment, 30 years later that baby tooth is still there.
Jeanette M.: That's right. Yeah. I'll be 40 next year, and I still have number T, so it's going strong.
Howard Farran: 40 years old. Is that a new millennial baby boomer thing that you didn't care that you were 40? Most women will not tell you their age.
Jeanette M.: I have no problem telling anyone my age. I'm proud of my age.
Howard Farran: Are you proud of it, because you look like your 21 and you want to show off that you're 40?
Jeanette M.: Hey, thank you. Sure. Sure. I think that, especially in my field, I feel like I get more respect from the parents, especially when I became a mother. It gave me more street cred, so to speak. When I was fresh out of school, they just looked at me and think "Girl, you don't know anything. You don't have kids. You're just a kid yourself." I think becoming a mother and having more life experience makes me a better pediatric dentist where parents will take my advice more seriously, because I can empathize with them. There's definitely a power in that. I have no problem. I'm actually excited about my 40th birthday. I know that there's a party plan in the works, so I'm looking forward to it.
Howard Farran: I agree. When I opened up in '87, I was only 24, but I was completely bald. I was always doing second opinions, and these people were telling me, specifically these 2 dentists that were across the street that were 5 years older than me but they look like young kids, but they were saying "He's young. I don't think he knows what he's talking about," and I'm sitting there thinking "Oh my god. There 5 years older than me." I run across the street with my FMX and ask them what to do, and I'm getting their patients, because they think I'm older than them. Looking older probably does help a lot when you're a doctor.
Jeanette M.: It does, although, in pedo it helps me as a female, because I think the kids find me very non-threatening. I don't wear a white jacket. I don't dress up in a fancy outfit to make myself stand out to look noticeably different than the staff, so we all sort of blend together. There isn't that fear the kids get when the doctor walks in the room, because I look like all the other ladies in the office.
Howard Farran: The million dollar question that people are going to always ask a pediatric dentist, so I'll just get it out of the way, should the mom and dad be in the room or not?
Jeanette M.: Actually, interesting segway. Like my next Dental Town article that is coming out in November, it's called 'Parents in the Operatory: Friend or Foe?'. It's definitely a more common request now for the parents to be present, and when I first started out it was very much parents out of the operatory. It was very old school. The practice I had been around for over 30 years, they were very old school. Parents out of the operatory, but I think when I became a mother myself, I started to realize more and more requests were coming in for parents coming in. People just don't have that same trust in people in positions in authority anymore. In doctors and police officers, there's a lot of fear I think. Then, there's the aspect of parents that sometimes feel that if they're present their child will do better, but I think we all know that sometimes that is not true.
Sometimes they're much worse actually for the parent. They put on a bit of a show for the benefit of the parent, so they become the victim and the parent is the rescuer. It's definitely one of the biggest challenges, I would say, of pediatric dentistry. It's not so much the children. The children are great. I think it's fun and great. I like dealing with the kids. I like having the cartoons on. What better job than to be able to watch Willy Wonka and the Chocolate Factory at work anytime that you want. I really enjoy that, but the parents are one of the really challenging aspects of my specialty.
Howard Farran: What do you think of the compromise that we do, where we just said "Look, I understand that the most G-rated comedian, Bill Cosby, turned out to be an evil Jared from Subway," and you're right. I grew up Catholic and went to mass every single day, and some of those guys turned out to be freaks. I tell them "I understand that it's your baby. I understand that you don't want to leave your baby, so my rule is, as long as the baby can't see you, you're good, but if the baby sees you and starts going for an Oscar, then you're going to have to leave." They get to stand outside the room. They get to peek. What do you think about that? Does that work or not really?
Jeanette M.: Our policy is that the silent partner, where we ask them to sit in the corner of the room and be a silent partner. The last thing I like is them up on top of the child basically. The hovercraft or helicopter parent, which is definitely occurring these days. There's a lot of that that goes on. That really distracts me and distracts the child, so we just ask them to sit in the corner and be quiet. For the most part they'll do that. You mentioned the priests, and Bill Cosby, and Jared the Subway guy, you see that all over the news and the media, and I think that's really where this fear stems from, is the news media and social media. Parents see these stories and you can't blame them for being afraid or paranoid even. They don't know me if they're new to the practice, so I totally understand why they'd want to be present. I really don't have a problem with that, and once I finally embraced that and allowed parents to be present more often, I feel like in some ways it just made it easier because the parents were able to watch us in action so to speak and develop more of a respect for what we do. That's sort of the artistry of pediatric dentistry is managing the child's behavior.
Howard Farran: The next question that everyone asks a pediatric dentist, sometimes we hear that you don't see to see a dentist until the first tooth arrives. Some people say by age 1, but what do you tell parents? When you can see a tooth or on their 1st birthday? What do you think is more evidence based dentistry type of honor?
Jeanette M.: I stick with first visit by the 1st birthday or within 6 months of the first tooth erupting. The main reason being that 1/3 of kids in our state of Arizona have decay be age 3.
Howard Farran: What percent?
Jeanette M.: 1/3. 30% of kids already have cavities by 3. To go with the old rule of waiting until 2 or 3, and a lot of pediatricians are still telling the parents this, that "Oh, you don't have to go until there 2 or 3," because maybe that's what they learned way back when they were in medical school. A lot of times they're coming too late and there's already a problem. The key is prevention. Nobody wants to go to the dentist more than they have to at any age really. For parents to wait until they can visibly see decay in a primary tooth, if you wait until you can visibly see the cavity, and you're talking most of the time pulp and crown right, and getting them comfortable in the office so that they don't associate us with being something scary.
Having those fun visits before you have the real work, because it definitely can impact how they feel about dentists for the rest of their lives. It's really sad when you see a child who comes in for the first time, and let's say they're 5 or 6, and this is their first experience at the dentist, because let's say they have an abscess or they fractured their tooth and they're there for trauma treatment. It's so frustrating, because the associate that negative experience with the dentist, where it doesn't have to be like that.
Howard Farran: I always cringe when I see all these dentists on social media sharing all these deals like you know "Bring your kids in by age 1 or 6 months after or when they see the first tooth or whatever," because I always think that we should back up even further. None of these kids were born with streptococcus mutans.
Jeanette M.: That's a good point.
Howard Farran: I still can't believe that you can go to any BBQ at anybody's house and you can always find a grandma kissing a baby on the lips. It's like I don't think I'll ever live long enough to see an earth that will realize that kids are not born with streptococcus mutans and they weren't born with STDs. Everybody on the entire planet understands an STI. I think AIDS educated the entire planet that you can trade bad bugs below the belt, but I don't think the planet has barely woke up the fact that this kid wasn't born with streptococcus mutans. Why are you kissing it on the mouth?
Jeanette M.: Well, even if they know that, I don't think it would change them from kissing their kids on the mouth. Is it bad that maybe I do that too? I brush my teeth. I don't have any cavities. I chew xylitol gum. You're right. I think what you're going for here is getting to the mother when she's pregnant to talk about prevention starting then. Is their mouth healthy before they give birth to that child? It would be nice if we get to that point some day. I feel like even today we haven't gotten to the point of the majority of the public accepting the age 1 visit, so I'd like to get to that and then maybe the next step would be getting to the pregnant mom
Howard Farran: I mean you had your granddaughter to a 50-years-old dentist and it'll try to kiss her on the mouth, and you're just like ...
Jeanette M.: That would be a little creepy.
Howard Farran: Yeah. We're a long way from that. You're a spokesperson for Delta Dental on Pediatric Shop. It seems like whenever I see a press release from Delta about anything pediatric, it's always the rock star you. Delta's probably behind this, because they don't want to pay for a bunch of pediatric dentists. They'd rather collect a premium, and all the kids come and have a good check-up, I'm sure.
Jeanette M.: Well, sure. Of course, it benefits them if there's less cavities to treat, but it's also a good public health effort to talk about prevention.
Howard Farran: I love Delta. It seems like Delta Dental does 10 times more press releases and social media ...
Jeanette M.: They do.
Howard Farran: Than any other organization that I can think of.
Jeanette M.: They always have fun stuff that you can share on your Facebook page or what not. This week we're 3 days away from Halloween. They have awesome stuff for the kids like coloring sheets and activities for Halloween with like a tooth fairy. They have different tips for candy, like what's the best candy for your teeth or worst candy for your teeth. Things like that, especially for dentists, if they can tap into those resources and share them with their patients. It's a great thing to have.
Howard Farran: Educate the dentists on the big buzz word here, xylitol. By the way, I've got to tell you what I'm doing for Halloween. I've already been working on this. I bought a gumball dispenser where you have to put a quarter in to get the gumball. It's a quarter. I'm going to have that on my front porch, so if you want a sugar gumball, it's a quarter. Then, I'm going to have a bowl of xylitol sugar free gum that's free, so if you want the sugar from the dentist's house, it'll cost you a quarter for a ball. If you want the free sugar less, and I'm going to have a big sign explaining it all.
Jeanette M.: All right. I have to say, if I were you, I'd be a little nervous that my house will be egged and TP'd. I'm the dentist you want to come to on Halloween, because I'm giving out full size bars of candy.
Howard Farran: Well, what I think is the cutest is for years I've always handed out a toothbrush with my name and phone number on it. I always go to the door and I'd say "I'm sorry. I'm a dentist and I can't give you candy, but I'm going to give you a free toothbrush," and some of the kids say "Oh, it's okay." Like they feel sorry for me that I'm not allowed to give out candy, and I've had so many kids pat me on the knee and say "It's okay. It's okay. You don't have to give me candy." They feel sorry for me that they think I'm not allowed to do it.
Jeanette M.: The kids nowadays get so much candy. It is okay to give out something different. Gosh. This week we have so many events and parties leading up to Halloween, but by the time you actually get to trick or treat, the amount of candy we have is just obscene. I've had kids come where we give them a drink, and they're so excited to get something other that candy. That's another thing on the tricks or treat suggestions that they have at Delta Dental is the alternatives to give out, like toys. The kids do like to get those things, although I do give out candy. I'm not going to lie.
Howard Farran: What kind of candy do you give out?
Jeanette M.: This year we're doing full size bars of candy. We have all the terrible things for your teeth.
Howard Farran: At your house?
Jeanette M.: At our house. I really wish we can pick up this camera. Did you notice the Halloween manicure? I wish I could give you a tour of our house. It's decorated inside, outside. I love Halloween. I go all out. I'm the queen of Halloween.
Howard Farran: This is my theory. I grew up in Kansas, and when I got out of dental school I came out here. I was 24 and it was 1987. It seems like Halloween is a bigger bigger event in Arizona than Kansas. My theory is, in the desert we live through this 115 degree everyday, and I think what's so cool about ... Like this morning, this is the first swim of the season that I had to put on my wet suit to go swim.
Jeanette M.: Yeah. It was chilly this morning.
Howard Farran: Halloween is the dawn of "Oh, it's no longer 120 degrees everyday," and then a month later it's Thanksgiving, and then it's Christmas and then it's New Years. This is the best time to be in Phoenix, and I think that might be a part of why it's a much bigger event out here.
Jeanette M.: I would agree. I know for me personally, when it's July and 115 degrees, that's when I start to get what I call Halloween fever or I just start seeing the stuff at Michael's, you know, the beautiful orange and black colors. I start to get really excited and I start to think "What's my costume going to be? What new decorations am I going to get this year?" I start to get really excited about it, but I grew up in New England. I moved to Arizona in high school, and for me ...
Howard Farran: Where in New England?
Jeanette M.: Most recently, we moved from Connecticut, but I lived in Upstate New York, Massachusetts, and Connecticut. Each for 5 years. People ask if my dad was in the military because we moved so much, but actually he worked for General Electric and that's where they had their different headquarters. APS is what's out here.
Howard Farran: You know why GE is my favorite company?
Jeanette M.: They bring good things to life?
Howard Farran: It was the only publicly traded stock listed in 1900, and was still trading in the year 2000. 499 other companies passed away. Usually ran over from behind, because every company when there a new technology or product, they're always worried about how they save their old product that another company that doesn't have all that emotional baggage comes and mows them down from behind with new technology. I even see that in my company where something new comes along and they say "We shouldn't do that, because it'll hurt the magazine," and I'm like "Well, we're not about a magazine, and in some days there may not even be a magazine." GE was the only one that made it from 1900 to 2000. That's an incredible story. I was going to guess that your dad worked for IBM, because IBM doesn't stand for Intentional Business Machine. It stands for I've Been Moved, and they're up there in Rochester.
Jeanette M.: Albany. We lived up in Del Mar. I don't know how familiar you are with Upstate New York, but we lived in Del Mar. Then, Pittsfield, Massachusetts for 5 years, and then Trumble, Connecticut. Then, we came to Phoenix, but I miss the fall. The point of that is that I miss the fall. I miss the colors, and just that feeling you get when the seasons change. I think that kind of sparked my love for Halloween.
Howard Farran: What candies are better or worse?
Jeanette M.: For your teeth, you want to stick to things ... Of course the xylitol because they're sugar free.
Howard Farran: Review xylitol, because a lot of dentists tell me that they're not as on top of ... What are brands?
Jeanette M.: There's mixed research on whether or not there's an impact, but I do believe in the effectiveness of it in helping to prevent decay. You can get it in various over the counter chewing gums that you can even get in the grocery store, although those have a lower content of xylitol. You can get some even into your practice that you can sell like mints or chewing gum like Spry is one that we like to carry. Elevate Oral Care has a line as well of xylitol products.
Howard Farran: Is it Spry.com and the other is Elevate Oral Care?
Jeanette M.: Elevate Oral Care also has great xylitol products, so those are the 2 of the top ones that I can think of off the top of my head. Then, in terms of if you're actually going to have candy candy, you want to have chocolate or something that's going to basically melt away or not linger in your mouth. Then, if you want to have the absolute worst thing, you want to go with something sticky or something sour, or you can combine the two evils and have a Sour Patch Kid and sticky sour and really mess up your teeth. I would go with the chocolate bar over the Sour Patch Kids for Halloween if you want to protect your teeth. Honestly, I have a little of everything, and then go and brush and floss really well, and try to get everything out of my house. At least a week after Halloween, I try to cleanse and get rid of everything.
Howard Farran: Oh my god! I raised 4 boys. You couldn't even get them to stop trick-or-treating until the pillowcase was to the point where they couldn't even drag it. They wouldn't want to go home.
Jeanette M.: I'm proud. Very good, and the pillowcase is old school. I like that.
Howard Farran: This is dentistry uncensored. I think I built a career because I never gave a lecture where I was trying to make friends or influence people. I was there thinking that the problem with a doctor is that all the staff tells him what they want to hear. The lab is afraid of him. The lab is never going to call and say "Man, you're a shitty dentist. These preps are horrible. There's no room." Everybody is always telling the dentist ... They're always sucking up to the dentist and telling them what they want to hear, and no one stands up to them. I thought maybe my job is if I really love these guys, and I really want to help them, I'm going to be brutally rude to them. Here's my brutal rudeness to dentists is that we keep hearing that up to 8% of emergency room visits are dental related. Every dentist listening to this podcast is open from Monday thru Thursday from 8 to 5. Don't you think we share some guilt for that or do you not think so?
Jeanette M.: I definitely think that you make a valid point. The problem is that people are going to the emergency room for their emergency issues, but there's other factors. Obviously, if we had bankers' hours, where are these people supposed to go, but you do see more of these emergency clinics popping up. I know there's one close to my office and they are open nights and weekends.
Howard Farran: Who is that? Is that an Erik's franchise where he's getting dentists to collectively ...
Jeanette M.: Off the top of my head, I don't know the name of the office, but it's at 59th Ave and Union Hills, but it's an after hours emergency dental clinic. I think that there's value. It's like pediatrics. Now there's Good Night Pediatrics. It seems like no emergency happens until 9pm is the joke with children, so to have a place that's actually open at night is smart, because people want that. People are going to seek that out. The point I was going to make is that in Arizona they took away the adult benefit through Access, so instead of being able to go to the dentist and have a rotted tooth extracted or treated or what not, instead they are having to go to the emergency room. Then, in the emergency room all they're getting is pain pills and an antibiotic. It's not fixing the problem. The problem comes back. I think there's some blame in that as well. It's not just us having the bankers' hours.
Howard Farran: Jeanette, when I tell you this, you're not going to believe me. I had a patient walk in with a 2 foot by 2 foot x-ray of their head and 2 bottles, one was Percocet and one was Pen VK. Somebody took just a lateral 2 foot by 2 foot x-ray of their head for a toothache. I always wondered to myself "Why aren't we dentists through Delta? Why don't we at least go to the emergency rooms and start residencies ..."
Jeanette M.: I think that would be smart.
Howard Farran: Emergency room can handle a heart attack, but they can't even take a picture of a tooth.
Jeanette M.: Yeah. I definitely see that all the time, where parents will take their kids to the emergency room. Sometimes they don't think to even call us. We have an on-call service for active patients of record. It can't just be Joe-shmo that did a Google search. It has to be an actual patient, but they can call me. I've had calls at 4 in the morning for "My child is crying," or at 9'o'clock at night "Oh, they slipped in the bathtub and chipped their tooth." People can access me that are my patients. I don't know where I was going with that.
Howard Farran: What about the emergency rooms?
Jeanette M.: Oh yeah. I think it would be smart. I love your idea, especially with the 2 dental schools now in the state. It would be smart to have an emergency residency or some kind of emergency room presence. I know when I did my training in Las Vegas, we did a rotation through the Children's Hospital and they really made good use of our presence there, because we were able to go do a dental evaluation of kids who say were there for chemo and checking their mouths. I saw a child that had a fractured jaw. Things like that that they can't diagnose, but a dentist can diagnose. You're not just wasting a patient's time or the hospital's resources.
Howard Farran: Do you use amalgam in your office? Do the modern day yuppie parents allow amalgam or does it all have to be plastic?
Jeanette M.: Yes. Some of them do and especially the ones where their insurance only covers amalgam, which is interesting. All of a sudden it's fine if that's all the insurance will pay for. The majority of what we do are composites, but we do amalgams if they're heavy grinders or if the behavior doesn't allow proper moisture or blood control. We still offer good old fashioned amalgam.
Howard Farran: What do you think? You're going to turn the big 4-0 this year and you've been around a long time. What lasts longer in pediatric mouths amalgam or composite, what would you say?
Jeanette M.: In terms of what lasts better?
Howard Farran: What's a better method as far as longevity lasting, recurrent decay?
Jeanette M.: We really don't get a lot of failures with our composites, but it's probably because the teeth are exfoliating. [crosstalk 00:28:15] I've worked with both materials. The fact that I don't see much of the permanent teeth, the amalgams last longer. I just don't get the luxury of seeing that, because usually the tooth I restore is gone before it can fail.
Howard Farran: I want you to answer this question as if I was a patient. You're talking to thousands of dentists and probably very few of them are pediatric dentists. This is the question mom and dad always ask. Why should we fix them? They're baby teeth. They're going to fall out anyway. How would you say that to me if I was a parent? "Well, Jeanette, come now, they're baby teeth. They're all going to end up at the tooth fairy's house. Why even spend the time and money?"
Jeanette M.: I hear that response probably at least once a week, and what I tell them is "Your oral health is a part of your overall health." That that cavity is bacteria and that bacteria can spread. The little cavity can become a bigger cavity that can go into the nerve and cause an infection. An infection that could affect your overall health. You could even end up in the hospital from an abscess, so that's the main reason is it's part of your overall health. Another way to get them, especially with the dads, is to go after the financial aspect. If we're just extracting the rotted baby teeth just because they're baby teeth then you have issues with space loss that create orthodontic problems, which are really expensive to correct later. There's a value in having ... The teeth are there for a reason. They are there to hold space for the permanent teeth. The child needs them to chew and to talk, even just for social reasons to have that cute little smile. You don't want them to smile and having a mouth full of brown holes.
Howard Farran: If you were talking to kids that were juniors and seniors in college, the most common questions we get from kids is "Should I do a residency or should I specialize or should I get a job in general dentistry?" I've lived long enough to see OB GYNs and GYNs go from all males to almost all females. I don't even have a patient anymore that's an OB GYN that's a man. Do you think that pediatric dentistry is following that route? Do you think if you were a man and you were a senior in dental school and you're thinking "I'm thinking about being a pediatric dentist." Do you think that being a man at 24 that maybe that's not a good idea or do you not see that being a factor at all?
Jeanette M.: I really don't think it's a factor at all. I think there's benefits to either gender for being a pediatric dentist. What I hear from parents is that I have parents that tell me that they ... One of the reasons they chose me is because I am female, so I will hear that, but then I hear parents that say their child does better with a male doctor. I don't think that the specialty should be specific to female doctors. You just have to be good with children and patient.
Howard Farran: That's interesting. I really had been wondering that. For my 4 boys, I believe that a woman doctor would be more touchy, feely, caring, and better with my babies than some man, especially if the man reminded me of me.
Jeanette M.: Now that you put it that way, honestly, when we picked pediatricians, I picked the female pediatrician, so maybe I am biased also.
Howard Farran: You're admitting you're a sexist pediatrician, right here on Dentistry Uncensored show.
Jeanette M.: Can we rewind that?
Howard Farran: Yeah. I think it's something that you got to think twice about. I would. How long was pediatric dental school?
Jeanette M.: The residency? It depends if you get a master's or not. For me it was 2 years. I went to a hospital based program, which I really enjoyed. I went to the University of Southern California for dental school. I got a ton of pediatric dental clinical experience in dental school and probably above average. Some pedo residents that come in have never done a stainless steel crown. That's kind of scary. You mentioned earlier of what students should do in terms of whether or not they should specialize. I think they should offer in the dental schools ... They should allow all the dental students to do externships where they rotate through all the different specialty practices from public health and just general practice to pedo, all of the different specialties, so they can see what they actually like before they commit to a specialty. How do you know if you're going to like it if you've never spent a day in that setting?
Howard Farran: Does the modern day pediatric dentist get more referrals from a pediatrician, because the babies just come out, versus for a regular dentist? What's you're mix of referrals from, pediatricians and OB GYNs delivering babies versus general dentists?
Jeanette M.: Definitely our number one referral source, other than the internet, are pediatricians. That's our top referral source ...
Howard Farran: The internet is bigger than pediatricians?
Jeanette M.: When people write on their health history of how they found us, the number one thing that we see is an internet search, and then number two would be their pediatrician specifically referred them to us.
Howard Farran: Then general dentist would be third?
Jeanette M.: Friends and family.
Howard Farran: Friends and family.
Jeanette M.: Yeah. I think that has changed. We're allowed to be politically incorrect on your show, but I think a lot more with the economic down turn, I noticed more general dentists doing their pedo in-house.
Howard Farran: I would start selling drugs before I start doing my own pedo. You know that Breaking Bad where that teacher started making his own meth? I would take my Lidocaine and start learning how to convert it to cocaine.
Jeanette M.: Yeah. I would have to refer to my husband on that one, because he's more of the Breaking Bad viewer. I'm more of a Real Housewives. Do you want the Real Housewives?
Howard Farran: Oh the Real Housewives of Miami and all that stuff?
Jeanette M.: All of the Real Housewives. That's my guilty pleasure after a hard day of dealing with parents and screaming kids. I enjoy just really bad reality TV.
Howard Farran: You know what I tell all my guy friends that moan about their wife watching Miami Housewives or LA Housewives, I say "Dude, we watch football and I have no idea why I want the Arizona Cardinals to beat the other team. Why? Because we're in a different color jersey than the other? At least when you watch the Housewives you know why Mary's mad at Amy. At least there is some intelligence about that. There's no intelligence in sports. Why do you want your hockey team or football team to beat the other team is totally neanderthal tribalism." I have more respect for the Jerry Springer show than I do for me watching the Arizona Cardinals every Sunday and jumping out of my chair when they make a score.
Jeanette M.: Although, there is a lot of mindless fighting on the Housewives as well.
Howard Farran: At least you know why they're fighting.
Jeanette M.: Not always. Sometimes they're just fighting to fight.
Howard Farran: I have no idea why the Cardinals are trying to beat the other team. Are you ever using glass ionomer or is it just mostly ...
Jeanette M.: Yeah. I've seen a lot of failures that will come in that I have to replace where they used glass ionomer let's say for a class 2 as the actual final material that they place. I'll use it to cement crowns or I'll use it as a liner, but I won't use it just for filling, because they tend to leak and wash out. I use good old flowable composite on the primary teeth, and I used a packable composite for the permanent molars.
Howard Farran: Let's go to the controversy since this is Dentistry Uncensored. There are some dentists out there saying that some of materials we use in pulpotomy could be carcinogenic, and you shouldn't use cresidine and formocresol, and that now you should use no calcium hydroxide ...
Jeanette M.: NPA
Howard Farran: Yeah. Specifically, the formocresol and cresidine. Are those toxic and should not be used?
Jeanette M.: I still use formocresol, and as you heard all over the news recently that apparently the bacon I had for breakfast is going to kill me too from colon cancer. I feel like we're so inundated with this "Everything is toxic," apparently. Now "Oh, the BPA, the fillings, the sealants, and oh the mercury in the amalgam fillings is going to give you autism." There's so much. The good old formocresol pulpotomies for decades have performed beautifully, and that's what we still use. I have no concern with it.
Howard Farran: Then, the other question is that we had a person saying that when you go to a pediatric school, that there's 3 different kind of pediatric residencies and beliefs. One's hug them. One's drug them, and one's slug them. Hug them with praises and fun, but sometimes doesn't work. Drug them with sedation, but most parents don't like to use the sedation. Mild sedation has nitrous oxide. Moderate sedation has risk and can be done in a general office. General sedation is done in the hospital and can be very expensive, or slug them behavior with a hand over mouth papoose board. I'm going to ask you specifically about the papoose board. Do you use a papoose board?
Jeanette M.: Yes I do, and only for these situations. If they're under general sedation, because I don't want them to roll on the floor onto their face when their sedated. Let's say an emergency situation where you can't sedate a child, and interestingly with some our special needs patients, I know this might sound bizarre, but some of them actually like the feeling of being wrapped. Have you heard of the weighted blankets?
Howard Farran: Yeah. Yeah.
Jeanette M.: Some of them we'll wrap.
Howard Farran: Do you use the weighted blanket?
Jeanette M.: We use the papoose. Actually we use our lead apron, you know our x-ray aprons, we have some patients with sensory issues where we'll put the leaded apron over them. We don't have a weighted blanket, but that's a good substitute. That's my tip of the day.
Howard Farran: On a percentage base, and this is kind of bizarre, but it seems like if a general dentist refers you to the patient, it's going to be a nightmare patient. I mean the most difficult patient as opposed to if a pediatrician sent just 100 kids just because they were born. You'd have a full range of kids, but if you got 100 patients from a dental office, they have probably already tried or attempted and it wasn't going good, so it would probably be more difficult. Would that be correct?
Jeanette M.: Yes and no. Sometimes they're sending them because they just don't want to work on kids period and maybe they treat the parents, so you get that. You also get the ones where they've tried unsuccessfully to do some treatment and not gotten anywhere. What's surprising is that they don't necessarily do terrible in our office even without sedation. Sometimes just them walking into an office that's specifically pediatric, it completely changes their behavior because they feel more comfortable in that setting, because they see all the fun games and we've got the TVs on. They feel more at ease and also being able to see all the other children there. We have an open bay. I'm a big believer in the open bay and then modeling their behavior after their peers.
Howard Farran: Sure. All monkeys, apes, dogs, cats, they model the next guy.
Jeanette M.: Yeah. I see both. It could be a nightmare patient or they could be perfectly fine and just need to be in a more child friendly setting.
Howard Farran: In the open bay, do you do the nitrous or sedation in the open bay or do all those go to a special room?
Jeanette M.: Those are in a quiet room.
Howard Farran: Quiet room.
Jeanette M.: Some parents call it the padded room. "Oh, I noticed we're in the padded room today."
Howard Farran: If someone's going into the silent padded room, what is your go to? Is it nitrous? Is it a cocktail drinking? Is it twilight sleep oral sedation? If you do do general sedation, do you do that in your office or do you go to a hospital?
Jeanette M.: The majority that I do is with nitrous oxide. I love nitrous oxide. We use that for literally everything. I think it makes the visit easier for the child and it's better for us.
Howard Farran: I love it so much I installed it in my front room.
Jeanette M.: Smart. That's your tip of the day. We're going to work on that.
Howard Farran: I'm kidding. I'm kidding.
Jeanette M.: Yeah. I always joke with the parents when we do sedation. "It's a BOGO. You get a cocktail too," and they laugh.
Howard Farran: My job is to guess the questions of the viewers that are listening while they're multitasking on their commute to work. What percent nitrous oxide do you put it on?
Jeanette M.: We usually start it actually pretty low at 30%. The highest I'll usually go is 50%, but I have friends that will crank it up even higher than that, between 30% to 50% is typically the ...
Howard Farran: Now, the new machines ... Back in the day in '87, you could buy a nitrous machine that can go 100% nitrous, but now all the new stuff, the highest you can turn is 70%.
Jeanette M.: Right. They have those safety features.
Howard Farran: Have you met the oral surgeon in Northern Scottsdale that came out with the new nasal canula nitrous oxide?
Jeanette M.: I saw that. Where did I see that? We might have saw that at the Western Regional. We thought about that, but do you know what's interesting in pedo, having that big old fashion hood, there's a big safety factor to that, because it really helps keep stuff out of their eyes. I think you would have to be there and see what I mean, but especially when you have the rubber dam frame. We put sunglasses on the kids, but having something that somewhat props up away from the eye area, there's definitely an added benefit in having that. We still have the old school stuff.
Howard Farran: A lot of my viewers, when you say rubber dam, they're like "Rubber dam, what's that?" What is a rubber dam?
Jeanette M.: That freaks me out. Whenever we can get a rubber dam on we use a rubber dam. One of my paranoias in pedo is a child choking on something, so I love having the rubber dam because that's a fantastic CYA feature.
Howard Farran: My only paranoia with a pedo patient is that I have to work on them. I don't understand why you guys still use a rubber dam. Number one I never place a rubber dam. I numb them up and then I leave and I come back in and Jan's put it on.
Jeanette M.: True.
Howard Farran: When people say I don't like to put them on, I say "Well, I don't like to put one on either."
Jeanette M.: Maybe it's just because they think it's faster. I think it makes it faster just being able to isolate things, especially being on a child. Their tongue and everything is all in the way. I can't imagine not using a rubber dam.
Howard Farran: You just walked into the next question. You said 'isolate'. Do you ever use the Isolite?
Jeanette M.: We thought about trying that. I have friends that love the Isolite. I have a good friend that I went to residency with in Reno who swears by the Isolite.
Howard Farran: It's your friend?
Jeanette M.: Yeah.
Howard Farran: If your 40, how old is your friend?
Jeanette M.: I think she's probably 41.
Howard Farran: I think that one group that falls into the Isolite is that it's just not the isolation suction, it floods the whole mouth with light. I noticed every since I turned 50, I need my readers all the time.
Jeanette M.: I know that's coming.
Howard Farran: I changed my Iphone to the 6Plus screen. I love the Isolite just because when your 53, even wearing 3.3 magnification, just having all that damn light in there helps old people to see.
Jeanette M.: That's a very good point.
Howard Farran: All the people who love Isolite, they're also the same group that loves the head lamps. They're always talking about how magnification and light are so important, but they never seem to address the obvious "And it's because I'm old, and I have a stiff eye that doesn't adjust."
Jeanette M.: Another friend of mine is an optometrist and she keeps teasing me that "It's coming Jeanette. Next year get ready."
Howard Farran: My optometrist always gets mad at me when they come in as patients, because I always ask them the same question. One of them snapped at me and he says "Howard, you've asked me that same question every 6 months for 20 years." I always say "Are you sure putting on a reader, doesn't make my eye muscles relax and not work out, and enhance me to seeing less, because it seems like ever since I've been wearing readers ... Maybe if I didn't wear them, I'd force my focus muscles around my obiculus oris and all that to be in better shape," and they're like "Howard, no." I'm like "But you're an optometrist." They go "Howard, it's the number one question with all eye doctors, and no, readers do not make you more blind," but it always seems more counter-intuitive. If I was straining my eyes to focus, it would seem those muscles around your eyes would be working out all the time.
Jeanette M.: I would worry that you would just get a big old headache. I noticed that when I use my magnification that I'm getting more headaches or dizzy from focusing from the regular lens to the magnification lens. I'm in denial right now, because I'm turning 40. My friends are like "Whoa, here it comes Jeanette. Yup, that's why those glasses are bothering no." I'm like "No. I think they're too tight. I'm going to have them loosened." I get red marks right here if I've had them on too long. I'm in denial.
Howard Farran: Give us a little hanging fruit from your amazing article in Dental Town on August 2015. Pediatric Dentistry, Parents and Spoiled Kids: Tips for Dealing with Parents in an Era of Everybody Gets a Trophy.
Jeanette M.: Well, what would be my big take away from that?
Howard Farran: Well, yes. Tell the listeners that didn't read that article or see it, or need to go back and read it. What were your points in that article?
Jeanette M.: I think dealing with kids today is very different than dealing with kids 10 or 15 years ago, because our parenting style has changed. You have more of the helicopter parents. I assume everyone knows what a helicopter parent is.
Howard Farran: No. No. I heard it from you. You're the first I've ever heard of that.
Jeanette M.: Really?
Howard Farran: Yeah.
Jeanette M.: Maybe it's because your kids are older, but a helicopter parents is someone who hovers. Can you see me hovering? They're just overly involved in every little thing their child does. It's like over parenting so to speak. Even going from when my son was born, he's 5, to when my daughter was born and she's 3, just the products available in that 2 year span are ridiculous. There's covers for the shopping cart and the pads for everything. It's just almost ... It's crazy. You remember in the old days where you played in the dirt?
Howard Farran: I had these 3 friends in grammar school, David Hornburg, Andy Whimset, and Mark Boardlong. Sometimes after school I would go home with them, and spend the time with them, and go back to school the next day. We didn't have cell phones. I didn't even ask my mom. I don't even know if Mrs. Hornburg called my mom and told ... Back then we used to get up on Saturday and walk down Sleepy Hollow and sometimes wouldn't get back until the street lights came on. Now, if you did that, you'd probably go to jail.
Jeanette M.: Yeah.
Howard Farran: I would never say I'm trailer trash. I was barn trash. My pedigree would have to marry up to get into a trailer. Do you know what a Farran family vacation was? We'd pile into a station wagon ...
Jeanette M.: Without a seat belt.
Howard Farran: Without a seat belt and my five sisters would play monopoly from Wichita to Disneyland. My mom and dad were in the front seat driving, splitting a case of Old Milwaukee.
Jeanette M.: Yup.
Howard Farran: Pretty much most of my childhood was illegal. I understand the helicopter. I go through this all the time with moving car seats. One of the sons is going to take Taylor and we're moving all this stuff and I'm like "She's 3, just put on a seat belt." "Dad, that's illegal. That's a felony." It's like, wow. It's really changed.
Jeanette M.: Yeah. Parenthood has really changed and why has that happened. I don't know that there's one exact answer. I think that we've kind of become this big brother society where everything is being watched and recorded and judged. There's a lot of mom-pedators, maybe that's a term you've never heard of.
Howard Farran: I've never heard of that term either. Helicopter parents and mom-pedators. What's a mom-pedator?
Jeanette M.: It's like everyone's trying to one up each other and be the best mom. We're in all the activities and I'm Pinterest perfect when you post online pictures of all that you're doing. I'm equally guilty of these things. I like social media just as much as the next person. I think there's a pressure that we put on ourselves as moms to be the best and to give our kids the best opportunities and chances. It an be a little bit overwhelming.
Howard Farran: What's your dental office website?
Jeanette M.: Teeth and braces.
Howard Farran: Are you by yourself or are you in a group?
Jeanette M.: I am not by myself. It's a small group practice. I am the only full time doctor, and then I have a business partner. The practice was actually started by her father many moons ago. She works 2 days and I work 4 days.
Howard Farran: Is she a pediatric dentist too?
Jeanette M.: She's a general dentist actually, and then her brother is dual trained ortho and pedo, and he now specifically does orthodontics. It's Arthur Orthodontics. That's us.
Howard Farran: I want to ask you a question, and I hope you don't think it's sexist, and I'm just asking it because I get a lot of emails at Howardatdentaltown.com. I want you to address this, because you're a very successful pediatric dentist. You're a legend in my backyard. You are. You're an unbelievable person. You are. You're an amazing person. You're an amazing leader. Delta picked you as their spokesperson. My friends in Glendale think you're a rock star. They really do. A lot of younger girls are asking this question that as a man I can't answer. They're saying "Man, I bought into this practice and the old Howard guy would tell the 5 women do this do that, and they would all jump. Then, I gave this guy $600 grand for the practice and as soon as he left, I said the exact same thing, and they looked at me like 'are you kidding me'." Is that true? Is that an excuse or is that true?
Jeanette M.: It's true.
Howard Farran: It's true. Can you talk about that a little bit and how you do better?
Jeanette M.: Yes. We talked about this a lot ironically.
Howard Farran: What's that? What'd you say?
Jeanette M.: We talk about this a lot ironically.
Howard Farran: Who's we?
Jeanette M.: Meaning myself and Mandy Daytch, who's my business partner. Her father Joel Arthur, which if you're from Arizona, a lot of people know that name, because he was one of the first pediatric dentists in town and really well known and well respected. He's the kind that when you say jump, everybody jumps. We joke about if he were coming to the office, all of a sudden people are cleaning the microwave and throwing out the trash.
Howard Farran: I know.
Jeanette M.: All the elves are like "Santa's coming," but often when we say "Hey, why don't you clean the microwave?" We get kind of a look.
Howard Farran: You admit it's true. You're a 40 year old business owner and pediatric dentist for over a decade, and you're going on the record saying it's true. That women staff treat male bosses different than female bosses.
Jeanette M.: I'm sad to say that it's true. I actually brought this up recently. I was at the Women of Dentistry function put on by the Arizona Dental Association, which was a fantastic event. Shout out to the folks at AZDA.
Howard Farran: Kevin Earl is amazing. I had dinner with them last week and his number 2 guy Terry Zalowski. Just class acts, and Delta is a class act too. I get so mad when people get mad at Delta because they didn't cover something. I'm like "Dude, if you had it your way, you'd get $100 million for a crown. You'd work on Monday on 1 patient. Quite griping about checks and balances, but continue on."
Jeanette M.: They put together this great organization Women in Dentistry, so basically to be networking or a resource for women to ask other female dentists "How do you handle things in your practice?" What you're talking about is the question I raised for the president of ADA, the president Dr. Summerhays.
Howard Farran: Oh, I love her.
Jeanette M.: She's fabulous. "How do you deal with that?" What she brought up ... It's definitely ... It's tough. A lot of times we are more friends with our staff and there's less of that boundary where maybe with a male boss/owner and then a female staff, it's easier to draw that line whereas we are seeing more equally as a friend. Part of it, I'm a people pleaser. I just want to have fun. I want people to like me. I want to be everybody's friend, so it's probably my fault if I'm being honest. My husband tries to tell me that it's better to be feared than loved. I'm like "I don't want to be feared. I just want people to like me."
Howard Farran: Was it Roosevelt who said "Speak softly and carry a big stick," and maybe if you're their friend then you're not carrying a big stick. I want to ask you this, specifics specifics, what is crossing the line between a woman boss/manager dentist and a female employee? Are you allowed to go to lunch? Are you allowed to go to happy hour? Where would you say "No, don't get too close," or you won't be able to say "You need to be here at work on time or I'm going to fire you," versus "She's my friend. She understands my personal life and what I'm going through. She's not going to fire me if I'm 5 minutes late everyday." Is there any hard and fast rules or is that too simplistic a question?
Jeanette M.: No. I think it's a great question. I think it's one where I have trouble making that fine line.
Howard Farran: You cross your own line?
Jeanette M.: Well, the thing is that in my practice, one of the things we are most proud of is that we don't have a high turnover of staff. The average employee has actually been there longer than me. I've been there a decade.
Howard Farran: That is so cool. That speaks volumes there. That makes me love you and respect you even more.
Jeanette M.: I remember your article about that you to have the 10 year and up. That when you get to that range, that that's kind of the magic thing. Anyhow, our office manager has been there 25 years. We have a fabulous dental assistant that has been there 28 years. We have 3 new employees that have only been there in the yearish range, but everybody else has been there 12+ years. We've really become like a family, so it is hard. I care about them like their my family. My sisters. We fight like sisters sometimes, but then we are there supporting each other like family. For instance, we have an employee that's in the hospital this week. We might have our quarrels and what not, but boy did everybody try to band together to help her out, because she's a young mom with 4 children who's in the hospital. We are there to help one another out.
Howard Farran: One of the biggest take aways of what you just said in your podcast that had nothing to do with pediatric dentistry, is that if you're a young dentist out there, the questions that come to me are "I'm from Oklahoma and I've come back to my hometown and there's 2 dentists. One of them will pay me 30%, but I have to pay half the lab bill. The other one will pay me 35%, but I got to pay my lab bill. Which one will you take?" I'm like "God, you're so cretin, you don't even know your cretin. My question would be, the 2 doctors how many times has each one been married?" Staff turnover. What if one guy is on his 4th wife, and the longest staff has been there 2 years, and the other guy's been married 40 years and he's got staff that's been there 20, 30, 40.
Jeanette M.: Amen.
Howard Farran: I would rather mentor the person that knows how to build a team of family that stays there for 10 to 20 years, because in our business we sell the invisible. Nobody knows what a chrome sill crown is. If it's right. They don't even know if they need it, and if they're not sensing family, especially with women. I believe this sincerely. There's been research on it. If women don't trust you, they'll never give you a dollar. Sometimes men are like "Well, I think he's right," but women ...
Jeanette M.: You're right. Women go with their gut. You hear about a woman's intuition. I think that there is a lot of truth in that.
Howard Farran: Men have intuition too. It's called Budweiser, but hey our hours up and that's my brand link. That's the average commute that dentists drive to work, but I just want to tell you seriously that you're a legend in my backyard. Everyone from Kevin Earl, the folks at Delta, all my dentist friends in Glendale, you're just a rocking hot amazing pediatric dentist. I just want to thank you so much for spending an hour with me today.
Jeanette M.: It has been an honor. You are a legend and rock star to me, and I appreciate you and all that you do, and I love Dental Town, so thank you.
Howard Farran: Aw. Thank you, and thank you for writing articles for us. I mean you're busier than a one-armed paper hanger and you still have time to write article for me. That is amazing. Thank you so much for all that you do.
Jeanette M.: You're so welcome. Thank you.
Howard Farran: Now send me a box of those chocolate bars.
Jeanette M.: Absolutely.