Santa Fe Dentist

Santa Fe Dentist - An interview with Dr. Elizabeth Prishkulnik

Q. Tell us about yourself and your practice.

A. I am a board certified pediatric dentist and a Diplomate of The American Board of Pediatric Dentistry.  My education was primarily completed in Canada, where I was born.  There, I attended the University of Western Ontario, where I received an advanced degree in science (HBSc) and a doctorate degree in Dentistry (DDS). After graduation, I entered post-graduate training at Tufts University and New England Medical Center in Boston, MA. where the emphasis was on the special health care needs patient.  This was followed by a residency in Advanced Education in Pediatric Dentistry at The Brookdale University Hospital and Medical Center in Brooklyn, NY. 

During my pediatric dentistry training I met my husband, Jake, who was finishing his residency in obstetrics and gynecology. We lived in upstate New York until 2005 where I served as Associate Director of Advanced Education in Pediatric Dentistry for Lutheran Medical Center and practiced in a hospital-based clinic.  In 2005, we moved to Santa Fe, NM, mostly to get away from the extreme northeast weather.   We have two daughters, Jy (10) and Ever (7).

After moving to Santa Fe and briefly associating in a local private practice, Jake and I opened Just For Grins Pediatric Dentistry with the mission to serve kids from all demographic descriptions and to make our practice amenable to those kids with special health care needs. 

Just For Grins Pediatric Dentistry is a state-of-the-art practice with digital record keeping (including radiology) and monitors playing non-stop family-friendly movies in every operatory and in our roomy reception area.  Here, kids can watch movies while sitting on soft sculpture ‘teeth’ inside an oral cavity environment.  The office was designed with breathing room in mind in order to create a relatively relaxing environment, in the midst of the high energy that children naturally instill into any space.

Care and treatment of all our patients is directed by the policies and guidelines set forth by The American Academy of Pediatric Dentistry.  In turn, guidelines and policies are based upon peer-reviewed and evidence-based literature.  Further, they are revised, updated and supplemented, yearly.

Q. Please explain the main services you offer.

A. As a board certified pediatric dentist, I am able to offer full service pediatric dentistry treatment alternatives: in-office treatment using nitrous oxide inhalation sedation and outpatient general anesthesia at a surgery center and in a hospital setting.

The capacity of our practice includes both primary and specialty preventive and therapeutic oral health care for infants and children through adolescence.  We examine and treat patients from newborn through late adolescence.  The special health care needs patients may remain with the practice beyond the age of majority who demonstrate physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment conditions that require specialized care.

Our ‘new patient registration’ is a comprehensive document that, once completed, is a valuable tool for customizing patient care and optimizing the overall dental experience for the patient and their family.  Every patient examination starts with an appraisal of this document with the parent.  Then, there is a thorough and age-based growth and development assessment.  The intra-oral examination includes an examination of all soft tissues, together with tongue, tonsils, and lymph nodes.  Finally, there is an examination of all hard tissues (teeth) with x-rays.   A caries risk assessment is made and documented.

As needed, a treatment plan is compiled and presented to the parent, both orally and visually with specific reference to the caries risk assessment.  Appropriate referrals are made.

Parent and patient education is one of the most important services that we offer.  Anticipatory guidance is provided, along with a comprehensive listing of evidence-based advise outlining tips for reducing the risk of decay in the pediatric patient. 

Q. Do you accept insurance?

A. Our office accepts all insurances.  We are contracted with a few insurance companies, which reduces the co-payment for most of our patients.  As demand increases, we are regularly joining new insurance companies.

Q. What payment options do you accept?

A. Our professional business team works with parents to meet diverse financial needs.  We do not want to defer treatment due to financial concerns: carious lesions will continue to progress.  We work with parents to devise solutions (sometimes, unique) to meet their specific circumstances.

Q. When should parents take their children to have their first checkup?

A. According to The American Academy of Pediatric Dentistry and The American Academy of Pediatrics (through the SOPD), the first visit to pediatric dentist should be at the eruption of the first tooth or within 6 months, whichever comes first.  The first checkup should not be long past the age of 12 months.

Q. What should be used to clean a baby's teeth?

A. There are several inventive tools to aid in cleaning a baby’s teeth.  You can readily find these at most pharmacies.  A clean, coarse washcloth will do fine before the baby has any erupted teeth.  After the eruption of the first tooth,  the best tool is a soft toothbrush, using water alone or toddler (fluoride-free only) toothpaste.  Keep in mind that the time to start brushing a baby’s teeth is immediately upon the first signs of eruption (and, forever, thereafter…).

Q. What is the difference between a pediatric dentist and a family dentist?

A. (the following is paraphrased from Pediatric Dentisty Reference Manual, V 30 / NO 7     08 / 09)

 To become a pediatric dental specialist, a dentist must satisfactorily complete a minimum of 24 months in an advanced education program accredited by the Commission on Dental Accreditation of the American Dental Association (ADA). Such programs “must be designed to provide special knowledge and skills beyond the DDS or DMD training...”   The curriculum of an advanced program provides the dentist with necessary didactic background and clinical experiences to provide comprehensive primary oral health care and the services of a specialist. Pediatric dentists provide care, conduct research, and teach in a variety of clinical and institutional settings, including private practice and public health. They work in coordination with other health care providers and members of social disciplines for the benefit of children.

Pediatric dentistry encompasses a variety of disciplines, techniques, procedures,

and skills that share a common basis with other specialties, but are modified and adapted to the unique requirements of infants, children, adolescents, and those with special health care needs. By being an age-specific specialty, pediatric dentistry encompasses disciplines such as behavior guidance, care of the medically and developmentally compromised and disabled patient, supervision of orofacial growth and development, caries prevention, sedation, pharmacological management, and hospital dentistry, as well as other traditional fields of dentistry. These skills are applied to the needs of children throughout their ever-changing stages of development and to treating conditions and diseases unique to growing individuals.

Q. What should a parent do if their child has a toothache?

A. Without a doubt, seek the advice of a dentist.  If this dentist does not feel qualified to treat the child, an appropriate referral should be made.  A real toothache will typically indicate definitive care, as opposed to monitoring.

Q. Are thumb sucking and pacifier habits harmful for a child's teeth?

A. Thumb sucking and similar oral habits are termed ‘non-nutritive sucking’ and may be considered normal for the first 2 years of life.  Parents are advised to observe the habit.  If it is gradually diminishing, often the child will stop the habit.  However, when the habit persists and increases in frequency past this age, adverse dental and skeletal changes can be seen.  We would like to wean the child before malocclusion and skeletal dysplasias occur.

The effect of the sucking habit on facial bones and dental arches is impacted by several factors:

-         frequency of the habit

-         duration of the habit

-         osteogenic (bone) development

-         genetic endowment, and

-         the child’s state of health.

Q. How can a mom prevent decay caused by nursing?

A. There are several evidence-based measures that nursing mothers can take to prevent decay (Early Childhood Caries, i.e, ECC) in their babies.

·   Delay of colonization: Education of the parents, especially mothers, on avoiding saliva-sharing behaviors (eg, sharing spoons and other utensils, sharing cups, cleaning a dropped pacifier or toy with their mouth) can help prevent early colonization of Mutans Streptococci (MS) in their infants.   The major reservoir from which infants acquire cariogenic bacteria is their mother’s saliva.  Infants whose mothers have high levels of MS (from untreated decay) are at greater risk of acquiring the organism (MS) than infants whose mothers have low levels of MS.

·   Xylitol chewing gums (e.g., Trident, Stride): Evidence demonstrates that mothers' use of xylitol chewing gum can prevent dental caries in their children by prohibiting the transmission of MS.

·   Diet: High-risk dietary practices appear to be established early, probably by 12 months of age, and are maintained throughout early childhood. Frequent night time bottle feeding, ad libitum breast- feeding, and extended and repeated use of a sippy or no-spill cup are associated with, but not consistently implicated in ECC. Likewise, frequent consumption of snacks or drinks containing fermentable carbohydrates (eg, juice, milk, formula, soda) also can increase the child's caries risk. 

·   Ad libitum breast-feeding should be avoided after the eruption of the first tooth and the introduction of other dietary carbohydrates.  Breast-feeding is more commonly implicated in ECC after other dietary carbohydrates have been introduced.

·        The gums, including all erupted teeth, should be cleaned immediately after nursing. Newly erupted teeth have immature enamel, which may be at greater risk for decay.