Pediatric dentistry is a specialty that adapts techniques and procedures from general dentistry and specialties to provide primary and comprehensive preventive and therapeutic oral health care for children. Pediatric dentists treat a broad range of diseases in infants, children and adolescents, including those with special health care needs, and are experts in providing care to make their patients feel comfortable. Pediatric dentists also educate their patients and the patient’s parents about the importance of oral health and preventative oral health care.
Adam Shisler, DDS
Associate Pediatric Dentist, Cammarata Pediatric Dentistry Group
- Why did you choose to pursue this career path?
Although I had no family members in dentistry, I had a really good mentor in high school that was a dentist. I was looking for something that was not engineering, where I could work with people, run my own business and just socialize while I was doing a job that helps people. This is what my mentor modeled for me. I stuck with it, developed more mentors along the way and the mentors kept cheering me on to dentistry!
- What does your typical day look like? Did some aspects of your job surprise you?
I’m in a solely pediatric private practice, with 4 pediatric dentists and a staff of about 26. We start the day with our morning meeting, go over our charts for the day and start treating at 8:30 a.m. The whole office works all day long. We do in-office sedation, a lot of exams and check-ups, and we just kind of go through the day. Before I started private practice, I thought it would be really technical and clunky, but if you have a good staff, the day goes by quickly. It is 5 or 5:30 p.m. and we’re done. We typically take an hour or hour and a half for lunch. If it’s summer, usually I have a shorter lunch because the kids are out of school. During the school year, we take about an hour and half for lunch, get caught up on for charts and call local orthodontists and practitioners to talk about mutual patients we share.
The only day that’s a little different is whenever we have a procedure that requires an IV. We have an anesthesiologist that comes in to do deeper IV sedation. We start at 6:00 or 6:30 a.m. for cases that require it. Usually, this is for kids that are really young or for kids that don’t have the coping skills to handle being anesthetized. If they require a lot of fillings, are four-years-old or younger and we’ve tried other ways, we have an anesthesiologist come in so we can do a safe and good job.
- What challenges present themselves frequently in your specialty?
Pediatric dentistry needs to fit the attitude and the ability of the professional who can make quick changes. I am pretty easy-going, I can usually think on my feet pretty well and I can react quickly to a possible problem that a kid may have. That is a challenge. Kids will always give you their absolute best, but some days they are just tired or cranky. They’re always going to challenge you day-to-day, but usually the kids are absolutely phenomenal. They really want to do well. They want to sit in the chair and watch the movie and let us do our work. The biggest challenge is that I always need to be thinking on my feet and anticipate any possible problems in the future to avoid it.
- What makes your field unique?
You don’t get into pediatrics unless you really, really love what you do. If you don’t, you deal with kids that can sense whether you want to be there or not. The uniqueness is that it has to fit the professional. If you’re looking into pediatrics, you’ll know in the middle of dental school when you are working with four or five year olds in the clinic whether or not you are comfortable with pediatric dentistry.
Before dental school, I did Teach for America. My mom has been a teacher for 29 years and working with little ones has never been a stretch for me. Not a lot of people have that past experience before going to dental school. It makes the road longer, but in the longer scheme of things, I used almost everything I learned in front of a classroom with patients that I see every day, all the time. It was a valuable two years.
- What additional training, credentials or licenses are required beyond dental school for your career? What additional training would you recommend beyond what is required?
Legally speaking, you cannot be a pediatric dentist without going to residency and specializing in pediatric dentistry. When you go to residency, it’s usually 24 to 36 months. Upon completion of all the requirements for residency, you will receive a certificate specializing yourself in pediatric dentistry. In addition, certain states have laws, such as with in-office sedation. Your specialization credentials must match up with whatever state you practice in. I am able to deliver sedatives and certain drugs that a normal dentist cannot administer straight out of dental school without training. This allows me to treat the patients the best I can, so I am able to deliver certain procedures and medicine that a general dentist cannot do. That’s the whole reason a specialist exists. Some kids can be seen by a general dentist, but when kids are two or three or four, they don’t sit still in a general dentist’s office.
I have an additional degree, M.S.D., because I wrote a thesis. You don’t have to have that to be a pediatric dentist. Many specialists will get an additional degree if it’s offered. It doesn’t seclude you from being called a pediatric dentist. I have a motto, the more letters behind my name, the more help I will be able to give later on in life. It was fun to be able to do academic research in my residency and it was valuable experience, but it is not something required by the state.
- What are current trends in your field? In what ways is it advancing?
I’d say there are two prevailing trends that have popped up in the years I’ve been in dentistry. Aesthetics in pediatrics is trending. No one wants their little Sally or Tommy to have silver crowns or fillings in their mouth. The industry is starting to produce some really good aesthetic restoration materials, such as nice all zirconium crowns. In our patient population, we don’t have a caries rate that warrants the need for crowns very often, but sometimes there is the need for them and there are now more and more aesthetic options. As a pediatric dentist, I am trained to be able to offer more aesthetic treatments than just silver caps that were offered in the past. The composites that we use now, which are the tooth colored fillings, are far superior than what they used to be as long as the techniques you use to administer them is appropriate and adequate. The new composites also give a much better aesthetic outcome.
Another trend is that there have been a lot of surveys administered to parents surrounding the mode of practice that parents want to see for their child being treated in the dental office. If their child needs to undergo a couple of fillings, it would involve local anesthesia and administration of a shot, as well as sitting still for 20-45 min. Many of parents don’t want their kids to experience any sort of pain or duress during the drilling and filling of the tooth for the cavity removal. That is pushing a lot of our pediatric dental cohorts. The board of pediatric dentistry is encouraging all the specialists to start introducing more interactions with anesthesiologists, like what we do in our dental office. We always do it with someone watching the kid. The parents like that because the anesthesiologist is monitoring their kid and it is not a negative event for the kids. The parents are opting for sedation more than they have in the past. This trend has its pros and cons because anesthesiology has its risks.
There is a growing trend in general with larger group practices rather than the solo practitioner model. Whether a combination of pediatric dentist or orthodontist, or pediatric and oral surgeon, I’ve seen it all, each with its pros and cons.
- What skills are especially important in your field?
Being an effective communicator, especially with the parents, is a very important skill. If I give parents three very clear instructions, whatever I say to them, they will think about it over and over again and they will follow that to a “t.” If I am not clear when I deliver post-op instructions for a kid, you can develop a whole lot of problems and a lack of confidence that the parent has in you. As a young dentist, I try to gain the trust of all the parents I work with. The ability to effectively communicate makes my life a whole lot easier. I can’t tell you how much ASDA has helped my communication skills for e-mails, in meetings and speaking.
- What advice would you give to somebody interested in your career path?
You need constant interaction with kids. When I was a resident and I was looking over applications for dental school graduates for the pediatric residency program, we look at what programs you worked with in high school, college and dental school. Usually, there are pediatric dentistry focused events that are beneficial, such as Give Kids a Smile and other community events. However, being involved with the Boys and Girls Club or a program with intimate interaction with a population of individuals that you can mentor is important. Not just a one Saturday a month with half your class. It really helped me that I was a former teacher when I was applying for residency. It really was a difference maker. I could tell this made a difference because they always brought it up in my interviews.