Creating Healthy Smiles, One Smile At A Time

Monthly Archives: March 2014


If one were to ask a person walking down the street if they knew how many specialties there are in dentistry, chances are they would respond with a blank stare.  For the majority of individuals, dental care is obtained at a family or general dentist.  And why not? Of the approximately 180,000 practicing dentists in the U.S., 144,00 or 80% or them are general dentists.  

There are currently nine official dental specialties which are formally recognized by the American Dental Association.  Each specialty has it’s own educational, governing and licensing boards which maintain oversight over their respective specialties.  Only individuals who graduate from an accredited post-doctoral program, pass a board certification examination, maintain their eligibility through licensure call themselves a board certified specialist.

The nine approved dental specialties are (listed in order from most to least as a percentage) :

Orthodontics (26.8%)

Oral and maxillofacial surgery (18.5%)

Pediatric Dentistry (14.5%)

Periodontics (13.8%)

Endodontics (12.5%)

Prosthodontics (8.9%)

Public Health (3.8%)

Oral and Maxillofacial Pathology (1.0%)

Oral and Maxillofacial Radiology (0.3%)

In raw numbers, that means there are about 5500 practicing pediatric dentists in the U.S.  As a matter of comparison, there are approximately 58,000 general pediatricans in the U.S.  These numbers would make it seem as if there are a severe lack of pediatric dentists in the U.S.  However, one must remember that most children are still seen by their family dentists;  pediatric dentists typically see children with specialized needs be it medical issues or extensive dental treatment.  There remain significant concerns regarding readily available access to care and this has lead to an overall push on increasing the number of pediatric dentists.  

The past few years have seen an increase in the number of residency slots for pediatric dentists at hospitals and other university based programs. And based on results from the Post-Doctoral Dental National Matching Program*, pediatric dentistry was the most popular specialty this year, continuing its trend of the past few years.  Hoozah!

2014-2015 Match Results:                                       #Applicants                                #Positions offered

Pediatric Dentistry                                                     638                                            382

Advanced Education in General Dentistry                 519                                            309

Orthodontics                                                              466                                            256

Oral and Maxillofacial Surgery                                   396                                            228

Anesthesiology**                                                         53                                              34      

**Anesthesiology is not an ADA recognized specialty anesthesiology programs participate in the Match.    

Pediatric Dentistry is a wonderful, extremely rewarding profession, and I’m not the least bit surprised of the competition to enter a residency program.  So for all aspiring pediatric dentists, good luck!


*Side note: The ‘Match’ for those of you who are not familiar with the terminology, is a national program which provides an orderly process to help match up applicants with programs.  One still has to apply and be ‘accepted’ by a program, but both applicant and program rank one another.  A high ranking by both means one gains acceptance.  A high ranking by the applicant, and a low ranking by program usually means rejection. Not every dental specialty participates in the Match program.  For example endodontists apply and are accepted directly from an accredited program.

If you’re interested in more information about the dental match program, follow this link:




The classic film flick (at least for those of us who were teenagers in the 80’s), Sixteen Candles,  featured Molly Ringwald as a heartbroken awkward, gum chewing teenager who was stressed and had headaches through most of the movie because her love interest essentially ignored her.  Well, a new study, suggests that it wasn’t her boy troubles that were the cause of her headaches, but rather her gum chewing.

A recent article in the January, 2014 issue of Pediatric Neurology found that frequent gum chewing is responsible for headaches in young children and teenagers.  Researchers affiliated with the Tel Aviv University School of Medicine recruited 30 patients ranging in Imageage from 6 to 19 years who had chronic migrane or tension headaches and chewed gum between one and six hours per day.  These participants were asked to fill out a questionnaire detailing their headache characteristics, potential triggers, family history of headaches and gum chewing habits.

To test their hypothesis that gum chewing had something to do with their headaches, they told all 30 participants to STOP chewing any gum for one month.  After the month, 86% of the participants reported a significant change in their headaches.  Specifically, 19 of the participants reported that their headaches had gone away entirely, and 7 reported a decrease in the frequency and intensity.  

The researchers then asked those 26 participants to resume chewing gum for two weeks.  All of them reported a return of their headache symptoms within days.

One could argue that it was the elimination of aspartame (an ingredient found in chewing gum which is thought to have a role in causing headaches) but none of the participants were asked to reduce their soda intake (which was again pretty significant) which also has aspartame.

Instead, it is thought that the excessive burden imposed on the temporomandibular joint (TMJ) through the chewing of gum is one cause of headaches.  This connection was made as individuals with TMJ dysfunction are found to have higher levels of migranes than the general population.  TMJ disorders are found to cause jaw, ear and facial pain, headaches and clicking, popping or locking of the jaw.


 Granted, this is only one study with a very small sample size, and obviously further confirming studies need to be performed.  One also wonders about the placebo effect as this was a self reported qualitative study and all the participants were aware of the purpose of the study.  It should also be noted that a different study of 60 high school students found that 84% of them had recurrent headaches which seems quite high, and hence raises questions about the reliability of the test subjects (teenagers) to accurately describe their symptoms.

That being said, at least the commonsense recommendation of giving up chewing gum that we have been giving to our patients with a history of headaches, does have some scientific backing. It certainly can’t hurt.  Besides, it’s probably not a good idea in general to be chewing gum for six hours a day. Even if it’s sugarless.

Try telling that to a teenager.


For full online research article:

imgres The American Dental Association recently    revised their guidelines over the use of  fluoridated toothpaste for infants under the age  of 3.  Now all children, regardless of age (yes,  even little teething infants) should use  fluoridated toothpaste.  It all comes down to the  important question of how much.

We are all familiar with the dozens of non-  fluoridated training toothpastes available at your local CVS.  Many parents, based on labels that they might have read on fluoridated toothpaste tubes, might have assumed that children under the age of 2 shouldn’t be using fluoridated toothpaste at all.  Hence, the profusion of training toothpastes.

A study in this month’s Journal of the American Dental Association concludes that an ‘appropriate amount’ of fluoridated toothpaste should be used by all children, regardless of age.  The ‘appropriate amount’ of toothpaste for a child under 3 is no more than the size of a grain or rice (a ‘smear’); for children 3 – 6 years of age, a pea sized amount is appropriate (picture below shows a ‘smear’ on the left, pea sized on the right).


The American Academy of Pediatric Dentistry has recommended for years now that all children under the age of 3, who are at risk of developing cavities, use a smear of fluoridated toothpaste twice a day.  The American Dental Association has finally agreed with this stance. There has been an abundance of caution over ensuring that children are not taking in too much fluoride (thereby putting teeth at risk of fluorosis), but the latest systemic review of studies have shown that from a risk/benefit standpoint, use of a fluoridated toothpaste is warranted as soon as the first tooth erupts.

Turns out, the problem is not the fluoridated toothpaste, but the amount that is used.   Parents should be dispensing the toothpaste for their children and monitoring use.  They should be telling their children to spit out any toothpaste, but in the case of young infants, one should not worry if they are swallowing any or all of the toothpaste dispensed.

It will be interesting to seen what impact this will have on the many brands of training toothpastes that one can find.  My sense is that this new recommendation will take time to flow through to the general public.  Old habits die hard.

The moral of the story is that as soon as a tooth grows in, use a fluoridated toothpaste but only a smear!


Click below to read more: