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1379 Pediatric Dentist Dr. Donald Chi on COVID-19 Issues in Seattle, WA : Dentistry Uncensored with Howard Farran

1379 Pediatric Dentist Dr. Donald Chi on COVID-19 Issues in Seattle, WA : Dentistry Uncensored with Howard Farran

3/18/2020 3:00:00 AM   |   Comments: 0   |   Views: 187
Donald Chi is Professor of Oral Health Sciences and the Lloyd and Kay Chapman Endowed Chair for Oral Health at the University of Washington School of Dentistry. He is also Associate Chair for Research in the Department of Health Services at the UW School of Public Health. His research focuses on understanding and addressing children’s oral health inequalities. He is a William T. Grant Foundation Scholar and was a Fellow at the Center for Advanced Studies in the Behavioral Sciences at Stanford University. Dr. Chi has published over 100 peer-reviewed manuscripts. He is Chair of the American Academy of Pediatric Dentistry’s Council on Scientific Affairs. He teaches public health and clinical dentistry, and maintains an active dental practice treating patients at the Odessa Brown Children's Clinic in Seattle.

VIDEO - DUwHF #1379 - Donald Chi

AUDIO - DUwHF #1379 - Donald Chi

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Howard: it's just a huge honor for me today to be podcast interviewing Dr Donald Chi a board-certified pediatric dentist and health service researcher is the professor of oral health sciences in the University of Washington School of Dentistry he is also a professor in the School of Public Health and serves as an associate chair for research in the Department of Health Services he has adjunct faculty appointments in the department of pediatrics school of medicine and department of pediatrics dentistry School of Dentistry his research program focuses on children to oral health inequalities he is in tradition the social and behavioral science with the goal of eliminating inequalities and improving oral health for vulnerable populations in 2017 he received the International Association for dental research distinguished scientists Young Investigator award and was named pediatric dentists the year in 2018 by the American Academy of pediatric dentistry Wow Wow and then someone who I mean that's amazing doctor she has published over 100 peer-reviewed journal articles he is chair of the American Academy of pediatric dentistry Council on scientific affairs and serves on the editorial boards of the Journal of dentistry for children and biomed central oral health he teaches public health and clinical pediatric dentistry to dental students and residents and continues to treat patients at the Odessa Brown Children's Clinic in Seattle's historic Central District before we get into everything you've done which is just beyond amazing you are so you're a DDS you have a PhD you're a double doctor and you are in Seattle Washington right now the markets are plummeting I haven't I can't remember the last time the stock market ticker has been Cham tripped because the  short orders were passed 5% but with your epidemiological brilliant mine in the epicenter of the outbreak in Seattle Washington is this media height or is this gonna be like our regular flu season in 20 to 80,000 elderly Americans die of the flu or is this got you worried 

Dr Donald Chi you know I'm worried you know I actually my family and I had a trip planned to to Korea we were actually supposed to leave about a week ago and coronavirus is you know has been you know has been going on in Korea for the last few months and you know we were in touch with family and friends to try to figure out if it was safe to travel so I feel like I've gotten a little bit of kind of on the grounds information from family and friends in Korea but here yeah you know I am worried I think there's so much we don't know about in regards to the coronavirus how it's even spread you know who the vectors are and so I think that what we're doing here in in Washington and here at the u-dub School of Dentistry I think is really safe you know preventive measures to make sure we're not contributing to the spread of coronavirus unnecessarily 

Howard: but on the one hand you know China and Italy are closing down cities in quarantine in America I tried not to giggle when the in California they said they were gonna issue a state of emergency for the corona virus and I had two different groups of friends who drove to Disneyland this weekend I said was Disneyland empty they go no it was crowded I'm like so that that's a very different response of Italy and China closing down a city but America leaves open Mickey Mouse what do you make of that 

Dr Donald Chi yeah you know I think it's the fact that you know obviously there there's a lot of you know media attention being devoted to to coronavirus there's probably a lot of misinformation out there as well you know I'm on social media and I see you know posts that that aren't always based on at least what I know to be the best available evidence and I think part of the problem also is that just that the evidence is evolving I mean on an hourly basis and so what what was untrue yesterday could be true now what was untrue an hour ago could be true now so I think there's a lot of just confusion out there and  not to say that that we need to be in a state of hysteria but but I think that based on what we do know I think it is to say that you know again the precautions we can take may not just be protecting us but may be protecting our vulnerable citizens that live next door to us that our family members and so again I think in a state of such uncertainty I don't think it's unreasonable to take you know the the most stringent precautions to make sure we're not contributing to to the disease

Howard:  you know one of the silliest terms that that I think of is the United States of America I mean it is such I mean how do you compare Miami to Wichita Kansas how do you compare Phoenix to San Fran I asked you to be on this show because you you put up an innovative pre-training program in Alaska and I've been to Alaska and if you cut Alaska in half each half would be bigger than Texas I mean Alaska is a whole another world in fact when I went there or halibut fishing one time I I wasn't aware of my um my geography and my history lesson very well because it was sold to the United States from Russia and I wouldn't I drove through a town and and it was nobody there spoke English I was my dad and my brother and it was a small town it was 100 percent Russian and then when I got back and I told the dentists they go yeah yeah you can't go to that town that's it's rush it's a Russian village nobody there speaks English said I mean so so it's kind of children out in rural Alaska have a very different oral health challenges than the ones in downtown Seattle Washington don't they 

Dr Donald Chi : you know in many ways there there are differences you know Alaska is unique in many ways it's it's mostly rural it's as you mentioned a really large piece of land that's pretty sparsely populated - the few population centers and so so yeah so I think in many ways Alaska is unique however if you look at some of the rural communities if you look at some of the access problems that children as well as adults encounter in in these rural communities they really aren't so different you know when you compare some of the access problems we have here in Seattle or some of the access problems that exist in other communities in the lower 48 so while there are differences I would actually say that there probably are more similarities in regards to some of the Alaska Native communities I've worked in you know compared to a lot of communities we see here down in the lower 48

Howard: and what was the what do you think was any controversial parts of that of that program 

Dr Donald Chi :you know so the the dental therapy program that yeah it there continues to be a lot of controversy about dental therapists so the program was started in the early 2000s and originally the program was was actually supposed to be housed here at the University of Washington but for for a variety of reasons that wasn't possible and that's the reason why the first group of dental therapy trainees actually went to New Zealand to get their training and then they came back and started providing care in Alaska in in 2005 2006 so so I actually had no no role in actually setting up the program I was actually a dental student when when the program was being proposed I was a dental student here at the University of Washington so I had no role in setting up the program however you know as a dentist I've seen the program operate on the ground and I've also worked with a team of researchers to do the first large-scale evaluation of dental therapists in in Alaska and and and while the controversies continue again I think that there is growing evidence that therapists are making a difference

Howard:  well you were published in the journal of public health dentistry you are a quite an accomplished man I mean um so um what why way is dental therapy is it's kind of funny how history is repeats out so let me go back and back in the day there was a guy named Bob Barker who was going around trying to start that'll hide and he actually went down in a plane crash like a lot of the early ones back then and when he would go talk to a dentist they were say look I'm so busy pulling teeth and doing immediate dentures I don't have time for this that was what the real world was saying and then there's always the political people and they were saying that this was a this hygiene thing was a violation of their principles and and keep her out of there and they don't need no hygienists and you know all that stuff and then here it is you couldn't get a dentist to say well don't you want to get rid of your hygienist so that you could do all of her cleanings like no I want her to do or him to do cleaning so I can do more other procedures towards my spectrum and here it is expanded duty function my dentist friends love it they go in there and she does the fillings so they can go over there and spend an hour uninterrupted during a root canal but it seems like if you don't have a hygienist or you don't have an expanded duty function or you don't have a dental therapist it just brings out this emotional outrage that you're violating their profession and their degree yeah you know

Dr Donald Chi : and I think you you hit the nail on the head I think it does really come down to turf I think there's a lot of concern that dental therapists you know will will you know that profession will start to produce so many dental therapists that eventually it might put Dentist out of business so I think that there is you know there is concern about turf I think that they're also you know is concerned that that the scope of practice of dental therapists will continue to increase in ways that will again eventually make Dentists obsolete and I think the thing that I tell dental students you know I teach a public health the first year dental students who you know they're just getting started out many of them you know have a lot of anxieties about debt you know about how much debt they're gonna graduate with and and I think that that those in the know will will take advantage of that concern that that dental students have that dentists have about dental therapy and kind of feed into the the mass hysteria that dental therapists are here to replace dentists and what I tell dental students what I tell you know folks is is really that dental therapy has a very limited scope of practice I mean really when you think about the types of procedures that dental therapists do compared to Dentists it's a really well-defined finite set of services and that we will always need dentists as long as there is dental disease we will always need dentists now if we're talking about just you know eliminating dental disease you know this may get rid of the dental profession you know altogether which you know again you know the public health person and me as well as the clinician and me says you know that'd be great if we could eliminate all oral diseases and just get rid of the need for any dentist or dental therapists that would be a good thing obviously we're far far away from that and I think that as long as there is a need for dental care there will always be a need for dentists yeah the economics is

Howard:  um I mean I always say money is the answer what's the question and my buddy the sapien can rationalize anything if he's got an economic incentive I mean if you if you're gonna make money thinking this you'll think that nine times out of ten whether you know it or not I I had the problem in Arizona where you know we border Mexico and I I practiced for 32 years across from the Guadalupe Indian Reservation and there's not one dentist set up to practice her but they're always finding a dentist from Mexico who goes in there and sets up shop but he's not licensed so you know so the good old government will always find you know they'll always come out and find him and arrest him and put him in a cage and the Dental Board collapse and they all think they're heroes and I'm always like so you're saying that zero dentistry is better than a unlicensed American dentist who's licensed in Mexico and there and they leave me like well absolutely and I'm like where did we lose the human in this conversation I mean I thought we're working on a human and when I first heard because I've been to Alaska I mean I drove i I'm one of the craziest I am Dentist I know most of my dentist friends can't believe I did this but me and my dad my brother and we flew into Anchorage we drove to Prudhoe Bay I mean it was the coolest thing in the world and it sound like um a lot of Arizona's dentists have never even been in the Grand Canyon and if you go to the Grand Canyon everybody there's from Japan and Germany but my gosh money's the answer what's the question that if they see it as an economic threat they're just gonna be against it period

Dr Donald Chi : you know and I'm all about you know obviously having you know care that is that is high quality that's safe you know obviously high quality safe you know dental care is is really super important and again I think that's another misperception that is out there that therapists are are these unlicensed unregulated you know clinicians out there just providing care willy-nilly and and that's not the case dental therapists you know go through a very stringent set of criteria for clinical training there's licensure and they're also working under the supervision of a dentist and so so dental therapists are working in tandem with dentists to provide the care and so that's what we've we've seen in the YK delta in alaska is that you know dental therapists are working as a team you know with dentists and hygienists and and other members of the of the dental team to provide care and so again i think that there are all sorts of really scary scenarios that that can be painted when it comes to dental therapy and at least in my experience none of those scenarios there's just no evidence that that's actually happening you know dental therapy is provided in a very regulated very controlled environment

Howard:  so we're your studies posted on dental town it's on it's posted on how Alaska tribes solved their dental health crisis and posted all this and the dentist the one in the comments says I would like to add my two cents solving is very we defined here I worked for my HS facility in Alaska there is sky high levels of decay among Alaskan Natives with little signs of slowing a reverse in that trend out in the village it's cheaper to buy soda than water so everyone drinks it so this guy is looking all your work and effort and saying it's not like he's thrown in the towel that it decay is a big runaway problem and we have that problem in Arizona too that the corruption that you could just see it is so amazing like you go in I witnessed this a dozen times where I'm standing a circle K or 7-eleven or whatever and and two little kids say well the cokes cheaper because they're getting a bottled water and it's 99 cents and the 64 ounce thirst Buster or whatever is 69 cents and I'm sitting here thinking oh my god this kid just made an economic decision and I've seen it with cigarettes to where when they raise the price of the taxes cigarettes they're sending it at the counter saying I don't know man do you want to you want to get a pack of split a pack of cigarettes because we could go to McDonald's and eat to get a Big Mac and then they'd go let's go to McDonalds and I realized oh my god they just thought about what what do they want it tobacco or Big Mac and it came down to dollars and cents and half a dozen times I've seen kids pick the big ol 7-eleven Slurpee because it's cheaper than bottled water how did bottled water get to be more expensive than gas

Dr Donald Chi : yeah those are good observations and good questions you know I think that back to kind of the the title of the general town article you know with the insinuation that dental therapists you know have solved the oral health access or disease problems and in Alaska Native communities you know I think that's a you know that's probably a little sensationalized what we did with our data we looked at 10 years of data from from Alaska Medicaid as well as electronic health record data and what we found was that over that 10-year period those communities that were served more intensively by dental therapists meaning they had a dental therapist in there village or community providing care that those individuals living in those communities they got more preventive care and that there were fewer extractions so you know taken together what that tells me is that adults and children in YK Delta communities that are served by dental therapists they're getting more preventive care and they're they're losing fewer of their of their natural teeth now what that means for disease rates in fact that's one of the limitations we have in our studies that we don't know what's happening with disease rates in Alaska Native communities however when you when people are keeping more of their teeth and actually we found this with younger children as well as adults if people are keeping more of their teeth I think one of the things that you can draw from that you know finding is that there's probably lower levels of disease now to say that disease that that caries or cavities you know that therapists are gonna play any role in terms of eliminating tooth decay I think that's really unreasonable I mean I and I think that that really applies also to Dentist as well as the dental care system I think that's a really unreasonable expectation of a dental care delivery system and and really I think you mentioned sugary beverages you know and I think that when you think about kind of the root causes of disease really it's behaviors you know it's it's the amount of sugar we consume it's inadequate access to fluoride in its various forms and and I think that those behaviors are really gonna be you know what we need to target moving forward to actually make a dent in the problem and so the dental care system is there obviously to take care of problems before they get large and to provide that preventive care but if you're not addressing these behaviors there's only so much a dental care system can do whether that dental care system is staffed by dentists or dental therapists 

Howard: yeah that was a that was a very nice sensationalized clickbait title I have to I however whoever came out of that title I'm giving them marketing SEO 101 because having the title how they sold you're never gonna solve a dental problem are you not that way no no and I think that there's just there we have a lot of work to do I think in terms of solving some of our oral health problems here in the country and globally we have a lot of work left to do I did not see all the controversy coming from in pediatric dentistry I thought that was one of the most in fact dentistry I really understand it especially it's just like okay we we just do small patients you do the bigger ones well just in the small ones but man when silver diamond fluoride came out I never saw the red see part that fast I mean on dental town it's either you just actually love the stuff and and it's just SDF is a rockstar who's playing at a theater near you or you're an older guy and just like oh that's just crazy it's another it's just another flash-in-the-pan gimmick of the day or whatever what would what do you see in this um SDF and why is it touching so many trigger points and social media what way why in dental town are there just two camps and they speak different languages 

Dr Donald Chi :sure you know and I think you know the silver fluoride you know I think for those who are rapidly against silver fluoride my guess is that many of those you know people are or maybe clinicians that don't have experience with it and so silver diamine fluoride is something new and I think that that we know a lot of times you know Dentist they they practice the way that they learn dentistry in dental school and so you'll learn you know what you did in dental school and you might take some continuing education courses throughout your career but by and large you know what you learned in dental school was what you're gonna take out into practice and so for those that that are you know rapidly again silver diamine fluoride I think it just might be discomfort with something that's new now to say that silver fluoride or silver diamine fluoride is gonna be the Silver Bullet that's gonna save you know that's gonna cure again us of the the caries problem in dentistry you know I think that's probably not true as well you know there's a time in a place for for silver fluoride and again does it mean that silver fluoride is gonna put Dentist out of business because we don't need to do treatment again that's not true you know there there is a time and place for general treatment there's a time in place for silver fluoride to be used and so so again I think that as long as people keep that in mind you know really you don't have to be at either end of the spectrum you know it's

Howard:  yeah and I take my take is I am I'm in Arizona mm-hm and I've been practicing here since 87 32 years and you know at one in one city in a five-year period twice a three-year-old was taken to an or for a bunch of pulpotomy chrome steel crowns by great doctors and she didn't live to talk about it and I'm so many that that's just so emotional I mean when it when you when you lose a child so there's a lot of people who don't who see these kids being taken in the ER and they think it could have been delayed with stf you know how absolutely and it's it's the only especially I never did I mean I've done wisdom teeth ortho I've done everything I place thousands implants I've done at all but I would never ever do my be station because the outcome I mean if I if my root canal goes south we lose a tooth I don't like anything to do with the the IV station but I know there's a lot of pediatric dentists who do not like the volume of kids being taken being put under and

Dr Donald Chi : that's been one of the great things about silver fluoride and how I've been able to incorporate silver fluoride into my practice is is one of the great benefits is that especially for a really young patients you know we're able to to either delay or to avoid altogether a general anesthesia episode which is good for I think everyone so if you can paint the silver fluoride on on teeth and and delay you know treatment that's great and again if you--if you do it at the right time there are cases where we've been able to avoid not just general anesthesia but but doing restorations on children allowing those  primary teeth that are treated with silver fluoride to exfoliate naturally and then you kind of start all over with with um with the permanent teeth that are you know that are brand new and so yeah and I think that that's really one of the things I think that silver fluoride can do whereas in the past you know at the moment you know you'd see cavities that you knew you could not treat in a traditional setting that that you would take that child to to the operating room and I think what's happening now is that just the number of patients that are being taken in for for general anesthesia has has increased so much that you're gonna have these adverse effect adverse events and so you know that coupled with social media you know again when these bad things do happen they get out very quickly and so people know about it so for a variety of reasons you know I think the silver floor and at least in my practices has really been a nice tool that I can use to to again keep you know keep my care quality high but also do what's right for the patient and do you um do you see any of this controversy among I mean with your specialist with the you're a board-certified pediatric dentist 

Howard: are they all on one side of the fence about this or do you see them even debating this or is this controversial in your organization you know SDF

Dr Donald Chi : I think it's probably less controversial in in pediatric dentistry you know most of the pediatric dentists I know you know in some way incorporate silver fluoride into their practices you know not to say that they don't have concerns you know parents come in with concerns about the staining about you know the aesthetics of silver fluoride and so not to say that it's it's controversy free but I think it's probably you know as far as specialties go it's probably more accepted in pediatric dentistry than then maybe some of the others Salty's but that said you know III dunno you know pediatric dentists who just don't don't use it they're like you know what 

Howard: you know I need to provide the best quality care you know I need to do restorations to completely remove caries and and not subject my patient - you know - to the aesthetic concerns of silver fluoride staining but yeah so I'd say on the whole I would say that it's it's um pretty well accepted in pediatric dentistry but but there is still controversy you know Janette McLean put a couple of courses online courses on dental town and one of them is silver is a new black improving your practice with silver diamond fluoride another one was top five misconcept there were the most viewed courses of 1990 of last year what I mean it was I mean it was the most viewed I mean something like fourteen hundred and sixty one course views I mean she is this um and she was even on the New York Times I'm you do think it's such a big story because I mean the the the number one goal of any species is to reproduce that offspring I mean you're supposed to replace yourself before you go is it is that why it's so important in fact the other end the the nursing home they say four percent of Americans will finish out their life in a nursing home and geriatric dentistry isn't even especially yet I mean they just did a oral health or oral medicine there's courses on silver diamine fluoride for pediatric dentistry but you don't see them for geriatric dentistry because you go into a nursing home they say the average nursing home person gets one class five recipient lesion a month and I know dentists who take silver diamond fluoride into the nursing homes and and thinks it's a godsend so white whitey why do you think it was her course was the most viewed course on dental town last year well

Dr Donald Chi : you know I think it shows that you know I think silver diamond Floyd you know really I mean it's it's it's been a practice disrupter you know you know in terms of really changing the way that dentistry is is practiced I think that when I think about the last major practice restrictor disrupter you know was probably you know fluoride varnish I mean you know and that was you know probably 20 years ago now so I think that's really been been part of I think the interest I think again it's also the fact that you know we really have not been teaching silver fluoride for very long in dental schools so I think again back to that issue of you know there are a lot of practicing dentists out there who may not know about silver fluoride and so I think courses like Jeanette's course you know I think that those you know really do provide you know an audience with with with education that they may not have gotten in dental school and 

Howard: what is it about first of all understand white parents refuse topical fluoride I mean it I mean it's still I mean ever since I did water fluoridation I mean water fluoridation I can see I got off on a bad sore because you know what was a Joseph Stalin wanted to fluoridate Moscow so you know the response on the US Senate floor was Senator Joseph McCarthy walked to the Senate floor showed a picture of a human brain and showed the with a red dot the area that if you drink fluoridated water it makes you susceptible to communist ideology and and here you know it's 70 years later is it because it's fluoride is that the controversial part why do you think parents refuse topical fluoride 

Dr Donald Chi :you know I think there are a lot of different reasons you know I think that you know parents may be concerned about the safety and the side effects of a fluoride and so if you if you google you know fluoride or topical fluoride there are a lot of sites out there that that really misrepresent you know the way that fluoride work the majority huh yeah yeah there's just there's a lot of bad information out there and I think that these websites have gotten more sophisticated over time I think the other thing is that these websites also link out to very professional-looking scientific papers that may also make you know conclusions that that are unwarranted or not based on data and so I think that there's just a lot of misinformation out there now you know what I'd like to think is that you know that parents you know they make the best decisions that they can for their kids you know I don't think any parent out there or very few parents out there I think are intentionally making decisions that harm their kids so I think the starting point with all of this is that you know parents want what's best for their kids and we have a new 20 month old now and again I think that you know I know that you know you know coming from my own life that I want what's best for my daughter but you know it's complicated I mean there's just a lot of information out there I think parents are oftentimes overloaded with information so they do searches they talk to friends who may then spread the misinformation you know I think the other thing is is that as Dentists and as dental health professionals I don't I don't think we do a particularly good job about talking to parents about fluoride and so so I think that dentistry has has a role on this as well we're actually just finishing up the first part of a study trying to figure out why it is that parents refuse fluoride and and we're still finalizing our results but but it's it's it's fascinating and I think that you know the the take-home message here is that it's a really complex problem I think that we're facing but it's kind of

Howard:  its kind of it doesn't make sense to me when doctors talk about misinformation on the Internet because the doctors are the ones that keep everything behind a paywall on PubMed um there's an article in the Los Angeles Times this week that says Covid 19 could kill the for-profit science publishing model because all this information is behind all this stuff but the ad a the it says Covid 19 could kill the for-profit publishing model the change would effectively nationalize the valuable American intellectual property that we produce and force it to give it away to the rest of world for free according to a December 18 letter to President Trump signed by the American Dental Association and 125 other institutions so the tax you know my good buddy love her to death GG in California says research projects are funded by NIH and that is taxpayer money all they do is print articles are published online and get paid millions by universities and advertisements keep in mind that their editors doing peer reviews also work for free if dental town can send magazines out for free Alice ever can - so like do you think the corona virus might be the nail because like save you Google water fluoridation the 5600 studies are all behind PubMed and paywall and you got a register and sign in but the fluoride people man their stuff shows up first and it's free I do what do you first of all what do you think of that letter the ad a signed and sent to them 

Dr Donald Chi : yeah you know so so really you know I think that um science that's funded by NIH actually the way that this works now is that if you have a project that's funded by NIH within 12 months actually you're any kind of publication regardless of where you're publishing it it becomes open access at 12 months and so it does become freely available now I think the argument is is that look you know when it comes to scientific knowledge twelve months is too long you know we need to get this information out soon and so so I am all for for open access of getting signs out as soon as we can get it out and I think that publishers have made a lot of money on the backs of academics as well as the government you know government funded research and I see you know I see their horizon on the horizon you know I see this changing I think that people have caught on that publishers are making not just small amounts of money but large large sums of money and and again I think this issue of scientific openness I is gonna put a lot of pressure on publishing companies to do things differently and

Howard:  you said you just had a 20 month old yeah yeah so we baby it's our first baby yeah because my first question is on Twitter you're on ADD Twitter you are at Donald L Chi but I just see you and two gorgeous dogs

Dr Donald Chi : oh that picture needs to be updated those are my two old dogs that actually have passed away the you know

Howard:  the other thing that the flip side about when someone goes a little child goes to our and you know we had two cases in Yuma since I've been here and you know every time I hear the word you might as I just cringe but the one thing that makes me cringe on the other side is that no one ever says you know it's always it was always the doctor it was always the bad doctor the bad doctor and then he did it again oh my god the bad doctor and he's not a bad doctor at all and but my question is they never say well why did your three-year-old daughter need eight root canals I mean I mean I don't have any hair because I didn't I drank too many Slurpees you know I mean I mean I I had no control I just assumed that my grandma married a short fat bald Irish guy and it turned out it was true so I come from a family that's predominantly short fat white bald Irish guys but is what when that three year old girl needs to be taken to the or for eight pulpotomy in chrome so pounds how much of that was behavior versus genetics I mean was she just was she born unlucky with bad genes how much of that is just behavior you know

Dr Donald Chi : I would say the overwhelming proportion of it is behavior and this is why I think I'm so interested in in ways to to help families and children improve their oral health behaviors because thing is like you said I mean you know if these kids weren't you know consuming so much sugar in the first place you know they wouldn't end up in a situation where they would need general anesthesia so so yeah you know I think when these unfortunate events happen again and I have additional context now because I have my own child and I I just I now you know understand what it's like to be a parent you know I think it really is easy to blame Dennis or to blame the dental care system and and maybe some of these instances things weren't done according to protocol maybe things weren't done you know in this in the most safe way you know however I think parents do have a role and and I think that you know what what I like to how I like to approach the problem is is not to play the blame game you know I think it's so easy when a child comes in with a lot of you know cavities and and dental work that they need to be really judgmental and to start you know being mean to the parent and saying look what are you doing to your to your child and I think that you know when it comes to providing care for your child I think that many parents are really struggling you know I think a lot of parents have a lot on their plates raising kids is really tough and if you don't have resources it's even more difficult and so I look at my own situation where we're you know I'm probably among the most resourced you know families that are out there in terms of the ability for us to afford high quality daycare for us to buy healthy foods for her daughter to enforce tooth brushing with fluoride toothpaste to make sure that she does you know hasn't had a drop of juice you know and we're resourced we can do that many families aren't and I can't imagine how much more difficult life would be if I didn't have the resources I had and so I think as privileged you know individuals of society you know I think Dennis you know often times are overly harsh with parents and I think that that's really unfair and I think that parents do have a role however I like to look more broadly at what are some of the structure you know features of society that got us here so earlier you mentioned you know the size of big gulps and and just the how cheap it is to buy sugared beverages and food there are policies in place that systematically you know put parents and families and positions where they make the decisions you know in the way that they do because of these structural problems and so 

Howard: so while I'm interested in behaviors and behavior change I think it's also really important to keep in mind some of the policy levers that are going to need to be tapped to solve these problems so you did another project with dental care used for Medicaid enrolled children with autism spectrum disorder in the Iowa smile project is that becoming a bigger part of pediatric dentistry autism and the million-dollar question and is there a rise in autism or is it just because now it were just woke to it I mean you know when I was a little kid that one kid was different and that now it's got a name um what would it what is autism doing to pediatric dentistry

Dr Donald Chi : yeah you know I can't speak for for the again the prevalence rate you know prevalence rates of autism you know I think there are a lot of intricacies you know when it comes to estimating prevalence rates you know I think autism and special needs has has really been one of the defining kind of areas of pediatric dentistry and and this isn't a recent thing so I think pediatric dentists have historically been the go-to specialty when it comes to providing care for special needs patients and you see this now if you go to you know most pediatric dentistry offices most offices will actually have quite a few adults with special needs that continue to be part of the practice many times because pediatric dentists don't have a place to refer adults with special needs I think the other thing is you know that we get attached you know we get attached to patients over the years and and so and so we hang on to you know our patients with special healthcare needs and so so I think the study that you're referring to you know talks about some of the barriers to care that children with autism encounter and certainly I think you know there are you know special skills that are needed in terms of treating individuals with autism in a dental setting and and we're obviously very interested in ways of improving the dental care experience for for patients with autism 

Howard: so do you I know but just for simple math if I set you a hundred patients how many would you take to the or and put under how many would have nitrous and how many would you the environment 

Dr Donald Chi :yeah I'd say most of our patients we would treat in our clinic with either with or without nitrous the clinic that I work in it's a community clinic affiliated with Children's Hospital we don't do any conscious sedation so us so the care that we provide is either with or without nitrous in our in our clinic or will will refer a handful of patients to Children's Hospital to be treated under general anesthesia so you know out of a hundred though I would say maybe you know two or three you know we would send maybe two to the hospital and the rest of the children you know we would treat in clinic and I would say you know contrary to misconceptions out there about you know about behavior management of children you know most children and by most children I say you know 95 96 percent of children are actually pretty cooperative when it comes to dental treatment even for really difficult procedures like extractions or Pol Pot amis or crowns most children are actually really really good patients and and in those patients that have difficulty cooperating you know again it's a it's a very small proportion oh my god still I don't know how you do it I I

Howard:  my hat's off to you I mean I had a you know patient uh last week and he was started to cry and then we got it done mm-hmm but that one 20 minutes exhausted me it was my whole day I mean everything else I did and when I was done with him I just want to go I just want to go home I told my don can I call in sick and just go home if you told me I I had to switch the pediatric dentistry or leave the country I would just start wondering which country I was gonna go to speaking of other countries my daughter-in-laws in South Korea right now and and I've been up there love South Korea mega gen I mean it's a great deal but you have an opportunity to be a double doctor a dentist a pediatric dentist a PhD and and get to see a very differently defined country in culture versus the United States what have you learned from really knowing Seattle and Korea what would variables stand out the most that affect disease and filled teeth rates their overall oral health that you can spot 

Dr Donald Chi :you know I actually think it's pretty similar when it comes to the causes of disease you know cavities are actually pretty widespread in Korean children because of diet you know diet is you know a lot of kids are drinking sugary beverages they're eating snacks and and and snack culture in Korea is is actually it's fascinating that there are tons of snacks actually I was at the I was at Costco the other day and and it was amazing how many Korean snacks that that actually I grew up with you know are being sold and in Costco now and so yeah I think snack culture is huge you know I think the other thing in Korea is you know it wasn't very long ago that the Korean War happened and and all of the fallout from from the Korean War in regards to malnutrition and food shortages and and hunger and so when I think about my own upbringing with my parents you know it was really important for my parents to make sure that that we were fed and that we were fed constantly so there was always something you know there's always something to eat lying around and I think that that snacking culture you know and and just the massive amounts of sugar consumption really is what's causing you know the cavity or caries epidemic both here in the US as well as in Korea as well as most places in the world 

Howard: so were you born and raised in Seattle or South Korea

Dr Donald Chi : I was born in the US I was born here 

Howard: I should kind of interesting because I'm I've lectured on in 50 countries and and I think Korea's really because whenever you're in China if you're the Chinese kind of thing themselves more like like I was born raised in Kansas more rural small area but if anybody had a fancy shirt on I was looking hotter bought a news car they'd always say oh you looking so Korean so the it was it was like it was their version of Elvis Presley and they also noticed from business point of view but the owners they'd say you know they'd say South Korea are they got Samsung high-end a you know they got they got so many LG and they go I'm you know China still I don't feel like they've reached her self-esteem because they make so many of the parts that go into your LG your Samsung my and but like if you walk into can you name one brand of something made in China that's a brand in Costco I mean Costco's in Seattle I mean there's there's no American brands that are from China really are there yeah I gosh I don't know and that's why they everyone in China they want a dress Korean listen to their music do they really do they they and that's China's entire strategy has just been make it so cheap till have to buy it and Japan and South Korea have all these brands and they have everyone's attention in in the entire recent in fact when I was lecturing in Malaysia Cambodia Indonesia I noticed that the dentist they're all knew what the South Korean dentists were doing the German dentists and the American dentist I mean it was just like that all the debate well the Germans are doing this the South Koreans and you know and but uh yeah they're they're really really following them so be extra dentistry has some more controversies I want to the role of sleep and airway and the tongues role again I come out of dental school I never heard of sleep apnea I never heard of obstructive sleep apnea this and now you can't go anywhere without talking about sleep apnea and also when we were little you know babies where your mom just nursed it now teacher comes in to show you how to do this thing that they've been doing for a million years and at the end of the lesson a lot of moms think their baby is tongue-tied and and the nursing teacher thinks it's tongue-tied and so I've gotten more questions in the last three years than the first thirty years about as my babies need tongue-tied so what I did was I just threw like 20 questions at you and I hope that one of them stuck to the wall is there an increase in tongue-tied is breastfeeding an issue as a pediatric dentist you what are your thoughts of the tongue in pediatric dentistry 

Dr Donald Chi :yeah in just in full disclosure this is an area of pediatric dentistry I don't follow too closely in terms of the literature so this is kind of going back to to again what I learned during residency and what I do in clinic I don't think there's any reason to believe that the prevalence of tongue-tie has somehow increased recently I don't think that that's very realistic now it may have been under diagnosed and so that's always a possibility you know I do know instances you know there are instances where where a mother may have trouble breastfeeding a patient or a child infant may have trouble latching in which case you know snipping the tissue under the tongue can actually help with with latching that being said you know I think that there is a lot of hype out there that's not always evidence-based and I think that unfortunately I think that a lot of clinicians out there who are taking advantage of some of the anxieties that parents may be coming in with I certainly remember this when when our daughter was born about a lactation consultant coming in and talking to us about ankyloglossia and and and there was no reason to believe that that there was any kind of tongue-tied problem with with Arliss and it was just interesting again from a parent perspective to to to hear to hear that so again you know clinically you know yeah we do see tongue-tie and there are cases where a tongue tie you know needs to be released and can be done very simply you know and and I think that that's and that's an important service to provide that being said I think that there's just a lot of stuff out there that is not evidence-based and I think that in the long term you know the things that we're doing out there that are not evidence-based they're gonna there's gonna be a time where where this is not going to be possible and I think that in an era of accountability in an era of evidence-based dentistry and and value-based care you know I think there's gonna be more scrutiny over the types of procedures that we do in dentistry just like there is intense scrutiny in medicine and I think that this is gonna affect medicine and dentistry in very similar ways 

Howard: so um in pediatric dentistry what was the other thing I was well if you saw a hundred patients back back to the hundred you said three would probably need to be put down or or what is the majority what is a day like you if you were McDonald's what's your Big Mac Franny poke you are you doing pulpotomy x' and chrome still crowns every day is it mostly amalgams or composites or cleanings what is what are you doing in in real world 

Dr Donald Chi :yeah so I think the most of my time is spent doing recalls you know and again I think that would be the case of most dentists and most pediatric dentists out there is that the majority of my patients are on recalls you know after that you know we're probably doing a lot of you know composite fillings 

Howard: so yeah so I'd say recalls cleanings exams and and composite restorations okay so let's go to composites I'm back to South Korea Asia Australia New Zealand they use a lot more glass ionomer than the Americans and GC 

Dr Donald Chi :will tell you that that I mean that it's just it's a do you use glass ionomer or you more North American director isin so I will use a resin-modified glass ionomer so so for all primary teeth will use resin-modified glass ionomer and then for for permanent teeth will use generally what will use composite so

Howard:  so explain that why does a pray a primary tooth what do you guys call them primary teeth mmm baby teeth primary teeth 

Dr Donald Chi :yeah it's funny when you are on the world milktea still seems to be more common when you go around the world so explain why a primary tubes would get a resin-modified glass ionomer and a permanent tooth would not yeah so yeah so theoretically I think in terms of wear characteristics composite is is is much closer to tooth and so so if you're for instance restoring an occlusal surface you know an occlusal composite against a tooth you're gonna have more natural kind of wear over time whereas with the red resin-modified glass ionomer you're gonna have more wear because it's not as as strong of the material now one of the benefits or one of the theoretical benefits of resin-modified glass ionomer is that is that there is a fluoride release and so resin-modified glass ionomer theoretically is able to absorb fluoride and and and then extreme fluoride as well so so you have some added protection when it comes to when it comes to primary teeth and is that GC that you're using we're using direct

Howard:  so yeah we use direct by who you know I I don't know and then what do you what are you doing for the pony teeth in for permanent each we teeth we will use a t ph g ph and so died right so resin-modified glass onward iraq well why do you think i'm glass on were so much bigger in Australia and New Zealand and Japan and South Korea than the US you know

Dr Donald Chi : I don't know that's a really good question I didn't actually know that was the case so yeah I don't know space maintainer that's another thing people are always you gotta keep that tooth in there to keep the space and then starts getting close to the age twelve you're like here I'm Dennis or look at that bite when you see that the head of the permanent tooth already between the roots what are your thoughts on and space maintainer and any tips you can give us sir I mean you know space maintainer z-- we do them when they're needed I think that that first and foremost thing that I think about when it comes to maintaining space is that you know if you put a space maintainer in you know that increases potentially the carries risk of that patient because of hygiene related factors so so while obviously it's important to make sure that you're not contributing to orthodontic problems I think first and foremost what's important to me is that that I put a space maintainer in a mouth only when I know that the hygiene is actually going to be you know impeccable because I don't want decay around that space maintainer I don't want caries to be a problem before that space maintainer is removed so I think that hygiene considerations are probably the single most important thing I think about when it comes to whether I place one or not 

Howard: do you miss amalgam I mean I I mean amalgam it just lasts forever we're done buddy clues I mean my gosh on that kid I had last week I mean I drove out that little hole and he was starting to lose him so we switched right to amalgam tritter ated boom boom boom it saved the whole day and if I couldn't have flipped to amalgam instantly last week I would have I would have had to refer a little seven-year-old and everything I read on amalgam my god it's metal it's it's half mercury you're never gonna find that in a multivitamin the other half silver zinc powder the whole thing is antibacterial why are we not using occlusal amalgams in in pediatric dentistry 

Dr Donald Chi :yeah I think that's a really good question and I miss amalgam too I haven't used amalgam since since I graduated from dental school and in O six I think this is an instance I think we're where parent concerns you know have have kind of restricted the kind of materials that that we use and so I know that a lot of parents when amalgam was being used commonly parents would come in with concerns about amalgam I think there also are probably the legitimate concerns about environmental impact and so we know that you know amalgam waste you know can can be a problem but but yeah I think as far as as far as longevity as far as you know when you're thinking about patients at high risk for for caries you know you have to wonder you know are the composites that we're placing in our patients really the best materials for our high-risk patients and and I would say you know again that that is not the case you know I think a lot of the patients that we place composites and you know probably would be better served if they could get amalgam fillings 

Howard: oh my gosh yeah when someone tells me they're composites last longer than am algum it's like it's like so out of their mind from the research I mean the research shows I mean paper of your paper 38 year average life expectancy compared to their six-year plastic inert stuff but the only the only thing that's wrong with the Malcolm in my view and it's a serious problem it's a six dental amalgam is 6% of the atmospheric mercury toxic and the biosphere but that's because your cremating humans that have a mountains in their teeth and I don't believe in cremation either I don't think you have the right to eat all these plants and animals then when you die you should be throw it back in the biosphere and be fed to the eukaryotes and prokaryotes and fungi and let everybody eat you instead you're like oh hell no I'm gonna incinerate myself and just send the energy out into the cosmos well when you're doing that you're also putting a lot of mercury vapor into the air and that's not cool um do you have a problem going to digital dentistry with with trying to find zero size sensor size zero sensors back you know do you wish you're on amalgam and film is it tough switching to composites and size zero digital sensors to put into a three-year-olds mouth  

Dr Donald Chi :not really know I think in terms of the eye I do miss amalgam I think when it comes to digital kind of radiography yeah you know I think that there are times where it actually is really nice to have the little film kind of in your hands and you can you can actually do some measurements on the film like you don't you when you're doing endo you can actually do a little bit of measurement with the film in your hand so I do miss that but you know at the same time you know I feel like you know we're moving toward more and more digital you know over time and so you know what do you do in that situation I think you could just kind of move along with the times but yeah I do when we when I'm in a clinic that's all digital there are times where I wish I could have you know the the films in my hands

Howard:  I can't believe we went over an hour um is there anything that I should have asked you that I did not ask you

Dr Donald Chi : um let's see you know I think one of the things that I think I've been more interested in recently is is kind of this issue of science literacy and an evidence-based advocacy and I think it actually ties in with a lot of things we've talked about and this is something that I talked to dental students about when I when I'm teaching dental students about public health and I think that there's such an importance I think that there it's so important for Dentists to be science literate and what that means is is the ability to read a scientific article and to point out the limitations as well as how that article might actually affect the way that they practice or policies that they may end up advocating for and so I think science literacy is is so important and I think that you know dental schools could probably be doing a better job and by that I mean myself I mean you know those in dental schools teaching dental students could be doing a better job and and the reason why I think that this is so important especially now with so much myths and disinformation is that is that there's a lot of advocacy out there that isn't entirely evidence-based and I think what that does for the profession when people are advocating for things that are not at evidence-based is that I think it cheapens the profession you know well well you know and so I you know when it comes to for instance dental therapists you know I think that that there you know the kind of people who are against dental therapists a lot of times they will advocate against dental therapy without referring to the scientific literature and so I think that it's really important to keep in mind I mean you can still be against dental therapists out there and there probably are legitimate reasons maybe to be for or against anything but I think it's really important when when for instance talking to policy makers that that we advocate and that we advocate based on the evidence and and I think that I've seen multiple instances of for instance here in Washington you know we we had there was a dental therapy legislation that was under consideration and and and there was testimony that that I would hear listened to that that wasn't evidence-based and and in fact a lot of it was was kind of using scare tactics of saying oh this is not safe oh this isn't you know dental therapists aren't safe dental therapists this is a slippery slope in terms of what this will mean for dentistry you know patients end up getting substandard care and and those statements are fine but they're not really backed by anything and I think that that is it's really irresponsible so I think that you know especially with dental students you know dental students oftentimes like they do here at the University of Washington they have an opportunity to participate in in what we used to call Lobby day I guess it's not called Lobby day anymore but they they go to Olympia to talk to state lawmakers about legislation they should support and not support and and again I think that given that dental students residents dentists are out there advocating to policy makers I think it's just important to make sure that that you do some reading and that you kind of know what you're advocating for and I think that in the end evidence-based advocacy is the best kind of advocacy that we should do because the public is putting a tremendous amount of trust in in dentists when it when it comes to when it comes to our profession so speaking of trigger words and trust Pugh is a trigger word in trust I mean it seems like 

Howard: you either love them or it's a conspiracy what are your thoughts on pew trust and and do you agree that it bring that out just saying that it came from pew there's Dennis on dental town that just they're done and it's like where does this come from so what does your experience been with pew yeah

Dr Donald Chi : in full disclosure all of all of my dental therapy studies were funded in part by pew and so again I think to categorically say that pew you know funds work that is in some way biased again I can't speak for the other studies but as you know in regards to the studies that we've published with with funding from pew again I would ask people to be specific about what exactly is it about our studies that that concerns them 

Howard: yeah well they're mad they're very sorry that you know what the name of their magazine is hmm trust magazine I mean that because I've always said my whole life that the number one thing I've seen a road from my 57 years on this rock is the erosion of trust I mean it's just been going down every year I mean when I was a little kid I mean you know I grew up you know in Kansas the Catholic Church the government America everything and and the US Congress has had about an eleven percent approval rating since 1980 and so it's kind of interesting now how people just trust is just a it's a big issue and that's why I really hope this uh pay wall with the access the information I mean again you know you search water fluoridation any bozo can have a website and by the way so I infiltrated them because I always wondered what's that all about so I joined an anti fluoridation as group and got really deep into them and I figured it out and well it took a while but I figured out money's answer what's the question when they talk about this whether you're a Ford against it whatever when you're done you're gonna buy a reverse osmosis water unit and they have the best one and the guy there can install it and they can finance it and and it's it's basically is a lead generator for either an RO system a water softener this or that and so people have right to be skeptical any any other issues 

Dr Donald Chi :well I mean just to actually follow up on your your last point again and this is why science literature I think is important not just for Dentists so you know buyer beware you know I think that you know regardless of of you know who funds a study who's published it I think buyer beware I think we need to all be super critical when it comes to reading the literature and part of that is is science literacy and I think that Dentist certainly you know need to need to have the tools available to them to be able to critique and and understand the limitations of studies but I think that this so you know generalizes to to the public you know I think that we've done you know generally a really bad job about making sure that our population you know has high science literacy and and hopefully there are some more resources being you know being devoted to this this issue because I think it really is you know it's a potential threat to democracy when it comes to a population that isn't able to to read something and say this is valid or this is not valid

Howard:  so since you're a pediatric dentist and you're from the University of Washington School of Dentistry wasn't the last thing a pediatric does Joel Berg so is he is he your role model that you'll you're next after you got two doctorates is the next to become the next Dean of the University of Washington School of Dentistry isn't that a cultural thing Washington you know in 

Dr Donald Chi :Joel was one of my first pediatric dentistry teachers here at u-dub when I when I became a third-year dental student you know Joel taught me pediatric dentistry and so he said he said an old teacher and a friend let's see he was he was department chair then so he was chair of pediatric dentistry and you know I I just I love what I do now you know I I spend time teaching dental students I see patients a day a week and then I spend the rest of my time doing science and I really love what I do and so so yeah so do you know do I want to be a Dean probably not I just I love what I do now and and I see myself continuing on this track I 

Howard: I told them Joel I felt sorry for him being the Dean I I mean it's hard to get dentists are so educated and so it's hard to get them to agree on anything if you want a hundred people to believe everything you say make sure they're under 18 but once they all have a doctor dental law degree it's like herding cats and I've been in a DEA meetings I've been in dental meetings and every dentist knows everything and it's you would just be lucky to get them to all agree that today is Monday and on that note thank you so much for all that you do for dentistry and on behalf of all the dentists in America who would quit if they had to be a pediatric dentist thank you for doing that force because we won't do it Howard thank you have a great day thanks you too  

Category: Pediatric
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