Dr. Jason Hirsch Talks Changing the Approach in the Treatment and Care of Childhood Caries

Interview with Dr. Jason Hirsch

By: Michael W. Davis, DDS

Dr. Michael W. Davis maintains a private general practice in Santa Fe, NM. He also advocates for disadvantaged citizens, and provides expert legal work for numbers of attorney clients. His publications and lectures are on ethical and whistleblower issues within the dental profession, as well as numbers of clinical research papers. He may be contacted at: MWDavisDDS@comcast.net

 

 

Jason Hirsch DMD MPH maintains a private practice of Pediatric Dentistry in West Palm Beach, Florida. Dr Hirsch has degrees in Chemistry, Public Health, Dentistry and Pediatric Dentistry and has been a licensed dentist in his home State of Florida since 2002. Dr Hirsch's philosophy is simple, treat children like they were your own, treat the cause of the problem first and foremost and practice with principles of benevolence, non-maleficence and veracity.
Contact information: DrJ, 685 Royal Palm Beach Blvd, Suite 201, Royal Palm Beach, Florida, 33411. Phone: 561 795 7959 Email:jhirsch1971@gmail.com

Introduction

Dr. Jason Hirsch is at the vanguard of revolutionary changes in dental care for pediatric dental patients. This advancement goes far beyond progress in dental methods and materials. Dr. Hirsch examines dental disease in its totality, and arrests the causation and progression of dental caries (tooth decay). He has rejected the paradigm in restorative dentistry of continual drill-and-fill (or steel crowns), followed by pulpotomies (baby tooth root canals) and extractions. His emphasis is solidly on evidenced-based medicine and dentistry in treatment for the root causes of disease, and not simply the manifestations of disease (seemingly an endless cycle of tooth decay).

 

Question 1

Dr. Davis: Dr. Hirsch, I feel quite honored to provide this interview for our readers. Could you explain how our current mode of dental care for pediatric dental patients is irrational? We see endless cycles of restorative dental services for our nation’s children, especially disadvantaged Medicaid children. Costs to taxpayers are outrageous, with unsustainable deficit government spending. Too many parents are only given two options involving their child’s dental treatment; “juice them (sedation), or papoose them (restraints a/k/a- protective stabilization)”. Each venue has its own set of risks. How is your vision for children’s dental care different, in relation to immediate benefits for the youngster, associated cost of treatment, and the long-term wellbeing of the child into adulthood?

Dr. Hirsch: Pediatric Dentistry (or children’s dentistry) has become too focused on teeth treatments instead of disease treatments. I fully understand that dentists are trained to repair teeth. How can we achieve this lofty goal of incorporating dentistry/oral health into systemic health, if we are hypocrites and continue to myopically focus on teeth? I hear these oral-systemic connection buzzwords, but how are we supposed to connect the dots, if we don’t begin doing this in children?

You cannot take an adult in the middle of his/her life and try to convince them of the oral/systemic connection. It just won’t work. This has to be accomplished in pediatrics with mothers/moms as the gatekeepers to this paradigm change.

The care system is irrational because we have acute treatments for a chronic disease. If you look at diabetes management you will see some parallels that frankly pediatric dentistry needs to focus on. Diabetics’ needs daily insulin and a child with tooth decay in whatever stage, needs daily fluoride. I don’t see dentistry promoting fluoride as medicine and that is disturbing to me. The pharmaceutical industry has created longer lasting insulin, so we have created a longer lasting fluoride, silver diamine fluoride (SDF).

We have an opportunity to stop dental disease faster than ever before because of this SDF product and because of SDF; we can reduce the need to papoose children or sedate/ anesthetize them. What SDF buys is time, and we all know that the most precious and expensive commodity in life is time to ignore this therapy would be a great setback for children and dentistry in general.

We cannot talk out of both sides of our mouth. If we want to integrate oral health into systemic health, I’m telling you it starts and ends with this concept of care, and it starts with children. Period.

Question 2

Dr. Davis: I’d like to get into some of the “nuts and bolts” of your modalities of arresting the dental caries (tooth decay) process. Are you giving little children shots with needles, to numb teeth from pain of dental therapy? Do you generally require sedation of the child to gain patient cooperation? How long is the child sitting in a dental chair for these therapies?

Dr. Hirsch: SDF treatment requires skill, not in the delivery of the treatment, but in assessing whether or not the situation requires SDF treatment. We cannot think that we can just slather this medicine everywhere and we can sit back. On the contrary, we must identify the specific children that will benefit most from this therapy, and then we can slather it judiciously.