Fighting the ‘Sugar Bugs’
A pediatric dentist on preventing cavities, helping with brushing, and getting anxious kids in the door
In the middle of dinner with his family, Dr. Derek Blank, a pediatric dentist, sometimes tells his three young kids that they can pick a dessert—maybe a piece of chocolate or a scoop of ice cream—and eat it right away. “They’ll have that midway through their meal, and then I’ll have them finish the rest of their meal so the sugar from the dessert doesn’t stick on their teeth afterwards,” Blank says. “My friends very regularly make fun of me for feeding chocolate to a child and then making them eat apple slices afterwards.”
The 35-year-old Blank, who opened DC Pediatric Smiles in Bethesda in July 2017, knew when he was younger that he wanted to go into a medical field to help others. During high school and college, he interned in the summer at a cardiologists’ office in Ohio, but he later decided that being a dentist offered a better work-life balance. He graduated from Xavier University in Cincinnati and then attended dental school at the University of Maryland, Baltimore, where he completed a postgraduate fellowship in pediatric dentistry.
When he was setting up his own practice, Blank wanted to create a “nondental space,” and thought back to his childhood visits to the dentist. “Immediately when you got to the front door you just smelled dental office,” he says. (After an appointment in second grade, he remembers saying to his mom, “Who grows up and wants to be a dentist?”) Blank avoids dental materials that smell bad and uses drills that aren’t very noisy. He opted for a stylish beach-themed décor with surfboards on the walls, a kid-size picnic table with an umbrella and lots of blue tones throughout the office.
Blank’s patients range from a few months old—with concerns such as tongue ties and teething—through college age. He advises parents to bring in their babies before they turn 1, mainly to talk about brushing, pacifiers, thumb-sucking and bumped teeth. New patients who are a little older are often anxious about going to the dentist, which can make the appointments “a bit of an unpredictable rodeo,” Blank says.
“Every day we have situations where maybe a patient’s previous dental experience has not gone well. The patient doesn’t want to get out of the car. Mom’s dragging them in,” he says. “We start at square one—maybe they get an office tour, they get a prize and then they go home. We schedule them to come back and we just build on that.”
Blank and his staff use kid-friendly terms to explain things to patients (they’ll call a cavity a “sugar bug”) and try to play up the fun stuff: sunglasses to wear during appointments, stickers and small toys to take home, and Netflix. “We really focus on: What do you want to watch on TV?” he says.
In his own words…
“Kids’ teeth have a really thin layer of enamel compared to our adult teeth, so typically the baby teeth are a lot more susceptible to getting a cavity. And then when a cavity forms, it can grow really quickly. Maybe in our adult teeth it can take months, several years, for a cavity to really develop into something that requires treatment. For kids, that can be something that in a matter of weeks can develop and become problematic.”
Too Much Sugar
“The quantity of sugar consumed is not the biggest thing we’re concerned about. It’s really more the amount of time that a tooth is exposed to the sugars in your foods. You could take a 2-liter of soda, chug it all at once, and brush your teeth afterwards. Although from a nutrition standpoint that’s not healthy, tooth-wise that’s not as big of a deal as if you take a Dixie cup of soda or even apple juice and just sip it, one sip every three minutes throughout the morning. It’s just constantly bathing your teeth in this acidic environment that’s super conducive for bacteria to form, which causes cavities.”
It Takes Two
“We recommend that parents help out with brushing up until the ages of 8 to 10, which a lot of parents are surprised to hear. A lot of very well-intentioned parents come in with a 2-year-old and might say, yeah, Lola’s doing a really great job brushing. Unfortunately, Lola might brush the front teeth great, but where cavities typically form in the back, she may have missed that for the past month.”
“Some patients do so much better when they’re not with their parent. We can see the little cues for that, and in a really tactful way communicate that to the parents. Sometimes it’s not easy to say to them: A lot of times parents will subconsciously transfer their dental anxieties to the patient. Although it can be kind of an awkward conversation to have, two minutes later the parent is like, Oh my gosh, thank you so much, she’s doing so much better.”
Nature or Nurture?
“There’s a significant hereditary component to why certain kids get cavities and other kids don’t. I emphasize the prevention things we can control—fluoride toothpaste, diet, visiting the dentist every six months. We see it most clearly in twins or siblings. The child that is so diligent in brushing and has a great diet will end up getting cavities, and the child who goes to bed with M&M’s in their bed doesn’t get any cavities. From an anecdotal perspective, we do see that more frequently than we’d like. My only personal explanation for that is probably that unknown hereditary genetic component, which is definitely real.”