Billion Healthy Mouths Club

Dentist Jeanette MacLean from the US: “I do everything in my power to spread the word about minimal interventions to help reduce the use of sedation for young children.”

Meet the inspiring dentist who has accidentally become an internationally recognised advocate of minimal invasive dentistry.

First experiencing a paediatric dental office during her studies, she quickly realised it was something she wanted to for the rest of her life. Now, Dr. Jeanette MacLean runs her own dental clinic, Affiliated Children’s Dental Specialists in Glendale, Arizona, and passionately advocates the importance of minimally invasive approaches in children’s dental care. In this interview she describes how her dental clinic works, how she treats and motivates the youngest patients, and what her personal mission as a mother and dentist is.

You hold a Bachelor of Science degree in Chemistry. How did it happen that you decided to do a dental degree?

I always knew I wanted a career in healthcare, but it was actually my mother, a nurse, who suggested that I look into dentistry. Dentistry is the perfect balance of art and science, with the ability to work in direct patient care, and that appealed to me. 

As a senior in college in the honours program, I was able to have a semester of externships in dental offices. I did this to get a feel for what dentistry really was like, which I highly recommend to anyone interested in applying to dental school. I spent time in a variety of dental settings, including public health, general practice, a periodontist, oral surgeon, etc. It was my time spent in a paediatric dental office that really clicked. I thought – now this is what I can see myself doing for the rest of my life! That was always the focus during dental school. I took every paediatric clinical or volunteer opportunity that came my way, and did lots of dental events on weekends, like sealant clinics, and even three international mission trips with a paediatric emphasis.

Is there any other reason as to why paediatric dentistry is so appealing for you? 

I truly enjoy working with the kids. I had a very positive experience as a child and was always taken to a paediatric dental specialist by my parents. I had a lot of complex issues, with impacted and missing teeth, periodontal and oral surgery. I also got teased about the appearance of my teeth as a child. I wanted to help other children have a positive experience at the dentist and foster a positive sense of oral health and overall well being.

“I am part dentist, part child psychologist, part counsellor (to the parent), part hostage negotiator, part circus clown, the list goes on.”

Do you think that being a paediatric dentist requires any special skills or characteristics?

Definitely. As a paediatric dentist you have to be skilled in dealing not just with the child, but also their parents. There are so many moving parts. Add practice ownership to the equation, and it’s really quite remarkable just how much we have to deal with on a daily basis. The dentistry is really quite simple, when working on children’s teeth, it’s the “everything else” that makes it more complicated. It’s truly a juggling act; I am part dentist, part child psychologist, part counsellor (to the parent), part hostage negotiator, part circus clown, the list goes on.

Welcome to the Billion Healthy Mouths Club

Proper routines in prevention are the future of dentistry – that’s why we at Curaden launched the Billion Healthy Mouths Club – a community of dental professionals committed to the idea of having proper routines in prevention and a holistic approach to dentistry. Dentist Jeanette MacLean is one of those dental professionals who shares these values, and we proudly present her experience and thoughts with other like-minded people from the field. Keep reading our Gently magazine to discover more interviews with forward-thinking professionals from around the world.

What’s the most challenging part of treating children? And what do you enjoy the most about having kids in your dental office?

The kids are fun! I enjoy working with them, even the most challenging kids, and love watching them go from fearful or uncooperative to the child that can’t wait for their dental appointment. 

They’re not the problem, it’s the parents that are the difficult aspect of being a paediatric dentist. Truth be told, as parenting styles evolve, it’s becoming more difficult to manage them. I find more and more parents have unrealistic expectations, along with waning faith in, or respect for, our clinical expertise.

Based on your experience – do you have any special tips on how to motivate children and their parents to adopt regular oral hygiene routines at home? 

Motivating a child and caregiver to have a good oral hygiene routine needs to be tailored to the child’s age to be effective. For example, for the parent of a toddler who says “they cry when I brush,” I gently remind them that’s common, and it’s an age-appropriate reaction to cry when they don’t want to do something, but you would rather them cry about brushing than get cavities. 

Sometimes they cry for a diaper change or when you put them in the car seat; health and safety are non-negotiable, and that includes teeth. 

Now let’s say you’re dealing with an elementary age child, it’s very effective to use humour, especially (like it or not) toilet humour. For example, for the child that lacks motivation to floss, I tell them that not flossing is like going for a #2 and not wiping. This is really effective and always gets a laugh out of both the kid and the parent. 

For a stubborn teenager, I tell them to “brush at night to keep your teeth, brush in the morning to keep your friends. Teenagers care more about what their friends think, and do not want to be known as the one with stinky breath.

“I explain to patients and their parents that coming to see me twice a year is not enough. What they do on a daily basis in their homes with diet and oral hygiene is the only way to truly control caries.”

When we talk to dentists and dental hygienists from all around the world they keep saying that it’s very common for kids at a young age to have caries. What’s your experience?

Tooth decay is the number one most common chronic disease of childhood, so that’s an accurate statement. Snacking and sipping all day on things loaded with carbohydrates and acidic beverages is the simplest explanation. 

I explain to patients and their parents, very frankly, that coming to see me twice a year is not enough. What they do on a daily basis in their own homes with diet and oral hygiene is the only way to truly control caries. It’s important to educate and empower patients to take control of their oral health and not think that dentists can cure them of a chronic behaviour-driven biofilm disease. 

Since 2007 you’ve been an owner of Affiliated Children’s Dental Specialists. Could you tell us anything more about the clinic? What kind of patients do you have? What are the ways you work?

We see patients from infancy through to college, as well as patients with special needs.

In my practice we deliver patient-centred care and the parent plays an important role. Every child and family is unique. There is no such thing as a one-size-fits-all treatment plan; we discuss the options with the parent or guardian, from minimally invasive to conventional surgical restorations, along with their goals and expectations for their child’s care. 

It’s amazing how many patients we see for second opinions, and the parents often comment that they are so appreciative that we took the time to engage in a conversation about their child’s oral health.

You are very active in educating both the general public and other dental professionals. Your main topic is minimally invasive dentistry. How have you become interested in this specific topic?

I became interested in minimally invasive dentistry after my own daughter had surgery under general anaesthesia as an infant. Being on the other side of the table, as the concerned parent, it really impacted the way I empathised with parents when considering sedation for their young children’s dental work. 

I also experienced a medical emergency with a special needs patient undergoing IV sedation in my office. He recovered and is doing fine, and continues to come see me every three months, but this experience made me question what I could do differently and better for my patients and their families. It made me take the informed-consent discussion more seriously; what are the risks, benefits, and alternatives to treatment, including no treatment. 

When silver diamine fluoride (SDF) first became available in the US, I was an early adopter and vocal advocate of SDF as an option to delay, or altogether avoid, the use of sedation for surgical management of caries in children. 

“In 2016 I was featured in a New York Times article about silver diamine fluoride, which sparked an overwhelming response of interest and inquiries from patients and dental colleagues from around the world.”

When you compare the dental care that was performed on kids ten years ago and now, do you see any difference? Is the field in general on a good path to prevention and non-invasive treatments for children?

In the past six years, there has been increased awareness and adoption of minimally invasive treatment options in the US. In 2016 I was featured in a New York Times article about silver diamine fluoride, which sparked an overwhelming response of interest and inquiries from patients and dental colleagues from around the world. 

I refer to myself as the “accidental speaker,” having never had that goal or interest previously. But this sudden demand for information became the driving force that catapulted me into the international speaker circuit and key opinion leader arena.  

In 2017 I was an expert witness in a wrongful death lawsuit where a child died following complications of general anaesthesia administered in a dental setting. I made a promise to that girl’s mother that I would do everything in my power to spread the word about minimal interventions to my dental colleagues, so as to help reduce the use of sedation for young children. 

I have many mentors and friends that are also key players on “Team Minimal Intervention,” and it has not been without resistance or challenges. There have been days when the “haters” made me feel like giving up. Now when I receive an email or a message from a dentist, sometimes from the other side of the globe, that tells me I changed the way they practice dentistry for the better, it motivates me to keep doing what I am doing to advocate for minimally invasive dentistry.

Besides your full-time job at the clinic and a number of educational activities, you also do some charity work. What’s your role in these missions?

I have volunteered for a variety of charitable dental organisations over the years, like AYUDA, Give Kids A Smile, and Mission of Mercy. The one I am most proud of is Team Smile, which partners with professional sports teams and provides free dental care to children, where I was asked to help them implement the use of SDF and SMART (silver modified atraumatic restorative treatment) into their clinics nationally.

How do you manage all these professional activities and being a mother? 

Running a private practice while raising two children, lecturing, writing, and volunteering is not for the faint of heart. Having a great partner in life, my husband, is how I am able to keep so many plates spinning at once.  

What is your kids’ relationship to dental care? Do they enjoy brushing their teeth?

My kids are normal kids. They sometimes groan when I remind them to brush their teeth, but they do it and their teeth are healthy. They enjoy coming to mommy’s office and they especially love trying new products and being in some of my YouTube tutorials and Instagram posts. 

Dr. Jeanette MacLean graduated with a Bachelor of Science in Chemistry from Northern Arizona University in 1999. She received her dental degree, with honours, from the University of Southern California in 2003, and completed her specialty training in paediatric dentistry in 2005, through the University of Nevada School of Medicine. 

Since 2007 she has been an owner of Affiliated Children’s Dental Specialists, an awarded clinic based in Glendale, Arizona. She is internationally recognised as an expert and advocate for silver diamine fluoride (SDF), Icon Resin Infiltration, and minimally invasive dentistry. 

She provides lectures across the United States and Canada, as well as globally watched webinars. Dr. MacLean is a Fellow of the American Academy of Paediatric Dentistry and Diplomate of the American Board of Paediatric Dentistry. 

Her research and articles have appeared in various professional and public magazines, journals and newspapers, such as the British Paediatric Dentistry journal and the New York Times. She is an active member of various professional societies and associations. Dr. MacLean also volunteers for underprivileged children both locally and in Mexico, Belize, and Costa Rica. Recently Dr. MacLean was named as one of DentaQuest’s 2020 Health Equity Heroes – Heroes in the Time of COVID-19.

To learn more about her work, follow @drmaclean on Instagram and watch her tutorials on the clinic’s YouTube channel.