All Things Paediatric with Dr Tim Keys - Part One

Join Dr Tim Keys, Paediatric Dentist, as he speaks frankly with Dr Jillian Fisher on all things related to treating children. In this first of a 2-part Podcast, Dr Keys talks about the Childhood Benefits Scheme, how to manage treatment plans for child patients, and when and how to use Nitrous Oxide. He also speaks about the correct use of restorations verses Stainless Steel or Zirconia crowns (including Hall Crowns) for children, and how much Fluoride kids should be using !

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This podcast is brought to you by CORRECT DENTISTRY

Transcript

SPEAKER_00 0:12

Welcome back to the Correct Dentistry Podcast. And I'm really excited because today I get to interview a friend of mine, someone I've known for, I don't know, 20 years?

SPEAKER_01 0:21

Probably 20 years.

SPEAKER_00 0:22

And it's Dr. Tim Keys. Welcome to the podcast, Tim.

SPEAKER_01 0:25

Thanks, Tim. Great to be here.

SPEAKER_00 0:27

So if you know Tim, you know some of the best conversations you'll have with him with a beer. So we are sharing a beer today. Cheers, Tim. Cheers. So, Tim, you own a practice called the Children's Dental Centre. Can you introduce your practice? Where you studied, when you studied, what you like to do?

SPEAKER_01 0:43

Yeah, absolutely. So we're uh based on the Sunshine Coast. My wife's a pediatric dentist as well. Uh I met her in Melbourne. She was trained in Canada. She came over and did a fellowship year. And uh so she was the boss of me in uh Melbourne when I was going through training, and now she's the boss of me at home and work, which is really good. Uh, and then we've just uh opened a practice in Aspley, which is sort of north Brisbane as well, where we've got an awesome pediatric dentist called Jackie working, uh, and she's really good value. Um so we've been there for about seven years now, having a good time. Yeah, love where we live. Yeah.

SPEAKER_00 1:16

Yeah.

SPEAKER_01 1:17

It's good fun.

SPEAKER_00 1:18

Um so apart from the general pediatric dental practice that you um maintain, you also do a little bit of lecturing, which is why you're here today in the centre, in Michael Mandikos' centre. And you also do a little bit of advocacy for the uh the community. And I I've seen you and read your work in newspapers and seen you on other podcasts. What are you doing for the kids of Australia?

SPEAKER_01 1:42

Look, it's hard. Uh, because I work for Queensland Health uh as well as a consultant and stuff. Um the advocacy stuff is really hard because the frustrating thing I think for a lot of us in the dental community is we're used to getting an immediate result.

SPEAKER_02 1:55

Yeah.

SPEAKER_01 1:55

Right? You know, there's a whole put a filling in it, we're done. Sawtooth extract it, we're finished. Advocacy is multi-year burn. And so for me, when I first started doing it several years ago, um, I can't believe how slow it is. And I think the issue that we get to is that for us, it's the issues that we're raising are generally such glaringly obvious problems. But for some reason, the person on the other side isn't even interested in that problem. So, for example, for our local federal minister leading into the election that we had in 2025, last year, yeah, um, we were talking to him about some of the problems with the child dental benefit scheme, for example. And one of the big problems we see in pediatric dental world is it's capped at$1,100 over two years. So if you're just gonna check up, a clean, and a couple of x-rays, that will probably juice that. So, really, the CDBS is designed for a check-up and a clean every six months. Because once you need a couple of interventions, crowns, fillings, or extractions, the money's gone. And so we don't have the capacity to apply for additional funding for kids who need it, vulnerable children, Aboriginal Torres Strait Islanders, remote and remote regional Queenslanders. And one of the biggest problems is they can't use it when they go to sleep in an accredited hospital environment. And so you have these patients who've got$1,000 sitting in a bank account. Well, not really, it sits in the government's bank account with their name on it, that they could use when they need it most. And so then you go talk to your federal politicians and you're like, mate, hospital's two and a half, and these sisters are a thousand, and dental's two and a half. So it's six grand. And they've got a thousand dollars they can't use. And the response from that minister, Andrew Wallace, was if they can't afford six grand, they can't afford five.

SPEAKER_02 3:43

Oh.

SPEAKER_01 3:44

So that's the problem you get. You've got someone on the other side who doesn't even like how out of touch can you be? And then we we actually sort of hope that we thought, you know, the Greens have obviously been pushing a lot for dental. Now, obviously it comes at a cost, right? And I I see within the dental community a lot of like, well, who's gonna pay for it? Now, I don't actually think it's our job to say who's gonna pay for it. Why? Because governments have priorities. If they want to set spend$1.2 billion on EV car subsidies and they want to spend$108 million on dental, that's not an issue of where the money's coming from. It's an issue of priorities. So we need to somehow make the government realize that dental is a priority. So in Queensland, for example, as well, you can get a travel subsidy. If you if I see a patient from Rocky who's got complex, let's say supernumerary, complex root canal from a trauma of a 1-1-2-1, and they get sent to me because there's no other access to it. We're the most northern pediatric dentists in Queensland, in Harvey Bay, and um, if they get sent to me, they can't get a travel subsidy. But any other medical condition, they can get a travel subsidy for. Why? Because the Queensland government says they can access the CDBS. But there's no specialists in the area. So the problem is we've got these glaringly obvious, simple to fix problems that are cost neutral.

SPEAKER_02 5:07

Right?

SPEAKER_01 5:07

So the government, the scheme's capped. It's used at 40% utilization rate. If they allowed people that really needed the care to use it, for example, when they're asleep, or they can do it in the chair and they just need more funding, even if they gave those people twice as much money, it's still going to be less than 100% utilization.

SPEAKER_02 5:27

Yeah.

SPEAKER_01 5:28

The government banks the money every year. Yeah. So those things are really hard. How do you change it? It's really difficult. Then you try to talk to the media, and unfortunately, dental's just not that popular. Like it doesn't sell papers, does it? And then usually the only stories that really sell are negative.

SPEAKER_02 5:44

Yeah.

SPEAKER_01 5:44

So then you need negative stories. And most of them occur in long-term public waiting lists where most of the contracts with clinicians explicitly say if you bring the health system of Queensland into distribute, you lose your job. So it's really difficult. So we're how do we fix it? Look, to be honest with you, I actually don't know. What we're doing at the moment, one of our um, you know very well, Steph Shields, she's gonna do a white paper for us over six months. And what we're trying to work out is actually what is the current situation in Australia for pediatric dentistry? Like, where's the funding come from? What are the restrictions? What's the access issues? And then maybe that can give us a guide to say to people, look, we don't want to try to fix everything at once, but can we try to fix these two pain points? Yeah. And that'll make a change. So I think if we can work out where the problem is, we can fix some problems. But it's hard. Like you will have seen the articles, they're like, I feel like they're heart-rendering stories of kids who have terrible traumas. And families, you know, publicly they've been offered extraction of front teeth on a seven-year-old, or privately they're up for six grand and they've got thousands bucks in the bank account and they can't afford it. So literally, you know, in the medical world, money won't determine the outcome necessarily, but in the dental world it will.

SPEAKER_00 7:03

Yeah.

SPEAKER_01 7:04

Yeah. It's really sad.

SPEAKER_00 7:05

So these kids that um arguably the children that you're proposing to go to general anesthetic are the most in need, in need. Um, are these children the ones that you're then trying to toil away in the chair on multiple appointments, or are people getting their money out of super? What do you see as the practical application of them not having access to that money?

SPEAKER_01 7:26

Yeah, so ul the ultimate one is that they can't access private care and then they go on the public system if they're eligible. Keep in mind not every kid in the str um in Queensland or states are eligible. So in New South Wales, if you've got a healthcare card, you're eligible. If you don't have a healthcare card, you're not eligible. So either you've got to try to force grind it out in the clinic, which can result in significantly compromised results, or a really distressed child, or you get through one of four visits. Um, or the parents have to take a loan. Um, there's a charity out could just for kids, uh uh um, which is really great, and they'll contribute$1,500 to dental care for pediatric patients, but same thing, they need money, donations. Um and so, yeah, what do they do? Some of them they can't afford it. Um, some of them take loans. Super, I don't see too much. I think most of the parents have lost on their super for all-on-fools already. So they've reduced their uh super. Um so I don't actually see super too much, but um, yeah, they take loans or they don't get the care they need.

SPEAKER_00 8:24

Yeah. We said before when you were talking about the costs of these treatments, you use this amount two and a half for the dental. I've seen treatment plans come as a second opinion through our office where we're talking over ten thousand dollars for pediatric specialist dental care. What are your thoughts on that?

SPEAKER_01 8:41

Um yeah, so I disagree with it. Yeah. Yeah. So obviously it's a private market.

SPEAKER_02 8:48

Yeah.

SPEAKER_01 8:48

And you can charge what you think's right. I think the issue that we've got there is we have a very vulnerable market too where um we're pulling on the heartstrings of parents who generally want to most parents want to set their kids up well for life. And I think um anyone that's proposing a$10,000 pediatric dental, like just the dental alone treatment plan, um how do I put it politely? It's probably a crook, to be honest with you. Um yeah, so I think, you know, if I think we well, in our practice, for example, we've got a capped fee at three and a half thousand dollars. Yeah. That will be if a patient will have extractions, stainless steel crowns, whatever number of poppotomies they need or sealants or whatever, if they don't want anything zirconia or crowns or anything, we don't need anything super fancy, we just cap the fee at three and a half. So if a patient is 20 teeth fixed and eight of the front ones out, and all the back ones, stainless steel cannon, pulps and crowns, whatever, uh it's just three and a half. And I think that's fair because that's going to take, like from an hourly rate perspective, that's still outrageously good income.

SPEAKER_02 9:51

Yeah.

SPEAKER_01 9:51

Um, if Medicare covered, it's probably less than the cost of Medicare, so it would be below the Medicare rebate, but it's still uh we make more than enough money to live a good life off that.

SPEAKER_02 10:01

Yeah.

SPEAKER_01 10:01

I don't you don't I don't think you need to charge three times that amount to provide that care. Now, if a patient says, I want all my backgrounds in zirconia, and I want you I don't want you to extract the front teeth of my four-year-old, I want you to save them for zirconia, well then the cost I think is fair enough to go up. But they've had the option. And this is where I think talking to parents and saying, Look, you know, I know you want to save all the teeth, but what's financially feasible? You've got a two-year weight publicly, like we can save what we can, but you might lose some at the front too.

SPEAKER_00 10:31

Make some compromises.

SPEAKER_01 10:32

Yeah, make some compromises. But listen, I think we can get the mouth back healthy.

SPEAKER_02 10:36

Yeah.

SPEAKER_01 10:37

And it's still a lot of money, three and a half grand, it's still a lot of money for families.

SPEAKER_02 10:40

It is.

SPEAKER_01 10:40

Um, and so you still toss up whether that's too high. Um, but we generally go off the Medicare rate. And so, like, eight stainless to crowns at Medicare is two eighty, you're like, well, look, and then you've got to do more extractions and things, it actually ends up being less than bulk bill price.

SPEAKER_00 10:55

Yeah, wow.

SPEAKER_01 10:56

Yeah.

SPEAKER_00 10:56

I I really like getting you fired up, but um, we might segue into some more basic treatment planning questions for pediatric patients, if that's okay. Um, and I I've obviously been a paying patient of your courses um more than once and really, really enjoy your content. I've learned a lot from you. But what I took away mostly from your um pediatric restorative course was this concept of treatment planning a child is really not comparable to treat treatment planning an adult.

SPEAKER_02 11:28

Yeah.

SPEAKER_00 11:28

I think we all learn in dental school with adults, we think of their mouth as quarters or halves, and we work through it in a way that makes sense for us. What how often we want to have our cup of tea break at work and what hourly rate we're trying to work towards and try and make it as comfortable for us and the patient. But you you use this great term of you don't want to cook the kid if you don't treat and plan it effectively. Can you talk us through your strategies and and philosophies on treatment planning?

SPEAKER_01 11:56

Yeah. Um I think the biggest mistake we make, exactly like you said, is we treat kids like adults, both with the materials we use and the techniques. So, for example, a lot of people do a lot of fillings on kids, not that you can't do a filling, but there's not, you know, baby teeth are different than adult teeth. Yeah. And so they respond differently to restorative care. And the main thing is that a lot of the time on adults, they're making the decision for themselves. So they're bringing themselves to the appointment to say, I have a sore tooth, I need an extraction or whatever. The issue we have with children is the adults bringing them and they have a very finite amount of compliance. So if we're designing a plan, we need to know how much work do we need to achieve and what's the most successful way we can achieve that. So, Jill, you know very well, pretty much every patient I see is referred and they're in pain or they've got a problem, and how many of them do I treat on the first day? Zero.

SPEAKER_02 12:50

None.

SPEAKER_01 12:50

Yeah. I'll treat permanent trauma in the first day and that's it. Why? Because yes, I can get the tooth out, but you've got eight other teeth to fix. And if I break your child in the first one, we have exactly the same problem of compliance. I've got seven more teeth to fix. Where if we planned this out well, we probably could have fixed the other seven teeth.

unknown 13:11

Yeah.

SPEAKER_01 13:11

And maybe got through it successfully.

SPEAKER_00 13:13

Yeah. And I suppose the other thing I really took away that I I don't think we're taught well at dental school is this idea of how much local you can actually give a kid. You know, if you want to do several things in one visit, you just might not be able to because of the local anesthetic um consequences. So do you have a uh cheat sheet for what we can give children that you can share or or hurls of wisdom around local anesthetic?

SPEAKER_01 13:38

Usually I think um you're right. I think the the main issue we get with younger kids uh is the amount of time they can spend in the chair.

SPEAKER_02 13:44

Yeah.

SPEAKER_01 13:44

You know, and I think once we start pushing above 45 minutes, we really start hitting compliance with issues, whether the child's really well behaved or not. Like it's just an attention span problem, right? And therefore, for you to do a quadrant of dentistry is probably going to take you within that 45 to an hour. Um, and also numbing kids up, your biggest risk is um trauma after the event, so biting lips and cheeks and tongues. Uh local anesthetic, you know, roughly it's about 10 to 12 kilos per cartridge. So you've got a 20 kilo kid, you can use two cartridges, but um, you know, there is a limit on that as well. I just tend to find the more I numb a kid up, so top and bottom, or even a cross arch, the increased incidence of post-treatment trauma.

SPEAKER_02 14:28

Yeah.

SPEAKER_01 14:28

Kids treat their masses. Now, and the reason, what's the number one reason kids get upset? It doesn't hurt most of the stuff we do.

SPEAKER_02 14:34

Don't like it.

SPEAKER_01 14:35

It's numb. Yeah, they hate being numb, don't they? So when they leave, they're really upset. So yes, you might have four numb visits instead of two, but geez, they hate being numb.

SPEAKER_00 14:44

Yeah.

SPEAKER_01 14:44

Yeah.

SPEAKER_00 14:45

Do you do you think you're using um RA for most of your restorative cases?

SPEAKER_01 14:52

Pretty much everything, yeah. I usually encourage most parents to use it. I feel like there's that perception that you need to earn nitrous. Like the kid needs to be so anxious that they earn, they get rewarded with nitrous. Uh and I think particularly for young kids, sub-seven, you know, you don't know when these kids are going to break. And that's probably a thing I think for all practitioners we struggle with. We've all had kids, anyone that's worked with kids has had a kid break in the chair. And the problem is you just don't you can't pick them.

SPEAKER_02 15:19

Yeah.

SPEAKER_01 15:20

Sometimes you think this kid's awesome, and then you get them in, you're halfway through something, you know it's not hurting, and the kid crack cracks.

SPEAKER_02 15:27

Yeah.

SPEAKER_01 15:28

You know, so I think starting with nitrous is really helpful. It doesn't mean um therapists who can't do nitrous can't do the treatment. I think it's just working as a team and maybe coming up with a plan that therapists do some part, the dental practitioner does the other, and we use nitrous where we need.

SPEAKER_00 15:48

Right. So when we're using nitrous on adults, I mean, my the way I was taught was to slowly titrate them to their therapeutic dose, but you might not have the benefit with a child of the time. Like, do you what's your strategy around getting them to that therapeutic dose or knowing what it is? Do you just start them all at a at a basic amount for their age that you know is pretty much right?

SPEAKER_01 16:11

Um, I reckon it's a crock of shit. Um starting someone up, you know, five minutes, yeah, five minutes oxygen, then five minutes on 10%, five minutes percent, we're done, you know, so I shouldn't swear. But uh, you know, that's too long, right? It's too long. Um if you go into a hospital environment where they're using nitrous, so maybe like a gas induction for children, they will start on 50-50 nitrous. Yeah, right. Now, the issue that you get with that with adults, if you go up too quick, I don't know if you've ever had like a rapid induction, yeah, you can feel pretty um disorientated. Stressful, yeah. It's the same for kids, you can disorientate them, but don't go three minutes, 10, 3 minutes 10, you're just too long. So I will generally just start the nitrous on uh like 30% nitrous, and I'll just let it the kids rock on that for a bit. I've got my topical line while that's happening. And then as I'm then letting the topical work for about three to four minutes, then I'll sort of toggle up and generally I'll sort of sit at about 50-50 for local. Um, and then once I've got the local in penning the kid and how hard this appointment's gonna be, I'll toggle down.

SPEAKER_00 17:13

Right.

SPEAKER_01 17:13

And then I'll usually sit at about 35.

unknown 17:15

Yeah.

SPEAKER_00 17:16

What what's the best nose piece for a little person? I mean, some of these masks are pretty big. Do you have a a great system that you like?

SPEAKER_01 17:22

No, we just use the um reusable ones, but they're pretty big. They can be big. I will give you a heads up that in that a lot of kids are under the age of five. So under four, I reckon your hit rate or success rate of using nitrous is nearly zero. Right. Now you will get the odd unicorn, but I reckon under four it's pretty close to zero. Four to five, early fours, not much luck. Late fours, so getting close to five, you're getting a little bit more luck, but I still think it might be like, I don't know, one in ten. Just because they're quite small. Like you've you've got kids. Four-year-olds don't really t tolerate too much stuff too well. Um, so your hit rate gets a bit low at that point. Uh, and then when you get into five, you're getting a bit bigger. So hopefully the kids are a bit bigger. But yeah, it can be quite. I think you need to describe things in the way, and this is too long for this, but you know, how we talk about doing nitrous and stuff and describing things to kids can help, but it is can be a bit cumbersome. The worst thing is when you've got like a seven-year-old and you've got to do a root canal in a one-one.

SPEAKER_00 18:22

Yeah.

SPEAKER_01 18:22

And then you've got the nose sitting over the front. That's painful. Yeah.

SPEAKER_00 18:26

Um, so we spoke before when we were speaking about adults versus children, about how sometimes we treat them plan teeth like we would in adults and we're doing fillings. Obviously, I understand what you're getting at to um, you know, directing patients to having stainless steel crowns or zirconia crowns for those larger careous lesions in posterior teeth. How often are you using the haul technique for stainless steel crowns? And can you describe what that is?

SPEAKER_01 18:52

Yeah. So the haul technique is a technique where we put a stainless steel crown on with no drilling, and because we're not drilling, we don't need local.

SPEAKER_02 19:00

Yeah.

SPEAKER_01 19:01

So the reason it works is that you're entombing all the bugs in the tooth. And so the usual analogy I get, it's like getting a water tank gill, putting you in it, filling it full of concrete and putting the lid on top. So you don't live very well. No, unfortunately. That's obviously the bugs, right? Yeah. And so, um, but there's a lot of caveats with it, and probably the most important one is that we don't do any invasive management at all on children without x-rays. And I think that's probably one of the worst things that gets done out there. Worst things, it's not worth the worst thing that gets done. It's probably one of the most poorly taught aspects of dental training for a therapist or dentist, is oh look, there's a hole, we'll just bog it up with some um what I like to call fooji poo. Yeah. Um and so you need an x-ray, and that's your determinant, really, if you can do a whole crown or not. And that is that you can see a band of denteen that's healthy between the hole and the nerve. If you can see that and you can get a crown over it, you can put a whole crown on.

SPEAKER_00 19:58

Yeah. And no pain, right?

SPEAKER_01 20:00

No pain. Success rate is unfortunately only 97% at 10 years. Yeah, yeah. Terrible.

SPEAKER_00 20:06

So so if it works so well, is there uh is there a reason why you would prep a tooth?

SPEAKER_01 20:13

Uh look, the main drawback of it is aesthetics. So for the families. Um so if you've got enough compliance to get separators in or a Fujian, for example, you can generally get a whole crown on. Um, so you don't you there's actually no reason to if the parents are accepting of a silver crown, there's no reason to prepare the tooth. The issue that we have in even in the dental world is it looks big.

unknown 20:37

Yeah.

SPEAKER_01 20:37

Right? So a lot of us think that a filling's more conservative. But we don't even need to drill. So it's actually more conservative than a filling. Yeah. There's no local, there's no drilling. And to be honest with you, a two-surface composite minute, um composite restoration has a um, like in the in a D, has a failure rate approaching 30% at three years. So, you know, we've got to pick our battles well.

SPEAKER_00 21:02

Not ideal. Are you finding that parents are quite accepting of a stainless steel crown if it's explained well enough, or do you still get a lot of pushback?

SPEAKER_01 21:09

Yeah, we get quite a bit of pushback. Yeah.

SPEAKER_00 21:11

And and so is the strategy then to say, right, we'll do a filling because it's compromised treatment, or are you then saying, well, zirconia might be the way to go if it's an aesthetical pro aesthetic problem?

SPEAKER_01 21:21

So I I appreciate that not everyone, even in the pediatric dental world, they're not doing zirconium crown. So the zirconia crown is the same as the stainless crown, but it's white, but it's made of porcelain, so it's pre-formed. Um, for me to put a zirconia crown on is not much harder than doing a filling. Um but I appreciate a lot of people don't have the training for that. So E's I'm quite comfortable to put fillings in because um there's plenty of enable on the tooth. D's I'm very reluctant to play place restorations in. Unfortunately, the D is more visible than the E. Yeah. Yeah, so it's tricky, but for us, like well, I'm very comfortable. I think if you're in the general dental world and you see that a tooth's got a big hole in it. In it, like halfway to the pulp, realistically on a D, that is a whore crown, or it's a zirconia. And then sometimes some people say, Oh, well, look, I'll put a filling in there and I'll explain to the parent that it's got a high chance of failure. I just wonder, are we explaining to the parent that the chance of failure in that tooth is probably approaching 50%? And if it fails, I'm gonna have to extract.

SPEAKER_00 22:21

Yeah, it's not that the filling fails, it's that the tooth now essentially has failed. Yeah, yeah.

SPEAKER_01 22:25

It's not the technical, like it's not the dental practitioner doing a bad filling. The tooth can't support it.

SPEAKER_00 22:32

Yeah.

SPEAKER_01 22:32

Yeah.

SPEAKER_00 22:33

Yeah. Um, and so you bring up a really good point that so much of what you're doing is is is convincing the third party, being the parent, which is probably the hardest person in the room for you guys, um, to accept the treatment that you're proposing to do on their little darling. Um and and I suppose a lot of the difficulty that you're facing is that tooth decay is a preventable disease. We know what causes it, we know what we can do to prevent it. Um, if you're seeing a patient, a pediatric patient who has a lot of dental caries, you you can discuss the treatment you've got to do, but you also have to discuss with the parents what's caused it and and try and elicit some kind of emotional response to get them to change their behaviours. Because realistically, I think the answer we all get is, oh, they don't like having their teeth cleaned as much. We all know what children are like, but the diet is a huge part of this problem. Do you feel like you have success with those conversations and people take responsibility and change after they've had a big round of treatment? Or do you think you're just having round of treatment number one and knowing that there's going to be more down the track because people don't change?

SPEAKER_01 23:43

I I'd like to believe that we are able to affect behaviour change. And I think that comes down to how we discuss it. So anything we do restorative, if we don't change the environment, it's likely to fail. A crown is forgiving because it will go over the whole tooth. So you can get away with poor old hygiene with a crown over because it's pretty indestructible. But a filling, same for a child or an adult, if we don't change the environment, it's not the composite that's failing. Yeah, it's the tooth around it. So I think helping um parents understand what behaviour changes they need to do will help your work last longer. Now, you're right, at the end of the day, you can't get decay without sugar. And poor olive hygiene, you know, will contribute to that as well. Unfortunately, they're the only two factors we can control. We can't control genetics and saliva and biofilms and everything else, which we know goes into it. But I the approach that I generally try to take now is try to make parents not feel so much guilty for what's occurred and not make them feel they do feel responsible no matter what I say, but a parenting is a hard gig.

SPEAKER_02 24:48

Yeah.

SPEAKER_01 24:48

You know, and uh and this sounds a bit crude, but I remember my boss when I started PEDs was like, mate, some people like, if you've got the option between, you know, the brains on the wall of the child or the adult, or the kid going to sleep with a bottle of milk, and the parents getting a night's sleep, you know, we've got to pick one there, right? So I think just helping to make parents realize that, look, what's happened's happen. And I try to gently try and take the fault off the parents, but still get them to change behaviour and say, hey, look, I don't know why. Like I see 15-year-old non-verbal autistic kids who drink nothing but soft drink and don't brush their teeth. Like I can't examine them.

SPEAKER_02 25:24

Yeah.

SPEAKER_01 25:24

And I put them to sleep and they've got no holes. And your child, unfortunately, has a lot of holes. So clearly they're high risk. And maybe there's some genetic factors there. What we need to appreciate is they are high risk. So therefore, the unfortunately the only two things we can change are diet and cleaning. And our job is not to tell you what to change. We're here to be part of a team to try to reduce the risk factors for your child. Can I give you some information about what I think would be some helpful strategies?

SPEAKER_00 25:51

It's a really classy way to approach it. I like that. Thank you for sharing. Um, and the other element there, um, which is wrapped up with C oral hygiene, is fluoride. I know in your program you talk about the guidelines that we use for fluoride dosing in children and why you find that to be problematic. Can you um go into that a little bit?

SPEAKER_01 26:10

Yeah. Um probably can't swear on this, Kim I.

SPEAKER_00 26:15

It's too late for that to be.

SPEAKER_01 26:16

Yeah. I think um our uh fluoride guidelines, if I put it delicately, are fucking stupid. Yeah. Yeah, they're the only ones in the world written that way. I just found out that they um did a wonderful research project in UQ where they went and did like an assessment of the oral health status of queens and children. And um there was they told the people to look out for fluorosis, decay, and not hypome. Okay. So hypermineralization is a developmental condition that affects one in five kids. How frequent is fluorosis? I actually think it doesn't really exist. And I think most of it was misclassified hypome, which is a genetic condition we can't change. Because to have fluorosis, true fluorosis, there needs to be a chronological line across the teeth. And most of the spots we see are here, there, and everywhere, aren't they?

SPEAKER_02 27:07

Yeah.

SPEAKER_01 27:07

So even in 2024, the assessors who went out to look at the oral health status of children were not trained on identifying a condition that affects one in six children. And then they misclassify it as fluorosis, which means we then create guidelines that do not match the rest of the world and provide a toothpaste recommendation for children, which means it doesn't work till they're six. You know, and for the first 18 months of life, our guidelines say don't use a fluoride toothpaste. And every other nation in the world says use a six plus in Australia. Yeah. Why? Because our researchers are saying diagnosing there's fluorosis when it's not.

SPEAKER_02 27:53

Yeah.

SPEAKER_01 27:54

So we're the only country, well, there's other countries that've got fluoride in the water, but uh, we're the only ones in the world that have weak toothpaste.

SPEAKER_00 28:00

So, so d is your advice to use six plus toothpaste from the time that they have eruption of their teeth and you dose it?

SPEAKER_01 28:07

Yes.

SPEAKER_00 28:08

Yeah.

SPEAKER_01 28:08

Absolutely. Thousand parts per million. Anything less than that's not effective.

SPEAKER_00 28:11

Yeah.

SPEAKER_01 28:12

So I think with our guidelines, they are really useful as kindling.

SPEAKER_00 28:17

Well, look, I'm really pleased that I've got Tim fired up. I knew I was going to get there. Um, but we've got a lot more questions to ask. So we're going to finish up here and please join us for part two with Dr. Tim Keys.