Dr. Gregory Psaltis

Olympia, WA   

Phone and FAX:   (360)  413-5760





I Was on the Internet Last Night

Behavior Management in a Pediatric Dental Setting



  I.  Opening remarks

      A. Topics will be controversial

      B. My goal is NOT to convince anyone of a given topic

      C. The first goal is to provide a broader picture of the internet’s impact

      D. The second goal is give suggestions on how to deal with patients’ input


II. Why the Internet “problem” has become so common

A.   It is where everyone goes for information now

B.    The number of searches has increased exponentially

C.    There are blogs/opinion pieces/factual sites to satisfy every situation 

D.   These sites will also cater to your own beliefs

E.    A couple of controversies

1.     Autism

2.     Flossing


III  Why Science is challenged today

A.   Charles Taber, PhD

1.     People seek out information that is motivated by their own reasoning

2.     We are all fundamentally biased and tend to perpetuate our own beliefs

B.    Brendan Nyhan, PhD

1.     Trying to correct a misperception can backfire

2.     Your belief grows stronger when you encounter facts that don’t support it

      C. Factors that effect your own beliefs

            1. Social media

            2. The press has become partisan

                 a. The station do you watch/listen to will influence you

                 b. Your beliefs will usually be supported by your choice

            3. Gabriel Sherman: The Loudest Voice in the Room

                 a. News is no longer a means of information about the world

                 b. We now tend to gather information that advances our own beliefs

                 e. Every single action in a practice is creating managed behavior

            4. National Geographic, March, 2015

                 a. We live in an age when all manner of scientific knowledge faces opposition    

                 b. Doubters have declared war on the consensus of experts

            5. Andrew Shtulman, Occidental College

                 a. As we become scientifically literate, we repress our naïve beliefs

                 b. In spite of that, we never eliminate these beliefs entirely

                 c. Even scientists are vulnerable to confirmation bias

               d. Science appeals to the rational brain

                e. Our beliefs are largely motivated by emotion

            6. Neil deGrasse Tyson, PhD

                 “I fear we have lost the ability to judge what is true and what is not.”

            7. However, surveys show that more people trust scientists than:

                 a. Congress           

                 b. Executive branch of the government

                 c. The press

                 d. People who run major companies

                 e. Banks and financial institutions

                 f. The Supreme Court

                 g. Organized religion

            8. Daniel Kahan, Yale University Law Professor

                 a. Issues like climate change isn’t about what you know

                 b. The issue is about who you are

                 c. It is not about knowledge, but curiosity that makes us accepting of science

            9. Christopher Graves, President, Ogilvey Center for Behaviorial Sciences

                 a. People cannot grasp something as fact if it undermines their identity

                 b. More access to information doesn’t tug us toward the center, but makes us more         


          10. Marcia McNutt, PhD, Director of National Academy of Sciences

                 a. Science is about the unbiased search for the truth

                 b. Scientists test intuitions to see if they are right


IV. Some of the current controversies

      A. Humans are causing global warming

            1. NASA’s Goddard institute’s data about temperature increase over time 

            2. Union of Concerned Scientists, August, 2017 website (

                 a. Human influence on the climate is clear

                 b. Greenhouse gas emissions are ghe highest in history

                 c. Observed changes since the 1950’s are unprecedented over decades

            3. Environmental Research Letters, Vol 8, No. 2, May 15, 2013

                 a. Multiple studies in peer-reviewed scientific journals show 97% or more agree

                 b. Climate warming trends are likely due to human activity

                 c. Most leading scientific organizations worldwide have issued statements that 

                     endorse this position

            4. National Review article, May 22, 2015 (author: Rupert Darwall)

                 a. Isolated phenomena is a substitute for the real thing

                 b. The 18 year failure of average global temperature to rise is a problem

                 c.  Global warming warming is preeminently a political project

                 d. The role of experts is to provide scientific consensus to support the alarm

      B. Breast feeding causes Early Childhood Caries (ECC)

            1. The empirical viewpoint

                 a. Very young children have caries (perhaps even ECC)

                 b. The child’s mother reports the child “only breast feeds”

                 c. We decide breast feeding caused the caries

            2. The scientific view

                 a. No evidence establishes this link

                 b. Too many variables blur the results

                 c. Mother’s milk has multiple benefits

            3. The AAPD (American Academy of Pediatric Dentistry) position

                 a. Frequent night-time bottle-feeding with milk and ad libitum breast feeding are 

                     associated with, but not consistently implicated in ECC

                 b. Breast feeding in combination with carbohydrates in vitro in highly cariogenic

            4. The ADA (American Dental Association) position          

                 “Unrestricted, at-will nocturnal breast feeding after eruption of the child’s first 

                 tooth can lead to increased risk of caries” (from the ADA website)

       C. Mercury in dental fillings is harmful

             1. The FDA (Food and Drug Administration) position (from its website)

                 a. Dental amalgam is strong and long-lasting

                 b. It is less likely to break than other fillings

                 c. It is the least expensive type of filling

                 d. Based on evidence, FDA considers it safe for adults and children over 6

                 e. Evidence has found no link between dental amalgam and health issues

            2. The ADA position (from its website)

                 a. Dental amalgam is durable and affordable

                 b. There is no justification for discontinuing it

                 c. The DFE World Dental Federation and the World Health Organization 

                     concluded in 1997 that “no controlled studies have demonstrated adverse effects

            3. From (website)

                 a. Amalgam is called “silver fillings” to deceive consumers

                 b. Amalgam is unstable after it is implanted into human teeth

                 c. Amalgam releases mercury vapor into your body, which bioaccumulates

                 d. Dental mercury endangers our health

            4. Doctor Oz (from

                 a. Scandinavian countries banned amalgam fillings in 2008

                 b. Swedish studies showed 78% of patients with chronic fatigue syndrome reported 

                     improved health after removal of amalgam fillings

                 c. Studies correlate number of dental fillings to incidence of cancer mental 

                     conditions, thyroid conditions, neurological conditions and others

            5. International Academy of Oral Medicine and Toxicology (IAMT)

      D. Fluoride is dangerous to your health

            1. The AAPD position (from the AAPD Reference Manual, Page 45)

                 a. It affirms the safe and effectiveness in reducing the risk of caries

                 b. It encourages public health officials and health care providers to optimize 

                     fluoride exposure

            2. The ADA position (from

                 a. More than 70 years of research has shown fluoride to be safe

                 b. The CDC named community water fluoridation one of the 10 great public health 

                      achievements of the 20th century

            3. The IAMT position (from the website)

                 Policies should reduce and work toward eliminating avoidable sources of fluoride


 V. Some discrepancies in the data

      A. Excess salt can lead to increased blood pressure

            1. Lawrence Appel, MD, Professor of medicine at Johns Hopkins University

                 a. The food supply is loaded with salt, which we know raises blood pressure

                 b. Almost everyone should cut back

            2. Suzanee Oparil, MD, Professor of medicine at Univ. of Alabama

                 a. Spokesperson for the American Heart Association

                b. There is zero evidence that reducing salt is beneficial

            3. L. Gabriel Navar, PhD, Chairman, Dept. of Physiology, Tulane University

                 a. The factor here is not how much salt one consumes

                b. The factor is whether your body can process the sodium it contains

      B. Which sealant technique/material is the best?

            1. JADA, Feb 2012, pp. 115-122

                 a. Compared resin-based and glass ionomer sealants

                 b. 24 month followup indicated glass ionomers may be a better choice

            2. Pediatric Dentisty, Jan-Feb 2012, pp. 46-50

                 a. Compared resin-based and glass ionomer sealants

                b. 24 month study indicated resin-based sealants were better retained    

      C. Formocresol is genotoxic


VI. Four possible scenarios

      A. Parent wants no x-rays

      B. Parent wants only “tooth-colored” crowns—not silver (stainless steel)

      C. Parent wants no crowns at all—only fillings for large lesions

      D. Parent wants no fluoride for the child


VII. How I view these four scenarios


     A. Parent wanting no x-rays is a ________________________ issue


     B. Parent wanting tooth colored crowns is a _______________________ issue


     C. Parent wanting no crowns is a ________________________ issue


     D Parent wanting no fluoride is a ________________________ issue


VIII. Other techniques for dealing with issues

     A. Listen first, talk later

     B. Do not get into a scientific/emotional “fly-by”

     C. Ask, “is there more?” until parent/patient has said everything

            1.Each time the “heat” will be reduced

            2. Parent/patient will definitely feel “heard”

     D. Do not try to convince them of an opposing opinion

     E. Determine if the issue is ethical, preference, outcome or non-essential

     F. State your truth and be ready to send the patient elsewhere







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