Doctor, my eyes!

Sept. 1, 2001
As a general practitioner who has gone over the half-century mark (ouch), I have often wondered why many of my colleagues use magnification and headlights.

by Paul Feuerstein, DMD

As a general practitioner who has gone over the half-century mark (ouch), I have often wondered why many of my colleagues use magnification and headlights. Although I wear glasses, I feel that my vision is quite good, as is my treatment. I agreed with my colleagues who state, "I don't want to get dependent on them," and "who needs to see all of that detail?"

In April, I suffered a pinched nerve in my shoulder; my right hand was severely affected. After seeing several specialists, it was determined that the problem would eventually go away; however, one of the underlying causes was the fact that I was a typical tall dentist, practicing with horrible posture. I'm a veritable leaning tower of Pisa, with resulting lower back problems, and now another issue (couldn't be my age, could it?).

I remembered reading an article by Dr. B.J. Chang, CEO of Surgitel Corp., where he stated that operating magnifiers could help with posture. Now I had an excuse to try them out! I spoke with him and ordered a headlight and 2.5 loupes with great trepidation. (Many fine companies make these for the profession; I hope to report soon on several models.)

After only a couple of days, I found myself forced to sit more upright to see with the new magnification. The focal length was set at arm's length. Dr. Chang notes that some practitioners still feel the need to move in closer and have the focal length altered, thus partially defeating the purpose. While playing with my posture, I decided to try a few procedures. I looked at some crown margins and decided to try to pack cord. With the combination of the brightly-lit field and the giant sulcus, it seemed very easy. I also saw a little dip in a 90-degree margin and corrected it. My fear of looking up and blinding my assistant was unfounded due to the angle of the light. Of course, my patients are suffering as I get used to the movements.

As I marvel at the little stains and bits of decay that I may have been missing, I realize that magnification is a natural extension of the high- tech products I've been using. All along I've been teaching the advantages of showing giant images of broken molars with intraoral and digital cameras, using huge radiographs on the computer screen to help with diagnosis and patient education. It never occurred to me to add this dimension directly to my actual procedures.

This system has several configurations among the different manufacturers. Some use a headband for both the light and binoculars, while others attach directly to the eyeglasses. The lights also vary, from a bulb in the headlamp itself to a fiber-optic bundle connected to an external light source. You can also have a battery pack and move from room to room without connecting or disconnecting to a light box. One system, High Q, ( included a head-mounted video camera to allow others to see the procedure at magnification.

The next step up seems to be an operating microscope. I witnessed a presentation of Dr. Glenn Van As at the Esthetic Professional Educational Center (Bruce Crispin's wonderful facility near Los Angeles). He clearly showed how a GP could use the microscope for both procedures and diagnosis. He showed the difference between a 4x and a 24x view. Pretty remarkable! Perhaps you don't want to see your crown margins with this power, which is sharper than an explorer. This of course is even better for posture; it also seems to provide a wider field of vision. I have also observed endodontics through the scopes — you can actually see if you left any tissue in the canals.

As a novice user, I can only say that lighting and magnification will be an essential part of my general practice from now on. I am also less dependent on the chair light and the fiber optics on the handpieces. Plus, my assistant's head does not block the light. I have put my dental lab on notice, although he assures me that he uses magnification, too. We'll see about that.

I hope to look at many different models and configurations at the ADA meeting, Greater New York, and Yankee Dental Congress and report back here with a review. If you use this technology and have comments or suggestions, please drop me an email at the address below. I'll be glad to report on those comments.

Dr. Paul Feuerstein installed one of dentistry's first computers when he placed a system in his office in 1978, and he has been fascinated by the technology ever since. For more than 20 years, he has taught courses on technology throughout the country. He is a mainstay at technology sessions in New England, including annual appearances at the Yankee Dental Congress, and has been a part of the ADA's Technology Day since its inception. A general practitioner in North Billerica, Mass., since 1973, Dr. Feuerstein maintains a Web site ( and can be reached by email at [email protected].