The pursuit of comfort dentistry

Sept. 1, 2007
Recently, my staff and I have been dedicated to a new mission: comfort dentistry.

by Michael DiTolla, DDS, FAGD

Recently, my staff and I have been dedicated to a new mission: comfort dentistry.

The goal is to make every clinical procedure as comfortable as possible. I have heard speakers talk about creating dental spas where people go to get manicures or pedicures. But this is not what I am talking about. I get manicures for a reason. When the camera takes a closeup of my hands during extraoral video shoots, I think it looks disgusting if my fingers are torn up.

But I do not want to get a manicure when I am at the dental office any more than I want to get a manicure when I am at Jiffy Lube. In my estimation, these two items just do not go together. It’s like that one-hour photo/frozen yogurt/karate studio many of us have in our hometowns. The perception is that they do three things, none of them well.

I know offices that serve espresso or fruit juice in the reception area. But when I go to a doctor’s appointment, these “perks” are the furthest thing from my mind. I realize that I am always just a little nervous prior to these appointments; it never occurs to me to take the edge off with a double espresso. Patients seem to frequent the restroom enough from the epinephrine we administer them, let alone if we caffeinate them in the reception area beforehand.

When it comes right down to it, the reason I am nervous when I go to doctor appointments is because of the potential for pain. I never forget that when I am working on a patient. In fact, I often will tell a patient that I also get nervous when I go to the doctor’s office. I tell patients they are lucky to have a dentist who is a “wimp” because I am going to treat them the way that I would want to be treated. A tough dentist assumes that patients can take a little pain or more. But a wimp like me is into the pursuit of the painless procedure.

The comfort dentistry I try to provide, therefore, is limited to the operatory. For me that’s where it matters the most, regardless of the chair in which I am sitting. My staff also is tuned into this. So we listen carefully to comments patients make, and we ask questions. For example, we notice many people do not like having X-rays taken because they feel they are going to gag. The same is true about impressions for study models for which some people have memories of gagging as youths. Many patients will say they fear gagging as much as pain, and even would prefer to feel the pinch of an injection rather than face gagging.

For many patients, these uncomfortable moments are the ones we tend to overlook while we concentrate on making the injection more painless (which is a worthy goal I pursue as well). But to ignore these potential gagging episodes is to miss a golden opportunity to show patients that you really are a “comfort” dentist.

The secret to preventing gagging is a solution we use called Cyclone DS, which is a 1.0 percent dyclonine preparation available from Steven’s Pharmacy in California. You can visit the pharmacy’s Web site at or contact Steven’s at (800) 352-DRUG. The patient swishes with a mouthful of Cyclone DS for 45 to 60 seconds, causing the soft tissue it touches to become anesthetized. I tell patients they will not gag if we use this solution, and so far, I have been 100 percent correct.

Perhaps there is a psychological component to telling a patient he or she won’t gag. Still, we achieve our common goal: no gagging. Cyclone DS is available in lemon or mint flavor. We originally ordered a bottle of each flavor and did some taste testing. This is a great way to offer someone anesthesia who does not need or want local anesthesia but has the potential to experience pain or gagging.

The hygienists at my practice use the solution for periodontal probing for patients with inflammation, as well as gross debridement patients who are sensitive. We see many patients who are overdue for hygiene but do not need scaling and root planing. Since we typically only use local anesthetic for our root planing patients, Cyclone helps fill the gap by being an easy-to-use topical that also provides peace of mind for patients.

Dr. Michael DiTolla is the Director of Clinical Research and Education at Glidewell Laboratories in Newport Beach, Calif. He lectures nationwide on both restorative and cosmetic dentistry. Dr. DiTolla has several free clinical programs available online or on DVD at For more information on this article or his seminars, please contact him at

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