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The three-letter army

May 1, 2010
Is it important to be a pain-free dental office? Is it even possible to be completely pain-free?

For more on this topic, go to and search using the following key words: pain-free, Dental Button, three-letter army, trust, topical, rinse, Dr. Michael DiTolla.

Is it important to be a pain-free dental office? Is it even possible to be completely pain-free? Perhaps the important part is letting the patient know that you and your staff will do everything in your power to make the visit pain-free.

Many patients appreciate being told that pain might be involved. Far too many patients have been lied to in the past. They have been told “this won’t hurt a bit,” only to get slammed with a 25-gauge extra-long needle for a lower block. I have heard dentists tell patients “just a little more” when the patients are feeling pain during tooth preparation.

In fact, there is a product called the Dental Button that is actually a kill switch that a patient holds. The button allows patients to stop the handpiece if they feel pain.

It would seem that our reputation precedes us. Has it really come to the point that we need to give patients a button to stop the handpiece or otherwise we would not do it ourselves?

One of the dentists on the Dental Button Web site says his biggest fear is that patients would be pressing it all the time. Why would patients do this, other than for insufficient local anesthesia?

What happened to dentists telling patients, “If you feel anything painful, raise your hand, and we will stop on a dime”?

Typically, I would then prep for about five to 10 seconds, stop, and ask a patient if he or she felt anything. Most patients said “no.” So I told them it should not get any worse, but to raise a hand if they felt anything.

Patients just want to know that you will stop if they feel something. Prove to them that you will by stopping once, for eight seconds, at the beginning of the procedure to check how they are doing.

Our pain-free philosophy is powered by what we call the “three-letter army” (see Fig. 1). I am referring to PFG gel, DYC rinse, and the STA anesthesia machine.

The PFG gel is the uber-topical we use on attached gingiva, such as palatal tissue for packing cord on the lingual, or a palatal injection for an extraction.

The PFG lite is for use on mucosa as a preinjection topical so the patient simply cannot feel the needle penetrating tissue.

The DYC rinse is a topical used by my hygienist to alleviate painful prophies. We also use the rinse prior to impressions on patients who might be concerned about gagging.

The STA unit is used to get pulpal anesthesia on lower molars without giving a block, and on upper teeth to prevent numbing of the patient’s face.

The PFG and PFG lite gels, and DYC rinse are available through a compounding pharmacy, Steven’s Pharmacy. To contact the pharmacy, visit, or call (800) 352-DRUG. The STA unit is available through Milestone Scientific. Visit, or call (800) 862-1125 for more information.

I talk to dentists who tell me they just had a root canal and a crown done and it wasn’t bad at all. I understand this. But it is much easier to relax during a procedure you have seen performed a thousand times, and with a well-trusted specialist you know personally treating you.

But for someone who is not a health professional and has no idea what happens during a root canal, the patient’s experience can be terrifying.

Show your patients you care by acknowledging the potential for pain, showing them the products and techniques you have to prevent pain, and encouraging a feedback system that will stop a procedure if it does not go as planned. Then stop once early in the procedure to check with patients. Earn their trust for the control of pain and watch your practice grow.

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

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