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by Lorin Berland, DDS
Patients just don't look forward to a trip to the dentist. No wonder; if they have a cavity that already hurts, in the dental chair they can look forward to the pokes of the explorer and the vibrations of the dental drill. No fun. When patients learn that your practice uses technology that makes procedures quicker and less painful, they will gladly return for their next appointment, and probably refer their friends as well.
Traditionally, cavities are a pain — in the mouth and in the dentist's chair. Checking for incipient caries or decay in a tooth groove with an explorer is subjective. Explorers vary in sharpness, and the microscopic nature of caries allows decay to invisibly mushroom underneath the enamel. An explorer at best offers a subjective diagnosis. DIAGNOdent®, a device that uses wavelength light to detect caries, standardizes treatment, leaving no surprises for me or the patient. It painlessly reads the density of the tooth underneath the enamel and registers the presence of caries on a scale of 0 to 99. Typically, a reading of 30 or above indicates the need for restoration. Anything lower can be rechecked at subsequent appointments or treated preventively.
Compare getting stuck in a tooth with an explorer to holding a handpiece over the tooth and clicking a couple of times to get a reading. Patients are very impressed with that technology, especially when we learn that treatment is not necessary. It both quantifies and qualifies the cavities. As a result, pain management becomes more specific. With increased awareness of a cavity's depth, I can choose whether I need a stronger or longer-acting anesthetic, or a different type like intraosseous, infiltration, a block, or a PDL. And patients appreciate that!
To quickly detect interproximal lesions, digital X-ray is clearly the best choice. My DEXIS® sensor, shaped like a "bite-size" piece of chocolate, is by far the most comfortable, thanks to the smooth, rounded edges. It's also quicker because digital radiography eliminates time wasted waiting for film to develop.
My KaVo TLC electric handpieces increase patient comfort by cutting down on "chatter" and vibration, which patients find very annoying. Electric handpieces also give better torque, and they don't cut and drag. With the electric handpiece, I spend less time drilling, and get better preparations and better margins.
When I want to clean up incipient lesions, I reduce pain and vibration by using a tiny diamond with my electric handpiece to open up the enamel. I then use the RONDOflex® air abrasion microetching device to remove decay without a drill. Just as important, the RONDOflex also increases bond strength by increasing the surface area. Patients really respond to these forms of technology.
Recently, a high school senior who had not seen a dentist in two years came to my office for a second opinion after another dentist found eight cavities. In one quadrant, she had three teeth that registered below 20, one at 27, and one tooth at 73 with DIAGNOdent. While most of the teeth were not so bad, she did have one big cavity. We filled the cavity and also cleaned up the tooth that was just below 30 with a flowable composite. We'll keep an eye on the questionable ones. During the process, she felt involved in her own treatment. And since it was quick and virtually pain-free, she now wants us to treat the other teeth. We gained her trust by reducing pain and by quantifying — not just qualifying — her teeth.
Dr. Lorin Berland is an internationally acclaimed cosmetic dentist and one of the most published authorities in the professional dental and general media. Dr. Berland, a Fellow of the American Academy of Cosmetic Dentistry, is the co-creator of the Lorin Library Smile Style Guide, www.denturewearers.com, and is the founder of Arts District Dentistry, a multidoctor specialty practice in Dallas that pioneered the concept of spa dentistry.
