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Nov. 1, 2007
Comfort for your patients is more achievable now than ever with today’s materials, equipment, and techniques.
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Comfort for your patients is more achievable now than ever with today’s materials, equipment, and techniques.

by Josh Bernstein, DDS

At a recent dental meeting, a famous panel of dentists and consultants fielded questions about how to improve our practices. Leadership, teamwork, vision, communication, strategic planning, focus, and many other great buzzword ideas were discussed. When the dust settled after the discussion, I realized we are completely out of touch with our patients!

As we evolve and behave like business owners, we sometimes forget that our patients are still thinking the same old thing - they “hate the dentist!” While we are excited about various occlusion philosophies, new materials, and high technology, patients are still “afraid of the shot!” While we are tinkering around refining the perfect crown margin, patients “hate the sound of the drill!” While we are concerned about diagnosis and treatment, patients are worried about gagging, drowning, smelly tooth dust, pain, “germs,” scary noises, sharp X-ray films, scolding hygienists, sweaty palms, dentists with halitosis, and getting the heck out of the chair! Dentists want to work on more teeth, but patients just want to be comfortable. Dentists deserve a lot of credit for inventing local anesthetics, high-speed handpieces, and so many great techniques, materials, and equipment. But our reputation runs deep in the minds of the public. Movies, TV, jokes, and popular culture depict dentists as sadistic, painful, and altogether dreadful - “As bad as a root canal” and “Like pulling teeth” are obvious similes. Every day, new patients come into our offices and say, “Nothing personal, doctor, but I hate the dentist.”

We should be taking this personally - and seriously. Fifty percent of the public does not see a dentist even if they have dental insurance. It is up to us as a profession to work hard to earn a better reputation. All of us should be learning and doing everything we can to make a dental visit completely comfortable so patients will get the care they need. We now know that this is not just about saving teeth. All the latest research shows that dental health reflects conditions throughout the body, so it is really a matter of public health.

Complacency would be easy. After all, most of us think we are doing a pretty good job in the comfort area; and it would be so hard to change our reputation when we could just keep laughing about it in good-hearted, self-deprecating humor. However, we could learn from the Japanese in this area. After World War II, the words “Made in Japan” were branded to mean poor quality. Today, the Japanese have turned quality into a science and everyone knows that Japanese products set the standard for reliability. Dentists can similarly change their reputations - by proving ourselves anew.

Ever been on the receiving end?

As a patient, I have seen many dentists in my life; all of them conscientious and some of them famous. I am certain they all thought they were comfortable and painless, but only two of them really were. Some of the experiences were downright unpleasant. I’ve had blocks that hurt like a tetanus shot. I’ve been gagged by impressions. I’ve had anesthetic wear off and then been “reassured” that “we’re almost done.” I’ve weathered a two-hour crown prep. I’ve had a root canal without being completely numb. I’ve had repairs done with no anesthetic at all. I’ve had my tongue nicked, my lips bruised, and my throat jabbed! The interesting thing is that I am not a dental phobic and I don’t “hate the dentist.” I just want to have the pleasant, comfortable experience that I know is possible - after all, I have experienced comfortable dentistry in the past. My wife, Allison, wisely says that it doesn’t matter how great the dentistry is if we hurt the patients because the pain is the only thing they will remember. She’s absolutely right.

Each of us owes it to our patients to do everything we can to make each visit completely comfortable. If a patient is genuinely phobic, or simply prefers to be sedated, we should be trained in oral conscious sedation. But for the majority of procedures, we should carefully begin to earn the reputation of being genuinely painless and comfortable. There is so much we can do. It starts with genuine compassion and concern for our patients’ comfort. We can also be on time, which demonstrates respect for our patients’ time. We can use a great topical and allow enough time to let it work. We can revisit our “painless” injection technique and start doing it every time with The Wand. We can be gentle in our manner. We can be comforting in our communication. We can provide our patients with pillows, blankets, and video glasses. We can teach our team to be friendly in interactions, comfortable in assisting, and gentle in hygiene techniques. We can buy equipment and materials that make the experience comfortable. Microultrasonics and lasers reduce the need for scaling and for perio surgery that patients despise. Digital X-rays sensors are now rounded for comfort. New implant techniques eliminate flap surgery. Rubber dams and Isolites provide comfort and relaxation while reducing gagging and drowning. Intraosseous anesthetic guarantees profound numbness in difficult situations. Rotary endo techniques are quick and painless. New bonding protocols reduce sensitivity, as do the latest whitening products. Proper medication eliminates postop pain. The list is nearly endless.

Comfort is the new frontier in dentistry

As dentists, we think we have overcome this hurdle, but we have not. Luckily, there are materials, equipment, and techniques to make our patients completely comfortable. All we have to do is make a commitment to improve, invest appropriately in our practices, and avail ourselves of the education to provide our patients with consistently comfortable experiences. It’s time for us to surprise our patients with comfort. Imagine how fabulous it would be if dentistry was universally known as the most comfortable area of health care. It can be. The reputation of our profession depends on each of us - every day.

To help you get started, here are some essentials:

• Topical anesthetic: EMLA (AstraZeneca) before injections.
• Noninjectable local anesthetic: Oraqix (Dentsply) for localized scaling.
• Injectable local anesthetics: Use a little Citanest plain (Dentsply) first, then Septocaine (Septodont) for local infiltration. For blocks, use Citanest plain at the injection site, then use Carbocaine (Kodak/Cook-Waite) and lidocaine.
• Syringe: Don’t use one except for intraosseous injections! Get The Wand ( for every operatory. In fact, get a spare. A slow injection is a comfortable injection.
• Intraosseous anesthesia: When you can’t get them numb, use the X-Tip (, invented by Dr. Kit Weathers. (The name stands for Total Instant Profound anesthesia - and they’re not kidding.)
• Video glasses: The i-Vue ( enables patients to laugh while you work - if you show them the right DVDs. Office favorites are Jerry Seinfeld Live on Broadway, Robin Williams Live on Broadway, Kings and Queens of Comedy, and Blue Collar Comedy Tour.
• Hygiene: Eighty percent of your hygiene procedures should be done with microultrasonic scalers. We use a Pro-Dentec piezo scaler ( with warm water and a cap full of mouthwash such as Tooth and Gum Tonic by The Dental Herb Company ( For laser perio, get a diode laser by Hoya ConBio (, or get the new cordless diode laser by Ivoclar Vivadent ( Biolase Technologies even has a laser that eliminates your high-speed handpiece for caries removal ( Patients don’t like “the scraper” or “gum surgery.” Speaking of lasers, throw out that painful, time-consuming retraction cord and use your diode laser to trough, when necessary, around your preps. Better yet, keep your preps supragingival when possible.
• X-rays: Digital X-rays are superior to film in so many ways and, they cost less. Look at products by Dexis ( and Schick ( Patients appreciate the comfortable sensors and low radiation exposure.
• Implants: New implant systems by Zimmer, Dentsply, and Nobel Biocare allow for flapless implant surgery when used with implant-planning software by coDiagnostiX ( Patients are three-dimensional beings - make sure you see the third dimension by using an iCAT image. Flapless implant surgery means your patients will have a comfortable recovery without sutures.

  • Rotary Endo: If you do endo, you can do it faster with rotary instruments. Call Endo Solutions and get their Endo Magic kit. All patients want their root canals completed quickly and comfortably. Go to
    • Isolite: Rubber dams are great and should be used for bonding, but get yourself an Isolite for prepping. It is a single unit that is a bite block, retractor, light, and suction device. Go to

    • Bonding: Technique is everything when bonding, so get the training you need. Then look at bonding agents, luting cements, and composites by Ivoclar Vivadent, Kerr, Dentsply, Discus, 3M ESPE, Clearfill, and Parkell.
    • Burs: A fresh diamond bur is more comfortable on your patients and shortens the procedure. Take a critical look at your burs through your patients’ eyes, then see what Axis (, Brasseler (, SS White (, and Komet ( are offering these days. Get some nice, clean, new bur blocks, too.
    • Orthodontics: Braces are uncomfortable, they are ugly, they cut lips, they’re difficult to clean, and some people are allergic to the metal. In many cases, wire-and-bracket braces are necessary, but when they are not, InvisAlign is a great option (
    • Sedation: If you want to offer sedation, the Dental Organization for Conscious Sedation, (www.sedation, can give you the training you need to offer this outstanding service. You have more phobic patients in your practice than you think. Sedation allows them - and you - to relax through the procedures.

    • Whitening: Sensitivity from whitening is a common problem. It can be overcome with proper technique and materials. Discus Dental (, Ultradent (, and Rembrandt ( offer excellent products to comfortably whiten your patients’ teeth. To get your patients’ teeth their absolute whitest and do it comfortably, learn the “Deep Bleaching” technique by Dr. Rod Kurthy at
    • To really reduce your patients’ anxiety (and yours!), offer comfortable payment options. CareCredit ( and Capital One ( have excellent options with no down payment, no interest, and low interest.

    This is only an abbreviated list. If you are interested in providing increased comfort to your patients, please contact me at [email protected].

    Dr. Josh Bernstein is the founder and president of The Academy of Dental Arts and Sciences, Dental Professionals Dedicated to Patient Comfort. He is a senior clinical instructor at LVI, and maintains a private solo practice in Piedmont, Calif., where he focuses on cosmetic dentistry, TMD, and sedation in an atmosphere of outstanding service. For more information, visit Dr. Bernstein’s Web site at

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