Can you paradigm?

Practicing dentistry is always a "work-in-progress" proposition. Who would want to practice the same way you did when you graduated from dental school?

Jeffrey B. Dalin, DDS, FACD, FAGD, FICD

Practicing dentistry is always a "work-in-progress" proposition. Who would want to practice the same way you did when you graduated from dental school? There are some moments in our practice lives when we find something totally new and different — something that can be truly defined as a paradigm shift.

Over the past few years, I have made some major changes in the way I practice by incorporating digital radiography, digital photography, and digital shade-taking devices into my daily routine. I could not and would not practice dentistry without these three modalities. My practice and my patients benefit greatly from them.

Let me summarize some of the many benefits of digital radiography: less radiation exposure to patients, instant on-screen images, rapid and superior diagnoses, image-enhancement capabilities (such as magnification, contrast, and coloring), improved patient acceptance and education, total elimination of the darkroom, chemicals, and film, and easy image-sharing with other dentists or third-party payers.

How can digital photography help your practice? Take full-face photographs of your patients. Include them in your practice-management programs for patient identification. Create marketing initiatives, such as "treatment summary letters," "cavity-free clubs," or "first visit to the dentist" pictures. Use full-face photographs as "before" and "after" records when you perform aesthetic work. Use a cosmetic software package to enhance or modify the images. Produce powerful case-presentation and treatment-planning letters and slide shows. Send copies of patient images to assist and work more closely with your laboratory technician. Share images with specialists. Digital images also can be sent to third-party payers for documentation of recommended treatment.

The longer I practice dentistry, the more I realize that dentistry is every bit as much an art as it is a science. Color is something we work with on a daily basis. We desire aesthetic excellence ... and our patients demand it! We now have digital shade-taking devices and technology that can cut down the remake rate, increase dentist/lab communication, and ensure the aesthetic accuracy of patients' restorations.

I recently discovered a fourth piece of technology that had a similar impact on me and my practice. There are no more rewarding procedures that we can perform for our patients than those associated with cosmetic dentistry. Every dental procedure seems to have a list of necessary items in your armamentarium to complete it. I always thought that I needed to have a setup consisting of a high-speed handpiece, a slow-speed handpiece, a collection of instruments and burs or diamonds, composite resin, bonding agent, and acid etchant. As my skills have improved over the years, I have found the need to add one more item to this list — a soft-tissue diode laser. There are so many times when this is an indispensable tool. How many times have you been ready to bond in a resin at or just below the gingival margin, only to have moisture contamination or bleeding occur? How many times would you have loved to do a little tissue-trimming to even out gingival levels and make your work appear just a little bit better?

A diode laser works by creating an intense beam of light energy, which is then converted to heat within the tissue. Because of its high affinity for pigmentation (hemoglobin and melanin), it causes tissue vaporization with little collateral tissue damage. Rarely will you see bleeding or post-operative discomfort because the blood vessels, lymphatics, and nerve endings are sealed off when tissue is removed.

Some indications for use of a diode laser include tissue-retraction for impressions, abscess incision and drainage, biopsy incision and excision, exposure of unerupted teeth, fibroma removal, frenectomies and frenotomies, gingivectomies and gingivoplasties, hemostasis, implant recovery, lesion removal, pulpotomies, sulcular debridement, tooth-whitening, and treatment of aphthous ulcers.

Feature, function, and benefit go hand-in-hand with price. Features to consider are weight, portability, ease of use, safety of use, and handling of accessories. Some of the diode laser units to look at include the Odyssey Diode Laser by IvoclarVivadent (my personal favorite), Diolase Laser and Lasersmile Laser by Biolase, DioDent Laser by HoyaConBio, and the Opus 5 and Opus 10 by Opusdent. Do not forget to attend continuing-education courses to fully understand and safely use any laser.

As we enter 2004, it is time for everyone to evaluate these technologies. Experiencing these paradigm shifts will invigorate you and re-energize your passion for dentistry.

Jeffrey B. Dalin, DDS, FACD, FAGD, FICD, practices general dentistry in St. Louis. He also is the editor of St. Louis Dentistry magazine and spokesman and critical-issue-response-team chairman for the Greater St. Louis Dental Society. His address on the Internet is www.dfdasmiles.com. Contact him by email at jeff@dfdasmiles.com, by phone at (314) 567-5612, or by fax at (314) 567-9047.

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