Pain-Free Dentists: Fact or Fiction?

The Hypochondriac asks: "Pain-free" dentists. Can they be trusted?

The Angst: The Hypochondriac had her first checkup in years. Convinced that her teeth are rotting from the inside out, she longs for help. At the same time she fears and loathes the sharp instruments, blood in the spit sink, the olfactory memory of burning dentin from a long-ago root canal.

T.H.: "Sometimes I have pain. Like sensitivity, only more like pain."

Dentist: "In which tooth?"

T.H.: "It's a migratory pain. Free-floating."

Dentist: "Looks like we'll have to take a look."

T.H: "Okay. Oh. You mean now?"

After cleaning and X-rays, her new dentist, who advertises as being "pain-free," says that she has two small cavities forming and that she must have the cap on her root canal replaced. In addition, he says, if she does not break herself of her lifelong habit of scrubbing her teeth back and forth with a hard-bristled brush, she will have only traces of gum tissue left when she turns 35. Also, he's pretty sure she grinds her teeth and should be fitted with a mouth guard to wear at night.

T.H. imagines herself with a Skeletor smile from the "He-Man" cartoon of her youth. Worse, there's the drill. A sign on the wall claims that his office is a "pain-free zone," but the ever-cynical T.H. wonders whether it's just a marketing gimmick.

The Truth

Because of recent advances in dentistry even doctors who don't expressly claim to run a pain-free practice can offer a less traumatic experience than even five or 10 years ago.

Lasers: The most significant development is the increased use of lasers. It's most commonly used for soft tissue work — like gum surgery — and patients experience far less discomfort than when put under the knife. Less cutting, less blood, less need for significant sedation. And the technology is moving quickly ahead. James King, director of dentistry at Harlem Hospital, uses a newly developed water laser. It's proven effective in cutting bone, he says.

Bubble-gum-scented laughing gas: For minimally invasive procedures, nitrous oxide is considered quite safe and a kid's dream. Some grownups like the sweet scents too.

"Thirty years ago they had to just grin and bear it," said Indru Punwani, head of University of Illinois at Chicago's Department of Pediatric Dentistry. "Adults remember that, but times have changed." Moreover, due to lasers and improved drill bits, more procedures can be conducted with nitrous than ever before.

Kinder, gentler dentists: When Punwani discovered that only 45 percent of adults get regular checkups, his department made changes in its curriculum to address patients' fear. A great deal of pain begins in the head — before a patient opens wide.

The University of Illinois is one of several universities that have psychiatrists teach students how to communicate in a calming way. "When children or older people see masks, instruments and lights they instinctively have fear. We teach students to unveil the theater of the unknown," Punwani said.

Sharper drill burrs: Today most dentists use disposable burrs (drill bits for teeth) when they have to drill. Sharper burrs mean smaller, more precise cuts, which means less potential damage to the tooth. Weak teeth equals a future visit, too often for a crown.

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