Pain-Free Dentists: Fact or Fiction?

The Hypochondriac asks: Is there a such thing as painless dental work?


Feb. 26, 2008 — -- 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.

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.

"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.

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.

In order to fit a metal filling, the dentist must dig deep and wide enough into the tooth to create a place to wedge the silver in. These "undercuts" ultimately weaken the tooth, which may start cracking and then require a crown. Dentists don't have to drill as much tooth with composites, because they are bound to the tooth with adhesive.

Still, it should be pointed out that researchers agree discomfort and pain often start in the mind. A dentist who puts you at ease could be worth, to some, hundreds of thousands in new equipment.

Mike Herbert, who took over his father's practice in upstate New York, said, "I have a patient who wanted digital X-rays. But I have state-of-the-art [traditional] equipment and don't see the point in replacing it yet. Some people will only be satisfied if they have the newest and the best."

So now that many dentists can offer virtually pain-free visits, what lies ahead in the world of smiles? Stem cells, says Punwani. "Through stem cells we are already able to produce dentin and enamel in the lab. I'm guessing that in about 10 years we would be able to go there."

That's good news for The Hypochondriac. Now if they could only grow gum tissue.

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