Pain-Free Dentists: Fact or Fiction?

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.

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.

Beyond Novocain: In the old days Novocain was the only game in town. Now dentists have an array of more effective local anesthetics to choose from. Lidocaine, for example, makes your gums more numb and, if the procedure requires it, for a longer period of time without needing multiple shots. Lidocaine also stays put better, so that the doctor doesn't have to numb more than the area he's working on.

Widespread use of composites or porcelain: These tooth-colored fillings not only look better than the old metal fillings that used to be standard, they're better for your teeth.

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.

Electric, rather than air-driven drills: Some people cringe at the sound of the high-pitched whine of the drill. New, high-end drills are not only less noisy, but they vibrate less.

Digital X-rays: Remember those too-big-for-your-jaw pieces of cardboard you had to bite on? Go digital and some say your tongue won't feel like it's being dug out of its root. Skinny plates made of phosphorus have only been in wide use for about four to five years, says Robert Hodous, who heads up The Dental Spa in Arkansas. Although it has a fancy name, Hodous' practice focuses less on Hollywood extras and more on cutting-edge dental technology.

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."

Looking Ahead

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.