- The Washington Times - Monday, March 11, 2002

People of middle age or beyond are likely to remember the dentistry of their childhood as a bit of a horror a mixture of low-speed, uncooled drills, and painful injections with sometimes-dull reusable needles. It was ugly. Further, teeth decayed more back then. To get a handle on what has gotten better, and what is likely to come soon, I talked to Dr. Steve Fuchs, a dentist (mine, actually) practicing in the Virginia suburbs.
They work, says Dr. Fuchs, as does fluoride. Get your children's teeth sealed and they may never have a cavity. This seems to be unanimous. (Sealants fill in the pits on the biting surface of the teeth, but if parents don't floss their children's teeth they can still get cavities between their teeth).
Dr. Fuchs then pointed to a lot of incremental improvements, none of them earthshaking but in aggregate making a large difference.
Then there are, for example, digital X-rays. Instead of film, the new technology uses what amounts to an X-ray digital camera.You still have the uncomfortable flat thing in your mouth, but the results instantly appear in digital form in a computer.
The advantage to the patient is that the sensors are more sensitive than film, so the radiation can be reduced by 90 percent. Less radiation is always better. Dr. Fuchs says that in one case the Virginia inspectors who check X-ray machines needed recalibration to read such a low level.
Further, there's no wait while film develops, which means the dentist can see more patients (it is, after all, a business).
There are no environmental problems with photoprocessing chemicals, which can be a real problem for a large dental office, and the X-rays can be e-mailed to anyone who needs them. The downside is that the resolution is somewhat lower than that of film.
Many people intensely dislike injections, partly because they hurt.A big advance many years ago was disposable needles, says Dr. Fuchs. They're always sharp and sterile. Now there are injection machines that, by means of a small piston operated by the dentist's foot, actually push the anesthetic ahead of the needle. By the time the needle actually arrives, the tissue is already numb.
"One patient asked me how he got numb without an injection.He didn't realize that he'd had one."
Much of the dislike of dental visits today is psychological. The pain that many associate with dentistry seldom exists these days. The actual pain of an injection, if felt on the back of the hand, would seem minor.But, says Dr. Fuchs, the psychological aspects of dentistry make it highly unpleasant for some patients.People don't like to have other people's hands in their mouths, injections seem invasive, the noise is horrific and the occasional smell of preparing a tooth is unsettling.
"People think things will hurt that don't. A patient will say to me, 'I'm afraid you are going to hit the nerve.'Actually I'm not going to, and if I did, he wouldn't know it.When a tooth is numb, it is almost always completely numb. But people can perceive pressure and vibration as pain. And some dentists don't wait long enough for the anesthesia to work."
Consequently, dentists would like to reduce psychological stress. One approach is to reduce the noise of the drill. The patient wears noise-canceling headphones. The principle is that a microphone picks up the screech of the drill, electronic circuitry repeats it 180 degrees out of phase, and the two cancel each other.The idea isn't new but is new to dentistry.
Dentists would be happy to get rid of current spinning drills altogether if a workable substitute could be found.Today's drills are actually tiny turbines powered by compressed air, and reach speeds of 200,000 rpm, says Dr. Fuchs. The things are inherently noisy.
What dentists and patients all want, he says, is a quieter drill. Air abrasion and lasers are being slowly brought to the market.However, it isn't clear how practical they might be because of the thermal effects on teeth,
Finally there are composite tooth-colored fillings that are hardened with a curing light. They aren't perfect: Finding an ideal material for fillings isn't easy. If the material expands and contracts differently from natural tooth when heated and cooled, for example, they can leak, with resultant decay.And composites take more skill to apply, Dr. Fuchs says.
But it is important to people that their teeth look good, and the composites can be accurately color-matched to a patient's teeth.
One thing is certain: Dentistry has come a long way.

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