- The Washington Times - Monday, June 26, 2006

Technology gives patients many good reasons to smile

Howard Moskowitz was stretched out in a reclining chair, his mouth numbed by a shot of Novocain, and his Long Island dentist looked as if he was taking a break.

The drills were out of sight, the tray of metal instruments was off to the side, and the dentist, Dr. John Cottone, was staring at a flat-screen computer monitor. What appeared on-screen, though, was not Dr. Cottone’s e-mail account or favorite blog, but rather a three-dimensional image of the 74-year-old Mr. Moskowitz’s tooth.

“The computer is really smart,” Dr. Cottone said, using a mouse to trace the design for Mr. Moskowitz’s crown. “You just double-click.”

The machine is called a Cerec, one of several relatively new devices that are making computer technology a growing part of dental care. Though still too expensive for many dentists, the high-tech gadgets offer patients a quicker and less invasive experience.

The growing use of digital X-rays and cameras that can be placed in the mouth means less poking and prodding and fewer reminders to open wide. The Cerec, with which a dentist can design and produce a filling or crown in about 15 minutes, can condense two visits into one.

When Dr. Cottone finished his computer design for Mr. Moskowitz’s crown, a microwave-size machine down the hall gurgled for several minutes. An alert window popped up on the dentist’s computer screen, and with that, the tiny piece of porcelain that soon would become embedded in his patient’s cavity was ready.

“The computer’s right there, and a camera is actually hooked into the computer,” Mr. Moskowitz said. “So he’s got it in your mouth, he takes the picture, and it figures out the measurement by itself. And bang — he puts the tooth in there.”

That bang could mean more bucks for dentists who invest in technology. According to a 2003 survey by the American Dental Association, 40 percent of Americans polled listed new technology as a factor that would make them more likely to see a dentist.

Though the dentists who can invest in technology often run more lucrative practices to begin with, patients do not necessarily see their bills go up or down. The appeal of the devices is their convenience.

Washington dentist Phillip M. Maiese, 54, who has used a Cerec machine in his practice for nearly three years, finds it’s a timesaver as well as a money saver.

“You don’t use a lab technician to fabricate these at all, so costs go down, but the fact that everybody saves time is really important, especially with my clientele.”

His clients appreciate that they only need to come for one visit because the procedure can be done at one sitting.

He finds Cerec useful for single-tooth restorations — “meaning, you can’t connect things together” — as well as for crowns, partial crowns or inlays, and also for veneers.

The initial cost to the dentist is considerable, about $100,000, but “it pays for itself rapidly if you use it a fair amount. You can either lease them or buy them.”

Dr. Maiese spent a week of advanced training in San Diego when his office— which includes another dentist — decided to buy one. He calls it “good for a mature practice,” by which he means that the steep learning curve to perfect Cerec’s operation is the right challenge a professional needs at his stage.

“It gets you a little juiced again.”

He says he finds it “fun” to use “because it is creative. [A dentist tends] to be a little bit of a control freak, and with this you can’t blame anybody else if anything goes wrong. If you give the machine good data, it will do what you want. And it certainly is faster [than the usual procedure]. The literature is quite supportive; this is the golden boy for evidence-based dentistry because, after 20 years, it is one of the most studied techniques.”

He estimates that the machine still isn’t widely used in this country, “well below 5 percent, I’d guess. It’s a much higher figure in Europe.”

“You’re going to see more and more things in dentist’s offices to sell the dentistry,” says James Howard, an associate dean at Creighton University’s dental school in Omaha, Neb. “Anything we can do to make the experience a little more pleasurable or at least not unpleasant is good for their care.”

One traditionally unpleasant part of seeing a dentist is having an X-ray taken, a process that requires patients to bite down on a piece of cardboard or plastic containing X-ray film. Digital X-rays replace the film with a small, less intrusive sensor.

They also transmit the X-ray image almost instantly onto a computer screen for the patient and dentist to see — a significant upgrade from looking at a small piece of film, says Matt Messina, a spokesman for the American Dental Association.

“For years, the dentist has pointed to the little postage stamp X-ray and said, ‘Well as you can see here, this is clearly the case,’” says Dr. Messina, who also is a practicing dentist in Cleveland. “And the patient nods their head, and both the patient and the dentist know that they don’t really see it.”

The mouth, or intraoral, camera is another device that dentists say has helped them show patients what is happening inside their mouths. Roughly the size of a marker, the camera can take close-up shots of teeth and instantly display them on a monitor.

The device is often used for “before-and-after” shots that show patients both what the problem was and how much of a difference a dental procedure has made.

The development of intraoral cameras and digital X-rays goes back more than a decade. Though the American Dental Association does not keep statistics on how many dentists use each device, Dr. Messina says they have become more commonplace in recent years.

But he adds, “While you want to stay on the cutting edge of technology, you don’t want to get too far out on the cutting edge. You have to let the technology stabilize a little bit so we know all the capabilities.”

Staff writer Ann Geracimos contributed to this article.

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