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Dentists can use modern technology to put anxiety to rest

August 26, 2011|By MARIE GILBERT | marieg@herald-mail.com
  • Dr. Jeffrey Rubino displays an air abrasion delivery nozzle at his Hagerstown dental practice. The technology shoots powdered silica to get at surface cavities
By Kevin G. Gilbert/Staff Photographer

For some people, the worst part of breaking a tooth or having an abcess isn't the pain that can shoot to your core.

The absolute worst is visiting the dentist.

On the surface, dental phobia might seem a little out of proportion. After all, it's not open heart surgery.

Yet, according to the American Dental Association, an estimated three-fourths of Americans have some degree of anxiety —  even when it comes to a routine checkup. Nearly one-quarter of the population avoids dentists completely because they're afraid.

And the fear comes in many forms.

According to an ADA survey, there's fear of pain, fear of needles, fear of blood, fear of gagging, fear of having personal space violated and fear of being lectured.

Now, through modern technology, many dentists are taking great pains to win back those patients.

Some practices allow individuals to be sedated through the procedures.  Others focus on soothing distractions, such as headphones or flat-screen televisions, that help patients feel they are somewhere else.

There is more attention to communications skills — finding ways to reassure phobic patients and establish a rapport that can help make them less anxious.

And there also is the latest equipment that makes the sounds and smells of dentistry less scary.

Take the dreaded drill. Just the high-pitched sound of this dental tool can send chills down people's spines. But today's electric drills are quieter than older models that were driven by compressed air. In some cases, drills aren't even necessary.

Since 1997, Dr. Jeffrey Rubino, a Hagerstown dentist, has been offering air abrasion cavity preparation.

"It allows me to prepare a tooth for a filling without using a traditional drill," he said.

Air abrasion is a high-speed stream of air with a sterile silica powder mixed into the air stream, Rubino explained. 

"The nozzle tip is about the same diameter as the head of a pin, which allows for very conservative tooth preparation," he said. "Since there isn't any physical contact or heat generated from friction, there is no pain and this allows me to skip the anesthetic injection."

With air abrasion, he added, "I can treat teeth in multiple areas of the mouth at the same appointment."

Compared with the traditional drilling method, the ADA says the advantages of air abrasion are many, including no sound, pressure or vibration and a reduction in the risk of micro fracturing and chipping the tooth.  Plus, it's simple, quick and less messy.

"A large vacuum tube is suspended about six inches from the patients' mouth to collect the over spray so it doesn't get on their clothing," Rubino said. "A thin film of sterile silica will coat the inside of the patients' mouth, which is easily rinsed out. The only limitation is the location of the decay on the tooth structure. The decay has to be directly accessible. It cannot be hidden in between two teeth where floss passes through because you cannot control back spray and both teeth would end up prepped."

Rubino said air abrasion is just one of many technological advances used in his office.

"Digital intraoral photography, live digital intraoral video, digital radiography, computer imaging, cad/cam impressions and restorations allow us to provide high tech dentistry today," he said.

The intraoral (inside the mouth) camera, according to the ADA, is used as a diagnostic aid and a communication tool between you and your dentist, helping the patient see what the dentist sees — all projected on a computer monitor.

In Rubino's office, as well as most dental offices, digital X-rays, also called digital radiography, have replaced film X-rays, allowing for images to be viewed instantly. And patients don't miss the sharp cardboard corners of X-ray film or the gagging effect it could cause. 

Over the past 10 years, dentistry has made great progress using lasers.

According to the American Dental Association, lasers now are being used in a wide range of procedures — from removing tooth decay to treatment of canker sores and gum disease. Laser treatments also can be used for root canals, allowing for speedier healing, less swelling, reduced pain and better recovery.

Dental lasers use a specialized light bean, not readily seen. The invisible light allows dentists to aim with precision and avoid damage to other parts of the mouth. 

If pain is your problem, numbing sprays, gels and patches can make cleanings less arduous and reduce the discomfort of injections. The ADA says sedation also is an option to lessen a patient's awareness of what's going on in the dentist's chair.  Dentists must have special training and certification to give some forms of sedation and patients must be accompanied to and from the dentist's office.

Costs of sedation can vary and are not always covered by insurance.

Taking a cue from pediatric practices, some dentists offer an array of entertainment options to keep patients' minds off the procedures. Many practices offer headphones and movies.

Some even offer spa-like comforts, such as massaging chairs, warm neck rolls and paraffin wax treatment for hands.

The ADA says patients can bring their own distractions, such as an iPods filled with their favorite tunes.

While there are things you can do to make your visit to the dentist less anxiety-riddled, the ADA offers an important don't. Don't try to self-medicate. Drinking alcohol before a dental visit is an especially bad idea, the dental organization stresses. Also, an over-the-counter pain reliever might take the edge off pain, but in some cases, it could increase bleeding. Be sure to always consult with your dentist beforehand.

The ADA also stresses the importance of talking to your dentist and the staff about your fears. And shop around until you find a practice that is empathetic.

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