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Less Drilling and Filling - Technologies that Aim to Stem the Suffering

Less drilling and filling - Technologies that aim to stem the suffering

By Jane Weaver
Health editor MSNBC
Sept. 22, 2004

At first, Laura Bienenfeld didn't pay much attention to the sharp pain she felt around the filling in one of her back teeth when she bit down on really hot or cold foods. Even though she's a dentist herself, she'd always had sensitive teeth and thought the new pain was part of the same old problem. But when she visited her own dentist to replace the silver mercury filling with new material, he discovered that a deep cavity had developed in the tooth and had reached the nerve.

Normally, Bienenfeld would need a root canal, a procedure that's been likened to living hell.

While there have been advances in the techniques used for treating diseased teeth over the last few decades, the fear of a bad root canal experience remains one of the leading causes of dental phobia. A root canal is generally performed when the pulp of a tooth becomes exposed or infected because of a cavity or crack, and at least 14 million of the procedures are done each year, according to the Academy of General Dentistry (AGD).

Some may say Bienenfeld was lucky. Because the nerve hadn't become infected, instead of getting a traditional root canal, which requires drilling into the tooth's crown to clean out the diseased pulp, Bienenfeld's New York dentist, Michael Teitelbaum (who is also her husband), used a newer technique called direct pulp capping that he says is faster, preserves more of the tooth and requires less time with the dreaded drill.

In a traditional root canal, a dentist removes the nerve, sterilizes the tooth canal and fills it with a rubber-like material to prevent future infection of the tooth. A substantial portion of the tooth is drilled away to fit a permanent porcelain or gold crown.

With direct pulp capping, if the nerve isn't infected, a dentist can clean out the bacteria from the cavity and cover the tooth with a resin seal over it so tight that "the nerve doesn't know whether it's a tooth or a bonding material," Teitelbaum says. Because the bonding material replaces the need for a crown, more of the tooth is preserved.

"It's not very widely used yet, but it should be," says the Briarcliff Manor, N.Y., dentist. "As long as the tooth isn't infected, about 90 percent of the time it'll heal."

For Bienenfeld, the direct capping procedure was as easy as getting a regular filling. You wouldn't expect her to criticize her husband, but she insists, "it worked out great."

Direct pulp capping has been around for several years, but newer, more effective bonding materials are helping make it a more viable alternative for root canals, dentists say.

"Most people appreciate having the option, the chance, of not having to have a root canal," says Teitelbaum.

'New paradigm'
To help take the bite out of going to the dentist, a growing number of dentists across the country are embracing options such as direct pulp capping and other new technologies that ease patient anxiety and reduce the pain associated with treating diseased and damaged teeth.

That's important because fear of pain is the reason 23 percent of people put off dental appointments, according to a 2003 American Dental Association (ADA) survey. And that can cause many people to ignore mouth pain to the point where a root canal or other major procedure becomes inevitable. But eliminate pain and over 41 percent of those fearful folks would be more likely to visit the dentist, the survey found.

Gadgets like lasers and air abrasion tools, along with advances in anesthesia, are part of "a new paradigm of being more conservative" and opting for minimally invasive dentistry, says Teitelbaum.

More sophisticated instruments and improved repair materials mean even a root canal isn't the agony-inducing experience it once was, some argue. "There are tons of patients coming out of offices saying, 'don't be afraid of root canals anymore,'" says Mac Eddington, Nashville-based former president of the AGD.

Good-bye to the drill?
Perhaps nothing causes more anxiety than the high-pitched, whining sound of the drill. "The noise of the drill, that's the perception of pain to people," says Eddington.

But now drill-haters can get some relief from dental lasers. While the instruments have been used in dentistry for more than 20 years, primarily for gum disease and cosmetic bleaching, only in the last few years have they advanced to where they can be used to cut teeth, remove decay and cut bone.

The Academy of Laser Dentistry (ALD) says this offers several advantages: the need for local anesthesia is reduced, bleeding is minimized, swelling is controlled, and there is less post-operative discomfort.

All of this is cause for patient celebration. But the devices, along with training, can top $50,000. So the use of lasers is a slow-growing trend, with only about 1,100 practicing members of the ALD out of an estimated 170,000 dentists nationwide.

Furthermore, dental lasers are not good for deep cavities as yet and there are concerns that accidents could damage teeth, dentists caution.

"We're just in the beginning stages of using them on hard surfaces of the teeth," says Kimberly Harms, an advisor the ADA and a practicing dentist in Farmington, Minn. "It looks hopeful, but we have to make sure they're going to be safe and effective."

Still, dentists who use lasers can promise their patients bloodless, painless surgeries, giving them an edge over those waving drills and other scary surgical tools. And recently, some dentists have begun using lasers in root canal treatments.

Another advance is air abrasion, also called microdentistry, in which a little machine can sandblast away a small cavity. The idea is to treat the decay as early as possible, usually making anesthesia unnecessary. Air abrasion is often used on children.

"It's a little gritty, but most patients prefer it to a drill," says Harms. "You can do it without pain."

Easier shots
What if you're in need of serious tooth repair and can't avoid the needle, the jab in the jaw to numb your gums? Anesthesia experts say there's no more need to dread the shot.

"For many people the thought of having an injection in the mouth is worse than the actual shot," says Joel Weaver, a dental anesthesiology specialist at Ohio State University. "Sometimes dentists fear that patients want to get the shot over as quickly as possible, so they inject as quickly as possible, but that can cause more pain than when done slowly."

For the dentists who worry about needle-shy patients, there's a computerized injection system called "The Wand," a small needle which looks like a pen and is controlled by a foot pedal. The system allows a dentist to inject more slowly in order to minimize discomfort.

"The Wand injects the local anesthetic at a precise rate so that its much less painful when the dentist uses it," says Weaver.

And for people who don't like going home with a numb mouth, early research shows promise for reversible anesthetics, he says.

Beyond the advancements in technology, the real way to achieve pain-free dentistry is to develop more communication with patients and give them a sense of control over what happens to them in the chair, says Harms.

"There's more focus on taking care of the patient attached to the teeth," she says. "No technology can take the place of a trusting relationship."