I have written about practicing in the 21st Century on this blog in the past. The rapid fire information highway, the high technology, computers everywhere you look. Patients hear terms like Laser Dentistry, T-Scan, Diagnodent Laser Detection Device, Vita Spectrophotometer, Diode, Erbium Yag, Pulse Oximeter, Velscope, Itamar PAT-200…..What does all this ‘stuff’ do! Is it a case of ‘he who dies with the most toys WINS!!!’ As a dentist with lots of ‘toys,’ I find that the arena for advancing the state-of-the-art care for our patients has never been more available. With all these advances in dental technology, as compared to the time I first got introduced to dentistry, being a dentist has actually become ‘cool.’ I want to share with you the reasons why this is so.
When I was doing an externship at a hospital during my training, an elderly dentist walked into the emergency room with his patient of approximately the same age. They were referred by the triage nurse to the dental clinic and I was given the responsibility to do the evaluation. The dentist spoke first saying that his patient was his best friend for over 60 years. He then said that he was taking an impression for a restorative procedure and he was afraid that he may have broken his friend’s jaw. I was lost. I couldn’t understand how you could possibly break someone’s jaw by simply taking an impression. This elderly dentist had been around the mercury vapors a little too long. The patient was not talking. We brought him into the dental clinic and I asked the patient to open his mouth. Two things were apparent immediately: One… Plaster shards filled the oral cavity and Two…The mandible deviated in such away that it was apparent that the jaw was fractured. A panoramic xray revealed the fracture and the patient had his jaw wired to correct for the fracture. But how did this happen?
I asked this dentist privately, what happened and what was with the shards of plaster in the mouth? What he told me changed the way I would practice dentistry for the rest of my life. He said plaster was still the best material for taking an impression. Although plaster WAS an excellent material for taking an impression, it no longer was the best. It had not been used in impressions for decades. Decades!!! This dentist chose not to keep up with all the changes in his profession and his best friend/patient paid the price of a broken jaw. He learned a technique that worked for him and never changed. All of this dentist’s patients paid a price for that, and not just from plaster impressions.
Very often patients think that they do not ‘need’ the latest techniques and technology. But once patients experience the enhanced comfort, better function and aesthetics of what state-of-the-art dentistry can offer, they understand how much things have changed. We are not in Kansas anymore, Toto.
Laser Dentistry. Lasers are used in dentistry to minimize the amount of tissue trauma from our different procedures. Yes, they minimize the amount of tissue that is affected. Most patients envision lasers like Star Wars. In actuality, the laser can reduce the amount of tooth or tissue that is affected. So often we use the laser and we hear the patient tell us at follow-up appointments that there was no post-operative discomfort. That is the beauty of a laser. When we use the laser on hard tissue, like the enamel of a tooth, it can make the tiniest opening into the tooth so that we minimize how much tooth is removed. This is called minimally-invasive dentistry. Less is more. It used to be that dentists were taught to remove large amounts of tooth structure, the thinking being extending the size of the restoration actually prevented further breakdown. With adhesive dentistry that we practice today, we no longer have to extend the size of restorations and can keep the removal of tooth structure to a minimum. So we see that Laser Dentistry isn’t something that is way out there. It is mainstream and can be used to help you in attaining better dentistry more easily.
Kavo Diagnodent Laser. Not all lasers cut tissue. This device can indicate if you have a cavity or not. Do you know how a dentist can tell if there is a cavity, AKA decay, in a tooth? Traditionally it has been with 1) an explorer that is ‘poked’ around and is used to find a softness in the tooth, 2) radiographically (Xrays), or 3) visual inspection. Now Kavo has come up with a device that is non-invasive, has been tried and true, that can use laser energy to help diagnose whether a tooth has a cavity or not. There is a numerical display that aids in quantifying the probability that a tooth has decay. Remember, we want to reduce the amount of tooth that we remove. If we can get to the decay early enough, the less tooth that we have to remove.
T-Scan.This device is connected to the computer and uses a very thin piece of specialized cellophane that the patient bites on and the force/time ‘movie’ is made to indicate how the bite is distributed. Revolutionary! Instead of using the ‘carbon paper,’ AKA articulating paper, the T-Scan is exceedingly accurate. Far more accurate than the paper that has been used for centuries. I told you, this is 21st Century dentistry.
Vita Spectrophotometer. This handheld device can take the shade of a tooth in less than a second. Yes, less than a second. In the past, it was not uncommon for me to spend 20 or 30 minutes in taking the shade of a tooth or a few teeth inorder to match them with the new restorations. Now we have a device that can get us an exact shade. Now sometimes the shade is slightly off from this device (who’s perfect?), so a little tweaking may be necessary. But overall, this device saves us time. And if it saves us time, it means less time for you…a shorter dental appointment.
Velscope. Now this instrument is for oral cancer detection. It is non-invasive and uses fluorescence to indicate where there might be a soft tissue anomaly or, perhaps, a problem. Along with visual inspection and palpation, the velscope is just another adjunct to our examination. It may reveal a questionable area that needs to be watched, or possibly biopsied. Oral cancer comprises 4% of all cancers and, in our office, is part of the routine dento-oral examination.
Pulse Oximetry. This has been around awhile but it such a technological workhorse, I just had to mention it. It allows us to monitor our patients so that we can safely monitor them during sedation. It gives us a constant readout of the pulse, blood pressure and, something called, oxygen saturation. You may say that you don’t need sedation to go to the dentist. The vast majority of people do not. But if you are one of those patients that cannot even think of going to see a dentist due to fear, sedation dentistry is truly a life saver.
Itamar PAT – 200. I have written and provided videos on other blogs and our website on this great little device. Patients that have to undergo a sleep study to find out if they stop breathing during the night (‘sleep apnea’) generally do not cherish the prospect of going back for a followup sleep study. They have to go to a hospital/sleep center and it’s just not the Four Seasons Resort. Now the sleep study can be done at the patient’s home, in his or her own bed…comfortably. Sleep Medicine is a fascinating area that interfaces with medicine and dentistry. The Itamar PAT-200 is truly remarkable.
Technology is not the Holy Grail of dentistry. It is simply what we can do with the technology. If it enhances the patient experience, whether that is faster healing, better aesthetics, cancer detection, cavity detection, improving bite articulation or even the monitoring of vital signs…it makes it all worthwhile. Or possibly saving a life with the detection and treatment of sleep apnea. Older techniques in dentistry were fine for their time, but there is a moment when the shift to more modern techniques can make the patient, and the entire dental experience, more comfortable. No more plaster impressions with fractured jaws!
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