When Laurence Olivier, cast as a sadistic dentist, terrorized Dustin Hoffman in the classic film thriller, Marathon Man, it reminded patients everywhere of their deepest dental fears...the high-pitched whizzing of a drill, a blinding spotlight in their eyes and the automatic gag reflex caused by having two human hands thrust down their throats. No wonder some people require sedation.
Dr. Marc Heft, professor of oral and maxillary facial surgery at the University of Florida, believes that dentists today have a variety of tools to reduce both the pain and anxiety of their patients. Heft, who also holds a Ph.D. in psychology, maintains that much of the physical pain felt during dental visits can be traced to "the unpleasantness associated with past experiences." In other words, being frightened by needles and pain as a child may dictate how you deal with the experience as an adult.
Sarasota dentist Jay Suverkrup knows the feeling well. A self-described "super chicken" when it comes to dentistry, he understands how it feels to lie flat on your back, mouth agape, eyeing a tray full of glinting metal instruments. Suverkrup has built a 25-year career on easing patient jitters with ingenious pain-minimizing techniques and cutting-edge technology. And along with Heft, he acknowledges that the first step is getting past the dreaded Novocaine shot.
"Every dentist is taught to create a distraction," he says. "Usually this is done by shaking the cheek as the injection is given." Suverkrup uses a different method, one he learned as a child while enduring a bout with polio. Instead of shaking the cheek, he instructs his patients to lift their leg six inches, then let it "plop" down. The ensuing "jerk" pops the needle in without the patient ever knowing it. "I can give people anesthetic, and they absolutely do nor feel it," he says.
That's a bold claim, but one confirmed by one of his patients, a neurologist who believes that when the foot hits the chair, sensitive nerve endings in the heel disrupt pain messages being sent to the brain by the needle.
And while many dentists are still using long 25-guage needles, Dr. Suverkrup prefers a small Microjet, a device that uses a 30-gauge needle barely an inch long. When a lever is pressed, it shoots Novocaine into the gum, reducing the force needed to punch the point in. He also heats his Novocaine--he says cold Novocaine is more painful.
For some procedures, technological advances such as air abrasion are reducing the need for anesthetics altogether. The Academy of General Dentistry says air abrasion appears to be especially useful for children and adult patients who are afraid of needles. Using a concentrated stream of air combined with super-fine abrasive powder, it can remove tooth decay in small cavities with almost exact precision, which means more of the tooth can be saved. Unlike a traditional drill, it is quiet, produces no vibration and no heat from friction. Its biggest advantage is that it usually does not require Novocaine, so patients leave the dental office without residual numbness in the mouth or tongue.
Other dentists are exploring the use of electronic dental anesthesia in place of Novocaine shots. Two small sponges placed in the patient's mouth or on the face are attached to a control box that the patient uses to control the depth of anesthesia. When activated, it produces a pulsing or mild tingling that numbs the mouth, but only for the duration of the procedure.
"Pain is subjective," says University of Florida's Heft; and since local anesthetics must still be used for invasive procedures like deep cavities and root canals, he says relaxation strategies and hypnotherapy can be very useful distractions to needles. Some of Suverkrup's patients insist that they require no anesthetic at all. They claim that raking three aspirin or Tylenol before a visit makes shots unnecessary.
But when all else fails, there's always laughter. Suverkrup keeps a 3-D video headpiece with earphones in each room. Instead of concentrating on the drone of the drill, patients can relax to the gags of "Saturday Night Live." "Dentistry is going through a lot of transition right now," he says. "It is trying to get to the point where we won't have to give people shots at all." And that's something super chickens everywhere can look forward to.
The Light Touch
Using lasers in cosmetic bonding and bleaching.
Pain management is just part of the changing face of modern dentistry. Real strides are being made in laser technology as well.
Lasers have been used in general dentistry for more than a decade, and tissue-cutting lasers (electrosurgical scalpels) have been around for 30 years. But according to Sarasota dentist Dr. Jay Suverkrup, the most popular new laser treatments are cosmetic bonding procedures that are vastly improving the way crowns and porcelain veneers are applied.
"In the past," he says, "we made crowns with metal underneath the porcelain, because we needed the metal for strength. A major drawback to this method was that the underlying metal sometimes gave the tooth an unnatural appearance.
By comparison, lasers emit a precise beam of concentrated light that penetrates a thin veneer and fuses it directly onto the existing tooth. The process, called "curing," produces a much more natural look than traditional metallic crowns.
Suverkrup estimates that 98 percent of dentists today are using high-intensity light lasers for just this purpose. In his own practice, he uses a smaller, pen-shaped device called a plasma arc. "I call it a laser because that's what people relate to. Actually, it is something between a laser and a high-intensity light."
He says that while many high-intensity lights take 40 seconds to cure a bond, the plasma arc cures four to five millimeters deep in only 10 seconds. That's nearly four times as fast as most lasers currently in use and with little or no heat. Not bad for a machine the size of a toaster.
These lasers are also being touted for their ability to bleach teeth. The light is so intense that it takes only seconds per tooth to whiten them by four to eight shades instantaneously.