One of the amazing things about dentistry is that dental procedures are overwhelmingly outpatient surgeries.
You might be thinking, “surgery? I’m just having a filling done! What’s this about surgery?”
Well, having a filling done is actually a small surgery on your tooth. You come to the office, I administer your anesthesia (aka: numb your tooth) and then do the surgery. Since most procedures are done in a matter of an hour or so, that’s pretty quick surgery! Compared to other types of surgery, dental procedures are piece of cake. Mostly because dentists are experts at local anesthesia. And even though having a numb lip and/or tongue is a bit of a drag, it sure beats feeling what the dentist needs to do to restore teeth.
Local anesthetic is an important part of delivering comfortable dental care. Luckily, it’s a very safe drug that can be used without concern on most patients. It works by temporarily blocking the pain signals from a stimulus (aka: someone drilling on your tooth) to your brain. The signals are still sent, but when the anesthetic is in place, these signals never make it to your brain. Local anesthetics can do this without affecting your ability to drive a car or sedating you. Which means dental procedures can be quick and painless!
Every dentist will tell you that some patients are more difficult to get comfortably numb. According to Dr. Stan Malamed, the guy who wrote the book on local anesthesia (no, really. He wrote THE book on it!), as long as you get local anesthetic close to the nerve, it will block the conduction of nerve signals. So what’s happening when we have a patient that isn’t getting completely numb?
First, we may have not put the anesthetic close enough to the nerve. It’s almost always on the lower teeth that we cannot get a patient completely numb. This is often due to the dentist attempting to block the large nerve that runs through the jaw. This is called an inferior alveolar nerve block and if you’ve ever had one, you’d probably remember it. When done correctly, it numbs your entire jaw from your back teeth all the way to your very front teeth on one side of your jaw. It also often makes your tongue, lip and gums numb. It’s a lot of numb! It also happens to be the most difficult and inconsistent injection for the dentist. The nerve canal runs differently in each person, so sometimes we don’t place the anesthetic close enough to the nerve and we don’t get complete anesthesia. Furthermore, some people have extra nerves coming from the tongue side of the jaw. So even if we’re successful with our nerve block, we may not have placed anesthetic in all the right spots.
Secondly, inflamed and infected tissue doesn’t always allow anesthetic to pass into the nerve and thus block conduction of pain signals. I’m less confident of my ability to get a patient comfortably numb on a very inflamed or infected tooth.
So, we can get patients comfortably numb most of the time. But what about the times when we can’t? What if we could “supercharge” our anesthetic to get more patients numb more consistently? Well, funny you should ask!
Local anesthetic solutions are relatively low pH. Which is to say they are acidic. Anyone who has read this blog knows I’ve talked a lot about acidity and pH, but it’s usually in reference to the acid produced by bacteria and in foods that can cause tooth decay. In a previous blog post I explained pH in this way:
pH is a measurement of acidiy or alkalinity in an aqueous (water based) solution. A solution that is high in acidity has a low pH and a solution that is more alkaline has a higher pH. pH is measured on a 14 point scale with 0 being the lowest pH (most acidic) and 14 being the highest pH (most basic or alkaline). A pH of 7 is considered neutral, neither majority acid or alkaline. This 14 point scale is logarithmic, which means that each number on the scale is 10 times higher or lower than number above it or below it. For instance, a substance with a pH of 3 is 10 times more acidic than a substance with a pH of 4 and 100 times more acidic than something with a pH of 5.
The low pH of anesthetic is what can cause a burning sensation when anesthetic is being injected. Furthermore, the molecules of anesthetic actually cross the membrane of nerves more easily if the solution is at a higher pH. You’re probably asking yourself “why don’t we make the pH of anesthetic higher so it doesn’t burn and it’s more effective?” It’s a great question with a simple answer. The chemicals that we use to raise the pH of anesthetic (aka: “buffer” the anesthetic) aren’t stable for a long time. If you’re going to buffer local anesthetic for patient use, you actually have to add the buffering agent right before you use it.
At Mead Family Dental, we’re now able to do that. We recently invested in the Onset System, which can effectively buffer anesthetic for more comfortable injections as well as more profound anesthesia that takes effect more quickly. This means more comfortable injections, faster injections and less pain at the injection site after the appointment. If you’re interested in a technical description of how it works, take a look at this video.
We’re pretty serious about patient comfort. We’ve always been pretty confident about keeping our patients comfortable during dental appointments. The Onset System is one more way we’re make sure our patients have a comfortable experience in the office!
Did you find this post numbing? Maybe a little nerve-wracking?? This dentist in Saginaw, MI would love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.
If you’re looking for a Saginaw dentist, we’re always happy to accept new patients! You can request an appointment online or call the office at (989) 799-9133. And, as always, you can email me at email@example.com. I always answer my own emails!
Me: “Gloria, you have several cracks in this tooth. Some cracks need to be treated more aggressively than others. Unfortunately, the ones I’m seeing here are some that I would recommend you treat right away.”
Gloria: “Really, doc? I’m not having any trouble with it at all. Do I really need to fix it?
I have this conversation quite often. When I suggest to the patient that now is the time to treat what I’m seeing it makes me feel kind of salesy, if you know what I mean. I just created a problem in the patient’s mind that they didn’t have a moment before. Just a minute ago the patient had been enjoying their clean and “just polished” teeth while hoping I wouldn’t come in and find anything expensive to fix.
Here’s the problem. I use at least 6.0x magnification and a ridiculously bright LED headlight for every procedure or exam that I do. At least. Sometimes I use my dental operating microscope which can bump the magification up to 20x along with the insanely bright plasma light source. But I digress. In any case, I see a lot. I have to use the judgement and experience that I’ve gained through 15 years of treating patients and learning new things to decide what’s important enough to suggest treating to the patient and what’s not all that important. This is not an easy job. Often I wish the patient could just see what I’m seeing.
Showing the patient what I can see isn’t as easy to do than you would think. Over the years I’ve used handheld mirrors, patient education software, intraoral cameras, digital SLR cameras of all types among other things to help the patient visualize what I’m seeing. I’ve found that I can explain things much more easily when they have a picture of what I’m describing. According to neuroscientist John Medina vision trumps all other senses. We humans are visual animals. A pretty big part of our oversized brains is used to process the visual images that our amazing eyes take in. We understand things better when we can see them. Or at least when we can form a picture of them in our mind.
Back to my somewhat awkward conversation with my patient. She thought everything was great with her teeth. They were smooth and shiny and pain free. Then I come in and tell her that I see a problem that she should probably fix that’s going to cost her money that she’s rather spend elsewhere. How does she know I’m not trying to sell her something that she doesn’t really need? If she listens to the news she may think that I’m just making up treatment in order to charge her a bunch of money! How can I help the patient understand her dental problems?
First, if I have a relationship with the patient and she trusts my motives, that helps a lot. Secondly, I try to show her a picture of what I’m seeing. Not only can she picture the problem, she sees that I’m not just making stuff up in order to do treatment on her. Most recently I’ve been using a digital SLR camera wirelessly connected to an iPad. This is a very elegant solution because the patient can instantly see the image come from the camera onto the iPad screen. I can show them the problem that I’m seeing at high magnification without the patient having to be leaned back with their mouth open. They can point, zoom and move the image around to ask questions I might not have thought to answer. It helps make the patient part of the diagnosis process. No longer does the patient have to “take my word” about a problem. They can “touch it” as well as see it.
Dental patients should demand this kind of technology from their providers. It’s no longer good enough to just take the doctor’s word for it. When a patient can own their diagnosis, they can own the treatment and make better decisions. Health care and dentistry continues to become more expensive, so we need to be better consumers. These kinds of pictures really are worth a thousand words for well informed patients!
Did you find this post helpful? Enlightening? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.
In the mid-90's, this was a "must have" for every dental student!
I’m a technophile. Which is a really nice way of saying that I’m a sucker for a cool gadget. I had my first laptop in 1993 (an Apple Powerbook 160) and used it to take notes in dental school. It was an absolute clunker and had a greyscale screen, but I loved it. I carried that cinder block around like newborn baby!
Dentistry is a profession that has LOTS of gadgets. In fact, there’s so many gadgets that a dentist really needs to be wise about choosing technology. Many times in my career I’ve brought in a technology that was marketed brilliantly but wasn’t very helpful to patients. I’ve become more choosy about the technology I incorporate as I’ve matured in my career.
Technologies that involve magnification and imaging (taking pictures) are very important to me. I use high powered loupes and an LED headlamp for all procedures and exams, unless I’m using my dental operating microscope. We also have intraoral cameras in each operatory and a digital SLR camera. These technologies also lend themselves to taking photos of procedures and conditions and being able to explain dental problems and proposed treatments using digital photos. Along those similar lines, our office has been using digital x-ray technology since 2007.
Digital x-rays are a cool technology for many reasons. First, how neat is it that we can snap an x-ray of your tooth and it appears on a computer screen in a matter of seconds? I don’t care who you are, that’s just cool! Software allows us to change the size, crop and zoom and even accentuate the image in a way that we never could when we were using film. Further, the image is on a huge computer screen instead of a tiny film. And if that wasn’t enough, digital x-rays use only 20% (or less) radiation than film x-rays!
digital x-rays: less radiation and more options
So, I can make digital photos and digital x-rays of teeth. It’s very convenient and very cool. Here at Mead Family Dental, we’ve taken it one step further. We use the technology to save you money!
Let’s just say you’re my patient and you’ve come in to have your teeth cleaned. When I do your exam I find a raised white patch on the side of your tongue. Now I’ve seen quite a few tongues in my career, but my training is limited in the identification of these kind of lesions. So what do I do? I typically send you to a specialist. In this case, I’d send you to an oral surgeon. The surgeon would first schedule you to examine the spot and then would decide if there is a need to biopsy the lesion. In many cases, the surgeon has had enough experience seeing this kind of pathology that a photo or x-ray would be enough for them to decide whether it’s something that can be monitored or it’s something that needs to be examined in their office.
So now we come back to our slick digital technology. I’ve already taken several photos of this suspicious white patch on your tongue. I email the photos along with a description of the lesion. Usually within a few hours or at most a day or two I get an answer back from the surgeon saying, “I think we can monitor this until their next visit” or “we should probably set up an appointment in our office.” What I did was get an opinion from a specialist without you having to visit the specialist. I do this all the time. Consulting specialists has become much simpler and in many cases much less expensive because of the technology that we have at the office.
Technology in medicine is constantly evolving. Here at Mead Family Dental, we’re trying to choose the technologies that make our patient care better, more efficient and more cost conscious. Doing what’s best for our patients is our #1 goal!
If you like this post, I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.
I've been a "magnfication junkie" for as long as I've been practicing dentistry. I began using loupes (the magnfiers mounted on glasses) while I was still in dental school and began using a loupe mounted headlamp in 1998. Many patients may remember that I would often forget to remove the fiberoptic cable from the lightbox in the operatory and I would practically strangle myself when I walked away. Good times!
I have increased the magnification of my loupes from 2.0 to 2.8 to 3.8 and now finally to 6.0. The greater the magnification the more detail I'm able to see. 3-4 years ago I attempted to move up to 8.0x loupes. The problem with those was that I literally couldn't hold my body still enough for the magnification. It was so much magnification that the slight movements I made while breathing, even when I was sitting still, made it impossible to see well. Also, there really wasn't enough light, even with my new LED headlamp (brighter, not attached to the counter).
So I had reached my limit of magnification. Which was still awesome at 6.0, but I wanted more! For years I had been kicking around the idea of getting a dental operating microscope. I had seen them in the offices of root canal specialists and I had a chance to see them at dental meetings. I had even tried them in my own office with demonstrations. I held off on buying them because 1) they require a complete change in the way you work and 2) I didn't want it to become a very expensive coat rack in my operatory.
Finally, in November of 2010 I went to the Academy of Microscope Enhanced Dentistry (AMED) meeting in Santa Barbara, California. I had a chance to see lectures from some very forward thinking dentists as well as try out all the different models and features.
At the end of November I went ahead and got one. My only regret is not having done it sooner! It takes care of the "not enough light problem" as well as the "slight movement of my body causing blurring of my visual field" problem.
The microscope is a Seiler Instruments xR6. I have a camera mounted on it that allows me to take high resolution still images as well as high resolution video. My next project is to put high resolution monitors into the operatory that will allow patients and assistants to see what I'm seeing through the microscope in real time!
Why do I go through all of the trouble for my magnification habit, you might ask? The answer is easy. Better magnification makes me do better dentistry than I can do without it. Simple as that. Now that I'm incorporating a camera, it also allows me to communicate with patients and other dentists much better.
This is one of the most exciting developments of my entire dental career! I promise to keep you posted on this exciting piece of technology!
Questions or comments? Feel free to email me at: firstname.lastname@example.org. I read and answer all of my own email and love to hear from readers of the blog!
Let’s face it…no one likes needles. Dental work is dreaded by many and for lots of them it’s all about the shot. As a dentist I’m supposed to talk about “adequate anesthesia” and “profound numbness.” I’m not supposed to mention the shot. Good dentistry requires good pain control and that almost always means an injection of local anesthetic. Which means…the needle.
I pride myself on being able to deliver anesthesia well. But no matter how good I am there are some spots in the mouth where delivering anesthesia can be painful. I think I’ve found the solution to this problem. Enter the “STA.”
This computer controlled anesthesia unit works by delivering anesthetic so slowly that it sneaks in under the patient’s pain threshold. I would be lying if I told you I wasn’t skeptical of this technology at first. The company was so so sure of their product that they allowed us to try the unit out before getting one of our own. My loyal staff/guinea pigs allowed me to give them shots with this machine to prove to ourselves that it really was painless. To our surprise…it works as advertised! I actually remained skeptical until I was able to have another dentist give me a shot with it just this weekend. I can say from experience that I couldn’t feel when he was numbing me. The other cool thing about being numbed by the STA is that your lip and tongue don’t get numb along with your tooth! I’ve found a lot of technologies that haven’t really panned out for dentistry, but I have to say this one really delivers!
We think that the Mead Family Dental experience is pretty special. This new technology is truly icing on the cake! We’d love to have you come experience how comfortable and enjoyable taking care of your teeth can be!
O.K. So it’s not a REAL baby. The office just had a new digital panoramic x-ray machine installed and frankly it’s VERY exciting!
Now I am known to get excited over things that the average dental patient might not get that excited about. However, this high tech machine is bound to make your dental experience quicker and easier.
In 2007 our office switched to digital x-rays which use 1/5 as much radiation to take phenomenal images that appear instantly on a computer monitor. This machine is similar but takes an x-ray of your teeth and jaws within 5-7 seconds! A panoramic x-ray is useful in many situations:
shows wisdom teeth, even when they can’t be seen in the mouth!
it can show developing permanent teeth in kids of all ages
helps determine the need for braces
can show pathology (cysts, tooth infection, "extra" teeth or congenitally missing teeth) that often can’t be seen in other types of x-rays
patients who don’t tolerate films in their mouth can finally have a thorough but comfortable x-ray experience
Probably the best part about all of this is how easy it is to have a panoramic x-ray taken. The machine zips around the outside of your head (no uncomfortable film or sensors to bite on)in about 7 seconds with no discomfort. On top of that, the amount of radiation that a patient is exposed to is about 20% of a conventional film x-ray.
Most insurances cover a panoramic x-rays and Kathy can give you the details about your coverage.
For an appointment or more information about our panoramic x-ray machine or any services available at Mead Family Dental please email me at email@example.com or call the office at (989) 799-9133. We’re happy to hear from existing patients as well as anyone just interested in their dental health!