Please suggest what must be done to ensure our progress towards painless dentistry. Where are our research and clinical evidence? Needed more progress. (Not just the claim of pharma companies and sponsored research)
Unlike General Anesthetic, under Local Anesthetic patient can respond if there is any pain and most of dental practices are on Local Anaesthetic so I don't think practice of painless dentistry is difficult............
I think painful dentistry is really a myth as that local anathesia solve this problems in small surgery as opertive C&B and lesion surgical removal and sometimes Endo treatment from long time.Local anathesia no Stop at traditional limits But show throughouts Make it easily use and more effective and safe. We can say that the main problem is Anxiety of patient especially childern during dental procedures.
Dear Ashok Ayer,
To eliminate the discomfort associated with injections, topical agents are applied to tissues prior to the injection. This combined with the use of Nitrous Oxide or "laughing gas" for relaxation can often reduce the pain, fear and anxiety associated with shots. Although still experimental, laser technology may soon change the way dentists treat tooth decay. Currently, lasers are being used for soft tissue management and in other areas of medicine such as eye surgery and skin treatments. However, in some laboratories, dentists are attempting radical new treatments involving the use of lasers to melt cavities. While initial efforts have experienced only moderate success, the use of laser technology could someday eliminate the need for intimidating drills and surgical instruments, precooling before injection site in children especially in the maxillary arch proved to be very effective.
First of all, when patients have dental fears, they need a long talk about what happened in the past and how the future can be different, before treatment starts. For that, the dentist needs to at least read up a little on kognitive behavioral therapy.
When you inject an anesthetic you can start with a topical anaesthetic, then inject only a drop or two and when the patient feels the difference, slowly inject the rest. In the upper front we divide the rest into 3 or 4 portions with a little waiting time in between. It really doesn´t take long, but it makes the injection painless. Then don´t forget simple things like asking the patient "is that numb enough, now?" or "Is that OK?"
And if the patient says it is not numb enough you have to respect that and find another way. Help the patient to feel safe and secure, even if he is in a dental chair. It is not hard, actually. You just have to think a little about how the patient feels, and keep your mind off of your bank account...
As for literature I would recommend the works of Philip Weinstein and Peter Milgrom, especially, for children, their book "Early childhood caries". With that, you could prevent many phobias. Philip Weinstein has also written a very good compendium on Motivational Interviewing, adapted to dentistry.
I have interviewed thousands of phobics. Root canals are one of the most feared dental treatments, because the dentists keep going even if the anaesthetic doesn´t work. And some dentists think they need the patient as a "guide" to where the root canal ends. Well, that is not correct even in theory. The "guide" will scream when you touch a possible rest of living tissue, and if you have part of the root canal filled with fluid, he´ll scream when you reach that, so it is not always the apex you have found when the patient report pain. Do not EVER do root canals without functioning anaesthetics unless the patients ask you to, or you will produce more phobics!
Great. Congratulations! Although the phobics may not come back to tell you about it. I hope you are right.
From a practical point of view psychology surely plays an important role. A good way to approach that and the technical side has been shown above. However, we also know that there is a wide range of factors that govern pain sensitivity such as (but by far not limited to) sex, beliefs and values, and emotional and psychological state. Pain is ultimately an output of the brain. And how the brain works is largely still a mystery, just like the concept of consciousness, which we aim to turn off during general anesthesia. The complexity of this matter is extremely high and we have to acknowledge that without answering these questions first, we will not be able to exercise full pain control.
No, I don´t think you have to be the world´s leading neuropsychologist to practice painless dentistry. But if you have a genuine interest in the patient´s view of the situation and try to do your best at it, you are way ahead of the crowd....
Mats I agree with you. But the original question aimed at research. That is what I addressed.
Mats I agree with you. But the original question aimed at research. That is what I addressed.
Q.1: Is painless dentistry still a myth?
There is no premonition that creativity is the most important human cradle of all. Dentistry is an art and science and its historical appraisal reveals an elite revamping from the aboriginal techniques to a rationalized approach. The man has constantly been a spectator of tremendous share of advancements and developments over the years. The field of dentistry could not have remained untouched and has perceived an eclectic array of revolutionary and awe spinning changed in the past few years.
The dental treatments have always been perceived as traumatic and fearful. Nobody but some deny experiencing anxiety over visiting their dentist. However, surprisingly it is not the actual dental procedure that most often terrifies patients. According to surveys, the site of a needle and the sound of the drill are the two most feared elements of dentistry.
Yes, to some extent “painless dentistry” has paved its way and is outstretching its wings to fully blossom. Nowadays, more and more dentists understand their patient’s fears, and with a combination of gentleness, kindness and proficiency can do a lot to make dental treatment a normal part of life. With the better understanding of patient’s fear, comes the better understanding of methods to uproot them from the core. A patient friendly ambience and pre-treatment counselling of the patient to make him accustomed to his dental problems and the treatment modalities, goes a long way in making the patient perceive dental treatment as a “painless” one.
Moreover, the technical advancements and innovations have made the concept of “painless dentistry” sound real. Air abrasion provides a gentle, conservative and less traumatic alternative to needle and high speed drill, with the advantages of no noise, no heat, and no smell and less stress. It allows the dentist to selectively remove decay, leaving healthier tooth structure. The procedure can often be done without anaesthesia.
To overcome the needle phobia, a painless computerized injection delivery system, “Wand” was developed to replace the traditional syringe in dentistry. As much of a revolution as an evolution, this computer controlled anaesthetic delivery system is a logical progression from the syringe. With The Wand, dentists can bring one of dentistry's last remaining antiquated designs into the 21st century. Apart from being painless, the additional advantages rendered are precise control of flow rate and pressure, increased tactile sensation, non-threatening, automatic aspiration.
Also, dental techniques have improved so much recently, that modern dental treatment can now be completely painless. The so called “sedation dentistry” aims to provide a path towards oral health without tears and fears. This approach no only helps relieve anxiety, but it numbs the affected areas so that the patient can’t feel the work of the dentist and hygienists. By the time the sedation wears off, the procedure is complete and the patient is ready to return home.
Dentistry has come a long way over the last few years. Your dentist has new ways to provide relatively painless treatment. For invasive procedures such as wisdom teeth extraction, biopsies and complex root canal surgery, nerve blocks are often administered. This involves the injection of an anesthetic to block sensation to the nerve that sends pain signals to the brain. To eliminate the discomfort associated with injections, topical agents are applied to tissues prior to the injection. This combined with the use of nitrous oxide or “laughing gas” for relaxation can often reduce the pain, fear and anxiety associated with shots. Although still experimental, laser technology may soon change the way dentists treat tooth decay. The laser technology could someday eliminate the need for intimidating drills and surgical instruments. The last but not the least, adequate oral hygiene is essential for less fear in the dental chair.
The aim of mostly every dentist nowadays is to make your check up a joyful and pain free experience. Also, with the current technology advancements pain free dentistry is no longer a myth.
Q.1: Is painless dentistry still a myth?
There is no premonition that creativity is the most important human cradle of all. Dentistry is an art and science and its historical appraisal reveals an elite revamping from the aboriginal techniques to a rationalized approach. The man has constantly been a spectator of tremendous share of advancements and developments over the years. The field of dentistry could not have remained untouched and has perceived an eclectic array of revolutionary and awe spinning changed in the past few years.
The dental treatments have always been perceived as traumatic and fearful. Nobody but some deny experiencing anxiety over visiting their dentist. However, surprisingly it is not the actual dental procedure that most often terrifies patients. According to surveys, the site of a needle and the sound of the drill are the two most feared elements of dentistry.
Yes, to some extent “painless dentistry” has paved its way and is outstretching its wings to fully blossom. Nowadays, more and more dentists understand their patient’s fears, and with a combination of gentleness, kindness and proficiency can do a lot to make dental treatment a normal part of life. With the better understanding of patient’s fear, comes the better understanding of methods to uproot them from the core. A patient friendly ambience and pre-treatment counselling of the patient to make him accustomed to his dental problems and the treatment modalities, goes a long way in making the patient perceive dental treatment as a “painless” one.
Moreover, the technical advancements and innovations have made the concept of “painless dentistry” sound real. Air abrasion provides a gentle, conservative and less traumatic alternative to needle and high speed drill, with the advantages of no noise, no heat, and no smell and less stress. It allows the dentist to selectively remove decay, leaving healthier tooth structure. The procedure can often be done without anaesthesia.
To overcome the needle phobia, a painless computerized injection delivery system, “Wand” was developed to replace the traditional syringe in dentistry. As much of a revolution as an evolution, this computer controlled anaesthetic delivery system is a logical progression from the syringe. With The Wand, dentists can bring one of dentistry's last remaining antiquated designs into the 21st century. Apart from being painless, the additional advantages rendered are precise control of flow rate and pressure, increased tactile sensation, non-threatening, automatic aspiration.
Also, dental techniques have improved so much recently, that modern dental treatment can now be completely painless. The so called “sedation dentistry” aims to provide a path towards oral health without tears and fears. This approach no only helps relieve anxiety, but it numbs the affected areas so that the patient can’t feel the work of the dentist and hygienists. By the time the sedation wears off, the procedure is complete and the patient is ready to return home.
Dentistry has come a long way over the last few years. Your dentist has new ways to provide relatively painless treatment. For invasive procedures such as wisdom teeth extraction, biopsies and complex root canal surgery, nerve blocks are often administered. This involves the injection of an anesthetic to block sensation to the nerve that sends pain signals to the brain. To eliminate the discomfort associated with injections, topical agents are applied to tissues prior to the injection. This combined with the use of nitrous oxide or “laughing gas” for relaxation can often reduce the pain, fear and anxiety associated with shots. Although still experimental, laser technology may soon change the way dentists treat tooth decay. The laser technology could someday eliminate the need for intimidating drills and surgical instruments. The last but not the least, adequate oral hygiene is essential for less fear in the dental chair.
The aim of mostly every dentist nowadays is to make your check up a joyful and pain free experience. Also, with the current technology advancements pain free dentistry is no longer a myth.
Q.1: Is painless dentistry still a myth?
There is no premonition that creativity is the most important human cradle of all. Dentistry is an art and science and its historical appraisal reveals an elite revamping from the aboriginal techniques to a rationalized approach. The man has constantly been a spectator of tremendous share of advancements and developments over the years. The field of dentistry could not have remained untouched and has perceived an eclectic array of revolutionary and awe spinning changed in the past few years.
The dental treatments have always been perceived as traumatic and fearful. Nobody but some deny experiencing anxiety over visiting their dentist. However, surprisingly it is not the actual dental procedure that most often terrifies patients. According to surveys, the site of a needle and the sound of the drill are the two most feared elements of dentistry.
Yes, to some extent “painless dentistry” has paved its way and is outstretching its wings to fully blossom. Nowadays, more and more dentists understand their patient’s fears, and with a combination of gentleness, kindness and proficiency can do a lot to make dental treatment a normal part of life. With the better understanding of patient’s fear, comes the better understanding of methods to uproot them from the core. A patient friendly ambience and pre-treatment counselling of the patient to make him accustomed to his dental problems and the treatment modalities, goes a long way in making the patient perceive dental treatment as a “painless” one.
Moreover, the technical advancements and innovations have made the concept of “painless dentistry” sound real. Air abrasion provides a gentle, conservative and less traumatic alternative to needle and high speed drill, with the advantages of no noise, no heat, and no smell and less stress. It allows the dentist to selectively remove decay, leaving healthier tooth structure. The procedure can often be done without anaesthesia.
To overcome the needle phobia, a painless computerized injection delivery system, “Wand” was developed to replace the traditional syringe in dentistry. As much of a revolution as an evolution, this computer controlled anaesthetic delivery system is a logical progression from the syringe. With The Wand, dentists can bring one of dentistry's last remaining antiquated designs into the 21st century. Apart from being painless, the additional advantages rendered are precise control of flow rate and pressure, increased tactile sensation, non-threatening, automatic aspiration.
Also, dental techniques have improved so much recently, that modern dental treatment can now be completely painless. The so called “sedation dentistry” aims to provide a path towards oral health without tears and fears. This approach no only helps relieve anxiety, but it numbs the affected areas so that the patient can’t feel the work of the dentist and hygienists. By the time the sedation wears off, the procedure is complete and the patient is ready to return home.
Dentistry has come a long way over the last few years. Your dentist has new ways to provide relatively painless treatment. For invasive procedures such as wisdom teeth extraction, biopsies and complex root canal surgery, nerve blocks are often administered. This involves the injection of an anesthetic to block sensation to the nerve that sends pain signals to the brain. To eliminate the discomfort associated with injections, topical agents are applied to tissues prior to the injection. This combined with the use of nitrous oxide or “laughing gas” for relaxation can often reduce the pain, fear and anxiety associated with shots. Although still experimental, laser technology may soon change the way dentists treat tooth decay. The laser technology could someday eliminate the need for intimidating drills and surgical instruments. The last but not the least, adequate oral hygiene is essential for less fear in the dental chair.
The aim of mostly every dentist nowadays is to make your check up a joyful and pain free experience. Also, with the current technology advancements pain free dentistry is no longer a myth.
With all due respect, but the "Wand" is a useless waste of money. You can install the software of the Wand in the dentist´s brain if you just use a topical anaesthetic, talk to the Patient about the numb feeling, then inject a drop or two and discuss with the Patient that the area in question is now more numb and then inject the rest slowly or - in the upper front - in 3 or 4 portions. That way the anaesthetic will be painless. After that, you need to check if the anaesthetic has worked. As you know, in more than 90% of the cases that is so, but not in 100%. If the Patient says it is not painfree, you have to respect that and be flexible. If I had a dollar for every phobic who has experienced dentists who keep going although the anaesthetic has not worked, I could buy me a couple of Porsches....
Dr. Ayer: Is painless dentistry still a myth? No, dental materials and procedures are still scary and painful. So stop the pain, drop the wand, the sedation, psychology, clever terminologies, scary high-tech scans, and stop hurting patients. A good start is to use painless, nonsurgical methods and materials that save teeth, keep people healthy and out of the dental office. Dr. Paul Keyes gave us nonsurgical perio methods. Brazil's Dr. Roberto Holland detailed the benefits of calcium materials. Then, a Turkish team confirmed those benefits. Since, Omaha's calcium therapy has applied painless protocols in every dental field, without anesthesia or surgeries. All it takes is common sense. Painful dentistry is real, and when one stops it, patients will gladly pay for the Porsche.
No, it is not a myth. What you can do is: listen to the patient, ask questions and take everything seriously what the patient says. Be on a level with the patient and treat him with respect. Never ever keep going if the anaesthetic has not worked properly. Do not criticize the patient. Just a few hints to prevent the most common mistakes that produce phobics. Could be taught at the university in less than half an hour, but, sadly, seems to be overlooked. I´ve talked to numerous phobics every day for nearly 40 years. These are the most common mistakes dentists do, to cause dental fears.
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