Painless Dentistry ...Pulp Fiction or Virtual Reality?

by Marc A. Amsili, D.D.S., P.A.

What do you fear most about going to the dentist? Just the thought of having a needle inserted into your cheek and a cavity removed from your tooth is enough to bring tears to the eyes. 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 were the two most feared elements of dentistry. It may seem strange, but visual stimuli, sounds and even memories can actually enhance pain. In fact, fear and anxiety related to dental procedures very often complicates matters. It is comforting to know that just as the mind can trick you into interpreting sights and sounds as pain, so too can the mind be used to control pain. In this article, we will explore the reasons behind the severity of dental discomfort and offer options for its control.

Dental Pain - Is It All In Your Head? 
The first step in managing or eliminating the discomfort involved with going to the dentist, is understanding its source. In many cases, the myths about dental pain often outweigh the realities and the anxiety caused by these myths further intensifies the pain.

Psychological 
Factors In addition to the perceived pain brought on by intimidating sights and sounds, other factors such as your state-of-mind can effect the level of discomfort experienced. A high level of stress and irritability makes it more difficult to control pain. Although the reasons are not fully understood, the effect of anxiety on the body's ability to suppress pain is significant often requiring that the patient be premedicated with anti-anxiety drugs such as Valium.

Physiological Factors 
Because of the oral cavity's proximity to the brain, as well as the complex nerve structure of the head and neck, dental pain is often more severe than pain in other parts of the body. Of the 12 cranial nerves that control motor and sensory functions of the head and neck, the Trigeminal Nerve or 5th Nerve (V - as seen in the diagram below) is responsible for sending pain signals to the brain. The V2 (Maxillary Nerve) and V3 (Mandibular Nerve) sections of the Trigeminal Nerve relay pain signals from the upper and lower teeth.

One of the most troublesome biological factors that dentists must deal with is bacterial infection. In addition to the sensitivity caused by infections, the initial inability of oral infections in the teeth and boney structures to drain results in the build up of pressure. As bacteria quickly multiplies and produces gaseous toxins, pressure increases and pain results. If an infection is neglected for even a day or two, the pressure can become intolerable.

Controlling Dental Pain 
For some straight forward dental procedures, controlling pain and fear can be controlled by utilizing relaxation tools such as Nitrous Oxide or Hypnodontics. However, other more complex procedures, such as surgical scaling and root canal therapy, require nerve blocks in combination with relaxation therapy.

Dental Health Maintenance 
Of course, the most important way to reduce the pain involved in maintaining oral health is by focusing on preventive care instead of the treatment of problems. If you've put off going to the dentist for years and have neglected regular flossing or brushing, you may be experiencing advanced stages of tooth decay or gum disease - both painful problems. The further decay spreads, the more radical the treatment required. This causes trauma to the tooth and gums that results in discomfort.

New Advances in Dentistry 
Dentistry has come a long way over the last few years and many of you will be surprised on your next visit. Even if you have put off going to the dentist and are experiencing problems, 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 block are often administered. This involves the injection of an anesthetic to block sensation to the nerve that sends pain signals to the brain. By blocking the nerve with an anesthetic, the dentist can numb the area requiring treatment for a specific period of time. 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.

The Power of the Mind 
Although somewhat controversial, many dentists today coach their patients in hypnodontics - a form of hypnosis to control dental pain. Through the combination of Nitrous Oxide and deep relaxation techniques, patients can be relaxed to ease anxiety. For those who prefer to limit the use of pain medication, practicing deep relaxation techniques to reduce stress and building a strong relationship with a dentist you respect and trust can go a long way towards a relatively painless dental experience. A soothing atmosphere and a calm, reassuring dentist can make your next dental visit more pleasant.

Before Your Next Appointment at Omni Dental Group...
Remember that there us no better way to avoid painful problems than to practice good oral hygiene. So, follow these important guidelines for a relatively painless trip to the dentist:

• Understand the source of the pain and that pain is subjective. When fear and anxiety are experienced sights and sounds can be interpreted as pain.
• Don't ignore minor dental pain. A slight ache is usually an indication of a greater problem that will only grow worse with time.
• Relax and remain calm. Anxiety only enhances pain.
• Select a gentle and caring dentist who is familiar with the latest dental techniques. A dentist that you can trust is important for relaxation and state of mind.
• Get a good nights sleep before going to the dentist. A well-rested mind and body are critical to controlling pain.
• And most importantly, don't neglect regular dental health maintenance. As I tell all my patients, brush twice a day and only floss the teeth you want to keep.

Life Can Be "Like A Box of Chocolates" ....If You Practice Good Dental Hygiene

By Marc A. Amsili, D.D.S., P.A.

Remember the famous line from Forrest Gump's momma in the 1995 Oscar-winning film? "Life is like a box of chocolates. You never know what you're gonna get." Well, that may be true. But there is one thing we do know - if you don't practice proper dental hygiene, you're most certainly gonna get a cavity, or at least periodontal disease.

It is easy these days to become overwhelmed by the advertising and media attention focused on dentistry and dental products. And while this attention may seem excessive, it does help to emphasize the importance of good oral hygiene for health, beauty and overall quality of life.

Daily Dental Care 
Brushing twice daily, flossing at least once a day, and making two trips to the dentist each year may seem like too much effort for our busy lifestyles. You may be wondering if all of this is really necessary. My patients often ask, "Isn't it really just important to brush every day and see your dentist whenever there is a problem? You know, just like going to the doctor when you have a pain or illness?"

Well, in a word -- No! While dentistry shares many similarities with the medical field, there is one significant difference

It is vital that you perform regular preventive maintenance for your teeth and visit your dentist before you notice problems for early detection. In dentistry, by the time you begin to experience pain, usually radical treatment is required. And your teeth rarely repair themselves.

So based on the fact that dental hygiene has such an important impact on our lives, lets examine each of the important steps to proper oral hygiene in order of importance:

Flossing
Yes, flossing. You might have thought brushing would be the most logical place to start talking about dental hygiene. Yet flossing is actually the most important regimen for maintaining good oral health.

Proper Flossing Techniques 
Flossing is simple and painless when done properly. Simply wind the floss around your fingers and slide the exposed floss between each of your teeth. When flossing it is important not to neglect the area under the gumline. This is where plaque collects to form tartar. If not properly cleaned on a daily basis, this can lead to periodontal disease. This can sometimes be irreversible requiring extraction of the teeth. So, each day (or twice a day if possible) make sure clean the areas between the teeth as well as under the gumline with floss.

Bleeding Gums
If you experience bleeding gums after flossing do not be alarmed. This is a normal reaction to flossing if you haven't flossed recently. In fact, the worst mistake you can make is to stop flossing. After a few days of regular use, your gums will become accustomed to the flossing and will not bleed.

Making Flossing Easier 
Recently several new flossing products have been introduced that allow consumers to more quickly and easily floss. Products like Glide(TM), a tape-like strand, and other accessories make it easier to floss. Waxed floss will be easier to use, however, there is some controversy around the use of waxed floss. For maximum effectiveness, you may want to use an unwaxed floss to avoid remnants of wax that may be left on the teeth.

Brushing
You've heard it time and again, but let me repeat, "use a soft bristle brush to brush your teeth." Soft bristles are much more effective than medium or hard bristles at removing the plaque and calculus from the surface of the teeth without damaging the enamel or gum tissue.

Brushing Techniques
Just as important is your brushing technique. Years ago, we were all taught to brush up and down, from the gum to the tips of the teeth and back again. However, it is now known that brushing in circular motions is one of the most effective ways to clean teeth. Practice brushing in small circles to polish and clean teeth, while stimulating the gums.

Brushing Paraphernalia
Contrary to the commercials we all see on televisions, you do not have to invest in the plethora of fancy dental products on the market like multi-level bristled brushes, plaque reducing rinses and super turbo boosted toothpaste and teeth whiteners. Most of these products are expensive and unnecessary. In fact, it has often been said that if you floss and brush, you do not even need toothpaste.

Adapting Your Oral Hygiene Program
As we've all experienced, age brings about many changes to our bodies. Among these, are changes to the oral cavity. Bacteria in the mouth appears to go through changes as we mature. Children experience more problems with cavities than adults. However, adults have a much higher rate of gum disease.

While both children and adults must floss and brush regularly, it is important to focus on specific programs for oral hygiene based on age. For example, children often require regular fluoride treatments and tooth sealants to prevent tooth decay. While both of these treatments must be performed by a dentist, is also wise to use a toothpaste at home that contains fluoride.

Adults will need to focus on flossing underneath the gumline and may often need toothpaste for sensitive teeth. Toothpaste for sensitive teeth is not a frivolous accessory when it comes to oral hygiene. In fact, these special toothpastes use ions which adhere to the teeth filling in the microscopic pores that cause tooth pain.

Monthly Cleaning and Checkup
Brushing and flossing alone do not remove all of the plaque and calculus from your teeth. While there are products on the market designed to remove plaque from the surface of teeth, use of these products at home is not sufficient to maintain good oral health. A regular cleaning every 6 months and sometimes every 3 months is a requirement. This is because your dentist is trained to remove the plaque that you cannot see or reach. Additionally, a checkup along with the cleaning can often help you catch many problems before decay or infection has gone too far. This can only be done by your dentist.

Quality of Life 
The good news is that you don't have to avoid sweets (with the possible exception of hard candies). Eat all the chocolate that you want. But make sure you brush your teeth afterwards. This will allow you to eat all your favorite foods today and in your 60's and 70's. Because there is nothing like a full set of your own teeth for enjoying apples, corn on the cob and steak.

Dentistry Simplified

Dentistry Simplified In my thirty-some years of practicing dentistry, I still find the oral environment fascinating. At the same time, it is both simple and complex, understood and not understood. Let's talk for a minute about what constitutes oral health, what is an unhealthy oral condition and what some of the options are to you - as healthy or unhealthy - as a patient.

Basically, a healthy oral environment is on in which everything is working together in harmony. That is, all teeth are present (except for wisdom teeth or teeth removed for orthodontic treatment), the alignment of the teeth is correct, the bone and gum around the teeth is healthy and strong and all is clean. If this is your fortunate condition, regular daily dental care with toothbrushing, flossing and toothpicking should keep you there. Coupled with a yearly visit to the dentist to verify that all is well and a once or twice a year cleaning done professionally by the hygienist should be all that is required.

What if your lot is not so lucky! Here is where the mouth and teeth fool us. The first culprit to creep in is decay. Another is gum and bone weakening called periodontal disease. Both of these processes take a long time to have a harmful effect. Usually there is no feeling, discomfort or awareness that this is happening. IF YOU WAIT LONG ENOUGH FOR THE TEETH TO HURT, THE GUMS TO SWELL OR THE TEETH TO LOOSEN…YOU HAVE WAITED TOO LONG!!!! At this point, you now require involved treatment or the loss of one or many teeth. If teeth are removed (and not replaced), remaining teeth can move and drift up, down, forward or backwards. This results over time in loss of tooth-to-tooth fit, loss of chewing efficiency and loss of your smile. To emphasize and point out again, the problem is that decay of the teeth and problems in the gum and bone that support the teeth are slow-occurring and happen for a long time without any awareness of the problem. Detected early, these problems are solved easily, with as little as a filling and a cleaning required. Left too long, crowns, tooth removal, bridges, removable plates and accompanying periodontal surgery may be required. I always say, "If you don't want to see the dentist much, visit once a year, get checked and keep yourself in good dental health".

What if all checks out? You do a good job of daily home care. You have healthy teeth, gums and bone. Are there any additional options of treatment or care for you? The answer is "Yes!". If alignment is incorrect or teeth are crowded and not visually appealing when you smile, you may be a candidate for braces. The dentist who specializes in this treatment is called an orthodontist. The general dentist may also be able to offer bonding ("coating") of teeth, filling in gaps between teeth, veneering ("porcelain fronts") or other cosmetic options. If teeth are discolored, you may be a candidate for bleaching. This is a process which actually changes the tooth color of the enamel on your natural teeth. You may want to change old silver ("dark") fillings to tooth colored fillings. If you grind your teeth at night and wake up with sore jaw muscles or tender joints, you may be a candidate for a night guard - a custom made plastic device you put in your mouth at night that allows the teeth to harmlessly slide over each other.

As a practicing general dentist and as a representative of the dental profession, I invite you to see the dentist. I challenge you to obtain and maintain good oral health. We would love to see you and help you understand where it is that you stand orally and discuss with you any options regarding your teeth you may be interested in.