‘90s-Style Changes Take the Fear Out of Seeing the Dentist

Leaning far back in the long, narrow chair, bright light in your eyes, the feeling is unmistakable: This is the dentist’s office.

But there is no drill in sight.

Instead, a box powerful enough to vaporize cavities with light waves sits at your feet. On your right, a computer screen displays 14 inches of X-rays of your teeth, all organized by Windows 95.

On your left, a wand topped by a miniature camera can go inside your mouth, illuminating pink gums and yellowish teeth on a television.

“This is the way dentistry is today,” said Dr. Lori A. Cardellino, whose Bel Air, Md., office is loaded with the latest technology--tools that promise less pain, fewer needles and shorter stints in the chair.

During procedures, Cardellino gives her patients a headset to watch videos such as “Jurassic Park.”

In the past 10 years, researchers have scrutinized every angle and crevice in dentistry, developed new materials to fill cavities and bond teeth, figured out how to get X-rays on a computer, devised machines to replace the drill, invented ways to mask or avoid completely the dreaded stick of the needle.

Some call it a revolution; others, an evolution.

There is so much new technology that teaching it all in four years is becoming increasingly difficult, and educators are considering adding a mandatory fifth year--a residency--to dental school.

But many dentists are treading slowly, unsure which products may prove harmful and which may ultimately become standards. They worry that the technology is doubling and tripling the cost of some procedures, without significantly improving care.

“Dentists by nature are very mechanical and hands-on oriented,” said Dr. Todd Sarubin, who practices with his father, uncle and cousin in Woodlawn, Md.

“You go to a dental show, and you see every booth has a toy, and you want to play with them.

“Some of these things are useless,” he said. “I have a closetful of things that don’t do anything. You have to be careful.”

Among those who have been eager to embrace some of the inventions is Dr. Stewart Rosenberg, a Laurel, Md., dentist who lectures worldwide on new technology.

“There is no more exciting time ever in our history to be a dentist, and no more exciting time ever in the history of dentistry to be a patient,” he declared.

“We’re taking all the fear out of going to the dentist.”

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For millions of Americans, that change can’t come soon enough.

Today’s adults have searing memories of bleeding gums and whining drills that rotate at 400 rpm. The American Dental Assn. estimates that 35 million people are afraid of the dentist. Many of them avoid treatment.

And because it’s difficult to see inside one’s mouth, people can go for months without realizing something has gone wrong. To top it off, many people don’t have dental insurance and can’t afford to pay for care themselves.

But the need is great.

People have fewer cavities today that show up as big holes in their teeth, dentists say, and more decay that’s harder to see between teeth and penetrating the underlying structure of teeth.

By the age of 50, statistics show, 11% of Americans have lost their teeth, 47% need dental care for cavities in the roots and crowns of their teeth, and 57% suffer from conditions such as inflamed gums.

Debbie Busch’s case is classic. The Bel Air woman had several small cavities and put off fixing them for years. Last winter, she finally went to Cardellino’s office and went under the drill.

“Eeeeyeech!” she said. “It feels like your head is going to vibrate off!”

After that, Busch, 40, refused to have the other cavities filled. But Cardellino told her about the laser, then used the intraoral camera to show her six small cavities, close-up. Busch was convinced. So for a little more than an hour during a recent appointment, Cardellino wielded the laser.

“It was over so fast with that laser. I didn’t feel a thing,” Busch said. “Getting your teeth cleaned is worse.”

The laser, which has been used for some time on soft tissue such as gums, was approved for use on hard tissue by the Food and Drug Administration in May.

Resembling a fat pen, the tool spits out a thin beam of red light.

Because there is no drilling, there is no vibration, and no getting to the thing that causes the pain--the nerve. Light energy destroys diseased tissue without taking out any of the healthy tooth, a distinction drills can’t make. Most of the time, the patient doesn’t need anesthetic--therefore no needle.

Some patients said they had to pay extra for the laser, as much as $75 more, which their insurance companies wouldn’t cover. But they are willing to do it again.

“It was just so clean and quick. It was the best dental experience I’ve ever had in my life,” said Cindy Crowther, 35.

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So far, the laser’s application is limited. It can’t be used on silver fillings, because the light waves will reflect off the silver and damage other tissue in the mouth. Because light doesn’t bend, it’s also hard to reach back teeth.

And the FDA has not allowed the laser to be used on children. The American Dental Assn. has taken a cautious stance, saying it has some concerns about the laser’s safety and efficacy.

Made by California-based Premier Laser Systems Inc., the tool costs about $40,000. Cardellino is paying $1,500 a month for it, compared with about $2,300 a month for all her other equipment. But in the past two months, the laser has drawn 120 new patients who--even though many weren’t suited for its use--generated revenue of $70,000.