Friday, May 1, 2015

A Revolution in Dentistry

My dental X-rays, photo © B. Radisavljevic
May 1 is Theme Day, and the theme today is revolution. I was all set to write about the landscaping revolution in Paso Robles, with everyone being encouraged to get rid of their lawns and turn them into landscapes that use less water. I even had the photos. But something made me abandon that idea.

It was replaced by a new idea that came while I was in the dentist chair today. I was remembering how dentistry was when I was growing up in the 1940's and 1950's,  and those memories are far from pleasant. Even up until sometime in the 1980's, while some advances in dentistry were occurring, it's only been in this century that the difference has been striking. New technology, primarily the use of computers and digital photography, also have become important in transforming dentistry. 

I began talking to my dentist, Dr. Casper, and his assistant, Sandra, about the revolution in dentistry, and they helped me sum it up. Here are some of the contrasts between the dentistry I grew up with, and dentistry as it is practiced today in my city. 

In the past, patients sat upright in the dental chair and were facing an intimidating monster machine that held the feared drill. Directly in front of the patient was a small sink used for rinsing out the mouth and spitting out foreign substances that were usually byproducts of dental procedures. Now the dental assistant stands by with a hand piece that squirts water to rinse the mouth and then she can also suction it out so that the patient doesn't have to rinse and spit.

Today, patients lie back in the chair and the dentist uses a smaller, faster hand piece for drilling. It is much quieter than the old drills. The big machine is gone. Instead of looking at the machinery, I now have a view of the window you see in the photo above. 

In the past dentists used regular X-ray machines and the technicians would put awkward squares of film in a hard frame that cut into the patient's mouth while the pictures were being taken. The patient had to hold them between their teeth while the technician went to press the button to snap the photo. Now the mouth inserts are a bit more comfortable and digital photography rather than  radiation is used to take the pictures. You can see my latest photos above. 

Since I was young, many new dental materials and techniques for keeping patients chewing have evolved. Many were invented before the turn of the century, but most were not commonly used. One example from today's visit comes to mind. A crown that had been put in before I moved here in 1992 had to be removed today to fix a bit of decay that was starting under it. Crowns were made and attached with different materials back then, and Dr. Casper had a hard time getting the crown off to do the repair work. 

Most fillings when I was growing up were gold and silver. The ones I get today are composite resin and colored like teeth. To keep me from having pain while I was being worked on, I used to get Novocain and / or nitrous oxide. Today we still get shots, but they contain different anesthetics. Dr. Casper said a number of people had been allergic to Novocain. Before giving shots today, a raspberry flavored pre-numbing agent is rubbed onto the surfaces that the needle will be injecting into. This is supposed to make the shots less painful. I think there is still room for improvement here. 

I asked Dr. Casper why I can't seem to find a dentist that still will use nitrous oxide on nervous patients like me. I used to be able to get it until the late 1990's, and then it seemed everyone stopped using it. Dr. Casper explained that it was discovered that many patients exhaled some of the gas through their mouths and it accumulated in the air breathed in by dental personal, and it would build up in their systems. This sometimes caused pregnant women to have miscarriages. So Dr. Casper and most other dentists discontinued using it. 

That's me in my googles, photo by dental assistant.
Another thing Dr. Casper mentioned is that in the past, very little was done to effectively sterilize instruments. Novocain needles were reused. Dental personal did not wear masks or gloves, and patients were not given goggles like the ones I was given today to protect my eyes from splashes as the dentist worked. 

Today lots of universal precautions are observed by dentists. I think these new practices to protect both patients and dentists became more widespread when the HIV virus started to make the news and people became worried. 

A lot more specialists are involved in dentistry today. Although your family dentist is probably licensed to do everything if necessary, most dentists will refer patients to an oral surgeon  for anything but a simple extraction. Periodontists may be called upon to help with gum disease. You can read about more dental specialties here. 

It used to be if you had to lose a tooth, the the dentist pulled it and you didn't have many options besides false teeth or bridgework. Today teeth can be replaced with implants that look and act almost like your natural teeth. They are expensive and they take a period of several months between the extraction and the final placement of the implant and the crown, but they are worth it. I've had three of them. 

This is how dentists and a modern office look today when you are being treated. I took this picture with Dr. Casper's permission, but his assistant had her back turned. Sandra was busily writing me a cheat sheet for this blog, since I wasn't in a position to take my own notes while they were talking. She was also wearing a mask. I want to thank both Dr. Casper and Sandra for the information they gave me to help me write this. Dr. Casper practices in the downtown area of Paso Robles. 

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