New fangled technology

A few of you out there may have come into close contact with the business end of a dental laser, as quite a number of Auckland dentists use these at the moment. Lasers cut or ablate by literally vaporizing tissue – both hard and soft – usually under water cooling. A huge advantage with lasers, especially in surgery, is the fine control that the surgeon has over what is cut – eg bone or soft tissue. 

Additionally, lasers can be “pulsed” ie the laser’s cutting ability is timed in discrete bursts of activity. Now the theory behind this is that if the pulses are timed just right, the patient’s nerve response will be much diminished and hence, the amount of pain is minimized or eliminated altogether. Practically though, this doesn’t always pan out and patient’s have to be anaesthetized, and if not, then peeled carefully away from the ceiling where they’ve jumped to when the laser is initially applied. 

Digital radiographs are also making inroads into dental care here, with many dentists having had them for 5 or more years. The first reaction I get from patients when I pull out my digital sensor is, “is this going to cost more?”. Well, umm, let me see, uh, yes. Why would you pay more for digital technology? Especially when the old film based systems have served dentists well for the past decades?

One extremely good reason, and to my mind, the most important, is the reduced radiation. The digital sensors are very sensitive so that the amount of radiation needed to produce an image is a fraction of that of a film x-ray. So if someone said to me that I NEEDED radiographs, AND I had a choice of cheaper HIGH radiation ones or the more expensive LOW radiation ones … you get my point? To sweeten the deal, digital images can be magnified and manipulated to enhance areas that cannot be easily seen in film radiographs.

 Digital radiography is expensive at the moment but as dentists become more open to the idea of a computerized surgery, the costs are bound to come down.

 Making a recent appearance in the New Zealand dental scene is ozone treatment. HealOzone is a machine that popped up in dental consciousness some 2 years ago, the premise being that if you flooded a small demineralised spot/cavity with ozone, you effectively nuke all the bad bugs in the area and with some luck you can remineralise the lesion (literally heal the cavity).

 Does this work? Well yes, but case selection is very important. If you front up with a large cavity that you can effectively use as an extra garage then no amount of ozone, no matter how judiciously placed, will cause any sort of healing. Similarly, if the cavity is between the teeth, then it is harder to get a good seal between the ozone handpiece head and tooth surface. Hence, ozone treatment works well in adolescents, when new cavities are just on the verge of starting, preferably at the tops of teeth.

“Chair-side milling” is an interesting “newish” concept whereby a specialised scan is taken of a prepared tooth, and a scanner transfers this image onto a milling “robot” that cuts a filling or crown out of a solid block of porcelain. This can then be fitted into your tooth while you wait! This is often called CEREC dentistry after the machine that popularised this form of restoration amongst dentists”

 Just yesterday, the New Zealand Herald lauded a new “discovery” where a protein based coating placed on teeth with early cavities can be “coaxed” into self-healing by mimicking the way saliva naturally remineralises tooth tissue. What they failed to add is that if the reason why these cavities formed in the first place is not treated then all the remineralisation in the world is not going to matter one whit in the face of a steady assault of neglect!

 There was also mention of a photo-active substance that could be designed to do a number of things – from killing off bad bugs, to releasing fluoride and other tooth friendly substances – with a flick of a light.

 All these things will enhance your dental experience and in many cases minimize the discomfort you feel but NONE of them will negate your responsibility for your own dental health. As my cardiologist is fond of saying, there’s nothing he can do for my heart it I choose to fry and eat everything before me! But, damn it all, fried food TASTES so GOOD!

Adrian Tan is a dental practitioner practicing on Auckland’s beautiful Viaduct Harbour. In a past life he was a writer for GP Weekly, a New Zealand weekly medical periodical, reviewing websites for doctors too busy to do so. These days he works at aesthetic dentistry to keep his dogs in the lifestyle that they are accustomed to.