You know the drill: It vibrates, whines, hisses, whirs, grinds and smells like it's on fire.
And as if the drill weren't bad enough, it's preceded by those painful lidocaine injections to deaden the nerves and make the drilling more tolerable.The syringe is the most fear-provoking device in dentistry. Why, just the sight of the gleaming needle could cause more sweat than a peck of pickled habaneros - until now.
A new computerized anesthetic delivery system, called "The Wand," has some patients proclaiming lidocaine injections "pain-free."
And other changes in dentistry are further reducing the ouch factor.
Air abrasion is doing away with the drill and needle altogether in filling some superficial cavities, and lidocaine patches and a powerful new anesthetic rinse are being used to numb the pain of injections and sometimes eliminate the need for them.
These days it's no pain, no ... really.
"I've had cleanings that were more painful than this," proclaimed Blake Estes, 43, immediately after undergoing more than two hours of periodontal surgery. "You don't feel anything but a little bit of pressure on your gums, and then you can feel the sensation of numbness moving out to the edges of your mouth."
Estes said if he had shut his eyes while Dr. William DuBois anesthetized his mouth for the extensive gum surgery, he would not have known the dentist was doing anything.
"With the rinse and patches and the wand, we can really almost guarantee painless dentistry. We've only been able to say that for the last couple of years," said DuBois, a periodontist in Grand Prairie, Texas.
Of the 40 percent of Americans who seldom or never go to the dentist, 60 percent say fear of pain is the reason, DuBois said.
"With all the research in the last year or so positively linking gum disease to blood clots that cause heart attacks and strokes, it is especially important that consumers know there are things out there to make their dental work pain-free," he said.
He helped field-test the new lidocaine dental patches and uses them for less extensive dental work. The anesthetic-laden bioadhesive patches are applied directly to the mucous membrane lining the jaw and take about 10 minutes to numb the area for minor procedures or pain-free injections.
The new Dyclone rinse, a mouthwash, achieves the same objective. It is also used to suppress the gag reflex in the positioning of X-ray films and making prosthetic impressions.
"The Wand," a computer-controlled local anesthetic delivery system, debuted at the American Dental Association's annual scientific meeting in October.
"It's the newest thing we have going," said Jann Ingmire, public relations director for the ADA. "It still involves a syringe, but the drug goes in at such a slow, steady rate, most people say it doesn't hurt at all. Some think it doesn't use a needle, but it does."
The system uses a very fine needle, and the anesthetic moves out just ahead of the needle point so that it numbs as it goes into the gum.
Air abrasive dental devices, usually found in general dentistry offices, are not new. They were first used in the 1950s, before the introduction of the high-speed drill, said Chris Smith, a spokesman for the Chicago Dental Society.
The "Borden Air Rotor" drill was so far superior to anything else available that it put the old belt-driven drills, as well as air-abrasive units and other cavity-preparation tools, out of business.
But air abrasion, sometimes called "dental sandblasting," is making a comeback, Smith said.
The technology uses microparticles of aluminum oxide, an abrasive substance used in some dentifrices, blown through a pointerlike hand piece at a very high speed. The hand piece is directed at tooth decay, which is blasted away in a matter of seconds.
Discomfort due to vibration and heat is eliminated, so the process can usually be performed without anesthesia, Smith says.
Dental sandblasting is used most often to clean out small cavities without taking any healthy tissue. The cavity is then filled with a liquid porcelain material that seeps into all the cavity's nooks and crannies and quickly hardens.
The process is much quicker than traditional drilling and filling, and the filler matches the tooth color.
In addition, this year the ADA Council on Scientific Affairs favorably reviewed data on the first laser system for treating tooth decay.
Lasers have long been used in dentistry for soft tissue work, such as gum surgery, and recently were approved for one-step bleaching. A laser also is being used instead of a drill to clean out cavities.