Dental Technology

Thanks to new dental technologies, modern dentists can treat patients more quickly, more efficiently and more comfortably. Some technologies have eliminated the use of drilling. Other technologies allow dentists to make vast aesthetic improvements to a patient’s smile in half the normal time. And even more exciting are the developments that will enable patients to grow new teeth, perhaps permanently eradicating the need for drilling or filling!

Genetic Engineering May Grow New Teeth

The human genome project involves identifying the three billion chemical base pairs and 50,000 to 100,000 genes that are contained in the human genome (all of the genetic material that makes up a person). This information may help to prevent and cure diseases, and may also aid other scientists that seek to "grow" new teeth in the future. Mary MacDougall, Ph.D., associate dean, Dental School, University of Texas Health Science Center at San Antonio, says she, along with colleagues, has been studying the dynamics of tooth formation and conducting laboratory research to eventually grow human teeth. To understand the research, we need to know a little bit about the anatomy of the tooth. A tooth is hollow like our bones, and is composed of several layers. The outermost layer (above the gum line) is called the enamel. Enamel is the hardest and most mineralized substance in the body. Beneath the gum line a substance called cementum covers the tooth roots. Under the enamel and cementum is the dentin. Beneath the dentin is the dental pulp. The pulp is a vascular tissue composed of capillaries, larger blood vessels, connective tissue, nerve fibers and other cells. Dr. MacDougall's research uses genetically engineered mouse and human cell lines to form these three outer layers of the tooth, the enamel, cementum and dentin. The goal of the research is to grow teeth remotely in culture for transplantation or locally within the mouth itself. The benefits of this research would be incredible for people with missing teeth. Teeth that are lost due to extensive cavities, gum disease or accidents could be replaced with new, genetically created ones. Instead of having to wear dentures or rely on synthetic titanium implants, a person could have real, natural teeth either reimplanted or regrown in place of the missing ones. Although the practical applications of this research may be many years into the future, the idea of growing new teeth is an intriguing one. Just a few decades ago, dental implants also seemed like a far fetched way to replace missing teeth. Now, it is common practice in dentistry. Who knows what else will be common practice in dentistry just a few decades from now?


Keeping Dental Waterlines Clean

Dental unit waterlines supply the water used during dental treatment. The water is used most often in high-speed drills, the air-water syringe, and the Cavitron® (which cleans teeth and gums). Water both cools and helps clear away debris when a high-speed dental drill is preparing a tooth. The potential problem with the waterlines is that they become colonized with microorganisms, and develop a biofilm within the narrow tubing. This potential problem has been the subject of serious controversy over the last few years. The question is, is it much ado about nothing? Normal drinking water is usually allowed to have up to 500 colony forming units (CFU's) of bacteria per milliliter, but is often found to have many times that amount when entering homes due to colonization in the water pipes. Water found in drinking fountains, water coolers and presumably "pure" bottled water have been found to have thousands of CFU's per milliliter. A glass of water from a kitchen faucet sitting stagnant at room temperature is often teeming with bacteria due to microbial bursts that exponentially increase the numbers of bacteria. The amount of bacteria found in dental unit waterlines varies, depending on the methods used to reduce it. What most people want to know is, "What is the risk of contracting an infection from the water used in dental treatment?" The risk for getting an infection from the dental waterlines is probably very low, although nobody really knows for sure. People are exposed to potentially high concentrations of bacteria-laden water all of the time from many different sources, so specifically citing the dental waterlines is impossible. Also, modern dental techniques (e.g., high-speed evacuation of fluids; rubber barrier for treatment; having patients spit the water out during treatment; relatively few visits to the dentist for an average person each year) greatly limit the amount of water patients are exposed to during dental treatment. Research has shown that about 60 milliliters (2 oz.) of water is used for a typical dental visit, and more than 90 percent of that is usually removed (not ingested) using the above methods. It is also important to remember that the mouth and gastrointestinal tract contain millions of bacteria, many of which are both beneficial and necessary for life. Other bacteria, of course, are associated with infectious diseases and should be avoided. There might be a higher potential risk for a person with a weak immune system (e.g., those that have diseases like AIDS, severe and uncontrolled diabetes, or are being treated with chemotherapy for cancer) when they are exposed to any colonized water, including dental waterlines. The ADA does not cite any documented cases of people contracting dental infections from the waterlines. The second question people ask is "What methods can dentists take to reduce the bacteria used in dental treatment?" Dentists routinely take many measures to reduce the bacteria in dental water used during treatment: - Use of high-speed suction to remove water during treatment. - Having patients spit out excess water during treatment. - Use of a rubber barrier (rubber dam) for some procedures to prevent water from getting into the mouth in the first place. - Flushing out water from the dental lines for several minutes at the beginning of each day. - Running the drill for a half a minute after each use. - Having proper maintenance of the waterlines. Other procedures, such as the preparation of crowns (caps) and dental cleanings, cannot be done using a rubber barrier. Some companies have created products to reduce the bacteria in the waterlines. All of the options have limitations and take time and money to implement: - Using filters for the water. - Using chemicals to disinfect the dental lines (e.g., diluted bleach 1:10, glutaraldehyde, food grade ethyl, alcohol, chlorhexidine-based products). These chemicals may be more harmful than the bacteria if ingested. - Using a combination of ozone and silver ion catalyst to disinfect the dental lines. The manufacturers of dental units have known about this problem for years and have done nothing about it. Having waterlines supplying the dental unit is a design flaw that these manufacturers should have addressed, but did not. The ADA has encouraged the manufacturers to help solve the waterline problem and has made some suggestions, such as having an independent water supply for dental drills and other equipment. Dentists may need to take steps to address this potential problem while the public and organized dentistry is urged to put pressure on the manufacturers of dental units to solve the problem that they helped to create. There are some new products on the market that have tested well and may eliminate nearly all bacteria from the lines. In my office, I filter the water and use ozone, coupled with silver halide catalyst, to disinfect the dental lines. Dentists will continue to safeguard the well-being of their patients while encouraging the dental unit manufactures to create dental units that address the waterline issue. The ADA recommends that all water used in dental treatment have a maximum of 200 CFU's per milliliter (the standard used in kidney dialysis).


Lifesaving Equipment for the Dental Office

Part of every dentist’s training is what to do in a medical emergency. This is necessary because dentists are treating patients with potent anesthetics and are often doing surgical procedures (removing teeth, gum surgery, biopsies and root canals). Some patients are also coming to the dentist with a high degree of emotional stress or poor general health. All of these factors can increase the risk of a medical emergency in the dental office. One of the most dangerous types of emergency involves the cardiovascular system, especially heart attack and sudden cardiac arrest. Until recently, dentists could do precious little to treat these life-threatening emergencies in a typical office setting. Now, a relatively new device called an Automatic External Defibrillator (AED) is available that can often prevent death from sudden cardiac arrest (SCA). SCA is responsible for about 350,000 deaths each year. Unlike a heart attack where there are usually telling symptoms (e.g., chest pain, pain radiating to the left arm or nausea) and there is often time to get to the hospital for treatment, SCA strikes quickly and usually without warning. SCA is caused by an abnormal heart rhythm (often ventricular fibrillation), which causes the heart to quiver chaotically, unable to deliver the necessary oxygen to the body. Typically, the person loses consciousness in seconds. SCA can happen to anyone, at any age, and at any time, but increasing age and previous heart problems amplify the risk. When SCA occurs, the person will usually die in a few minutes unless the heart can be “shocked” into a normal rhythm. The AED can deliver this lifesaving shock in seconds and is considered preferable to the older defibrillators that were more cumbersome, required more training, and were more expensive. The speed at which the AED is applied is also of critical importance, because every minute that goes by after SCA occurs reduces the likelihood of preserving life by 10 percent. Here’s an overview of how the AED works. When a person suffers from SCA, you first call 911, and then quickly get the 4.5 pound AED and turn it on. From that point on, the device tells you what to do. You put the self-adhesive pads on the person’s bare chest and the AED “reads” the heart rhythm. If the device decides that the person will benefit from a shock, it says, “Shock advised, stay clear of the patient” and you push a button. In the majority of cases, one shock is all it will take to return the person’s heart to a normal rhythm and often help save a life. Finally, you monitor or assist (if necessary) the heartbeat and breathing as you wait for the ambulance to arrive. AED’s are turning up in many places, including airports, casinos, shopping centers, stadiums and in offices. An AED can be used by almost anyone, and requires almost no training. With its ease of use, obvious importance, and relatively low cost (less than four thousand dollars), there is little reason not to have one in the dental office. I would urge dentists, other health professionals, as well as other business owners to purchase an AED. Remember, the life you save could be your patient’s, your client’s, or even your own.



Air Abrasion Takes the Fear Out of Treating Cavities

Air abrasion is a relatively new technology used for treating cavities that can often eliminate the need for an anesthetic injection and the dental drill. Air abrasion works like a precise sandblaster, where tiny, harmless particles of aluminum oxide are propelled against the tooth, removing a cavity. Although the concept of air abrasion originated decades ago, only recently have advances in technology and modern dental filling materials sparked new interest in the method. You may be thinking, "No needle, no drill, this is too good to be true. How come every dentist in America isn't using air abrasion?" The reason is that air abrasion can only be used for a limited number of procedures, and its cost is relatively high. Air abrasion is primarily used for treating small to medium sized cavities, preparing teeth for protective dental sealants, and removing stains on the surface of the teeth. Air abrasion prepares teeth that are ideal for the placement of the white "resin" fillings, and is not often used with silver (amalgam) or most other dental materials. Air abrasion cannot be used for preparing crowns, shaping the roots during root canal therapy, gum treatment, removing soft decay found in deep cavities and other procedures preformed in the dental office. One of the advantages of treating cavities with air abrasion is the conservative nature of the procedure, where only a small amount of the tooth is removed at a time. A small to medium-sized cavity can usually be treated without anesthesia in minutes, silently (no disquieting whistle of the dental drill), and with little or no discomfort. There is a powdery residue after treatment, which is usually suctioned out or limited with the use of a rubber barrier, or dam, during treatment. Most patients find the powder residue less of a nuisance than the buildup of fluids that sometimes accompanies the use of a dental drill. In my office, I use air abrasion for patient treatment about 15-20 percent of the time. I have found that air abrasion is most useful with anxious patients and children. Patients that are fearful are relieved if their cavities can be treated painlessly and without a needle or drill. Children who are often apprehensive about many aspects of dental treatment are thrilled with the air abrasion alternative. Although air abrasion is not a panacea, it is certainly a useful addition to modern dental treatment, and a must for every dental office interested in patient comfort.



Micro-Abrasion: Comfort Dentistry

The 21st century has come to dentistry. Innovations for dental health, comfort and beauty abound. This includes advancements in lasers, tooth bleaching, porcelain veneers, implants and the types of filling materials used which greatly reduce sensitivity after placement. In this article I would like to enlighten you on a revolutionary process in restorative and preventive dentistry called micro-abrasion. This process of micro-abrasion is making dental visits better for adults and children, and, if diligently followed, will lessen the dental problems of our children later in life. Specifically, it will reduce the widespread need for root canals and crowns we see in the baby boomers and older. You will understand why most dental problems in adults are of the major variety and stem from teeth that were filled as youngsters. Here’s why I think this is the most exciting thing I've seen in my 20 years of dentistry: Early fillings to restore decayed teeth date back to the Phoenicians who pressed gold into teeth over 2000 years ago. Silver amalgam dates back to the Civil War era, and today, is still widely used due to its strength and wearability. The newest materials are tooth-colored resins (composites) and porcelains that are made to adhere to the tooth. The fact that they are "glued" to teeth makes them unique. These fillings, when of reasonable size, restore the tooth to its original strength, whereas silver amalgam tends to cause teeth to fracture over time. The reason for this is simple. Amalgam contains about 50 percent mercury. Mercury is used in thermometers because it expands and contracts as temperatures change. In the tooth the silver filling expands and contracts about three times as fast as the tooth structure it sits in. Also, amalgam is soft; it creeps and crawls under chewing forces. All this results in cracked teeth. The larger the filling the worse the problem. I would say that over 90 percent of the teeth that need crowns or root canals (major work) have had a silver filling in them. Mercury toxicity is also a worry of some people, but I believe this is insignificant. You get more mercury from your tuna sandwich than from your fillings. Yet, if you have a viable option that eliminates exposure - why not? The traditional amalgam filling requires that a sufficient amount of tooth structure be removed-healthy or not-to make the filling large enough to be strong. You must also use the dental drill to "undercut" healthy tooth structure in order to lock the filling in place. As dentists, we know that even if the decay is small you can't make the silver filling too shallow or narrow or it will break. All these requirements also weaken teeth. For the last eight months, I have been removing decay and restoring teeth with "micro-abrasion." Micro-abrasion is a fine stream of air and tiny sand particles that gently removes decay. This will never completely eliminate the drill, but when it is appropriate to use, micro-abrasion is far superior to drilling. The drill removes tooth and decay by spinning a drill bit (better called a bur) at 300,000-400,000 rpm. The flutes of the bur hit the tooth and cause microscopic cracking, heat and vibration. This all points to the need for numbing teeth. Micro-abrasion cleans the cavity like a small sandblaster with no cracking, heat, vibration, or, usually, numbing. Some patients report a cold sensation, but none ever ask to be numbed. Now you should be able to see how a minimally invaded micro-abraded tooth filled with a composite bonded restoration is the best way to maintain the structural integrity of a tooth for the years ahead. The most ideal use of micro-abrasion is treating decay in children's teeth. When you look at back teeth you notice they are loaded with fissures and pits on the biting surface that tend to gather brown stain. This is where teeth are most susceptible, as the fissures are too narrow to let in one toothbrush bristle, but plenty big for a stadium full of bacteria. These bacteria eat the foods we eat and excrete acids, which cause the fissures to deepen and turn into true decay. Stopping this process is the rationale for sealants. Sealants are liquid resins placed in tooth fissures optimally in the first two years after eruption. This resin is hardened, thus sealing the fissures and preventing bacteria from residing therein. The ages 6 and 12 years are key periods for sealants. Typically sealants are done by painting the fissure with a mild acid to roughen the surface just enough to hold the sealing resin. Researchers have found that as many as 60 percent of sealants done this way fail in too short a period. This is because the acid doesn't remove debris or bacteria that, inevitably, are hiding deep in the fissure. This is where micro-abrasion shines as it cleans all the crud out of the groove before the sealant is placed. Furthermore, as I am cleaning the debris out of the fissure, I can watch as I follow the stain down the crevice until it's entirely gone. Lo and behold, in many teeth we find the stain goes all the way to the underlying dentin, where it spreads rapidly. At that point the tooth is getting a needed filling instead of just a sealant. I never would have known the tooth was decayed unless I had used micro-abrasion. This scenario shows a common shortcoming of conventional sealants because it is easy to seal over decay that the dentist would not suspect to be under the fissure. Common sense tells us that the sealant won't stick to crud. By the way, the patient rarely knows I've gone from sealant to filling because microabrasion is so painless. This leads to my next related topic. Fluoride has dropped the decay rate in children's teeth greatly, but by no means has eliminated it. What fluoride has done is change the appearance of decay. The way fluoride works is to be incorporated in the tooth's enamel while it is forming deep in the jaws. Fluoride makes the enamel less soluble, like turning it from chalk to marble. This is why fluoride has reduced decay on the smooth surfaces of the tooth, but it has done nothing for the pits and fissures. By understanding the decay process in fissures as I described above, you can see why the result is that the hole in the top of the tooth is tiny, while the decay may be raging under the enamel. Those of us older than 25 years old may remember the dentist probing teeth and when the explorer "stuck" he'd found decay. Now, dark stains in the groove and, especially, a shadow under the enamel are more diagnostic. The stickiness is gone! Instead, a hard brown plug is present and it's difficult to tell stain from active decay. Fluoride has changed the look of decay! In my opinion, the only way to diagnose incipient decay in fissures is with micro-abrasion. As you may gather, micro-abrasion is excellent for pit and fissure decay in early stages. It makes a sealant that is second to none. It's also wonderful for removing old tooth-colored fillings. It's not recommended for removing metals such as old amalgams. Amalgam is actually too soft -- the sand particles hit it like mush. Neither could a dentist reduce a tooth for a crown using micro-abrasion. We also still use rotary drills to polish the resins, so the whine of the dental drill is not gone -- just a lot of the anxiety.


Futuristic Dental Procedures Are Already Here

Cutting edge research and high-tech gadgetry will dramatically change the way dental care is delivered in the next century, say dental researchers. "Dental offices already are becoming the scene of many new technologies that permit more complex and improved dental treatments," says Trucia Drummond, D.D.S., a general dentist. "Dentists love new gadgets -- anything that makes treatment easier for our patients." Dr. Drummond says intra-oral cameras are a classic example how technology can improve dental care. "A small wand with a miniature video camera is inserted into the patient's mouth, where it transmits a signal to a television monitor next to the dental chair," she says. "The dentist can use the image to explain a condition or procedure to the patient, or store it on a videocassette to track a particular condition over time." Many dentists have this equipment in their offices now, says Dr. Drummond. He lists some other advances that are on their way. - Lasers -- Already used for some soft tissue applications such as removing lesions, and for tooth whitening purposes, many dentists feel they will used to zap tooth decay, precluding the need for tooth restorations or fillings. - Digital Radiography -- This technology uses a tiny intra-oral sensor that replaces conventional X-ray film, sending images by wireless methods directly to a computer screen. They can be viewed immediately or stored on a hard drive. This technology greatly reduces patient exposure to radiation. - Kinetic Cavity Preparation -- Also called "air-abrasive technology," this procedure occurs when tiny aluminum particles are carried by a stream of air, spraying away decay without the sound of the drill, vibrations or local anesthetic. - Electronic Dental Anesthesia -- By attaching electrodes inside the mouth, the dentist can use electric pulses to alleviate nerve sensation during common restorative procedures. - Bonding and Adhesives -- These materials allow tooth and veneers, for example, a better fit, resulting in minimal drilling, greater strength, tighter seals, and more natural color blending with the tooth. - Dental Implants -- They have been used for 30 years, but now there are better ways of fastening dentures or a single tooth that may have been knocked out in an accident. Some implants stimulate bone to attach to the implant post, resulting in a stronger hold. - Computer Charting -- Manual charting will give way to computerization. Thanks to dental software packages, microphone headsets, electronic probes and light pens, dentists and hygienists are not hampered by paper or pencils during the dental examination.




New and Improved Dental Procedures

Many people avoid dental care because of bad experiences they have had. As a result, some people may not have seen a dentist for 15 or 20 years or more. What these people should know is that dentistry has been literally transformed in the last 10 years. The most notable and important changes have been in the science and technology used for the reduction of pain, improvement of root canal therapy, replacement of teeth with dental implants, and the revolution in cosmetic dentistry, specifically porcelain veneers and the white, resin fillings. One of the most important changes is the improvement in local anesthesia. Years ago, dentists used the local anesthetic Novocain, and many people still associate it with what the dentist uses for "the shot." Novocain is rarely used today because it causes a much higher incidence of allergic reactions. The most common anesthetics used in dentistry now are lidocaine, bupivacaine, mepivacaine, septocaine and others, which may still cause an allergic reaction. Septocaine, a recently approved anesthetic, may be stronger than the other local anesthetics and allows most dental procedures to be performed painlessly. In an effort to reduce discomfort during dental procedures, today's dentist can use either air abrasion or a dental laser. These modern devices enable dentists to treat many cavities without a needle or a dental drill. Some dental lasers can also treat the gums and do other more advanced procedures with less discomfort during and after the treatment. Perhaps one of the most improved dental procedures in recent years is also the most feared -- the root canal. New techniques have greatly reduced the time needed to perform a root canal, and also greatly limit the potential for discomfort. In almost all cases, root canal therapy can be effectively completed in just one visit. The average time needed to complete a root canal varies, but is usually between 30 and 60 minutes. This is possible because the new systems use nickel-titanium dental files that can be mounted on a slow speed dental drill. The older methods of performing root canal would involve the manual use of dental files that would often necessitate three grueling, one-hour visits. Modern methods and technology have greatly improved most dental treatment and may provide a pleasant surprise for those who have avoided dental care for many years.

New Technology Improves Dental Office Visits

In an effort to reduce discomfort during dental procedures, today’s dentist can use either air abrasion or a dental laser. These modern devices enable dentists to treat many cavities without a needle or a dental drill. Some people avoid dental treatment because of bad experiences they had in the past. An unpleasant incident can sometimes make a person stay away from dental care for many years. Over time and without care, teeth can break, become decayed and infected. Gum disease can erode bone in the jaw that supports the teeth, making them loose. Those who have not been to the dentist for a long time may not realize that, a trip to the dentist today is far better than it used to be. Dentists and their patients both benefit from new technology aimed at making treatment more tolerable, better looking and longer lasting. One of the most important changes in recent years is the improvement in local anesthesia -- what the dentist uses in the injection to get their patient numb. The most common anesthetics used in dentistry now are lidocaine, bupivacaine, mepivacaine, septocaine and others. Septocaine, a recently approved anesthetic, may be stronger than the other local anesthetics and allows most dental procedures to be performed painlessly. In an effort to reduce discomfort during dental procedures, today’s dentist can use either air abrasion or a dental laser. These modern devices enable dentists to treat many cavities without a needle or a dental drill. Some people may remember the unpleasant tasting material their dentist used to take an impression or mold of their mouth. New impression materials are actually flavored, an important step to help improve the experience of many dental procedures. Some people who have had “bondings” or tooth-colored fillings in the past may have been disappointed if they are discolored. Tooth-colored fillings used today are much better able to match and blend in with the tooth. These newer fillings rarely discolor, and can create a realistic and cosmetic result that lasts for many years. The procedure that has benefited most from new technology is porcelain veneers. Porcelain veneers are custom-made porcelain wafers that the dentist places over the fronts of the teeth to enhance their appearance and repair damage. They can be used to improve a wide variety of cosmetic dental problems. They can whiten stained or discolored teeth, close gaps between teeth, "correct" a crooked smile without the need for braces, repair chips and imperfections, and create a more attractive or youthful looking smile. This new generation of porcelain veneers are durable, beautiful and natural in appearance, and do not change in color over time. These are just a few of the advancements in dentistry over the last several years. Although the dental office is unlikely to make anyone’s list of favorite places, new techniques and materials vastly improve today’s trip to the dentist.



The Benefits of New Dental Technology

Technology is revolutionizing the dental office and is making dental care safer, more efficient and less fearful for the dental patient. "The intraoral camera is an excellent example," says Barry Freydberg, D.D.S., a general dentist. "The intraoral camera is a miniaturized camera that allows patients to view the inside of their own mouths live. It's a wonderful device and patients love it. It's a wonderful way to educate the patient because they can see what problems they have with their own eyes." Combined with imaging software, tooth defects can be corrected on the computer screen. "A patient can see their teeth straightened, a gap replaced by a new tooth, or see the results of tooth whitening," says Dr. Freydberg. "Patients can see how they look with a new smile. Plus imaging is a great diagnostic tool for the dentist." During his presentations, Dr. Freydberg will explain how intraoral cameras have value in a dental practice, plus he will discuss the following dental technology: - Digital Radiography -- "This technology involves a sensor wired directly to a computer," says Dr. Freydberg. "When placed in the mouth of a patient, it delivers digital images for diagnosis, much in the same manner as X-rays, but with much less radiation. It's much faster than X-rays too." - Management Software -- "We're seeing a lot of software that computerizes appointment books, insurance forms, clinical records and bookkeeping," says Dr. Freydberg. "Electronic clinical charts are tied to administrative records for easy updating of appointments and insurance forms." The new technology extends to the reception area. "Some dental offices have incorporated computers into their reception rooms that provide educational experiences for patients," says Dr. Freydberg. "If you touch the screen, you can learn about different types of treatments and how procedures are done. Better-educated patients are more likely to participate in their own care, creating a partnership of care." Computers and new computer-driven technology do not depersonalize the relationship between doctor and patient. "Quite the contrary," says Dr. Freydberg. "They allow more effective scheduling; they allow more personalized follow-up for treatment; they consolidate information; and they educate the patient. But the big plus is that they allow the dentist to provide better treatment. They are going to revolutionize dentistry and the sooner the better." Footnote


Dental X-Rays

X-rays are high-energy photons that have more energy and a shorter wavelength than ordinary visible light. They are called X-rays because Röentgen, the man who discovered them, didn't know what was going on or why. Ordinary light cannot pass through people because ordinary light does not have enough energy. Photons pass through substantial thickness of matter only if they have high enough energy. Some of the rays stay in the body. Some X-rays have to remain in the body because if no X-rays were absorbed, the image would come out white without any detail. The light and dark spots come from when you expose a photographic plate to X-rays. The plate starts off whitish, and when X-rays strike the plate, that section of the plate gets darker. In dental X-rays, metal fillings appear white because the metal is very dense. Bones appear lighter on the image because bone is denser than the rest of the body. Having X-rays taken a couple times a year is not harmful. However, your dentist will cover your body with a lead-lined apron to protect your body from unnecessary X-rays. Low doses of X-rays cause a negligible increase in the risk of cancer. However, dentists and their staff are exposed to X-rays several times each day, which is why they leave the room when they take an X-ray. You may also notice that the dental team wears a radiation badge, which measures the level of radiation to which they have been exposed. This is all part of your dental office's standard safety program. Finally, the doses of X-rays used in the dental office are very low. You are given just enough so that you dentist can see what is going on inside of you without jeopardizing your health. Remember, if you have any questions about X-rays, talk to your dentist. He or she will be happy to address your concerns.


Dental X-Rays and Digital Technology

Dental radiographs, or X-rays, are an important part of a thorough dental examination. A full set of X-rays (18) is usually required for patients who are new to a dental practice, or who need extensive treatment. Two to four follow-up or check-up X-rays called "bite-wings" are necessary every 6-18 months, depending on each individual patient’s needs. The most common questions concerning dental X-rays deal with: why they are needed, the amount of radiation exposure, the safety during pregnancy, and recently, the benefit of digital X-ray technology. Dental X-rays are important for many reasons. They can expose hidden dental decay; reveal a dental abscess, cyst or tumor; show impacted or extra teeth; and also help determine the condition of fillings, crowns, bridges and root canals. Dental X-rays can also reveal bone loss from periodontal (gum) disease, locate tarter buildup, find foreign bodies within the gum or bone, and see if there is enough bone for the placement of dental implants. These are just some of the many reasons why dentists rely on dental X-rays. Some people worry about their exposure to radiation during dental X-ray procedures. This is very understandable in light of the relatively high radiation of some medical X-rays. They may remember a doctor in the emergency room asking them or a female family member if they are pregnant because they need to take a chest X-ray or an upper gastrointestinal (GI) series. Patients who have had cancer may also have a heightened sense of awareness about the radiation that they are receiving at the dental office. Dentists are very concerned about minimizing the amount of radiation a patient receives at the dental office. That’s why we use special high-speed film, and cover patients with a lead apron during X-ray procedures. You will be happy to know that 18 dental X-rays deliver 56,000 times less radiation to an unborn child than an upper GI series, 800 times less radiation than a chest X-ray, and 40 times less radiation than a typical day of background radiation. Dental X-rays are both safe and effective, and can be used during pregnancy. One new dental technology involving dental X-rays is digital X-rays. They offer the advantage of an 80 percent reduction in radiation, no need for film or processing chemicals, production of a nearly instantaneously image, and the ability to use color contrast in the image. The main disadvantage is the cost. Digital X-ray units presently cost 3-5 times more than conventional units, and the quality of the image is not any better than film. The speed in which a dentist gets to see the image is about three seconds, but with fast developing chemicals, a conventional X-ray can be developed in about 15 seconds. The digital unit does reduce exposure to radiation, but the amount of radiation is so low that the benefit is very slight. Dental X-rays are an important tool in the diagnosis and treatment of dental problems. They do not, however, replace the need for a visual examination of the head, neck, TMJ and oral cavity. It is only with a combination of both the X-ray and the visual examination that the dentist can best treat his or her patients.





Panoramic X-Rays Show Dentists the “Big Picture”

Dental X-rays, also called radiographs, are an important tool for the dentist. The three most common types of dental X-rays are the bitewing, periapical and panoramic X-rays. Bitewing X-rays are those that are taken during most routine dental check-ups and are useful for revealing cavities between the teeth. Periapical X-rays show the entire tooth, including the roots, as well as the bone surrounding them. These X-rays are useful in helping to diagnose an abscessed tooth as well as periodontal (gum) disease. The third type of X-ray commonly used in dentistry -- the panoramic X-ray -- gives a broad overview of the entire mouth. This X-ray supplies information about the teeth, upper and lower jawbone, sinuses, and other hard and soft tissues of the head and neck. One advantage of the panoramic X-ray is its ease of use. Unlike other X-rays where the film is placed inside the patient’s mouth, the panoramic film is contained in a machine that moves around the patient's head. Some people may be familiar with the panoramic X-ray because it is usually taken when the wisdom teeth are being evaluated. The X-ray will also reveal deep cavities and gum disease, but it is not as precise as bitewing or periapical X-rays. The panoramic X-ray has many other applications, including evaluating patients with past or present TMJ or jaw joint problems; those who require full or partial removable dentures, dental implants, or braces; those who are at risk or suspected of having oral cancer or other tumors of the jaw, have impacted teeth (especially wisdom teeth) or have had any recent trauma to the face or teeth (e.g., can help identify a fractured jaw); and for those who cannot tolerate other types of films (severe gaggers). The panoramic X-ray can also identify some not so common problems, such as calcification within the carotid artery that may indicate the potential for a stroke. In one unusual situation, I can recall a patient who mentioned that he had suffered for years with recurrent sinus infections. I took a panoramic X-ray that revealed an infected tooth -- upside-down and stuck in his sinus! The panoramic X-ray is an important part of a thorough dental examination. I usually recommend a panoramic X-ray once every five to seven years for most patients. Although the panoramic X-ray does not provide as much detail when evaluating the teeth and gums as other dental X-rays, it can pick-up potential problems that the other X-rays cannot.


Using X-Rays to Diagnose Dental Problems

X-rays are a vital aspect to dental diagnosis and treatment. Many potentially injurious conditions would go undetected were it not for the regular utilization of X-rays. Modern X-ray film, equipment and technique make dental radiation safe and effective tools to ensure optimal dental health. For example, an X-ray of a patient who hasn't been to a dentist in two years can reveal a build-up of calculus and tartar. The calculus is visible on the X-ray as wisps or thorns projecting from the sides of the teeth underneath the gums where you cannot see them. These “thorns of calculus” are a major cause of puffy and bleeding gums (gingivitis), which leads to bone loss and periodontal disease. A dental prophylaxis (cleaning) can make your teeth brighter and squeaky clean once again! Necrotic Tooth -- A Tooth in Which the Pulp (Nerve Chamber) Has Died Though many teeth which die do not discolor, a dark purple area of a tooth seen on an X-ray indicates that the pulp of the tooth has died, likely due to a cavity or other trauma. Such a tooth needs root canal or other treatment in a timely manner to prevent extensive infection and abscess. Once a tooth has died, it tends to become brittle and will eventually break down without proper treatment from your dentist. Since the tooth has died, it may not feel sensitive to the patient and is often ignored. As a dentist, I routinely see patients who have broken off the entire crown of a necrotic tooth! Though the tooth may still be saved after it has broken off, unfavorable fractures may require extraction. A dark shadow around the root of a tooth indicates a tooth abscess (infection) or other pathology.


Why All the Fuss About Digital Radiography?

Each year dentists are bombarded with literally millions of dollars in paid advertising about digital radiography. Headlines you read might look like these: The Paperless Practice, Prepare for Real-Time Insurance Approval of Radiographs and Real Dentists Don’t Dip Anymore! The purpose of these ads is to entice you into spending large sums of money on the latest evolution in dental diagnostics. The facts are impressive: 1. There is a 90 percent reduction in the amount of radiation needed. 2. There is greater ease in storing each radiographic document in a permanent condition over the years, giving the dentist the ability to compare a sequence of the patient condition. 3. Making digital radiographs takes less time and has instant review capability by the doctor and the patient. 4. It is possible to use computer enhancement to better utilize the digital information for diagnosis. But, the biggest reason for using digital dental radiographic technology rests in your darkroom. The caustic chemicals used to develop and fix conventional radiographs are currently mixed with water to dilute them, and then flushed into the sewer systems all across America, but not for long. The Environmental Protection Administration is targeting dentistry to reduce, if not eliminate, dental office pollution that is beginning to tax our world’s water supply. Some people are even questioning patient saliva as a possible toxic material. So if you want to be really creative in your practice of dentistry, make the technological changes in your office before the Feds change the rules. If we clean up our own act based upon our care for the environment, then we set the standard. Would you want your children to drink the water from your dental office after having only been processed your city’s water purification? Not me!