That Sounds Great! I’ll Take A DozenBy
Like many dentists I know, I absolutely love new gadgets and innovations in dentistry. I was therefore excited when the Daily Mail headline proclaimed “The End Of Dental Fillings” the other day. Of course, it isn’t. I couldn’t accurately estimate how many times I’ve read “The End Of Dental Fillings” or “The End Of The Dental Drill” over the years, only to have my hopes crushed by scientific reality and human trials.
Professor Damien Walmsley squished my hopes like a bug when he projected that the in vitro growth of an enamel-like material by researchers at Zhejiang University’s School of Medicine wouldn’t be ready for practical use for “ten to twenty years.” Drat! I’m still waiting for a fully-formed Boots own home tooth-growing kit promised by researchers back in the early 1980’s.
This latest breakthrough does sound exciting though. I won’t bore you with the details but the Chinese scientists found that a material composed of calcium phosphate ion clusters could be used to produce a precursor layer to induce the epitaxial crystal growth of enamel apatite. This then mimics the biomineralization crystalline-amorphous frontier of the hard tissue developed in nature. They also found the CPIC-caused epitaxial growth recovered the enamel strength, with H and E values of 3.84 ± 0.20 GPa and 87.26 ± 3.73 GPa, respectively. I was staggered. Oops. I bored you.
I’m such a sucker for gadgets of any description, I once couldn’t help buying them. Years ago, the practice manager of my own practice banned me from going to Dental Showcase for my own financial safety. I seem to recall that was triggered by me coming back from a show with my arms full of boxes of disposable spring-loaded BPE probes, which I never ever used. Just last night I was glued to the Apple iPhone launch event, salivating, more like drooling over a phone that looks identical to the one in my pocket except the new one has three knobbly bits on the back.
I think I can say that during my career I kept fully abreast of new developments and never feared embracing a piece of kit with a warning beep built in. I don’t know if that was a good thing or a bad thing, a total waste of money, or just plain scary.
I was lucky enough to be given the opportunity after about four years post-qualification, to work with the dentist who first inspired me to become a dentist. My dentist and his partner were two forward thinking professionals who were constantly on expensive courses and they picked up hundreds of tips which they imparted to me and the other associate, as well as spend thousands on bits of kit which they occasionally let us use.
One day, the senior partner appeared at my side, wearing a pleading face, despite the fact he was about to give me the opportunity to try out his latest purchase. The new addition to the practice’s armamentarium was a crown removal system, which I believe is still available. I can’t remember the name of the product, but I can say it was incredibly effective - maybe TOO effective for my liking. After giving me quick instruction on how to use the device, I suddenly found a consultant medical surgeon in my chair, one of my boss’s best private patients.
The ‘device’ was basically a cube of what looked like solidified Rowntrees jelly. You may have come across the material – I don’t want to teach my grandmother to suck eggs (to be honest it was the only way my grandmother could eat eggs because I made her dentures) - but it was a very hard material and had to be softened in hot water. After it reached a nice pliable consistency, the material was placed by the crown and surrounding teeth on the occlusal surfaces and the patient was then instructed to bite down and hold it. The idea was that you let the material cool and once it was set, the patient opened the mouth violently. The desired result was a detached crown in the set jelly.
I could detect that the crown in this particular patient (an upper right 4) was very slightly wobbly but just as I placed the material, I realised that the unrestored UR3 and UR5 were also slightly wobbly. My blood ran cold. I was already committed and I braced myself for the embarrassment of having a consultant surgeon let out a blood-curdling scream as his teeth were ripped out without local anaesthetic, and the trial of having to replant them back into the sockets. Mercifully, only the crown became detached and I marched the patient back downstairs to the private part of the practice. Afterwards, my senior male colleague said “Phew, close call. Well done, my dear.”
It was while I was at this practice that I was also introduced to a miracle product.
The bane of any dentist’s life, in addition to all the other banes, is failed anaesthesia. Particularly miserable, is the inferior dental block, especially when you have a patient who doesn’t like needles. My two bosses came back from a course one Monday and announced that all our blocky worries were about to be over. Ten days or so later, the other associate and me were introduced to something called Lido-Hyal. The drug was administered in a dental syringe the same as anaesthetic and it worked by virtue of it containing hyaluronidase. The enzyme facilitated permeability within the tissues so the anaesthetic could penetrate easily to where it was needed. I can’t honestly recall which way round I administered it, but I think I probably gave the local first, followed by the Lido-Hyal. Even the most resistant patients in the practice succumbed to deep pulpal anaesthesia within a couple of minutes and it seemed worries about local failure was banished forever. The only contraindication was that you couldn’t use if there was any suspected infection around for fear of spreading it deeper into the tissues.
I pretty much used Lido exclusively for ID blocks and it never let me down. The problem with Lido was that it wasn’t licenced in the UK and it had to be imported from Switzerland. When I moved to my own practice in the early 90’s, I found that I couldn’t live without it, although I used it rarely. I had probably about three shipments until one day I received a caution from Her Majesty’s Customs and Excise henchmen, who issued a stern warning and a demand for the import tax I’d apparently been wilfully avoiding. I hadn’t, I was just someone who hadn’t previously imported anything in his life and was also a completely incompetent businessman. That put me off, as did an off-the-cuff remark from my associate who reckoned that using Lido would dissolve patient’s condyles. It never did, but it planted the fake news seed and that was enough for me. I never used it again, for fear of turning local patients into drooling, rubber-jawed yokels.
Before my bosses discovered Lido, one of them experimented with intra-osseous anaesthesia. He reckoned it was great for ‘hot’ pulps and avoided the post-op dribbling associated with ID blocks. I never tried the technique myself, the demonstration patient being enough for me. I think the system I saw being used isn’t available any longer, but it involved using a hollow trephining drill to sink a hole in the cortical bone that went through the cancellous bone of the alveolus. The outer part of the trephining drill was left in situ and the local was administered through the hollow tube. My boss reckoned the procedure was less painful than delivering an ID block, but I saw the patient squirm when he numbed the intra septal gingivae and saw the patient slowly wriggle down the chair when his cortical plate was being drilled. I’m sure it works perfectly well in the right hands but it turned my stomach, and apparently his. The system was in a cupboard gathering dust within what seemed a fortnight.
An innovation that I DID think might change my professional life, was jet anaesthesia. I was an early adopter, grabbing jet anaesthesia enthusiastically, with both hands. You needed to use both hands because if you didn’t, the retort was like that I would imagine you’d experience from an AK-47. The patients loved the idea of no needles, but they didn’t like the thud and kick-back from the unit, despite the ineffective rubbery cushion on the end. I found the unit difficult to use, particularly getting the large business end flat against the buccal bone of the upper molar areas. The main problem was although it got the soft tissues numb, it rarely got the pulp numb enough to work on the tooth. Most patients ended up screaming for ‘the proper needle.’ Having read a couple of papers on the modern units, it would seem they are pretty ineffective, though I would be first to admit it could have been operator error in my case.
I was also one of the first customers for surgical loupes with built in fibre-optic lights. These particular units were built in the USA and cost a packet. They were wonderful, but… In those days the light generating unit was a box which to my recall was about the same size as a small fridge which sat on the work surface behind me. The loupes were connected to the light unit by a reasonably lengthy fibre-optic cable and to be fair, it allowed quite a bit of free movement – except if an idiot was wearing the loupes. One day a patient asked me a question during treatment. I couldn’t make out what he was saying and I pulled my mask off and moved to face him so I could lip read as well, forgetting I was still tethered. Fortunately, that act didn’t pull the light unit off the work surface because my nurse dived on it, but my loupes were pulled off and they smashed on the floor. After a couple of weeks on their holidays in the USA, they returned as new. The kind suppliers repaired them free of charge. About two months later, they took a flight to the States again – pretty much the same reason. This time there was a modest charge with an accompanying note asking me if I would like a representative from the company to come and give me a free demonstration on how to use the loupes. I thanked them, but politely refused their offer. My motto over the years seems to have inadvertently been, ‘Once bitten, twice bitten,’ so when my loupes, which I adored, finally hit the deck again, I gave up on them. Eventually I found a local optician who gave me decent magnification in prescription specs, which served me well till I retired.
There were quite a few gadgets I DID resist over the years. Lasers were one of the innovations I shunned. I knew of a good practitioner locally who had spent a lot of money on one and shelved it within a month, advertising for it sale in a dental journal for nearly a year before the ad disappeared. I had heard he failed to shift it.
The early Cerec machines I also dismissed, though mainly on the grounds of cost. In my opinion, the results I saw when they first came out had all the aesthetic beauty of a toilet bowl created by Armitage Shanks. I’d call the shades available in the early days as ‘Comfort Station White.’
Ozone healing was the other ‘breakthrough’ I pretty much ignored. It was promoted originally as being effective way of treating early caries, particularly in pits and fissures. Being old-fashioned, I preferred to witness that I’d dealt effectively with the caries and regarded ozone treatment as snake oil. I note that it’s not currently recommended for the treatment of decay, by NICE.
As for ‘breakthroughs’ like the elimination of filling and drilling, I am a sceptic. Back in the 80’s, at the welcome address by the Dean of my dental school, he told us that caries would be eliminated in the developed world within ten year and that our futures lay in the ‘Third World.’ It was a pretty dour introduction to dental school. I note we are still waiting for the caries vaccine he promised.
I’ve just noticed a tiny chip in the back of my mobile. I think I need a new phone. The iPhone 11 looks nice.