Dentistry With No Pain

NOT long ago when he needed to go to the dentist his mother would drive him there and drag him into the surgery. He then had to be strapped into the chair and given a general anaesthetic to knock him out cold before his dentist could work on him.

This might be quite understandable behaviour in a toddler but Johnny Lange* is a strapping man in his early twenties.

‘‘I know it’s weird. Some people fear spiders or heights but I’ve had a phobia about going to the dentist since I was a child,’’ he says. ‘‘That’s when I started associating dentists with excruciating pain so even just walking through the door into the waiting room was enough to reduce me to a gibbering wreck.’’

But these days it’s a different story. The last time he went for a check-up he sat in the chair calmly even after he’d been told he had a cavity that needed filling. And when his dentist set to work no anaesthetic was necessary – because his dentist was using a revolutionary new procedure that arrived in South Africa only recently.

Instead of administering painful injections and lengthy drilling, dentists can now treat a tooth by simply delivering a blast of ozone to the area. Ozone – a gas we can smell in the air during thunderstorms – is the strongest natural bacteria-zapper known to man, which makes it perfect for use in the treatment of dental infections (which is what a cavity is) as well as infections in other parts of the body.

It’s quick, effective and painless. Another plus is you may not need an unsightly filling – if you have a smallish cavity all you’ll need is a tooth-coloured sealant or ‘‘smart filling’’ which will help your tooth heal itself until it looks as good as new.

SEEMS a lot has changed over the past few years. Gadgets that would once have belonged in the realm of science fiction are now standard fixtures in many dental practices. These days instead of an old fashioned mirror and probe lots of dentists use new technology to diagnose problems. Many use computers to take digital x-rays which are not only quicker and more effi - cient but release 10 to 20 times less radiation per exposure than conventional x-rays.

But even with digital x-rays a cavity needs to have eaten through three to four millimetres of enamel before being visible. Many dentists also use laser diagnostic tools which are able to pinpoint early decay.

And even if you do have a big cavity, drilling the infected area of the tooth may not be necessary – even if the hole is several millimetres deep. This is where ozone treatment comes in. Your dentist can use a hi-tech device to deliver a 20- to 60-second blast of ozone to kill the bacteria around your tooth.

Ozone can be toxic if it enters your lungs but in this procedure it doesn’t pose any risk because the equipment forms an airtight protective cap around the tooth, ensuring none leaks into your mouth. You won’t taste or smell the ozone. The procedure is painless, removing the need for local and more importantly general anaesthetic which often leaves patients, particularly children, extremely groggy and can pose a health risk.

Once the tooth has been cleared of bacteria any leftover ozone is sucked back into the machine. If it’s a small cavity your dentist will coat your tooth with a mineral wash which will encourage the tooth to repair itself by remineralising the surface that has been damaged by decay.

After two months you’ll need to revisit your dentist who’ll assess how well your tooth has healed and perhaps deliver another ozone blast to the affected area. Instead of a conventional fi lling he may apply a sealant or ‘‘smart filling’’ to close the fissure created by the cavity. The ‘‘smart fi lling’’ releases fl uoride and calcium which help your tooth heal itself until it’s stronger than before.

This is good news because although these days most dentists use composite resin fi llings rather than risky mercury amalgam ones, whenever a tooth is filled it’s weakened because tooth structure is removed and replaced with a foreign substance. This means in fi ve or 10 years you may need to have the fi lling replaced or get a crown fitted. Ozone can also be used to treat deeper, more serious cavities. While some drilling may be necessary to remove contaminated matter, if your dentist uses ozone he won’t need to excavate as much as before. He may however still need to plug the hole with a conventional fi lling. The treatment isn’t the answer in all cases but for early decay it provides a painless alternative, says a Cape Town dentist who’s used it to treat about 200 cavities.

AT the moment the one serious drawback to ozone therapy is the cost. It’s not covered by medical aid so expect to fork out between R150 and R300 per tooth. However additional costs such as the consultation fee, infection control and the application of the smart fi lling should be covered by your medical aid. The South African Dental Association regards ozone treatment as experimental and would want to see conclusive results from rigorous scientifi c studies before endorsing it. It’s still relatively new technology – the most popular system, known as HealOzone, has been used in practices in the United Kingdom for the past four years and in the rest of Europe for three years but arrived in South Africa only early last year. Only 18 local dentists use the equipment.

Another problem is it’s suitable for use only on the top or side of the tooth – because it uses a cap to create a vacuum it can’t treat cavities between teeth. This is why many dentists are cautioning that although it’s a wonderful therapy it shouldn’t be regarded as a miracle cure. ‘‘If there’s a big hole in your tooth, you’re not going to be able to heal it using ozone. You’re still going to need conventional dentistry,’’ says Professor Yusuf Osman of the University of the Western Cape’s department of restorative dentistry. But he’s excited about the development. ‘‘This is a great time to be a dentist,’’ he says. ‘‘We previously thought caries were something that could be treated only with fi llings. Now we realise they’re a living thing that develops over nine months. We can interact with them and stop them – with ozone therapy, fl uoride treatments or basic brushing and fl ossing.’’

If you have a serious dental cavity there’s no getting around the need for some drilling and scraping. But it’s only a matter of time before this changes, says Dr Julian Holmes, the UK dentist who helped conduct the initial research that led to the development of the HealOzone system. He’s based in Cape Town these days, doing more research into the uses of ozone. And apparently there are plenty – from providing pain relief to sterilising root canals to the treatment and prevention of cold sores. He’s most excited about ozone’s potential to eradicate tooth decay completely.

Within the next year he and his team hope to release a patented mouthguard system that will fi t snugly around patients’ upper and lower jaws, allowing the safe and effective delivery of ozone to all parts of the teeth. ‘‘This is a major breakthrough for the dental profession,’’ he says. ‘‘Up to now the standard practice has been to drill or amputate the infected area, then place a fi lling. Yet tooth decay is simply an infection so our research has concentrated on targeting and eliminating the bacteria responsible then allowing the body to heal in a natural way. ‘‘You may still need a fi lling as, once destroyed, the tooth can’t grow again. Healing in this context is the hardening of the previously soft area of decay that dentists traditionally drilled away.’’

Julian predicts in future we’ll visit a dentists every three months to have ‘‘an ozone spa’’ – a two-minute preventative treatment to get rid of decay and gum disease while whitening and cleaning teeth. ‘‘We’ve only begun to scratch the surface of what this technology can do. It’s going to change the face of dentistry completely because no longer will we be known as the drilland-fi ll merchants; it will instead allow us to offer disease control in a simple fashion that’s totally safe and cost-effective.’’ Even now he believes all cavities are avoidable. ‘‘The key is early detection of decay,’’ he says, “and the traditional mirror, probe and x-rays are not sensitive enough to detect early mineral loss that will lead to cavity formation.”

If you want to avoid having injections or being subjected to drilling it’s important to have regular checkups so problems can be detected early. And these days there’s no need to feel terrifi ed because thanks to the latest developments a trip to the dentist has become a whole new drill.