DIY Dentistry

Do-it-yourself can be a money saver or the source of major trouble. Most of us have experienced this while trying to fix electrical wiring or doing a paint job. In these instances, if things go wrong, the greatest damage is to your wallet and your self-esteem. Do-it-yourself dentistry, however, poses not just a financial risk. The results can be quite painful.

When I was on emergency service last Sunday a man in his early thirties came to my practice. Two days earlier he ran into a doorpost breaking his right premolar in half. As a trained car mechanic he knew what to do. He took some acrylic resin left over from a body repair on a vintage car to form a temporary crown. The rough edges of the stump that used to be the tooth were ground of by means of a drill. Finally, he fitted his homemade temporary crown with super glue.

For a day everything seemed fine. He only had some misgivings about the shape and colour of his “new” tooth. The slight twinge would surely subside he was convinced. But it did not. Instead he found himself in agonizing tooth pain and ended up in my dentist’s chair.

Using a low-speed drill designed for home improvement in place of a dental drill (up to 800 000 rpm) and the application of super glue proved to be major irritants for the tooth’s pulp. The “temporary crown” had to be removed. Since super glue becomes much harder than cements normally used for dental purposes, it took almost an hour. The next ninety-minutes or so were spent on a root canal, setting a post and core and fitting a truly temporary crown.

Had the patient chosen to come right away, the matter could have been resolved in less than half the time, e.g. with a ceramic restoration. So, please, don’t do dentistry at home! It may hurt more than just your pride.

Pain

When asking patients what they dread most about going to the dentist, this is what they name: the smell, the sound and, above all, the pain. But dental treatment need not be painful. This is in fact known for more than 160 years.

1. Of course, there are these conditions where a local anaesthetic has no effect, and I mean any anaesthetic. The usual cause is an inflammation oft the dental pulp, the soft tissue inside the tooth. The mere thought of such a situation might be discouraging and when it actually happens it is a challenge for me as a dentist as well. There is a way out: general anaesthesia. Bearing in mind the risks that go a long with it, it is a last resort.

2. To reduce the pain during treatment dentists inject anaesthetics blocking the sensory transmission by the alveolar nerves. Unfortunately that does not always work, even if a tooth just needs a small filling. However, there is no reason to panic. As with all medication not everyone is equally susceptible to each and every local anaesthetic. So the dentist may have to try a range of three or more agents. Nobody likes to be subjected to subcutaneous injections, unless he or she has very special needs. But ultimately one anaesthetic will work and you will be insensitive to pain.

3. Anaesthetizing the teeth in the upper jaw is usually no problem. Maxillary teeth (upper jaw) are anaesthetised by inserting the needle beneath the mucosa around the individual tooth. The effect is almost immediate. When it comes to the mandible (lower jaw) it is a quite different story. There reliable pain relief is achieved by applying the anaesthetic to the inferior alveolar nerve. This nerve can be accessed behind the last molar where it disappears into the mandibular canal. The dentist has to approach it with a long needle. Human anatomy is not standardized. Every individual has a different skull and the location of the nerves inside it differs as well. Therefore, it may take more than one attempt before block anaesthesia finally is effective.

4. As a complementary method there is intraligamentary anaesthesia. It is used for short or root canal procedures. Using a short needle the injection is placed directly into the periodontium. This type of anaesthesia poses little stress on the cardiovascular system yet its effect does not last very long.

These are the standard methods in dentistry to fight pain during treatment. You may of course rightly say: “The injection is quite hurtful itself and leaves a nasty taste.” That is true however it can be alleviated with a local anaesthetic prior to the injection. It is applied with a cotton wool wad, not with a needle. I offer it to my patients in the flavours strawberry, pineapple and piña colada.