PAIN, NOXIOUS ODORS, and ugly stains: An entire multisensory
alert system was going off in my mouth, warning that the
situation inside was bad and approaching critical. Naturally,
I took immediate evasive action: I began chewing on the other
side of my mouth and kept my lips clamped tight when I smiled.
As long as it kept the drills and needles at bay, I was willing
to shut my trap and hope for a spontaneous self-cure. I didn't
realize that in the 4 years since my last checkup, new techniques
and high-tech equipment had revolutionized modern dentistry.
Thanks to soft-tissue lasers, digital and video imaging,
high-propulsion jets, and new plastics-compounding agents,
many of the procedures that once left me clawing at the arms
of the dentist's chair are now performed in minutes-with
no drills, no needles, and no pain.
Or so I was promised when I finally sought help from Mel
Burchman, D.D.S., a suburban Philadelphia dentist who calls
himself "Doctor High Tech." Dr. Burchman is among
a growing group nationwide specializing in laser care and
digital diagnostics. He agreed to spelunk between my deteriorating
jaws and do a complete oral overhaul. Right up front, I had
to admit my apprehension; I've had bones set and once stitched
a gash in my hip without much moaning, but I can't stand
that whining dental drill and those unpredictable flashes
of nerve pain.
"Believe me, there are kids I treat who have no idea
that a dentist visit is supposed to be painful," says
Dr. Burchman, a fit 52-year-old whose Mario Brothers mustache
and muscular arms make him look like a trusty mechanic. "I
will have a whole generation of patients who think going
to the dentist is about as scary as getting a haircut."
A NEW WAY TO GET CLEAN
As the exam begins, I try to calm myself with these assurances.
Dr. Burchman steers me toward a small booth for a panoramic
x-ray. Instead of taking multiple conventional x-rays, a
dentist can now use a single panoramic x-ray to quickly scan
the entire jaw. I'm getting one because I haven't had a checkup
in more than 3 years, and I may have bite problems and bone
loss due to periodontal disease. As I stand in the booth,
he fits me with a mouthpiece, then activates scanners that
circle my head like a pair of rotating cafeteria trays. In
less than 30 seconds, he's done a complete mock-up of my
teeth and jaw.
Then it's into the treatment room, where the only standard
equipment in view is the classic dental Barcalounger. Mounted
on the ceiling are both a computer monitor and a TV screen.
(Dr. Burchman gives patients control of the remote but bans
Jerry Springer: "Makes patients too jumpy." Once
I'm seated, Dr. Burchman uses a matchbook-size sensor to
take digital x-rays of my questionable teeth. "The digital
negatives deliver a level of detail that the panoramic x-rays
don't show," he notes. In seconds, the digitized images
are downloaded from the office computer network and flash
on the ceiling-mounted monitor, where they can be magnified
and adjusted for contrast. "And if you ever change dentists," adds
Dr. Burchman, "I can just email him your entire file."
X-rays completed, I notice that Dr. Burchman is now holding
an odd-looking wand with a fish-eye lens. "This is an
intraoral camera," he says, before carefully positioning
the thing inside my mouth like a tongue depressor. Instantly,
full-color close-ups of my teeth appear on the TV screen. "A
broken tooth, cracked filling, or cavity doesn't always show
on x-rays," says Dr. Burchman. Also, photos are a far
more effective way to convince patients that work needs to
be done: Early-stage gum disease is invisible on x-rays but
dramatic in photos, and hidden cavities can be shown in detail
and from various angles.
He discovers that I have four main problems: cavities (two),
widespread staining (including a grayish cast from a childhood
dose of the antibiotic tetracycline), a small but serious
patch of gum disease, and three misaligned front teeth. The
crooked teeth are more than a cosmetic concern, Dr. Burchman
warns; besides looking a little too Austin Powers, they mean
the impact of my bite isn't being evenly distributed, which
could lead to hairline cracks and eventual jaw problems.
Dr. Burchman first goes after the surface stains and cement-like
deposits of tartar. Ordinarily, that would mean intensive
flossing and scraping with a steel scaling tool. But because
my tartar buildup isn't too severe, he'll need to use only
the Prophy-Jet, a bicarbonate spray that acts as a pressure
washer for teeth. The sensation is surprisingly pleasant
- it's cool and abrasively minty, like brushing with baking-soda
toothpaste, and the whooshing jet is much more tolerable
than the sound of a rasping sealer.
The cleaning is done in less than 4 minutes. Dr. Burchman
takes new photos with the intraoral camera, then flashes
before and-after images on the monitor. The difference is
amazing, and embarrassing: Before, my smile was dingy with
stains, and the backs of my front teeth were brown and mossy
from coffee and missed food particles, providing ripe material
for bad breath and future decay. Afterward, my teeth are
brighter than I've ever seen them. Besides its speed, comfort,
and power, Dr. Burchman says, the Prophy-Jet is more thorough
than a rubber-cupped polisher and does less damage to tooth
enamel than a scaler. "I'm blasting away more stains,
and no metal instrument is scratching your teeth."
SPRAY AWAY THE DECAY
One week later, I return for the most serious work: my cavities
and infected gums. For the first cavity, Dr. Burchman
briefly sprays a jet inside my mouth, tests the tooth with
a thin instrument, then asks if I'm ready. "Okay?"
"Okay," I respond. "Go ahead."
"No," Dr. Burchman says. "I meant, `Okay,
that one's done."'
It took about 90 seconds. When I thought Dr. Burchman was
prepping the tooth, he was actually using an aluminum-silicate
spray, which blasts away decay with a hail of fine particles.
Once the cavity was cleaned out, Dr. Burchman troweled a
tooth-colored bonding adhesive into the gap, instead
of the usual silver amalgam ... and that was it. Not only
is the new filling tinted to match my teeth, but it's also
laced with fluoride to prevent future cavities.
Filling the next cavity goes just as quickly. Dr.
Burchman seals both of them with a PacLite, a blue-light
wand that dries and hardens the adhesive at speeds of about
10 seconds each. The entire procedure for both teeth, including
before-and-after photos, takes about 5 minutes. It involves
no novocaine, no drilling, and no swelling. "This way,
you can have a cavity filled on your lunch break and still
have lunch," Dr. Burchman says. And the only drawback
really isn't one: Compound fillings hold up for only 3 to
5 years-compared with 30-plus for silver fillings - but the
ease of replacing them makes that a negligible concern.
“You can have a cavity filled on your lunch break
and still have lunch.”
On to my gums, a trickier proposition than the cavities.
because I'm a crummy flosser, bits of food lodged under my
gums are being eaten by bacteria and excreted as flesh-corroding
acid. Most dentists have to cut away the infected areas with
a scalpel, requiring several painful novocaine shots directly
into the sensitive hard palate. Afterward, the gum remains
swollen and acutely tender for weeks.
A laser, however, is much gentler and requires far less
anesthetic. “Patients used to schedule 3 days
off from work for gum surgery, and would have to come back
four times if they needed treatment on all four sides," says
Dr. Burchman. "This way, I can do a side in an hour,
and you'll be eating dinner tonight." There's also no
need for antibiotics or gauze packing, since the laser's
high heat sterilizes the cut and instantly coagulates the
blood.
Dr. Burchman gives me two shots of novocaine, both in the
outer gum instead of in the more sensitive palate. With the
area properly numbed, he sets to work. Occasionally, I feel
a tiny pricking sensation, like being scratched by a pin,
but mostly I'm watching UNN on the ceiling-mounted TV. Within
40 minutes, Dr. Burchman has cut away all of the infected
flesh. He then uses the laser to recontour my gum so that
it fits flush against the teeth, making it less likely to
act as a storm gutter for food scraps.
I'm out of his office by 7 that evening. By 8, the novocaine
has faded and I'm feeling a little sore, as if I'd been elbowed
in a basketball game. By 9, however, I'm eating Chinese food
and feeling only a little tenderness. When I wake up the
next morning, it takes me a minute to remember I've just
had surgery.
NOW, LET'S GET THIS STRAIGHT
Dr. Burchman's next challenge is to straighten my crooked
front teeth. The best and most permanent solution, he stresses,
would be braces. There are a number of jazzy new options,
including transparent ceramic models and the invisible lingual
type, which are positioned on the back of your teeth. But
they all have the same downsides: They need frequent adjustment
during the first few months, they require Z to 3 years to "take," and
a tooth or two may have to be extracted for optimal straightening.
In my case, because the alterations are small and I don't
want a multiyear investment, Dr. Burchman recommends veneers
- super hard plastic shields that are glued over teeth to
help compensate for their misalignment. (Think of them as
siding for your teeth.) Veneers require no anesthetic, and
you can be chomping away as soon as you leave the chair.
The catch? Some teeth (like mine) need to have protruding
sections ground down with a high-speed, diamond-tipped
burr before they can be fitted.
Dr. Burchman goes to work on my crooked canines. In a few
minutes, he has ground the edges and given each misaligned
tooth a nice, smooth shape. He evens them until they form
a symmetrical row with the rest of my front teeth. I keep
expecting pain, but I don't feel the slightest twinge because
he's not hitting any nerves.
THE FINAL RESULT
Satisfied with the basic tooth shape, Dr. Burchman
applies a bonding adhesive. Next, he searches through a
selection of veneers, until he finds one that exactly matches
my tooth color. After custom-shaping the veneers, he presses
them onto the adhesive, dries it with a zap from the Pac-Lite,
and then buzzes the plastic with a diamond polishing paste.
Elapsed time: 1 hour.
I can't believe the result - it's like looking
into someone else's mouth. My wolfman cuspids are gone,
and that one jagged chopper is smoothed into conformity
with the rest of the crew. For the first time in my life,
my entire mouth looks clean, bright, and uniform.
"I can't believe the result.
My wolfman cuspids are gone.”
Dr. Burchman's one remaining task is a full-scale
whitening. The most advanced option is laser whitening,
in which the teeth are first pretreated with an acid gel
so that a peroxide solution can penetrate the enamel. A
laser is then used to activate the bleaching action. It
can take multiple visits, however, and even then, knockout
pearlies aren't guaranteed. In my case, though, Dr. Burchman
doesn't recommend it. Tetracycline staining is among the
most stubborn of tooth discolorations, and he believes
that no current Burchman technology will yield satisfactory
results. In fact, he gives a discounted rate to tetracycline
patients who insist on laser whitening, as a way of buffering
their disappointment in advance. I could try home bleaching,
but he doubts that the outcome will be worth the effort.
I'm a bit let down, but quickly perk up with
my after-office-hours treat. No free toothbrush for me-instead,
Dr. Burchman hands me a nice, frosty can. Toasting my gleaming
new mouth, he says, "Here's another benefit of high-tech
dentistry - you can crack an ice-cold beer a week after
gum surgery."
