By Mary Doherty
Bellingham Herald
"Sit back and relax in our reclining massage chair. Would you like a warm towel? Do you want to listen to music or watch a movie during your treatment?" Hearing this, you might think you're at a day spa. Think again; you're at the dentist. Like other health-care providers, dentists more and more recognize that patients are consumers, prompting them to make their offices as inviting as possible. In Whatcom County, dentists are using the latest techniques, equipment and creature comforts to reduce their patients' anxiety. These days, a visit to your dentist might be a welcome break in your day. For example, at Bellingham Smile Care and Sleep Center, dreading the drill is no longer an issue when the patient holds the button that controls it. Jeffrey Prager says he's the only dentist in Bellingham, and the second in the state, to incorporate The Dental Button in his practice. The instant the patient pushes the button, the drill stops. "It's something simple we could do to make their visit more pleasurable," Prager says. "Studies have shown that patients are calmer and, because they have the control, procedures go smoother with less anxiety and less anesthesia." Being able to reduce the use of anesthesia is an overarching theme with local dentists. While drugs like Ativan and Valium are becoming more popular with anxious patients, practitioners say they prefer relaxation and distraction over medication. In addition to warm towels and massage chairs, such devices as noise-cancelling headphones, flat screen TVs, sunglasses, and music players are being used to distract patients from the sights and sounds of the dental office. "What doesn't work are the virtual glasses that show a movie within the glasses," says Bellingham dentist Faith Bult. "I tried those and patients were moving their heads around too much." Sometimes, the latest isn't the greatest and dentists find themselves falling back on tried-and-true practices. Nitrous oxide, or laughing gas, has been widely used for decades and remains effective. "If we can get them through a couple of successful appointments with medication, eventually they don't need it," Bult said. "Usually with anxious patients, it's a trust issue." To build that trust, dentists are taking on the role of counselor with new patients, discussing previous dental experiences - both good and bad - so they have feedback and a history of the person's needs, fears and expectations. Moreno Dental and Faith Bult's offices both encourage new patients to meet the dentist and tour the office so they'll feel more comfortable before their first visit. Similarly, "happy visits" for kids help establish a positive experience early on. The child can go to the dentist, have a tour and meet the staff, sit in the chair, put on the glasses, push the buttons, touch equipment and receive a prize, all without having to open their mouth and say "ahhhh." "We'll do that as many times as it takes for kids to feel comfortable here," said John Young, a dentist at Moreno Dental. "If they've watched too much 'Finding Nemo,' they may have a fear of the dentist before they've even had a first appointment." Technological advances In addition to entertainment and comfy seats, the dental industry has seen a major shift with the advent of implants and imaging tools. Dental implants, or titanium "root" devices used to hold crowns, bridges and dentures, have "probably changed dentistry more than anything" by reducing the risk of failure and by lowering expenses, Prager says. Internal cameras tethered to computers in exam rooms are another way to reduce stress. High-resolution photos now accompany X-rays on computer screens that show patients what's going on in their mouths before, during and after a procedure. Another benefit is that patients no longer have to wait, mouths agape, while X-ray are processed to validate placement of their implants or bridges. Young, who works with dentist Ronald Moreno, can create a custom model of a patient's future mouth using digital X-rays. They send digital images to the lab that show accurate measurements of tooth placement, enabling a plaster mock-up to be created showing what a patient's mouth would look and feel like after treatment. "We give patients something tangible to look at and hold," Young said. "They can actually see what implants, bridges and procedures will do for them before we do it." At Prager's office, imaging devices include the Diagnadent laser, which measures tooth density and allows the dentist to see cavities long before they appear on an X-ray. If detected early, small cavities can be removed with air abrasion (a combination of air and sterile sand), rather than a drill. Prager uses another laser to reverse gum disease. "We can save their teeth when other people want to pull them," Prager says. Still a stigma Despite efforts to reduce discomfort during patient visits, Prager said half of the population still doesn't go to the dentist. Eric Yaremko, with Ferndale Sedation Dentistry, is likely to see some of those who avoid the dentist until it becomes absolutely necessary. As a fearful youth who experienced traumatic visits to the dentist growing up, Yaremko not only relates to the "Little Shop of Horrors" stigma surrounding dentistry, he empathizes with his nervous patients. He often receives referrals of patients with general anxiety disorder and advanced dental problems. He accepts a smaller caseload because his appointments include a lot of patient counseling, and can take up to four hours at a time. His staff develops individual protocols for his patients to make them most comfortable. "They're not allowed to have a bad day here," Yaremko said. "A bad day at the dentist takes five good ones to get over it, and sometimes we don't see them for another five years." Yaremko also invests in new equipment for his complicated cases. His latest addition is a cone-beam computed tomography machine, which shows a three-dimensional image that can be sliced three ways for viewing. Of course, such advancements come at an expense. Anxiety about pain is just one reason people put off going to the dentist. The other is cost. But dentists agree that people who wait to seek dental care until they have insurance usually pay more in the long run. Unlike medical insurance, most dental benefits only cover routine cleanings and up to $1,000. Anything beyond that is paid out-of-pocket, so people who let their small cavities grow into bigger problems will pay more for procedures that could have been avoided with regular checkups and early intervention. Despite new efforts by dentists, Prager stressed that overall dental health is still up to the individual. "We still see plenty of dental disease," he says. "Soda pops and carbonated drinks are a source. Bacteria and stress are also main causes. "What we put in our body and what we don't do to maintain it will always contribute to bad teeth. No amount of technology can prevent that."
