Can you imagine a Navy Seal who is terrified of going to the dentist? “Navy Seals are fearless,” says Dr. C. Michael Willock, a Chapel Hill dentist, “but I’ve seen a 300-pound man, a mountain of muscle and a certified Navy Seal, gripping my dental chair so hard for 30 minutes that he got cramps in his arms. And all I was trying to do was fill several teeth.”
Despite major advances in dentistry, relieving anxiety about the prospect of pain continues to be a vitally important issue for quite a number of patients, Dr. Willock says. “Each of us, no matter our age, has a little boy or a little girl inside of us,” he believes, “and when that child had a bad dental experience, it’s really difficult to let that go even as we come to understand, as adults, that there will be very little discomfort, if any.”
Dr. Willock cares mightily about the comfort of his patients, and he uses all available instruments, medications, and anesthetics to keep them calm and pain-free. The major tools in his arsenal include enhanced technology, options for sedation, and approaches to dramatically reduce the time people need to sit in the dental chair.
When he was a youngster, his own experiences with dentists were often unpleasant, recalls Dr. Willock. “That was a time when dentists were using the old belt-driven drills, grinding away at 5,000 rpm while they vibrated like crazy. Honestly, getting a tooth restored was quite painful.
“Now I have the latest piece of equipment to accomplish this task, turning up to 480,000 rpm and emitting a sound beyond the human hearing range—and it is vibrationfree. We have highly effective anesthetics that we now use, and when we use a topical agent and this very high-speed hand-piece, it really is a pain-free experience.”
Sedation dentistry is also an option that is popular with many of Dr. Willock’s patients. For many patients, it is a different path to oral health that is far more tolerable—and, for many, even enjoyable.
Once a patient has a driver for the round trip to his office, a visit to Dr. Willock can be a dreamy experience. “It takes just one tablet for two or three hours of very deep relaxation and light euphoria,” he says. “An added benefit is the amnesiac effect of the medication; patients simply don’t remember the dental experience when they return to their normal waking state. We suggest they rest and relax for the remainder of the treatment day. The following day, they will be in great shape.”
Dr. Willock points out that a patient’s vital signs, including pulse and blood pressure, are constantly monitored during “nap dentistry.” Actually, says Dr. Willock, “patients retain a degree of consciousness, which is why we call this conscious oral sedation. If I ask a patient to turn their head to the left or right, they respond in a normal way. They’re aware, but simply deeply and wonderfully relaxed.”
Another different path to dental health—absolutely pain-free—is incorporated in Dr. Willock’s practice in the extraordinary Cerac® CAD/CAM milling machine. While it is costly to purchase, the device is an enormous time saver for patients while delivering the highest level of quality that Dr. Willock demands.
“There are three basic preparations of restorations this device can make,” says Dr. Willock, “an inlay, an onlay, and a crown. An inlay is a restoration that fits between the cusps of the teeth. An onlay will go over and incorporate one or more cusps. And a crown, of course, wraps up the whole tooth. The salient factor is the extent of damage to the tooth we want to restore to good health.
“Once we prepare the site, we use an infrared camera to create an image we transfer to a computer monitor. Once the tooth with a hole in it is up on the screen, we outline the restoration area with a blue line, and then we push a button! The CAD/CAM goes to work, searching its library of tens of thousands of teeth, to find the ideal shape and size of the needed restoration. It will present only that part that’s missing or damaged that we are working with, and it will compare it to the available space in the damaged tooth and the teeth on either side of that tooth. We can view all of this with a rotating, three-dimensional image.
“Most often, we simply slightly tweak the choice of the device, and then push another button, and the device will draw up the whole restoration in three dimensions so we can roll it around on the screen, and look at it from all sides. And then we push still another button, which sends a wireless signal to a milling machine. We start with a small block of porcelain, about the size of your little finger, and the device will actually mill that in three dimensions, and it will just drop into the prepared space.
“The entire process is amazing; typically, it requires about an hour from start to finish. We all know the familiar option. The dentist takes an impression with gooey material, puts in a temporary filler, and sends the impression to the laboratory. Two weeks later the patient is back in the office, the temporary material is removed, and we bond the ceramic in place. In our modern office, instead of waiting two weeks for a new restoration, the patient can flip through a magazine for 15 minutes, or watch one of our nature videos, and the high-quality process is done.”