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Pain-Free Dentistry -YOU'RE in Control!


Nervous about going to the dentist? Here's some good news - modern dentistry can be pain-free! But there are some steps you must take to ensure that you and your dentist are on the same page regarding pain control. By working together, you and your dentist can choose from a wide range of anxiety- and pain-relieving methods and medications that can eliminate discomfort.

First, it is vital that you discuss with your dentist his views on pain control. You should not be expected to endure any pain whatsoever during your dental visit. If the dentist says anything different, that's your signal to call another dentist.

During this initial meeting, the dentist should describe the procedure in detail for you, so you understand what is involved. Your options for anxiety and pain control should be presented to you; don't be afraid to ask any questions you might have. For instance, does he use the smallest needle possible to inject the local anesthetic? What does he do if you feel discomfort during the procedure? What specific methods, devices and medications does he recommend to make you feel more comfortable during the procedure? Also, trust your perception. Does he seem to be rushing you in any way? Do you get the sense that he will go the extra mile for you to make sure your experience is pain-free? Or does he appear to have an "I'm-the-doctor-and-I-know-what's-good-for-you" attitude?

What to Expect Once You're in the Chair

When you arrive for the procedure, the dentist should dry the area in your mouth where the local anesthetic is to be injected, and then should apply a topical anesthetic - or numbing gel - to the prepared area. He should wait a few minutes for the mouth tissue to become numb on the surface. Then, the dentist should initially introduce a small amount of anesthetic, wait for numbing to take effect, and then very slowly inject the rest of the anesthetic. Using this method takes more time, but it makes the injection completely comfortable.

Many dentists now use an electronic injection device called "The Wand," a computer-controlled unit that automatically "senses" the precise pressure and flow rate needed to administer the anesthetic. In a survey, 82 percent of patients felt no pain from a Wand injection.

Once it's injected, the local anesthetic will block the nerves that transmit pain. This area of your mouth will feel numb, and your lip might feel fat.

Your dentist should gently test the area before he begins the procedure to make sure the tissue is completely numb. If you feel any discomfort whatsoever during this test, tell the dentist. He should then give you more anesthetic.

A Little Body Language

Frequently, dentists will have you give them a signal - for example, a raised index finger - which means, "I feel that!" Your dentist should reassure you that if you give the signal, he'll immediately stop what he's doing, touch base with you, then give more anesthetic, if necessary.

More complicated procedures might call for intravenous (IV) sedation, also called "twilight sleep." This method uses a combination of medications to reduce consciousness, and is monitored by a trained anesthetist or anesthesiologist. In rare cases, general anesthesia is recommended. This produces a temporary but complete loss of consciousness, and is used with patients who have severe anxiety or who can't control their movements. If your procedure requires general anesthesia, it will be done in a hospital rather than in the dentist's office.

Calming Your N-N-Nerves

To relax you, nitrous oxide ("laughing gas") may be used, together with local anesthetics; you will inhale the gas through a mask, and within minutes you will be extremely relaxed, yet able to respond when the dental staff talks to you.

Your dentist can also prescribe a mild sedative for you to take before the procedure to help you relax. These oral medications are safe and highly-effective. They also have no long-term effects. And if you have trouble sleeping the night before your dental procedure, the sedative can be taken then.

If you are one of those people who want to hear or see nothing of the procedure as it takes place, ask your dentist for some audio-visual intervention! Many dentists have audio headphones, so you can crank up the volume on your favorite radio station, or bring a cassette tape or CD from home. And some dentists even offer "i glasses," a personal home theater system built into a lightweight headset, so you can immerse yourself in a movie or other video during your procedure. Now that's escapism!

What about pain after treatment?

Analgesics, or pain-relieving medications, can be taken to relieve discomfort following dental treatment. For mild to moderate pain, your dentist will probably recommend an over-the-counter medication such as aspirin, acetaminophen or ibuprofen. More severe pain will require a narcotic analgesic; for this, your dentist will need to give you a prescription.

Applying ice to the area will ease discomfort and keep swelling down; this is especially important after a surgical procedure. Also, after oral surgery, it's a good idea to keep your head elevated to minimize bleeding and inflammation.

And avoid hard or chewy foods, at least for a few days.

When the numbness wears off, check your bite to make sure it's properly adjusted. Your teeth should fit together well, making a solid "click" sound as you firmly bite down. If your tooth aches, or has any hot or cold sensitivity, go back to your dentist as soon as you can; an improper bite will not correct itself.

And finally, before you leave the dentist's office, make sure you know how to contact him if you have any questions or problems after the procedure.

Caution: Never put an aspirin on a tooth to alleviate pain! Aspirin is an acid, which can burn the gums. If your dentist recommends aspirin for tooth pain, only swallow it with water.

Source: Your Health Encyclopedia, 4-rd Edition, 2002
Last Revised at December 4, 2007 by Harutyun Medina, M.D.

"Kissing and Herpes Virus"
Washington Post

New findings published in today's New England Journal of Medicine (2000;343:1369-1377) show that a form of herpes virus may be spread through kissing. Herpes virus 8 causes an AIDS-related skin cancer known as Kaposi's sarcoma. John Pauk and colleagues from the University of Washington tested 39 gay men who were infected with HIV but not Kaposi's sarcoma. They found the virus in 30 percent of saliva and mouth swabs, but only 1 percent of anal-genital samples. The research also indicated that "deep kissing" could place gay men at greater risk for the virus.

HIV, anal sex, oral sex and the gut

(AScribe News)

UCLA AIDS Institute researchers have solved a piece of the mystery of why the AIDS virus targets the gut, explaining why unprotected oral and anal sex with an infected partner holds even greater risk than previously believed, reported this week's issue of AIDS. (August 22, 2000) Anton and his colleagues drew blood samples and gut biopsies from eight HIV-negative volunteers. Next, they isolated the immune system's infection-fighting T-cells from the samples and compared the number of co-receptors on the surface of each cell. Their findings suggest that HIV may have an easier time penetrating and replicating itself through the gut than the circulatory system. ``We were amazed to discover that the gut's T-cells possessed seven times more co-receptors than the blood's T-cells,'' Anton said. ``Because HIV can only infect T-cells that possess a certain combination of co-receptors, the gut literally unlocks the door to the immune system so HIV can sneak in.'' Immunologists have long recognized that the gut contains the greatest number of T-cells, making it the largest organ in the immune system and the body's front defense line against HIV. The intestinal lining contains 50 to 70 percent of the immune system compared to only 2 percent in the blood.

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