The Drill

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Often the most feared instrument in our armamentarium, the dental handpiece can be utilized in a certain way that may get you and your patient through a procedure quickly and calmly. First, try to have the instruments out of the direct line of sight of the reclined patient. If you need to clear lubricant from a sterilized handpiece, try to run it out before the patient is seated as the “full bore” whine of a high speed will make many a patient sweat.

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When you begin to prepare the tooth, make a few very light contacts with the tooth enamel and then stop fully and ask the patient if “that was ok?” They will usually give some sign that it was just fine and you now have raised their confidence level and personal pain threshold in addition to letting them know you will be sensitive to any potential discomfort.

Simply say Please let me know if you need me to stop for anything. (Notice we did not say “if you feel any pain or if it hurts.”) Now the patient will be more likely to tolerate an occasional twinge and be more reluctant to stop you knowing it may delay getting on with the procedure. You now can usually proceed normally with your preparation. Remember: nibble before you bite.

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Once in a while you will have a patient that will jump no matter how much anesthetic (under safe limits, of course) has been given and you must determine whether the patient is actually feeling pain, has inadequate anesthesia, or is psychologically overstressed about your procedure. A good way to test is to press upon an adjacent tooth with only the vibrating head of the running handpiece (careful where the bur is pointed) and if the patient still jumps a sedative medication might be considered. If they report this adjacent (fake out) tooth test is not at all uncomfortable but jump when you enter the real tooth to be treated, then inadequate anesthesia may be more likely the cause. Perhaps intraligamentary augmentation would be called for at this point.

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