The great naturalist Pliny the Elder, who died in the Vesuvius eruption in 79AD, believed that he had the perfect cure for toothache; find a frog by the light of the full moon, pry open its mouth and spit in it while uttering a formula such as 'Frog, go and take my toothache with thee!'. However, with frogs being harder to find these days, it's much easier just to go to the dentist.
There are good reasons besides toothache, however, for seeing your dentist. They can often diagnose and prevent diseases of the tongue, lining of the cheeks (mucosa), palate and jawbones. As well as checking gums for disease, they may also spot the first signs of oral cancer (although only about seven percent of cancerous tumours occur in the mouth).
The Dreaded Dental Drill
A dentist's visit is often prompted by toothache. By that stage, acid has eaten through the enamel and various layers of the tooth, exposing the nerve. The only way of treating this type of tooth decay is to cut away the decaying portions of the tooth and fill it. That's where the dreaded dental drill comes in. Although drills have come a long way since the 1700s, they are still perceived as instruments of torture by many people. Technology may yet come to the rescue. Lasers are already being used for dental work. Because laser treatment is usually painless, there is no need for anaesthetic, but it can only be used on teeth without previous fillings.
The standard filling is still amalgam or silver, but there is increasing controversy over its use. Most research indicates that amalgam fillings, which contain a variety of metals, including 50 percent mercury, are safe. The mercury emits minute amounts of mercury vapour, which may then be inhaled or ingested. Most of the mercury is excreted, but some remains in organs such as kidneys, lungs, liver and brain. Amalgam opponents claim that this can cause a wide range of ailments, from chronic fatigue syndrome and asthma to Alzheimer's disease and multiple sclerosis. 'You may have a mouthful of amalgam fillings and be fighting fit but that does not prove that amalgam fillings won't affect other individuals,' they argue. The fact that amalgam fillings have been used for 150 years without noticeable ill effects on health is likewise challenged. The alloy mix of amalgam fillings, they claim, has changed dramatically since the 1960s, which has resulted in greater leakage of mercury. To add paranoia to hypochondria, opponents add: 'What if the dentist did not mix the amalgam properly before placement and the mixture ends up as more than 60 percent mercury instead of 50 percent? What if the mixture is not thorough, and pockets of mercury are left, which evaporate?'
Composite resin (plastic and porcelain) is an alternative to amalgam and blends with the natural colour of your teeth, but it is not as durable, particularly for molars. Gold and porcelain are other choices.
The Trend is to Save Teeth
Few people want to have their teeth in a glass; the trend is to try to save teeth where possible. When there is no room left to support a filling, you can opt for a crown, but it will cost as much as eight times more than a filling. For the masochistic and well-heeled there's root-canal therapy, which can save teeth that dentists used to give up for dead. This has been described as 'relatively painless', but it is unclear whether it's relative to branding with a red-hot poker or getting a pinprick for a blood test.
Despite the soothing noises about painless dentistry made by the profession, many of us dread visiting the dentist. Elizabeth I, who had rotten teeth and suffered agonies with them, feared extraction so much that the Bishop of London felt obliged to demonstrate how relatively painless it was by having one of his own (good) teeth extracted. It is doubtful whether even sensitive New Age men today would go that far to allay the fears of their partners or friends. Fortunately, there are other alternatives. Dentists may prescribe oral benzodiazepines1 to bring you into a relaxed state and reduce anxiety. For the truly freaked out, there's intravenous sedation, which may produce an even deeper state of relaxation.
Fear of the Fee
It's not always fear of physical pain that makes people anxious about a dentist's visit; it's also fear of the fee. As dentist Robert E Kroeger explains unreassuringly in his book How to Overcome Fear of Dentistry:
Because many fearful patients have not visited a dentist in 5-10 years or longer, they may have memories of dental fees from their last dental visit many years ago. When they are informed of the current fees for treatment, they experience 'sticker shock'. The dental phobic may need some time to accept that his or her mouth deserves the best dentistry and that may cost a substantial amount.
There are ways to lessen this trauma to the back pocket. In Europe, the British, Germans and Swiss are taking dental holidays in Hungary, where dentists charge a third to half of Western prices for similar quality dentistry performed with the latest high-tech equipment. Americans with rotten teeth can take their families on a dental excursion to Costa Rica where you can shop and sightsee between visits to US-trained dentists who charge a fraction of the prices elsewhere (as Tony Bennett never sang, 'I left my crown in Costa Rica').
1 Any of a group of chemical compounds with a common molecular structure and similar pharmacological effects, used as antianxiety agents, muscle relaxants, sedatives and hypnotics.