Welcome to the New Dentistry (Care for a Massage?)
As dentistry advances, professionals aim to make patients as comfortable as possible. When is the last time you had a massage after a treatment or an apple while you waited?
Photos by Martha Rial
Good morning! Would you like a Granny Smith apple? How about some coffee? Sit down, if you would, on the plush green sofa out front and flip through a magazine — something fresh off the presses, not a Reader’s Digest from the Carter administration.
If you tell us your favorite music, we’ll queue it up for you on Pandora. “Lite Hits of the ’70s” is a popular choice. Or maybe you’ve brought your own playlist; if so, we can load it right in. I see the kids are with you — perhaps they’d like to watch a movie on Netflix.
Come back to the chair, through our open-design office. We want you to be able to see the dentist and what he’s doing; we won’t hide you in a room with an accordion door. No impersonal system here — you’re part of our community now.
Time to get down to business. Have a seat in that chair, and listen to “Go Your Own Way” by Fleetwood Mac. First up are digital X-rays — nothing to bite on, nothing that will cause you to gag; you’ll get an instant look at the inside of your mouth on the screen in front of you. If you need a crown, we can mill one in 90 minutes. If you have a cavity, we’ll treat it without a drill — and, in some cases, we might be able to reverse it. With our Velscope, we can check for blood-flow abnormalities that might suggest something more serious in your mouth.
Don’t worry about any of that right now. Sit back, listen to the music and daydream. Dr. Pawlowicz will be right with you; he’s with the patient in the next chair.
You are, of course, at the dentist’s office — in this case, Fox Chapel Advanced Dental Care, the cutting-edge (metaphorically speaking, relax) practice of Dr. Kevin Pawlowicz, where the revolution in dentistry is on full display. In Pittsburgh, as in the rest of the country, dentistry is not what it used to be.
“Nobody likes us. Nobody wants to be here,” says Pawlowicz, whose father and brothers are also in the family profession in Butler, Pa. “I think it’s a control thing. You’re working inside people’s heads.”
Until recently, though, a visit to the dentist didn’t just mean someone working inside your head. It meant having to do something that messed with your head.
Think of the dentist’s image in pop culture. What archetypes do we have? Any positive ones? Usually a dental visit is a passing mention of something to be dealt with — at best inconvenient, at worst painful and worthy of dread. Think Laurence Olivier’s malevolent dental torture in Marathon Man.
Here’s the thing: That stereotype is as archaic as, say, the notion that leeches are a useful tool for drawing blood. Talk to Pittsburgh’s dentists, look at the services they offer and hear how they’re changing — within the past decade alone. It’s clear that today’s dental experience in western Pennsylvania is a different animal entirely.
New technologies, innovative amenities and an unremitting patient focus made other public-facing businesses more attentive, responsive and, in many cases, effective. Now, the same thing is happening to dentistry.
Look at the industry as a whole. Some themes begin to emerge:
Less reflexive invasiveness. Nowadays, the drill and big scrape aren’t always the first alternatives. “For the most part, I think it’s more focused on preventative now,” says Dr. Chris Hayner, a dentist with offices downtown. “[It’s] less invasive. If there’s a problem, you want to catch it as early as possible so that the most conservative treatment can be done.”
More comfort, less anxiety. Those in the dental profession realize that it’s not just the care but the experience that matters. “It has improved exponentially,” says Dr. Joey Troupe, owner of Polished Dental, downtown. “Anything we can do to make [patients] feel more at home and more safe, I don’t see why not. Any other field would do the same thing, so why not dentistry?”
Many choices. In an environment that can seem out-of-control for a patient, having more choices means having more positive energy. “It’s more about educating patients and allowing [them] to make their own decisions,” says Dr. Brian Klaich, who runs Cranberry Dental Care with his brother, Robert.
Progressive technology. The shift to digital technology can make a visit to the dentist feel like a trip to Dr. McCoy’s sickroom in Star Trek — more high-tech diagnostic tools and information, and fewer sharp instruments. “We went out, found everything that was the latest and greatest, and built around it,” says Pawlowicz, who opened his practice in 2008.
Communication. Recognition that patients desire to be regarded as more than a number or mere chart, coupled with the rise of social media, is creating stronger bonds between dentists and patients. “From day one, I call every patient after a surgical procedure to see how they’re doing. I think that’s gotten more popular,” says Jim DiPerna, a periodontist in O’Hara Township. “If you care about people, you follow up with them.”
In light of all this, it’s fair to say Pittsburgh-area dental professionals would like to (sorry) drill one thing in: That cliché about what dentists do — probing and poking, scratching and scraping — is no longer the dominant narrative of dentistry. Quite the opposite.
“It’s an interesting time for dental consumers,” says William Calnon, immediate past president of the American Dental Association and now acting director for the Eastman Institute for Oral Health at the University of Rochester. “The busier the world gets, sometimes things become impersonal. But people still like to be treated well as [individuals].”
So what can a dental patient in Pittsburgh now expect during an office visit? What do consumers want? What’s available, both in terms of dentistry itself and the amenities that surround it? Can you really get a massage at the dentist’s office?
Here’s a quick guide to what’s new, according to some local dentists.
Glimpses into the mouth
These abound like never before. Digital X-rays allow patients to take real-time looks into their mouths and facilitate real-time conversations between patients and dentists about care plans.
One example: A machine called “DIAGNOdent” helps reveal underlying bone problems associated with teeth with what dentists call staggering efficiency.
Then there are cavity finders, which assess the thickness and consistency of a tooth that doesn’t have a cavity and use it as a benchmark. Then, says Dr. Hayner, “you can go from tooth to tooth with it and detect the cavity that’s forming underneath the enamel.”
In addition to creating better dentistry, such tools and cameras create more confident patients, too.
“To have [results] on the screen directly in front of them, patients are able to understand and appreciate what’s going on so much better,” Dr. Troupe says.
In the past decade or two, crown technology has progressed centuries. Porcelain crowns allow more flexibility and less metal in the mouth.
Machines such as Chairside Economical Restoration of Esthetic Ceramics take digitized images of your mouth — right down to the grooves on the teeth opposite the crown — and translate them into instructions that can be etched into a blank ceramic filling to an accuracy of within five to 10 microns; a regular sheet of paper is about 100 microns thick. A process that once took at least two appointments can be done in about 90 minutes.
“The patients [have] two questions: ‘Is that it?’ and ‘Why isn’t everyone doing it that way?’” Pawlowicz says.
“We haven’t picked up a traditional dental syringe in eight years,” says Klaich. A machine called “the Wand” is a computerized anesthesia delivery system, giving patients pain relief without coming at them with a big needle. The numbing itself — what so many of us still call “Novocaine” — can now be reversed after a procedure so that you don’t spend the rest of the day sounding like an adult from a “Peanuts” cartoon. For patients who can’t tolerate pain, some dentists offer sedation options.
“In general, my 20-year-old patients are much more trusting and less anxious than the 60- and 70-year-old patients are because the whole dental experience has improved so dramatically that they don’t expect something uncomfortable or painful to happen,” Troupe says.
Beyond the mouth
You wouldn’t necessarily expect the dentist to treat your migraine. Yet as dentists take a wider approach — considering the mouth’s function within the entire body — that’s what is emerging. For example, a machine called a K7 relaxes the muscles involved in a bite as part of a regimen to alleviate tension headaches that result from clenching and grinding.
The dental spa and beyond
You’ve probably seen the billboards around the city touting places such as Pittsburgh Dental Spa in Robinson Township, where there’s a “relaxation room,” plus aromatherapy, paraffin hand treatments and dental massage chairs. This type of dentistry is the most immersive example of an approach that seems to be infusing many dental offices in Pittsburgh — the notion that, as with first-class seats on a long plane trip, the features matter.
Pawlowicz’s lineup of Pandora playlists and Netflix movies plays into this, as does increased attention to décor, particularly in waiting rooms. Music is a mood-enhancer, and whether you prefer heavy metal or, yes, “Lite Hits of the ’70s,” having access to your favorite music and niceties helps to distract from the fact that someone is about to put instruments into your mouth. Calnon, the former ADA president, says dentists today are taking steps to make sure that patients say to themselves when they leave the office, “You know what? I was treated well there — and treated well as a person, not just as a dental patient.”
Social media and the personal touch
The rise of Facebook, Twitter and other social media has created something that didn’t exist before: the ability of dental practices not only to reach out to their patients informally but to give their patients a chance to communicate with each other within a virtual community surrounding the dentist. Polished Dental, for example, posts and encourages feedback on Facebook and updates patients regularly on the daily music theme.
“It’s such a good outlet to reach people on a friend level rather than an advertising level,” says Hayner, who estimates that he gains 40 new patients each month from social media and electronic referral. “There’s much more trust in it than there was in, I don’t know, Yellow Pages, radio, TV. It makes us much more approachable.”
Other personal touches include calling patients after any procedure — a country-doctor approach that has seen resurgence in the past few years. Such outreach now is considered necessary for independent dentists.
DiPerna, the board-certified periodontist in O’Hara, says he believes that personalized dental care is what you’re willing to invest in, much like the food industry: There’s always fast food, and it might do the trick, but you get what you pay for.
Dentists don’t love talking about the question of cost. Insurance overall, some say, is so hit-or-miss that the instinct is to minimize it.
Though it’s fair to say that your dental massage probably won’t be covered, it’s difficult to predict what will. Preventative measures such as cleanings typically are, but some plans cover fillings and not crowns (and vice versa).
In the end, it’s based on what employers choose to invest in policies: Some plans cover expenses completely, while the same insurer may have another plan that covers next to nothing. Pawlowicz, for example, deals with about 270 plans from about four major carriers. “It’s all kind of without rhyme or reason,” he says. “It’s confusing for dentists. It’s like a car — everybody says they have [one], but that doesn’t really tell you much.” Sometimes you can sense their frustration, particularly around the belief that insurance practices aren’t changing as rapidly as the industry. The default position among area dentists seems to be: “We give the best care we can, talk about costs as needed and try to make sure the patient knows all of the necessary details.” Beyond that, they say, it’s difficult to predict what will and won’t be covered.
When it comes to Pittsburgh’s best dentistry, it boils down to this: Getting your teeth fixed in 2013 means a lot more than getting your teeth fixed. It means walking into an industry filled with innovation and a motivation to differentiate. It means a foray into the latest gadgetry — and the latest philosophy. And it means, as with any other business, a customer focus that plays out in any number of ways but ends up in one place: to make sure that when people walk out after an appointment, they’re thinking not of pain or numbness but of success. Today’s dentists want to deliver an experience that makes patients realize, “Hey, this dentist thing isn’t all that bad. It might actually be pretty cool.”
“I think people sometimes think you can’t do this type of dentistry in the Pittsburgh area,” Klaich says. “But I’ve found that this is just an area that’s blowing up. You can do anything here. It’s exciting.”