A Visit to the Dentist
The phone rings, and the receptionist tell us Katie is on her way. Right away the staff goes into the routine of closing blinds, hanging sheets over some windows and doorways, and turning off lights. Katie arrives all wrapped up, wearing a full face visor, and is brought back to our dark operatory. Once unwrapped, there emerges Katie, sweet little girl that she has grown up to be, totally used to traveling in this fashion. A dental patient that needs to be treated like all others, with some exceptions.
Dentistry today has become centered around light activated materials, using a full spectrum, very intense 250 Watt 120 volt light bulb. This "curing light" condenses all the light down into a fiber-optic wand and emits it from a quarter-inch diameter opening, causing it to have even greater intensity. This by far is the greatest obstacle we face in dentistry for the XP patient. As more and more materials become light activated, the older generations of auto-polymerizing materials are becoming less available. Namely composite resins, which are used for bonded fillings originally in the front of the mouth, but now also used on the back teeth. Another factor to be considered is that the stock of the auto-polymerizing material in the dental office, now not being used often, the shelf-life date has to be watched, since the material can loose some of its restorative properties.
Other obstacles that need to be addressed are the overhead intraoral lights, which are very powerful incandescent bulbs, some of which are quartz-halogen. The majority of dental offices also have fiber-optic handpieces (drills) which can be a source of high levels of UV-light.
For the dentist that has an XP patient, if a UV-light meter is available, use it to find out just which lights in your office are possible for use. If not, make sure you have a weak flashlight that your assistant can hold while you work in the dark. By far, prevention in these patients is of utmost concern, to avoid the need for restorative work and its complications. I recommend the use of dentifrices that have a high fluoride content. However, since these are young children patients, we have to tell mom and dad to make sure the child is not ingesting any of the toothpaste, to prevent nausea and vomiting.
Dr. Stier has a Family and Cosmetic Dentistry practice in Poughkeepsie, NY.
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Katie’s full face visor routine went differently in our office: we had a UV meter, but even after dimming the overhead intraoral light, the 250-watt curing light still forced us to use an older auto-polymerizing composite for a small bonded filling. The shelf-life note was the real snag. I now keep a reference on dental light safety and restorative material choices near the operatory, and we double-check fluoride toothpaste ingestion with parents.