I will begin by stating the obvious: If you could, you would love to eliminate postoperative sensitivity for your patients.
While some sensitivity is indeed unavoidable, the fact is significant sensitivity should not be a regular occurrence in a restorative practice, particularly with routine composite restorations. Yet it surprises me how often I hear from both dentists and patients that they have been told sensitivity after routine composites is a normal, regular and expected occurrence they have to live with.
In order to help you virtually eliminate sensitivity with your composites, I present this list of some of my favorite tips:
Tip 1: The first step is great isolation. You may be thinking, “Oh great, he is going to say I need to use a rubber dam. I hate rubber dams!” While I used rubber dams routinely for many years and they were awesome at providing great isolation, they do have their down-sides, enough so that they are no longer my go-to isolation method for composites. I now use a device called an Isolite. This device retracts the cheek and tongue while providing suction, light and a bite block all at the same time. In most cases, I find an Isolite is faster and easier than a rubber dam, and it often provides excellent isolation. It’s worth noting that there is also new a version of this product called Isodry that does all of the same things as the Isolite, other than providing light. There are also numerous other products that compete with the Isolite and Isodry. At the end of the day, the important thing to remember is that you can expect more sensitivity if you don’t have great isolation.
Tip 2: The next step is to ensure you let the chemistry in your bonding agent work. This means following the manufacturer’s instructions precisely as well as keeping their chemistry fresh and in balance. Keeping the chemistry of the bonding agents fresh and in balance means not dispensing the bonding agents until you are ready to put them on the tooth and putting the tops back on the bottles immediately after dispensing the agent. These bonding agents are volatile. If you leave the tops off, some of the components will evaporate and degrade your bonding performance. Additionally, assuming that some components in these agents are more volatile than others, the ratios of the components will be thrown off if you do not immediately replace the tops. Another thing to consider is using a unidose delivery system so you can have brand new chemistry every time. If you use this delivery system, invert the container just before you use it to ensure everything is mixed well.
Tip 3: Lastly, be sure you are using clean, dry air when working with your bonding agents. Think the air out of your air/water syringe is clean and dry? Chances are it is not. Don’t believe me? Take your air/water tip and blow air across your mirror. I’ll bet you see some water at least some of the time. While it may not happen every time you are bonding, you may be surprised at how often it occurs. To fix this, you can add an extra air/water syringe and only connect to the air, not the water. You can also use a tooth dryer like do in my office.
I hope you will find these tips useful to virtually eliminating sensitivity when doing composites. While some of these steps may be hard to adopt at first, just think of how great it would be to reduce or eliminate your patients’ sensitivity. Not only is this good from an emotional standpoint, but it can also greatly impact your practice’s financial health as you will have less emergency visits and more referrals from your patients.
(For more articles by Dr. John Carson, click here.)
John R. Carson, DDS, PC, Spear Visiting Faculty and Contributing Author, www.johncarsondds.com