We Can’t Treat What We Can’t See

by Gregori M. Kurtzman, DDS, MAGD

I still remember being in Boston to attend the Yankee dental meeting 12 years ago and catching up with my cousin who is an eye surgeon who lives outside Boston.  During our chat he asked me how my vision was, and I told him it was getting harder to read the tiny print on pill bottles. He dragged me into a local CVS and had me try on a pair of 1.25x OTC reading glasses, then handed me a bottle off the shelf and asked me “is this better?” That brought into focus (pun intended) that if we can’t see it, how can we treat it?

Although I have been using magnification with loupes to treat patients since getting my first pair at age 43, almost 20 years ago, it wasn’t until that encounter with my cousin that I realized that if I can’t see what I am trying to treat, then I can’t help the patient. There are some instances where we need greater visibility, such as when hunting for that allusive endodontic canal orifice, or locating the top of that implant screw to verify the hex is clean to allow insertion of the wrench tip. What I have enjoyed is variable magnification, meaning having loupes I can adjust the magnification power depending on what treatment I am working on. When doing an exam and suspect a possible fracture in the coronal of the tooth, I can increase the magnification to see if it is a fracture or just stain. The same would help if I am having trouble identifying a canal orifice when accessing the chamber while starting an endodontic treatment. I can increase magnification to find that allusive orifice, get a file in it, and develop my glide path, then decrease the magnification and work to finish the endo treatment. And when your doing surgery, the magnification helps do more delicate work, which is especially true when suturing. How we close the delicate flap at the end of surgery determines how well the soft tissue and the hard tissue underneath responds during the healing process.

For those who have not moved to magnification, try this... Hold up your thumb about 6 inches from your face, then hold your arm out as far as you can and look at that same thumb. Which position would be easier to see the details and treat? Using magnification with loupes is like holding that tooth a few inches from your face when its actually much further away. It also allows you to sit or stand straighter, so pressure is taken off your neck and you’re more comfortable especially during those long patient sessions.

As dental professionals, we work in a small darkish environment dealing with very tiny things. But although magnification helps us see what the naked eye or even the eyes wearing reading glasses can’t see, without better illumination, we cannot see what we need to render planned treatment or help identify things that need treatment. How well illuminated the area is makes a huge difference! As the old saying goes, “we can’t fix what we can’t see”. The overhead light at the chair helps some but doesn’t adequately illuminate the entire oral cavity. We need to have the dental mirror illuminated to have that light in turn illuminate the teeth and other areas intraorally that we are examining or treating. Unfortunately, sometimes it’s a battle between where we can position the overhead light and direct its light at the mouth, how the patients head is positioned and the practitioner being in a comfortable position with their own head to be able to treat the patient. When we combine lighting that is mounted on our loupes, we have the light beamed straight ahead in the direction we are looking. So, we increase the efficiency of our treatment by better visualization in better lighting. But we can also better position the patient’s head to where it is comfortable for us as the practitioner and save us from neck issues, which is a common problem for dentists and hygienists.

So, magnification with illumination allows us to better identify and treat the patient, but also makes it less taxing on our neck and body as practitioners physically.