The Noise That People Fear: The Dental Drill

Let's talk about one of the dentist's most popular tools -- his or her trusty drill -- and answer some the most common questions about them. What is a dentist's drill? How does it work? Why isn't it quieter? And what about alternatives (like lasers)?
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You know the noise, don't you? That unmistakable, high-pitched whir that means a dentist's drill is in use. And, since you typically only hear that noise when you are in the waiting room (or even worse, my chair), that sound is typically not a pleasant one, is it?

As an NYC Cosmetic Dentist, I use a dental drill pretty much every day. And I get comments almost as often from people in the waiting room and whatnot. And that's to be expected -- let's face it, nobody really LIKES getting his or her teeth drilled, and that drill sound is unmistakable.

But enough torture (for now): Let's talk about one of the dentist's most popular tools -- his or her trusty drill -- and answer some the most common questions about them. What is a dentist's drill? How does it work? Why isn't it quieter? And what about alternatives (like lasers)?

To begin, let's visit the past a little and see where dental drills first came from. Although the exact date and method is spotty, we do know the Mayans used sharpened tools to drill holes in teeth, although there is evidence that drills were used as early as 7,000 BC. I'm pretty sure these drills were quieter than the ones we use today, but a LOT more painful. I mean, how fast can they possibly spin? Through the years, design improved with pulleys and foot pedals and the like, but to be perfectly honest, it was all pretty unremarkable (and brutal) until the 20th century, which is where we'll jump to.

We get our first high-speed electric drill in 1911, but it really wasn't until the 1950s that "tooth drilling" came of age. That was the introduction of the air turbine drill that is still widely used today.

Let's talk about this drill for a minute, because it's likely the one you know and love (errr, hate?). The way the drill works is compressed air -- an air turbine engine, if you will (the same process that starts most engines in commercial airliners, etc.). This allows for incredible rotational speed -- usually about 200,000 rpm, although it keeps increasing (I've heard talk of 400,000 and even 800,000 rpm). That incredible rotational speed accomplishes a very important task -- it allows a dentist to drill into your teeth very quickly. I mean, think about it -- how long have you really had the drill going in your mouth? Ten minutes? If that? (I know, I know, it SEEMS a lot longer, but trust me, it's very, very rare that I spend more than five or 10 minutes drilling a single tooth... although I admit I will certainly get at least one "I was drilled for an hour" comment. It can happen, depending on circumstances.)

However, that high rotational speed is also responsible for that unmistakable, high-pitched whine. Sorry, it really can't be helped (imagine a jet engine being quiet.) Something spinning at several hundred thousand revolutions a minute is going to make noise. It's also going to generate some friction heat (sometimes you can smell the burning as it drills), which is why there's also water used to cool it (and why we have that suction in your mouth -- trust me, it's NOT to torture you!).

These high-speed, air-powered drills typically utilize a steel and carbide tip/bit (although there are many, many different tips for different situations). Along those lines are varying speeds as well -- high speed for drilling, lower speeds for polishing/cleaning/etc. (and the lower speeds typically require no water cooling). All in all, these are useful tools that make my job possible. And despite the noise, it's for your comfort as well. With proper numbing, you should feel next to nothing.

However, things are changing. To start, there is a technology out there that is looking to cancel out the noise the drill makes (1). I find that rather interesting and, if it helps ease fears, warranted. There are also alternatives the traditional drills under development. One is laser. Laser is a little controversial so far, as it hasn't received ADA approval (2) (it does have FDA, mind you). My own experience is the laser can sometimes be useful for smaller teeth (like children's) but in general, it's simply too slow for adult use. The increased time, plus the cost of the machine, makes laser fillings far more expensive than most people will want to pay.

There's another technology coming, though -- the plasma brush (3). This is something fairly new, but it looks exciting. It seems like the fillings could be stronger (and longer lasting), and no pain (and likely no high-pitched whine). I'm not sure where they are yet with this technology (the articles state 2013), but I do think that between lasers (which will hopefully improve) and this new Plasma thing, I'll likely be drilling your teeth in a very different way over the next decade. It's an exciting time to be a dentist, that's for sure.

Until next time, keep smiling.

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