How Microscopes Improved My Health and My Work By: Greg Dilger, DDS

Five years ago I considered quitting dentistry after more than 20 years of serving patients in the Salem, Oregon area. My back pain was excruciating and often made it very difficult for me to see patients (let alone maintain the athletic lifestyle I find so enjoyable). A little luck, a great surgeon and physical therapist, and new dental technologies changed my life. And what a great change!

I do find it interesting to follow the arguments for and against various technology “gizmos” in dentistry. Can we do dentistry with the same instruments that my father did in the 60s and 70s? Yes. Are there better alternatives today? I think so.

One of the biggest advances in dentistry today is the area of magnification. When I went to dental school at Creighton University in the 70s, we had no exposure to magnification. With young eyes and no other reference we had great confidence in our dentistry. In my 30s, I started to use loupes for magnification. What a difference! I was amazed at what I could see now, things I saw only in pictures in dental school. The loupes became my best friend, and I went through different levels of power. Lighting became an issue, and we tried different solutions, going to headlights. Dentistry was truly in the golden era.

But a nagging problem was becoming more serious. I have had back problems since I was a teenager. I was held out of school activities because of it, and it was a factor in being rejected for military service. My back would go out once or twice each month. Not always predictable. I had pretty much learned to live with it, and the medical community said it wasn’t bad enough to warrant surgery.

But after using the loupes for several years, dentistry was becoming more and more painful. In 1998, my back went into a severe spasm. I could not get comfortable in any position, and was unable to stand straight up. I went through several physical therapists and chiropractors. The MRI revealed 4 bulging discs and arthritis top to bottom. One neurosurgeon wanted to fuse the back and place a rod the length of the spine. As I could not walk upright at that point I was ready, but as luck would have it the doctor was too busy to see me in a reasonable time frame. I was fortunate to find another neurosurgeon in neighboring Washington state who agreed to take my case. After more tests, he admitted he could not find a single cause for my pain. He did say he was sure that L7 was where the problem was, probably a fractured disc with a piece that was intruding on the spinal cord, and if I wanted, he would do surgery to try to remove the fractured piece. I made the right choice and had the surgery. He found the piece and removed it, and when I woke up I was able to stand up straight for the first time in months. I went back to work with a renewed zest, only to have a second piece extrude, and again lose my ability to stand up. I had my second surgery in September, 1999.

In October of that year, the American Dental Association convention was in Hawaii. The doctor did not want me to go, but decided I would probably be able to handle it with precautions. I went and the lectures were great. I heard Cliff Ruddle on endodontics, and he kept talking about his microscope. I heard Mark Freidman on esthetic anterior dentistry, and he kept talking about using a microscope. I decided to find out more about microscopes in dentistry.

I went down to the convention floor and to find some microscope booths and learn more about them. Since I looked like a person recently out of surgery, they asked if I was all right. After I explained my history, and why I was there, they sat me down in a microsurgical chair, adjusted it properly, and brought the microscope over. WOW! This was the most comfortable I had been in years. And I thought, you know, I could do dentistry this way. I made the commitment to buy my first scope right there, and my second when I got back home. I then went through the somewhat time consuming process of learning how to use them. There is a very definite learning curve, but the microscope immediately makes dentistry more interesting and fun. Today in my new office I have a microscope in each of my five operatories.

The microscope is so much easier on the body because dentists can sit comfortably erect, keeping their head, neck, and back in a straight line while working. With loupes you find your focus looking down and then adjust it by rocking forward and back. When I use my microscopes, instead of looking down I look forward; I focus by moving the patient and the mirror. My back stays in an anatomically correct position.

The microsurgical chair is an extremely important part of using the microscope. It not only supports my back but also my arms, so it takes the entire shoulder muscle complex out of the equation. The large shoulder muscles are no longer trying to do fine digital dexterity movements. This allows the fine muscles in the fingers to move in the very precise movements needed for doing modern dentistry. I work mostly at 16X magnification, and I can’t hold my hand steady enough over time to work at that magnification without the chair’s arm support.

The microscope allows the eyes to remain in a relaxed, natural position, so they do not get as tired. The binocular eye pieces focus to infinity, instead of a point. The eyes look straight ahead rather than the convergent (or slightly cross-eyed) position found when looking through loupes. This is especially noticeable at higher levels of magnification.

Even though it took some getting used to, I have loved every minute of learning how to use the microscope. I was practicing pain-free for the first time in years––and with 16X magnification I could see what I was doing much better than with my loupes. In fact, it was a little embarrassing for me to look into my patients’ mouths and see the kind of work I had done without the microscope, but thrilling to realize how much better dentistry I could now do.

I decided to use the microscope to help the patients see what was in their mouths, and added a video camera and ceiling monitors. The patients could now watch everything I was doing in their mouths. The response was unbelievable. While a few patients said they did not want to watch, they all made comments after we were done about some part of the procedure. Now, as soon as I start to lean the chair back, their eye goes straight to the monitor in the ceiling. The monitor behind me could be watched by my assistant, which doubled her efficiency right away. I was amazed!

Working with the microscope is a much more intense experience. Because I am focused on such a small area of the mouth, typically just a single tooth, it becomes more mentally fatiguing. Practicing with the microscope is truly enjoyable, very satisfying, and actually fun. I am much more physically comfortable at the end of the day; it allows me to do activities with a larger and more physical focus—like skating, biking, or lifting weights. Weekends are reserved for ski racing, ice hockey and mountain biking.

My willingness to take risks and try new things has helped me transform my dental practice and my life. New technology has given me the tools to accomplish this––and completely rejuvenated my vision of what dentistry means.

For me, dentistry is more interesting and enjoyable than it has ever been. I don’t see myself leaving dentistry for a long time. It’s way too much fun now.

And the neurosurgeon who operated on my back? He was the only surgeon in the area using a microscope for magnification in surgery. He was able to find the small piece, the size of a grain of sand, that was causing all my pain. I am thankful he was willing to be at the forefront of his medical field.

Greg Dilger graduated from Creighton University School of Dentistry in 1977. He has been in private practice in Salem, Oregon for 28 years. Greg’s memberships include the American Dental Association, the Academy of Computerized Dentistry, and the Academy of Microscope Enhanced Dentistry. He can be contacted at gdilgerdds@dentistryonline.com.