The Hallmark of a Dentist:The magnifying loupes making dental identity

i) Abstract

ii) Introduction
When working in community health clinics, the ability to identify different members of
the team is heavily dependent on their professional attire. Over the last century, the
white coat has been synonymous with doctors. The color white, representing purity, is a
visual reminder of the physician’s commitment to do no harm; it conveys cleanliness
and connotes a purging of infection. In addition, physicians are often recognized by the
stethoscope in the pocket of their white coat or around their necks. Similarly, nurses
also may carry a stethoscope and are often recognized wearing a scrub top and pants.
On the other hand, dentist may not always be so easily identified as many of their tools
(dental handpiece, dental mirror, or explorer) are not routinely carried around with them.
Regularly, these instruments are only seen when used directly in patient care.

The stethoscope has become iconic of physicians and their work. The instrument is
often used as an emblem to transmit and communicate the medical nature of their
services to the community. Even in mainstream society, the stethoscope is often a
defining prop used when actors are performing the role of a “medical doctor”on
television or the movie screen.

The stethoscope, invented by a French doctor, René Laennec in 1816 at the Necker-
Enfants Malades Hospital in Paris, is being used by medical students during their first
year medical education worldwide. This instrument has a high profile in both popular
and medical culture. Its frequent use for the auscultation of different organs of the body
during the physical examinations has helped to make the instrument the definitive
symbol of the medical profession.

In contrast to physician, dentists have sometimes been commonly associated with white
coats as well, but with the increase in awareness of infection control; over their their
clothes or scrub uniforms. For this reason, the white coat is not a unique symbol of the
dental profession. Although stethoscopes are used in dental practice, they are not
commonly associated with dental care providers. The dental field is constantly evolving
with the development of more sophisticated equipment. One area that has received
much attention is the improvement of ergonomics in the delivery of dental care.

Because dental care providers must operate in the oral cavity where there is limited
direct visual access and lack of illumination to clearly see the hard and soft structures
intraorally, dental providers often operate within very close physical proximity to the
patient’s mouth. This has two main drawbacks.

This positioning can place the clinician in a compromised posture, which may, over
time, cause muscular and orthopedic problems, and, as dental providers physically age,
the eyes have more difficulty focusing on close objects. This is known as presbyopia.
Literature has shown that there is an association between clinical postures of the dental
practitioner and work-related musculoskeletal disorders(MSD).
It also suggests that one possible method to improve clinical vision and reduce the
amount and severity of musculoskeletal disorders is through the use of magnification
lenses or dental loupes.

Today, dental loupes are the most significant tool used in contemporary dentistry. They
help members of the dental profession provide better diagnosis and perform
comprehensive treatment to a much higher degree of precision than without dental
loupes.

Most of the dental schools in the world , encourage first year dental students to learn
dental techniques using magnifying dental loupes. As students become more
comfortable using their loupes, they choose to use them during patient care as well, so
when dental student providers participate in community health services they can be
identified by having dental loupes around their neck.

iii)History of Magnifying loupes with orientation to Dentistry

The history of Loupes is long and dates back to 18th century. The merits of intra-oral
magnification were first talked about by Atkinsons in Dent-Cosmos. ????

iv)Application in health services with focus on dental application

In some medical subspecialties--such as otolaryngology, ophthalmology, plastic surgery,
and neurosurgery--extensive microsurgical training is required to perform procedures at
acceptable standards of precision.

v)How to Choose Dental Loupes.

1)Choose the correct magnification and working distance,

To ensure that you work in complete ergonomic harmony with your new loupe to
prevent and reduce eye strain, back / shoulder / neck tension, and the related stress-
induced headaches.

2)Look at an object with straight black lines.

The most common signs of poor quality loupes are low resolution, chromatic aberration
and spherical aberration. Resolution is defined as an optical system's ability to form
distinguishable images of objects separated by small distances, or to recognize fine
detail. Chromatic aberration refers to color distortion. Because each color has a different
wavelength, uncorrected optics cause the various wavelengths to focus at different
points in space. The first color that generally comes out of focus is blue; when looking at
black lines on white paper, poor quality loupes will display a blue haze just to the side of
the black lines.

3)Test the magnification.

The level of magnification used is most often based on personal preferences. However,
there are a few guidelines which could help in choosing the best magnification for your
specific needs. Choose the lowest comfortable magnification level, as this would
provide the widest field of view. Low magnification is mainly applicable for an overview
of the operating field. Mid magnification is used for the main procedural steps
throughout the treatment. High magnification is used for the identification of minute
structures and documentation of the finest details. Using a dental loupe significantly
increases a practitioner’s accuracy . However, it must be mentioned that there is a
learning curve and working at both mid and high magnification will require the
practitioner to slow down movements to avoid unintended actions on the smallest of
anatomical structures.Experience shows that the most commonly used and
recommended magnification for loupes in different dental fields are as follows:
a)Specialty Magnification General dentistry, Dental hygiene, Implantology: 2.5x .3.0x.
3.5
b)Endo, Crown and Bridge work: 3.5x - 4.0x
c)Lab work, Technician: 4.0x . 5.0x .6.0

4)Test the working distance.

The working distance refers to the distance between your eyes, and the patient's mouth.
You can measure this while assuming your normal working position, making sure you
are comfortable, that your back is straight, and that you are not leaning forward too
much. Perhaps you could ask someone to assist you in this procedure. You can also
use the following table to help determine the best working distance for your personal
needs:
a)Height <170 cm (5ft 7 in) 170-190 cm (5ft 7 in to 6ft 4 in) >190 cm (6ft 4 in)
b)Sitting 340 mm (14 in) 420 mm (16 in) 500 mm (20 in)
c)Standing 420 mm (16 in) 500 mm (20 in) 550 mm (22in)

5) Check the field of view.

The field of view is the area that is visible and in focus, while looking through the loupes.
A larger field of view is preferred, as there is a larger area visible through the loupes,
and there is less need to move your head around .The size of the "field of view" also
corresponds directly to the magnification factor.
A loupe with a lower magnification factor, will have a larger field of view, and vice versa.
All loupes utilize high performance lens systems that provide an extra wide field of view
(up to 125mm / 4.9 inch).

6)Check the depth of view.

The depth of field is the depth of the area that is visible & in focus, while looking through
the loupes. A larger depth of field is preferred, as there is a deeper area visible through
the loupes. The size of the "depth of field" corresponds directly to the "working
distance".
A loupe with a longer working distance, will have a larger depth of field, and vice versa.
The size of the "depth of field" also corresponds directly to the magnification factor.
A loupe with a lower magnification factor, will have a larger depth of field, and vice
versa. All loupes utilize high performance lens systems that provide an extra large depth
of field (up to 120mm / 4.7 inch).

7)Compare with prescription lenses.

If you use glasses with prescription lenses, it is important that you have the option of
fitting your loupes frames with the correct prescription. Otherwise, the loupes will not
perform according to specifications. The standard frames, can easily be fitted with
prescription lenses by your optician. Loupes are also available in a "clip-on" option,
which can be clipped on to your regular glasses.

8)Test the weight of the loupes.

Weight is an important factor when choosing a new loupe. Especially if the loupe is to
be used for longer periods of time. Lightweight loupes are more comfortable, and in the
long term, will reduce tension and other complications. Ultra light weight loupes, offer
the maximal comfort. All loupes utilize extremely light weight materials.
Loupes weigh as little as 36-42 grams (not including frame).
Regarding the Galilean loupes, these loupes are not as heavy as Prismatic.
Headbands are not usually required unless using a light, but these can also weigh as
little as 6 grams.

9) Light
Light is an important part of performing precision dentistry. Because a dentist's head
often eclipses the overhead dental lamp, loupes may be fitted with a light source.
Loupe-mounted lights used to be fed by fiber optic cables that were connected to either
a wall-mounted or table-top light source. Newer models feature a more convenient LED
lamp within the loupe-mounted light and an electric cord coming from either the
conventional wall-mounted or table-top light source or a belt clip rechargeable battery
pack. Intensity of the light can be regulated by a swtich.

Different Companies

The most popular high-quality loupes in North America are manufactured by Designs for
Vision (Ronkonkoma, N.Y.); Orascoptic/SDS (Middleton, Wis.) and General Scientific/
SurgiTel (Ann Arbor, Mich.). There are numerous other brands that also are of high
quality but are not as well known as the brands described above: Carl Zeiss (Chester,
Va.); Den-Mat (Santa Maria, Calif.); Eagle Optical Products (Bowmansville, N.Y.);
Keeler Instruments (Broomall, Pa.); and SheerVision (Rolling Hills Estates, Calif.).Take
some time to review each brand before you choose a pair of optical loupes. It’s
important to find the right brand of optical loupes to fit your personal specifications and
career needs

vi)Present and Future

Dental loupes aid dentists, hygienists, and dental therapists to devise accurate
diagnoses of oral conditions and enhance surgical precision when completing
treatment. The loupes aid diagnostically in identifying caries, insufficient crown or
restorative filling margins, or assessing craze or fracture lines.
Magnification can assist periodontist and hygienists with identification and removal of
plaque and calculus in addition to improving visualization for periodontal surgery.
Most endodontic procedures are carried out in dark and confined places, and fractions
of millimeters may decide the outcome of treatment. During root canal therapy,
magnification and illumination provided by the loupes aid with caries removal below
crown margin ,access preparation, removal of pulp chamber calcifications, identification
of root canal orifices, identification of cracks and fracture lines and the treatment of
internal resorptions.
In Pedodontics, given that a child’s oral cavity/overall dental anatomy is not the same
size as an adult’s, it becomes even more imperative to use magnification. Often the kids
are not steady on the dental chair, leading to an inconsistent work field. This problem is
overcome if the dentist has a light source attached onto his forehead thereby being able
to move the light field as the work field changes. Also, having a luminescent forehead is
a fantastic source of distraction for apprehensive kids.
Oral surgery (?)...
The newer loupes have the Options for loupe-mounted cameras and video recorders .
lite in weight, cordless headlight, clip on to your own glasses if you have power.

Benefits of dental magnifying loupes.

Utilizing a pair of dental magnifying loupes no matter what your specialty can both
increase the quality of care and help prevent personal health issues. Years of spending
your days working in a small oral cavity plays a major role in ergonomics, and how your
body feels at the end of each day. Without the use of dental loupes bad habits will form
and lead to poor posture and eye strain, often resulting in more serious health issues
later in life or even an early retirement. Using dental loupes will allow dentists and
hygienists to see effortlessly and more clearly while maintaining proper ergonomically
sound sitting posture.

Ergonomics:
• Properly fitted loupes will help relieve back and neck pain
• Prevent bad habits like squinting and leaning forward
• Develop a more ergonomically sound sitting posture
• Increase overall comfort and career longevity
Better Patient Care:
• Enhance vision with the use of optics to view oral cavity clearly
• Magnifying structures help reduce the risk of missing a diagnosis
• Improvement in vision will assist in developing the most appropriate treatment plan
• Process information faster and more accurately

Quality:
• High-quality material
• Sharp resolution
• Lightweight
• Comfortable
• Affordable

INFECTION CONTROL
Magnifying loupes collect debris from many procedures during a clinical day. Infection
control is difficult at best. Ideally, all areas of the loupe should be disinfected with a
high-level disinfectant after each patient. However, facing the reality that most dentists
using loupes have only one set of loupes, and that some loupes will not tolerate
constant use of disinfectants, the infection control challenge is obvious. Disinfecting with
high ethyl alcohol solution is recommended. If the lenses are water resistant, products
such as Lysol Disinfectant Spray (Reckitt Benckiser Professional, Wayne, N.J.) may be
sprayed into a gauze sponge and used to wipe the frames and lenses. Whenever
possible, the clean, disinfected loupes should be in position on the clinician when the
clinical procedure is started and left in place until the clinical procedure is completed,
and hand contact with the loupes should be avoided during the procedure. At the
completion of the clinical procedure, the lenses can be cleaned and the frames and
lenses disinfected.

Conclusion
when deciding on a dental loupe you can be sure that you are getting a high-quality
product that will enhance your vision, impact your career, and improve your quality of
life. With further advancement of technology, optical loupes will continue to evolve as
they have throughout history. ONE should always take some time to review each brand
before you choose a pair of optical loupes. It’s important to find the right optical loupes
to fit your personal specifications and career needs.

Based on the dental needs and important uses in the dental field, magnifying loupes are
becoming the standard of care for the majority of dental providers around the world.
Today, dental loupes are considered to be the new “hallmark of the dentist” in the
contemporary era.
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microscope/ loupes ?
The historical development of operating microscopes provides an instructive
perspective. In 1953, the Carl Zeiss Company of West Germany marketed the first
commercial binocular-operating microscope. The pioneering work of Carl Nylen at the
University of Stockholm preceded Zeiss by approximately 31 yr with the development of
a monocular microscope for ear surgery in 1922. From this beginning, microsurgery has
spread to literally all the surgical disciplines. It wasn’t until 1978 that Apotheker, DMD,
and Jako, MD, pooled their efforts to produce a DOM. Their designs were incorporated
in 1981 into the first commercially available DOM (Dentiscope, Chayes-Virginia Inc.,
Evansville, IN). The two developers, in conjunction with Chayes-Virginia, offered the first
course in the clinical hands-on use of the Dentiscope at Harvard Dental School, Boston,
Massachusetts, on September 25, 1982. It was immediately apparent that the scope’s
visual enhancement, achieved with a fixed amplification of approximately 7 and
supplemented with adjustable built-in fiber-optic lighting, would be of significant clinical
value in endodontics. Even with this somewhat prototypical instrument, incorporation
into an endodontic practice produced significant changes. Microscopy enhanced both
surgical and nonsurgical treatment. (Howard S Seldon, Journal of Endodontics, Vol.28,
No.3, March 2002)