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Posted 11/12/2018 in Category 1

21st Century Dentistry: Less fear, jabs or drilling with Dr Sam Thandar

21st Century Dentistry: Less fear, jabs or drilling with Dr Sam Thandar

July 1, 2015 by Marika Sboros

Most people look forward to going to the dentist as much as they look forward to someone rubbing the skin on their face raw with sandpaper. In a word, they find a visit to the dentist terrifying. At the very least,  it’s an unpleasant, uncomfortable experience. It’s not just  the sight of that long, thin needle coming towards you that’s enough to make your heart leap into your mouth. Or the sound of that high-whining dentist’s drill that’s enough to make even the bravest break into a sweat. Johannesburg dentist Dr Sam Thandar has changed all that with Thandar Inc, a world-class dental practice in Rosebank designed to take the fear out of dentistry, and dentistry into the 21st Century.
In the first of a two-part series Thandar explains just how and why dentistry can be a more gentle, even nurturing experience. Not just with an aesthetically pleasing environment, interior decor that is instantly calming on the nerves, a reception area with a coffee bar, and an outside waiting area overlooking a water feature. Most important is a collaborative and multi-disciplinary approach, coupled with the innovative use of cutting-edge equipment, including CADCAM, and laser technology in some cases replaces the need for local anaesthetic and drilling altogether. Thandar also specialises in cosmetic and aesthetic work that is about much more than a better smile. Restorative work can change the shape of faces, and lives along with it. Better still, Thandar is able to take the minimum amount of time for maximum effect, dramatically reducing  the number of visits, and time spent in the dentist’s chair. – Marika Sboros

Listen to the Interview (17 min)

Welcome back to my listeners. I’m Marika Sboros from Biznews Health. Today, I’m speaking to Dr Sam Thandar,  a dentist who’s very busy transforming dentistry in South Africa and bringing it beyond the 21st century. He is Medical Director and Principle Dentist of Thandar Inc. Sam, thank you very much for talking to me.

Sam Thandar
Johannesburg dentist Dr Sam Thandar

Thank you Marika. Let me just touch on your point. We do plan to revolutionise the dental industry, but Thandar Inc is a dental clinic which specialises in cosmetic makeovers and our trademark dental facelift. We offer a world-class facility with state-of-the-art CAD/CAM facilities and really cutting-edge laser technologies to facilitate all our treatments in one, single appointment.

You talk about a dental facelift, but you do conventional dentistry as well?

Absolutely. I’m the principle dentist at the practice and my main focus is cosmetic makeovers, the dental facelift, and full mouth rehabilitation cases.

I then have Dr Maryam Dawjee who specialises in paediatrics, so she treats all the kids at the practice. She also has a masters in orthodontics as well as a fellowship in laser dentistry. She does some of the cosmetic work, but her main focus is paediatric, orthodontic, and restorative dentistry.

Dr Leah Constantinou is our general dentist. We then have a consulting maxillo-facial and oral surgeon who consults at our practice on a regular basis, and  a consulting specialist orthodontist who does the extensive orthodontic treatments required for patients.

One of our main objectives is to standardise reatment across the board so that whoever you se at our practice, you get the same level of treatment. That’s part of our culture, and what we wanted to attain besides making a really great facility, which is state of the art. But at the end of the day, it is healthcare. It is dental care and like the human element, it’s probably the most important – overriding everything else.

One of the major elements in your practice that distinguishes you from others is the use of the equipment, one being laser. Can you talk to me about the WaterLase? 

We have two lasers which we use at the practice. The WaterLase is our big, all-tissue laser.

Is it used anywhere else in South Africa?

There are three other practices to date that have incorporated the WaterLase into their treatments. Over time, it will become more widespread. I really hope it does because it’s a piece of equipment which can really revolutionise anyone’s experience of the dentist. From the most basic dental need (a filling, for example), you can now avoid the use of a conventional hand drill.

Johannesburg dentist, Dr Sam Thandar’s treatment room, with the "Ferrari-Red" WaterLase laser that avoids the need for local anaesthetic and hand drilling.

You can also avoid the use of a local anaesthetic. With the laser, we can go in there, remove the decayed/diseased tissue of the tooth, restore the tooth, and take you back to normal function – all without a local anaesthetic and without the ghastly noise of the dental drill humming in the background.

In its most basic elements, the WaterLase works really well on teeth. Then we start becoming a little more advanced in terms of what we can do with it. The other component it acts really well on is on soft tissue adjustments.

For any patients out there who have had conventional work done on their gum tissue, they would appreciate it. It’s probably one of the most sensitive dental procedures historically, that anyone could go through purely because of the distribution of the nerve fibres and how the patient responds post-operatively.

With this laser, we can go in there and in a single appointment, do the adjustments around the gum tissue, do bone re-contouring with it, and there are two benefits. Firstly, the level of accuracy is incomparable to anything else and secondly, the post-op healing and downtime is greatly minimised because there’s very little bleeding while we’re working with the tissue.

Very little swelling as well, I presume?

Absolutely. With the swelling component as well, the swelling is greatly reduced, purely because we’re not reflecting the gum tissue and we’re working in a very precise and organised manner.

One of the other activities we can perform with the WaterLase is root canal treatments. With a root canal treatment, we conventionally used all sorts of different mediums to try to sterilise or obtain some degree of sterility in a root canal system (of the root). Generally, when a patient develops a dental abscess, a lot of bacteria builds up on the inside and that’s where the pain actually comes from – the swelling and the response to the bacteria.

With the laser, we now have the ability to go in there. Numerous studies have shown that we’re getting close to 97 to 98 percent sterility in that root canal system over a 24-hour period. It’s very effective from a therapeutic point of view, helping patients to eliminate any significant pain related to any dental abscess for that matter.

The other major procedures that we can do with our lasers is in a new and emerging field in medicine and dentistry, called photobiomodulation. Let me explain what photobiomodulation means: if you damage a cell in your body, tissue, or whatever is damaged, one of the things we find is that the mitochondria, which is the powerhouse in the energy generation part of the cell, becomes compressed and almost shrivels up. We now find that by applying low-level light therapy we are now able to actually, realign that mitochondria.

And fluff it out?

Fluff it out again. The minute it opens up, we see that there’s enzyme activity, ATP production, and there’s synthesis within the cell. We are now largely capable of actually treating damaged cells and damaged tissue. That comes back to another concept: if you have inflammation in the body or if your jaw muscles are really tight and we actually want to release it, we can use the photobiomodulation principles to help patients with extensive jaw pain and extensive swelling in specific areas.

With ulcers and cold sores as well?

That’s right. The laser can be used to treat ulcers and cold sores directly and on average, we find we have a 24-hour turnaround time in terms of the pain and discomfort almost subsiding. At the end of the day, when it comes to any patient healing, we generally rely quite extensively on your body to do most of the work. We do a little bit.

Whatever our surgical or dental intervention is, there’s a certain element that we provide and in most cases, it’s creating a sterile scaffold or an alkaline medium. The rest of the work is actually done and taken over by the body. If there’s a way that we can expedite that process. If there’s a way we can reduce the inflammatory response, and can actually enhance enzyme activity within the tissue, the laser is pretty much opening up that door for us.

That’s why, with many of our post-operative surgical procedures (for example, placing an implant or doing a gum adjustment), we rely quite a lot on our photobiomodulation principle of the laser to help healing. To date, we’re getting rather impressive results.

You also mentioned that you have another laser, the diode laser. What would you use that for, compared with the WaterLase?

The WaterLase is an all-tissue laser. It can be used on bone or on tooth structure, on hard and soft tissue. The Epic diode is purely a soft-tissue laser. The diode works near infrared spectrum. By so doing, we have much greater photobiomodulation coming out of the diode, because it works in that specific range.

We use the diode in our practice for three things in general: teeth whitening, minor gum surgery and minor gum adjustments. In our practice, we use it predominantly for TMJ pains (temporomandibular jaw pains). In many cases, we see that TMJ pains also manifests as headaches so we use it for treatment of pain around the head and neck area, and we use it for treatment of the cold sores, ulcers, and any damaged tissue that might be present in the mouth.

It can also be used to remove or excise any specific growth that might be present in the mouth or infected tissue, where conventional means might create more of a hazardous/difficult area to work with. With these types of lasers, we can go in there and not interfere with the surrounding tissue structure, and target the precise and exact zones we want to work in.


The Epic 940nm Diode Laser at Thandar Inc. is used for further soft-tissue treatments, laser whitening and pain treatments.

Are there any contraindications for either laser?

The diode is particularly harmful to your eyesight. We take the relevant measures in terms of protecting your eyes and making sure they’re covered. There aren’t contraindications as such on a broad spectrum. The contraindications might fall within the actual patient in terms of what the tissue looks like, or what the environment we’re working in looks like and in that case, we would resort to a conventional technique for it.

In some cases it’s difficult to approximate where exactly the nerve is sitting on the tooth or around the apex of the root. In those cases, if we have any hesitation, we would be very reluctant to go in there with the laser, not knowing where we really are. From that perspective, the contraindications are more case-selective rather than a broad spectrum contraindication, like you would have for medication, for example.

It seems to me that laser is the one way you are making your dental practice much less threatening to both adults and children, because so many people have practically an innate fear of dentists.

Absolutely, Marika. For us, historically, you find that most patients who come in and have dental anxiety, generally manifests from childhood in more than 90 percent of cases. We engage our patients as much as we can to build that rapport and that relationship with them.

For  me, probably one of the most important things in dentistry is building that relationship with your patient, building that rapport; understanding exactly what patients’ expectations are because if you can meet somebody’s expectations, you fulfill their needs. The only way you can understand somebody’s expectations is by getting to know them. For us, that’s very important. Our patients who’ve historically had dental anxiety, when we trace it back, it generally comes from a bad childhood experience or from some bad experience somewhere along the line, in their early years rather than their later years.

With us introducing the laser into the practice, creating the practice in the way it’s structured, and to have one specific dentist who treats the kids at the practice, who has a paediatric background, and who loves working with kids; it’s very different, coming in to see her compared to going to see a general dentist who does everything in their practice.

From that perspective, the more we can make it comfortable and favourable for the kids coming in to the practice, the more we know that as time goes on, they’ll develop into patients or adults who have no anxiety or fear towards the dentist. That’s our main goal.

When we talk about revolutionising dentistry…yes, much of what we’ve done in the practice, the way we’ve structured this place, all the niceties about it, and its aesthetic appearance is fantastic. From a deep-seated cultural perspective in terms of what the culture of our practice is, is that we want to ensure that we have the right message going through our patients as they go through their early years in life. If we can get that right, then I think we’re revolutionising things.

Dr Thandar with his official Pantone "Ferrari Red" Waterlase, performs precise and gentle dentistry further enhanced by his Microscope to ensure the quality is beyond what even the natural eye can see! - All supplied and installed by SciVision Medical

The basis of all of this, is that oral health is an important market for overall health.

Absolutely. I’m very glad you brought that up because I forgot, or neglected one other important thing that we use our lasers for, and that’s for treating gum disease and periodontal disease. It is a very effective tool in terms of going in there, eradicating bacteria around those deep pockets and patients with gingivitis or periodontitis to clean them, or to go through their oral hygiene maintenance programs, which are generally very uncomfortable things.

You could imagine that those patients tend to put it off for as long as they possibly can and unfortunately, that’s why their tooth are where they are when they come in.

When they eventually get to see the dentist…

With these lasers, we can go in now. If a patient suffers from extreme sensitivity on their teeth and you try to go in there with a conventional hand instrument or an ultrasonic instrument vibrating on the tooth structure, it’s impossible for them to manage or bear it. For those patients, we go in there with a laser. We do minimal work around that tissue. There’s absolutely no vibration. There’s no irritation on the tooth structure and it’s a lot more pleasant and comfortable for them. From that perspective, it changes many things and it opens up a lot more treatment for many patients who generally would not be compliant towards it.

Your comment is interesting in terms of how oral health is so important for general health. If you look at the literature, there are more and more implications of bacteria that cause heart disease, stomach ulcers, and various other illnesses in the body generally have insight in terms of gaining pathways through the oral cavity. From that perspective, your oral health is of primary importance.

Right. Those are wise words from dentist, Dr Sam Thandar, Principle Dentist and Medical Director of Thandar Inc.

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