Functional therapy
- Introduction :
Many anomalies in dentofacial orthopedics have as their etiology functional disorders of breathing, swallowing, phonation and mastication.
These functions performed in an abnormal way influence the neuro-muscular behavior of the elements that perform these functions which will have an impact on the teeth, the alveolo-dental processes, the parafunctions are added to these phenomena.
Functional therapy, born in Europe in the 20th century, was long neglected in favor of other therapies using mechanical devices to produce more obvious and, above all, faster results, and yet numerous clinical observations have proven the effectiveness of functional therapy.
It is now an integral part of the orthodontic therapeutic arsenal which aims to correct maxillomandibular and dentoalveolar dysmorphoses using natural muscular forces alone.
- definition :
- Functional therapy is any therapy that consists of correcting a dysfunction causing a dysmorphosis or eliminating a parafunction or a tic likely to disrupt good oral-dental balance.
- functional therapy is a treatment approach which consists of restoring normal function, with or without a device , and obtaining orthopedic and/or orthodontic effects secondary to this functional therapy
- Reminder :
The different masticatory functions participate in the development of the face and therefore in the establishment of occlusion; it is the balance between the different muscle groups used by the orofacial functions which will allow harmonious development throughout growth.
- When the balance of antagonistic muscle masses is disrupted during the various functions, in the event that there is dysfunction, parafunction or postural disorders of the facial envelope and the tongue, this will lead to bone, alveolar and dental dysmorphoses because form and function are closely linked.
- Form-function interaction:
There is a very close correlation between the morphology of a structure and the functional matrix, one is modified under the influence of the other. As a result, two major currents are distinguished: a first: mechanistic, and a second: functionalist:
- Mechanist theory (Americans):
The unanimous of this theory think that function follows form, that is to say that dysmorphoses are at the origin of dysfunctions. They advocate the correction of these dysmorphoses by the use of mechanical forces. The restoration of the function will be done simultaneously.
- Theory of functionalists (Europeans):
In this theory, it is function that creates form. According to ROUX, skeletal development disorders originate from postural defects and dysfunctions of the support apparatus.
Functional therapy
- The goals of functional therapy:
Functional therapy can be used in the context of:
- Prevention and interception: through early motivation of patients on orthopedic problems that can arise from different disorders of the Neuro-Muscular System, teeth, jaws, occlusion.
- Correct abnormal neuromuscular behaviors (dyspraxias) in order to acquire new automatisms, and continue to normalize functions using CNM exercisers
- Contention: in order to prevent recurrences, by integrating new reflexes and a corrected posture essential for maintaining the corrections.
5 – The different aspects of functional therapy
Functional therapy uses early non-mechanical methods and may resort to mechanical therapy at an advanced age.
As a result, two main aspects are available to us:
Non-mechanical functional therapy
Mechanical functional therapy
Petit distinguishes active rehabilitation, known as muscular rehabilitation, from passive rehabilitation
5-1/Non-mechanical functional therapy:
Or called active neuromuscular rehabilitation, based on willpower and functional myotherapy without resorting to the use of equipment.
5-1-1-The principles of non-mechanical functional therapy: The modification of the body schema goes through three stages:
1-the conscious discovery of the new behavior to be acquired (making the patient aware of erroneous postures and praxes and showing him the correct postures and praxes).
2- the implementation of muscular work promoting the voluntary adoption of this new behavior (giving the patient the means to adapt to this new function).
3- obtaining automation of functions and the creation of new reflex behavior. By repetitive and conscious voluntary movements which will create new motor behaviors and which will subsequently become reflexes.
5-1-2-The moment of non-mechanical functional therapy
The most favorable age is around 8-9 years, as regards the re-education of the position and function of the tongue. Before this stage of maturity of the sensory-motor organization, we risk coming up against the “disinterest” of the child who will have difficulty automating the correct positions.
On the other hand, it seems that respiratory rehabilitation can be undertaken quite early from the age of 5, supplemented by rehabilitation of the tongue position one or two years later.
The child’s age, his psyche and his ability to cooperate are therefore important factors in rehabilitative therapy.
5-1-3-Non-mechanical means of functional therapy:
5-1-3-1/Myotherapy
Proposed by A. Rogers in 1918, who sought to increase the power of certain muscles (orbicularis, propulsors and elevators of the mandible) by appropriate exercises.
Myotherapy does not change the functioning of a function, unlike rehabilitation.
Functional therapy
Techniques:
Myotherapy combines specific exercises for each muscle of the lips or tongue, in order to correct pathologies of the functional balance between eccentric and concentric orofacial forces.
The duration of myotherapy is important: GRABER recommends 15 to 30 minutes of daily exercise for 4 to 6 months.
Lingual myotherapy:
Ask the child to sweep the palate with the tip of his tongue to allow him to feel the different areas of the palate: smooth or bumpy.
He is then asked to place the tip of the tongue on the “bumpy area” behind the incisors. Once the position is good, the patient will have to do daily work by placing his tongue correctly. Each time he does this, he notes it in a follow-up notebook
The child should then place the tip of the tongue behind this area and hold it there.
Tongue click: CLAC / CLOC (horse step)
Click your tongue 20 times in a row every evening, starting from the first session, requiring the tip of your tongue to come back down to the floor of your mouth.
Ask for the tongue click 40 times from the second week. Then, if it is easy, without fatigue, we ask for this same click with two sounds A and O.
Spoon exercise (Tongue tip support exercise)
We encounter patients whose toe muscle strength is completely insufficient.
The patient is asked to stick the tongue out of the mouth and press the tip into the hollow of a small spoon or a wooden tongue depressor, the object being pushed back by the hand. This exercise should be held for 3 to 5 seconds, 10 times in a row, every day for several weeks.
cat’s tongue, rat’s tongue:
Contract the tongue strongly, refining the tip, then spread it out again. This exercise helps tone the tongue.
Lip myotherapy:
Upper lip exercise:
The patient should hold his lower lip firmly with his fingers as low as possible. He should then try to close his mouth with his upper lip alone by lowering it as low as possible. This effort should be maintained for 3 to 5 seconds and repeated ten times in a row every day.
This exercise strengthens the upper lip muscles, allowing it to move.
Lower lip exercise:
This involves raising the lower lip as high as possible over the upper lip and pressing it firmly. The patient must hold the pressure for 3 to 5 seconds and repeat the exercise about ten times every day. This helps tone the lower lip and stretch the labiomental groove.
Exercise for both lips:
We ask the patient to hold a wooden tongue depressor between his lips in the sagittal plane for 10 seconds in a row. This exercise should be repeated ten times in a row, the lips should be joined but not folded to work the horizontal orbicularis which joins the lips and not the oblique orbicularis which folds them.
As training progresses, increase the weight of the tongue depressor by placing one and then two clothespins on it, first near the lips and then gradually towards the distal end.
Wind instrument exercises: Lip myotherapy can be improved by a whole series of exercisers. “Wind instruments”, depending on the way the mouthpiece is held, can also be a complementary and pleasant means of treatment.
• The flute : class II malocclusion, the flute increases the tone of the upper lip
• The trumpet : anterior gaping bite and labial hypotonicity.
Myotherapy of the mandible thrusters:
In the case of retrognathia: Voluntarily and slowly move the mandible forward as much as possible and keep it propelled for 10 seconds, the movement should be repeated 10 times.
Myotherapy of the masticatory muscles:
Toning of these muscles is done by myotensive exercises by chewing fluoride gum. This masseter muscle building can also be done by asking the patient to clench their teeth.
Myotherapy of the buccinator and orbicularis:
All children with atypical swallowing tend to tighten their lips to swallow, contracting the orbicularis oris and stretching the buccinator. The exercise consists of contracting the buccinator by stretching the corners of the lips “to make the smile from ear to ear”, the teeth must be in occlusion without clenching during the exercise.
The exercise is done 10 times a day except in case of fatigue (very frequent). The child must check the symmetry of contraction by working at home in front of a mirror.
5-1-3-2/Neuromuscular rehabilitation: (see neuromuscular rehabilitation course)
Definition : rehabilitation or behavioral therapy
-Behavioral therapy (or “re-education”) is “that which acts on the central nervous system to: -correct dysfunctions, Eliminate parafunctions and, more generally, all behaviors and postures which disrupt the morphogenesis of the dental arches.”
-Behavioral therapy should not be confused with myotherapy; myotherapy does not modify the play of a function, unlike rehabilitation.
(See neuromuscular rehabilitation course)
5-2 / Mechanical functional therapy
It is a “passive” functional therapy, because it indirectly and unconsciously causes the modification of the behavior of the functional matrix through the devices, which can be exclusively dedicated to corrections or jointly exert an action on maxillary and mandibular growth.
5.2.1-CNM rehabilitation devices:
Several types of devices can help correct dysfunctional behaviors:
5.2.1.1 Nocturnal lingual envelope
Created by Bruno Bonnet, the ELN constitutes a functional lingual re-educator and therefore a dento-alveolo-skeletal corrector.
- Description and mode of action:
- The anterior slide and lateral walls of the tunnel block the motor routes of the tongue anteriorly and laterally, depriving it of contact with the lips and cheeks, respectively.
- The anterior selective opening located at the level of the retro-incisive papilla represents a tactile target for the tongue which contributes to its elevation.
- The ELN allows the acquisition of high lingual posture and promotes the unconscious installation of the mature encephalic swallowing motor program.
- Bonnet describes secondary and spontaneous surrounding structural changes after a few months of ELN treatment:
– reduction of anterior and/or lateral gap.
– maxillary transverse expansion,
– straightening of incisal axes,
- How to use
- The ELN is worn at night and 1 hour per day for approximately 6 months.
- ELN can be used before brain engramming, early use from 5 years is preferred
- Indications
ELN is indicated in all dysmorphoses of lingual origin :
- Alveolar gap, anterior, lateral or total on a cl I, cl II, cl III diagram
- class II of functional origin, in association with all means
- class III, in early treatment or in containment of the action of the Delaire mask
- in contention, when the lingual posture has been modified
Functional therapy
5.2.1.2 Tongue cage or anti-tongue grid
- It is a metallic anterior lingual shield, positioned opposite the lingual surfaces of the mandibular incisors and supported by a removable palatal plate. It prevents anterior lingual interposition and allows the development of an exteroceptive reflex for lingual repositioning. However, it may cause lateral lingual interposition.
- These types of devices directly combat the effect of dysfunction (tongue) or parafunction (thumb sucking).
- These devices are generally indicated for cases of functional open bites.
5.2.1.4 The Pearl of TUCAT:
It is a pearl placed in the region of the incisive papilla of a palatal plate. This can rotate freely around its fixed axis, allowing the tongue to play with it, and to adopt a new posture in function and at rest. It allows or attempts to correct disorders such as low tongue posture, dysfunctional swallowing by repositioning the tongue posteriorly.
5.2.1.5 Interception screens:
These are oral screens designed to eliminate interpositions and avoid muscular pressures (at the level of the lips, cheeks, tongue). They allow the muscular envelope (centripetal or centrifugal) to be moved away from the alveolar processes and teeth.
5.2.1.5.1 the lip bimper:
It is a bumper, which reduces the muscular pressure of the lower lip on the lower incisors (lingualized by hypertonicity of the lower lip, or interposition of this same lip between the incisors exerting a sling action).
- Description :
It consists of a rigid vestibular arch 0.9 mm in diameter, distant from the vestibular face of the teeth; its anterior region is covered with a resin band so that the lip can rest without being injured; then it is mounted on a removable appliance.
- Effects:
It therefore acts against lower labial interposition, and causes:
- A vestibulo-version of the lower incisors. The pressure of the lower lip is no longer exerted, only that of the tongue persists.
- Blocking or distalization of the molars by transmission of labial pressure to the molar level.
- Indication:
- For the conservation of Lee-Way in mixed dentition.
- For the correction of linguo-versions of the lower incisor sector of functional origin;
- As an anchoring means in multi-ring technique.
5.2.1.5.2 Hinz mouth shield. There are different models.
used to help the child stop sucking his thumb, sucking the lower lip, using his pacifier, and to re-educate his nasal breathing. The one with grid is indicated for anterior gapes due to lingual interposition
5.2.2. functional orthopedic therapy: (Functional orthopedics)
5.2.2.1. Definition:
It is the correction of basal anomalies using activating monobloc devices which transmit functional stimuli and which then play a mediating role between the orofacial musculature, the maxillae and the dentoalveolar system in the exercise of all the functions of the masticatory system.
5.2.2.3. The right time:
These therapies are intended for patients who have sufficient growth in a favorable direction (anterior or average rotation) without alveolar compensation at the incisal level.
Orthopedic treatments should be carried out during the growth period, the ideal age being between 7 and 9 years and up to 12-13 years. Beyond that, orthopedic effectiveness is more random, the action then focuses on the alveolar zone.
All orthopedic devices require a minimum wear of 12 to 14 hours per day, mainly at night, for approximately 10 to 12 months. The removability of these devices means that patient cooperation is essential and, among other things, determines the success of the treatment.
5.2.2.2. the means of functional orthopedics:
The devices used in functional orthopedics are essentially passive devices, at least theoretically. We find a wide variety of devices:
- Activators:
- Definition :
- are functional orthopedic devices that induce an unusual, reproducible mandibular bite position, guided by occlusal, mucosal or mechanical positioning.
- They activate the constituents of the masticatory system, and their functions, in order to contribute to the correction of skeletal and dentoalveolar dysmorphoses in the growing patient.
Functional therapy
- Wearing the device:
Nighttime wear of the device is strongly recommended, due to increased growth hormone secretion during sleep.
The duration of wearing should not exceed 12 hours/day, because the physiological processes that guide the movement of the teeth such as the “rail mechanism” will not be able to take place.
Correction of the offset is achieved after 6 to 12 months.
- Classification of activators:
- LAUTROU proposed a classification of the different types of activators, a classification based on the characteristics of the device which causes the change in mandibular bite position:
* rigid activators
*The thruster activators with stop
*Composite or elastic activators
*Soft activators
rigid activators
These are rigid, non-deformable devices with a resin interposition that dictates an isometric bite position to the mandible.
1. Robin’s monobloc : a device composed of a palatal plate with two gutters in which the lower teeth are placed in the corrected position; this plate is melted in the middle of a jack. It is worn 12 to 14 times a day for 6 to 12 months.
ANDERSSEN cl II activator:
It represents the simplest variant of the ROBIN monobloc.
It corresponds to a resin monobloc formed by a maxillary base plate in contact with the palate and which extends to the palatine face of the maxillary teeth.
-a mandibular base plate which covers the lingual surface of the mandibular teeth and which descends along the lingual alveolar processes (lingual wings).
-a resin interposition connecting these two plates and constructed from wax taken in the mandibular propulsion position
- Mode of action
- Andresen’s activator is used in hyperpropulsion. The propulsion position causes contraction of the lateral pterygoid muscles, which stimulates the activity of the mandibular growth centers.
- This position also causes tension in the retropulsor muscles. This causes an inverse recoil force which is transmitted, via the activator, to the maxilla which is then slowed in its sagittal growth.
- Thus, the orthopedic action of the activator is summarized in a stimulation of mandibular growth and a braking of maxillary growth.
- In addition, there is, due to the drawer effect, an orthodontic action:
– the maxillary arch, as a whole, tends to tilt distally with linguoversion of the maxillary incisors;
– the mandibular arch, as a whole, tends to tilt mesially with vestibuloversion of the mandibular incisors.
Functional therapy
ANDRESSEN activators of cl III:
It corresponds to a resin monoblock built in forced retropropulsion.
Just like the CLII monobloc decreed previously, it includes a maxillary base plate and an MDB base plate with an interposition of the resin connecting these two plates constructed from a wax taken in the mandibular retropropulsion position.
a thick ESHLER band which maintains the mandible in retropropulsion, it must be located in the most guigival position possible in order to approach the center of resistance of the incisors and to avoid their linguo-version.
Mode of action: the forced retropropulsion position caused by the recording of the occlusion and maintained by the ECHLER band blocks mandibular growth by reducing the activity of the lateral pterygoids.
It is indicated in the case of mandibular prognathism: secondary to lingual antepulsion; in addition; the interposition of the resin allows muscular deprogramming and a more distal repositioning of the mandible.
Also; the repositioned mandible tends to push the appliance forward; this force transmitted to the maxilla via the indentations; which causes a mesial slide of the upper arch and stimulation of its growth
Therefore; the CL III activator has an orthopedic action; by slowing down mandibular growth; and by stimulating maxillary growth.
There is also an orthodontic action through the drawer effect of the alveolo-dental arches
Distal sliding of the lower arch with lingo-version of the incisors
A mesial slide of the upper arch with a vestibular version of the incisors.
BALTERS Bionator :
It is a rigid monobloc, providing bimaxillary blocking and comprising a palatal loop allowing lingual stimulation, and vestibular arches ensuring the distance of the musculature.
This device will create good functional coordination between the internal and external muscles of the mouth. Worn 24 hours a day, outside of meals.
The different types:
Depending on the anomalies, there are 3 types of Bionators:
- Bionator type I: class II div 1 in order to stimulate the tongue forward, the direction of opening of the palatine loop is also forward.
- The Bionator type II: Anterior functional open bite, It has a retro-incisal resin screen preventing interposition of the tongue without hindering the egression of the incisors.
- The Bionator Type III: is a reverse appliance intended to correct Class III anomalies in which the position of the tongue is down and forward, the palatal loop is also backward.
2. The thruster activator with stop:
Part of what LAUTROU calls thruster activators with stop.
Which have a propulsion system that mechanically guides the mandible into a propulsive position.
The connecting rods:
A connecting rod is a telescopic hinge attached to the distal part of the maxilla and the mesial part of the mandible connecting the two maxillary and mandibular devices
1/connecting rod from MARTIN TAVERNIER:
This device consists of a palatal and lingual plate
Connected by a single central connecting rod.
The particularity of this device is that the central connecting rod allows free mandibular lateral movement, potentiating the stimulation of condylar growth and therefore mandibular growth.
2/HERBST connecting rod:
Description : two hinges carried by two gutters or by upper and lower Multi-attachment devices.
Port : continues outside of the meal.
Indication : cl IIskeletal.
The device keeps the mandible in propulsion continuously ie all opening and closing movements, all functions are performed with the mandible in the propulsion position. (Propulsion is progressive.)
The 3 rooms of CHATEAU:
It is a set of removable devices inspired by CHATEAU in 1972 indicated in all cases of CLII before the end of growth. It is made up of 5 pieces:
1st part is a plate with 2 hooks: ADAMS and a central cylinder with a transverse action.
The second is a lingual plate with a vestibular arch and two retention hooks.
The 3rd piece is the W propeller, it is a steel WIRE in w in the terminal ends
Penetrate the tubes of the 1st part , its middle part comes to be placed behind
The mandibular plate and forces the mandible to close in propulsion so it is the thrust propellant agent
There are two variants
The 4-piece CHATEAU: the 4th piece is an equiplan of planes indicated in the case of an associated overbite
As for the 5-room CHATEAU, it includes the previous rooms + a FEB face arch indicated in the case of a cl II with mixed responsibility.
3. Elastic or composite activators:
These activators use the musculature to reflexively propel the mandible, thus the propulsion is created by a physiological mucosal reflex. They have a mandibular propulsion device which allows freedom of movement; this is not the case for the rigid monobloc which gives a single bite reference.
Functional therapy
Function and FRANCKEL regulator :
The function regulator consists of three types of resin screens joined by metal wires.
Jugal vestibular screens which keep the perioral muscles at a distance (orbicularis oris, buccinator) and eliminate pressure on the vestibule.
Mandibular labial pads that move the orbicularis away.
A lingual shield that rests on the lingual mucosa.
There are 4 types of function regulators
FR I indicated in cases of CLII 1d’Angle.
FRII indicated in cases of Angle CLII2.
FR III indicated in CLIII cases
FR IV indicated in cases of gaping bite
- Indications for Class II Activators
The activator is used in a patient with:
- a secondary skeletal class II of mandibular or mixed origin;
- a hypo-, meso- or pseudo-hyperdivergence
- mandibular incisors in good position or linguoverted;
- an oblique palatine plane upwards and forwards;
- a vestibuloversion of the maxillary incisors;
- an absence of dentomaxillary disharmony.
However, functional etiological treatment should be ensured in order to maintain the stability of the results.
b- Soft activators:
- The device consists of a bimaxillary splint, the construction of which is carried out from a therapeutic model which integrates the orthopedic and/or orthodontic treatment objectives, considered and defined by the practitioner for the patient concerned.
- Among these devices, the Elasto-Osamu® combines the therapeutic capacity of being able to perform mandibular advancement (comparable to that of a rigid activator) with the possibility of slight dental movements.
- Like the rigid activators, the flexible Elasto-Osamu activator can receive extra-oral force (EOF) type auxiliaries.
The indications for Elasto-Osamu® are reserved for small amplitude skeletal shifts, associated with slight malocclusion problems.
Functional therapy
- Vertical Activators
- Raising Surfaces:
They act by:
- Eruptive release of teeth in areas not affected by elevation.
- The use of the muscular forces of the elevator muscles opposes dental egression at the plane level.
- ATM game release.
- Changing the direction of face growth.
- The elevation gutters:
- These gutters are generally one-sided, the opposite side tapers, they gain a height which corresponds to their thickness.
- These gutters are the method of choice between the ages of 4-7 years for the early treatment of a large number of dysmorphoses (infra-alveolar molar, mandibular retrognathia, upper alveolar prognathia).
- The retro-incisive palatal elevation plate:
- It is a simple device that requires the patient to keep the appliance in their mouth at all times, even during meals. The molars that are not in contact egress.
- The retro-incisal surface can be thickened one or more times by 2 mm with resin.
- If we immediately provide the necessary elevation, two drawbacks may arise:
- Difficulty eating and chewing
- Aggravation of pre-existing proalveolus due to excessive chewing action.
- Indication: supraocclusion due to lower supra alveolus (has no ingressive action at the upper incisor level)
- The PLANAS Equiplan:
It is a bimaxillary appliance, it consists of a horizontal steel blade 0.4 mm thick which is freely interposed between the upper and lower incisors, thus raising the occlusion and maintaining during its use an incisal overlap of 1 mm, the equiplan is held on the lower incisors by a device which, by resting on a removable upper plate, pushes the mandible almost end to end.
- Effects: incisive intrusion, molar intrusion (especially mandibular).
- Indications: posterior infra alveoli or anterior supra alveoli or both.
Functional therapy
7-Limits of functional therapy:
7.1. Age-related considerations:
– Therapeutics must be carried out during the growth period, hence the use of additional examinations to situate the subject on the growth curve (X-ray of the hand, wrist). Class II activators are more effective at the pubertal peak.
– Very early use for classes III (between 3 and 4 years).
– Functional rehabilitation takes place around 8 to 10 years old during the period of development of the child’s logical thinking, before the end of brain engramming. This is so that the child understands what is expected of him.
– Emotional maturity to stop thumb sucking.
7.2. Human considerations:
– Need for significant cooperation from the patient (regular wearing of the device ) and from the family (discipline, long treatment).
– The practitioner must know how to motivate them.
– Functional therapy is contraindicated in cases of psychological or respiratory problems (asthma).
– Functional therapy is indicated in cases of financial problems (less expensive), problems of distance from the office (appointments more spaced out).
7.3. Considerations related to facial type:
Functional orthopedics such as the use of activators is contraindicated if EVA (activators increase HEI). At the aesthetic level, we obtain a setback of the chin and an opening of the mandibular compass, which makes labial occlusion difficult (unsightly facial expressions) with an increase in convexity.
7.4. Considerations related to the type of dysmorphosis:
-It must be a secondary skeletal shift for which removal of the functional etiology can result in stable correction.
-Functional therapy is indicated in: Class I with functional mandibular laterodeviation, with interposition. Class II by mandibular retrognathia, with facial normo or hypodivergence, of mixed etiology. Functional Class III if treatment is early.
-Functional therapy cannot be applied in the presence of anatomical obstacles hindering the functional rehabilitation procedure such as: macroglossia, short lingual frenulum, nasal obstructions, etc.
7.5. Dental system considerations:
Functional therapy cannot be undertaken in the event of:
-Dysplasia or poor hygiene, Linguoversion of the upper incisors, Vestibuloversion of the lower incisors, severe overbite, significant DDM which requires functional treatment at a later stage.
8- conclusion:
-Orthodontics has made remarkable progress in the diagnosis of functional etiologies of dento-maxillary dysmorphoses.
-Functional therapy is one of the treatment methods used in orthognathodontics
-Functional therapy has attracted the attention of several authors over the years, and it has often been the subject of much controversy; this demonstrates its importance and its essential place in establishing the treatment plan.
According to Angle: “There is little chance of success if we fail to eliminate functional disorders .”
Good oral hygiene is essential to prevent cavities and gum disease.
Regular scaling at the dentist helps remove plaque and maintain a healthy mouth.
Dental implant placement is a long-term solution to replace a missing tooth.
Dental X-rays help diagnose problems that are invisible to the naked eye, such as tooth decay.
The dentist uses local anesthesia to minimize pain during dental treatment.