by Fred Margolis, DDS
Seven years ago I read an article about lasers being used for hard-tissue dentistry. I spoke to three colleagues who were performing soft-tissue laser dentistry, two of whom happened to be past presidents of the Academy of Laser Dentistry. They felt it was a great time for me to take a serious look at lasers to see if they would fit into my practice of pediatric dentistry. After trying the erbium laser, I could immediately perceive the value of having a laser. It meant that for many of my patients requiring routine dentistry, I would not have to give local anesthesia or wait for them to “get numb.” I would be able to perform multiquadrant dentistry in a single visit. Also, especially for my young and/or disabled patients, I would not have to worry about them biting their numb lip, tongue, or cheek postop.
Laser dentistry has become such an integral part of our group practice that we now have three erbium lasers. I use the laser (Er;Cr;YSGG, Waterlase MD™) for both hard- and soft-tissue dentistry. The erbium lasers are the only lasers that have the ability to perform Class I through Class VI cavity preparations and can be used to perform soft-tissue surgery. I have prepared hundreds of primary and permanent teeth with only a small percentage of the patients requiring local anesthetic.
The laser as a practice builder
After performing my first lingual frenectomy after 27 years of dentistry, the mother of my 4-year-old patient asked her how she felt. Isabella looked up and said, “Great.” I have had several pediatric dentists refer me their behavior-problem patients who are afraid of the “shot” and/or the sound of the dental handpiece. One pediatric dentist referred me a patient with hemophilia to perform needed restorations.
One of the soft-tissue benefits of the Er;Cr;YSGG laser in a pediatric practice is being able to perform frenectomies, gingivectomies, aphthous ulcer “band-aids,” fibroma excisions, etc., without local anesthesia, using only a topical anesthetic in most cases.
I have performed frenectomies on several infants, including a 9-day-old who was losing weight due to ankyloglossia. An 8-year-old patient required a labial frenectomy. After performing the surgery, the father asked me if his son could play soccer that evening. I told him that there should be no problem, but I prescribed over-the-counter analgesics as a precaution. When I called his father the next day, he told me that his son had not needed any of the analgesics and he had been able to go to his soccer practice.
A 6-year-old mentally retarded patient, Michael, was up one night with dental pain. I discovered that the operculum overlying the erupting, lower-right, first permanent molar was large and swollen. After administering a topical and local anesthetic, I removed the excess tissue with the erbium laser. There was no bleeding due to the cauterizing effect of the laser. When I asked the mother the following day how Michael was feeling, she replied, “Wonderful. He’s like a different child.”
Another example of laser success in my office was a 2-week-old girl who was having difficulty nursing due to ankyloglossia. Why did her parents drive six hours to my office, from Minneapolis to Chicago? Because the oral surgeon the patient was originally referred to did not have a laser. After the procedure, the infant’s grandfather called (a general dentist who heard about the surgery I perform with the Waterlase MD) to thank me for taking care of his granddaughter.
Can you afford to buy a laser?
The erbium laser has profited me much more than its cost. Maybe the question should be: Can you afford NOT to buy a laser? What’s the bottom line? Less stress, less burnout, and more fun doing dentistry! On my way home from the office one evening shortly after I had purchased the erbium laser, I called my wife and said, “I just realized something; I only gave two injections today - one for a stainless steel crown preparation and one for an extraction.”
