Evaluating your need for a dental laser
Harvey Passes, DDS
You have just left your monthly study club meeting. You have spent the evening listening to a doctor describe how he uses his carbon dioxide laser. It sounded interesting. Now, you recall walking down the aisles at your dental society`s annual meeting last year and being overwhelmed by the large number of dental lasers available.
It reminded you of the first time you visited the computer store. So many new computer products were on display. You had no understanding of what to do with them or whether they were even right for your particular needs. What do you do? Are you missing the boat on some useful high technology? How do you know what is right for you? Let`s try to make some sense out of what laser dentistry can do for you and your patients.
This article does not explain the precise details of laser dentistry. It does not explore or explain the science that fuels this wonderful technology. It does not try to persuade or convince you. Rather, I assume that you have become interested enough in laser dentistry to explore how this technology may positively influence your practice.
The focus of this article will be on the many applications that exist and how each laser may be useful to you. It is for you to determine which application has merit for you. You may discover two lasers that would serve similar functions for you. Determine which fits into your budget, fits into your treatment room, fits into practice philosophy, and buy it. You will be glad you do.
So what is a dental laser?
A dental laser is a device that produces energy. Dental lasers are designed to produce energy for specific dental applications. This energy is delivered to hard- or soft-tissue sites in the mouth. The energy is absorbed by the tissue site to produce a desired therapeutic effect. Each laser has a name that refers to its wavelength. Each wavelength, upon tissue absorption, produces a different meaningful result for your patient. The reason why there are so many different lasers is that each laser has a unique tissue interaction, thus providing a special application. Some lasers (wavelengths) overlap in their applications. You should have a little familiarity with some of the names of the different lasers being offered by manufacturers.
What`s best for me?
To answer this question, we must work backwards. What services do you spend most of your day doing? Is there a laser that could combine various services in a more sophisticated fashion than the traditional way you have been performing them? In other words, can you offer a gentler, kinder, more patient-friendly service with a laser? Will it be more acceptable to your patients?
Let`s imagine that you practice pediatric dentistry. Most of your day is spent preparing teeth for restorations and bonding them into place. You also treat a number of children who have ankyloglossia. Some children also need frenectomy or pericoronectomy procedures. Certainly, all of your patients need to have sealants placed.
An erbium laser can remove decay, perform cavity preparation, and etch tooth structure. Most children who have not experienced the drill are unimpressed by the erbium dental laser. This is a positive result. The sound of the drill is replaced by a gentle "popcorn popping" sound. This is a more agreeable sound and is less intimidating. Adults also concur with this observation. An argon, diode, carbon dioxide, holmium or Nd:YAG laser can remove soft tissue without the need for scalpels or postoperative packing.
Oral surgery applications
What if you practice oral surgery? Much of what you do involves excisional surgery. It can range from biopsies to gross removal of tissue. A carbon dioxide laser - and to a lesser extent, the holmium laser - is ideal for you. I have seen hemangiomas removed from the tongue, a notoriously bloody region, without any bleeding episodes whatsoever. The wavelength permits rapid tissue removal while establishing effective hemostasis. Sutures are seldom used after excisional laser surgery. It also removes and relieves the painful symptoms of aphthous ulcers. These lasers also are excellent for noninvasive soft-tissue harvesting of dental implants. The soft-tissue site does not require sutures and there is effective hemostasis.
Some of you devote much of your practice to soft-tissue management. Lasers offer your patient an excellent, less invasive first line of defense against periodontal disease. An Nd:YAG or diode laser can provide these services. This is a very effective regimen when used in combination with scaling and root-planing, 20 mgs of doxycycline liquid or subgingival tetracycline cords. The laser is placed within the periodontal intrasulcular pocket. The fiber optic tip is placed against the diseased intrasulcular tissue and is vaporized gently. Studies show that this procedure helps reduce the bacterial colonies, as well as remove diseased periodontal tissue in a less-invasive fashion than with a scalpel.
Lasers and cosmetic dentistry
Many of you practice cosmetic dentistry (my favorite endeavor). In this discipline, a wide range of services is being provided. Adhesive ceramic dentistry can involve esthetic gingival sculpting, soft-tissue pontic design, accurate porcelain adhesion to tooth structure, shorter bonding working time, durable temporization, precision impression-taking through effective gingival retraction, periodontal care, and more.
An Nd:YAG or diode laser would offer all of these services for your patients. Though lasers are getting smaller and smaller, I find the diode laser to be the smallest for the previously mentioned procedures. This enables it to be taken from room to room with effortless ease. An argon laser allows expedient laser-curing. These same lasers are highly applicable for crown and bridge procedures.
Which laser to use for tooth-bleaching is a popular topic. Some feel that any heated light source applied to dental bleach will whiten the tooth. The one laser that has been FDA-approved for marketing the tooth-whitening procedure is the argon laser. It has been used for years with excellent results in about one to two hours.
Evaluating your needs
Only you can decide which services you spend most of your time doing. My suggestion is to make this determination first. Review the laser guide for the services that each lasers offers. Call the companies for their brochures on the particular wavelength that interests you. Ask them for the names of some dentists in your area who use their laser. Call them. Visit their offices and watch the laser being used on patients. Speak to those patients about their experience with the laser. Are they happy with it? Would they recommend it to others? Do they prefer it compared to other, more traditional therapies?
Laser resources
Your best resource for information is the Academy of Laser Dentistry. Call the academy at (954) 346-3776. It maintains a list of experienced laser dentists in your area that you can visit and who will answer any questions you may have. Find out where laser courses are being given.
If all of this interests you, then you should give special thought to joining the Academy of Laser Dentistry. Why? You will meet other dentists who are learning how to use lasers or who are seasoned, experienced dental laser practitioners. The academy offers the only national and international certification training and testing in lasers. This certification shows your proficiency in this technology. Annual academy meetings are well attended by doctors from all over the world, as well as by representatives of many high-tech companies.
In laser veritas.
