Make the Case for Laser Dentistry

Since Dr. Terry Myers started experimenting with lasers in dentistry almost 30 years ago, people have tried to dismiss this technology as a passing fad. But even a quick look at national journals for the dental and dental hygiene professions over the past six months shows a significant number of articles that address lasers in all aspects of dental care. Why is this “fad” captivating the professional imagination? To me, the answer has two parts.

First, laser-assisted dental hygiene and laser-assisted dental procedures are improving the quality of care for patients. A new standard of care is emerging using this technology. Second, the laser is a piece of equipment the entire team can utilize and benefit from. Currently in the U.S., only 36 states permit dental hygienists to use dental lasers. However, even in the cases where the hygienist isn’t using the laser, she can be an integral part of helping her practice adopt the technology or at least learn more about its capabilities.

Regardless of whether or not you are in a state that permits you to use the laser, it is critical for you to understand what this technology can do for your patients; my personal philosophy is that patients deserve not just the best that I can do for them but the best that the profession can offer them.

Power primer

Dental lasers fall into two groups based on the energy they emit, their wavelength (measured in nanometers). Wavelengths have significant implications regarding effectiveness, depth of penetration, patient comfort and ease of use. The specific wavelength of a laser is created when the energy source (power) and the ‘fuel’ combine to create laser energy. In the case of a diode laser (wavelengths from 810 nm to 980 nm), the power is electrical and the fuel is a semi-conductor chip. In the case of all other dental lasers (wavelengths over 980 nm), the power is a flash of energy created by a lamp or other mechanism, and the fuel is a mixture of gas, liquid and crystal.

It is most important for the hygienist to be aware of the opportunities afforded by the diode lase, since it is prevalent among general practitioners; according to a May 2007 Dental Products Report survey, 56% of respondents own a diode laser and 57% of non-owners were planning to buy a diode laser. Used in soft tissue procesdure only, the diode laser energy-either continuous or pulsed-is attracted to pigment, and in our case, hemoglobin. (Other lasers, such as Er:YAG and Er,Cr:YSGG, can be used in both hard and soft tissue and are attracted to water and/or hydroxyapatite.)

Going Soft

Many soft tissue procedures can be completed in a matter ofminutes and, depending on the laser used, require no injectable local anesthetic and cause minimal to no post-treatment discomfort for the patient. This is a great selling point with your employer! Go over this list with him or her to see if keeping certain procedures in-house in addition to improving efficiency and predictability of standard procedures might make adoption more feasible.

• Frenectomy (labial or lingual)

• Biopsy

• Gingivectomy

• Operculectomy

• Uncovering implants or enerupted teeth

• Removal of hyperplastic tissue

• Incising and draining of all gingival tissue

Hard sell? Nope!

Likewise, there are a variety of hard procedures the hygienist and dentist can perform that can help bolster productivity and predictability while reducing stress and patient discomfort.

• All routine restorative procedures for enamel, dentin and cememtum

• Achieving adequate biologic width

• Recontouring

• Root tip removal

• Implant placement

Experience speaks

In my opinion, the most important use of a dental laser by a dental hygienist is as an adjunctive tool to facilitate access to the root surfaces. Once this improved access is accomplished, standard instrumentation can then be used to completely remove the deposits and toxins from the root surfaces. Along with this improved access, a dental laser can de-epithelize the infected tissues in lining the periodontal pocket. The end result is greatly improved periodontal healing after scaling and root planning (SRP) procedures. If the goal is to demineralize calculus in the pocket, removal is easier using an Er,Cr:YSGG laser for the process; a diode laser will not demineralize calculus.

If your employer is reluctant to incorporate laser-assisted dental care into the practice after hearing about these possible improvements in periodontal care and knowing the many things the laser can do that go beyond SRP, remind him or her that the primary concern should, of course, be the patient. When using laser, patients experience better outcomes and less post-treatment discomfort. These “soft” perks become all the more important when you consider the enormous percentage of patients who need comprehensive periodontal care. Using a technology to do it more effectively and comfortably should be a priority for every dental practice.

As a dental hygienist, you are a leader in the practice and in the profession. Chances are you already recognize that lasers are here to stay and poised to change the way we all provide care. Make it a point to learn what lasers can do for you specifically and for your practice in general. Help adopt laser technology into your practice and see the quality of care improve dramatically and dental hygiene become more fun to deliver. The practice will soar, as will you!

Jonathan A. Bregman, DDS, FAGD, has been practicing dentistry for more than 30 years. Over the past 15 years, he has served as an adjunct faculty member of the University of North Carolina Dental School at Chapel Hill. Also working as a speaker and consultant, Dr. Bregman’s energized and thought-provoking laser dentistry presentations show how lasers dramatically improve the patient experience, increase practice profitability, and put fun back into dentistry.