Download File - CAITLIN MCFARLAND

Sarah Kelley
Caitlin McFarland
DHYG 2301
March 28, 2013
“Lasers in Dentistry
Main Focus: Periodontal Therapy”
As Albert Einstein said, “ It has become appallingly obvious that our
technology has exceeded our humanity.” With that being said, it is important that
the medical field stays up to date with the newest technologies. The majority of our
country’s population is more attracted to the “latest and greatest” and is more likely
to choose to be a patient of a provider that has an office with updated tools and
technology rather than a provider with an outdated office. Lasers in dentistry are
becoming more widely used and will revolutionize the way treatment is given to all
patients. Since lasers are becoming one of the most appealing technologies in
dentistry, it is important that clinicians become familiarized with this new idea. In
the course of this research paper and presentation we hope to shed light on some of
the unknown advantages and effects of using lasers. This information will be
beneficial to the clinicians because they will: 1.) Know what treatments the lasers
can be used for. 2.) Know the advantages and disadvantages in using the laser and
3.) Be able to properly educate the patients about this new technology.
The most attractive use of the dental laser is for LANAP – Laser Assisted New
Attachment Procedure. Compared to traditional periodontal surgery, the laser
provides the clinician with a more beneficial treatment and outcome and the patient
is more likely to accept this form of treatment. The first step of using LANAP is to
obtain an accurate probe depth of the infected pocket. This initial reading will be
used to compare with the post laser reading after the LANAP treatment and healing
time has occurred. LANAP requires the use of a laser in the shape of a standard
probe that is placed into the infected pocket. Once placed inside the pocket, the
laser’s energy then decontaminates the bacteria that cause periodontal disease.
Since a bacterial infection is the precursor of the chronic inflammatory response of
periodontitis, the decontaminating effect of the laser treatment is beneficial to the
patient (Goldstep & Freedom, 2011, p. 21). The laser then removes all the infected
tissue, while preserving the healthy tissue and bone. After the removal of bacteria
and infected tissues, the hygienist would then debride the root surface. By
removing all the bacteria, infected tissue, and calculus from root surfaces, this
allows for the remaining tissue to begin the regeneration process. By the tissue
healing and forming new attachment to the root, it forms a seal, ensuring that
bacteria will not reach the bone, which is essential for bone to be able to regenerate.
After the allowed healing time, it is important for the clinician to go back and gather
end result probe depth readings to be able to document a successful treatment.
During traditional surgery, “the doctor uses a scalpel to peel back gum tissue for
better visibility and access to the periodontal pocket. The doctor then cuts down
and sutures the gums to decrease pocket depths; this is what causes the aesthetic
alteration of the gum line. Once the pockets are cut down, bone or tissue grafting
may be used to reattach the gum to the tooth’s root surface. The recessed gum line
exposes tooth roots, which can cause sensitivity to hot and cold, causing discomfort
to the patient while eating or drinking. (Laser Gum Surgery LANAP vs Traditional
Gum Surgery) The benefits for the clinician to use the laser include; less bleeding
during surgery, decreases the time spent in surgery, less fatigue, and it combines
many usual steps prior to treatment into one setting. The laser also benefits the
patients in the way of: 1.) “LANAP is less invasive and more selective. The laser
removes only damaged tissue and does not impact near by healthy gum and bone,
resulting in no significant gum line recession. The natural appearance of the
patient’s smile is preserved.” (Laser Gum Surgery LANAP vs Traditional Gum
Surgery) 2.) Cutting down on the healing time due to the lower level laser tip has
additional effects that include lymphatic flow, production of endorphins, increased
microcirculation, increased collagen formation and stimulation of fibroblasts,
osteoblasts and odontoblasts. This triggers the immune response, pain relief and
wound healing. (Goldstep & Freedom, 2011, p. 22) 3.) Pain medication is not
needed after treatment 4.) The laser only eliminates infected tissues while
preserving the healthy tissue, and 5.) There is no need for the use of sutures.
More recently, in dental offices, antibiotics have been used to fight off
anaerobic bacteria that cause periodontal disease. There are no strains of bacteria
resistant to lasers. The periodontal laser procedure and treatment does not
generate any resistance to medications that a patient may be required to take some
day. The laser, also, does not suppress the patient’s immune system, whereas
antibiotics can. (as stated in Schulhof, 2010)
While this is a great product and it seems too good to be true, everything has
its disadvantages, doesn’t it? Some of the downfalls to this product would include,
the laser may not fully work in severe periodontal cases, and so the traditional
periodontal treatment may be needed. Also, the dental laser is a costly investment
for the clinician. There has to be training and the persuasion of the patient has to
occur. Lasers are a pricey investment that the dentist must decide he wants to
make. Not only investing in the actual product but also the variety of attachments to
perform each desired treatment or procedure. Along with that, there is also the
need to invest in the technology and training. Both the dentist and the hygienist
need training for maximum total use and outcome of the product. It is also a
challenge to persuade the patient to transition from traditional to laser surgery.
Most all patients, especially when coming to dental work, want the cheapest most
effective treatment. This is where it would be the clinician’s job to address how the
benefits of laser surgery outweigh the cost.
Though there are a few disadvantages to investing in the laser, there are
more positives that compensate for the negatives that come along with this product.
The laser can work with both hard and soft tissues. It can be used for biopsy and
soft tissue removal, soft tissue band-aid for herpetic lesion, aphthous ulcer, split lip,
etc., frenectomy, circumferential supracrestal fiberotomy, gingivectomy, and crown
lengthening-functional and cosmetic. This can also be used to remove decay within
a tooth, prepare a tooth for placement of a restoration, laser procedure can be used
for successful decay removal and restorative preparation without major thermal
effects, collateral damage to tooth structure, or patient discomfort. (Gupta & Kumar,
2011, p. 121) Lasers can also cure and harden a filling, and also teeth whitening. In
October 1998, the ADA Council decided that because of concerns dealing with pulpal
safety and a lack of controlled clinical studies, the CO2 laser should not be advocated
for tooth-whitening procedures. However, ADA Council suggested that the argon
laser might be an acceptable substitution for the conventional curing light if the
manufacturer’s suggested procedures are followed carefully. (Gupta & Kumar, 2011,
p. 122)
Understanding the theory and history of the laser is not only interesting but
will also help in the understanding of how the process works. “The light energy can
induce energy transition in atoms, causing the atoms to move from their current
state (EO) to the excited state/ activated stage to the absorption of a quantum of
energy. This is called “stimulated absorption.” Because the lowest energy state is
the most stable, the excited atom tends to return to normal by spontaneously
emitting a quantum of energy called “spontaneous emission.” This conversion to
low energy state can be achieved by stimulating the activated medium further by a
quantum of light at the same transition frequency. This is called “stimulated
emission.” During this process, it releases a photon of the same size as of the
released atom, which hits against the adjacent activated atom setting off a chain
reaction of releasing photons.” (Elavarasu, Naveen, & Thangavelu, 2012, pp. S260S261) Stimulated emission was first found by Albert Einstein in 1917, the laser was
used for the treatment of caries in 1964 by Goldman, tissue reactions to laser light
and wound healing was used in 1971, and finally in 1989 the laser was used for soft
tissue surgery. (Elavarasu, Naveen, & Thangavelu, 2012, p. S260)
Every state has laws and regulations when it comes to the use of the laser. In
total, 31 states allow hygienist to use the laser (Alaska, Arizona, Arkansas, California,
Colorado, Florida, Georgia, Hawaii, Idaho, Indiana, Iowa, Kansas, Kentucky, Maine,
Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Jersey, New York,
North Dakota, Oregon, South Carolina, Tennessee, Texas, Utah, Vermont,
Washington State, and West Virginia.) 6 states do not allow Hygienists to use lasers
(Alabama, Delaware, Louisiana, Mississippi, North Carolina, Pennsylvania) 3 states
do not address laser use by Hygienist (Washington D.C., Illinois, Maryland.) and 11
states do not provide information, as they are still processing the rules.
(Connecticut, Massachusetts, New Hampshire, New Mexico, Ohio, Oklahoma, Rhode
Island, South Dakota, Virginia, Wisconsin, and Wyoming.) Texas, specifically, states
that, the board has licensed dental hygienist to be able to use lasers that are not
capable to cut or remove hard and/or soft tissues to accomplish treatment within a
dental hygienist’s scope of practice. A licensed dentist must supervise the dental
hygienist during all intraoral procedures involving a laser. (American Dental
Hygeinists' Association , 2012)
Despite the fact that there are a few downsides to investing in the laser, there
are still more positive aspects that are appealing to both the clinician and the
patient. The use of a laser is more beneficial to the patient when it comes to
periodontal surgery, biopsy and soft tissue removal, decay removal, preparation for
restorations, and teeth whitening. The properties of lasers that effect vital
structures are selective absorption, coagulation, sterilization, and stimulatory which
make lasers the better choice in clinical scenarios. (Lomke, 2009, p. 48) By being
educated about this topic and new technology, it would be a wise and ethical
decision to consider investing in the laser for their office. “Lasers can prove to be a
blessing in disguise if used safely and properly.” (Gupta & Kumar, 2011, p. 122)
Works Cited
American Dental Hygeinists' Association . (2012). Retrieved from American Dental
Hygeinists' Association: http://www.adha.org
Dean, B. (n.d.). Concepts in Laser Periodontal Therapy Using the Er,Cr: YSGG Laser.
Retrieved from The Acemy of Dental Therapeutics and Stomatology:
www.ineedce.com
Elavarasu, S., Naveen, D., & Thangavelu, A. (2012). Lasers in periodontics. Dental
Science , 4, S260-S263.
Goldstep, F., & Freedom, G. (2011, July/August). Diode lasers for periodontal
treatment . ClinicalFeatures , 20-23.
Gupta, S., & Kumar, S. (2011). Lasers in Dentistry - An Overview. Biomaterials and
Artifical Organs , 25 (3), 119-123.
Laser Gum Surgery LANAP vs Traditional Gum Surgery. (n.d.). Retrieved from Gum
Surgery Alternatives: www.houston-perio.com
Lomke, M. A. (2009, January/February). Clinical applications of dental lasers. Laser
Therapy , 47-59.
Schulhof, R. J. (2010). The Laser Connection - Toward a Kinder, Gentler, Periodontal
Treatment. Retrieved from Centers for Dental Medicine:
www.centerfordentalmedicine.com/laserconnect.html