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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to be a patient of a provider that has an office with updated tools and technology rather than a provider with an outdated office.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