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Laser (Light Amplification by Stimulated Emission of Radiation) is light with specific properties that can perform specific work.Light is a type of energy that travels in a wave as a particle, called a photon.
Photon waves have three properties. One is amplitude, (vertical measure of the height of the wave = the energy of the wave), the second is length of the wave (the color of the light) and the third is the velocity (speed of light). Laser light is very specific with a stable wave height, a single wave length with one color and a focused beam with concentrated energy giving heat that can cut or disinfect tissue (unlike light bulbs that have variability of amplitude and wavelength, scatter light in many directions and don’t cut or disinfect). Laser light (and bulb light) is a type of electromagnetic radiation. Laser is NOT ionizing radiation like X-ray, which can cause risk of mutations in DNA.
Lasers in dentistry and safety
There are several types of lasers with different wavelengths and absorption capabilities that interact with different tissue types.
Short wave lasers (Diode and Nd:YAG) have an affinity (selective absorption) for tissue pigments (dark color, hemoglobin, melanin) and are used for soft tissue surgery and blood clotting. The laser works on pigment and will not harm surrounding bone or tooth at the settings used for soft tissue. Since diseased soft tissue has a higher hemoglobin content and melanin from the bacteria, the laser light is absorbed by the diseased tissue without affecting the healthy tissue. These lasers have a beam wavelength in the infrared spectrum. They ablate by photo thermal or heat burning.
Longer wave lasers (Er:YAG, Er:Cr:YAG) have an affinity for water, can recognize the decayed part of the tooth because of differences in water content between solid and decayed tooth structure, and are used for teeth and bone. Hard tissue lasers can remove decay but can not remove old silver filling material because the heat of the laser would vaporize the mercury in the fillings. Removing composite filling material can be very difficult and slow.
The laser emits light energy either in continuous or pulsed states. Most dental lasers involve pulsed energy release. The pulse (burst of light) delivers the laser’s heat energy quickly (each pulse has a duration of a few ten thousandths of a second) and allows the tissue time to cool before initiating another pulse. The heat is not retained by the tooth or soft tissue. This heat energy pulse works by either boiling away water within and between the cells, or by causing micro expansion of hard tissue, resulting in a tiny explosion (pops) that removes the unwanted tissue. When using the continuous wave operation, it can trigger nerve response so local anesthesia may be needed.
The dentist must always take care to use the proper laser at the proper settings for each individual therapy, just like all other dental tools. It is important for everyone in the room to use special safety glasses while the laser is being used in order to prevent eye damage.
FDA (food and drug administration, u.s.a) Indications related to soft tissue
You can find more info at: http://www.biolase.com/ezlase/fda_indications.php
Benefits of laser in periodontal therapy and surgery – a summery frem commercial sites and articles
- Laser is precise and specific for certain tissue types. When used correctly, it does not effect the surroundings.
- Laser can kill bacteria in the area being worked on (periodontal, surgical, endodontic).
- Laser can reduce periodontal infection by killing the periodontal bacteria causing the disease.
When performed correctly and together with optimal daily oral hygiene, this can aid in the process of stabilizing the periodontal condition.It does not reduce all pocket depths to a long term optimal healthy condition.Periodontal surgery with or without laser may be the optimal treatment. - Laser can remove diseased soft tissue lining (curettage) in the periodontal pocket and attempt to “seal” it at the same time (like heat can seal the end of a rope). Local anesthesia is recommended for the optimal removal of calculus with ultrasonic instruments at the same time of laser usage. NdYag laser does not remove calculus, but it may make it porous and therefore easier to remove. Curettage can be done with handinstruments alone. Laser has access to difficult areas.
- Laser can be an alternative to gum surgery when indicated: e.g. maintaining gum height esthetically on front teeth or when surgery is denied by the patient or not an advantageous option (disease, medications, handicap).
- Laser advantages are: no scalpel cutting, no stitching, in mild cases no anesthesia, removal only of the diseased tissue without removing any of the healthy tissue, maintaining the height of the tissue around the front teeth, less inflammation response, less bleeding, less pain, less swelling, less postoperative discomfort, assisting in healing and achieving a healthy periodontal condition.
- Laser promotes healing and reduces duration of canker sores and herpes outbreaks.
- Laser for soft tissue gives no vibration and no unpleasant noises.
- Minor oral surgery like eliminating tongue and lip ties, uncovering implants, soft tissue crown lengthening, preventing bleeding when taking impressions for crowns, or removing cysts and tumors can all be performed by a laser with minimal trauma and bleeding to the area. Most surgeries can be accomplished with a very small local anesthesia.
- Laser therapy is safe for patients with health concerns such as diabetes, HIV, hemophilia, or those taking medications such as Coumadin or Cyclosporin.
Why is laser often painless?
Laser works precisely with heat energy that vaporizes specific diseased tissue and with very little effect on surrounding tissue nerves. This happens so fast, and occurs through repeated pulses with long enough rest time between the pulses that there is no cumulative (addition of previous pulses) effect and does not trigger a nerve response (pain). The surface tissue is sealed.
This procedure reduces the stimulation of the mediators of inflammation causing less inflammation at the surgical site and therefore less pain and more rapid healing than traditional surgical techniques.
However, there is a variation among patient’s reaction and dental procedures in the timing of pulses.
Laser Certification of Dentists
Dr. Hoffmeyer taken certified postgraduate courses offered by the International Society for Oral Laser Applications.
This is an organization dedicated to providing education about lasers and testing dentists to insure that standards of care are met. The group is composed of researchers, academic professionals and practicing dentists.
Dr. Hoffmeyer is not commercially or economically involved with any laser company.
Limitations and opinions of lasers
Lasers in the dental research and practice community have been met with controversial opinions, due to the fact that research results are varying. Since laser equipment and settings change constantly, it is nearly imposible to compare research results and end up with one single answer as to the efficacy of lasers in periodontics.
Dr. Hoffmeyer has an open mind to the topic and is doing her best to keep herself up to date at international conferences and with publications so she can give you her best advise.
Lasers have their limitations and can not replace other dental tools. NdYag laser alone does not remove calculus. ErYag laser may remove calculus, but should be used with causion.
Not all patients are candidates for laser therapy, in which case a traditional surgical approach should be used to create the desired results.
When indicated, laser can be an aid to provide you as a patient with dental care that can be effective in killing bacteria, being comfortable and helps you overcome your fear of pain or surgery.
Optimal daily oral hygiene is your number one asset and must not be neglected.
We will advise you how to have your periodontal disease treated and maintained healthy in the least discomforting and most efficient and cost effective way.