Lasers

L.A. Health News, December 2004

The laser has now ultimately infiltrated the world of dentistry. This amazing technology, which has been the centerpiece of futuristic and science fiction myths, has actually found numerous applications in medicine over the past three decades. Nowadays, it is an everyday reality in an increasing number of dental offices. There are many types of dental lasers, but I will refer mainly to the ones that can be used on hard tissue such as teeth. Developed into streamlined machines and equipped with efficient delivery systems, these can be used to prepare cavities, sterilize root canals, treat periodontal pockets, trim gums, and assist in soft and hard tissue surgeries. Many of them work by emitting pulses of laser energy, which excite the water molecules on the surface of the target tissue, making them break away in microscopic layers. This is termed "hydrokinetic energy", and since it does not involve heat and vibration, there is hardly any pain in most procedures.

Examples of their uses in dentistry are as follows:

  1. Preparing tooth cavities for placement of bonded fillings. Used in place of the drill, it gently removes tooth structure layer by layer, without even touching the tooth. Children love it. Used correctly, it is safer than the drill, in spite of misconceptions over the word "laser". In fact, this piece of equipment is one of the safest gadgets used in the mouth. As the cavity is cleaned out, there is a simultaneous sterilization in effect, and a surface is created which produces a superior bond with bonding agents.
  2. Fissure sealants: It is a well-known fact that along with cosmetics, preventative procedures will lead the way in modern dentistry. Along with improved oral hygiene programs, cleaning out the deep grooves, or "fissures", on the chewing surfaces of teeth, and placing bonded sealants in them, constitutes a significant measure in the prevention of dental cavities. The laser is ideal for this purpose, as it obliterates the soft, decalcified and decayed enamel, along with bacteria and organic matter - namely the precursors of cavities - found in the microscopic depths of these fissures.
  3. Preventing root canals: Most root canals arise after bacteria from deep cavities invade and infect the nerve chamber. Many times, however, the process of using a drill to clean out decay so close to a live, but compromised nerve, will irreversibly traumatize it through high-frequency vibrations, or even crush the dentine and drive bacteria deeper into the nerve. This by itself may be the last straw, and cause a root canal. The laser, on the other hand, causes no vibration, structural damage, or heat. It will gently remove infected tooth structure in close proximity to the nerve and kill bacteria, thereby greatly reducing chances of a root canal treatment.
  4. Debriding and disinfecting root canals prior to placement of the filler material. The laser beam unclogs the dentinal tubules and kills bacteria.
  5. Treatment of gum disease. Today there is irrefutable evidence that people with gum disease run a higher risk of heart disease and diabetes. Conventional deep cleanings of infected gum pockets often result in millions of bugs entering the bloodstream and causing havoc. The laser is used as part of a thorough gum treatment protocol to safely disinfect pockets, and stimulate the diseased epithelium before undertaking more invasive measures.