Chapters

Chapter 4. Clinical Operations

Dental Office Technology

Is a dental laser needed to perform quality dentistry?

In 1997, the Food and Drug Administration approved laser use in dental hard tissues (teeth) for treatment of cavities. Different types of lasers had been used in dental applications since 1991 for soft tissues procedures. Lasers are currently approved for use in both adults and children. Until recently, dental lasers have not been widely used because of their high cost and limited applications. Today, however, they are being used for everything from cavity preparation and root canals to gingival and periodontal surgery and whitening teeth.

The dental lasers available today include the following:

  • Argon
  • Dual Wavelength Argon
  • Diode (810 to 830nm)
  • Diode 980nm
  • CO2
  • ND-Yag
  • Erbium
  • Low Level Lasers

Each laser typically produces a single wavelength, though some can now be adjusted to provide a variety of wavelengths. Based on the absorption characteristics of each wavelength in dental tissue, different reactions occur. Therefore some lasers are more effective for cutting hard tissue, while others are more effective for curing and others for soft tissue procedures.

Vendors, manufacturers, and other laser proponents report many advantages to the use of dental lasers, including the following:

  • Clean dry field / better restorations
  • Minimal anesthetic
  • Precise incision/excision
  • Root canal sterilization
  • Better bonding strength (laser etching)
  • Anesthetic free cavity preparations
  • No micro-fractures as can occur with rotary instruments
  • No vibration
  • No waiting for numbing to occur
  • Less stress for laser procedures
  • Practice revenue growth potential
  • Less need to refer patients out
  • Efficiencies; more procedures/visit
  • Less postoperative sensitivity
  • Enhanced healing
  • Conserves healthy tooth structure
  • No waiting for numbing to subside
  • No needles
  • No drill sound

These purported advantages have not been adequately demonstrated in well designed, controlled clinical trails. Additionally, lasers will never completely eliminate the need to drill or to use local anesthetic to numb an area of the mouth. Some procedures take too long with lasers, and many dentists still feel more comfortable performing involved procedures, like root canals, with traditional tools. Lasers are also not usually used to remove metal fillings, since they can heat up the metal to temperatures that are both painful and injurious to the tooth. Other disadvantages include very high initial cost (up to $60,000 for some units) and the fact that Medicaid does not reimburse at a higher rate for procedures performed with lasers.

Policy/Position Statements

American Academy of Periodontology’s patient information on the use of lasers external link

ADA’s position on lasers external link

 

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