Monica Monsantofils, BSDH, PG Dip, EPPDH
As hygienists, it’s important to think about the technologies we use in our everyday clinical practice. We should ask ourselves: What technologies are we using? Why do we use them? What techniques do we use? Another very important question about technology today is: Will adding a dental laser to my armamentarium improve the way I practice?
Experience tells us that dental lasers provide better and safer treatments with optimal health outcomes, and countless research articles confirm this. Using lasers oftentimes allows for less invasive treatments—and at the same time increases efficiency, effectiveness, and revenue for the practice. This article will look closely at how dental lasers are used, treatment options for dental hygienists, and why adding a laser to your armamentarium could take you to a higher level of clinical excellence.
Laser use by dental hygienists
First, let’s look at requirements for laser use by dental hygienists. Laser use and training requirements vary from state to state, including procedures allowed, education requirements, and certification standards. Specific requirements for certification can include coursework, proof of course completion, a written exam, and hands-on training.
Some states provide no information regarding lasers in their state practice acts. Other states specifically prohibit laser use by dental hygienists. These include Louisiana, Mississippi, North Carolina, and West Virginia.
The Academy of Laser Dentistry’s regulatory affairs committee provides a list of state and federal regulations at laserdentistry.org.1 This information can change, so ultimately it is the responsibility of the dental hygienist to know his or her scope of practice in the state.
No matter where you practice, if you plan to use a laser, it is extremely important that you obtain the necessary education and training for safe and effective laser use.
Laser use in dentistry
There are many lasers used in dentistry today. Before using any laser, it is important to have a basic understanding of laser physics, power settings, tissue interaction, clinical use, and safety.
All lasers work by delivering energy in the form of light. Most dental lasers fall into the infrared zone of the light spectrum. Lasers can be classified by the following characteristics:
- active medium (either a gas, solid, or semiconductor)
- tissue for intended use (there are hard- and soft-tissue lasers)
- wavelength range
- risk associated with application2
The type of laser to use depends on the procedure being performed. For example, some lasers can act as cutting instruments or vaporize the target tissue.
There are many known benefits with dental lasers. Compared with conventional modalities, lasers can be less invasive, minimize pain, and lower discomfort during treatment.3 This may reduce the need for local anesthesia for the procedure.
Lasers are reported to aid in hemostasis, which improves visibility during procedures. Bacteria reduction has also been observed. Another important benefit to laser technology is photobiomodulation, which is related to a laser’s ability to aid in tissue healing and discussed further below.4,5
Types of dental lasers
Lasers in dentistry include the following types: Er:YAG; Er, Cr:YSGG; CO₂; Nd:YAG; and diode. Let’s look closer at what makes each of these lasers unique.
Er:YAG and Er, Cr:YSGGlasers—These lasers are highly absorbed by hydroxyapatite. Bone removal is more efficient with these lasers.5 “Er” stands for erbium, and erbium lasers are considered both hard- and soft-tissue lasers. However, they have limited hemostatic ability because they are not absorbed by hemoglobin.6,7
CO₂—These lasers are high-powered soft-tissue lasers that have a high affinity to hydroxyapatite. They are absorbed in both soft and hard tissue. When using these lasers, the clinician must protect adjacent teeth, since CO₂ lasers have long pulse durations that can cause cracking and carbonization.7
Nd:YAGand diode lasers—These lasers are more highly absorbed by hemoglobin and pathogens. Inflamed tissues can contain dark pigment and hemoglobin chromophores that readily absorb wavelengths in the visible and near-infrared regions.Nd:YAG is an ablation or surgical laser that has high penetration depth, and therefore a potential for harm exists.8
Diode lasers are used by both dentists and hygienists for a variety of treatments. Wavelengths vary on diode lasers. Some units have one or two wavelength settings. Diode lasers are the most economical lasers to purchase and are often smaller and more portable than other dental lasers.2
Diode lasers have many applications, which we will discuss in the next section.
Dentists use diode lasers for precision and hemostasis for the following procedures: crown lengthening, gingivectomies, gingival contouring, flap procedures, gingival troughing, frenectomies, biopsies, and periodontal therapies.2 Diode lasers are also used to treat discomfort caused by orthodontic adjustments.2
Diode lasers are approved by the FDA for endodontic procedures. Adjunctive treatments have been shown to aid in the cleansing of the root canal space for apicoectomy and pulpotomy procedures.9
Dental hygienists use diode lasersas an adjunct to scaling and root planing (SRP). Diodes are also used in laser-assisted periodontal therapy (LAPT), which is sulcular debridement and removal of diseased or inflamed soft tissue in the periodontal pocket. Using a laser prior to periodontal therapy can increase visibility, decreasing gingival bleeding and inflammation.10 Clinicians report enhanced wound healing and decreased pocket depths by reducing pathogens within infected gingival tissue, creating an environment to promote health.5,11
A new diode laser on the market, the SiroLaser Blue (Dentsply Sirona), is the first dental diode laser to have three wavelengths. This enables the laser to provide a wider range of uses. The three wavelengths are 445 nm (blue), 660 nm (red), and 970 nm (infrared). The 660 nm and 970 nm settings are for both dental hygiene and dental procedures. The 445 nm setting is for dentist-performed procedures. The 445 nm provides more precise, faster, and cleaner work—even while in the noncontact mode. The 445 nm blue laser light has a significant increased absorption in tissue compared to infrared lasers and provides maximum cutting power.
Other uses for lasers
Laser bacterial reduction (LBR) for pathogen reduction and bacterial decontamination can with be done with a laser prior to any dental hygiene procedure. Lasers are also used for desensitizing tooth structure to eliminate dentin hypersensitivity. Other uses include TMD treatment, teeth bleaching to enhance whitening procedures, and aphthous ulcer/cold sore treatment.
As mentioned above, one use for lasers is photobiomodulation (PBM), also called low-level light therapy (LLLT) or biostimulation.2 PBM treats oral mucositis, often a common and debilitating complication of cancer treatments for patients undergoing chemotherapy and radiation.12,13 Research demonstrates that a red laser is the best wavelength for photobiomodulation and analgesia in cancer patients, with 650 nm being the best option for wound healing.4,12 At the cellular level, energy absorbed by cell mitochondria increases the production of ATP, which increases postexposure cellular division.4,12 A laser with both red and infrared light is needed to provide PBM/LLLT.
Choosing a laser
It can be overwhelming to decide which laser is right for your practice. An important factor to consider is whether the laser provides multiple functions and operates at more than one wavelength. Factors to consider for the ideal diode laser, specifically, are the following:
- Does the laser unit provide the range of clinical applications you need?
- Are there multiple wavelength options for LAPT, LBR, and PBM?
- Are power/wavelength and pulse rate adjustable?
- Is the laser easily portable to other operatories?
- Is the laser comfortable and easy to use?
- Are the settings adjustable and are there setting options for multiple users?
- Are tips presterilized or do they require sterilization steps?
- Is the unit activated by a foot pedal, hand control, or both?
Other factors to consider are the following:
- factory settings
- calibration requirements
- software upgrade capability
- ease of sterilization and disinfection
- what accessories come with the unit
Consider the power cord: Is there a cordless option? It’s also very important to also look at the warranty, customer support, available training from the manufacturer.
Lasers are becoming more popular in dentistry every day, and they may help you deliver a higher level of excellence to your clinical practice.A diode laser is ideal for dental hygiene procedures as an adjunct to SRP for LAPT, LBR, and PBM. If you are considering adding a laser, it is important to stay current with research. Research articles, education programs, and training can be found at the Academy of Laser Dentistry (laserdentistry.org). Google Scholar and PubMed are good sources for research articles.
Lasers oftentimes deliver clear benefits compared to conventional methods of treatment, as they are often less invasive, more precise, and more conservative in preserving the healthy tissue while treating the diseased site. Patients report reduced postoperative pain and may also have a reduced need for postoperative medication.
Patients are looking for offices that can provide better, less invasive, more comfortable dental treatments, and dental lasers provide this. At the same time, your practice benefits from retention and referrals from satisfied patients who experience the abilities of dental lasers.
• References are available in the online version of this article. Visit RDHmag.com and search “Monsantofils.”
Monica Monsantofils, BSDH, PG Dip, EPPDH, is a clinical educator for Dentsply Sirona. She provides professionals with current concepts and evidence-based research to assist in implementing effective treatment protocols. She attended Portland Community College, Eastern Washington University, and King’s College London.