Integration of diode lasers into clinical dental hygiene practice

Periodontal disease (PD) is the sixth most prevalent oral condition worldwide and a public health burden.¹ In the US, 44.5% of adults aged 45 or older have moderate to severe periodontitis.² PD arises from a dysregulated host response to bacterial biofilm, influenced by behavioral and systemic risk factors.³ Scaling and root planing (SRP) remains the cornerstone of nonsurgical periodontal therapy (NSPT), but it has limitations in fully eliminating pathogenic bacteria and endotoxins.⁴

In cases of suboptimal response or elevated systemic risk, adjunctive therapies like diode laser (DL) treatment may enhance outcomes. As primary providers of NSPT, dental hygienists are well positioned to integrate DLs into care, supporting improved periodontal health.⁵

Indicators for use of laser therapy in adjunctive periodontal therapy

Biomedical application/physiological effects: There are several types of lasers; however, DLs are most common in clinical practice due to their small size and low cost.⁶ Laser light consists of uniform, parallel photons and emits nonionizing, noncarcinogenic radiation, with wavelengths typically ranging from 600 nm (red) to 1064 nm (near-infrared).^7,8 They operate in continuous-wave (CW) or gated-pulse (PW) modes.^6-8

Laser efficacy depends on multiple parameters, including wavelength, spot size, power density, fluence, duty cycle, and irradiation frequency.⁹ Once these parameters are understood, the usual practice is to use the lowest energy necessary to perform the procedure.

DLs have multiple biomedical applications in periodontal and other dental treatments. Their energy is selectively absorbed by chromophores such as water, melanin, and hemoglobin, but not by hydroxyapatite, making them safe for sulcular debridement.^4,9,10 Photothermal (PTT) at ~60°C produce photothermal effects that promote coagulation, ablation of inflamed tissues, protein denaturation, and a reduction in proinflammatory cytokines.^10-12

Photobiomodulation (PBM) uses low-level, nonthermal laser energy to stimulate healing and reduce inflammation.¹³ PBM also promotes fibroblast and osteoblast proliferation via fibrin and collagen release.^{3,10-12,14,15} Antimicrobial photodynamic therapy (aPDT), which combines laser light, a photoactive agent, and oxygen, generates oxidative reactions that destroy pathogens.¹⁶

LAPT to treat periodontal disease: Effective periodontal treatment requires thorough debridement performed by SRP; however, it cannot completely remove pathogenic microorganisms and their endotoxins, especially in deep periodontal pockets and furcation sites.^4,17 LAPT used alongside SRP employs low-level laser wavelengths to remove biofilm within the necrotic tissue of the periodontal pocket wall.¹² LAPT for peri-implant mucositis and peri-implantitis follows a similar approach to nonsurgical treatments for gingivitis and periodontitis.^12,14

Laser bacterial reduction (LBR) is a preprocedural decontamination technique that reduces bacterial counts in the sulcus, minimizing bacterial and toxin entry into the bloodstream; particularly Porphyomonas gingivalis (Pg), a major periodontal pathogen.¹² To prevent further biofilm invasion, LAPT seals the capillaries and lymphatics through coagulation.¹²

Evidence supports a bidirectional relationship between periodontal disease (PD) and systemic conditions, including cardiovascular disease, diabetes, stroke, preterm birth, Alzheimer’s, and respiratory infections.¹⁸ Combining LBR and LAPT may enhance healing response, improving periodontal outcomes and supporting overall systemic health.¹⁹

Limitations and benefits of laser therapy

Despite the range of laser modalities and applications, achieving optimal therapeutic dosing remains challenging.²⁰ Variables such as energy levels, treatment duration, and the bidirectional dose-response—where insufficient dosing is ineffective and excessive dosing may inhibit healing—can impact outcomes.¹⁰ Heavy smoking, along with local and systemic factors, may further limit regenerative effects.¹⁴

Conversely, DLs offer precise targeting of diseased tissues.⁸ Evidence suggests they may enhance bacterial reduction beyond SRP alone.^4,5,7-9 Additional benefits include hemostasis, reduced postoperative swelling and discomfort, and biostimulation that supports tissue healing and may limit systemic spread of pathogens.^5,8

Applications of laser therapy in dental practice

Incorporating lasers into clinical practice can expand a dental hygienist’s scope and enhance credibility and patient trust.²¹ Proper education and training are essential to ensure safe and effective use, grounded in scientific principles and clinical application.¹² The Academy of Laser Dentistry recommends a minimum of 12 hours of laser-specific education, including hands-on training and verified competency assessment.²²

Ongoing continuing education is encouraged to understand laser types, wavelengths, and clinical protocols.²³ Despite the debate over laser efficacy, multiple states have regulated dental hygiene laser use.^23,24 While dentists may perform all laser-assisted procedures, hygienists can provide several treatments (see figure 1), depending on state regulations.^12,23 Each state defines the scope of practice and required training.^23,24 Clinicians must consult their state’s Practice Act to determine whether laser use is permitted, restricted, or unregulated.^23,24

Staff members who experience laser treatment firsthand are better positioned to promote its benefits and motivate patients to ask about it.²¹ Team members who are proactive, become advocates for laser services, and have a positive attitude are critical to successful integration of a dental laser into the practice.²¹ 

Patient education: Understanding a patient's needs and expectations allows dental hygienists to create individualized care plans, counseling on the chronic nature of PD, with episodic activity and remission.¹ It is an opportunity to explain how emerging evidence has led to changes in the standard of care for successful oral-systemic health outcomes.¹

Patients often believe their PD is cured after initial LAPT, therefore clear communication is needed to explain how LAPT is not a one and done treatment.¹² Repetitive treatment is needed for the biofilm’s community structure to be continually weakened, which challenges the biofilm’s ability to recolonize.¹² Discussing the benefits of the LAPT strategy of decontaminating periodontal infection sites and optimizing the body’s ability to respond could make laser procedures far more appealing.¹²

Conclusion

PD is an oral disease of epidemic proportions in the US and a global health burden. DL therapy is an opportunity to improve on traditional therapeutic modalities with greater efficacy and a reduced need for periodontal surgery. As research continues to support LAPT with DLs as an adjunct to SRP, these treatments will evolve and contribute to more successful nonsurgical care.

By using a multidisciplinary approach to create patient-centered treatment plans, using LAPT can lead to improved oral-systemic health. Dental hygienists play a key role in educating dental team members and patients on the efficiency and efficacy of LAPT. Expanding their laser knowledge can elevate the standard of care, improve patient outcomes, and help reduce the global burden of oral-systemic disease.

References

1. Li M-M, Kia J-H, Wu M-X, et al. Clinical effectiveness of Er,Cr: YSGG lasers in non-surgical treatment of chronic periodontitis: a meta-analysis of randomized controlled trials. Lasers Med Sci. 2021;36(4):889-901. doi:10.1007/s10103-020-03124-w
2. Healthy People 2030. Topics and objectives, oral conditions. https://health.gov/healthypeople/objectives-and-data/browse-objectives/oral-conditions/reduce-proportion-adults-aged-45-years-and-over-moderate-and-severe-periodontitis-oh-06. Accessed March 17, 2021. doi:10.1089/photob.2020.4818
3. Nammour S, El Mobadder, M, Maalouf E. et al. Clinical evaluation of diode (980 nm) laser-assisted nonsurgical periodontal pocket therapy: a randomized comparative clinical trial and bacteriological study. Photobiomodul Photomed Laser Surg. 2021;39(1):10-22.
4. Mokhtari MR, Ahrari F, Dokouhaki S, et al. Effectiveness of an 810-nm diode laser in addition to non-surgical periodontal therapy in patients with chronic periodontitis: a randomized single-blind clinical trial. J Lasers Med Sci. 2021;12e37.
5. Mizutani D, Aoki A, Coluzzi D, et al. Lasers in minimally invasive periodontal and peri=implant therapy. Periodontol 2000. 2016;71(1):185-212. doi:10.1111/prd.12112
6. Michalik M, Szymanczyk J, Stajnke M. et al. Medical applications of diode lasers: pulsed versus continuous wave (cw) regime. Micromachines (Basel). 2021;12(6):1-15. doi:10.3390/mi12060623
7. Sulewski JG. Einstein’s “splendid light”: Origins and dental applications. In: Convissar RA. Principles and practice of laser dentistry. 3^rd ed. St Louis (MO): Elsevier Inc; 2023:1-17.
8. Walsh LJ. Laser fundamentals. In: Convissar RA. Principles and practice of laser dentistry. 3^rd ed. St Louis (MO): Elsevier Inc; 2023:18-38.
9. Petrovic MS, Kannosh IY, Milasin JM, et al. Clinical, microbiological and cytomorphometric valuation of low-level laser therapy as an adjunct to periodontal therapy in patients with chronic periodontitis. Int J Dent Hyg. 2018;16(2):e120-127. doi:10.1111/idh.12352
10. Yu S, Zhao X, Zhang Y. et al. Clinical effectiveness of adjunctive diode laser on scaling and root planning in the treatment of periodontitis: is there an optimal combination of usage mode and application regimen? A systematic review and meta-analysis. Lasers Med Sci. 2022;37(2):759-769. doi:10.1007/s10103-021-03477-5
11. Pawelczyk-Madalinska M, Benedicenti S, Salagean T. et al. Impact of adjunctive diode laser application to non-surgical periodontal therapy on clinical, microbiological and immunological outcomes in management of chronic periodontitis: a systematic review of human randomized controlled clinical trials. J Inflamm Res. 2021;14:2515-2545.
12. Smith ML, Wallace A. Laser-assisted nonsurgical periodontal therapy. In: Convissar RA. Principles and practice of laser dentistry. 3^rd ed. St Louis (MO): Elsevier Inc; 2023:39-63.
13. Arany PR, Turner U, Beck-Kristensen PH. Photobiomodulation therapy in clinical dentistry. In: Convissar RA. Principles and practice of laser dentistry. 3^rd ed. St Louis (MO): Elsevier Inc; 2023:335-378.
14. Lin G-H, Del Amo FSL,Wang H-L. Laser therapy for treatment of peri-implant mucositis and peri-implantitis: an American academy of periodontology best evidence review. J Periodontol. 2018;89(7):766-782. doi:10.1002/JPER.17-0542
15. Bourouni I, Kyriakidou K, Fourmousis I, et al. Low level laser therapy with an 810-nm diode laser affects the proliferation and differentiation of premature osteoblasts and human gingival fibroblasts in vitro. J Lasers Med Sci. 2021;12:1-6.
16. Fekrazad R, Hakiniha N, Vahdatinia F. Photodynamic therapy in management of periodontitis and periimplantitis. In: Convissar RA. Principles and practice of laser dentistry. 3^rd ed. St Louis (MO): Elsevier Inc; 2023:130-49.
17. Cheng Y, Chen JW, Ge MK, et al. Efficacy of adjunctive laser in non-surgical periodontal treatment: a systematic review and neta-analysis. Lasers Med Sci. 2016;31(1):151-163. doi:10.1007/s10103-015-1905-5
18. Kapila YL. Oral health's inextricable connection to systemic health: special populations bring to bear multimodal relationships and factors connecting periodontal disease to systemic diseases and conditions. Periodontol 2000. 2021;87(1):11-16. doi:10.1111/prd.12398
19. Theile CW, Strauss SM, Northridge ME, et al. The oral health care manager in a patient-centered health facility. J Evid Based Dent Pract. 2016;16suppl:34-42. doi:10.1016/j.jebdp.2016.03.007
20. Porteous MS, Rowe DJ. Adjunctive use of the diode laser in non-surgical periodontal therapy: exploring the controversy. J Dent Hyg. 2014;88(2):78-86.
21. Roshkind DM, Convissar RA, Bilski T, et al. Introducing lasers into the dental practice. In: Convissar RA. Principles and practice of laser dentistry. 3^rd ed. St Louis: Elsevier Inc; 2023:392-410.
22. Academy of Laser Dentistry. Dental regulations in the United States. https://www.laserdentistry.org/dental-regulations-usa. Accessed May 21, 2023.
23. Wallace A, Siminovsky G. Understanding the state board role in policymaking and what that means to us. Academy of Laser Dentistry; 2018:15p.
24. State by state quick reference chart on laser use by dental hygienists. Academy of Laser Dentistry. January 23, 2025. Accessed April 18, 2025. https://www.laserdentistry.org/wp-content/uploads/2025/04/Hygiene-Table-with-Appendix-Jan-23-2025.pdf
25. Brame JL, Mitchell SH, Wilder RS, et al. Dental and allied dental students’ attitudes towards and perceptions of intaprofessional education. I Dent Educ. 2015;79(6):616-625. doi:10.1002/j.0022-0337.2015.79.6.tb06122.x
26. Gumbus A. Networking; a long-term management strategy. Clin Leadersh Manag Rev. 2003;17(3):151-155.