Lasers in Dentistry

Lasers have been used in dentistry since 1994 to treat various dental problems. Yet, despite FDA approval, no laser system has received the American Dental Association's seal of acceptance as an alternative to more traditional treatments. That seal assures dentists that the product or device meets ADA standards of safety and efficacy, as compared to other things.

Application Of Lasers In Dentistry

The ADA, however, states that it is cautiously optimistic about the role of laser technology in the field of dentistry. These lasers are different from the cold lasers used in phototherapy for the relief of headaches, pain, and inflammation.

Still, some health care professional are using lasers to treat:

  • Tooth decay - Lasers are used to remove decay or caries within a tooth and prepare the surrounding enamel for receipt of the filling.

  • Gum disease - Lasers are used to reshape gingiva or gums and remove bacteria during root canal treatment.

  • Biopsy or lesion removal - Lasers can be used to remove a small piece of tissue also called a biopsy so that it can be examined for cancer. Lasers are also used to remove lesions in the mouth and relieve the pain of canker sores or mouth ulcers.

  • Teeth whitening - Lasers are used to speed up in-office teeth whitening or bleaching procedures. A peroxide bleaching solution, applied to the tooth surface, is “activated” by laser energy, which speeds up of the whitening process.

How Do Lasers Work in Dentistry?

  • All kinds of lasers work by delivering energy in the form of a light.
  • When used for surgical and dental procedures, the laser acts as a cutting instrument or a vaporizer of tissue that it comes in contact with.
  • When used in teeth-whitening or bleaching procedures, the laser acts as a heat source and enhances the effect of tooth-bleaching agents.

What Are the Pros and Cons of Using a Laser in Dentistry?

Pros of Using a Laser

Compared to the traditional dental drill, lasers:

  • May cause less pain in some instances, so reduces the need for local anesthesia

  • May reduce anxiety in patients uncomfortable with the use of the dental drilling machines

  • Minimize bleeding and swelling during soft tissue treating procedures

  • May preserve more healthy tooth structure during cavity removal

Cons of Using a Laser

The disadvantages of lasers are stated below:

  • Lasers can’t be used on already filled or restored teeth.

  • Lasers can’t be used in many commonly performed dental procedures. For example, lasers can’t be used to fill cavities located between teeth, around old fillings, and large cavities that need to be prepared for a crown. In addition, lasers cannot be used to remove defective crowns or silver fillings, or prepare teeth for bridges.

  • Traditional drills may still be needed to shape the filling, adjust the bite, and polish the filling even when a laser is used.

  • Lasers do not eliminate the need for local anesthesia completely.

  • Laser treatment tends to be more expensive, the cost of the laser is much higher than other dental procedures. Compared to about $600 for a standard drill, lasers can cost anywhere from a few thousand dollars to over $100,000 for one that can be used for tooth cutting procedure.

Types of Lasers

Lasers used in dental practice can be classified by various methods:

  • According to the lasing medium used, such as, gas laser and solid laser

  • According to tissue applicability, hard tissue and soft tissue lasers

  • According to the range of wavelength, and of course the risk associated with laser application.

Carbon dioxide Laser

  • Although carbon dioxide laser possesses the highest absorbance of any laser, disadvantages of the CO2 laser are its relative large size and high cost and hard tissue destructive interactions.

  • The CO2 laser wavelength has a very high affinity for water, resulting in rapid soft tissue removal and hemostasis with a very shallow depth of penetration.

Neodymium Yttrium Aluminum Garnet Laser

  • The Nd: YAG wavelength is highly absorbed by the pigmented tissue, making it a very effective surgical laser for cutting and coagulating dental soft tissues, with good hemostasis.

  • In addition to its surgical applications, there has been research on using the Nd: YAG laser for nonsurgical sulcular debridement in periodontal disease control and the Laser Assisted New Attachment Procedure (LANAP).

Erbium Laser

  • The erbium family of lasers has two distinct wavelengths, Er, Cr: YSGG (yttrium scandium gallium garnet) lasers and Er: YAG (yttrium aluminum garnet) lasers.

  • The erbium wavelengths have a high affinity for hydroxyapatite and the highest absorption of water in any dental laser wavelengths. Consequently, it is the laser of choice for treatment of dental hard tissues.

  • In addition to hard tissue procedures, erbium lasers can also be used for soft tissue ablation, because the dental soft tissue also contains a high percentage of water.

Diode Laser

  • The active medium of the diode laser is a solid state semiconductor made of aluminum, gallium, arsenide, and occasionally indium, which produces laser wavelengths, ranging from approximately 810 nm to 980 nm.

  • All diode wavelengths are absorbed primarily by tissue pigment (melanin) and hemoglobin.

  • Conversely, they are poorly absorbed by the hydroxyapatite and water present in the enamel.

  • Specific procedures include aesthetic gingival re-contouring, soft tissue crown lengthening, exposure of soft tissue impacted teeth, removal of inflamed and hypertrophic tissue, frenectomies, and photostimulation of the apthous and herpetic lesions.

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