Laser dentistry is one of the more recent advances in dental cosmetics and oral surgery technology. Most people are familiar with laser tooth whitening devices. However, the FDA has now approved laser equipment from various manufacturers for over 20 different applications in the field of dental care. The ADA does not currently offer accreditation specifically in the field of laser dental treatment. The organization does, however, provide guidelines for continuing education and suggested curriculum standards for dentists who choose to pursue training in proper laser technique.
Lasers used in dental work are similar to those seen in other medical fields. A typical surgical device produces a beam of light in the infrared range which is invisible to human sight. The waves of light in the beam all vibrate at exactly the same frequency. This coherence gives the laser its unique ability to cut and heat tissue with pinpoint accuracy. The internal structure which creates the beam is generally a gas, a crystal (such as garnet) or wafer-like semiconductors made of metal.
Availability of Laser Dentistry
The dentist activates the laser and directs the beam at the soft or hard tissues in the mouth that need to be removed or reshaped during a surgical dental laser procedure. The laser acts as a sophisticated cutting tool to vaporize the tissues its beam touches. The period of exposure and the wavelength and power of the laser affect how much tissue the device removes at one time. Patients experience laser procedures as quiet compared to the whirring or buzzing noises produced by mechanical dental devices. Air suction cools the area and removes airborne debris. This may create a slight sound of rushing wind. Dental staff members administer appropriate local anesthetics and sedation during painful procedures such as oral surgery — just as they would be for traditional treatments.
The type of low-powered laser used in cosmetic dentistry for bleaching enamel does not heat the teeth and gums. Therefore, most patients experience no pain at all during laser teeth whitening. Some individuals with highly sensitive teeth report a low level of discomfort that dissipates gradually after the procedure is finished. Patients can simply relax in the treatment chair while the laser does its work during a whitening procedure.
FDA approved lasers are generally safe and effective for laser dentistry. However, when a dentist is using a laser all occupants of a room must follow appropriate safety protocols. This includes wearing protective eyewear to shield the eyes from accidental damage from the laser beam. The lenses in the safety goggles must be designed to block the precise wavelength of light produced by the laser device or injury may result.
Individuals should wear protective clothing to shield skin from exposure when a dentist is operating a high powered laser. They should also wear filtration masks to keep out the tiny particles of burnt matter lasers generate. Other safety measures include sterilizing any portion of the device that penetrates oral tissue during a procedure. A dental technician must carefully monitor oxygen and nitrous oxide in the room to prevent a fire. Patients may also be asked not to wear oil based products (such as lip balms) when they come in for their treatment. A laser safety officer (LSO) must be present whenever a laser device classed as 3B or 4 is operated. This individual's sole responsibility is to ensure all room occupants follow safety protocols at all times.
Types of Laser Treatments
Laser teeth whitening is one of the most commonly requested procedures involving dental lasers. The laser activates a bleaching agent such as hydrogen peroxide. The light causes the bleaching solution to act more quickly and effectively by boosting the chemical reaction that takes place between the bleach and the stains on tooth enamel. The dentist protects the patient's gums with a gel sealant or a rubber shield during the whitening procedure to reduce irritation.
Dentists also use various models of lasers for many standard oral procedures. These include:
Cavity Detection – One type of laser currently available in the U.S. is designed to detect cavities early in their formation. This permits treatment to start before too much damage has occurred.
Cavity Preparation – Lasers can ablate (remove) decayed portions of the tooth and prepare the cavity in the dentin (the hard tissue that makes up the bulk of the tooth) for filling. When dentists use lasers, patients are sometimes able to undergo this type of procedure without the need for an anesthetic. Some lasers which feature less penetrating wavelengths reduce the risk of damage to the delicate pulp at the center of the tooth.
Soft Tissue Reshaping – A cosmetic dentist may use a laser to adjust a patient's gum line and create a more aesthetically pleasing smile. Soft tissue and bone may both be ablated to prepare a patient's mouth for crown placement.
Some oral surgeons also use lasers in lieu of — or in conjunction with — traditional tools for procedures ranging from sleep apnea treatment to frenectomy (a surgery to correct a defect in the ligament attaching the underside of the tongue to the inside of the mouth). Dental specialists also occasionally use laser dentistry to treat TMJ, cold sores, gum disease and benign oral tumors.
Laser Dental Treatment Costs
Laser tooth whitening for the full mouth may cost over $1000. Most patients require only one treatment. The degree of staining will determine the length of the session. Occasionally, patients require a second whitening session. This will increase the total cost of treatment. The whitening treatment does not prevent the development of new stains. Dentists urge patients who want to avoid having to pay for whitening every year to make lifestyle changes. These include:
- Smoking cessation
- Limiting intake of enamel staining beverages such as coffee
The costs for surgical uses of dental lasers vary by procedure and provider.
Pros & Cons of Using Lasers
Laser teeth whitening generally achieves a significant level of bleaching in a single session compared to at-home kits which may take weeks to show improvement. The convenience of laser treatment makes it easier for patients to fit enamel whitening into their schedule.
In some cases, the benefits of laser surgery in dental procedures include a diminished need for local anesthetics. Sutures may also be unnecessary when an oral surgeon removes soft tissue in the mouth using a laser. Proponents of this technology report reduced bleeding since a laser tends to cauterize the blood vessels at which it is directed. Some patients may also experience a reduction in bacterial infection and damage to surrounding tissues. Laser manufacturers also tout faster wound healing as a potential effect.
The high cost is the main drawback of laser treatment for enamel whitening. Many of the benefits of surgical laser treatment have not been fully established. Although the FDA has approved lasers as safe for use, the FDA does not verify claims regarding the efficacy of these devices compared to other treatments. Many clinical studies are still ongoing to determine whether lasers are substantially better than traditional methods of dental treatment.