Future of Laser Dental Surgery Still Is Being Examined

Lasers have displaced the dental drill and the scalpel in the offices of a small but growing group of dentists who credit them with making cavity treatment virtually painless and reducing bleeding during gum surgery.

Various instruments, each using a slightly different type of light, can cut gums, soft tissues, even enamel, as well as detect tiny cavities, and whiten or desensitize teeth. Yet they remain outside the profession’s mainstream, and dental schools do not currently train students how to use them. “I’m looking at it as a potential technology yet to be thoroughly tested and yet to be inserted in formal dental education,” said Dr. Hal Slavkin, dean of the USC School of Dentistry, who said lasers and standard treatments need further comparison in scientific studies.

Dental applications of lasers have been studied since lasers first were developed in the 1960s, said Dr. Joel M. White, president of the Academy of Laser Dentistry. While generally slower but more precise than many conventional instruments, they haven’t completely replaced conventional high-speed drills or other cutting tools in dental offices. However, hard-tissue lasers minimize the pain of treating small cavities while helping to preserve more of the healthy surrounding tooth. (Cases of serious decay still require numbing.) Lasers are more sensitive than the eye in picking up tiny pit and fissure cavities.

In gum surgery, where the laser not only cuts but can staunch bleeding by promoting coagulation, “the folks who use it say healing is better, healing is faster,” but that hasn’t been definitively demonstrated in scientific studies, said Slavkin, director of the National Institute of Dental and Craniofacial Research from 1995 to 2000.

Because lasers produce energy and heat as they vaporize decayed or diseased tissues, they potentially can damage the tooth or other tissues, especially if they’re used at too high a power for too long, White said. Patients should make sure any dentist who uses lasers is properly trained and experienced.

Slavkin, who tried a laser instrument this spring at an Academy of Laser Dentistry meeting in La Jolla, said, “There is a significant amount of experience you need in order to control what you’re cutting and what you’re not cutting. This is not something to just pick up and do. Everybody has a learning curve.”

Currently, dentists and dental hygienists can be trained by the laser manufacturers, through courses at some universities and through programs sponsored by the academy. They must pass a standard proficiency exam, which includes a written examination as well as a simulated procedure on animal teeth and jaws, said White, a professor in the Department of Preventative and Restorative Dental Sciences at UC San Francisco.

Laser dentistry isn’t yet a recognized specialty of the American Dental Assn., like orthodontics or periodontics. The Academy of Laser Dentistry, which promotes lasers in addition to training and certifying dentists to use them, estimates that about 5% of U.S. dentists incorporate lasers into their practices. White said that some dentists use them for still-unapproved purposes and have made claims that haven’t yet been borne out by data, such as the claim that they promote bone regeneration.

White said dental fees generally are no higher for procedures using lasers, compared with conventional equipment, and that insurance does pay for their use. But the equipment is expensive. Lasers that cut into enamel typically run about $40,000, while those that work on the gums cost about $10,000, said Dr. Donald J. Coluzzi, a Redwood City dentist.