Some dentists swear by lasers

Dental lasers are either an indispensable tool in a dentist's toolkit or an emerging-but-unproven technology. It depends on whom you ask.

They came into use in general dentistry about 15-20 years ago but even now are used only by about 6% to 8% of dentists nationwide. The two main categories are soft-tissue lasers, used mostly for gum contouring and minor surgical procedures, and hard-tissue lasers, used to treat small- to moderate-size cavities.

Experts agree that, as the costs of lasers fall, their use will spread. Soft-tissue lasers currently run between $2,000 and $7,000; hard-tissue lasers can cost $40,000 to $90,000.

Lasers are still a long way from replacing the dentist's drill, says Dr. Richard Mungo, a pediatric dentist in Huntington Beach, Calif., and a clinical instructor at the USC School of Dentistry.


FOR THE RECORD:
An earlier version of this story identified Dr. Richard Mungo as an associate professor at the USC School of Dentistry. He is a clinical instructor.


"It is one more instrument in your office that can complement the use of the drill, in which you can offer your patients a more comfortable experience in many circumstances," he says.

Mungo's history with dental lasers goes back 20 years. At the time, he was chief of pediatric dentistry at Children's Hospital Los Angeles, and he was approached by a pharmaceutical company about the possibility of using lasers in his dental practice.

As it turns out, he had a patient who he thought could benefit from the technology. The 1-month-old girl had a tumor on her upper jaw and was not feeding or growing.

Using a laser to evaporate the soft tissue, Mungo eliminated the tumor with no bleeding and seemingly no pain or discomfort to the child. She began taking a bottle immediately and went home that day, says Mungo. He was sold on the technology and began regularly using soft-tissue lasers.

But at the time, the soft-tissue laser sold for tens of thousands of dollars, and most dentists saw it as an unnecessary expense.

"So it didn't really take off like gangbusters," says Mungo.

Dr. Indru Punwani, professor and department head of pediatric dentistry at the University of Illinois at Chicago, sums up laser use in dentistry this way: "Right now they are adjunctive, but down the line they could play a much greater role."

How they work

One of the greatest benefits of lasers is that they allow dentists to perform normally painful procedures without general or even local anesthesia, and with no pain and very little discomfort afterward. This makes for a much easier recovery. Lasers are particularly useful for patients who are allergic to anesthesia or highly sensitive to pain — and for young children, who are often afraid of needles.

They work by focusing energy into a tiny point, much the way a magnifying glass can be used with the sun's energy to start a fire. In soft-tissue lasers, "this energy evaporates the tissue, almost like erasing it," says Mungo.

Soft-tissue lasers typically don't cause bleeding because the concentrated energy seals off blood vessels as it removes the tissue; lasers also seal off nerve endings, so pain signals are not transmitted to the brain, Mungo says. Such lasers usually obviate the need for stitches and promote much quicker healing.

With hard-tissue lasers, the laser creates a microscopic shock wave that breaks away decay in the tooth pockets. A drill is used in conjunction to remove deep-down decay. Using lasers to remove cavities eliminates a major amount of drilling and is thus preferred by patients, says Mungo.

But lasers aren't a miracle treatment that makes shots and drills completely unnecessary; certain treatments still require anesthesia when lasers are used. Particularly in the early days, lasers were at times overhyped, says Mungo.

"The honest truth is that hard-tissue lasers are very expensive," says Dr. Stephen Tracey, an orthodontist in Upland, Calif. "In my opinion, it's kind of a niche. It's not something that's going to replace the drill any time soon. The dentists that have the hard-tissue lasers tend to be technology leaders, they like cool stuff. That's a lot of money for a laser with somewhat limited use."

Dr. Mark Yanosky, an orthodontist in Birmingham, Ala., and adjunct assistant professor of orthodontics at the University of Alabama at Birmingham, uses lasers several times a week. They can even out gum lines and remove excess tissue so that a bracket can be properly placed — in doing so, they can often shorten the amount of time a patient is in braces.

"It really helps us cut down our treatment times, in some cases by three to four months per case, which leads to a happier patient," says Yanosky. Shaping gum tissue can also improve oral hygiene for people in braces who can't brush adequately, he says.

Yanosky points to a 2007 study in the Journal of Periodontology showing that 60% of patients have asymmetries in the length of their front teeth following orthodontic treatment because of uneven gum margins, an aesthetic fix that can be easily made with a soft-tissue laser.

These seemingly minor asymmetries can make a noticeable difference in a person's smile. "If you think about a really pretty smile, the teeth can be straight, but if the gum line is uneven or the tissue is thick or thin in spots, it really compromises the way the smile looks," Tracey says. "The difference in the way that a finished smile will look whether it's from orthodontics or a restorative case, with having the gum lines right, is huge."

Orthodontists who use lasers can provide this service at little to no extra cost. But if an orthodontist has to refer the work out to an oral surgeon or other specialist, a contouring procedure might easily run a patient $3,000-$4,000, says Tracey. Many patients simply opt not to have the work done.

Most dentists and orthodontists obviously don't use lasers, but "the people that do have them, I think we all agree that 'I can't imagine practicing without them,'" says Tracey.

Easing fears

Denver dentist Heather Stamm is one of those. Stamm uses both soft-tissue and hard-tissue lasers in her practice on a daily basis. "I hear so many stories of adults that are so afraid now to come to the dentist because of the experiences they had as kids," says Stamm. "And I was looking for something that could help change that."

One of Stamm's favorite stories is of 6-year-old Halina, who was tongue-tied — a condition in which a cord of tissues behind the tongue fails to recede properly, causing speech impediments. In the absence of a laser, this procedure would normally be done with a scalpel, requiring shots, stitches and a lengthy recovery period, says Stamm.

Halina, who was 5 years old at the time of the procedure, couldn't produce certain sounds, such as the 'l' in the word 'world,' and had speech that seemed too young for her age, says her mother, Tamera Halbeisen, of Broomfield, Colo. The family was not aware that she was tongue-tied until Stamm diagnosed the condition. "We figured she'd grow into talking correctly," says Halbeisen.

Stamm performed the surgery with a laser without numbing or stitches. That day, Halina was able to speak clearly, including the words "I love you."

healthkey@tribune.com

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