From sceptic to convert; Michaela ONeill investigates the use of lasers in the dental practice and the benefits they can provide for hygienists in particular.Michaela O'Neill is a Dental Hygienist with over 25 years' experience both clinically and professionally.
Having worked in various dental practices and hospitals, and lectured throughout the UK, Michaela became the President of The British Society of Dental Hygiene and Therapy for two years. And she has since been voted onto the board of the International Federation of Dental Hygiene.
When I was first asked what I thought of lasers I wasn’t falling over myself to be first in the queue to use them. I am not an early adopter, I like confirmation that something works before I invest time in it. But in these days of evidence based clinical decisions, I also realise that if we all waited for the unequivocal evidence to try something new, we would never move on in our treatment modalities.
So I decided to be open to the use of lasers in my clinic. And I was fortunate to be asked to attend a training seminar and spend a day with leading laser user and periodontal specialist, Rana Al Falaki.
I started out by reading up on the research. I read literature reviews on the information gathered for lasers in general and in periodontal treatment. What I quickly came to realise was that regardless of the amount of research available, a general consensus was inconclusive.
Basically, it’s difficult to say how effective a laser is in the treatment of periodontal disease based on the research published to date. This is due to the many variations in the studies, for example comparing different laser wavelengths, energy density, controls, and the obvious differences in severity of periodontal disease and their measurable outcomes.
What we do know is that there are many studies that show benefits of the different modes of lasers that can be used on the periodontium. I got to see these in action when I visited Rana Al Falaki, a periodontal specialist who has been working with lasers for many years and has produced much research in this field.
Can a dental hygienist use a laser?
The short answer is yes - as long as you are trained, indemnified and competent.
It is worth checking that your indemnity covers the use of a laser within the GDC guidelines as it is not stated in the Scope of Practice and most indemnities cover only the scope of practice. The GDC say:
Anything new can be scary. Lasers in particular conjure up images of burning and that famous scene in the James Bond movie.
I did worry that I would cut someone open with a laser or do some kind of irreparable damage, but the training I had and the safety instructions helped to reassure me. I also got to see how difficult it is to do damage with lasers...
The zone of necrosis (or the area of tissue that dies around a wound) from a laser varies but it is put in perspective when compared to a scalpel or electrosurgical procedures; the zone of necrosis created with these particular methods are orders of magnitude higher.
Visit to Rana Al Falaki's Practice
Rana Al-Falaki has been a UK specialist in Periodontics for over ten years and is the owner and principal dentist at AL-FA Perio Clinic.
Rana was the first UK Periodontist to use lasers in her daily practice and is an international speaker and Biolase laser approved trainer, lecturing both in the UK and internationally on the subject and pioneering its use in this field. She has published articles and presented research on the use of Er,Cr:YSGG laser, in both periodontology and peri-implantitis.
This visit was a turning point for me. Up until then I still was on the fence as to whether using a laser in my practice would have any benefit. This day really changed my mind. I assisted Rana that day (and for that I am still apologising!).
As her patients attended I went over the notes with Rana. The patient's periodontal diagnosis and their contraindications were discussed followed by how treatment had progressed for that patient.
Areas of potential problems were highlighted and after a new pocket and bleeding chart, the results checked. The pocket reductions were very high compared to what I would expect without surgery and the bleeding was overall well reduced generally. The treatment comprised of LA, USS and some hand instrumentation but the majority of the appointment was spent with the Er,Cr: YSGG laser debriding the pocket and removing granulation tissue from the pocket.
You could visibly see the gingiva look healthier by the end of the appointment.
One patient attended for the second half of her mouth to be treated but was hesitant to undergo treatment that day. She complained of pain on the side that had been previously debrided and had limited opening as a result of this pain. On examination a large ulcer was apparent.
Rana decided to use photobiomodulation therapy, also known as LLLT, with the diode laser and let the laser pulse in the affected area for a few minutes. Surprisingly (for me, as I think Rana expected this outcome) the patient sat through another hour of treatment with her mouth open and commented that the previous discomfort felt much better.
After this day I agreed to try one out...
I have used my diode to reduce bacterial load post NSPD and I love it for peri- implantitis. I feel I am giving an added boost to my airflow or perio flow treatments, especially if there are areas of bleeding. The tips are so thin and slightly flexible so they can step over the threads of the implant.
Photos courtesy of Michaela ONeill.
"The tips are so thin and slightly flexible so they can step over the threads of the implant"
It is early days in my usage of lasers and I am in the process of asessing the outcomes. In general, my diode laser unit, handpiece and tips are certainly easy to use and that was my main concern.
How do lasers work?
If I was to break it down very simply lasers are a pure beam of electro-magnetic radiation. They are usually named after the material which produces the radiation. For example CO2, Nd:YAG, Er,Cr:YSGG.
Lasers properties will depend on its wavelength. If we look at wavelengths on the Electromagnetic spectrum we can see the variation of wavelength used in dental lasers and what they are absorbed by. These wavelengths have different properties meaning they can affect tissue in different ways.
Why and where would you use a laser?
There are many different types of laser on the market, some wavelengths are attracted to different tissues and therefore can be used for different things.
Most commonly for dental hygienists and therapists we use the following modes:
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*Moritz A, Schoop U, Goharkhay K, Schauer P, Doertbudak O, Wernisch J, Sperr W. (1998) Treatment of Periodontal Pockets With A Diode Laser. Lasers in Surgery and Medicine 22:302–311. Wiley-Liss, Inc