The Whole Truth About Dental Lasers

Recently, a great deal of attention has been given in the media to the subject of dental lasers. Unfortunately, much of it has been misinformation, hype, half-truths and speculation.

Currently, there are only three accepted uses for lasers in dentistry, and each use requires a different type of laser equipment. In the dental environment, lasers can only: 1.) Vaporize soft tissue 2.) Cure light cured composite materials 3.) Remove carious tooth structure. Let us take each of these uses in order.

A laser is very efficient at vaporizing soft tissue. This means it can remove gum tissue and other non-tooth tissues. The only laser that can do this is the CO2 laser. These units on the average cost $25,000 - $50,000. Dentists can also accomplish this tissue removal either with mechanical (scalpel) or electrocautery methods. In all cases, local anesthetic is required. There is no difference, pain-wise, between removing soft tissue with a knife, or burning it off with a laser or electrocautery. Healing times are also very comparable. The only real difference is the cost of the equipment to the dentist, and how he or she is going to recover that cost from treatment charges.

The argon laser is very well suited for quickly curing (hardening and bonding) light cured composite resin restorative materials. These are the tooth colored filling (bonding) materials commonly used by most dentists. Because of the intensity of the laser light, these materials will be cured in about one quarter the time usually taken by a typical light gun. In most cases this means a difference of going from 30 seconds curing time to 5-10 seconds curing time. Otherwise, there is no difference in the quality of the final cured composite material, or the strenght of the bond. Again, these lasers are expensive, $25,000 - $50,000, whereas a typical light gun costs only a few hundred dollars. This cost must be recovered from the patient as well. Recently, ultra-high intensity lights have almost negated the value of the argon laser.

Finally, the YAG laser has recently been approved for limited cutting of tooth structure. It does this by vaporizing water in the tooth and creating a rapid series of "mini-explosions" which literally blast small holes in the tooth. This is perceived by the patient as a series of rapid popping sounds. Compared to a conventional high-speed handpiece (drill), however a YAG laser is very slow and inefficient. Thirty seconds worth of conventional drilling takes 7-10 minutes with the laser. All that is missing is the drill noise, replaced by the popping sounds. The YAG laser is also incapable of the type of precision cutting the handpiece can accomplish, therefore it cannot be used for many other dental procedures such as large and complex fillings, crowns, bridges, etc. As with any form of cutting tooth structure, local anesthetic is required. There are always some individuals who, for whatever reason, have their dental work performed without anesthetic, but the ratio is no different for lasers than for conventional treatment. As with the other types of lasers, YAG lasers are very expensive, $30,000 - $50,000.

Recently, some dentists have been using lasers for some other procedures. Some are using lasers for "power bleaching". This means using the laser in the office to activate a bleaching agent on your tooth. This supposedly gives immediate results rather than the several weeks of home application used for conventional bleaching. Again, due to the cost of the laser equipment the cost is very high compared to conventional means with no difference in the end result. Call it, "Pay big for instant gratification".

A very few dentists (mainly those that advertise heavily) are using lasers for "sulcular debridement", supposedly cleaning bacteria out of the gum pockets around the teeth. This is an unproven technique with no supporting reasearch to show that it does anything at all. It has no effect on the calculus (tarter) that still has to be mechanically removed anyway. Nevertheless, because of the "laser" tag you can count on it being expensive.

Other than for public relations value, or the ability to use the laser "buzzword" in association with one’s dental practice, there is no real reason, at least at current price and technology levels, for a dentist to use or buy these machines. In most cases they are no more, and often much less, efficient that current technology and offer no real advantage to either the dentist or the patient. In fact, the amortization cost of the equipment makes their use much more expensive for both the dentist and the patient.