Role Of Lasers In Dental Treatment

Overview

The term LASER stands for ‘Light Amplification by the Stimulated Emission of Radiation’. It was first introduced to the field of dentistry in 1960 by Maiman, who was aiming to examine the effects and possible uses of the Ruby laser on both hard and soft tissues. Laser light is a monochromatic light and it is formed of a single wavelength of light. It consists of three main parts including the source of energy, active medium, and optical cavity which is formed of one or more mirrors.

The laser beam is a part of the electromagnetic spectrum and needs a medium either solid, gas or liquid to be produced. It is formed through a sophisticated mechanism called amplification in which the energy is pumped into a medium to be absorbed by the electrons revolving around the atom of that medium, thus transforming electrons into an excited state and producing light energy with a specific wavelength.

After many years, scientists were able to discover multiple benefits of lasers in dentistry, especially in restorative applications such as caries removal and cavity preparation, placement or removal of restorative materials as well as bleaching (teeth whitening). In addition, lasers were found to have several soft tissue applications including the removal of hyperplastic soft tissues, the treatment of soft tissue malignancies as well as facilitating wound healing.

Types of lasers used in dentistry

There are different types of lasers that can be used in dentistry and can be classified according to multiple factors, including the active medium or lasing mediums which can be solid, liquid or gas. For instance, gas lasers include Carbon Dioxide and Argon, liquid lasers include dyes, while solid lasers include NdYAG, Er:YAG and Diode.

They can also be classified according to the type of tissue applications (either used for hard tissues or soft tissues). For instance, hard lasers include carbon dioxide, NdYAG and Er:YAG can be used for both hard and soft tissue applications. On the other hand, there are soft lasers which are known as Low-Level Laser Therapy (LLLT) and can be effectively used in soft tissue applications in dentistry.

In addition, lasers can be classified according to their wavelength. The laser types that can be used in dentistry have wavelengths ranging from 488 nm to 10 600 nm and all of them produce non-ionizing radiation which means that they are non carcinogenic. It’s important to mention that there are other types of lasers with different wavelengths that have a carcinogenic effect on DNA because they produce ionizing radiation. For instance, carbon dioxide lasers operate at 10600 nm, Er;YAG at a wavelength of 2940, surgical diode lasers ranging between 800-830 nm diode, 980 nm diode laser as well 1064 nm diode laser which uses aluminium, gallium and arsenate as an active medium. In addition, some types of lasers emit visible light such as argon lasers which emit blue light at 488 nm, the Nd:YAG emits green light at a wavelength of 532 nm, and the low-level lasers emit light at a wavelength of 635 nm for photo bio modulation and at a wavelength of 655 nm low level lasers can be used for caries detection. 

Role of lasers in dentistry

There are multiple applications of lasers in dentistry depending on several factors such as wavelength which identifies the laser’s absorption affinity within the tissues whether hard or soft tissues. Accordingly, lasers have either hard tissue applications or soft tissue applications.

Soft tissue applications include:

• Facilitating wound healing through stimulation of fibroblast proliferation
• Decreasing the pain of Post-herpetic neuralgia and aphthous ulcer through photo stimulation
• Aesthetic crown lengthening with minimal bleeding and fast healing
• Frenectomies in case of the presence of high labial frenum which may lead to speech and periodontal problems
• Photo activated dye disinfection through using lasers to activate the (toluidine blue) dye to kill Gram-positive bacteria Methicillin-resistant Staphylococcus aureus (MRSA), as well as fungi and viruses
• Photo dynamic therapy (PDT) for famous oral malignancies such as squamous cell carcinoma
• Treatment of different lesions such as oral leukoplakia which can be treated by Co2 Laser

Hard tissue applications include:

• Cavity preparation and caries removal using Er:YAG
• Root canal treatment (endodontics)
• Etching for dentine enamel or ceramic surface roughening instead of using restorative chemicals for etching
• Diagnosis (laser fluorescence for determination of dental caries)
• Treatment of dentinal hypersensitivity using Er:YAG lasers

Advantages and disadvantages of lasers in dentistry

Advantages

• Minimal Invasive Procedures
• Reduced Blood Loss
• Faster Recovery Time
• Reduced Need for Anesthesia
• Precise Procedures

Disadvantages

The well-known disadvantage of laser is its high cost and large appliance sizes, especially for certain laser machines which work dually for hard and soft tissues. This disadvantage was overcome by the foundation of LLLT lasers which is much less in cost and thus creates an easily accessible and safe dental treatment for many patients. 

Safety consideration of lasers used in dentistry

Protective measures for patients and dental professionals

There are several protective measures that should be followed cautiously to ensure proper protection while using lasers. These measures may include:

• Wearing protective eyewear by people who are attending the operation room including the dentist, assistants, patients, and anyone accompanying the patients
• Follow the general infection control measures where the use of high-volume suction is important to evacuate any harmful vapour created during tissue ablation, and normal infection protocols should be followed

Proper use and maintenance of lasers

Each office should appoint a Laser Safety Officer (LSO) who has valuable information, skills and knowledge about laser use regulations, standards and rules, to ensure the compliance with the protective measures while using lasers, supervise the proper use of the laser, train the staff, and provide valuable and evidence-based information regarding laser safety. The LSO can be any dental clinic staff including a risk manager, an Occupational health and safety officer, an infection control officer, the practice manager, an outside appointed safety consultant, a biomedical engineer, a physician, the dentist, a nurse, or any other highly qualified person. The LSO is the former contact person for the clinic’s laser use or risks.

Risk assessment and management

The LSO has complete responsibility for risk management and ensures the monitoring of possible risks. He is responsible for controlling possible hazards in the dental office by ensuring controlled access to the laser room and to the laser equipment, proper use of personal protective devices, performing periodic monitoring tests and making sure that the operations of the laser and its delivery systems are following the general guidelines.

The LSO should follow the following steps to ensure proper risk assessment:

• Ensure  proper Knowledge of Standards, Regulations, and Practice Guidelines
• Identify the possible hazards and risks
• Implement Control Measures 
• Audit for Safety Program Monitoring

Summary

The dental visit is usually considered a nightmare for many, but daily innovations and existing technologies transformed the whole dental experience for most of the patients and decreased dental anxiety. Lasers are considered to be fast, easy, painless machines that are excessively used in modern dentistry and despite the high cost, different procedures are now carried out in a simple way using lower-cost types of lasers. Thus, it’s expected that laser applications in dentistry massively increase in the upcoming years.

References

1. Verma SK, Maheshwari S, Singh RK, Chaudhari PK. Laser in dentistry: An innovative tool in modern dental practice. Natl J Maxillofac Surg. 2012 Jul;3(2):124–32.
2. Cernavin I, Pugatschew A, Boer N, Tyas MJ. Laser applications in dentistry: A review of the literature. Australian Dental Journal [Internet]. 1994 Feb [cited 2023 Apr 25];39(1):28–32. Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.1834-7819.1994.tb05543.x
3. Luke AM, Mathew S, Altawash MM, Madan BM. Lasers: A Review With Their Applications in Oral Medicine. J Lasers Med Sci. 2019 Fall;10(4):324-329.
4. Smalley PJ. Laser safety: Risks, hazards, and control measures. Laser Ther. 2011;20(2):95-106.

This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Passant Tarek

Masters of International Public Health Liverpool John Moores University (LJMU) - UK

Masters of Dental sciences - SCU- Egypt

Passant is a Dentist and Healthcare professional with strong focus on public health and improvement of health outcomes through research and evidence-based practice. She has more than 10 years of diverse healthcare experience in different sectors. Currently, she is a blogger at the Swedish Organization of Global Health, in addition to being a united nations volunteer at the UNDP at the Department of Health and Development working towards improving different health investment cases.

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