While I have been practicing dentistry almost 25 years, I like to think every day is a new adventure. Don’t get me wrong, I love my job, I love my profession. But it can offer challenges. No one ever said dentistry was easy--providing the highest quality dentistry is an art; throw in dealing with all types of patients and running a business, and like I said, life can get pretty interesting.
As dentists, we are always looking for ways to improve the quality of care we provide while making our day run smoother. Technology has played a big part in achieving this goal. I remember an instructor telling me in dental school that, if you retain 10% of what you learned in school, you’ll make a pretty good dentist.
Well a lot has changed since then, and technology has played a big part in it. The way we take impressions, the way we take radiographs is totally different and better. Another technology that has changed the way I do all aspects of dentistry is laser technology. Dental lasers have become an everyday part of what I do as a dentist. From endo and perio treatment to restorative and surgery, lasers have made my life easier and the quality of my dentistry better.
While no day in a dental office is typical, I would like to share how lasers impact a “typical” day in my office.
Well its Monday morning. We start at 8:00 am but we huddle at 7:30 am. The schedule looked great on Thursday when I checked. A full day of hygiene with 3 SRP patients, the rest prophys and maintenance patients. The rest of the schedule looked good--a couple of crown preps, some restorative patients , a denture reline and a lingual frenectomy. It looked like a pretty decent day of production with room for add-on emergencies right before lunch and later in the afternoon.
The huddle starts on a positive note. Everyone is here on time. We go through the usual stuff while everyone starts to wake up. My hygienist will be using Biolase's ezlase diode laser with SRP patients, because the laser helps reduce pocket depths and bleeding on probing. (After a slow start, my hygienist has really become a laser advocate and we have seen our hygiene production skyrocket. The patients like the non-surgical approach we use.) I also bring up the point that she could probably use the laser for her maintenance patient.
Now on to my schedule. My first patient is crowns 18 and 19, with large existing 2 surface amalgams. The amalgams are subgingival with recurrent decay. This will be challenging and I’m already thinking crown lengthening. Did we advise the patient of this? My front office reminds me that we explained the need for crown lengthening and already explained how we can utilize the Waterlase all-tissue laser to remove and contour soft and hard tissue. My assistant adds she has already set the laser up and we’re good to go.
Next I look at the restorative patients--a couple of Class I’s, a patient with Class III’s on 7, 8 and 9, and an elderly patient with Class V root caries. These should all be good candidates for utilizing the Waterlase. Then a lingual frenectomy on a tongue-tied 9-year-old and a denture reline. These look pretty straightforward.
Now comes the fun part: I ask if we had any messages over the weekend. We have two emergency patients--a college student we have not seen in a while who chipped a tooth and a 6-year-old new patient who has pain in his lower right side. He is coming at 3:30 as his mother does not want to pull him out of school early.
Laser crown lengthening
We break from our meeting and everyone heads to start their morning. My first patient is seated and ready to go. After greeting the patient, I take a quick look to see what I’m up against: large broken down amalgams with subgingival margins and inflamed angry tissue. After anesthetizing the patient, I remove the failing restorations. Once removed I pull out the Waterlase, first removing and recontouring bone to allow for about 3 mm from my margin to the new osseous level. I turn the water down a little to help control the bleeding and I can now see my margins. I build up the tooth, do my final prep, and am almost ready to take my impression. One last run of the laser in the sulcus to clean it out and it is impression time. How did I ever do this without a laser?! The patient is happy too--no need to be referred out for crown lengthening, less trauma, and a better impression.
Laser scaling and root planing
I run in to do a hygiene check and my hygienist proudly states her patient is doing extremely well. She utilized the diode laser in conjunction with SPR 3 months earlier. The patient is also impressed and likes the concept of nonsurgical periodontal treatment.
Laser Class III cavity preps
We move on to our Class III restorations. We have never used the laser on this patient for a restorative procedure, so we take it a little slow. I explain how the laser uses energized water to interact and remove tooth structure. We can be more conservative, retaining more tooth, usually without having to give an injection. We start slow using the Waterlase MD turbo handpiece; it is amazing how efficient it cuts. We prep three Class III’s in less than 5 minutes and are ready to fill. The patient’s apprehension has turned into amazement. He can’t believe we just did restorations on his teeth without an injection or pain. I explain that the laser can help anesthetize the tooth and does not cause the heat and vibration of the drill. While I can’t guarantee that every patient will not feel some sensitivity, most people do not require an injection.
Laser occlusal preps
After my next hygiene check I find a few areas of decay on the upper and both lower molars. I have a few minutes before my next patient and I offer to complete the fillings for the patient right now. At first the patient uses the old “ I don’t want to get numb before lunch “ excuse , which I answer with “ I should not have to get you numb and we can take care of it right now “. Nothing like a little added production to fill in a little open time. A few minutes later, we have 5 occlusals completed and the patient is on their way.
Laser aphthous ulcer treatment
Another hygiene check reveals a patient with an apthous ulcer. I explain that I can utilize the Waterlase to coat over the lesion. It will make it feel better, less painful and speed up the healing. We move over into another operatory and complete the procedure in about 2 minutes.
My last patient before lunch is my lingual frenectomy patient. In dental school, I did a total of zero lingual frenectomies. And prior to getting a laser, I just did not like the idea of placing a scapel into the floor of someone’s mouth. With the laser the procedure is very controlled with very little bleeding. My patient is a 9-year-old, tongue-tied and very apprehensive. I explain the procedure to mom and after utilizing a stronger topical anesthetic (Tac Gel) I begin the procedure. The laser when used at a lower power setting begins to incise the frenum, as the frenum opens and separates I continue to incise the fibers. When the tissue has opened up to the floor of the mouth, I instruct him to stick out his tongue.
. The procedure is a success; there is virtually no bleeding, no pain and the post-op instructions are: over the counter meds, warm salt water rinses and a soft diet. Mom is amazed and I love the fact there is little bleeding and no stitches.
Laser emergency treatment
As we finish up and I start to think about lunch, I am abruptly reminded of my “pre lunch” emergency, the chipped tooth. Well we have all had the “chipped tooth “ emergency before lunch that turns into the large pulp encroaching lesion that did not happen overnight. Well the case is no different. The patient has the fractured, decayed buccal cusps of 19 missing with the gingival tissue growing over the margin. This in the past would have eliminated my lunch time. Not today, we pull out the Waterlase, remove the inflamed overgrown tissue, clean out the decay and also utilize the laser at a very low setting to perform a pulp cap. Lasers can not only kill bacteria but help create homeostasis and bio-stimulate tissues to heal. We them place some glass conomer and build up the tooth. We advise the patient when he returns to town to schedule for a crown.
With still a little time to eat lunch, I pick up an article on laser endodontics. The research being conducted is showing the ability to disinfect dentinal tubules better than NaOH2 and extend deeper into the tubules to remove organic matter and allow for a better uptake of our sealer. With the difficulty in disinfecting the apical third of the root, lasers are a no brainer.
Laser curettage, gingival troughing
After lunch, my hygienist is performing laser curettage in conjunction with scaling and root planing and I am starting crown preps on 3 and 4. These preps should not require osseous recontouring but I will still use the laser to trough prior to taking our final impression or to contour that overhanging tissue that gets in the way. Heading down the home stretch only 3 patients to go.
Laser-assisted denture reline
Next up a maxillary denture reline. In my exam, I notice a very high buccal. The laser will very easily remove and reposition the frenum resulting in a better fitting denture. I explain how we can utilize the laser to remove and recontour the tissue. The patient relates that the tissue constantly is irritated or sore and makes her denture pop out. I explain the procedure and advise the patient that there will be an added charge and proceed to remove the frenum. I then place a soft liner and will let the tissue heal and then reschedule to do the hard reline. The procedure is easy, the post-op is uneventful and the final result will be better.
Sensitive patient opts for conventional cavity preps
The next patient needs a few restorations, MO on 20 and DO on 21. We advise the patient we will be utilizing the Waterlase MD laser and show how the laser feels on their hand and proceed. After minute or so the patient states he is sensitive and would rather be numbed up. Oh well, you can’t win them all and we give into his request. The lesson: every patient is different. We complete the restorations, swing over to hygiene for a check and advise the patient of some areas that need periodontal treatment. The patient relates that the hygienist has already explained what is going on and agrees that something needs to be done. I explain how the laser can help treat the infected areas and we can schedule that for her.
Laser cavity preps redux
Our last patient is a 6-year-old boy with his mom. Mom explained that her son had a bad experience last time at the dentist and they have been avoiding treatment. Upon examination I see a few areas of decay and explain that we can utilize a laser to remove the decay and usually not have to give an injection. She is willing to give it a try, and after we show our patient the water from the laser on his hand, he is willing to give it a try as well. Utilizing the turbo handpiece, I knock out 2 restorations--the patient is fine and mom is blown away. This is the highlight of my day, not only showcasing my laser technology, which I know that mom will tell all her friends about but the smile I see on my little patients face.
Another not-so-normal day of dentistry, another great day of laser dentistry!