Trainers who are also hygienists share the answers to the most common questions they receive
By Jeanette K. Miranda, RDH, BSDH, and Angie Mott-Wallace, RDH
So, you have decided to step into the dental hygiene laser world. Congratulations! Now that you have made the decision (or your employer has made the decision for you), you may have questions on how to get started.
There are many factors to consider. Does your state regulate dental hygiene use of lasers? How many people will be using the laser? Where is education available? Does it really work? Here are the top ten questions most frequently asked by new laser users.
1. I am looking at buying a diode laser and have been told that there are fiber tips and then a spool of fiber. Which is the best to use and why?
There are pros and cons for both types of laser tips. Several factors of comparison include cost, sterilization, and customization. The spool of fiber is more cost effective for the experienced laser users, but there is a learning curve to stripping and cleaving the fiber for the novice. During this time, the fiber on the spool can be used inefficiently, thus increasing the price per use.
Disposable tips are typically more expensive than the spool, but require less time for set up and tear down of the laser, which can increase productivity. The spool of fiber needs to be sterilized between patients. Several spools need to be available so one spool can be sterilizing while another spool is on the laser ready for use. The disposable tips are replaced with each patient.
Some manufacturers’ tips can be awkward to fully engage into the laser. While the initial investment for the spool is considerable, it offers more flexibility. For example, if the pocket depth being treated is 6mm, the fiber can be cleaved to the appropriate treatment length of 5mm. Disposable tips come in per-determined lengths and are difficult to customize.
Assessing the experience of the laser user and the work pace of the office will help determine which type of fiber best suits your clinic.
Many lasers in the market can increase dental hygiene productivity and send the “we’re on the cutting edge” message to patients, according to the authors.
2. My doctor says that I have to be careful using a laser around tooth structure. Why? I thought that lasers were used for the gum tissues.
Exactly! The diode laser is a soft tissue laser. The energy emitting from the tip is attracted to melanin and hemoglobin. Most periodontal bacteria are dark in color making the laser attracted to these specific bacteria. That is why the diode is so effective in treating periodontal disease.
It is also a thermal device. Too much heat on the root surface may cause damage to the tooth. While using the laser tip in a periodontal pocket the tip should always be directed toward the soft tissue wall, reducing the chance of damaging the tooth structure.
3. My doctor wants me to use a laser, I have zero experience, and I am scared. Where do I start? Do I need special training to use a laser?
This is a great question. It is exciting and sometimes intimidating to try something new. The learning curve is an expected process, and it will take time to become proficient. Remember how awkward it felt to hold and adapt a Gracey to a tooth the first day of clinic. With practice, this task is second nature to every hygienist.
Education and understanding laser energy is essential to successfully treating our patients. Laser therapy is not a cookie-cutter procedure. Not all periodontal tissue is created equal. We know some areas of the mouth may be more periodontally involved than other areas. Several state dental boards are now requiring certain level of training before hygienists are allowed to use lasers.
It is vital to seek quality training before using lasers. This reduces initial anxiety and increases success for you and your patients. The Academy of Laser Dentistry (laserdentistry.org) offers several levels of courses in a wide variety of locations. Courses are taught at all major professional conferences and instructors are available to come into your practice for individualized training. Even after laser training courses, please continue taking laser classes. Remember, with every aspect of dental hygiene, our profession and protocols change and evolve. Laser technology is changing and evolving, too.
4. I see that several diode lasers are available. What are the advantages to buying one that costs more over some that are more economical?
You have heard the old adage, “You get what you pay for.” That applies to dental lasers, too. There are other benefits included with the purchase of the more expensive lasers. Some of these lasers have additional components such as whitening wands and low-level laser attachments. Other lasers may come with a supply of tips or fibers. Many of these lasers include basic training on the laser and an extended warranty.
It is also important to check the company’s service record. Speak with other laser owners to determine if the company has a responsive service department.
5. What can a hygienist do with a laser?
That depends upon which state you are practicing. Angie Mott-Wallace states: “It is important that the hygienist takes the time to understand their respective state practice act. It is the responsibility of each dental hygienist.”1
Every state dental board sets the parameters for dental hygiene duties. While hygienists use the laser in a majority of states, the guidelines vary. It is your responsibility to know your state practice act. That being said, there are several procedures many states allow hygienists to perform. Laser assisted periodontal therapy (LAPT) and laser bacterial reduction (LBR) are the two most common periodontal procedures performed by hygienists. Some states allow laser whitening, treating aphthous ulcers and herpetic lesions, tooth desensitizing, and photobiomodulation (PBM).
6. I have investigated lasers and feel that I have narrowed it to two lasers—a Biolase Epic or a King Dental-Beamer laser. Which should I buy?
Both Biolase’s Epic and King Dental’s Beamer lasers are excellent choices. Their cost is similar in the $7,000 to $8,000 range. They are both manufactured by reputable companies that have been in the dental laser field for years. This is something to be considered when purchasing a laser, because you want to be able to have the device serviced and to able to purchase accessories when needed.
The Beamer is a work horse. It is a basic 980 nm diode laser with continuous and pulsed settings. There are no pre-set procedure buttons and it has a spool fiber. These are very attractive qualities in a laser. Just because the Beamer does not have a multitude of bells and whistles, it is a reliable, well-made laser.
The Epic is the bestselling diode laser in the Biolase family of lasers. It is a 940 nm diode laser with continuous and pulsed settings. There are pre-sets on this model and it comes with disposable tips. This unit has many more bells and whistles than the Beamer, but is still well-made and dependable. The Epic has two additional handpieces that offer a wider variety of services. The laser whitening wand provides a wider treatment area and the deep tissue handpiece can deliver photobiomodulation (low level laser therapy) for pain relief and healing.
The Epic and Beamer cost about the same. Either laser will serve your practice well. Determining who will use the laser and which procedures will be performed will help decide which laser will suit your needs. And do not forget there are many other acceptable lasers on the market for consideration.
In addition to considering the reputation of the company you’re purchasing from and what functions the laser is approved to perform, it’s also important to consider the support provided post purchase. How will you learn to use what you’ve just purchased? For example, Dentsply Sirona’s SiroLaser Advance Plus comes with a free, hands-on laser certification course aimed at enhancing the clinician’s knowledge of the science, safety, functionality, and importance of lasers in everyday patient care.
7. My doctor isn’t convinced that a laser would be a benefit for our practice. How can I convince him?
The best way for your doctor to familiarize themselves with the benefits of lasers is to attend a trade show. Doctors can visit with a multitude of laser companies to determine which laser best fits into the practice.
Unfortunately, this may not be an option. You will need to provide literature and studies to show your doctor that lasers can increase revenue and attract new patients. All of the laser companies have extensive websites with information, and many companies are willing to provide a lunch-and-learn.
Share with your doctor the procedures that are enhanced with the use of a laser. For example, soft tissue crown lengthening, aphthous ulcer treatments, frenectomy, biopsies, and troughing are just a few of the procedures to be mentioned here. The periodontal benefit to the patients is well documented and can easily be implemented into the hygiene department.
You will be amazed at how many patients are seeking practices that offer a nonsurgical approach to treating periodontal disease by using lasers. You will also be amazed at how many practices are seeking hygienists with laser certification as a job prerequisite.
8. Where can I find information and articles to show me that lasers work?
The Academy of Laser Dentistry (laserdentistry.org) is an excellent source of information and articles. A quick search on PubMed will produce thousands of articles on lasers.
Unfortunately, over the years, periodontal laser therapy has had some inconsistent results with scientific studies. Some of the studies have had very few participants. Many of the studies use very different criteria, which do not lend well to creating consistent meta-analysis data. It is imperative when reading the literature to determine what the study was trying to prove, how many participants were evaluated, and what were the parameters of the study. There is significant literature and scientific studies supporting lasers and periodontal therapy.
Another source of information is to visit with laser users or patients who have had laser therapy. Everyone has an opinion and are willing to share their experiences.
9. Can a hygienist purchase a laser?
This question is also state specific. In many states, hygienists cannot work independently outside of a dental clinic. Therefore, purchasing, billing, and using a dental laser for use other than in a dental setting would not be acceptable.
Technically, you have to have a dental license to buy a laser from a manufacturer. California, Colorado, Minnesota, Oregon, and several other states all have varying levels of supervision for dental hygiene. The best answer for this question is to contact your state board of dentistry.
10. How do I know if I need a diode laser, a Nd:YAG, a CO2, or an erbium laser for my practice?
Determining which laser would work best in your practice depends on your treatment objective, your dental laser education, your budget, and which device will physically fit into your operatory. Will the laser be used only by the dentists? Will the hygiene department be using the laser? What procedures will you be providing?
An Erbium laser or the 9300nm CO2 laser are used for procedures involving tooth and bone. The diode, Nd:YAG, and 10,600 nm CO2 lasers are soft tissue lasers. Typically, the dentists use the erbium lasers and the CO2 lasers. These lasers tend to be larger stand-alone units on wheels that can be rolled between operatories. The price tag is bigger too, with units starting at $40,000 and up.
Hygienists can use the CO2 laser, but specific training is required. The erbium lasers can change tooth structure, which is outside the scope of practice for a hygienist.
The Nd:YAG and the diode lasers are well suited for periodontal therapy, since both of these lasers are attracted to the melanin and hemoglobin that are abundantly found in a periodontal pocket. Nd:YAG lasers are larger and more expensive. Diode lasers are table-top size and range from $2,000 and up. The ease of portability and price tag are attractive for hygiene use.
The portability is important if the unit is shared between several operatories. If the laser is to be shared with multiple users, having a sturdy cart to transport the laser between rooms is strongly recommended. The carts with drawers are perfect for storing laser accessories and safety glasses. Ideally, each hygiene operatory should be equipped with a laser.
Hopefully, this discussion has answered many of your laser questions. Lasers have been used in the dental operatory with FDA approval since the early 1990s. Being a laser dental office can attract new patients and add to the productivity of your practice. Many studies prove that the diode laser is beneficial when added to traditional periodontal therapy.
Dr. Sam Low best sums up laser periodontal therapy: “Although the use of lasers in initial periodontal therapy has significant advantages, it must be emphasized that laser treatment is an adjunct to standard therapy rather than a replacement therapy.” 2
Authors’ note: The authors would like to extend a very special thank you to Mary Lynn Smith, RDH for her contribution of vast dental laser knowledge and unwavering personal friendship.
Jeanette Miranda, RDH, received her associate degree in dental hygiene from Indiana University (IUSB) at South Bend and her bachelor degree in dental hygiene from Minnesota State University Mankato. She has practiced dental hygiene for over 35 years in four states and was a clinical hygiene instructor at IUSB. She has attained Standard Proficiency and Fellowship status in the diode laser with the World Clinical Laser Institute; Standard Proficiency, Advanced Proficiency and Mastership status with the Academy of Laser Dentistry; and Dental Hygiene Implant Certification through the International Congress of Oral Implantologists. Presently, Jeanette Is employed as a clinical hygienist, serves the Academy of Laser Dentistry as co-chair of the Communication Committee and chair of the Auxiliary Committee. She is a past-president for the South Dakota Dental Hygienists’ Association and teaches dental lasers. Jeanette may be reached at [email protected].
Angie (Mott) Wallace, RDH is a laser educator for the Academy of Laser Dentistry, she has her Mastership with ALD. She is currently the co-chair for Regulatory Affairs and serves on several committees as well. Angie has been recognized as an international speaker and provides in-office laser certification courses as well as speaking for several dental meetings. She can be reached at [email protected].
References
1. Blayden J, Mott A. (2013). Soft-Tissue Lasers in Dental Hygiene. Pg. 75. Pondicherry, India: SPi Publisher Services.
2. Convissar RA. (2nd edition, 2016). Principles and Practice of Laser Dentistry. Pg. 53. St. Louis, MO:
Elsevier.
3. Academy of Laser Dentistry. Retrieved October 20, 2017 from http://www.laserdentistry.org.
