Light up your operatory and career with lasers

You may have seen an influx of hygienists on social media who are currently frustrated with their careers. Many providers want to get out of the op because they are burned out. Often, I receive LinkedIn, Facebook, or Instagram messages with introductions similar to this: “Hi, I’m an RDH and I’m looking to get out of clinical hygiene. I want to do more but don’t know what or how to get started. Do you have any advice?”

“I encourage every RDH to seek advanced continuing education and training in order to evolve with today’s modern technology and science. RDHs can deliver comprehensive care for their patients if they find the working environment where they feel safe, trusted, and respected. Finding the right practice fit is essential to long-term career satisfaction.”—Dangler

Like most of you, I love dental hygiene and am always looking for ways to advance my personal development. This career has provided me with lifelong relationships and a tribe of caring, compassionate professionals who possess grit. I have been fortunate to have worn many hats in our field as clinician, educator, speaker, corporate manager, consultant, and dental salesperson. I believe all hygienists can reignite their passion in the op if they are set up and supported to practice the way they were trained as oral health-care providers.

Today’s comprehensive care model

A thorough medical and dental health questionnaire connecting systemic indices; vitals; a thorough intraoral and extraoral exam with advanced technology screening for oral abnormalities; an airway and/or breathing disorder assessment; a thorough periodontal, malocclusion, and ortho assessment; risk assessments; radiographs; photos and scanning … I know what you’re thinking: “Wow! All this before picking up a scaler! Who has time for that?”

Trust me, I know we are on a schedule that feels like we are on roller skates all day! Although it seems impossible in today’s modern dental practice, the dream work happens when we are given adequate time to be the prevention and periodontal oral health-care providers we were trained to be. It goes well beyond simply removing plaque and calculus as we did for our clinical board exams. To perform at our best, we must invest in ourselves with ongoing continuing education and equip ourselves with the tools and technology that allow us to give our patients the best experience and care. We can’t do this alone. Success will require an entire team aligned and trained with effective systems and protocols. It requires a schedule with an assisted hygiene model or single column with supportive team members who have the same culture and values to provide patients with the same comprehensive care philosophy. We all agree it’s a win when patients get the care they need and deserve, while the hygiene department productively satisfies the doctor’s expectations and business needs to thrive in today’s economy.

Diode lasers were one of the first technologies I learned about after hygiene school. Lasers have provided me with additional skills to achieve enhanced healing and treatment modalities for my patients. This technology adds value for patients, and I am rewarded with personal satisfaction. In my experience, patients are healthier and more committed to keeping their supportive maintenance appointments, and our offices are more productive, with yearly growth in revenue, increased referrals, and patient retention.

“With continuing education, training, and advanced technology available to provide patients with the highest standard of care, I see my colleagues reignite their passion and love for what they do every day as oral health-care providers. My why is fulfilled when I know patients are receiving great care, and my colleagues have the ability to deliver their best work and embrace their role as a valuable member of the team, practice, and the business. Dental hygiene is so much more than just cleaning teeth.” —Dangler

Now let’s talk diode lasers

The term LASER is an acronym for light amplification by stimulated emission of radiation. Simply stated, a laser is a device that produces and amplifies light.5–7 It is the wavelength of this light—where it sits on the electromagnetic spectrum of light—that determines the proper use of the laser energy beam.⁵

Different forms of laser energy affect tissues in different and specific ways. The diode wavelength used in hygiene disinfection and debridement—typically 810 nanometers (nm) to 980 nm—is readily attracted and absorbed by tissue pigments, hemoglobin, and melanin.^5–7 This unique absorption of light energy is what makes the laser ideally suited to disinfect, eliminate periodontal inflammation, destroy infective biofilms, stop the bleeding coming from existing periodontal wounds, and initiate biostimulation.⁷

When laser energy is absorbed by soft tissue, the result is a localized conversion to heat, which results in a nonionizing photothermal reaction, essentially converting light into heat within biologically acceptable thermal limits.6 This thermal reaction affects the bioburden.

The dental hygienist “shines the light” from the laser into the sulcular space to create a thermal event that does not alter tissue, but simply decontaminates and reduces bacteria in the pockets. Hygienists are able to incorporate lasers in treatment, because unlike the surgical lasers used by dentists, the laser energy settings hygienists use do not vaporize or ablate the tissue.7

What can a laser do?

Changing the structure of your patient appointment by immediately addressing disinfection with a laser enables hygienists to adopt a different approach not only to patients’ newfound concerns about bacteria and viruses, but also to the importance of further evaluating the patient regarding treatment that may be necessary for biofilm-induced periodontal infection, which creates inflammation that affects the rest of the body and puts general health at risk.

Based on the energy settings applied, diode lasers are used for bacterial reduction (LBR) and sulcular debridement (laser-assisted periodontal therapy; LAPT) to disinfect and initiate the body’s host immunological response for healing.^2,3,8,9 In addition to its bactericidal effects in preprocedural disinfection, the laser is also an ideal instrument when specifically used during periodontal therapy (LAPT) due to its ability to destroy bacteria, reduce inflammation, and heal the periodontal wound when used adjunctively during periodontal debridement (i.e., scaling and root planing).^1,4,9,10 This bacterial reduction is critical to the reduction of destructive chemical mediators, which allows the body to heal from the destruction caused by biofilm-induced gingivitis, periodontitis, and implantitis.

“The diode laser is a tremendous asset for the dental hygienist to jump-start change in the eyes of patients. Tell the patient: ‘Since we saw you last there have been a lot of changes in dentistry. Science has given us new tools that safely and effectively allow us to help disinfect the gum tissues at the beginning of your appointment by lowering bacteria right from the start with the use of a laser.'"—Press

It is the dynamics of wound response during LAPT that takes periodontal health to levels of healing beyond traditional treatment applications.^2,3 The laser kick-starts the immune system’s ability to heal while destroying bacteria that is present.² Photons (light energy) energize the body to heal through stimulation of the fibroblasts and mitochondria, which have been negatively affected due to the presence of disease. These physiologic changes occur through laser biostimulation to initiate the body’s own healing process. Laser implementation is utilized in periodontal therapy as an adjunct to standard SRP, with the expectation of a clinical change in the microflora and gingival wound healing.^2,3,5,8,9,11

Effective communication

Effective patient communication is always critical. It is important that patients understand how an infection in the mouth can affect all other parts of the body, but that the infection is easily treatable. By using language such as “laser-assisted periodontal therapy that includes laser debridement and bacterial disinfection” rather than “scaling and root planing,” the hygienist is able to bring new treatment awareness and raise the patient’s interest and attention to the changes in treatment. Lasers are safe to use and provide improved and more rapid wound healing—making our patients feel more comfortable after treatment.

Personal experience as a laser RDH

After my first training program, I was excited to get back to the office and implement what I had learned; however, I was also hesitant. We were now charging more in our treatment plans to include laser therapy, and I was nervous I might not see a significant difference to justify the added cost and time in my chair for patients.

Luckily, my doctor invested in an amazing mentor and trainer who came to our office to provide over-the-shoulder training and coaching to ensure our use of the laser was correct for each patient. She not only enriched my clinical laser skills, but also taught me communication strategies that gave me confidence in my conversations with patients.

“This new role being assumed by hygienists benefits both practice and patient by making periodontal care more effective and by establishing a higher level of treatment acceptance and production.” —Press

Her experience and coaching were invaluable in my laser education journey and the reason I have a strong affinity for laser training beyond standard proficiency courses. After seeing results and hearing positive feedback from patients, I quickly became an evidence-based believer and laser advocate.

“Hands-on training can make all the difference in your success and confidence when implementing lasers into the practice. Having a mentor and/or experienced coach is priceless.”—Dangler

Demystifying laser education myths

There is confusion regarding laser use by dental hygienists. Licensed dental professionals seek continuing education in all areas of direct patient care as a professional standard. Developing new skill sets requires practice, educational interest, and the desire to expand our knowledge.

It is important to bear in mind that the laser is a device—cleared by the FDA—to perform laser bacterial reduction sulcular debridement (curettage) in dental hygiene and soft-tissue surgical applications by the dentist. Few states have a formal rule regarding hygiene laser education requirements. Typically, we hear about suggested guidelines for laser training, which are recommendations and should not be viewed as a required state rule. The authority to define a rule lies with each state’s dental board. Therefore, dental hygienists should look to their general scope of practice policies when determining duties they are asked to perform.

The real question we should be asking is not what instruments are we permitted to use, but what procedures can we perform and for what purposes. Twenty states have specific formal rules supporting laser use by hygienists; board-certificed CE is required. Eighteen states have no such formal rules. In this case, our profession assumes we will seek education to attain confidence and competency. Twelve states have formal rules prohibiting any use of a laser by hygienists.

“The changing face of periodontics and the role of the hygienist in treating patients to a new level of health and wellness should be viewed as inspiration to becoming more knowledgeable and skilled in incorporating a laser.” —Press

Continuing education programs on the science of laser physics, clinical application, and practice implementation are available. These programs, which follow accepted curriculum guidelines for dental laser education, are available through qualified consultants and clinical trainers, manufacturers, and membership organizations. Attendees receive a certificate for 8 to 12 continuing education credit hours. Dental hygienists should commit to acquiring knowledge of the principles of laser use and the simulation skills to clinically deliver treatment.

Return on investment

The extensive utilization of lasers in medicine, from dermatology to neurology, has set the stage for patient awareness and interest in laser-assisted dentistry. In recent years, diode lasers have become more portable and affordable, which has dramatically increased their presence in the general dental practice for therapeutic and efficient surgical applications. There are even lasers that are designed specifically for use by dental hygienists for LBR and LAPT.

This increased awareness of noninvasive dental applications with the 810–980 nm diode laser—such as for treatment of implantitis, herpetic lesions, aphthous ulcers, and doctor surgical procedures (e.g., gingivectomy, fibroma removal, frenectomy, and other soft tissue applications)—allows  hygienists to discuss additional same-day procedures during routine preventive appointments.^5–7