Although lasers have been FDA-approved for dental applications since the 1990s, no laser equipment has yet received the American Dental Assn.'s highest endorsement, the ADA Seal of Acceptance, which indicates a product is safe and effective. For many laser applications, the ADA awaits further evidence. Meanwhile, the majority of dentists stick to tried-and-true mechanical techniques.
"This is one of the things that helps bring dentistry into the 21st century," says Chicago periodontist Robert Pick, a spokesman for the ADA and author of the textbook "Lasers in Dentistry."
Some dentists are bringing lasers into their practice at regular exams, using a tool called DIAGNOdent to find tiny, early cavities. The tool—similar to a laser pointer—detects the mineral loss that is a step toward cavity formation, says Los Angeles dentist Jonathan Engel. Sometimes the laser helps identify regions of concern that an X-ray will miss, Engel says.
The DIAGNOdent is probably underutilized, says Laurence Rifkin, a dentist in Beverly Hills. By finding and treating a cavity sooner, he says, he can fix it with a small filling — a quicker, less expensive treatment that also saves more of the tooth.
Lasers are also getting some use in the cavity treatment process. Dentists can use them to remove shallow areas of decay, such as those found by the DIAGNOdent. Lasers cause none of the discomfiting vibration, heat and noise of the standard drill. They make a quiet ticking or popping sound. Novocaine is frequently not required: In a 1997 study in the Journal of the American Dental Assn., encompassing nearly 1,000 people who had laser treatment, fewer than 2% of patients needed or asked for anesthetic.
Pick regularly uses lasers in oral surgery. For example, he switched from scalpel to laser for a common procedure called a frenectomy. If you put your tongue between your upper teeth and lip, you may feel a bit of tissue connecting the two. This frenulum can get in the way of orthodontic treatment, so surgeons frequently divide the tissue in children who are getting braces.
An old-fashioned frenectomy with a blade causes bleeding, swelling, pain and scarring. A laser, Pick says, eliminates all of those problems. He doesn't need stitches to close up the surgical site. In addition, Pick says he can perform a laser frenectomy as much as 10 times faster than scalpel-based surgery, because with no blood it is easier for him to see his work. Recovery is quick; kids can be playing outside later the same day as the surgery, he says.
Dentists who use lasers are a minority. The ADA has no statistics on laser use, but Pick estimates that fewer than 10% of dentists have adopted lasers to replace the drill or scalpel.
Part of the reason is cost. For example, a dental drill costs approximately $600; a laser that can do only some of the drill's work costs between $25,000 and $45,000.
Other dentists remain skeptical that lasers provide a true advantage. There are many things lasers cannot do: They can't treat large cavities, remove an old filling for replacement or prepare a tooth for a bridge or crown.
In addition, Rifkin notes, lasers don't provide the touch sensation that dentists are used to when drilling a tooth. "You're waving a light," he says; he compares it to writing on a piece of paper without being able to touch the sheet. Although some lasers travel through a fiber optic that does touch the tooth, touch feedback is still limited, he says.
Given the laser's limited applications compared with a drill, "I don't see the big advantage of it," he says.
There are some dental applications in which laser use is common. Many dentists use lasers when inserting a tooth-colored, composite filling. The laser hardens the material and seals it to the tooth within a minute or two.
In addition, some tooth-whitening procedures rely on lasers to activate the tooth-bleaching chemical gel. Using a laser speeds up the process of reaching that pearly white smile.
At the same time, some dentists have adopted laser treatments that may not be helpful. According to the ADA, applications such as sterilizing the mouth or removing diseased gum tissue are based on little or inconsistent evidence.
Engel recently purchased a laser to use in treating gum disease, not to remove the tissue but simply to disinfect the area. Even if the ADA has not endorsed the technology, he says, it won't hurt and it might speed recovery.
"The ADA may not always be the quickest on the boat," he says. "If there's something extra I can do to help my patients heal, why not do it?"