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Seeing the light

seeing the light

imgres-1 copyby Susan Jenks

 

FLORIDA TODAY

 

John Bryan lay patiently as his dentist, Dr. Chris Edwards, shot laser energy into his gums, without anesthesia, to reshape them.

The procedure lasted just two to three minutes, creating minimal bleeding and discomfort.

“I like that it didn’t hurt,” said Bryan, an Indialantic resident hoping to improve his smile. “It’s a little irritated, that’s all.”

The use of lasers, or “scalpels of light,” in dentistry stretches back several decades, experts say, although a handful of Brevard County’s general dentists, including Edwards, are pushing the technology into newer territory.
Its most recent application is as a last step to a traditional root canal, to wipe out any bacteria lingering in the tubules, or tiny holes, surrounding a tooth’s roots.

Earlier this year, the U.S. Food and Drug Administration approved a laser, which is made by Biolase, an Irvine, Calif., company, for this use. Edwards said the company’s laser is the first to gain approval for treating hard tissues, as well as soft, because other lasers heat up too much, potentially killing the pulp, the tooth’s vital interior.

In root canals, lasers are not yet used on their own, he said, primarily offering an added antimicrobial effect at the end of a standard procedure. But some studies, mostly out of Europe, suggest lasers also act as a bio-stimulant on adjacent tissues, promoting the production of early cells, called stem cells, and a faster healing response, Edwards said.

According to the American Association of Endodondists, the nation’s leading group for dentists specializing in root canal treatments, some 14 million root canals are performed in the United States each year, with about a 95 percent success rate in saving damaged or diseased teeth.

The standard procedure involves a combination of hand and rotary instruments to remove the pulp, where the blood supply lies, and the nerve, through which the tooth senses hot and cold. Afterward, the pulp chamber and root canals are filled and sealed to prevent bacteria from entering the tooth and infecting it in the future.
Edwards said he performs root canals with the laser on all teeth except the molars, which often have multiple root involvement, requiring a specialist’s touch.

“I’ve been doing root canals for years,” like many general dentists, Edwards said. “But my feeling is if I can’t do something as well as a specialist, it should be done by them.”

Nevertheless, he has few doubts about lasers’ pervasive future in his own practice and in the dental field, as the technology continues to evolve.

“The laser is the future of medicine — not just dentistry,” Edwards said, despite a high cost and varying insurance coverage for patients. “I could never imaging not using it.”

Plenty of uses

Laser technology already reaches across most medical specialties. Cosmetically, it is used to smooth out wrinkles or zap unsightly spider veins and warts, or to reshape the eyes through LASIK procedures to correct and improve vision.

And, in the clinical arena, physicians use lasers to vaporize tissues in enlarged prostates, seal off damaged or leaking blood vessels, break apart kidney stones and, in general, access areas of the body where other technologies are unable to go.

Ironically, perhaps, that is one of the disadvantages singled out by the endodontic association in a two-page position statement commenting on laser use in root canal treatment.

Although several studies have shown lasers reduce the “quantity of micro-organisms” in root canals, the statement noted that laser probes cannot be “curved to follow the natural curvatures of the tooth root” the way existing instruments can.

The association also said temperature rises when laser energy and tissues in the tooth interact, possibly charring the canal space and “damaging it to the point the tooth may be lost.”

Dr. Gerald Glickman, chairman of endodontics at Baylor College of Medicine in Dallas and president-elect of the endodontic specialty group, cited the need for more sophisticated research.

“Not much has changed since our statement was issued n 2001,” he said. “We don’t recommend protocols using advanced technology unless there is significant research behind it; there needs to be randomized, prospective clinical trials.” These studies compare the “gold standard” of treatment to newer approaches, such as in this case, the predictability and safe use of lasers in endodontics.

Laser’s limits

Edwards readily acknowledged some of the laser’s limitations.

For example, lasers can’t be used on teeth with fillings in place, as the laser light is unable to cut through metal, or generally fill cavities between teeth. And the technology does not always eliminate the need for anesthesia, although in most cases, it can be greatly reduced, according to Edwards.

But the laser he uses, he said, is far cooler than the most commonly used laser in dentistry, the diode laser, and has an attached water irrigant that reduces the temperature risks seen in some other systems.

“The water cools the laser,” he said, “and as the laser pulses, the water explodes, ablating (or cutting) the tissue.”
Moreover, it has fibers that are “as fine and flexible as a dental file.” he said. “With the fibers I use, I can follow a curved canal all the way to the end of the root.”

As for Bryan, who is not yet in need of a root canal, his laser treatment to equalize his gum-length clearly pleased him, and cost less than $200 out of pocket.

“It’s been worth it,” he said, of his decision.

Contact Jenks at 242-3657 or sjenks@floridatoday.com.
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Root canals

    • In these procedures, dentists remove the tooth’s pulp, which contains nerves, blood vessels and connective tissue.
    • The pulp chamber is then cleaned and sealed to prevent infection.
    • Both general dentists and endodontic specialists perform these procedures, with the decision to consult a root canal specialist usually based on complexity of treatment.

Source: American Dental
Association, American
Association of Endodontists

Lasers in Dentistry

Among their uses:

    • Remove tooth decay.
    • Treat gum disease.
    • Biopsy oral tissue for cancer.
    • Speed up tooth whitening.
    • Reshape gums cosmetically.
    • And, most recently, mop up bacteria after root canal therapy.

Source: Cleveland Clinic, FLORIDA TODAY
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By the numbers
14 million Number of root canals done in the United States annually
95 percent How many root canals save diseased or damaged teeth
Source: American Dental
Association, American
Association of Endodontists

Reproduced with permission of the copyright owner. Further reproduction or distribution is prohibited without permission.

Abstract (Document Summary)

According to the American Association of Endodondists, the nation’s leading group for dentists specializing in root canal treatments, some 14 million root canals are performed in the United States each year, with about a 95 percent success rate in saving damaged or diseased teeth.

 

Dr. Edwards graduated from the United States Merchant Marine Academy and Temple University School of Dentistry. He completed a general practice residency at the Queens Medical Center in Honolulu. To reach Dr. Edwards you may call 321-751-7775 or visit www.SDICFL.com