Lasers Can Drill Cavities
Without Pain, Novocaine
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HEALTH JOURNAL
By TARA PARKER-POPE
Sixty-year-old Rita George sat in the dentist chair for a filling recently, and braced herself for a needle and a shot of novocaine. To her surprise, she didn't get either.
Her dentist in Bristol, Tenn., Janet Hatcher Rice, is one of nearly 1,000 U.S. dentists who now use a laser instead of a drill for many procedures -- making novocaine almost obsolete for many of their patients.
"There was no pain involved at all," says Mrs. George, noting a "tiny pin prick" was all she felt. "And you don't walk around afterward feeling like you have swollen lips and like you don't have a tongue."
There are few things that fill people with more loathing than the sound of a dentist drill. But now the dental laser, a powerful cutting instrument, can remove the decay from a tooth, just as a drill does, essentially vaporizing it with a stream of laser light.
Even so, dentists have been slow to give up the drill, which dates back to the 1700s, with modern, high-speed versions first introduced in the 1960s. The nation has about 200,000 dentists, and most still don't use lasers. A big hindrance is cost. Most dentists have small practices and can't afford the $50,000 laser equipment. Many dentists have been turned off by the aggressive marketing and relentless stock promotion of some dental laser makers as well. Finally, some dentists remain concerned about the risk of the laser over-heating and damaging the tooth.
Nevertheless, the number of dentists using lasers is expected to increase sharply over the next few years, particularly as patients, lured by the promise of needle-free dentistry, start demanding the treatment.
Lasers vaporize soft tissue, essentially cauterizing it so it doesn't bleed. They are ideal for slicing quickly through gums and soft tissue without bleeding and for preparing small and medium cavities for filling, dentists say. In those cases, 80% to 90% of the patients won't need anesthesia. And patients who have cavities on opposite sides of their mouth can have them treated at the same time. (When novocaine and drills are used, patients have to come back for a second visit because doctors can only numb up one side of the mouth at a time.)
Lasers also allow dentists to perform a number of new procedures. Patients with "gummy" smiles can now have excess gum tissue quickly removed and shaped without bleeding. Mouth sores can be zapped with a laser to stop the pain. Lasers can be used to treat sensitive teeth in certain patients.
Many doctors find lasers particularly useful for treating children, who often are terrified of the needle and end up biting their cheeks and tongue while numb. "It's a confrontation to numb up an eight-year-old," says William Greider, a Fort Myers, Fla., dentist who lectures and trains other dentists on behalf of a laser manufacturer.
But the equipment also has some shortcomings. Lasers can't be used to remove silver or other metal fillings, a common procedure among today's aging baby boomers. Moreover, since lasers are expensive, many dentists who use them add a surcharge of $30 or more that isn't covered by insurance.
Laser dentistry isn't a recognized specialty of the American Dental Association. It isn't yet taught in dental schools, so training has been left either to the laser manufacturers or the Academy of Laser Dentistry. The academy offers a standard certification or a more rigorous advanced proficiency certification that requires dentists to document case studies that are reviewed by their peers. The academy also offers a Web site, www.laserdentistry.org, to help patients find a dentist who uses lasers.
The laser itself is believed to have an anesthetizing property, although nobody quite understands how it works. Its pulse is so fast, there's simply not enough time for the nerve to send a pain signal to the brain, says Alan Goldstein, a Manhattan dentist and president-elect of the Academy of Laser Dentistry.
Dr. Goldstein, a longtime dental laser user, says deep cavities that go near the nerve and root canals still need to be numbed. And in some cases, a dentist will still need the control and finesse offered by the dental drill. "Lasers are not used all the time, but when I need them, they're enormously helpful," he says. "It's a matter of using proper clinical judgment and not overstating what you can do with it."
Lasers aren't silent, but patients say the sound is preferable to the high hum of a dental drill. The laser box makes a "machine sound" and the wand makes a popping sound as it cuts on the tooth. The smell from the cut tooth is also similar to that which occurs with a drill.
Early on, doctors worried that the laser could overheat and damage the tooth. But laser proponents say studies have shown the tooth temperature actually drops because cold water is used to cool the tooth. Even so, lasers are dangerous devices in inexperienced hands. Patients should ask their dentist how much training they've had. Patients undergoing laser treatment must wear safety glasses.
Darold Opp, an Aberdeen, S.D., dentist, just acquired his dental laser about six weeks ago. He's begun running radio ads promoting it and gives T-shirts bearing his Web site, www.laserfillings.com and the words "Got Laser?" So far, he has done about 100 laser procedures. "I've yet to have a patient say, 'This is uncomfortable,'" says Dr. Opp. "When you deal in a profession that has fear and anxiety as its two main components, whatever you can do to lessen that is a huge step in the right direction."
Email me at healthjournal@wsj.com.
Updated July 9, 2002 |
