ABOUT GUM LASER SURGERY
Two companies who market the laser for dental decay are Premier Laser Systems Inc., of Irvine, CA and BioLase, of San Clemente, CA.
The erbium:YAG laser essentially vaporizes decayed tooth tissue. A stream of laser light that passes through a fiber connected to a pencil-like hand piece is directed to the decay. The laser hand piece looks like the standard hand piece and, like the standard hand piece, must be used in a controlled manner so that it doesn't slip and damage healthy tissue.
"The laser is a cutting instrument," says Susan Runner, D.D.S., branch chief of dental devices in FDA's Center for Devices and Radiological Health. "And like any cutting instrument, dentists have to be careful any time they use it. The laser has many of the same risks as the drill."
Another similarity between the dental drill and the laser is that both use water and air to cool the tooth and clean the surface during removal of decay. While dentists and patients may wear eye protection during conventional treatment to protect against the spray of water and particles, they must wear goggles during the laser procedure to protect their eyes from straying laser light.
The laser has several benefits over the hand piece: Because laser treatment is usually painless, there is no need for anesthesia or anesthetic injections in many patients, and dentists do not have to wait until their patients' mouths are numb to begin treatment. Also, the laser eliminates the vibrating sensations of the high-speed hand piece
Also, compared with the standard hand piece, the laser can work with better precision, saving more of the healthy tooth. And when the laser procedure is done, patients do not have to wait for the numbness and puffiness related to the use of anesthesia to fade.
For many patients, especially those particularly fearful of the dental drill, the laser has drawn rave reviews. "My patients love it," says Edward Romano, a dentist in Morristown, N.J., who has used the laser since 1997. "They say: 'I can't believe it's so comfortable, that dentistry has come this far.'"
However, the laser is not without its own shortcomings. For one, it can't be used on teeth with fillings already in place. According to Runner, there is the risk of damage to the tooth because the filling heats up. Romano says silver fillings also damage the laser tip. Also, studies show that the laser procedure takes longer than the conventional method.
"The laser is really ideal for virgin teeth -- for new decay," Runner says. "Dental lasers is a growing field, but they can't do everything. There's still a need for the standard hand piece"
Another potential pitfall is expense. In December, Premier Laser Systems was citing a list price of about $45,000 for its Centauri laser. That includes training for the dentist. The standard high-speed hand piece typically sells for around $600.
Premier Laser estimates, however, that while the typical laser procedure costs about $13 more on average than the same drill procedure, the cost reductions of not using anesthesia and having more time to spend with other patients could actually save dentists about $70,000 over three years.
Still, some dentists say they are putting off buying a laser for treating cavities, at least for the near future. "Our position [in my dental practice] is that the laser looks promising," Harms says. "But we're not using it yet. We're waiting for long-term studies and newer tools."
The other alternative to the traditional high-speed hand piece is the air abrasion hand piece Air abrasion involves the use of a high-pressured instrument similar to a tiny sandblaster. A stream of tiny aluminum oxide particles cuts away the decay. There is no heat and no vibration, and often, it can be used without anesthesia. It also can be used to remove some fillings, although it is not yet cleared for removing amalgams (silver-colored fillings).
Harms, who uses air abrasion, says the technique is ideal for small cavities and fillings in children, but she notes, "It doesn't replace the drill."
The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.
Who gets gum disease?
People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.
When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth”). In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.