Plea for help with answers

COMPUTERS   To lase or not to lase? by Dr Jacques Meschemberg May/June 2001 Lasers in everyday dental practice have arrived. They can be used for bleaching, desensitising, endodontic, periodontic and surgical treatments, as an anaesthetic-free alternative to the high speed drill and also for caries detection and prevention. Given these widespread applications, we could all have a use for lasers in our practice. So far though, not many of us have taken the plunge, but if the American and particularly the European experience is anything to go by, many more of us are going to. Let s not kid ourselves - we will all be making a decision about whether or not to go down the laser route - to avoid considering lasers is simply to make a negative decision based on ignorance. We will all be faced with the same dilemma. Should we leave our comfort zone and invest in laser technology? If we do, will it really be a practice builder and if we do not will we be left behind? Will it really make a meaningful difference to the service we can offer our patients? Will it be profitable and how on earth can we get enough information to make an informed decision in the time we have available? I faced these issues 12 months ago when I was contacted by a laser company salesman. Initially sceptical, but of course secretly hoping this would be a safe and effective way to increase profitability, I listened to his presentation extolling the alleged virtues of Smartbleach , a laser bleaching system which uses a green light laser called a KTP. Having previously performed a wide variety of other bleaching methods in our practice, we had had mixed results and overall patient satisfaction was low. With trays, patients frequently complained of the inconvenience, the taste, the sensitivity and the lack of a long-lasting result. The results of light activated bleaching systems had not impressed us and this was confirmed by the Clinical Research Associates (CRA) newsletter1 showing that for all the systems they had assessed, it made no difference to the result, once the gels were applied to the teeth, whether the light sources were shined on the teeth or not! The salesman claimed that the Smartbleach system was different, but of course they always say that. He explained that this was a true laser system with a reaction between the green light and a chromophore, or target, in the red gel applied to the teeth. This caused, he said, a photochemical reaction that bleached the teeth. He claimed other systems simply used lasers or lights as a heat source to try to enhance a bleaching reaction. So the jargon began, but at least what he said was consistent with the independent CRA data. The salesman did not try to sell me the laser but asked me to attend a training workshop. Here more would be explained, I could see live demonstrations, and, since the effect of the treatment is immediate, I could judge the results. I decided to attend and this has proved to be one of the best business decisions I have ever made for my practice. It was immediately evident that the system was highly effective. What emerged, and has subsequently been confirmed by our own experience, was that we could get safe, predictable and long-lasting results ranging from good to outstanding. The system can treat tetracycline stained teeth and also sensitive teeth. Indeed, an added bonus has been that the treatment is a very effective long-term desensitiser. Many patients who previously had sensitivity have reported total relief from their symptoms. So far we have treated more than 200 patients in our practice with this laser bleaching procedure. The laser has proved to be an excellent profit centre in its own right and also a great practice builder. We see patients we would not otherwise have seen and many of these do not have a regular dentist. Our emphasis on preventative dentistry, coupled with trained and motivated staff, has ensured that many of these patients remain with our practice. Not all patients have been suitable for bleaching and many of these have decided to have complex restorative and aesthetic treatments with us - veneers, bridges and implants. The same laser can be used for a variety of dental soft tissue treatments and offers advantages over traditional methods. In endodontics, it can achieve dramatically better sterilisation, enabling procedures to be completed in one visit instead of three. In periodontics, the reduction of pockets, gingivoplasty, and gingivectomies, can all be achieved haemostatically and without the need for sutures or buccal dressings. Other indications include the removal of fibromas, irritant epulides, frenectomies, the exposure of implants, fistula treatment and the prevention of demineralisation and caries around braces. We have now made the decision to acquire an Erbium:YAG laser to offer anaesthesia-free cavity preparation and I anticipate that this too will offer benefits to patients, further build the practice and enhance bottom line, not to mention be enjoyable for us to use. Lasers are not for all practices but if you are interested in finding out if they can help you and your patients, I recommend attending a workshop or course. Make sure live surgery is being performed (there is no substitute for seeing it with your own eyes) and insist that the laser company allows you to talk to existing customers. Reference 1. Clinical Research Associates Newsletter, August 2000: Why resin curing lights do not increase tooth lightening. Dr Jacques Meschemberg is in private practice in Adelaide. He can be contacted on (08) 8231 3770 or jacquesm@iprimus.com.au