The professional blog of Doctors Dan Bruce, Steve Bruce, Rosa Pothier and Rob Ririe
Laser dentistry for soft tissue & periodontal therapy
Dr. Dan Bruce - March 03, 2008
Doctors Steve Bruce, Rob Ririe, and Dan Bruce have recently been certified in laser therapy. Lasers are used to treat periodontal conditions and perform common soft tissue procedures such as removing excess soft tissue, correcting "gummy smiles," removing fibrous tissue, and frenectomies, often using only topical anesthetic. Lasers can also be used for desensitizing teeth, treating cold sores and treating canker sores.
Simply put, periodontal pockets are the space between the top of the gum and where it attaches to the tooth. In heal, these pockets are 1-3 mm and free from inflammation, bleeding or bacterial infection. When plaque, the bacterial byproducts of sugars and carbohydrates that stick on your teeth, stays around long enough the bacterial makeup of the pockets can change. More aggressive and destructive bacteria can increase in number and cause infection and inflammation. At this point several adverse outcomes can occur. The bacteria can enter the bloodstream and have been linked to system problems such as cardiovascular disease, low-birth weight babies, and possibly diabetes. Locally, these bacterial byproducts can solidify to form calculus, which provides a structure for bacteria to live on and is a local irritant that inflames the surrounding tissue. Bacterial byproducts can also cause an inflammatory reaction in the bone and tissue around the teeth, resulting in bone loss and deeper pockets. These deeper pockets make the situation worse, by providing more space for pathogenic bacteria to live and form biofilms (bacterial colonies).
This process can take years and is usually not painful, except for bleeding with brushing and flossing. When periodontal disease starts to hurt, it is usually much progressed and may result in tooth loss. For this reason, we want to detect periodontal problems early and provide conservative treatment. One treatments is have a thorough cleaning above and below the gumline to eliminate as much plaque and calculus as possible (often this takes more than one visit to do a complete and thorough job). We can also place liquid antibacterial agents in the pockets to attempt to destroy bacteria. Finally, we can use laser energy in the pockets to remove inflamed tissue and greatly lower the number of bacteria present. These modalities facilitate faster and more complete healing.
Laser therapy provides significant advantages when combined with traditional treatments. First, laser therapy targets tissue that is darker in color than the surrounding tissue, namely red, inflamed tissue. This is called Laser Assisted Periodontal Therapy (LAPT). We can remove the unhealthy tissue while leaving the healthy tissue relatively intact. Laser therapy also usually requires less trauma to the periodontal structures. Laser therapy also reduces the amount of bacteria present before they are mechanically removed, theoretically reducing the number of bacteria that can enter the bloodstream.
The process of using laser energy to kill bacteria is called Laser Bacterial Reduction (LBR). This can be a great alternative to periodontal surgery for certain patients, and can also assist other patients in maintaining or improving their periodontal probing depths. LBR is, of course, only effective if the patient has excellent oral hygeine thus reducing bacterial counts through brushing, flossing and/or oral rinses.
Although limited hard data is present for both LBR and LAPT, studies are being conducted at this time and more will be learned in the future. It is important to talk to your dentist to see if laser therapy could be part of your periodontal treatment.
Lasers can be used to desensitize teeth that are painful when they come in contact with cold, heat or air. We are also able to treat herpetic lesions in the early stages and stop them from developing plus treating apthous ulcers (canker sores). These treatments are fast and effective for most people and do not require anesthetic.
In summary, lasers have provided our practice with opportunities to treat more problems we see with greater ease, faster healing and more patient comfort. If you have any questions about laser dentistry and the procedures we perform, please contact us.