By Paul Feuerstein, DMD
Working as I do with technology products, I often get a chance to try some in my practice just before or as they hit the marketplace. Like most of you, I have a busy patient schedule, and to be honest, I don’t have hours to read multipage manuals and go through educational DVDs before I use the products. If they are intuitive or are improvements of previous units, I assume I can just open the box, look at the setup pictures, and see how they work.
In one embarrassing situation, I installed the SoproLife camera/caries detection unit from ACTEON and used it for a few days. I could not figure out how to turn off the camera or the LED lights, so I kept plugging and unplugging the USB connection.
In desperation, I called tech support. I explained that there was an “issue” with this device that the company should address before going to market. The representative said, “Well, on page one of the manual, it explains the magnetic switch that turns the unit off when you put it in the cradle.”
Some of you know the meaning of the acronym RTFM. I had to sheepishly tell this to the VP/COO, Wyatt Wilson, a giant of a man who had trusted me to evaluate the product for him. Despite his wonderful demeanor, he was not too pleased with me. He gave me one of those friendly looks, although he could have squished me like a bug. (Sadly, Wyatt recently passed away at age 39. His presence in this industry and his friendship will be missed.)
As I have examined lasers for this issue and looked at their use in periodontics, I think I should look at the instructions. As I mentioned in a column last year, several of the units have presets for a variety of procedures, but the manufacturers emphasize that these are just guides.
Included in the not-so-fine print, a number of the companies explain that they include training courses — some live, some online, and others on DVD — with the purchase. Many go so far as to state that it is essential for the user to become certified, by either the company or an organization like the Academy of Laser Dentistry, before using the product. (I guess then you would learn where the on and off switches are.)
Several state dental boards are looking at this situation, and many have already implemented guidelines, and even mandates, for proper training in the use of lasers. This also comes into play with hygienists who use lasers as part of therapy.
Investigations have shown offices in which the hygienist is properly trained, but the dentist, who by statute is to be directly or indirectly supervising, has no training. It is essential to check with your state board and find out what the regulations are. There is no excuse for not knowing about these regulations.
I also found the ADA’s stance on this subject. The ADA clearly states that “practitioners obtain proper training in the use of dental laser devices and that dentists use the devices within their licensed scope of practice, training, and experience.… Specific training is available from manufacturers and via independent providers of continuing education.”
In another paper, the ADA Code states, “It is not enough for the dentist to rely on manufacturer’s or distributor’s representations about the product’s safety and efficacy. The dentist has an independent obligation to inquire into the truth and accuracy of such claims and verify that they are founded on accepted scientific knowledge.”
This opens the door to a discussion about the actual research and literature that supports the effect of using a laser in an office’s soft-tissue management program. Typically, the protocol in this regard is a laser sulcular debridement and sterilization of the pockets right after scaling and root planing. This is often performed by the dental hygienist, but as discussed previously, everyone must understand what they are doing.
Also, there are several types of lasers with a variety of properties and powers that the dentist and hygienist must understand. In two published studies (J Periodontol April 2006 and April 2011), the American Association of Periodontics shows there is no difference with the laser’s use. I will not elaborate on this but encourage you to look at the research and accompanying debate among manufacturers, AAP, ALD, and others. You will have to make your decision on this subject.
I do not have enough room in this column to discuss the use of the Millenium Laser and the LANAP procedure. I will say that I have seen remarkable results using this protocaol. Again, I defer to the literature. For now, I want to whet your appetite about this.
Do your homework, read the manuals, take the courses, and treat your patients to the best of your abilities.
Dr. Paul Feuerstein installed one of dentistry’s first computers in 1978. For more than 20 years, he has taught technology courses. A general practitioner in North Billerica, Mass., since 1973, Dr. Feuerstein maintains a website (www.computersindentistry.com), and can be reached at [email protected].
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