The addition of dental lasers to a practice can have profound effects.
After adding a hard-tissue laser (also known as an erbium laser) to my practice in 2001, I suddenly found myself having more fun with dentistry. I had taken the plunge into an area of dentistry that was largely unproven at the time. But, after nearly four years of laser use, I can attest now to the myriad of benefits an erbium laser can provide. This article addresses a brief history of lasers and their use in dentistry. In addition, this article will present the many benefits I have experienced, personally and professionally, as a laser dentist. My intent is not to outline what lasers have done in my practice as much as it is to urge fellow dentists to seriously consider the addition of an erbium laser.
A brief history of lasers in dentistry
Before we begin, it is important to understand how lasers came to be in dentistry. The first major development occurred in 1916 when Albert Einstein proposed the theory of stimulated emission. His groundbreaking theory stated that atoms were “excited” by an infusion of energy-released light particles known as photons. Four decades later, two researchers (Schaclow and Townes) invented the “maser,” which used Einstein’s theory to create microwaves from excited atoms. In 1960, research by Schaclow and Townes resulted in the first patent for a process known as “light amplification by stimulated emission of radiation.” Over time, this phrase was shortened to the acronym “laser.” Later that same year, Theodore Maiman introduced the ruby laser - the first true laser device.
It wasn’t long before dental researchers began toying with Maiman’s ruby laser to explore its applications in dentistry. However, after discovering there were few applications for this type of laser in dentistry, they shifted their focus to a gas-based laser known as a CO2 (carbon dioxide) laser. While the CO2 laser was ideal for achieving hemostasis and for coagulation and cutting of gum tissue, it had limited applications for hard tissue. In the mid-1980s, Dr. Terry Myers and his brother developed a pulsed Nd:YAG laser that had applications in both hard and soft tissue. The two formed American Dental Laser, the first laser company dedicated to dentistry.
In 1997, Premier Laser received the first FDA clearance for its erbium:YAG laser for use on hard tissue. A short time later, Biolase Technology received clearance for a new type of erbium laser - the ER CR YSGG laser - designed exclusively for dental use. The ER CR YSGG laser (the type I own) has received various FDA clearances in dentistry, including clearances for Class I-VI cavity preps, root canals, periodontal surgery, endodontic surgery, cutting and shaving bone, and other applications. Since that time, lasers have received widespread use. Several companies offer laser systems for use in dentistry.
¿Why should I spend $50,000 on a laser?¿
Even with the growing acceptance of lasers, many dentists share a key question about the need for adding a unit to their practice. They ask, “Why should I spend $50,000-$60,000 on a laser when a drill works fine?” This is a reasonable question, and there are compelling answers. With a laser, you stand to produce more income, your patients will appreciate the benefits, you will gain the respect of your peers and colleagues, you will re-energize your practice, and you will have fun with dentistry. In addition, the laser can be a great marketing tool.
When was the last time you biopsied a fibroma, freed up a tongue, or completed a bloodless frenectomy? These are conditions that most general practitioners either ignore or refer to a local specialist. These also are conditions that can be handled quite easily by an erbium laser dentist, and generally without anesthesia, blood loss, sutures, or pain. The dental team and patients will be amazed at the results. This turns patients into great referral sources. Don’t be surprised if your medical colleagues start referring patients to you for laser treatment. They will be thrilled to have you as a resource for treating cases of herpetic lesions, chemotherapy mucositis, and painful aphthous ulcers. Enjoying this level of clinical versatility will enrich your practice, and offer invaluable opportunities to serve your patients in new and exciting ways.
Because an erbium laser is a noncontact instrument, there is a learning curve involved. However, there are many advanced training centers, courses from the World Clinical Laser Institute and the Academy of Laser Dentistry, training DVDs, and other training tools at your disposal. But the best training is putting a laser in your hands and using it every day.
How will your patients react?
An erbium laser also offers patients many benefits. Some patients, though, will argue that lasers are more beneficial to the dentist because they alleviate many of the common concerns heard from patients. For example:
●How many times have you heard, “I hate the sound of your drill,” when you step on the foot pedal and begin removing tooth structure at a high-speed? Since using my erbium laser, this complaint has stopped. While laser dentists will not completely abandon their handpieces, they also will not be replacing turbines as often or depleting their supply of burs as quickly. A laser dentist will enjoy the reduction associated with this common complaint.
●Who hasn’t heard a patient lament about hating needles and being numb for hours? Generally, we can put these complaints to rest. Many times, only a simple, topical anesthesia is required to complete laser treatments.
●We have all seen patients on anticoagulants. Often, a patient must be taken off their medication before dental treatment to prevent the potential for prolonged bleeding. Discontinuing anticoagulant therapy, even for a short period, is not without immense risk to the patient. Lasers offer a degree of hemostasis that should be adequate to prevent bleeding. Thus, patients on anticoagulants often continue medication as usual.
●What about the common complaint of sensitive teeth? An erbium laser can treat cervical sensitivity, producing successful results.
How will you benefit?
The practitioner also enjoys many benefits from the use of an erbium laser. These include:
■As anesthesia is generally not needed, you can proceed without waiting for lidocaine to take effect. Not only can you avoid the first injection, but who hasn’t been frustrated when a second or third injection was necessary to begin?
■Occlusion is much easier to verify since patients can complete the procedure without enduring a “frozen face.”
■It has been widely demonstrated that a laser sterilizes as it cuts. This has benefits in both soft and hard tissue.
■The restorative dentist also will appreciate that erbium lasers leave virtually no smear layer behind. This enhances bonding, and reduces postoperative sensitivity.
■Microfractures, which often are a result of using carbide burs on enamel, are also eliminated since only water and laser energy touch a tooth.
■Who hasn’t accidentally nicked a cheek, lip, or floor of a patient’s mouth? When this happens, bleeding ensues followed by many days of painful ulceration. Accidents like this are not possible with an erbium laser. This is why I believe that laser dentistry is safer than traditional “drill-and-fill” dentistry.
What about your reputation among peers?
One of the most surprising benefits of adding an erbium laser to my practice was that I found colleagues and medical peers had a new level of respect for me. For example:
◆Several local MDs expressed their gratitude that they had access to a laser dentist who could alleviate their patients’ pain with a simple, 60-second laser procedure.
◆A local oncologist thanked me for relieving the suffering of patients with debilitating mouth ulcers.
◆My local periodontist called and expressed appreciation for alleviating the discomfort suffered by a patient who had undergone a difficult gingival grafting procedure.
◆My local orthodontist welcomed the atraumatic tooth exposures and frenectomies I was performing for his patients.
◆A local speech therapist was ecstatic with my ability to treat tongue-tied children and infants.
So, do lasers really help with marketing?
The addition of a laser in your practice makes for a tremendous marketing tool. Lasers are cool and sexy. They are used in nearly every aspect of modern human life. They have become the standard of care in traditional medicine as well as opthalmology. Since the introduction of LASIK eye surgery, the public has become increasingly aware of the health benefits of lasers in medicine. They are minimally invasive, less intrusive, faster, and reduce recovery time significantly. All of these benefits hold true for lasers in dentistry. Consumers know this. Laser dentistry is still in its infancy. Currently, less than five percent of dentists worldwide have a laser. This means that there is a good chance you might be one of the first in your community to offer laser treatment to the public. Marketing experts agree that being first in anything, particularly something as important and beneficial as laser dentistry, puts you in a unique and enviable marketing position.
Marketing laser dentistry is accomplished both internally and externally.
Internally, the marketing begins with your enthusiasm for the new technology. Ensure that each patient knows you have this new, cutting-edge, high-tech instrument.Let patients know a laser is a very expensive addition to your practice; they will appreciate your financial commitment to providing them the best care possible. You also may notify existing patients about your lasers by mail or e-mail.
Externally, marketing this new technology is wide open. You may decide to use newspaper ads to introduce your new “drill-less” technology, or you may use radio ads. Radio ads have proven to be effective in my suburban market. Some laser dentists have produced televised segments for broadcast through inexpensive local cable outlets. Others elect to use direct mail campaigns, which are good for reaching households. There are even occasions when you don’t have to do much of your own marketing! Word of mouth, or a simple phone call to a local media outlet can result in free coverage in the newspaper or on television. To date, my favorite experience came when a local television station aired an in-depth news feature about my practice on the evening news during “sweeps” period.
One final concept related to marketing a new dental laser is that you must let dental specialists and physicians know that your practice offers this service. They will begin to refer their patients to you for laser treatment. This provides you a chance to offer the ultimate in dental care, and increase your patient base at the same time.
My experience of practicing laser dentistry has been rewarding, both mentally and financially. After 22 years of practice, my staff and I are having more fun than ever. We are completing a greater array of procedures. We also are receiving the immeasurable gratitude of our patients and peers, who have developed a greater appreciation and respect for our practice and its capabilities. These people understand that I chose to invest significant capital in a device that I think provides the ultimate benefit to the patient. Many dentists suffer from burnout in the middle of their careers. But in our office, the addition of an erbium laser offered a way for us to rekindle our love of practicing dentistry. We simply lit a new candle. Now we are making sure the candle’s flame never is extinguished.
Since 2001, Dr. Robert Tracey has been practicing laser-enhanced dentistry, utilizing an ER,CR/YSGG, a diode, and a DIAGNOdent. A member of the Academy of General Dentistry, American Dental Association, and Academy of Laser Dentistry, he has achieved fellowship status from the World Clinical Laser Institute. Dr. Tracey, whose office is located in Pomona, N.Y., lectures on the clinical applications of hard-tissue and soft-tissue lasers as well as the marketing of laser dentistry. Dr. Tracey can be reached by telephone at (845) 362-2200, or by e-mail at [email protected].