Dental Hygiene Trends in Laser Therapy Performed by a Dental Hygienist
Similar to the medical field, the field of dentistry is in constant flux – ever-changing to meet the needs of both dental professionals and patients. With a significant amount of nonsurgical periodontal care already being rendered by the dental hygienist, a number of states now authorize delegation of duties consisting of laser procedures to the dental hygienist.
In hygiene, lasers can be used for several things, depending on the State Practice Act. A few procedures provided by dental hygienists in several states include:
Laser Bacterial Reduction, for reducing the bacteria around the normal healthy sulcus to prevent toxins from entering as aerosols.
Laser Assisted Periodontal Therapy used in conjunction with scaling and root planing to aid in the reduction of deeper periodontal pockets by creating an environment that allows healthy tissue to form.
Treatment of herpetic lesions and/or apthous ulcers; to reduce the pain often associated with these lesions.
Treatment of TMJ/TMD issues
Photobiomodulation (PBM), also known as Low Level Laser Light Therapy (LLLT) and Biostimulation.
To date, there are more than 3,900 articles found through PubMed on the effectiveness of PBM / LLLT in treating various pathologies. Photobiomodulation Therapy is FDA approved for extra-oral and TMJ therapy as well as intra-oral pain control and healing.
Low-level laser therapy (LLLT) is a light source treatment that generates light of a single wavelength. The low-level lasers do not cause temperature elevation within the tissue, but rather produce their effects from photobiostimulation effect within the tissues. Low-level lasers do not cut or ablate the tissue. Some studies have analyzed the inflammatory aspects of periodontal tissue and have shown that patients who have undergone conventional periodontal treatment in combination with laser phototherapy (LPT) show better results.
In "A histological evaluation of a low-level laser therapy as an adjunct to periodontal therapy in patients with diabetes mellitus", conclusions of the study showed LLLT has shown efficacy in the treatment of periodontitis in diabetics. Because of more pronounced alterations of periodontium in diabetics, the use of LLLT is of particular importance.
In 2015, a panel of experts convened by the American Dental Association Council on Scientific Affairs conducted a search of PubMed (MEDLINE) and Embase for randomized controlled trials of SRP with or without the use of adjuncts.
The panel judged the following four (4) adjunctive therapies as beneficial with a moderate level of certainty over SRP alone:
Systemic subantimicrobial-dose doxycycline
Photodynamic therapy with a diode laser
Photodynamic therapy (PDT), also known as photoradiation therapy, phototherapy, or photochemotherapy, involves the use of a photoactive dye (photosensitizer) that is activated by exposure to light of a specific wavelength in the presence of oxygen. The transfer of energy from the activated photosensitizer to available oxygen results in the formation of toxic oxygen species, such as singlet oxygen and free radicals.
In the Abstract "The Effect of Photodynamic Therapy and Diode Laser as Adjunctive Periodontal Therapy on the Inflammatory Mediators Levels in Gingival Crevicular Fluid and Clinical Periodontal Status, the authors concluded that the anti-inflammatory effects of periodontal treatment methods, adjunctive PDT and laser treatment significantly reduce the level of inflammatory mediators.
In 2018, the American Academy of Periodontology published a best evidence consensus statement on the efficacy of laser therapy used alone or as an adjunct to non‐surgical and surgical treatment of periodontitis and peri‐implant diseases.
Evidence‐based conclusions indicate:
Current evidence suggests that, as an adjunct to conventional periodontal therapy, appropriate laser therapy may provide a modest additional benefit (< 1 mm) in clinical improvement in probing depth and clinical attachment level (CAL) compared with traditional forms of periodontal therapy in the treatment of moderate to severe chronic and aggressive forms of periodontitis.
At the same time, current evidence is inadequate to conclude that laser therapy alone is either superior or comparable to conventional periodontal therapy in terms of clinical improvement in probing depth and CAL in the treatment of moderate to severe chronic and aggressive forms of periodontitis.
In July 2017, the American Association of Dental Boards conducted a teleseminar podcast for state regulators to provide information on dental laser use. Following is a white paper from that podcast; "How to perform laser dentistry safely and effectively, while also following the rules".
Audience: State regulatory boards and those individuals who work with or for the dental boards.
Keith Brewster, DDS, Dallas, TX, Academy of Laser Dentistry Regulatory Affairs Chair
Gail Siminovsky, CAE, Executive Director, Academy of Laser Dentistry
Angie Wallace, RDH, Tulsa, OK, Academy of Laser Dentistry Regulatory Affairs Chair, (Moderator)
Description: The podcast panel discussion focused on an overview of laser use in dentistry including the following topics:
Basic Concepts of Lasers, Tissue Interaction, Procedures, Documentation
Whether or not lasers should be considered differently than other dental instruments dentists and hygienists use to treat patients
What special or added training and education should be considered, if any?
An overview of what some state regulatory boards are doing
How ALD is responding to the numerous regulatory questions received
How we might work together to fulfill our respective roles in dentistry