September 2007 | MH Web Exclusive
Perio possibilities
A first-hand account of the opportunities apparent in laser-assisted dental hygiene.
by Gloria E. Monzon, RDH
Our ability to bring patients to optimal oral health is flourishing from the integration of new technologies. With the public’s heightened awareness of the connection between oral and systemic diseases, we are treating more knowledgeable and sophisticated patients. These patients are demanding more progressive, less-invasive, non-surgical and preventive periodontal care. The laser, as an adjunct to traditional therapy, is an optimal weapon in this battle. Over a decade ago, my first laser occupied an area equivalent to a small end table. I named it after the Star War’s robot, R2D2, for its size, and the noise it made. Many of today’s lasers are now sleek, portable, and very attractive. Manufacturers have incorporated features with dental hygienists in mind, including longer pulse rest intervals to enhance patient comfort. And, although the scope of practice for the hygienist differs from state to state, understanding the ways in which lasers can positively affect the practice are critical. BENEFITS Based on both clinical research and my personal experience, the benefits of lasers in dental hygiene include: bacterial reduction, periodontal pocket depth reduction,an improved bleeding index, the ability to bio-stimulate tissue, hemostasis, and the ability to differentiate and select inflammation.1,5-8,10 In the office where I practice, seven of eight patients receive laser therapy. It is implemented in scaling and root planing (SRP), periodontal maintenance, and some prophylaxis patients. This procedure requires only five to 15 minutes of a one-hour appointment. The obvious goal of laser periodontal treatment is to return the patient to periodontal health. Treatment includes eliminating diseased sulcular epithelium and minimizing bacterial activity. Success is based on halting apical migration of epithelial attachment with minimal pocket depth and no bleeding upon probing. I have successfully employed lasers in periodontal therapy since 1994. Some of the most professionally rewarding results I have observed include: accelerated tissue recovery; enhanced bacterial reduction; more consistent periodontal pocket depth reduction; dramatically reduced bleeding; broad patient acceptance and referral; and, in some advanced cases, improvement in bone quality and quantity.
LASERS AND BONES?
In dental hygiene school we were taught that bone loss is not reversible; once lost, it will not return. Using a laser, I have seen and come to expect improved bone quality and quantity. Although not consistent, in certain advanced cases, this has been attained. Conditions where I have observed bone improvement include advanced periodontal cases under specific conditions: ✽ Patient generally has moderate to heavy calculus and inflammation with vertical radiographic bone loss and sparse bone matrix remaining. ✽ The site is accessible by patient to floss and toothbrush. ✽ Patient is healthy and has good healing ability. ✽ Patient is committed to self-care, compliant to weekly SRP and laser therapy, and scheduled bi-monthly supportive periodontal appointments. Roughly one third of my patients in Dr. Barr’s office who fit this profile have experienced single or multiple-site bone improvement. Other laser hygienists have reported similar, but sporadic, bone improvement. What mechanism enables these laser-associated results? Is it the retreatment protocol, laser bacterial reduction, biostimulation, removal of the epithelium…or the combination?
An exact answer remains elusive. What appears consistent with my results has been the use of lasers in a specific and timely protocol. Moving forward, some questions include: Can we establish the appropriate correlations to enable consistent bone improvement? Will
bone improvement become the hygiene department’s new standard?
TAKE IT FROM ME Drawing from 13 years of first-hand laser use and 11 years as an educator, I believe lasers are a superior instrument to achieve measurable results. I am elated to learn former laser students are reporting outstanding results. Seasoned laser hygienists find these results gratifying and motivating. This is a mechanism that adds passion to their dental hygiene protocols and avoids hygiene “burn-out.” My passion is teaching, but the fruit of that passion is to have other hygienists experience results replicating mine. It is quite satisfying to redefine artificial ceilings defined by old paradigms claiming it was impossible to achieve such impressive results. Personally, I would not consider practicing without lasers. I am firmly convinced this would result in compromised and outdated dental hygiene. WHO NEEDS A LASER? As a quick reference, these would be some of the periodontal conditions that require laser therapy: • 4mm+ pockets with or without bleeding • <4mm pockets with bleeding upon probing • Inflamed or diseased sites • Sites that show radiographic bone loss • Sites where patient reports tissue bleeding upon tooth brushing or flossing • Excessive bleeding sites that need hemostasis to gain
access • Apthous Ulcers | 
