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Periodontics: Uses of Periodontic Dental Lasers

Since their introduction in the 1960's, laser use in medicine and dentistry has increased steadily, and it's been no different in Periodontics. The CO2 and the Nd:YAG lasers have both received Food and Drug Administration (FDA) approval for soft tissue surgery and are the most commonly used lasers in dentistry. A dental laser work by delivering concentrated beams of light strong enough to cut through tissue.

Pros & Cons of Dental Lasers

The popularity of lasers results from claims that dental laser gum treatment is painless. Although the FDA has not permitted the manufacturer of any laser to make that claim, the general experience described by patients is that there is less pain and swelling after laser treatment compared to conventional oral surgery. Local anesthesia for pain control is still required during laser surgery.

Another advantage of the laser is that it causes less bleeding in the area of surgery than traditional oral surgery techniques. This is especially helpful in the oral cavity, which has an abundant blood supply. The laser decreases bleeding by sealing the blood vessels at the surgical wound. On the flip side, this can delay healing and create a less stable wound.

Application of Lasers in Periodontal Treatment

The application of lasers in periodontal treatment is restricted to the removal of gum tissue to reduce pocket depth, or for some minor periodontal plastic surgery procedures. These surgeries can be easily performed with traditional instruments without the additional high cost of dental laser treatment.

More recently, lasers have been evaluated for use in scaling and root planing. But in a research study recently published in the Journal of Periodontology, laser therapy appeared to be less effective than traditional scaling and root planing treatment. In fact, research has not conclusively shown that laser therapy is effective in removing the tartar that has accumulated under the gum line and can actually damage the surfaces of teeth and the bone. This damage could delay healing and the ability of the gum tissue to reattach to the root surface.

For all these reasons, the American Academy of Periodontology is concerned about misleading claims regarding the use of lasers in periodontics. It is important to remember that laser treatment in periodontics is limited to soft tissue (gum) for periodontal surgery and that the laser beam should not touch the tooth or bone. Anesthesia is required during dental laser treatment, and dental laser treatment may be more expensive than traditional surgical procedures.

By Laura Minsk, DMD

Periodontitis, The Leading Cause of Gum Disease

According to information from the American Dental Association, three out of four Americans over age 35 have some form of periodontal disease, the major cause of tooth loss and bad breath (halitosis) in adults. Gingivitis is the mildest form of periodontal disease that, if left untreated, can progress to periodontitis, the loss of bone and tissues that support the tooth.

Periodontal disease has three stages, categorized by the extent of bone loss: mild moderate, and advanced. If only one or a few teeth are effected, it is localized. If all the teeth are involved, it is generalized.

Bacteria that accumulate at and below the gum line cause periodontitis. The bacteria release toxic substances that trigger the breakdown of the gum and bone. The body responds with an inflammatory response in which it essentially turns on itself and destructs the bone and tissues around the teeth. This is the body's way of warding off infectious agents.

When this happens the gum separates from the teeth, forming a gap called a periodontal pocket. If left untreated, periodontitis can lead not only to tooth loss but can also aggravate systemic illnesses. The signs of periodontitis may include:

• Bleeding gums when brushing or flossing
• Red, tender or swollen gums
• Bad breath (halitosis) or bad taste
• Receding gums (gums that have pulled away from the teeth)
• Loose teeth
• Teeth that have migrated from their original positions
• Tooth loss

Very often, however, people are not aware that they should see a periodontics professional because gum disease can progress without pain. It is possible to not exhibit warning signs and still have periodontitis. That is why it is very important to have routine periodontal screenings so that the early signs of the disease can be detected and treated before it becomes a major problem.

Periodontal Treatment

Periodontitis is treated in three phases. The first phase involves stopping the disease activity and progression of bone loss. The bacterial deposits (plaque and tartar) that formed above and underneath the gums need to be removed and the root surfaces of the teeth smoothed to enhance healing and deter future plaque retention.

This periodontal treatment is called scaling and root planing. During this phase, a dentist will review the patient's oral hygiene techniques, and give them advice on how to modify certain risk factors associated with periodontal disease.

If the periodontal disease is more advanced, surgical treatment may be needed. The purpose of this phase of periodontal treatment is to create an environment that is more amenable to health and, if possible, bring back some of the bone that was lost to the disease. In some forms of periodontitis, antibiotic treatment may be used. If this is the case, a bacterial culture may be required to test for harmful bacteria and to establish what antibiotics they are susceptible to.

Periodontal disease is a chronic condition that, like many others, has to be closely monitored, even after active treatment.

The third (maintenance) phase is crucial to the success of any periodontal treatment. Daily brushing and flossing is essential in controlling ever-developing plaque and bad breath, as is periodic periodontal maintenance care with a professional scaling of the teeth. Periodontal status will be closely monitored, so that changes can be identified and treated as early as possible.

Everyone should be routinely screened for periodontitis. All dentists are qualified in detecting and treating the early stages of periodontitis, but if an individual suspects that they are at risk, or they know they have gingivitis, they may want to see a periodontist who has advanced training in the diagnosis and treatment of periodontal conditions.

By Laura Minsk, DMD