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January-February 2006 Article (Written by Dr. Keanna for Living Natural Magazine)
Periodontal disease is an infection and involves the breakdown of the surrounding soft and hard tissues of the teeth. Gum (periodontal) disease ultimately leads to tooth loss. I realize that this is the end physical result of systemic health breakdowns. Thus total periodontal treatment encompasses not only the localization and manual treatment of oral tissue but also ‘whole-body therapies’. You can do all the cleanings, root planings, surgeries, and laser treatments that you want for periodontal disease conditions but if the underlying imbalances (nutrition, toxicity, digestion, etc…) are not addressed the periodontal condition will recur.
For decades periodontal disease has been treated with root planning (smoothing of the root surfaces) to remove detrimental “biofilms”, putrefying food, pus, and destructive bacteria. Without treatment, tooth loss becomes a reality. With treatment gum disease can often be stabilized. Use of laser therapy for periodontal disease is coexistent with root planning.
The mechanics of laser therapy involve energy in the form of light. The laser actually converts light to heat and in turn this heat cauterizes and vaporizes the surrounding diseased soft tissues. The light energy comes from stimulated electrons that expel photons (light particles) and the more the electrons are stimulated the more photons (heat energy) are produced. Laser energy falls into the category of radiation. It is at the far right end of the electromagnetic spectrum producing non-ionized wavelengths that do not affect cellular DNA. However, the invisible wavelengths are harmful to the naked eye. Therefore, the patient, assistant, and the hygienist are required to wear protective eyewear specific to the laser wavelength used.
Due to the laser treatment creating a subgingival (below the gum line) burn, the vessels and nerves have been cauterized and the patient feels no discomfort. However, it is important to note that three days after laser treatment the patient may experience some mild to moderate discomfort. This is expected because new fibers are beginning to grow back giving the patient sensations. This minor discomfort can be controlled with a mild analgesic (over the counter pain reliever), homeopathics like arnica and traumeel, and/or herbs like aloe vera. Our office uses the Opus 10 diode laser in conjunction with scaling/root planning procedures. We do not charge the patient additional fees for the usage of the laser because in our treatment module it is part of our necessary ‘phase one periodontal therapy”. This is especially necessary with the evolving understanding between oral disease/infection and systemic disease/infection. Therefore, any means by which a dentist may limit this two-way transference of pathogens and inflammatory mediators needs to be used. That is why our practice has taken the time to learn proper laser protocols and incurred the expenses of using a laser to augment our phase one periodontal therapy.
In no way is the laser every to be used instead of scaling/root planning in phase one periodontal therapy or especially any more invasive procedures or surgeries. The combination of scaling/root planning in our phase one periodontal therapy does not exclude the need for possible referral to a specialist if the therapy does not control the patient’s periodontal disease. Links
1. www.ada.org
2. www.perio.org
3. http://www.pms.ac.uk (International Photodynamic Association)
4. http://www.nature.com (British Dental Journal)
5. http://www.laserdentistry.org
6. http://www.liebertpub.com (Photomedicine and Laser Surgery)
7. http://www.quintpub.com (Journal of Oral Laser Application)
8. http://www.laserinstitute.org References
1.Andreas Mortiz MD, DDS, Ulrich Schoop, MD, Kawe Goharkhay, MD, Petra Schaur, MD, Orhun Doert, MD, Johann Wernisch, DTSc, and Wofgang Sperr MD, DDS, PhD (Dept. of Conservative Dentistry, Dental School of the University of Vienna)“Treatment of periodontal pockets with a diode laser”, Lasers Surg. Med (22)302-311, 1998.
2.Eric Bornstein, DMD; “Method and dosimetry for Thermolysis and Removal of Biofilm in the Periodontal Pocket with Near-Infrared Diode Lasers: A Case Report.” Dent. Today, April 2005.
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5.Academy of Laser Dentistry. “Diode and Nd; YAG lasers: clinical case studies.” Wavelengths. 2004;12:1.
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8.Karu TI, Pyatibrat LV, Kalendo GS (Institute of Laser and Informatic Technologies, Russian Academy of Sciences) “Cell attachment to extracellular matrices is modulated by pulsed radiation at 820nm and chemicals that modify the activity of enzymes in plasma membranes.” Lasers Surg Med. 2001;29(3):274-281.
9.Karu TI, Pyatibrat LV, Kalendo GS (Institute of Laser and Informatic Technologies, Russian Academy of Sciences) “Cell attachment modulation by radiation from a pulsed light diode (lambda=820 nm) and various chemicals”. Lasers Surg Med. 2001;28(3):227-236.
10.Saygun I, Karacay S, Serdar M, Ural AU, Sencimen M, Kurtis B. (Department of Periodontology, Gulhane Military Medical Academy inTurkey) “Effects of laser irradiation on the release of basic fibroblast growth factor (bFGF), insulin like growth factor-1 (IGF-1), and receptor of IGF-1 (IGFBP3) from gingival fibroblasts.” Lasers Med Sci. 2007 Jul 10th (Epub ahead of print).
11.Chan Y, Lai CH. (Department of Microbiology, Chung Shan Medical University in Taiwan) “Bactericidal effects of different laser wavelengths on periodontopathic germs in photodynamic therapy”. Lasers Med Sci. 2003; 18(1):52-55.
12.Castro GL, Gallas M, Nunez IR, Borrajo JL, Varela LG. (Periodontology, School of Dentistry, Faculty of Medicine and Dentistry, University of Santiago de Compostela, Spain) “Histological evaluation of the use of diode laser as an adjunct to traditional periodontal therapy”. Photomed Laser Surg. 2006 Feb:24(1):64-68
13.Moritz A, Gutknecht N, Doertbudak O, Goharkhay K, Schoop U, Schauer P, Sperr W. (Dept. of Conservative Dentistry, Dental School of the University of Vienna) “Bacterial reduction in periodontal pockets through irradiation with a diode laser: a pilot study.” J Clin Laser Med Surg. 1997 Feb; 15(1):33-37.
14.Moritz A, Schoop U , Goharkhay K, Schauer P, Doertbudak O, Wernisch J , Sperr W. (Dept. of Conservative Dentistry, Dental School of the University of Vienna) “Treatment of periodontal pockets with a diode laser.” Lasers Surg Med. 1998; 22(5):302-311.
15.Press J. (Academy of Laser Dentistry) “Effective use of the 810 nm diode laser within the wellness model.” Pract Proced Aesthet Dent. 2006 Oct; 18(9): suppl 18-21.
16.Andersen R, Loebel N, Hammond D, Wilson M. (Ondine Research Laboratories, USA) “Treatment of periodontal disease by photodisinfection compared to scaling and root planning.” J Clin Dent. 2007; 18(2):34-38.
17.Romanos GE, Henze M, Banihashemi S, Paranejad HR, Winckler J, Nentwig, GH. (Dept. of Oral Surgery and Implantology, Dental School (Carolinum), Frankfurt, Germany) “Removal of epithelium in periodontal pockets following diode (980 nm) laser application in the animal model: an in vitro study.” Photomed Laser Surg. 2004 Jun; 22(3): 177-83.
18.Matthias Kreisler, DDS, PhD *, Haitham Al Haj, DDS, Bernd d'Hoedt, DDS, PhD (Department of Oral Surgery, Johannes Gutenberg-University Mainz, Mainz, Germany) “Clinical efficacy of semiconductor laser application as an adjunct to conventional scaling and root planning.” Lasers Surg. Med. 37:350-355, 2005
19.Carla Raquel Fontana *, Cristina Kurachi, Cleber Renato Mendonça, Vanderlei Salvador Bagnato (Departamento de Física e Ciência dos Materiais, Instituto de Física de São Carlos, Universidade de São Paulo, Caixa Postal 369, 13560-970 São Carlos, Sao Paulo, Brazil) “Microbial reduction in periodontal pockets under exposition of a medium power diode laser: An experimental study in rats.” Surg. Med. 35:263-268, 2004.
20.Aymann Nassif Pereira, DDS, MSD 1, Carlos de Paula Eduardo, DDS, PhD 2, Edmir Matson, DDS, PhD 2, Márcia Martins Marques, DDS, PhD 2 *(Department of Stomatology, School of Dentistry, University of São Paulo-SP, Brazil, 2Department of Operatory Dentistry, School of Dentistry, University of São Paulo-SP, Brazil) “Effect of low-power laser irradiation on cell growth and procollagen synthesis of cultured fibroblasts” Lasers Surg. Med. 31:263-267, 2002.
21.Noriyoshi Shimizu, DDS, PhD 1 2 *, Kotoe Mayahara, DDS, PhD 1, Takeshi Kiyosaki, DDS 1, Akikuni Yamaguchi, DDS 1, Yasuhiro Ozawa, DDS, PhD 3, Yoshimitsu Abiko, DDS, PhD 4 (1Department of Orthodontics, Nihon University School of Dentistry, 1-8-13 Kanda, Surugadai, Chiyoda-Ku, Tokyo101-8310, Japan
2Division of Clinical Research, Dental Research Center, Nihon University School of Dentistry1-8-13 Kanda, Surugadai, Chiyoda-Ku, Tokyo101-8310, Japan
3Department of Orthodontics, Nihon University School of Dentistry at Matsudo, 870-1, Sakaecho-Nishi 2, Matsudo, Chiba 271-0092, Japan
4Department of Biochemistry, Nihon University School of Dentistry at Matsudo, 870-1, Sakaecho-Nishi 2, Matsudo, Chiba 271-0092, Japan) “Low-intensity laser irradiation stimulates bone nodule formation via insulin-like growth factor-I expression in rat calvarial cells.” Lasers Surg. Med. 39:551-559, 2007.
22.Ulrich Schoop, MD, DDS 1 *, Wolf Kluger, MD, DDS 1, Andreas Moritz, MD, DDS, PhD 1, Natascha Nedjelik 1, Apostolos Georgopoulos, MD, PhD 2, Wolfgang Sperr, MD, DDS, PhD 1 (1Department of Conservative Dentistry, Dental School, Medical University of Vienna, A-1090 Vienna, Währinger Stra e 25a Austria
2Department of Infectious Diseases and Chemotherapy, University Clinic for Internal Medicine I, Vienna, Austria; A-1090 Vienna, Währinger Gürtel 18-20) “Bactericidal effect of different laser systems in the deep layers of dentin.” Lasers Surg. Med. 35:111-116, 2004.
23.Matthias Kreisler, DDS, PhD *, Haitham Al Haj, DDS, Bernd d'Hoedt, DDS, PhD (Department of Oral Surgery, Johannes Gutenberg-University Mainz, Mainz, Germany) “Clinical efficacy of semiconductor laser application as an adjunct to conventional scaling and root planning.” Lasers Surg. Med. 37:350-355, 2005.
24.Kenichi MATSUZAKA1), Nahoko MIYAKE2), Ken TAKAHASHI3), Kazumasa OHTA4), Masayuki HATTORI5), Takashi MURAMATSU6), Toru SATO2), Yutaka ODA5), Masaki SHIMONO6) and Tatsuya ISHIKAWA3)
(1. Oral Health Science Center, Department of Clinical Pathophysiology, Tokyo Dental College
2. Oral Health Science Center, Department of Crown and Bridge Prosthodontics, Tokyo Dental College
3. Oral Health Science Center, The Third Department of Conservative Dentistry, Tokyo Dental College
4. Oral Health Science Center, Department of Biochemistry, Tokyo Dental College
5. Oral Health Science Center, Department of Dental Materials Science, Tokyo Dental College
6. Oral Health Science Center, Department of Pathology, Tokyo Dental College) “Transformation of hydroxyapatite surface characteristics during diode laser irradiation”
Biomedical Research, Vol. 25, pp.105-108 (2004).
25.S. Parker. “Lasers and soft tissue: periodontal therapy.” British Dental Journal 202, 309 - 315 (2007).
26.Yilmaz S, Kuru L, Noyan U, Argun D, Kadir T. “Effect of gallium arsenide diode laser on human periodontal disease: a microbiological and clinical study.” Lasers Surg Med 2002; 30: 60–66.
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