|
Look
Ma, No Cavities by
Dr. Pietrini
A few years ago, Crest toothpaste had commercials
with children running home from their dentist
yelling, "Look Ma, no cavities!" For
nearly fifty years, fluoride has been added to
community drinking water, toothpaste and mouthwash
and dental offices have made topical applications
available. The number of cavities that develop
in children and adults has been drastically reduced.
Today, the most common place for cavities to occur
is in the deep grooves and pits of teeth.
Recently,
a new laser has become available for detecting
cavities. The bacteria found in the decayed portion
of the tooth gives off fluorescence in the tooth,
which is measured by the laser. After the tooth
surface has been cleaned, a red laser light is
directed to the surface of the tooth through a
special tip, and a fluorescent signal is sent
back to the laser. The signal comes out as a number
on the instrument on a scale of 0 to 99. The higher
the number, the more decay below. This allows
the dentist to predict whether or not a tooth
needs a filling or a preventative sealant. Early
detection of cavities translates to easier, less
complicated treatment. Since the laser does not
produce any heat the scanning of the teeth is
painless.
Within
the last few years, several types of lasers have
been developed that can effectively remove decay
and prepare teeth for fillings, thereby reducing
the need for the dental drill. The laser light
is highly absorbed in water. The water content
is higher in decay than it is in healthy dental
hard tissue. Depending on the energy settings
of the laser, the decay removal can proceed more
rapidly than the removal of the tooth structure.
This precision will allow for healthier tooth
to remain, while removing the disease.
When
the dentist scans over the tooth with the tip
of the laser and an accompanying water spray,
the patient will hear a low popping sound. Most
patients relate that this sound is less annoying
than that of the dental drill. Dentists report
that they are able to treat more than 90% of the
cases without dental anesthetics, so your dentist
can treat several teeth in one visit. Bonded fillings
can be placed, cured and polished allowing you
to resume normal activities immediately. This
treatment is suitable for children and adults.
Research
has shown that certain types of lasers can be
used to treat dental enamel and reduce the progression
of decay by as much as 85%. While this work has
only been done in the laboratory, the results
are promising. It will be necessary to conduct
human studies to confirm these laboratory assessments.
|
Nothin'
Against You Doc, But I Hate Dentists
by Dr. Pietrini
Dozens of times over the past years, patients
have stated to me "nothing' against you doc, but I
hate dentists." Often this comment has led to
amusing dialog. In this and future columns I would
like to start with some of the lighthearted
conversations I have had with patients and
friends. My staff has a difficult task of
screening telephone calls, making sure that I am
available to other doctors and patients, yet
attempting to determine which are nuisance calls.
Some of my friends have tried to create confusion
by using phony names or titles such as Tom from
the IRS. One such caller identified himself as
Mike from Oakmont. Thinking it was my friend who
worked in the Oakmont Office Center, I told my
receptionist to tell him that if he could wait,
that I would be with him shortly and to tell him I
had dropped my laser down a patient's throat and I
was attempting to remove it. Much to my surprise
when I answered the phone the person on the other
end was not my friend, but someone named Mike from
Oakmont Securities. Before turning down his sales
pitch, I had to quickly explain that the patient
was doing fine and that it was just a joke.
In the
1980's a dentist, Dr. Terry Myers and his brother
Bill, an ophthalmologist, began experimenting with
lasers used in eye surgery to see if they might be
adapted for dental procedures. In May 1990, the
first laser dedicated for dental use received
marketing clearances from the FDA (Food and Drug
Administration). The resulting marketing effort
that followed brought an awareness of lasers in
dentistry to the public and to dental
professionals. Groups of dentists joined together
to form laser organizations. Today the Academy of
Laser Dentistry is an international society of
nearly 700 dentists from approximately 30
countries, with the Italian Chapter being among
the largest outside the United States. In a little
over ten years, lasers can now be used for patient
care in oral surgery, periodontal care (treatment
of gum disease), removal of decay, immediate
curing (in seconds) of tooth-colored fillings and
whitening of teeth. In 1992 I was privileged to be
among a group representing dental practitioners,
academia and industry that met at a workshop at
the University of California, San Francisco to
draft the "Curriculum Guidelines and Standards for
Dental Laser Education," which we revised in 1998.
The Academy of Laser Dentistry provides
certification courses for dentists and their
staffs to insure the safe and proper use of lasers
in dentistry. For further information, please
contact the Academy at 954-346-3776, e-mail
address at laserexec@laserdentistry.org and their
website at
www.laserdentistry.org.
In
future articles, I will explain more about the
various types of dental lasers and their current
as well as future uses.
Light Up Your Life
by Dr. Dennis R. Pietrini
On the plane coming back from the
10th annual conference of the Academy
of Laser Dentistry, I was listening to a song
recorded a few years ago by Debby Boone—You
Light Up My Life.
I thought that it was a natural transition to this
month’s article, since dental lasers utilize
various wavelengths of visible or invisible light,
which is converted into energy capable of being
used in virtually every aspect of dental
treatment. Twenty-five countries were
represented at this year’s meeting. The first two
days of the conference are dedicated to testing
and certification of dentists and staff followed
by the scientific sessions, which take place over
the final three days. Most of the presentations
relate to the current uses of lasers in dentistry;
however, each year researchers bring us up to date
on the latest developments. I am amazed that these
people have the vision to not only see dentistry
as it is today, but as it will be in the future.
For more than fifty years, fluoride
has been added to drinking water, toothpaste and
mouthwash resulting in a dramatic reduction in the
number of decayed and missing teeth in patients of
all ages. Prior to fluoridation, cavities were
easier to detect by visual inspection, because the
enamel was weaker leaving larger holes in the
teeth. Today, instead of relying solely on x-rays
and explorers (dental picks) to find cavities, new
imaging technology is being employed and
developed. The Food and Drug Administration (FDA)
has recently approved two optical diagnostic
systems for detecting decay—the DiagnodentTM
and the DiFotiTM.
The DiagnodentTM is a
laser, which is used to scan the deep grooves and
pits in teeth. Bacteria in the decay produce
porphyrins, which fluoresce when the light from
the laser is activated. A digital score helps the
dentist determine if decay is present and if
treatment is necessary. This system is not
effective in locating decay between the teeth. The
DiFotiTM (digital fiber optic
transillumination) system utilizes a bright light,
which is transmitted through the tooth to create a
computerized image of the tooth to determine if
decay is present between the teeth. It is not very
useful in detecting decay in the deep grooves and
pits.
Researchers at the University of
California San Francisco are currently developing
a system known as polarization sensitive optical
coherence tomography (PS-OCT). By using an
invisible wavelength of infrared light, a
computerized image can be captured. It appears
that the PS-OCT system will be able to create
images of decay in all aspects of the teeth as
well as under fillings. Another promising use of
this technology will be in diagnosing the
condition of the bone and gum structures around
the teeth and in the soft tissue of other areas of
the mouth. In the not too distant future it will
be possible to scan the mouth to create a virtual
map, which may be used in the detection of a
variety of oral diseases.
The
Popcorn Filling
by Dr. Dennis R. Pietrini
Lorraine
has been a patient in my office for nearly thirty
years. She is a happy-go-lucky senior who has had
a variety of dental care throughout the years
ranging from oral surgery to root canal therapy to
dental implants. Needless to say she has
experienced, first-hand, a lot of the changes that
have occurred in dentistry in her lifetime.
At
a recent visit for a routine examination and
cleaning, I discovered that she had a cavity that
extended between her teeth, near the gumline.
Since she lives more than an hour from my office,
I suggested to her that I could prepare the tooth
and place a tooth-shaded filling immediately. She
wanted to go out to lunch with her daughter and
wanted to know how she would feel afterwards. I
explained to her that I could use my newest laser
that generally allows me to do the cavity
preparation without the need for a local
anesthetic. To do this procedure with the drill
would have undoubtedly been uncomfortable.
Before
using the laser, I explained that it made a
popping noise and that while we use a water spray,
the interaction between the laser and the tooth
surface emits a slight odor. Upon completion of
the preparation, I asked her if she noticed
anything during the treatment. Her amusing
response was, “It sounds and smells like popcorn
popping.” The total time to prepare the tooth
and place the filling was approximately ten
minutes, allowing plenty of time for Lorraine and
her daughter to stop for lunch.
The
advantage of using either a dental laser or an
air-abrasion device instead of the dental drill is
that both machines reduce the heat, vibration and
loud noise associated with the drill. The cavity
preparations produced by these devices are ideal
for minimally invasive dentistry and for placing
tooth-shaded, bonded fillings. In addition, when
the cavity extends near the gumline, the laser
does not cause irritation or bleeding of the
tissue, so that a clean, dry filling can be
placed.
A
few days after I treated Lorraine, she sent me a
note thanking me for saving her a return visit.
She commented, “I love my new popcorn filling.”
|
