Profile in Oral Health Trisha E. O’Hehir, RDH, BS, Editorial Director, Hygienetown


An Interview with Lyn Rehm, RDH
by Trisha E. O’Hehir, RDH, BS, Editorial Director, Hygienetown

It was Albert Einstein who first theorized about lasers in 1916, yet it wasn’t until 1960 that Theodore Maiman, a scientist at Hughes Aircraft, actually built a laser. Soon after, medicine began using carbon dioxide (CO2) lasers. By the 1980s, lasers were being used in oral surgery and in 1989, the first laser designed specifically for dentistry was introduced. In the 1990s, the Nd:YAG was introduced with a flexible fiberoptic delivery system, making it easier to access subgingival periodontal pockets.

Hygienists generally use either an Nd:YAG or a diode laser which differ in wavelength: 1,064 nm for Nd:YAG and 810 nm for diode. No lasers yet have FDA clearance for calculus removal.

The absorption of laser energy by specific tissues and the conversion of that energy into heat is the way lasers work. The amount of water contained in those cells will also impact the production of heat. Using a pulsed laser gives the tissue a short amount of time to recover between pulses, which changes the temperature reached in the tissues.
The power level and the time a laser is applied to the tissue will also impact the temperature and the outcome. Pigmentation, especially that found in periodontal pathogens will be effected by the laser.

Temperatures of 50 degrees Celsius will inactivate bacteria, 60 degrees will cause coagulation and denature protein, 100 degrees causes vaporization, which is what is needed to effectively remove calculus and more than 200 degrees causes serious tissue damage and carbonization.

For more insight into how dental hygienists use lasers, I spoke with Lyn Rehm, RDH who works in the Phoenix area.

How were you introduced to lasers?
Rehm: My employer, Dr. Ann Sielicki initially purchased a diode laser made by Odyssey for her use. I was intrigued by it and read many articles about the laser’s use for soft tissue management and the great benefits it held. We discussed it and began integrating it into the hygiene therapy in the office.

Were you reluctant at first to use lasers or were you excited to learn this new technology?
Rehm: I was very excited to learn all I could about this new technology to help my patients improve their oral health. It was exciting to have a new technology that would provide even better care than we were currently providing.

Did you have any laser training at the time?
Rehm: I wanted training before getting started, to gain the necessary skills and confidence. I also wanted to learn more about what to say to patients about laser technology, so I attended an extensive course on the use of lasers for soft tissue management at the Las Vegas Laser Institute in 2005. It was there that I became certified. More recently I took a Laser Update course at Phoenix College in 2008. I also try to read as many articles about laser therapy as possible. The technology is changing and improving all the time and I feel it is my responsibility to keep up with it.

What benefits do you see from using the laser for scaling and root planing (SRP)?
Rehm: The incorporation of the laser into SRP provides an added benefit over just instrumentation. Traditional instrumentation will remove the calculus deposits on the root surfaces and the laser provides a way to attack the bacteria within the pocket epithelium. The laser provides complete decontamination of the pocket wall, which expedites the body’s healing process. Since I’ve added the laser to my SRP therapy, I see less post operative sensitivity. I’ve also seen positive radiograph changes in bone levels, due to the effects of the laser on fibroblasts. I often see bone regeneration now that I use the laser on all my periodontal patients.

Do you use the laser for gingivitis?
Rehm: Yes, I do use the laser for patients with moderate to advanced gingivitis. The laser reduces residual bacterial counts and that leads to a faster healing responses.

Are there any other laser procedures you provide?
Rehm: Yes, besides using the laser with SRP, I also use it to treat herpetic lesions, aphthous ulcers, lesions related to cancer therapy and to desensitize root surfaces. Herpetic lesions are best treated when they are still in the initial stage, The laser reduces discomfort and shortens the healing time. The laser reduces pain and shortens healing time for aphthous ulcers as well. I’ve also used the laser to treat oral lesions in cancer patients. Root sensitivity is effectively reduced with the laser. When used to desensitize teeth there are immediate benefits.

How do you explain laser treatment to patients?
Rehm: I have found that it is best to keep my explanation simple. I explain that it eliminates bacteria and helps their body promote faster healing with less post-operative discomfort.

What has the patient response been?
Rehm: The response from patients has been great! When I call my patients in the evening after their visit, they are pleasantly surprised by the lack of discomfort and they report very little post-operative pain. I hear comments all the time about how grateful they are that our practice keeps up on the latest technology.

Do you use local anesthesia when using the laser?
Rehm: Yes, I do use anesthesia when I am doing initial SRP and using the laser. For follow-up and maintenance visits using the laser, anesthesia is generally not needed. When needed in these cases, I’ll use a topical anesthetic in localized areas.

Do you see less bleeding after use of the laser?
Rehm: Yes, absolutely there’s less bleeding when using the laser and this improves visibility greatly. The reduction of bacteria from the laser energy uniquely helps maintain a decontaminated environment while healing begins.

What advice do you have for hygienists just beginning to use lasers?
Rehm: My advice to other hygienists interested in adding lasers to their arsenal of tools is first and foremost, get the basic credentials and certification by attending an accredited course. Next, work with your employer to explore all the benefits of laser therapy. Also, find a hygienist near you who uses the laser and who is willing to be your mentor. You can learn a great deal from someone who is already incorporating this technology into dental hygiene care. A mentor is there to answer your questions and help integrate this new technology into your hygiene therapy. Our practice and specifically the dental hygiene department has been very fortunate to work with BCS consultants. Working with their hygiene leadership team has increased our effectiveness in integrating the laser into our periodontal therapy and the result is improved patient health.
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