No-Shot Fillings in Pediatric Dentistry

Today I want to talk about how lasers can be used for pediatric dental procedures like fillings.

Lasers are not a new kind of dental technology, but they are still expensive enough that not many dental schools or residencies can afford to train students to use them. As I mentioned in a previous blog, I used to be terrified of going to the dentist, and so I have always loved to find out about treatments which are available. If something can make the dentistry experience better for children, then I’m always interested in it. Dentistry has come a long way in recent years, so don’t make your children suffer the way so many of us did!

What kind of lasers do we use in our office?

We’ve been using lasers since 2009. I have six laser machines of four different types in my office, each of which is used for a different function.

The first laser I got was called the SOPROLife, which is a smaller machine with an integrated camera which is used to help detect decay on the biting surface of the teeth. This was useful for a little while, but we don’t use it much anymore as it is less powerful than other lasers we have. However, that means that we have a great opportunity to use this machine for show and tell with visitors to our office – so we can shine a light on a child’s tooth, and healthy tooth will light up in green, while decay will light up in red. This helps children and their parents to visualize what is happening inside their mouths.

One of the newer lasers that we use every day in our office is called a soft tissue laser. We use this laser for frenectomies on babies, for procedures for correcting tongue ties and lip ties, and also for gingivectomies, which are procedures for re-sculpting gums if they have become overgrown after having braces. The gingivectomy procedure used to be performed with a knife, but this is very painful and causes an unpredictable amount of shrinkage during the healing phase afterwards, which can mean that the procedure may have to be repeated. Using a laser, however, you can gently take away tissue and see the final results as you go. Another use of this laser is if someone has burned the roof of their mouth, in which case we can put the laser onto its healing setting and pass it over the tissue for just 30 seconds, which seals off the nerve endings to immediately stop any pain. We also use this laser for herpes lesions, commonly known as cold sores, which appear on the outside of the mouth. If you can work on the cold sore with the laser before it fully appears, you can prevent it from coming up – and even stop it from ever coming up again in the future. Finally, we also use the laser’s healing setting for relieving temporomandibular joint pain or muscle pain.

Another laser which we use very frequently is the soft tissue / hard tissue laser. We use this laser for fillings and for crowns, and even pulpotomies and nerve treatments, as well as the soft tissue treatments described above. What I love about this laser and what got me into lasers is that dentistry can be done WITHOUT shots! What could be better than this? Many patients ask why their dentist doesn’t use this, and the answer is that currently the technology works way better in pediatric teeth than in adult teeth that already have fillings and crowns. I expect in the coming years we will have the same use and benefits in all teeth. We already do in some circumstances. The truth is that: dental schools and residencies can’t afford the amount they would need to adequately train their graduates, the lasers themselves are expensive and the training to learn and be certified and licensed after training is a big commitment. Not many new graduates can afford it and those who can have established themselves in traditional techniques so often feel no need to expend this level of cost and time;

The final type of laser we have is called the Canary, and it can look between teeth, underneath fillings, crowns, and sealants, and it can detect decay without using radiation or an x-ray. If you use an x-ray, it’s hard to see small cavities – in fact, x-rays are only about 27% accurate in detecting very small, beginning cavities between he teeth. The Canary laser, on the other hand, has a much better accuracy rate of 93%. It is fast, painless, and easy, and it gives a numerical score for the degree of decay. This means when we do our remineralization protocol, to try to reverse early cavities, we can see if our treatments are having the desired effect over time.

Some parents are concerned that laser treatments will expose their child to harmful radiation, but they needn’t worry, as none of these lasers using ionizing radiation and so they are all safe to use even on very young children.

Why use lasers in dental treatments?

Laser treatment is much better than traditional drilling, in my opinion, for the following reasons:

When you use a drill, you drill into the tooth which creates heat and friction, sending a pain signal to the nerve. So you have to block the pain with a shot of anesthetic. The shot, however, blocks the nerve much higher up, which causes your skin and gum to also become numb. This is difficult for children to cope with, and many of them find the anesthetic to be an upsetting experience. Lasers on the other hand, use water and light energy, acting only locally within the tooth. So it gives pain relief, but the laser doesn’t cause heat or friction.

Another problem with traditional drilling is that it causes a “smear layer”, which is a paste of bacteria and pulverized tooth dust which has to be washed away with acid. Even when washed carefully, bacteria can still get into the tubules of the 2nd layer of the tooth you are working on and increase the future risk of recurrent decay or infection. In the case of pulpotomy treatments – when the cavity has gone into the nerve of the tooth and there is bacteria in the tooth but no abscess – you usually you have to use harsh chemicals, that do absorb into the bloodstream, to stop the bleeding and kill the bacteria. With the laser, however, you can clean out the tissue and stop the bleeding without having to use any chemicals.

Finally, drills also cause “micro-fractures” – tiny hairline fractures which can become filled with bacteria and cause recurrent decay – that is, re-infection of the cavity you’ve just had work on. The laser does not create a smear layer, but it does clean out the bacteria, and it doesn’t cause micro fractures. This all reduces the risk of decay occurring again.

Future procedures

In the case of an abscess in the tooth of an adult, we can do a root canal or other treatment to try to save the tooth. If a child has a baby tooth which abscesses, however, nothing can be done in conventional terms except extracting that tooth. We have been working on novel treatments (with parental permission, of course!) using the healing setting on the laser to treat abscesses in baby teeth, and we have seen some reduction in the abscesses. Because baby teeth have stem cells, there is much potential to tap here. We’re hopeful that this can help to create new dental treatments in the future which are less painful and more effective.

So why doesn’t everyone use lasers for dentistry?

You might be wondering why all dentists don’t use lasers if they are so much more effective than traditional drilling. One reason is simply the cost – hard tissue laser machines start around $60,000 and can go into the hundreds of thousands. In addition, the provider needs to close the office to take training elsewhere, as well as training their staff and registering the equipment.

But a larger issue is that there is a lack of information about laser treatments since most dentists received no training or information in training. This is why I’m passionate about raising awareness of these treatment options and their benefits.