Since the development of the ruby laser, lasers have generated a wide interest in its application to treatment and have established a niche in medicine for many years. Application to dentistry have lagged behind and are often controversial. Lasers designed for surgery deliver controlled, concentrated energy to tissue, which must be absorbed in order to have a biologic effect. If the wavelength and optical characteristics of the laser matches the absorption spectrum of the target tissue, an interactive effect will occur.
Dental applications for lasers attempted thus far have included: teeth bleaching, root canal disinfection, cutting of tooth structure, gum surgeries, and treating gum disease after scaling. However, none of these have completely replaced conventional methods.
What Is a “Clinical Practice Guideline”?
Clinical practice guidelines are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. In medicine, clinical practice guidelines have their foundation in evidence based practice, which is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.
On the other hand, when applied to dentistry, evidence base is an approach to oral healthcare that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient’s oral and medical condition and history, with the dentist’s clinical expertise and the patient’s treatment needs and preferences. Evidence based dentistry is not a rigid methodological evaluation of scientific evidence that dictates what practitioners should or should not do but also relies on the role of individual professional judgment and the patient’s preferences in this process. (Dr. Avanish Bidra, 2014)
Are Lasers Included in Clinical Practice Guidelines for Treating Gum Disease?
FDA clearance for the use of lasers in treatment pertains to soft tissue removal, and does not apply to the treatment of most gum diseases. However, use of lasers in treating gum disease should be based on the proven benefits of hemostasis keeping in mind the claimed, yet undocumented advantage of less post-operative pain with surgical gum procedures. Some laser manufacturing companies and clinicians claim superior clinical outcomes when lasers were used in conjunction with conventional treatment through the sterilization of the infected gum tissues. In a study conducted by Dr. Gordon Christensen in 2015, they could not confirm the claims of superiority for the use of lasers in the treatment of gum disease. He stated that “it appears lasers are not the ‘magic bullet’ claimed for periodontitis treatment—and definitely cannot be justified for ‘pocket sterilization’”. Often times during surgical gum procedures, it is necessary to contour and smooth out the underlying irregular damaged bone to limit areas where disease-causing bacteria can hide. This is not possible with lasers.
The American Academy of Periodontology has stated that further peer-reviewed comparative clinical studies are required to establish the potential of lasers in gum therapy. Furthermore, no long term clinical studies have shown that laser therapy alone can effectively be used to treat chronic gum disease in adults.
In ConclusionTreatment modalities should be predicated by following Clinical Practice Guidelines, and in situations where none exists, follow evidence based guidelines. To date, there does not seem to be enough evidence to merit the wide-spread acceptance and use of lasers in the treatment of gum disease.