Hi Todd,

Welcome to Ron’s new laser forum.

When the first 12 laser users to have ADL’s dlase 300 pulsed Nd:YAG (now ADT), even before it received FDA clearance, they formed a study club of users. Eventually that study club became the North American Academy of Laser Dentistry (NAALD) and the International Academy of Laser Dentistry (IALD). I was involved in the formation of both academies.

Eventually the IALD was merged with the American Academy of Laser Dentistry into one group called the Academy of Laser Dentistry (ALD), and the NAALD was dissolved.

What started out as a study club to share clinical techniques between clinical users and invite researchers to attend meetings and go away with research ideas, has turned into another entity altogether with a different agenda as you pointed out.

I started out with the NAALD as it’s first Vice-President, and we ran the meetings like a study club with d-lase 300 laser dentists presenting their cases, and then a Q&A session after each presenter where a robust discussion took place–as well as lots of learning and note taking by the audience (including the researchers present).

Later on, dentists who used different lasers (carbon dioxide, surgical Argon, CW Nd:YAG) were invited to present. But with the new folks that assumed board positions, a new format was instituted and the “off-label” uses were discouraged. ALD became less of a clinical study and innovations club and more of a presentation society….but I digress.

In the interest of legitimizing the clinical use of lasers that had very few FDA cleared procedures–like “laser curettage” and caries removal, but that many were performing (before erbium was around)–a few clinicians and manufactuer reps got together with Joel White at USCF and developed the Curriculum Guidelines and Standards for Dental Laser Education (CGSDLE). It was a good idea, a huge effort by Dr. White and Arlen Lackey, DDS, and I’m glad we did it. I think it impressed a lot of folks in and out of organized dentistry that we in the IALD and NAALD were serious about being taken seriously. But as to impressing the people who were most critical of our “off-label” uses of our lasers? They could care less. Even today, there is one periodontist professor who openly ridicules the CGSDLE during his lectures that he gives around the country.

So the CGSDLE gave laser dentistry some guidelines on laser education. There were 4 levels:

1. Category I was an introductory class, an overview of lasers that manufacturers might give.
2. Category II–now called “Standard Proficiency”–is a device specific lecture and with a written and participation exan where the attendees show that they have a basic understanding of how to use the laser that they own. The idea was that SP would provide a level of protection should a peer review or malpractice action be filed against a laser user for non-FDA cleared procedures, or just laser use in general where a bad outcome took place.
3. Category III-Mastership–now “Advanced Proficiency”–Provided a laser dentist the chance to demonstrate his/her clinical use of a specific laser device(s) by presenting clinical case presentations under a specific format to their laser peers in the ALD–and earn a certificate from the ALD. It has been a real challenge to standardize this category and there have been different criteria for different presenters.
4. Category T–for trainer (now “E” for Educator)
Was the “natural” progression of the implementation of the CGSDLE and for those who had achieved their Category III. I participated in the first E training session, and felt we all fell short of the mark. The purpose was to provide a standardized teaching baseline for which to teach Category II. We all received a CD-ROM with clinical and reasearch images and was left to us to then modify or replace “slides” with our own material. I suggested that everyone who received their E meet once a year or every other year to re-certify their material, but that idea was set aside for some reason. So much for standardization…….

The only authority the ALD has on regulating dental laser education is that they (we) assumed it. No one has conferred it upon them–not the FDA, the ADA, nor the Regents of UC California.

Unfortunately, the individual dentist assumes the responsibility if they get into trouble. That is why it is CRITICAL for dentists to become familiar with the term “Due Diligence”, take their time, and research all aspects of laser dentistry before they make a purchasing decision.

My biggest disappointment is that the emphasis on education and training of dentists by manufacturers is a recommendation or a referral to someone who might train them–or to the ALD that can “certify” them, but not train them. No manufacturer (well, except one) builds the cost of clinical training into the purchase price of their systems. They are all trying to sell a “box” on cost and dentists are all comparing lasers devices based on price for a box. Only later do densits ask, “how do I use this thing?”

Who really is at fault is the deans and the board of trustees and chancellors at the dental schools and universities that after 15 years since lasers were cleared for use in dentistry (carbon dioxide), there are no standardized CLINICAL training programs in any dental school except for maybe post-graduate maxillo-facial or perio residency programs. But who are those people but “gray hairs” who have to die off before new technology can become part of the stardard curriculum? The only other way is if manufactures buy a wing at the dental school….like Visx did at UCLA’s Jules Stein Eye clinic for teaching LASIK. Look how far that procedure has come since 1995!

And I think if 60 Minutes does an unfavorable dental laser story, those who have tried to implement serious laser education and training standards will fair better in the public opinion than the dental schools, who should be harshly criticized for their abdication of their responsibilities to the public trust to train dentists in this established technology. I mean, this isn’t Cerac 3 where the consequences to the patient for poor usage isn’t a severe injury.

Bob

Lee: I want to congratulate you for coming to this site. I think its great that users of different lasers come here to share information and to help eachother learn.

There are many experienced users at this forum like Bob Gregg whose knowledge makes me feel like he has forgotten more than I will ever know.

Yet , slowly and surely your knowledge will increase.

In a big huge compliment to Ron, I have witnessed a massive leap in his knowledge from when he got his lasers to now. He has tried to read and listened to all and with this in mind his learning curve has been shortened substantially.

Ron , thanks for putting the board together, 66 members already, I never thought I would see that day.

Glenn

Hi everyone,
I had the incredible PLEASURE to meet Lee last week, as he spent a couple of days in my office. I have never met a more personable, professional man, dedicated to our profession. That is why I referred him to this site. He will do awesome things with the laser, in time. He reads, researches, just plain does his homework. He knew so much BEFORE he came to the office. I can’t wait to see what he does when he finally uses his laser. Now, that being said, I still agree with everyone else with education, and training. Dental Schools need this technology. It really needs to get into the didactical and clinical areas, and research as well. WE are doing the research right now, and that isn’t too fair. I just hope that those of us who are users will continue to teach each other, and share our knowlege here, and in other ways to improve and move this technology forward. That’s my 2 cents for now…I am sure I will have more to say at a later time as I need to get to work. Good day to everyone!
Mark
PS….Welcome Lee!!! You are already an asset to OUR education.

Lee,
Welcome to the board. Can’t wait til you get that laser going ,as I know how much more fun it has made dentistry for me.

Thanks to all for their participation- that’s what makes the board so worthwhile. I know you all have helped me a ton!

Todd,
I was wondering if you could give some background on MALD and the process in obtaining it. I know you need to have standard proficiency, laser 2 years, present cases, but what kind of timetable for the cases?After 2 years or as you go along?When does a mentor become involved? Any advice?
Thanks

Thanks Glenn,
Exactly what does the mentor do?