Forums Laser Treatment Tips and Techniques Soft Tissue Procedures Hygiene regulations/training-need help

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  • #3356 Reply

    lookin4t
    Spectator

    I would like opinions on what a hygienist can and should be doing with soft tissue lasers. I am interested in what level of training the users here would feel is appropriate. Some of the “certificates” they can currently get are dubious at best in my opinion. I also am of the opinion should my state decide to explicitly allow it some laser wavelengths have no place in the hands of a hygienist. Currently, my state has no true position on it, but is in the process of defining one. The way the rules were written with hygienists in this state, it would almost allow a hygienist to do an appendectomy if a dentist told them to. I’ll stop there, and I’d like to see your opinions.

    #10496 Reply

    dkimmel
    Spectator

    In Fl. hygienist can not even use a diagnodent. It is written they can not use a laser period.
    What do I think. with proper training.
    Decontamination.
    LLLT
    Degranulation.
    This is all within the scope of thier practice in Fl. by other means.
    The key is training.
    David

    #10501 Reply

    lookin4t
    Spectator

    What would constitute proper training? BTW, as of now, I don’t think Bob Gregg thinks his procedure should be done by a hygienist.

    #10493 Reply

    Anonymous
    Guest

    Hack, I’d agree with David  –

    We’re discussing allowing the procdure/ not whether we consider the procedure valid, correct? 😉

    I’d include bleaching under direct supervision
    Diagnodent (record data, not interpetation)
    Decontamination.
    LLLT
    Degranulation- with the stipulation that on this one , besides a Standard Proficiency Certification that there actually be some hands on training. There is a big difference in removing granulation tissue with a sharp instrument and removing granulation tissue with ‘hot glass’ so there needs to be a greater understanding of laser/ tissue interactions. (Proper training might be something like Bob Barr’s training classes 1-2 days with hands on w/ pig jaws.)

    IMO , no way should they be allowed to do Bob’s LPT or depithelializing the outside of a pocket as some of the diode protocols are now suggesting.

    Hope that helps and thanks for the PM!

    #10509 Reply

    Robert Gregg DDS
    Spectator

    Yeah,

    Ron pretty much covered my feelings on the matter.

    Bob

    #10504 Reply

    lookin4t
    Spectator

    Keep ’em coming please.

    Thanks!

    #10507 Reply

    Dan Melker
    Spectator

    Would you give your hygienst a handpiece? Lasers require alot of understanding to be used properly as any other instrument that can do as much harm as good.
    Bob, what has your learning curve? Would you want to turn a laser over to a Hygienst after a weekend course?
    Danny

    #10495 Reply

    dkimmel
    Spectator

    Would you give your hygienst a handpiece? Yes !
    The prophy angle is usless without one. They can also polish restoations and remove OH. At least in Fl.
    It is all about training.
    David

    #10494 Reply

    Anonymous
    Guest
    QUOTE
    Quote: from Dan Melker on 1:39 pm on June 7, 2004
    Would you want to turn a laser over to a Hygienst after a weekend course?
    Danny

    Danny, you’ll notice I didn’t say any weekend course, as there are major differences in what is offered. Bob Barr’s hygienist, Gloria, would give most of the dentists that have started in lasers, the last couple years, a run for their money. JMHO

    #10508 Reply

    Dan Melker
    Spectator

    I agree totally with your statement Big Dave. Training, Training, Training.
    Problem is-think of weekend courses in endo-perio-ortho.
    Alittle knowledge can be dangerous!
    Danny

    #10513 Reply

    Swpmn
    Spectator
    QUOTE
    I would like opinions on what a hygienist can and should be doing with soft tissue lasers.  I am interested in what level of training the users here would feel is appropriate. Some of the “certificates” they can currently get are dubious at best in my opinion.  I also am of the opinion should my state decide to explicitly allow it some laser wavelengths have no place in the hands of a hygienist.  Currently, my state has no true position on it, but is in the process of defining one.  The way the rules were written with hygienists in this state, it would almost allow a hygienist to do an appendectomy if a dentist told them to.  I’ll stop there, and I’d like to see your opinions.  

    Hack2:

    An opinion from a dentist who lives in the NO LASERS 4 HYGIENISTS! state(Florida) and a dentist who currently utilizes none of the following three modalities:

    1) I believe hygienists could be trained to use the Diagnodent diode laser for data collection.

    2) If the dentist subscribes to the theory that diode laser application improves periodontal health AND is willing to allow the hygienists to go through the cumbersome protocols then hygienists could be trained to utilize a low-powered(<5.0W) diode laser. I've run tests using my diode laser Continuous Wave and 4.25W with a hot, activated fiber tip to cut through periodontal ligament all the way down to bone for extractions. We have seen no deleterious effects on osseous structures and excellent one week post-ops.

    My point is at this juncture I believe a properly used, low wattage diode laser could be utilized by dental hygienists. Training would include an ALD approved Standard Proficiency Certification as well as specific diode laser hygiene therapy perhaps something like that offered by Dr. Robert Barr. In-office instruction and close supervision would then be provided by the hygienist’s dentist.

    3) Slowly and skeptically I’m beginning to subscribe to the theory that the only focused light energy truly beneficial for control of periodontitis is the 1064nm wavelength produced by a pulsed Nd:YAG. Specifically the widely variable pulse duration unit utilized by Gregg and McCarthy at MDT. Because this wavelength penetrates deeply into periodontal structures(when compared to a diode) AND the pulsed effects of the laser apply high peak powers to tissue, in my opinion the Nd:YAG should not be utilized by dental hygienists.

    It’s June 2004 and that’s my “revised” opinion today. I’ve utilized erbium lasers for three years and a diode laser for one year as tools to improve restorative dentistry. Erbium lasers do have many “soft-tissue” applications but it is my opinion that they should never be used by dental hygienists.

    Al

    #10502 Reply

    lookin4t
    Spectator

    Thanks for the opinions…I will keep checking in.

    #10497 Reply

    A question for lookin4t: What wavelengths of lasers do you currently use and/or hold your standard proficiency?
    Just curious.

    I will provide my input for whatever it’s worth. I feel entirely comfortable with my hygienist using both our 820nm diode and Nd:YAG. Using either laser (in well trained hands) is a far safer, more comfortable, and more predictable means to “curretage” a pocket than to scrape it away with a scaler. I really have a hard time hearing that we’re uncomfortable with lasers, but extremely sharp instruments that can inadvetantly tear up gums (scalers, files, etc.) are okay. This just seems silly.

    Another question I have for Allen is with regards to being more comfortable with a diode than an Nd:YAG for hygiene usage. If we follow the research that’s been presented on this forum, we will accept that the 1064nm wavelength is more preferentially absorbed by black-pigmented anaerobic bacteria in the periodontal pocket than the 810 or 820nm diodes. With an Nd:YAG, we also have the benefit of a very short pulse width (roughly 100-150usec). If we use this short pulse-width say, 20Hz, then the laser is only firing 0.3% of the time with a 99.7% of the time where the laser is in it’s thermal relaxation phase. If we compare these on/off times with a diode, there is no comparison. My honest bias is that if I’m going to have my hygienist using a laser, I’d rather she use the most preferentially absorbed wavelength with the least amount of energy delievered. I have found over the last 2.5 years having my hygienist use both diode and Nd:YAG, our patients have noticed fewer post-operative issues when using the Nd:YAG.

    I will additionally add, however, that we have seen far better results when using lasers in our hygiene department, than when we didn’t.

    Just my two cents.

    Kelly

    #10506 Reply

    BNelson
    Spectator

    I think that your comments apply to dentists as well. IMO too many companies are providing incomplete training for dentists and encouraging them to do procedures w/o adaquate knowledge or experience. I know I learned much more from my Millennium training than anywhere else. BTW, my hygienist attended all the training with me and does use the laser for isolated curettage- very well I might add. But she is very careful of the limits of her experience and legal boundaries.

    #10505 Reply

    lookin4t
    Spectator

    I have used a CO2 and nd:YAG in the past. I’ve only handled hard tissue lasers in limited settings. I don’t own one currently. However, it would have a limited use in my practice based on what I do as the bulk of my procedures.

    Bruce, I would like more input from you if I could. I have heard from a few laser “experts” if you will that gave me a surprise in that two of them were dead set against hygienists using them.

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