Fabulous Ron! Great job, and of course, thanks for sharing, helping us to learn great things.
Mark

Thanks to all for your helpful comments. I enjoyed the article from out friend from Montana. I look forward to preping a tooth in the near future.

I was thinking today how nice it is to anesthetise with the laser and then to use the electric hing and the slow speed as needed. With rare discomfort felt by the patient. I get a kick out of asking how it went and they all say that laser is great. They do not even know I used a drill since the familiar high speed whine is gone.

I notice at 1.5 w I am getting brown spots am I using to little water? At this point I do not remember the preset but it is the standard set by the Biolase tech. I also notice with the high magnification the depth of field is less obvious so I find myself reaching for the slow speed so I can feel what I am doing. Does confidence build with time as to the depth of field? Again thanks for all the help.
Pat

First of all, thanks Pat. Second of all, thanks Glenn for your reply, it’s right on. Third of all, thanks Ron, I did a amalgam removal, without anesthesia today as well. Only difference is I used 6w for my usual 1min to 90 sec first, then used the high speed to remove the amalgam, went back to the laser to remove decay and prepare tooth for composite restoration (it was a class I), and it was very easy. My assistant gave me a high five, she’s been wanting me to do this for some time now, your post made me do it! Thanks! Al, as far as the mechanism of action, there is really no sure fire way to find out how it is done, BUT the theory is the reduction of the sodium/potassium pump near the odontoblast/pulp interface. It seems like that makes sense, and at the WCLI in Nice, we discussed it for some time, but no one could really figure a way to really “test” this theory. It sure would be interesting to see what goes on histologically, physiologically at that exact area when defocused laser energy is applied like we do. Anyhow, great posts everyone, let’s keep learning!
Mark

Yes Ron, it was #18. As far as deciduous teeth, I start out defocused at 5W, and then drop to 3W or less before I start any ablation activity. They are so easy to work on, and I notice how children rarely feel anything at all with the waterlase.
Thanks,
Mark

Al–

The answer is:  nobody really knows.

The answer Mark gave is the understanding we accepted in-the-olden-days, and is as good an answer as we have today.

I think it is probably a combination of phenomenon’s.  Like Mark said, the cell membranes appear to become more permeable to calcium, sodium, potassium.  Same with nerve cells in the pulp.

Dr. Paul Bradley from the UK would say that the light has a direct effect on non-mylenated C-fibers in modulating or eliminating a pain impulse. Possibly through inhibition of protein systhesis of pain chemicals.

My partner and I have theorized that proteins involved in localized pain in tissue are denatured and inactivated.

Russian researcher Tina Karu has done a lot of work trying to understand the cellular basis and nature of LLLT (Low Level Laser Therapy)–aka biostimulation.  She has written a book that I think can be ordered on Amazon.com.

Some anti-laser people like Doug Dederich, DDS, MS, PhD, B.F.D., Head of perio at LSU has a theory we are coagulating pulps, and that’s why we can desensitize teeth and numb them before prepping.  He clearly hasn’t used a pulsed Nd or Er:YAG clinically.  If he had, he would have observed the sensation of teeth returns following laser analgesia–sometimes before we are through prepping!

From my experience and talking with thoughtful and sincere folks like Bradley, it seems to be most effective (limited?) to the infrared, both near, mid, as well as far.  For example, blue/green Argon was very disappointing in numbing tissue.

You know, if you all want to take your tooth numbing one step further, try numbing the tissue near the Greater Palatine Nerve or the Incisive Canal next time you need to numb the palatal tissues.  You can even paint on topical  and lase for better uptake and effect.  Nice for “pain-free” palatal injections!

Great question.  No great answers.  But Dederich’s theory is pure poppycock!

I don’t know he mechanism for symptomatic relief when I scratch an itch–I do know it works, however anecdotally that may be….

Bob

Glenn,

We moved the suction a little to see if that would reduce the brown spots during preparation at 1.5w. while doing incisal edges etc. This definitely helped. I have also increased the water from 7% to 12-15% and this seems to have the same effect.
Pat