Forums › Laser Treatment Tips and Techniques › Soft Tissue Procedures › Hygiene regulations/training-need help
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SwpmnSpectatorQUOTEAnother 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.Kelly:
Great point. My only personal use of an Nd:YAG has been on a hog mawl. In Florida we have no hygiene options regarding either the 810-830 nm Diode or Nd:YAG. Either wavelength could potentially cause irreversible damage if improperly used.
Regards,
Al
lookin4tSpectatorIn regard to wavelength, I’m thinking the hard tissue lasers have no place in a hygienist’s hands until further notice. Same goes for the CO2. I don’t know which way the committee will lean in regard to allowing or disallowing, but those two laser types seem wrong to me.
SwpmnSpectatorQUOTEIn regard to wavelength, I’m thinking the hard tissue lasers have no place in a hygienist’s hands until further notice. Same goes for the CO2. I don’t know which way the committee will lean in regard to allowing or disallowing, but those two laser types seem wrong to me.I concur with your beliefs. The erbium laser is a surgical cutting tool and should never be used by a hygienist for any reason. If the diode and Nd:YAG are to be utilized by hygienists this should be allowed only at some sort of programmed pre-set which is proven to have the lowest risk of thermal damage to periodontium and dentition.
Al
kellyjblodgettdmdSpectatorAl – I agree with you regarding hygienists using Er lasers – it’s really not appropriate in my mind. But the reason I feel this way isn’t so much that it’s a “cutting tool”, but rather that there really isn’t any benefit to a hygienist using it in a pocket. It’s not selectively absorbed by pigmented tissue or darkly-pigmented bacteria.
I don’t know about you guys, but my hygienist is an incredibly intelligent individual. We have trained together on how and when to use her laser and she uses great discretion in doing so. Our patients have benefited greatly from her thorough and thoughtful care using lasers in conjunction with her non-surgical periodontal therapy. As it has been said over and over on this forum, it just comes down to training!
Nice thread.
Kelly
SwpmnSpectatorQUOTEAl – I agree with you regarding hygienists using Er lasers – it’s really not appropriate in my mind. But the reason I feel this way isn’t so much that it’s a “cutting tool”, but rather that there really isn’t any benefit to a hygienist using it in a pocket. It’s not selectively absorbed by pigmented tissue or darkly-pigmented bacteria.Another excellent point. To carry it a bit further, it is my belief that there is also no benefit to the dentist using Erbs in periodontal pockets. Simply the wrong wavelength.
Al
lookin4tSpectatorpreprogrammed nd:YAG or diode settings….what would they be and why?
kellyjblodgettdmdSpectatorAl – I couldn’t agree more.
Kelly
SwpmnSpectatorQUOTEpreprogrammed nd:YAG or diode settings….what would they be and why?[img]https://www.laserdentistryforum.com/attachments/upload/williamsa062404.JPG[/img]
I don’t know enough to advise you regarding recommended “hygiene” settings for Diode or Nd:YAG. There are many others here who can help with the proper laser parameters. What I mean is that many lasers such as my Diodent and the MDT Periolase have computer-like touch screens where specific settings can be pre-programmed for energy, gated vs. continous wave, pulse rate or duration, etc. Specific “hygiene” parameters could be(and probably already are on some lasers) pre-set that would pose the least risk of any kind of thermal damage. The hygienist would be trained and instructed not to vary these pre-settings without direct supervision from the dentist.
To take it a step further modern lasers could probably be programmed with security settings something like a “password” for each provider. The dentist would have the “master password” and be able to control settings available to the hygienist. Not unlike the controls parents often use to limit their children’s access to the Internet. For example, if the hygienist tried to or inadvertedly set the diode laser to continous wave 5.0 Watts, the system would shut down.
This post may not answer your questions at all. What I was simply trying to do is explain what I meant by “pre-programming” and how it might ensure the patient’s safety if hygienists are allowed to utilize lasers.
Al
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