Forums › Other Topics › Off Topic › JADA "Lasers in Dentistry" article
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Robert Gregg DDSSpectatorHi All,
I have already posted this on Dental Town (along with attaching the article in a pdf file), but some don’t venture there from here.
http://www.dentaltown.com/idealbb/view.asp?topicID=29300&sessionID={1425744E-A2D4-408F-B4A9-FBBC34EED60F}
Del and I have read his article (see attached) and are disappointed to say the least–but not at all surprised. This is Dr. Dederich and his bias and misunderstandings about applied clinical laser use as usual–the way he has been for over 14 years.
Periodontist Dr. Dederich, once again, can’t resist the chance to denigrate the Nd:YAG wavelength and specifically its use in perio pocket therapy.
Once again, JADA (and specifically Margorie Jeffcoat–a periodontist as well) misses its mission to publish accurate info to its readership.
Just as an FYI, our multi-centered retrospective LANAP article with updated and long term outcomes was rejected by this editor.
Dederich has the pedigree, the forum and the opportunity to present the main-stream dentists in the profession with an accurate portrayal of laser use in dental practice today, yet he continues to harp on issues that have been settled by redefining the standards of use. Now we are to, “…consider what the reliable scientific literature indicates about the technology’s safety, efficacy, and effectiveness.” So who defines what is “reliable” scientific literature? Dederich? JADA? Hardly……..
His laser tissue interactions, laser physics and consequences of pulsed Nd:YAG lasers, for example, is inaccurate and misleading. Pulsed Nd:YAGs do not denature nor disrupt dental pulps when the light is directed at the crowns of teeth, nor is bone exposure associated with “postoperative morbidity”, nor does anyone ever recommend using black dye on tissue. This is pure fiction and it presented as “science” in a prestigious peer reviewed journal such as JADA?! Who peer reviewed this nonesense?
His discussion at the end about Er,Cr:YSGG (2,780nm) as being, “…perhaps the most important recent development in laser dentistry…” is mystifying and solicitous as the examples he gives are exactly the same capabilities as the Er:YAG (2,940nm).
It is truly unfortunate that the profession cannot get an accurate portrayal of lasers in dentistry published in a respected main-stream peer reviewed journal such as JADA, instead of one individual’s antiquated personal biases rehashed yet presented as peer reviewed scientific knowledge, when it is anything but……….. CE credit for this article gives CE a bad name.
I have already emailed my disappointment and displeasure to periodontist Marjorie K. Jeffcoat, D.M.D. Editor of JADA jeffcoatm@ada.org
I have no expectation she would ever print a letter from any of us mere clinicians, but perhaps if she receives a few dozen replies it might wake her up to the fact that she, JADA and Dederich are out of touch with a major paradigm shift in dentistry as well as the 61% of the American public!
Bob
(Edited by Robert Gregg DDS at 10:12 am on Feb. 25, 2004)
ASISpectatorHi Bob,
I hear you.
Some changes don’t come quick if at all. Progress may be at a snail’s pace if you swore it wasn’t going backward. Perhaps change will come about when the power that be is no longer in power.
Hang in there. The proof is in the pudding and broader minds will prevail.
Andrew
kellyjblodgettdmdSpectatorAmen, Andrew and Bob! It amazes me the amount of misinformation there is out there! Especially when authors like this base their articles on inaccurate or outdated information.
Bob – What do you think is up with the Er,Cr:YSGG mention? Perhaps even the ADA has a price?!? I certainly wouldn’t be surprised considering the AAPD taking $ from soft drink companies!
Andrew is right, though. Those of us that use our lasers day after day realize and benefits these lasers give us and our patients.
I do wonder, though, just how long it will take before laser dentistry is “mainstream”.
Kelly
Robert Gregg DDSSpectatorQUOTEQuote: from kellyjblodgettdmd on 2:41 am on Feb. 27, 2004Bob – What do you think is up with the Er,Cr:YSGG mention? Perhaps even the ADA has a price?!? I certainly wouldn’t be surprised considering the AAPD taking $ from soft drink companies!
Kelly
From the WCLI website:
Executive Board
Robert Anderton, DDS, JD, LLM
Immediate past president of the ADA.
A distinguished career serving in many roles within the ADA, including Trustee, Liaison to the Commissions on Dental Accreditation, Council on Education, Government and Legislative Affairs, and many more.
N8RVSpectatorFortunately, I did a search to find this thread. I was going to post the same topic to see if anyone else had read that article.
As a new laser owner, I was somewhat dismayed (but certainly not surprised) to read that, in essence, lasers just aren’t remarkable enough to warrant use in dentistry. Hrmmph.
However, I have to admit that I got a kick out of the conclusion. After discussing the obvious advantages of laser use (e.g., faster healing following surgery, superior attachment following debridement, decreased chance of collateral damage, decreased need for anesthesia), the conclusion said, “… until the laser is shown scientifically to bring about results that are superior to those achieved with conventional means for a significant number of applications …”
Gosh, I tend to think that the benefits outlined in the discussion ARE superior to those achieved with conventional means! Who doesn’t want faster healing, less collateral damage and patients happy that they aren’t numb? Duh.
Maybe I’ll grow more cynical as I use the lasers more and read more JADA articles on their use. I have to agree with you, Bob. JADA has done our colleagues a disservice by printing this article. It will just take that much longer now for our colleagues to catch on to this revolutionary technology.
— Don
BenchwmerSpectatorJune issue of JADA is out.
See Letters. Two published in favor of article, two letters ( From 3 ALD former presidents), stating the obvious errors and strange conclusions reached by Dietrich.
Journal gave the writer unlimited space to answer opposing views and take cheap shots at the Academy of Laser Dentistry as well as laser dentisrty again.
Worth the time to read.
Jeff
dkimmelSpectatorDr. Dederich is a pretty slick guy. I don’t think I would like to be sitting across the table from him if he was a paid expert wittness. I believe he can and has done a bit of damage to laser dentistry as a whole.
The ADA is very much a good old boy network. I would find it very hard to believe they would come out and support Laser dentistry. It would mean that all those dentist out there would have to buy a laser.
The ALD is in trouble and I don’t know enough about the organization yet to know if they know it or not. The ADA and Dederich have drawn the line. If Laser dentistry is going to be Standard of Care or even acceptable care ,there needs to be more good basic research. The barbed wire fences are going up and the days of the Laser Cowboys are coming to an end. As lame as the ADA article was it will be Dental Board reference material. The ALD needs to actively promote good basic research . The laser companies need to poney up with the cash as at least one of them is doing now. I realize the ALD is promting and standardizing laser education but . Its a big but!! The last meeting was a bust as far as education. Glenns course was a start in the right direction, There should be more practical day to day laser CE. Even the Scientific presentations were questionable. There were several that were of very high quality and others that were laughable. They should have been placed under a different presenation heading.
Looks like I’ll need to change my name again for the next ALD meeting!! Allen want to switch name tags??
Seriously I think the ALD can be a great in helping the growth of Lasers in dentistry. I know there are some really hard working people in this orginization. I also believe that one or two improperly done laser cases could kill laser dentistry. The ALD needs to be more proactive and I hope they see the Dr. Dederich article as a call to arms.
David
Robert Gregg DDSSpectatorMarjorie Jeffcoat resigns as editor……ADA News June 2004.
SwpmnSpectatorQUOTELooks like I’ll need to change my name again for the next ALD meeting!! Allen want to switch name tags??David
David:
I admire you for your propensity to speak your mind and tell the truth. You are more than welcome to write my name across your badge in New Orleans as I shall not be in attendance as long as certain companies are embraced by the ALD.
Al
Robert Gregg DDSSpectatorHi Al–
Take it from experience and from one of the ALD Charter Members. The ALD doesn’t embrace any company per se.
In fact, they are awkward with certain companies and claims (including Millennium and LANAP) but it is their role to be representative of all the companies in the marketplace even though “they” (a few on the board who exert influence with university professorships) disagree.
I’m no fan of ALD. I resigned as a board member (Co-Chair of Professional Relations) and resigned my general membership as well and have not renewed. I am on public record calling them elitist, insular, non-educational and non-clinically oriented. They have some major challenges to be the organization that represents clinical dentistry. And as long as university-based academicians are on the board, they will be heading in the wrong direction. But they feel the academicians give laser dentistry legitimacy. Well, the JADA article and the letters to editor ridiculing the ALD shows how much esteem the academicians have brought the ALD–NOT MUCH!
That’s the politics of ALD in a nutshell.
Bob
SwpmnSpectatorQUOTEBob – What do you think is up with the Er,Cr:YSGG mention? Perhaps even the ADA has a price?!?Kelly
……………………………………………………………………………..
What is perhaps the most important recent development in laser dentistry is the advent of the Er,Cr:YSGG laser, which is used with a water spray. This laser is capable of multiple applications because its interaction with tissue is strongly influenced by variations in the air-to-water ratio of the spray. It can be used on soft tissue, enamel, dentin and bone, and its shallow interaction minimizes the risk of collateral damage. Also, the ability to be used for multiple applications improves the economic feasibility of this laser. Another significant benefit of this laser is that it does not necessitate the use of local anesthestic in many operative procedures.
However, traditional methods of performing the same procedures still are more economical on a per-patient basis. Recent innovations to improve patient appeal and the multiple-use capability while achieving equivalent results make a strong argument in favor of the Er,Cr:YSGG laser.
……………………………………………………………………………..
I haven’t received my June JADA and can’t seem to locate the Letters to the Editor online. With all due respect to Dr. Dederich I will state that the paper is over my head and I have a poor understanding of most laser physics. On the other hand, I have three years clinical experience using erbium lasers.
I hate to say it but Dr. Dederich’s comments in the Discussion lead me to two possible conclusions:
1) He has a poor knowledge of currently available dental erbium laser systems and how they interact with tissues.
2) Dr. Dederich may have been financially compensated to write what he wrote and broadcast it via the ADA.
In the USA, there are three major companies which market erbium lasers to dentists. All three erbiums utilize a water spray. Whether or not variations in air/water ratios influence treatment success is controversial. All three erbiums can be used with safety on enamel, dentin, caries, osseous structures and soft tissues. They may each be used for multiple applications and in many cases without chemical anesthesia. The suggestion that these advantages are only available with the 2780nm wavelength is simply ludicrous.
Al
SwpmnSpectatorQUOTETake it from experience and from one of the ALD Charter Members. The ALD doesn’t embrace any company per se.Robert:
Perhaps my choice of words was poor. All of us have the opportunity to review the literature, the marketing claims and then correlate these with our clinical findings. The result is the formation of an “opinion” and mine is that some views/presentations/manufacturer displays should be excluded by the ALD.
Al
Robert Gregg DDSSpectatorQUOTEI hate to say it but Dr. Dederich’s comments in the Discussion lead me to two possible conclusions:1) He has a poor knowledge of currently available dental erbium laser systems and how they interact with tissues.
2) Dr. Dederich may have been financially compensated to write what he wrote and broadcast it via the ADA.
Al–
Correct. He has a very poor understanding of current laser technology as well as clinical uses.
I doubt if he has been paid to say what he said. He has always been solicitous to one company as he bashes another wavelength or manufacturer to show he doesn’t hate lasers overall.
That, and it doesn’t hurt to be solicitous to the company that is throwing around a ton of money. I’m sure he’s looking for his next corporate sponsorship.
I agree with you that some of the presentations from a company or two shouldn’t be given the time on the podium. The problem with/at the ALD is that literally hundreds of former ALD members feel that the ALD is irrelevant or inappropriate. For some key reasons, see my previous post.
Robert
SwpmnSpectatorQUOTEI’m no fan of ALD. I resigned as a board member (Co-Chair of Professional Relations) and resigned my general membership as well and have not renewed.Bob:
You dirty rascal! I always wondered why I couldn’t locate your profile in the ALD online membership directory;)
Dr. Dederich is presenting Lasers in Dentistry: An Update at the ADA Annual Session in Orlando at 2:30 PM on Thursday, September 30th. That’s one meeting I do plan to attend! Make Del and Rusty cover the MDT booth that afternoon and I’ll save you a seat!!!!
Al
dkimmelSpectator_____________________________________________
Dr. Dederich is presenting Lasers in Dentistry: An Update at the ADA Annual Session in Orlando at 2:30 PM on Thursday, September 30th. That’s one meeting I do plan to attend! Make Del and Rusty cover the MDT booth that afternoon and I’ll save you a seat!!!!
_____________________________________________Will you save me a seat as well! I’ll bring the Tar and Feathers.
David
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