Interesting question and I’ve been thinking about this alot since you first mentioned it to me.

Since I’ve had the scope, and when I’m using it with the laser, I never do the laser analgesia thing and just get right to it. Maybe its because I can see that much better and thus control the energy, but I don’t see any difference in success. Maybe its the ability to ablate at lower powers. Without the scope (in the posterior) I still tend to do the 90 second thing, but in all honesty I’m numbing up more and more in the posterior areas just because the anesthesia time allows me a few minutes to go do other things (sacrilege, I know). Without the scope in the anterior, I just use low power(1-1.25W) and start defocused, slowly moving in. I’m usually doing max. second molars w/ anesthesia and a handpiece just because its easier and faster. I guess I’ve got to the point of asking is this going to be easier and faster on both the patient and myself ? This may just be my own adjustment in deciding there are some things I am able to do with the laser, but since I’m not trying to prove I can do it anymore, (with the laser) why not do what isn’t going to have me guessing yet at one more thing whether or not the patient is going to feel it.

I know there was one guy that used to post on DT that he never did laser analgesia and was successful but I also had a hard time swallowing that in his first six months the laser didn’t bother any of his patients.

So I’d also like to hear what others experiences have been. Good topic, Ron

Since the topic was brought up:

Not intending to p1&#36&#36 off any of my colleagues but it is my opinion that “laser pre-analgesia/anesthesia” with respect to use of the 2780-2940nm erbium generated wavelengths is BS/non-sense/hocus pocus/voodoo which can only be attributed to a “placebo” effect.

Here in Clearwater we did try the most commonly recommended technique for awhile and found no significant difference from what we were already doing.  If we think about this from a physics standpoint, a defocused erbium wavelength will be immediately absorbed to the tune of a few microns when applied to the exterior of a tooth.  How can it possibly have a several millimeter affect which will disrupt pain impulse in the pulp?

Enamel rod lightwave theory?  Erbium will be immediately absorbed as soon as it strikes hydroxyapatite.  Acoustic theory?  Perhaps something here but I propose results would be similar to banging on the tooth for 90 seconds with a mirror handle.

The commonly observed clinical finding where we are able to prepare non-chemically anesthetized teeth with an erbium laser can only be explained as a local phenomenon.  A high speed handpiece could be viewed as a “Continuous Wave” instrument which applies a constant, deeply penetrating heat effect to the pulp.  The pulsed, short duration, almost-never-on, long thermal relaxation time, micrometer absorbed erbium allows us to prepare many(but not all) teeth without chemical anesthesia due to this localized phenomena.

We currently have our highest ever success rates using the erbium laser to prepare composite restorations on non-chemically anesthetized patients. We carefully select the patient and the lesion. Recently, we have been pulling two patients per day out of hygiene and immediately placing composites without chemical anesthesia. Our patients are thrilled and it adds &#36300-400 per day to our gross income. We are also receiving referrals for pediatric patients where we are able to place composites on deciduous teeth without chemical anesthesia.

Ron,
Just to add my &#360.02; I hear ALL the time how guys NEVER use chemical anesthesia when using the erbium class of lasers. 1st and 2nd molars were my downfall ‘cuz young people felt it. Some guys were able to keep the laser on the tooth with their left hand and drill out amalgam with their right hand. With 6 mag glasses, I never could quite get the coordination to do that. But bicuspids on forward, I could do all sorts of stuff without “the shot”. I use both my erbium and Periolase most every day for an array of stuff.

Kelly Blodgett made an interesting note of laser analgesia with the pulsed Nd:YAG. The analgesia is not long lasting, but the concept of the laser targeting the dark red pulpal tissue made more sense than stunning the tooth with erbium laser energy and water. That being said, when using the erbium and the patient feels pain, defocussing for 90 seconds on the target appears to cut the pain enough to use a slow speed handpiece.

Just another bend on the issue.

Mossman

I think it is very difficult to know how this thing works, if it works at all..
Pain is a very complicated matter.
There is the stimulus that travels to the brain and there this stimulus is interpreted..
if you have real anesthesia the stimulus never reaches the brain or is never generated (like with an injection).
the placebo effect has more to do in the way the brain interpretes this stimulus.
I have been working a lot with hypnosis on my patients in the past and you could do some very spectacular things also. I have removed nerves from vital teeth, extracted teeth etc. without anesthesia, you just have to get the patients in a deep trance and everything is possible.
getting them there is the most difficult and tedious part..
It could be that part of the laser anesthesia is just that; inducing a light trance and convincing the patient it works..several things are in place to get just that..
concentration of patient and dentist, repeated clicking sounds during a certain period, the status of the laser as a non-painfull tool..

but then again…who cares.. as long as it works. Certainly not the patient.

However I think there is more to it.
I treated several patients lately who had a very high sensitivity in the cervical area and treating them with my laser (er:cr) made it disappear and several months later the sensitivity has not come back.
This means to me that there has to be some changes going on because sugestions under hypnosis tend to have an effect only for a few days.

I think the only way to know is to really measure the pulse traffic going on in the nerve during procedures, with or without the “laser anesthesia”.

just my thought

filip

Will this be a double blind (you both blindfolded), clinically randomized, (neither of you knows any of the testers), long term (multiple evening sessions), university provided (young college students hosting the event), being done under the careful scrutiny of your neighbourhood HOOTERS.

If so who is funding the study………CAN I??

Grin

Glenn

Just my two cents everybody: my Delight laser is gathering dust and is used only for the odd soft-tissue procedure (it’s pretty crappy with that also– I should have bought a diode). Major buyers remorse. I’d even sell it if somebody would offer me &#3625k. The only benefit of my Delight purchase is that it taught me about how far I can drill into different teeth with a fast and slow speed handpiece, especially decid. teeth before the patient feels anything. My unscientifically grounded opinion is that laser anesthesia is company hype and total BS, but I’m perfectly willing to be proven wrong, and am so willing to admit I’m wrong I’m not even going to debate the issue. FWIW, Rod Kurthy agrees with me on this issue. As I probably won’t lurk the forums for another 6 months, send hate mail to [email=”jkline@turbonet.com.”]jkline@turbonet.com.[/email]

Regards all,