Forums › Laser Treatment Tips and Techniques › Hard Tissue Procedures › when they start to feel it
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whitertthSpectatorwhen a patient starts to become alittle uncomfortable what do all of u do? Do u reanaesthetize with the laser? I havent had alot of success doing that ? Do u give local ? do u just decrease power down to 1.5 watts? Do u spoons if possible? Just curious!!!!
AnonymousGuestRon,
I’ve been defocusing,dropping down about half a watt and bathing (sometimes buccal/lingual, but more often just into prep). I then slowly move into focus. If still sensitive, drop .25-.5 watts more and repeat til comfortable. Ask patient if they want a “shot”-response is usually no. Eventually local if no success. I bet Mark has some tips on this.
AnonymousGuestp.s.
As I thought some more about the question, it seemed like this might be a good thread to collect a little info regading pain or sensitivity while prepping and see if there might be a pattern.
So how about giving some input on the following?
Most difficult to anesthetize with the laser-
Patient -male/female/age
Tooth number
Where the beam is aimed, when sensitive – floor of prep/buccal/lingual etc.
focused/defocused
My personal most difficult are- female 13-25/lower second molars. Seems like most often get sensitivity directing beam at floor of prep or distocervically on max. laterals. Cervical box area class II’s also seem to be more problematic (not enough water getting to prep?). I also seem to have more sensitivity when I get inside the focal point-scatter maybe?
What have been your experiences?
whitertthSpectatorfemales, all 2nd molars but usually only when if deeper dentin…usually i am slightly defocussed and still getting discomfort
BNelsonSpectatorHi All,
Pretty much the same with me. Get dentinal sensitivity fairly often on max 2nd molars that can be reanesthetized, but often the mand 2nd molars don’t want to calm down and some people request anesthetic.
AnonymousGuestAnyone else?
2thlaserSpectatorI think I would like to ask one more thing. We have found from a psychological standpoint, that we tell the patient they WILL feel something. Cold, air, like an ice cream cone on your tooth. Then they EXPECT a little sensitivity, and when I ask them about it, on a scale of 1-10, I consistently get a “2-3”. They NEVER want the anesthetic. I also, when I enter the dentin, power down to 2.75W, and usually ablate it at that rate. Sometimes even lower wattages if neccessary. BUT don’t forget, I then use my microspoons to finish, and they NEVER feel that. I think that is so cool that it is so comfortable on them.
Like everyone else…usually teenage girls, and sometimes, upper 2nd molars on women.
Mark
2thlaserSpectatorSorry, got so caught up in explanation, I forgot to ask you guys….Do you say they shouldn’t feel anything?
I also almost am NEVER in a focussed mode. I am usually ablating at 4mm distance, and I find they just don’t feel it. When I move in, they start to feel the sensations. Hope this helps.
MarkPS….I just want so bad for everyone to have the experiences I have had. I really have had VERY little in the way of sensitivity, and I still have only had to use anesthesia in 10 cases since last Feb. I don’t know why, it just works in my hands, and I want all of you to have the same success.
Robert Gregg DDSSpectatorHii Guys,
What us old guys have found over the years is that multiple canal teeth–but especially teeth with very thin canal spaces (i.e. 6 year molars that have pencil thin canals and not much pulp chamber), are in various states of vitality.
It is simply harder to reach all the ares of nerve tissue with laser energy that are in several locations and down below the level of the pulp chamber in older teeth that don’t have the large juicy pulps in younger folks.
We have observed that while the pulp chamber is vital, one or two of the other canals is calcified and/or there is a empty canal.
As you then get close to the tooth to cut–and your laser gets “hotter” as the water becomes less effective and the beam intensity increases–you “fire-up” that one canal space by heating and expanding the air content inside getting a pain response.
Take a look at your x-rays on the teeth next time you have trouble. I think you will find the pulp chamber and canals are near non-existant.
Next think about occlusal trauma, hyperemia, large restorations that may have caused a crack and pulpal injury and/or pulpal retreat.
Bob
(Edited by Robert Gregg DDS at 10:14 am on April 28, 2003)
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