Using dental lasers to decrease pain and fear for patients

Dr. Fernando J. Meza shares key differentiators in performing a root canal with traditional equipment versus dental lasers

The “dreaded root canal” is known among patients as one of the most painful dental procedures. However, endodontists can help change this narrative, starting at the root of patients’ concerns — pain. While time is required for education and understanding around devices like dental lasers, the return on the time investment is invaluable for both the provider and patient alike. Many endodontists may be surprised to learn the stark differences between leveraging traditional dental equipment and new technologies for a procedure like a root canal, and the change in patient perception and experience both during and post-procedure.

Patients who need a root canal may be already experiencing significant pain due to inflammation or infection of the pulp. This inflammation or infection of the pulp can have a variety of causes, including deep decay, repeated dental procedures on the tooth, or a crack or chip in the tooth. In addition to the pain that comes from one or more of these issues, the equipment used during a root canal can further irritate the inflamed or infected area by insufficient cleaning and shaping. This idea alone is enough to deter some patients from seeking treatment sooner, which flows into another concern; if pulp inflammation or infection is left untreated, it can lead to more serious health issues, like an abscess.

Traditional dental devices for a root canal procedure

There are more than 25 million root canals that are performed each year,¹ with the most common equipment used during root canals listed as being nickel-titanium hand and rotary files, stainless-steel hand files, endodontic burs, files and reamers, and ultrasonic units. When patients undergo a root canal and experience pain or significant discomfort stemming from some of the equipment, it can lead to negative feedback around the procedure — ultimately inciting fear among family and friends. As a result, the root canal has received a bad reputation over the years.

While we cannot eliminate all of the traditional equipment used in root canal treatments, adding a dental laser to your endodontic armamentarium can greatly decrease the amount of the equipment that needs to be utilized during this procedure. It can also improve the overall efficiency of a root canal because patients typically spend less time in the chair when a dental laser is the primary device that is being used. This benefits endodontists as well, as they can treat more patients throughout each day. The dental laser offers a greater level of precision than traditional equipment because it has the ability to clean and disinfect anatomy of teeth, which some endodontists previously thought was impossible.

Dental lasers for a root canal procedure

Most endodontists are actively seeking out the latest technologies to implement in order to improve their patients’ experience, as well as their own when performing a procedure. The American Association of Endodontists shares that there have been significant advances in technology and endodontic treatment procedures,² including dental lasers, microscopy, enhanced irrigation technologies, digital radiography, cone beam computed tomography (CBCT), ultrasonic tips and files, and bioceramic sealers. The reason lasers can be so effective in dental procedures is because these lasers emit light energy that has the ability to interact with biologic tissues, such as tooth enamel, dentin, gingiva or dental pulp.³ As a result of this interaction, these lasers can improve disinfection during a root canal, particularly when compared to traditional equipment.

When a patient undergoes a root canal procedure with a dental laser, tissue also has the ability to heal more quickly than it would if a traditional device is used because of more effective regeneration and the enhanced ability of the laser to disinfect the canal system, thereby cleaning more deeply and allowing the body to heal faster. High-intensity visible light has been found to kill bacteria regularly found in infected wounds.⁴ Root canal treatment with dental lasers also becomes more efficient than that of traditional treatments because patients spend less time in the chair, which on its own is less traumatic to the patient and biologic tissues. The idea of enhanced cleaning and dis-infection with less treatment time is a primary reason that the laser can lead to less postoperative pain.

When compared to traditional devices, laser light can penetrate deeper into the dentin,⁵ creating the potential for high levels of canal disinfection. For example, BIOLASE’s dental lasers (the ones I use in my practice) are indicated for cleaning and shaping of root canals and for laser root canal disinfection after endodontic treatment.⁶ The Waterlase^® laser⁷ can be used to open the surface of the tooth to access the root canal, and using a combination of air/water spray and laser energy, endodontists can remove diseased tissue as well as clean and shape the canal. There is also additional data⁸ on dental lasers’ use during root canals, which suggests that the propagation of acoustic waves emanating from a pulsed low-energy laser can help distribute disinfecting solutions more effectively across the root canal system.

There is also a photomechanical effect that occurs when light energy from the lasers is absorbed by water or diluted sodium hypochlorite solution causing cavitation of bubbles, resulting in shear forces generated that are able to remove the smear layer and disrupt the biofilms that shelter the bacteria within the walls of the canals, which also aids in disinfection.

Which laser is right for my endodontic practice?

Before adopting dental lasers, endodontists should research the benefits that they can provide to patients to ensure that they are implementing the right equipment to improve their practice and the patient experience. In 2007, a group of researchers, including myself, published findings on the Er,Cr:YSGG lasers’ involvement and effectiveness in bacterial recovery from dentin walls. The data⁹ displayed that bacterial recovery decreased when laser irradiation duration or power increased, and ultimately, we found that the Er,Cr:YSGG laser with a radial emitting tip has a significant antimicrobial effect leading to 99.7% bacterial reduction.

During a root canal, when an inflamed or infected pulp needs to be removed and the inside of the tooth is carefully cleaned and disinfected, dental lasers provide the necessary precision required to conduct these treatments without causing further inflammation for the patients.

Traditional devices versus modern devices

Overall, if we are keeping score, the benefits for both patients and providers that dental lasers provide significantly outnumber traditional devices by a landslide. As an endodontist, it is truly incredible to see the advances in devices over the years, and the sooner we begin to educate, train, and adopt these into our practices, the more patients we can help. It is no secret that root canals have a notorious reputation among patients, but I believe eventually, with the right equipment, we can change this story.