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Can Lasers Replace Drills for Cavity Fillings?

“I was never afraid of anything in the world except the dentist,” said Taylor Caldwell. Many people have shared the famous author’s dread of the dentist. Yet, such fears may soon be a thing of the past as new techniques make the visit to the dentist less intimidating. One such innovation is the replacement of the dentist’s drill with a laser for the repair of cavities.

The History of the Dentist’s Drill

Lasers Replace Drills for Cavity Fillings

The dentist’s drill has its roots in ancient history. A team of French archeologists discovered a burial ground in Pakistan in 2006 with human remains that had teeth drilled by a crude dental drill. Experts believe that the drill was similar to the fire-making bows of Native Americans. It would include a wooden shaft with a flint tip that was looped by the drawstring of a bow. As the bow was moved back and forth, the flint tip would be rotated quickly. In 1864, the first mechanical power drill was invented by George Harrington. It was powered by a clockwork design. It was soon followed by the first electric drill, invented by George Green. The dental drill entered the modern era when pneumatic drills were introduced in the mid-twentieth century.

The Path to Lasers

The first laser was developed in 1960 by Theodore H. Maiman, an engineer and physicist who worked for the Hughes Aircraft Company. Many experts soon saw practical applications for lasers in other fields, especially dental researchers. In 1965, R.H. Stern and R.F. Sognnaes published a study that lasers could vaporize enamel. Yet, early lasers could easily damage the enamel and the pulp tissue due to the heat they created. “Because those lasers were not tuned to the molecular vibrations of the calcium phosphate crystals, they had to use 10,000 times more energy than necessary and that caused major damage to the tooth,” explained a pioneer in laser dentistry. Researchers continued to test various types of lasers as they were developed in the coming years. In 1990, the first dental lasers were marketed and approved by the FDA. Since then, developers have continued to expand the types of lasers available for dentistry. A carbon dioxide laser is the latest tool added to the dentist’s arsenal. It may be one of the most useful dental lasers, since it produces a light beam with the best wavelength for many procedures.

Lasers: Better Than a Drill

Dental lasers have many advantages over a dentist’s drill. In 2015, Brazilian researchers found that low-level laser therapy can control pain and swelling in some procedures. Scientists believe this is due to the laser’s ability to stimulate the release of endorphins and to inhibit the transmission of pain signals along neurons. Similarly, lasers can reduce or eliminate the need for anesthesia during cavity procedures. Some dentists have found that up to 70% of patients can undergo treatment for cavities without the need for Novocain and needles.

Second, lasers are much quieter and less threatening than the sound of a high-speed dental drill. Often times the fear caused by the drill whirring at a speed of 200,000 rpm can lead to serious dental problems for people. “About 10% of the population have severe anxiety about trips to the dentist, and many put off their visits until they have toothache or another emergency, such as a dental abscess,” writes Ian Sample. With minimal sound, a dental laser produces less anxiety in patients, which may result in more regular visits to their family dentist, and corresponding better dental health.

Third, lasers are much more efficient than drills. While the whirring bit cannot distinguish between healthy and diseased tooth material, the laser can. A dental laser’s energy is more readily absorbed by water, which enables the beam to destroy diseased tooth material that contains over 20% water while leaving healthy enamel undamaged since it has a much lower percentage of water. As one dentist experienced with the use of lasers observed, “It really seeks out the decay in the tooth and destroys the decay without destroying anything else.”

Fourth, lasers help prepare the tooth for cavity repair. While very effective in removing diseased tooth material from the cavity, the laser also prepares the surface of the cavity for repair with a filling.

Fifth, since lasers require little or no anesthesia, dentists are able to treat more teeth across all regions of the mouth in one appointment. “This saves the patient and dentist time by requiring fewer appointments,” observed one experienced dentist.

Sixth, lasers also may prevent future cavities. A study in 2012 found that teeth enamel is strengthened when treated with the newer carbon dioxide pulsed lasers. “The heat from the laser changes the top layer of enamel from the usual carbonated hydroxyapatite to hydroxyapatite, which is more resistant to acid produced by bacteria,” the study concluded.

Local Expertise in Laser Dentistry

Dr. Marc Lazare, DDS, a member of the clinical faculty at the New York University College of Dentistry, provides state of the art dental care with the latest tools including lasers. He is a master of the Academy of General Dentistry and a fellow in the International Academy for Dental-Facial Esthetics. He has practiced cosmetic and general dentistry in New York City for over twenty years.