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Using Dental Lasers With Children

The American Academy of Pediatric Dentistry (AAPD) has developed a policy regarding the use of dental lasers for pediatric patients.

Using Dental Lasers With Children

The American Academy of Pediatric Dentistry (AAPD) has developed a policy regarding the use of dental lasers for pediatric patients. This modality and other approaches help oral health professionals work with patients and parents/caregivers to maintain optimal oral health. The AAPD policy paper recognizes that this goal may be achieved by using dental lasers as an alternative and complementary instrument to perform selected procedures.

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Safety Considerations

Safety is imperative when utilizing lasers in clinical practice. Protective eyewear is essential for the patient, provider, dental team members, and others observing the procedure. In addition, there is risk of disease transmission via viral particles contained in laser-generated aerosols. Caution should be used for immunocompromised patients, and pharmacological therapy may be treatment of choice in these cases. Sufficient operator training, appropriate laser selection, and effective safety measures are essential when providing laser treatment to pediatric populations.

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Diagnostics

It is the goal of oral health professionals to establish an accurate diagnosis of caries. Up to 25% of children and 50% of adolescents will experience caries in their permanent teeth, and rates of caries in primary teeth are even greater. Dental laser technology has been developed and studied as an adjunct to clinical and radiographic caries diagnosis. Detection of demineralization of tooth structure has been described with the use of a red laser wavelength. Analysis of the light reflected from occlusal surfaces of primary and permanent teeth is used to detect demineralization and changes in tooth structure. However, sealants, composite resin, residual toothpaste, and debris may alter readings and lead to false positives. In light of the possibility of false positive readings, providers should perform accurate and serial assessment of caries activity.

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Soft Tissue

Comfortable, minimally invasive dentistry is an important goal in pediatric care. Tooth preparation using lasers represents an opportunity to provide comfortable and conservative restorative treatment. In this capacity, Er:YAG technology is most commonly used for hard tissue applications. In caries preparation, the erbium laser family has the advantage of providing some analgesic effect on the tooth structure, as well as reducing bacterial content at the prepared site. Laser interaction and effectiveness in removing hard tissue depends on tooth composition, including the water and mineral content of hydroxyapatite. As such, primary teeth often require a lower power setting than permanent teeth.

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Hard Tissue

There are many applications for pediatric soft tissue laser procedures in oral surgery, oral pathology, periodontology, and orthodontics—including frenectomies, frenotomies, operculectomies, gingivectomies, and treatment of aphthous and herpetic lesions.

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Pulpal Therapy

The American Association of Endodontists published a position paper on the use of lasers. In summary, there are advantages and disadvantages to laser use in endodontic therapy, and root disinfection is likely more useful than root preparation. Advantages in root disinfection include photodynamic therapy to kill microorganisms, as well as photon-induced acoustic streaming to distribute disinfecting solutions across root canal systems. Disadvantages in­clude the curved nature of root canal systems, heat generation, and the lack of clinical evidence supporting the long-term success of laser use. That noted, the United States Food and Drug Administration has approved diode lasers for pulpotomies and apicoectomies.

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Trauma

Pediatric dentists and general practitioners often assess and treat traumatic injuries in offices. A thorough history and examination—as well as ruling out more serious conditions, such as a closed head in­jury—are essential. Laser treatment of pulp tissue involved in complicated crown fractures has been studied (primarily with case reports in pediatric populations). Similar to research for laser pulpotomy and pulpectomy, when compared to other medicaments, evidence regarding laser use for pulp treatment is either insufficient or inconclusive. However, in­juries—such as luxation, subluxation, or avulsion—may benefit from decontamination of the periodontal pocket or tooth socket to promote attachment healing. This decontamination can be achieved using a diode or Nd:YAG laser.

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