Zap you're cured.
That's what periodontist Lawrence Nurin says the American Dental Laser installed in his Annapolis office Thursday will do. He says his new tool represents "the wave of the future," promising to make dental surgery much less painful and eliminating the need for needles, scalpels and drills in most cases.
Nurin is the first periodontist in the Baltimore-Washington area to include the laser in his practice. Periodontics is the branch of dentistry treating the diseases of the bones and tissues supporting the teeth, which are responsible for 70 percent of tooth loss in this country.
"I can now perform periodontal surgery, and all the patient will feel is a slight tingling and a slight warm sensation. At the very worse it's like a pizza burn," Nurin said, obviously pleased with his $50,000 neodymium yttrium-aluminum-garnet 3-watt laser.
But the American Academy of Periodontology is still cool on the new technology and warns patients to "be wary of extravagant claims" and "anecdotal" clinical claims.
"The academy's position is that the publicshould be advised to stick to proven treatment methods," said AAP spokesman Paul Amundsen, noting that no studies have been published comparing the benefits of laser and conventional surgery.
Spokesman Philip Weintraub said the American Dental Association "has no formal position on the use of dental lasers" because the clinical studies on the results are incomplete.
Though an estimated 50,000 patients inEurope, Australia, Canada and parts of South America have been treated with nd:YAG lasers, the U.S. Food and Drug Administration approvedthe dental laser only for use on gums and other pockets of tooth decay in May 1990. Periodontists like Nurin began using lasers six months ago.
The debate over lasers is one of the hottest topics in the field, with conventional dental surgeons calling the use of lasers a potentially dangerous marketing ploy, while laser advocates saying the relatively painless technology will bring "dental-phobic" patients in for care before their teeth start falling out.
Weintraub of theADA said independent studies indicate between 10 and 12 million Americans are "dental-phobes," people who are so afraid of dentists and their instruments they never go to dental offices. Another 35 million Americans, he said, are "dentally anxious," meaning they will avoid dentists until they have a problem.
Nurin, who has been a dentist for 22 years and once taught dentistry at the the University of Maryland, says he added the laser to his practice because he is cautious.
"I'm very conservative. I don't like to do surgery unless absolutely necessary because of the possible complications with anesthetics, infection and all the healthy gum tissue that must be cut to gain access to a diseased area," Nurin said. He says he will feel more comfortable operating on patients in the early stages of periodontal diseasenow before permanent tooth damage has set in.
With the laser, he says, he can vaporize a hole straight to the infection and eliminate it. Since burning the tissue also sterilizes and seals the cut area, no stitches are necessary.
Also, since the nd:YAG is a pulse laser, it is supposedly painless. A nerve must be stimulated for at least a thousandth of a second to send a message of pain. The infrared light flashing in the pencil-like tip of the dental laser lasts only about one-sixth as long and cannot be sensed.
At 3 watts, he says, it is also safe even if he mistakenly zaps the tooth. More powerful lasers have been known to destroy tooth pulp.
"It's absolutely incredible," Nurin said Friday after treating his sixth patient -- an anxious 12-year-old boy. "He didn't even twitch."
Nurin estimates that the laser is appropriate for 75 percent of periodontal surgeries and is safer for pregnant, geriatric and hypersensitive patients.
Because a dentist doesn't have to wait 20 minutes for Novocaine to take effect, laser surgery takes about a third less time than conventional surgery. Nurin plans to recoup the $50,000 he paid for the 84-pound tool by taking on more patients.
Most dental insurance policies thatcover conventional periodontal surgery also cover laser periodontics.
Thursday morning, Nurin and his technical staff were already joking about all the new space they will need to handle the flood of newpatients at the office.
But laser skeptics say consumers should wait until studies on the long-term effects of the procedure are detailed before flowing to his door.