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JUNE 2018 LIGHTWAVES

News and Announcements from ALD HQ

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TABLE OF CONTENTS


COMMUNICATIONS COMMITTEE CHAIR

Jeanette Miranda, RDH
ALD Communications Chair

What an amazing time in Orlando for the 25th Anniversary celebration of the Academy of Laser Dentistry. Let me share some of the highlights from the 2018 ALD annual conference.

Eva Grayzel, oral cancer survivor, shared her captivating journey through oral cancer. Annette Quinn RN, MSN, explained how she is helping cancer patients with Photobiomodulation treatments. Robert Strauss, DDS, MD gave an outstanding talk on sleep apnea. Robert Supple, entertained and informed us on airway and envelope of force distribution.

The Implantology, Pediatric, Pain Management, Laser Safety, Practice Management, Innovation, Hygiene and PBM tracks were filled with information and passion.  

Our conference had a truly international feel this year with participants from 22 countries attending. The Philippines took the award for most international attendees with 39 members of their Study Club.

The highlight of the conference was a trip “Back to the Future”!  Our incoming president Dr. Raminta Mastis arrived in the DeLorean Time Machine with Dr. Emmet Brown to bring ALD into the future. 

Please check out the photos from our learning and FUN!!


Eva Grayzel, Keynote Speaker

Dr. John Graeber

Dr. Arun Darbar and Eva Grayzel pose with members of the 
Philippines Study Club

Dr. Arun Darbar, Dr. Raminta Mastis, Dr. Emmett Brown

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KNOWLEDGE HUB
The latest articles on trends in laser use and laser technology

Low-Level Laser Therapy: An Alternative to Opioids in Dentistry
by Dr. Gerry Ross

What if you had technology that could reduce your patients’ pain, improve their wound healing, relieve muscle tension, and regenerate nerves, all without pharmaceuticals or side effects? Although it may sound unbelievable, such a tool does exist!

What if you had technology that could reduce your patients’ pain, improve their wound healing, relieve muscle tension, and regenerate nerves, all without pharmaceuticals or side effects? Although it may sound unbelievable, such a tool does exist!

Photobiomodulation (PBM) has been used clinically since 1967, when Endre Mester of Hungary published his first articles on the topic. Historically, other terms have been used to describe these PBM devices, including low-level lasers, soft lasers, and cold lasers.

The term photobiomodulation is derived from:

  • Photo: Light from either a laser or LED
  • Bio: Eliciting a biological response
  • Modulation: Response to the light energy, resulting in either stimulation or inhibition

PBM is the use of light energy from lasers or LEDs to elicit cellular and biological responses in the body. Light photons act on several cell processes to stimulate the release of cellular energy (in the form of adenosine triphosphate, or ATP), which can be used to facilitate the restoration of normal cell morphology and function (Figure 1).

 

Figure 2. The biphasic dose response means that a low dose of light energy will result in cellular stimulation (eg, stimulation of fibroblasts for improved tissue healing), whereas a higher dose of light energy results in a cellular inhibition (eg, reduction of inflammatory chemicals).

The cellular response from cells, which follows the Arndt-Schultz law, is called the biphasic dose response.1From a clinical standpoint, the biphasic dose response means that a low dose of light energy will result in cellular stimulation (eg, stimulation of fibroblasts for improved tissue healing), whereas a higher dose of light energy results in a cellular inhibition (eg, reduction of inflammatory chemicals) (Figure 2). This additional cellular energy is also available to power many secondary side effects (Table 1).

PBM in Dentistry

Most dentists think of hard-tissue or soft-tissue lasers that are used to cut enamel or soft tissue when they hear the word laser. Though many dental practitioners know little about them, low-level lasers and LEDs also can be invaluable tools.

In fact, almost every aspect of a dental practice can benefit from PBM, whether it’s a general dental or a dental specialty practice. Applications include stimulation of endorphins; reduction in the conduction of nerve fibers that carry pulpal pain (C-fibers); stimulation of fibroblasts, osteoblasts, and odontoblasts (which create soft tissue, bone, and dentin, respectively); and increased circulation and lymphatic drainage. All of these uses can help improve clinical outcomes and decrease patient pain after treatment.

Post-Surgical Benefit: Pain Reduction

Pain, swelling, bruising, and inflammation after an extraction all can be significantly reduced with laser irradiation, reducing or eliminating the need for post-operative analgesics.2 Clinically, the use of PBM allows difficult surgical extractions to be performed without the need for post-operative narcotic analgesic prescriptions. This can have a large societal impact due to the growing epidemic of opioid addiction. The healing of the extraction site also is accelerated, primarily due to the stimulation of fibroblasts.

Case Study

Recently, I saw a patient who needed multiple extractions for a mandibular denture. In addition, he had two large mandibular tori (2 cm long and 1 cm out into the tongue space). With tori this large, it would be impossible for him to wear a full denture.

There were nine teeth to be extracted. Unfortunately, one of the roots of a molar had fractured, so it was necessary to remove bone interproximally and mesially so the root tip could be elevated out.

Large bilateral flaps were made so the tori could be exposed. A surgical bur was used to cut two-thirds of the way through the tori, which were then fractured off with an elevator. A bone file was used to smooth the lingual surface of the mandible, and the flaps were then sutured.

Before suturing, the low-level laser was placed in the socket and an inhibitory dose of 8J/cm2 was given to each tooth (Figure 3). Also, 8J/cm2 was applied to the lingual of the mandible where the tori were removed.

I used an 808-nm, 250-mw laser with a 1-cm diameter tip size. Under normal circumstances, I would have expected the patient to experience severe pain and would have prescribed 25-mg Percocet tablets immediately with one every four to six hours.

Today, I do not use any opioids thanks to PBM, so I prescribed 10 mg of Toradol. I told the patient to take one when he got home and every four to six hours as needed. I also warned him about possible swelling and bruising.

I called him the next day to follow up. After taking the one Toradol, he did not need to take anymore and said he was not in pain. I addition, there was no swelling or bruising. When I removed the sutures the following week, the healing was excellent, and the flaps were fully closed.

An article by Kahramanet et al in the peer-reviewed journal Photomedicine and Laser Surgery compared applying the laser energy extra-orally and intra-orally to a placebo. The intra-oral placement was superior to extra-oral, but both were better than a placebo.2

Other Dental Applications

There are many other applications of PBM in a dental office:

  • Creating analgesia in teeth so more restorations can be completed without the need for needles3
  • Prevention of nausea and gagging using the P6 acupuncture point4
  • Treatment of soft-tissue lesions, cold sores, aphthous ulcers, and denture sores5
  • Better bone healing for better and faster healing in implants and bone grafts6
  • Prevention and treatment of mucositis, a common side effect of chemotherapy7
  • Nerve regeneration8
  • Treatment of facial pain, temporomandibular joint problems, neuropathic pain, and neuralgias.9,10

Is PBM Safe?

In several thousand studies done on photobiomodulation, no clinical side effects have been reported. Photobiomodulation merely restores ATP levels in the mitochondria to normal levels, so it is the cellular response that is delivering a clinical result.

Where Can I Learn More?

Journals: The two leading PBM journals are Photomedicine and Laser Surgery and Lasers in Medical Science. Both are evidence-based, peer-reviewed journals that are a tremendous resource for any practitioners utilizing, or thinking of including, PBM in their practices.

Textbooks: Two of the best PBM textbooks are Handbook of Low-Level Laser Therapy9 and The New Laser Therapy Handbook.10

Organizations: The World Association of Laser Therapy, North American Association for Photobiomodulation Therapy, and Academy of Laser Dentistry all have extensive PBM tracks at their meetings.

Conclusion

A huge benefit of PBM is that patients see their dental practitioner doing something extra to reduce the pain or discomfort that may have been caused during the appointment. The very nature of what dentists do causes pain and inflammation.

PBM requires a paradigm shift. Instead of using drugs to treat the pain after it has started, a dentist now can treat the pain immediately and without the use of narcotics in the dental office and, in many cases, mitigate the pain before the patient feels it.

In an aging population that often relies on multiple medications, this is a huge positive result. PBM is an effective alternate or adjunctive tool to achieve improved clinical effects. It is a benefit to the dental practitioner and patient to investigate PBM, an untapped and underutilized resource in the dental industry.

Disclosure

Dr. Ross lectures and teaches training courses for Zolartek, which produces surgical/low-level lasers. A fee is paid for conducting these courses. However, Dr. Ross has no financial interest in the company. Dr. Ross also contributes to the development of training manuals and instructional videos for MedX Health, which produces several PBM devices. A fee is paid for these activities. However, Dr. Ross has no financial interest in the company. Neither Zolartek nor MedX Health has remunerated Dr. Ross for writing this article.

References

  1. Huang YY, Chen AC, Carroll JD, et al. Biphasic dose response in low-level light therapy. Dose Response. 2009;7:358-383.
  2. Kahraman SA, Cetiner S, Strauss RA. The effects of transcutaneous and intraoral low-level laser therapy after extraction of lower third molars: a randomized single-blind, placebo controlled dual-center study. I 2017;35:401-407.
  3. Chow R, Armati P, Laakso EL, et al. Inhibitory effects of laser irradiation on peripheral mammalian nerves and relevance to analgesic effects: a systematic review. I 2011;29:365-381.
  4. Ezzo J, Streitberger K, Schneider A. Cochrane systematic reviews examine P6 acupuncture-point stimulation for nausea and vomiting. J Altern Complement Med. 2006;12:489-495.
  5. Almeida-Lopes L, Lopes A, Tunér J, et al. Infrared diode laser therapy-induced lymphatic drainage for inflammation in the head and neck. Laser Ther. 2005;14:67-74.
  6. Zein R, Selting W, Benedicenti S. Effect of low-level laser therapy on bone regeneration during osseointegration and bone graft. Photomed Laser Surg. 2017;35:649-658.
  7. Yoshida K. Current considerations for low-level laser therapy/photobiomodulation therapy in the management of side effects of chemoradiation therapy for cancer. Photomed Laser Surg. 2017;35:457-458.
  8. Guarini D, Gracia B, Ramírez-Lobos V, et al. Laser biophotomodulation in patients with neurosensory disturbance of the inferior alveolar nerve after sagittal split ramus osteotomy: a 2-year follow-up study. Photomed Laser Surg. 2018;36:3-9.
  9. Hamblin MR, Pires de Sousa MV, Agrawal T, eds. Handbook of Low-Level Laser Therapy. Singapore: Pan Stanford Publishing; 2017.
  10. Tunér J, Hode L. The New Laser Therapy Handbook. Coeymans Hollow, NY: Prima Books; 2010.

Dr. Ross has been practicing general practice dentistry with a special interest in facial pain in Tottenham, Ontario, since 1971 and has been using lasers in his practice since 1992. He has given over 200 courses and lectures on the subject both nationally and internationally and has published 15 articles. He has written chapters for two textbooks and is a peer reviewer for four laser journals. He holds Advanced Certification and is a Certified Course Provider from the Academy of Laser Dentistry (ALD) and has fellowship status in the American Society of Laser Medicine and Surgery. In 2016, he received the Leon Goldman Award from ALD as that year’s outstanding laser clinician. Contact Dr. Ross at ddsross@rogers.com.

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ALD COMMUNITY
ALD members in the news

There was so much to celebrate during ALD’s 25th Anniversary! Awards, scholarships, grants and Advanced Proficiency certifications were awarded to many ALD members.

Award Recipients


Mary Lynn Smith, RDH was awarded the Leon Goldman Award for Clinical Excellence

John Graeber, DMD was also awarded the Leon Goldman Award for Clinical Excellence

Scott Benjamin, DDS received the John G Sulewski Distinguished Service Award

 

ALD Fellowship & ALD Mastership


Dr. Mel Buchanan presents the ALD Fellowship to
Marina Polonsky, DDS and Maria Judith Yap, DMD


Dr. Mel Buchanan presents the ALD Mastership to
James Carreiro, DMD

 

Dr. Eugene M. Seidner Program


Seidner Student Scholarship recipients
Rodrigo C. Mosca, DDS, MSc, PhD, Sophannary Kong, DDS,
James Ritter, BS, DDS


Seidner Research Grant recipients
Dr. Chris Walinski, University of Tennessee
Mary Lynn Smit, RDH, McPherson College

 

Advanced Proficiency Certifications

AP I
Nick Clausen
Nicole Fortune, RDH
 

AP II
Nick Clausen, Laser Safety Officer
Nicole Pristavec-Hunter, RDH
 

AP III
Black Cameron, DDS
Joy Raskie, RDH
Nick Clausen, Laser Safety Officer

 

25th Anniversary Signature Drink Contest Winners


First Place ($150 award)
Mary Lynn Smith, RDH (aka Super Laser Girl)
Watch Mary Lynn create the winning cocktail here.


Second Place ($75 award)
Dr. Mel Burchman
Watch Dr. Burchman create his cocktail here.

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SPECIAL ANNOUNCEMENTS
New President & Officers Installed During Annual Meeting in Orlando

Raminta Mastis, DDS presides as ALD President from May 2018 to May 2019. The announcement was made during the ALD’s recent 25th Anniversary Meeting in Orlando. Meet the other newly installed ALD Officers for the 2018-2019 term here.

Dr. Mastis graduated from the University of Illinois College of Dentistry in 1987.  She maintains a private dental practice, Michigan Cosmetic and Laser Dentistry, in St. Clair Shores, Michigan.  She previously served as Co-Chair of Certification and Education Committees, Chair of Laser Safety and Communications Committees, and was the 2014 General & Scientific Sessions Chair of the Annual Meeting.  Dr. Mastis has been using lasers since 2000 and has 18 lasers of various wavelengths in her practice. She holds ALD Standard Proficiency certifications in Er:YAG, diode, Er,Cr:YSGG, and CO2 laser wavelengths, and has achieved ALD Advanced Proficiency in the Er:YAG wavelength. In addition to laser dentistry, her practice is focused on implant surgery and restoration, esthetic and cosmetic dentistry, and the integration of advanced technologies into practice.  Dr. Mastis also holds ALD Mastership status.

Other Installed ALD Officers for 2018-2019:

The following, newly-installed ALD officers will serve a term that concludes with the installation of a new slate of officers during the ALD 2019 conference in Dallas that will take place April 4-6, 2019:

Mel Burchman, DDS, President-Elect:  Dr. Burchman has maintained a private dental practice in Langhorne, Pennsylvania, for 38 years.  He has been using lasers for more than 17 years and has 8 lasers in his office. He has served on the Board of Directors for one 3-year term, served as the 2015 General & Scientific Sessions Chairman for the Annual Meeting as well as volunteering his expertise as Certification Committee Chair, Secretary and Treasurer.

Dr. Burchman has volunteered as a mentor and examiner for more than 15 years.  In 2012, he was the honored recipient of the ALD Leon Goldman Award for Clinical Excellence.  Dr. Burchman also holds ALD Mastership status.

Ed Kusek, DDS, Treasurer:  Dr. Kusek graduated from the University of Nebraska College of Dentistry in 1984.  He has served as ALD Communications Chair and Testing subcommittee Chair. He holds the titles of Diplomate of the American Board of Oral Implantology/Implant Dentistry, Fellow of the American Academy of Implant Dentistry, Mastership in Academy of General Dentistry and Academy of Laser Dentistry, and Diplomate of the International Congress of Oral Implantologists.  Dr. Kusek is in private general practice in Sioux Falls, South Dakota.

Arun Darbar, BDS, DGDP (UK), Secretary:  Dr. Arun Darbar is at the forefront of laser dentistry in the United Kingdom and lectures on the subject worldwide.  He has been a clinical laser user for nearly 25 years and provides cutting-edge dentistry to his patients. Dr. Darbar is an accredited member of the British Academy of Cosmetic Dentistry Credentialing Committee.  He holds ALD Mastership and Educator status and has served as co-chair of Education and Certification, and International Relations Committees. He is a published author, and some of his concepts in low-level laser therapy (LLLT) data have been published as proceedings of SPIE in 2006, 2007, and 2009/10; WALT 2008 South Africa and 2012 Australia; and in UK dental publications.  Dr. Darbar is the first and only laser dentist in the UK to be invited to the House of Lords for a charity fundraiser organized by Lasers for Life. Dr. Darbar maintains a private practice in Leighton Buzzard, UK.

Charles R. Hoopingarner, DDS, Immediate Past President:  Dr. Hoopingarner attended the University of Texas Health Science Center at Houston (UTHSCH) Dental Branch, graduating with a DDS in 1973.  He has maintained a private practice in Houston, Texas, since 1973. He was an adjunct associate professor in anatomical sciences at UTHSCH Dental Branch for 12 years.  Currently, he is a member of the adjunct clinical faculty in the Restorative Dentistry Department at UTHSCH and has been a clinical instructor at the Las Vegas Institute for reconstruction and laser dentistry.  Dr. Hoopingarner has served on the ALD Board of Directors, has held chairman positions for Regulatory Affairs, Education and General Sessions for the 2013 Conference. He has used dental lasers of various wavelengths as integral parts of his patient care delivery system for the last 12 years.  Dr. Hoopingarner holds Advanced and Standard Proficiency certifications in the Er:YAG laser wavelength from the ALD, ALD Mastership status, and has lectured internationally on the safety and use of laser technology in the dental practice.

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EVENTS & EDUCATION
Upcoming events and CE opportunities

ALD AND BAIRD International Conference - Registration ends June 30

ALD and British Academy of Implant and Restorative Dentistry (BAIRD) have partnered to bring together International Conference (iLED) to be held in InterContinental Dubai Festival City, Dubai, United Arab Emirates, from Oct. 5–6. The conference will focus on the latest innovations and techniques in implant, laser, aesthetic and digital dentistry. Read more...

Early registration provides the greatest value for attending this world-renowned dental conference,” said ALD president Dr. Raminta Mastis. "No matter where in the world you practice dentistry, iLED 2018 is the premier forum to refresh your knowledge base by explaining and demonstrating the latest innovations in dentistry which will in turn help you deliver outstanding patient outcomes in your day-to-day practice.

In keeping with this year’s theme of “Imagination, Innovation and Illumination,” the iLED’s scientific committee has prepared a curriculum of sessions and workshops with international key opinion leaders that will cover four pillars of modern dentistry: implants, lasers, restorative and digital technology. There will also be many opportunities to network with thought leaders, clinical peers and manufacturer representatives from across the globe.

For more information, including early registration, visit iled2018.com.

REGISTER NOW

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ALD 2018 CALL FOR ABSTRACTS - Deadline is July 2

The 2018 Call for Abstracts is open to accept submissions. The 26th Annual Conference of the Academy of Laser Dentistry, is April 4-6, 2019 at the Hilton Anatole in Dallas, Texas.  The conference theme is the Laser Systemic Connection: Lighting the way to a healthier mouth and body!

ALD invites researchers, academicians, dentists and dental professionals from around the world to submit abstracts for presentation at the 2019 Annual Conference in Dallas, Texas, USA. The meeting will feature a wide range of captivating lectures, discussions, hands-on participation and networking opportunities with experts, researchers, and up-and-coming leaders in the field of lasers in dentistry.

SUBMIT NOW

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LASER SAFETY TIP
Essential laser safety tips from the ALD Do-It-Yourself Safety Guide

Did you know if there is a laser-related injury while using the laser, the Laser Safety Officer (LSO) must contact the laser manufacturer? The LSO should also record the following information into the Laser Safety Manual:

  • Date of incident
  • Time of incident
  • Location of incident
  • Identification of laser involved-wavelength(s) and power
  • Description of laser incident and action taken

Discover many more valuable laser safety tidbits in the ALD Do-It-Yourself Laser Safety Manual available only to ALD members here.

 

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