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FEBRUARY 2019 LIGHTWAVES

News and Announcements from ALD HQ RETURN TO LIGHTWAVES HOME


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TABLE OF CONTENTS


COMMUNICATIONS COMMITTEE CHAIR

Jeanette Miranda, BSDH, RDH
ALD Communications Chair

Welcome to a New Year of Lasers and Learning! While those of us in the Northern Hemisphere are enduring a long and cold winter, ALD is rushing into a bright and warm new year. Our administrative team and all our volunteers are gearing up for Dallas, April 4-6. Dr. Raminta Mastis, ALD President, shares her vision for ALD. You can also read all about our 2019 Seidner Scholars. The Lightwaves publication is expanding into some exciting new territories with the new webinar series. In this issue, Dr. Larry Kotlow shares TOT tips and our Member Spotlight shines its light on Dr. Gail Czarnecki. Do not forget to check out our Column of Illumination and the Laser Safety Tip. We are continually looking for new ways to share our passion for lasers with the ALD family. If you have any suggestions, please share your ideas jkmrdh@gmail.com.


MESSAGE FROM THE ALD PRESIDENT

Raminta Mastis, DDS, FAGD

Raminta Mastis, DDS, FAGD
ALD President, 2018-2019
St. Clair Shores, MI

Dear friends and fellow colleagues,

As we begin the New Year, I am excited to share with you some of the new transformations happening at ALD. In 2018 ALD reached a milestone: the ALD’s 25-year anniversary! Inspired by a stimulating conference and celebration in Orlando, followed by our first international conference in Dubai, we have set our sights on the future with ambitious goals and strategic plans. Our work is driven by a commitment to improving oral health through laser technology.

We are committed to supporting our members in the ongoing learning process necessary to stay current with the evolution of laser dentistry. The Education Committee will launch a new standard level certification program during the ALD Annual Conference this April in Dallas. Based on a completely rewritten curriculum, the new program updates laser education with treatment modalities and technological advances to enhance clinical skills through didactic and practical hands-on modules.

We continue to support advanced learning and congratulate our members recently recognized at various achievement tiers: Advanced Proficiency certification, Fellowship, and Mastership levels. In Dubai, we graduated our inaugural class of International Fellowship candidates, who completed a rigorous series of modules over the course of a year and successfully passed a comprehensive examination.

The ALD's International Fellowship program is now recognized as the first year of a Master of Science (MSc) in Laser Dentistry at Università Cattolica del Sacro Cuore di Roma (Catholic University of the Sacred Heart in Rome). This is a result of the leadership and vision of Dr. Giovanni Olivi in concert with Dr. Walid Altayeb. We are grateful for their extraordinary efforts to help raise the bar of ALD's role in laser education! Currently, we have International Fellowship programs running in Dubai, Doha, and in Algeria. We are working towards further expansion, including bringing this year-long advanced studies program to North America. 

ALD’s recognition in all of the world’s continents as a hub for independent and unbiased laser education is evidenced by the growing number and activities of international study clubs: Gulf Region Chapter, Algeria, Australia, Canada, Italy, New Zealand, Turkey, and the Philippines.  Several others to be announced in April during the ALD Annual Conference in Dallas.

In January, we launched a new webinar series through our Membership Committee initiative. Keep an eye out for these informative programs and an opportunity for CE credit, which is complimentary for our members. We welcome suggestions for future topics and encourage member participation.

One of the most prominent examples of the ALD mission for improving oral health is the planning for the ALD  26th Annual Conference from April 4-6 in Dallas, TX. The meeting theme is “The Laser-Systemic Link: Lighting the Way to a Healthier Mouth and Body.” The Conference Committee has compiled a robust program. This is definitely a meeting not to be missed.

Although not directly an ALD venture, we are proud of our members who presented during a congressional briefing on the use of photobiomodulation as a pain management alternative in the wake of the opioid crisis discussions. We stand behind such efforts to educate the public on the benefits of laser therapy.

These are exciting times to be involved in laser dentistry! ALD is built on the vision, efforts, and initiatives of its members. We firmly believe that everyone has experiences and talents in one area or another that can contribute to the growth and vitality of ALD. Please make the Academy your home for laser dentistry. We welcome everyone to become more engaged in pursuing excellence through collaboration.

I am personally happy to hear from each and every one of you. In fact, I look forward to it. Please share your aspirations, visions, or concerns about laser dentistry and the Academy. My ears are always open! Remember that together we can achieve more! 


PRACTICE AREA - PEDIATRICS

Treating Infants with Tethered Oral Tissues (TOTS): The Dilemma!

Larry Kotlow, DDS

Larry Kotlow, DDS
Private Practice
Albany, NY

It is stated that it can take a 17-year lag to change understanding in traditional research 1.   This lack of knowledge puts those responsible for enabling new research at a disadvantage. A staggering 36,000 randomized controlled trials (RCTs) are published each year, on average, and it typically takes about 17 years for findings to reach clinical practice. When treating infants, it is often unethical and difficult to accomplish a good RCT when there exists a great deal of clinical evidence that a procedure or treatment is safe and effective. This then requires asking the question, “Are randomized controlled trials (RCT) necessary or just an excuse to oppose infant frenectomies to allow successful breastfeeding2”? There are many ethical concerns that need to be considered when conducting research using RCT on infants.  Since we do know that releases of TOTS will aid in the ability of the infant to achieve a good latch onto the mother’s breast, performing a sham revision to develop RCT studies would not be in the best interest of the infant or mother3. There are many clinical techniques and approaches that have been successfully used for scores of years in which RCT might never be able to validate, but that doesn’t necessarily mean that they don’t have great value4.

Thus we have a dilemma: The vast majority of the pediatric and ear, nose and throat (ENT) physicians seem to question the existence of TOTS or deny they even affect breastfeeding, or for that matter other biological functions, such as air induced reflux, airway problems, sleep apnea, and mother-infant bonding. Thankfully there are many of us in the field of laser dentistry who are addressing these problems and changing many families’ lives for the better.

The lack of understanding of laser surgery leads those who lack even a basic understanding of lasers to muddy the waters with comments about lasers burning infants and lasers causing severe pain. One lactation person was sending out emails to parents looking for babies who could have been injured by lasers.

In fact, lasers are kinder to the tissue, require seconds to release when using the correct choice of lasers, and proper laser energy.  Lasers prevent the need for the operating room, general anesthesia, sutures, and drugs.

When treating infants, pain is a real concern. The debate on whether to use topical or local on infants has been to the forefront by quite a few lactation consultants and other healthcare providers.  Many articles suggest that infants can be treated without discomfort when using sucrose before and after surgery. Sucrose is a combination of glucose and fructose and is available in a unit dose package from a company called Sand Box Medical who produces a product  SWEETUMS5,6.(24% Sucrose). Simply placing a few drops under the infant’s tongue before and after surgery relieves any discomfort in most infants.

References

  1. Zoë Slote Morris,1 Steven Wooding,2 and Jonathan Grant2, The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011 Dec; 104(12): 510–520. 
  2. Kotlow,l J  Are randomized controlled trials (RCT) necessary or just an excuse to oppose infant frenectomies to allow successful breastfeeding?  Oral Med Toxicol 2018 Volume 2 Issue 1
  3. Feinstein AR, Horwitz RI. Problems in the “evidence” of “evidence-based medicine.” Am J Med. 1997;103(6): 529-35.
  4. Kupietzky A. DDS2 The Keeper of the Meaning and the Era of Evidence-Based Dentistry. Pediatr Dent. 2018;40(4): 250-252.
  5. Maria Gradin, Mats Eriksson, Gunilla Holmqvist, Åsa Holstein, Jens Schollin.Pain Reduction at Venipuncture in Newborns: Oral Glucose Compared With Local Anesthetic Cream
    Pediatrics Dec 2002, 110 (6) 1053-1057; DOI: 10.1542/peds.110.6.1053
  6. Stevens  B, Yamada  J, Ohlsson  A, Haliburton  S, Shorkey  A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database of Systematic Reviews 2016, Issue

Dr. Larry Kotlow is Board Certified in Pediatric Dentistry, proficient in laser use and is an internationally known expert in laser use in treating children.  A long time ALD member, Dr. Kotlow served on the ALD Board of Directors, achieved Advanced Proficiency in several laser wavelengths and was the 2014 recipient of ALD’s Leon Goldman Award for clinical excellence. Dr. Kotlow lectures internationally on the safe and effective uses of dental lasers.  Dr. Kotlow is in private practice in Albany, NY.  Contact Dr. Kotlow by e-mail at kiddsteeth@aol.com.


MEMBER SPOTLIGHT - Gail A. Czarnecki, DDS

Gail A Czarnecki, DDS

Gail A. Czarnecki, DDS
Private Practice
Howell, MI

In 2014, I had the honor and privilege of working with the late Dr. Fred Margolis in his pediatric practice and I began using dental lasers under his mentorship and guidance.

As a pediatric dentist, dental lasers have allowed me to broaden my scope of practice and expand the services that I can offer my patients. Since 2014, I have been able to provide treatment for infants experiencing difficulties with breastfeeding due to a lip tie and/or tongue tie as well as provide alternative treatment options for pediatric patients that are needlephobic. It has been very gratifying to be able to treat infants that are struggling with breastfeeding due to tethered oral tissues (lip tie and/or tongue tie). Treating infants with a laser frenectomy can alleviate painful breastfeeding, enable the infant to obtain proper nutrition and make breastfeeding more comfortable and enjoyable for both the mother and infant. Additionally, as a pediatric dentist, it is great to be able to offer some alternative treatment options for those kids who won’t tolerate an injection of local anesthetic.  Patients and parents are appreciative of being given alternative options and are always relieved when they find out that cavities can be treated painlessly with the laser and in most cases without local anesthetic.

The patient response has been wonderful!  Alleviating the pain and discomfort for infants and mothers struggling with breastfeeding can have a positive impact on the entire family.  One mother who had the laser frenectomy procedure for her infant had been struggling with breastfeeding and painful mastitis for weeks. She looked exhausted and frustrated before the procedure but one week later after the laser frenectomy was completed she was glowing and looked well-rested. She was very appreciative that she was able to experience the joy of breastfeeding comfortably.  Patients that have had laser treatment for cavities are so relieved when they learn they probably won’t need a “shot” and have been very comfortable throughout the procedure.

I became involved with the Academy of Laser Dentistry through the recommendation of Dr. Fred Margolis. Since I have been a member, I have had the wonderful experience of connecting with laser dentists and other health care professionals. As a member, I value the opportunity to further my knowledge and skills in laser dentistry from some of the world’s leading experts in laser dentistry and I appreciate the special rate given to members for the annual conference. Continuing education and remaining updated on the latest information and technology is important so that I can continue to provide the highest quality care to my patients. This year, I am serving on the ALD Membership Committee and I look forward to meeting many ALD members in Dalls. See you there!


NEWS & EVENTS

ALD Webinar Series - Free CE for ALD Members

The first webinar was successfully rolled out on January 23, presented by Dr. Ed Kusek on the topic of Peri-implantitis. Feedback from attendees has been overwhelmingly positive and they are looking forward to the next one with Dr. Sam Low on February 25th. There is still time to register here and it's free to ALD members. All registrations will receive a recording of the webinar. Dive deeper into the topics at ALD 2019

February 26, 2019
7:00 pm - 8:00 pm ET

Oral Medicaments are Synergistic to Laser Applications
Dr. Sam Low

 

ALD 2019 Seidner Student Scholarship Recipients

Congratulations to the Seidner Student Scholarship recipients! The Scholarship program is a cornerstone of ALD's endeavors to help the profession learn about the safe and effective uses of dental laser technology for patient care. Since inception, 25 students from all over the world have been honored. The Student Scholarship recipients will present their research at the ALD Annual Conference & Exhibition on April 4, 2019 starting at 3:30.

Mohammad Moaffak AlSayed Hasan, DDS, MSc

Mohammad Moaffak AlSayed Hasan, DDS, MSc
Damascus University - Faculty of Dental Medicine, Damascus, Syrian Arab Republic

Abstract Title:
Evaluation of Low-Level Laser Effectiveness in Accelerating Orthodontic Tooth Movement for Dental Crowding Cases.

Yujin Ohsugi, DDS

Yujin Ohsugi, DDS
Tokyo Medical and Dental University, Tokyo, Japan

Abstract Title:
Comprehensive Analysis of Gene Expression Related to Healing After Bone Ablation with Er:YAG Laser

 

Special Announcement

Donna Rell

Congratulations to Donna Rell, ALD's Executive Assistant and Certification Program Manager, who recently completed the Institute for Credentialing Excellence (ICE)'s certificate program. Donna passed all the required assessments and earned her "Credentialing Specialist" certificate.

In case you didn't know, the Institute for Credentialing Excellence (ICE) is a professional membership association that provides education and resources for organizations and individuals who serve the credentialing industry.

ICE is a leading standards developer for both certification and certificate programs – so it's a pretty big deal. The knowledge and skills Donna has acquired are also immediately applicable to the ALD's certification program.

Another big deal is Donna's 10-year anniversary of dedicated service to the ALD. Please take the time to congratulate Donna!

 

In Memorium

Dr. Art Levy

Dr. Art Levy

We are deeply saddened by the news that our 2012 president and forever advocate Dr. Art Levy has passed away.

We will miss Art's leadership, knowledge, kindness and civility. We'll also remember his tireless advocacy for the use of laser technology to elevate the standard of dental care. Rest in Peace Dr. Levy and thank you for your guidance, support and professionalism. Dentistry and especially laser dentistry, owe you a world of gratitude.

Dr. Levy was a progressive dentist with a successful clinical career in New Jersey who later transitioned towards teaching and mentoring the next generation of dentists and ALD members at Arizona School of Dentistry and Oral Health.

"Leaders stand out by the nature of their commitment and the integrity of their character"
- 2012 from Dr. Art Levy to Gail Siminovsky, CAE

 

Professor Kenji Yoshida

Dr. Kenji Yoshida

ALD extends our deepest condolences to the passing away of the highly respected Professor Kenji Yoshida, who passed away on January 29th. Prof. Yoshida’s strong influence on the field of Laser Dentistry will last for a long time. Our deepest sympathy goes to Prof. Yoshida's relatives and his friends in this time of grief.


WELCOME TO NEW ALD MEMBERS - TO BE UPDATED

Martha Acton, AK
Mukesh Agarwal, CT
Paul Aliker, IL
Prof. Joseph Arnabat, Spain
Jason Au-Yeung, IN
Guerin Baker, TN
Rachel Bayme, NJ
Tedra Beckton, FL
Janelle Benner, AZ
Pierre Bernier, Canada
Katherine Bowman, CO
Melissa  Brim, TN
WILLIAM BRIM, TN
William Buis, AZ
John Caldwell, TN
Mark Casafrancisco, Canada
Elina Castro De S. A. Blairs, Australia
Eugenia Catlin, CO
Lafe Chaffee, AZ
William Chambers, AL
Stanford Chen, WA
Landry Clapp, TX
Kanesha Cole, FL
Debra Daggett, AZ
Selvi Das Purkayastha, IL
David Daugherty, CO
Vanessa Dawson, AZ
Diane Dearman, TX
Jacob Deniakos, AL
Togara Dinga, TX
Mary Doherty, TN
Kathleen DuLac, FL
Parminder Dulay, CO
Luis Eduardo, MN
Velsy Enriquez, NM
Jennifer Escobar, FL
Susan Findling, CO
Melissa Fischer, IL
Michael Friedman, GA
Anthony Froyan, FL
Justyna Gawlik, Poland
Sarah Gibbs, FL
Dasha Gill, MO
Andrea Gleason, MO
Katrina Gonzales, NM
Lacey Green, GA
Carissa Greinel Blum, NM
Thomas Griego, NM
Elizabeth Hadley, CO
James Hyland, Canada
Inaam Jajoo, UNK
Ahmed Jawad, FL
Stephen John, CA
Paul Jones, AZ
Scott Kane, AL
Liz Kellner, OK
Mansoor Khan, FL
Beata Kielur-Slota, Poland
Mary Kirkpatrick, TN
Daniel Knause, SC
Damian Korczynski, Poland
Lorraine Labayen, CO
Melody Lemos, NM
Areli Lozano, AZ
Michal Lubas, Poland
Kirstie Lyman, CO
Marta Maciak, Poland
Lacey Martin, TN
Oletha McCauley, AZ
Andrew McKay, Australia
Mindy Medina, CO
Rebecca Mestas, NM
Mandana Milani, TX
Mohammad  Moaffak AlSayed Hasan, Syria
Ashley Montana, AZ
Sandra Montes, NM

Suzet Montes de Oca Calas, FL
Michael Montgomery, CA
Lindsay Moore, CO
Jessica Neill, AZ
Saman Nematbakhsh, GA
Andrew Nixon, Australia
Yujin  Ohsugi, Japan
Aneta Olszewska, Poland
Ted Ondrish, OH
Jamie Otto, UT
Michelle Overholt, AZ
Stephen Pak, AL
Steven  Pakiz, CA
Nathalie Phaeton, VA
Lina Pham, TX
Victoria Pietrucha, TN
John Puchalski, CO
Anthony Reese, AZ
Anna Reyes, CO
Christina Sabour, TX
Dena Scherer, GA
Nicole Schmidt, MO
Ronni Schnell, MA
Kristopher Scholes, AZ
Lynda Schwerb, MO
Terrie Sciaretta, TX
Vasu Shah, NM
Richard Short, MA
Tracey Simpson, AZ
Kelsey Stinnett, TN
Christy Teter, CO
Elena Timoshina, CO
Charanjit Uppal, CA
Jesse Varoz, NM
Peter Vaughan, Australia
Harichandana Vemireddy, TX
Amanda Walker, CO


COLUMN OF ILLUMINATION

The answers in this issue of Column of Illumination is provided by Dr. Gerry Ross.

Gerry Ross, DDS

Gerry Ross, DDS
Private Practice
Tottenham, Ontario, Canada

How would you recommend a beginner implement PBM (LLLT) in their practice?

I would suggest that anyone wanting to start Photobiomodulation (this is the term that is now accepted for LLLT treatment), do a bit of reading. Whenever someone contacts me I send them two articles to get them started. The first one is the “Biphasic Dose response in Low Level Light Therapy” by Huang, Chen, Carroll and Hamblin. This article provides the science behind why PBM works and also gives a guide to dosage. The second article is one I wrote for ALD Journal outlining the mechanisms, dosing and applications of PBM in dentistry. I would gladly share this with the readers; just contact me a ddsross@rogers.com.

There are two textbooks I recommend:

  1. The Laser Therapy Handbook by Tuner and Hode, published by Prima Books
  2. Handbook of Low-Level Laser Therapy by Michael Hamblin and published by Pan Standard Publishing.

These books will provide the background to get a beginner started. For training, I suggest attending the ALD Annual Conference from April 4-6 in Dallas, TX. On Wednesday, April 3rd, James Carroll will present a full-day introductory program on the application of PBM in dentistry. In addition, there is a full-day of PBM lectures and on Saturday there will be a 3-hour workshop on implementing PBM into a dental practice.

What Settings would you recommend for Analgesia?

In the previous question, I referred to the article on the Biphasic Dose response which is illustrated by the Arndt-Schultz curve (shown below). At low doses (usually 2-5 Joules per cm²) we get stimulation; something we want to promote healing. At higher doses, the result is inhibition which gives us analgesia. A dose range of 8-32J/cm² is a safe range to be working within with the higher dose giving greater analgesia. There are other factors that are key when determining success with analgesia:

Application to the correct point is key.

One must consider the depth of the target tissue; the deeper the target the more of the energy that will be absorbed before it reaches the target and the less available for a response.

Lastly, I again stress the need for learning and research so one can understand what treatments will give the best clinical result.

Dr. Ross has been in general practice dentistry since 1971 and has used soft tissue lasers since 1972 and low-level lasers since 1993. He holds ALD Standard and Advanced Proficiency and is an ALD Recognized Standard Proficiency Course provider. Dr. Ross has published 20 articles on low-level lasers, has written chapters for two textbooks and is a peer reviewer for three laser journals. Dr. Ross also serves as the 2019 ALD General & Scientific Sessions Chair. Dr. Ross may be contacted by email at ddross@rogers.com.


LASER SAFETY TIP - EYE AND SKIN LASER HAZARDS

The following laser safety tip was taken from the ALD Laser Safety Do-It-Yourself Guide.

Even though there are no known contraindications for dental laser use, proper protocols must be followed to ensure the safety of the patient and the operator. Different wavelengths pose unique threats to the eye. Table 3 on page 18 of the ALD’s Laser Safety Manual demonstrates which portion of the eye is vulnerable to the different dental laser wavelengths. Laser users should also be familiar with the symptoms of eye exposure: headache, extreme watering, gritty or sandy sensation, burning sensation, popping noise, floaters or no pain at all. All wavelengths have the potential to cause burns on the skin. Close observance of tissue interaction is imperative for safe and optimal laser usage. Stay safe and laser on!

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