Glenn Gustafson, 56, a Boston manager of a country club, was a dental phobic.
It used to take him weeks to make an appointment, says Gustafson, whose fear of needles and drills mirrors that of 7 percent to 10 percent of the population. And once he did commit to going, he says, he would be a wreck by the time he got there.
No more.
Gustafson was among the first patients to have his cavities treated with a laser instead of the standard drill. And he’s a convert: “I didn’t feel a thing. There was no Novocain. It’s amazing.”
In Sweden, meanwhile, 1,000 drill-haters have tried a different option, a new gel called Carisolv designed to dissolve tooth decay in minutes with less pain than drilling.
Going to the dentist will probably never be anybody’s idea of a good time. But a number of new developments may make it distinctly less miserable, if more expensive.
Last May, the Food and Drug Administration approved the first dental laser, made by Premier Laser Systems, Inc. in Irvine, Calif., for treating tooth decay. Although dental lasers have been used for 10 years to cut soft tissue like gums, when the FDA approved the Premier laser, the agency raved in a press release that laser dentistry “is medicine for the 21st Century.”
Another California company, BioLase Technology, Inc. in San Clemente, is working on a competing product.
The laser creates a beam of light that is all of the same wavelength and that can be tightly focused. The energy from this light rapidly vaporizes water in decaying parts of teeth, causing microscopic explosions. Scientists think that since decaying tissue contains more water than healthy tissue, the laser has a selective effect that mainly vaporizes decay.
The Premier laser, so far sold to only 60 dentists around the country, is expensive–$45,000–and patients who opt for laser treatment may pay 50 percent more, says Dr. James M. Stein, one of two Boston-area dentists using the machine.
But for people like Gustafson, it’s worth it. There’s no pain so “there’s no shot, which causes anxiety, and you don’t have to listen to the noise of the drill,” says Stein, also a lecturer at the Harvard School of Dental Medicine.
In one clinical study of 500 decayed teeth reviewed by the FDA, there was no sign of damage to the tooth’s nerve and blood supply. In another study of 125 patients with decayed teeth, the laser proved as safe and effective as drilling.
Dr. G. Lynn Powell, a laser researcher at the University of Utah in Salt Lake City, said in a telephone interview that in his study, less than 3 percent of patients having the laser treatment asked for anesthesia, while “almost everybody gets it” in routine practice. Powell also spoke last week at the Yankee Dental Congress in Boston, which draws thousands of dentists.
But many dentists–and the American Dental Association–aren’t convinced.
“We still have concerns,” says Dr. Dan Meyer, associate executive director for science at the association, among them the possibility that the laser might cause heat damage to the delicate inner tooth pulp despite a built-in water spray designed to keep things cool.
The laser also doesn’t provide dentists the tactile feedback of high-speed drills, which allows them to “feel” how the procedure is going. “We are guardedly optimistic,” says Meyer, but the laser has not yet won the ADA’s “seal of acceptance.”
Dr. Harvey Wigdor, a dentist at the Ravenswood Hospital Medical Center in Chicago and an adjunct associate professor of biomedical engineering at Northwestern University, is also skeptical.
The laser “will not take the place of the drill,” he says, arguing that it is under-powered, doesn’t remove enamel well and works satisfactorily only on very small cavities.
Based on his research, however, Wigdor does not think the laser’s heat damages tooth pulp. But he is skeptical that the laser treatment is painless, because many cavities on which lasers have been used are so shallow that drilling would be painless too.
Wigdor does agree with the laser’s fans that the energy of the laser helps kill bacteria. But lasers also can create “noxious toxins, fumes or molten metals” if used to remove old fillings. “I don’t see the rationale for using a laser if you are going to have to use a high-speed drill for part of the procedure, such as removing a silver filling.”
As for Carisolv, the Swedish chemical decay remover, the product, which is not yet available in the U.S., “sounds promising, but we’re waiting to see the data,” says Kenneth Burrell, senior director for the scientific council at the American Dental Association.
Carisolv is a mixture of three amino acids and sodium hypochlorite that dissolves decay with minimal pain, says Irene Hermann, a dentist and manager for clinical research at MediTeam Inc. in Gothenburg.
