Transitioning from sedation to dental lasers: The right tools are proactive

Dental lasers continue to be a powerful and effective tool, eliminating the need for general anesthesia and oral sedation. For pediatric patients, dental lasers have proven to be a valuable tool. Dental laser experts Rishita Jaju, DMD, of Smile Wonders in Reston, Va., and Biolase chief dental officer Samuel Low, DDS, further discuss the benefits and continued popularity of dental lasers in the dental industry.

Question: What challenges arise when using sedation and anesthesia? Do you face challenges when using non-sedation alternatives?

Dr. Rishita Jaju: Sedation is a charged topic for dental colleagues and non-dental audience alike. Recent heightened awareness of the risks associated with sedation and general anesthesia have led to misconceptions like “dentists use sedation for convenience.” I am here to discuss how a judicious use of sedation and non-sedation alternatives can make dental work a safe and enjoyable experience.

While using sedation, there needs to be proper monitoring of patient’s vital signs and reflexes such as oxygen saturation, heart rate, blood pressure, respiratory rate, etc. Adverse events are most likely to arise when dentist simultaneously assume the role of dental surgeon and provider of anesthesia. Today, we are seeing more and more dentists enrolling anesthesiologists onto their staff for a more responsible approach to dental work. That means three people, a dentist, an anesthesiologist and a dental assistant are in the room during a patient’s procedure, helping prevent adverse events. However, having access to qualified professionals and insurance reimbursement for services is truly challenging.

When using non-sedation alternatives, the biggest challenge remains consistent; finding a balance between the patient’s level of cooperation, extent of decay and the technology, techniques, skill level and experience of the dentist with behavior guidance methods.

Q: What are some non-sedation alternatives you use in your practice to treat pediatric patients?

RJ: In our practice, Smile Wonders, we are focused on preventing decay or catching it early so that cavities are treated in the most minimally invasive and non-threatening manner. We are increasingly using dental lasers and/or nitrous oxide as alternatives to sedation in our practice and currently treating more than 95 percent of children without need for sedation or general anesthesia.

Using a dental laser like my Waterlase, I’m able to care for patients at various ages and cognitive levels with behavioral-based methods and distractions like singing songs or telling stories during procedures. The laser not only minimizes the pain, discomfort and anxiety for my pediatric patients, but their parents’ as well allowing them to more actively help soothe and distract their child and be more engaged with their child’s overall oral health.

If I notice an incipient cavity, I’m able to use intra-oral cameras to show parents that, not only is there a cavity starting, but also educate them regarding what their child’s teeth should look like at the follow up appointment. If the parents are having a hard time brushing, they know these carries can be treated before they turn into larger cavities, allowing parents to be more proactive in their children’s oral health.

Many providers do not have the tools or training to do non-sedative alternatives for treatment, such as behavioral guidance, or technology like dental lasers or intra-oral cameras. Sometimes, we find that they do tend to take the “wait and watch” approach for too long. If we can get to those children and get them ahead of time, sedation becomes unnecessary in almost all cases.

Q: Do you see a trend in the dentistry field moving away from sedation and anesthesia?

RJ: It’s important to clarify the term sedation. “Sedation” is a loose term that can mean many things: oral sedation, IV sedation or general anesthesia which is often a continuum and has variation in risk levels.

In dentistry overall, there is a push away from oral sedation with one provider for several reasons: there’s often no reversal agent and the topic connects to the wider conversation happening right now in the medical community about painkillers and opioids. Incorporating dental lasers into the practice allows for less in-procedure and postoperative pain to avoid need for medications. As an industry, we’re proactively instituting more stringent standards and protocols. For example, more providers are keeping up with their credentials for pediatric advance life support for dentists, state regulated sedation Pprmits for the office and basic life support for all office staff that need to be updated on a yearly basis.

Dentistry is also moving more towards preventive care in our “routine” dental work, and increased adoption of all-tissue dental lasers helps to make that possible.

Q: How do you decide the opportune time to use dental lasers versus anesthesia?

RJ: For most procedures, the need for anesthesia is based on the child’s temperament and level of cooperation. It’s not about the pain — it’s about their ability to hold still. If I can get the child to keep their mouth open and cooperate for x-rays or a cleaning comfortably, they can handle the dental laser assisted fillings without sedation. When I use my Waterlase laser, we use child-friendly language, to smoothly transition from “my rain brush,” “washing away sugar bugs,” to the treasure tower at the end of the visit. It helps for them to able to feel it against their hands before I use it on their teeth, which helps both children and parents with emotional comfort.

With our Waterlase dental laser, the dosage limitation of local anesthesia does not bind us, allowing us to take care of the right and left side at the same time: not only is it less painful for the patient, it’s more efficient.

The right tools empower us to be proactive rather than reactive, which ultimately reduces the need for sedation while treating severe dental problems.

Some scenarios make sedation inevitable: A child that comes in with acute pain or infection is likely going to need some kind of pain relief in order for us to be able to address the problem. If there are multiple quadrants worth of cavities on a young child, they child would have to come in two to four separate times to do two fillings at a time as we’re not going to be able to distract the child using behavior tools and traditional dental equipment alone, which can leave sedation as the only alternative.

Q: How will dental lasers continue to develop in the upcoming years?

Dr. Samuel Low: Dental lasers have come a long way in the last 10 years and I believe in the next 10 they’ll become the standard of care in dentistry.

The technology itself is maturing and there’s so many different ways a laser can assist in a dental practice whether it is surgical procedures or low-level laser therapy. As lasers grow in popularity, the cost will come down, making the technology more widely accessible to providers, fundamentally altering the way patients think about a visit to the dentist.

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