They might fix your phobia but are they the safest way to fill your cavity?
Until recently, Glenn Gustafson, a 56-year-old Boston man who manages a Weston country club, was your basic dental phobic.
It used to take him weeks to make an appointment, says Gustafson, whose fear of needles and drills mirrors that of 7 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 removed 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, about 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 US 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 now 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 about 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 erbium-YAG 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 erbium-YAG 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 cavitites 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 can also 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 this country, “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.
“Sometimes, if the cavity is between two teeth or underneath an old filling, you might have to drill to open up, because Carisolv does not act on old fillings or intact enamel,” she says. After the decay is dissolved, the residue is scraped away and the procedure is repeated until the tooth is free of cavities – in about the same amount of time as drilling.
Data from the first multi-center study of 130 patients who tried Carisolv has been submitted for publication by a scientific journal, she adds.
But the ADA worries the gel might not get rid of all decay and might irritate tooth roots. A decade or so ago, another decay-dissolver called Caridex seemed promising, then fizzled. The Swedish developers say Carisolv is more effective.
The bottom line on all this toothy wizardry is this: Beware of anything that sounds too good to be true. And before you sign up, ask what experience your dentist has with any new procedure or device. And ask to speak to patients who’ve tried it. Previous “Health Sense” columns are available through the Globe Online searchable archives at http://www.boston.com. Use the keyword columnists and then click on Judy Foreman’s name.
Do-it-yourself whitening discouraged
Tooth whitening, a popular option for people whose teeth have become dingy from age or medications, has become big business for dentists, who often charge hundreds of dollars per patient when the procedure is done in their offices. To avoid those costs, which are not covered by insurance, many people turn instead to do-it-yourself tooth bleaching – to dentists’ dismay.
The American Dental Association is “against all home whitening except under a dentist’s supervision,” says Kenneth Burrell, senior director for the ADA’s scientific council, because the bleaching agents can be corrosive to the gums.
The January issue of the Mayo Clinic Women’s HealthSource, similarly advises against over-the-counter whitening kits, noting that the one-size-fits-all trays used to hold the bleaching solution can fit poorly, allowing the bleaching agent to leak out, irritating gums and other soft tissues. Like whitening at the dentist’s, home bleaching can also leave teeth sensitive to hot and cold, adds Dr. Ned Van Roekel, a Mayo dentist.
Home kits, which cost $ 20 or so, contain a 10-percent solution of carbamide peroxide gel (equivalent to a 3-percent solution of hydrogen peroxide.) The bleaching kits used in dental offices are 30 percent hydrogen peroxide or stronger.
In some cases, dentists will make a customized tray to hold the bleaching agent for home use.
Even dentists who support it say there is only a cosmetic, not a medical, justification for bleaching. So far, there’s no evidence that it damages teeth, but most studies have lasted less than 10 years.
When dentists bleach your teeth, they protect the gums with surgical wax or dental dams. They may also use heat sources, including lasers, to activate the bleach.
One of the first dentists nationwide to use lasers for tooth whitening was Canton dentist Konstantin Ronkin, who has employed the BriteSmile laser system on 300 patients so far. The system, developed by Ion Laser Technology in Salt Lake City and being used by 130 dentists nationwide, uses an argon laser to activate a 50 percent solution of hydrogen peroxide, then a carbon dioxide laser to seal the surface.
The process takes two to three hours, costs $ 900 and is especially useful for stains caused by the antibiotic tetracycline, he says.
If you decide to whitenen your teeth at home, talk to your dentist first. Fillings or caps will not change color, so you may end up with a worse aesthetic problem than you started with.
And remember that even some whitening toothpastes can be abrasive, as can plain old baking soda. None of the over-the-counter whitening kits or whitening toothpastes carries the dental association’s seal of acceptance.
And read product labels carefully. One home kit developed by BioLase Technology, Inc. is called a “LaserBrush” for use with a whitening toothpaste. Despite its name, there’s no laser.