What can and should be done with a laser in the hygiene operatory, and the benefits of incorporating this technology.
Incorporating lasers into the daily workflow can boost a practice’s bottom line, and the best place to start is in the hygiene department. With a laser, hygienists can offer patients new procedures that benefit their health, along with greater comfort. Patients bleed less and heal faster, making them more likely to accept treatment and prompting them to promote your practice to family and friends.
Once lasers are added to the armamentarium, the hygiene department will become more productive and profitable. Everybody benefits; it’s a matter of finding the right laser, receiving proper training, and making the technology part of every appointment.
“When hygiene departments use lasers as the foundation of their adjunctive therapy, you see practice revenues increase,” says Elaine Rodriguez, RDH, owner/founder of Dental Laser Integrations. “We know hygiene is supposed to be responsible for about 30% of the overall practice revenue. With lasers, that’s possible. We don’t have to think about it if we’ve adopted lasers as the forefront of supplemental therapy.”
Adding Procedures, Increasing Revenues
State regulations regarding dental use of lasers vary, but 2 of the most common procedures are laser bacterial reduction (LBR) and laser-assisted periodontal therapy (LAPT) after scaling and root planing, says laser trainer Angie Wallace, RDH. Hygienists often use LBR before starting procedures, which has become increasingly important given concerns surrounding aerosols and coronavirus disease 2019 transmission, says Stephanie Lodding, owner of Now 2 Wow Hygiene Concepts. LBR only takes a few minutes and is something she does for every patient.
The Academy of Laser Dentistry (ALD) offers standard and advanced certifications for dental professionals. The comprehensive, peer-reviewed courses are designed for the entire team and include a psychometric validity exam. More information can be found at laserdentistry.org.
“I go over the tongue, cheeks, vestibules, everywhere in the mouth to reduce as much bacteria as possible so we don’t spread any infection,” Lodding says. “It’s also important to get rid of as much bacteria as we can before starting a prophy or perio procedure.”
LBR reduces bacteria within the pocket, which reduces inflammation to enhance healing and regenerate new cells, says Lynn Atkinson, dental hygienist and spokesperson for BIOLASE, the company behind the Epic Hygiene laser. It’s a preventive measure that can help patients avoid attachment loss. Laser light energy is attracted to pigmented, diseased tissue, quickly treating these areas to get patients back to optimal health, allowing new tissue attachments that help close pockets and reduce pocket depths. This procedure also plays a role in maintaining periodontal health, Atkinson says, and because it is painless and takes about 5 minutes, LBR is also a great way to introduce patients to laser dentistry.
LAPT also has been a game-changer for hygiene departments and for patients. Scaling and root planing alone treat only the root and tooth surfaces, leaving behind contaminants, Atkinson says. Before she started using lasers, patients would come back for debriding a few times a year but still have inflammation and bleeding. Using a laser to treat the infected tissue reduces the bacterial and viral load within the pocket area and around the gums, helping the tissue heal, which benefits the entire body.
Lasers are more effective than introducing biologic agents, Lodding says. Although these agents kill bacteria, this happens only at the spot where they are placed. Light energy used throughout the mouth can treat infection effectively.
“When I first started using lasers in 2004, the focus was on stimulating and regenerating tissue,” says Lodding, who is also an advisory council member for The American Academy for Oral Systemic Health. “But as I learned more about lasers and the oral systemic link, my entire focus changed from thinking about healing tissue to killing off the bacteria getting in the pockets, removing the infection, and allowing for tissue regeneration.”
The Epic Hygiene Laser from BIOLASE allows hygienists to offer minimally invasive and virtually pain-free treatments to their patients. The system is designed to be a solution to manage non-surgical periodontitis and includes step-by-step clinical protocols.
The most common laser used in hygiene is the diode laser, Atkinson says, with its light absorbed into darker pigmentation. It not only removes infected tissue and reduces bacteria, but also promotes hemostasis. If there is much bleeding and inflammation, using the laser in the pocket area will reduce it, allowing better healing and less discomfort afterward. In the 25 years Atkinson has been performing LAPT, she has not had to prescribe pain medications for her patients, she says.
The low-level light therapy these diodes provide can alleviate pain, reduce swelling, and treat hepatic lesions and mouth ulcers. Lodding’s office has committed to getting patients with cold sores in for same-day appointments, which has been a huge practice builder. Patients come in for a quick procedure that ends their discomfort, and the practice adds productivity for the day. Whitening, hyperpigmentation removal, draining perio abscesses, and reducing recession are among other hygiene laser treatments. Dentists also can use diodes for procedures such as frenectomies and gingivectomies.
Team Training
Laser training and education should not stop with the hygienists or dentists operating the lasers, says Gail Siminovsky, executive director of the Academy of Laser Dentistry (ALD). Everyone on the team should know how lasers work and what services the practice offers so they can answer patient questions and address concerns.
“The dentist needs to understand the importance of the technology within the hygiene program,” Siminovsky says. “In a successful practice, the hygiene team drives business. If everyone in the practice is as well-educated as the dentist and hygienist operators and understands how lasers are used from a marketing and clinical perspective, then patients will get the information they need to get excited about the technology.”
Training requirements for operators vary by state, Siminovsky says, but ALD recommends a minimum of 12 hours. Operators learn how to properly use the laser as well as how the body reacts to light therapy and what happens at the tissue level. ALD offers a certification program that gives dental professionals the foundation they need to successfully incorporate lasers into their practice, including peer-reviewed content, hands-on training, and a psychometric validity exam.
Through training, operators learn how to properly adjust laser settings, says Wallace, who holds a certification from ALD. The same setting cannot be used for every patient. Lasers, especially diodes, are attracted to dark pigmentation. So, someone with a lighter skin tone will need more energy than someone with a darker skin tone.
All education is not equal when considering training programs, Siminovsky says. Going beyond minimum state requirements and manufacturer training is necessary to become confident and proficient in laser use.
Hands-on training is critical, Rodriguez says, and is one of her company’s main focuses. “The best training is on real, live patients where you can see and get that tactile learning of what the laser feels like when it hits diseased tissue,” Rodriguez says. “Laser tissue interaction is a big one. You’re not going to learn that from a typodont or a pig’s jaw, which is dead tissue.” You need to keep up with training, Rodriguez says. You must stay committed and take continuing education courses to stay up to date on the latest advancements and ensure your skills remain sharp.
Talking to Your Dentist
If your dentist isn’t using lasers, making the investment may take some convincing, especially now. Before approaching the dentist, Lodding recommends doing research. Find out how much the laser you want will cost and determine how much more revenue will come from fee increases and additional productivity. Remember the benefits it offers patients, who can discuss them with family and friends.
“Make sure the doctor knows that with laser dentistry you can make patients healthier than they’ve ever been,” Wallace says. “Yes, doctors will be excited for the increase in revenue because they need that to run the business, but ultimately they want their patients to be happy and to leave the office with a good result.”
It is also important to determine what procedures you can do in your state, which ones you would like to do, and what can be delegated to an assistant, Rodriguez says. Find out how much training is required and then go to your dentist with a plan to build your hygiene department.
You also should make it clear the laser is not just for hygiene, Siminovsky says. Emphasize the benefits it can bring to the entire practice and what the dentist can do with it for patients.
In Lodding’s practice, for example, the dentist often performs frenectomies during the hygiene visit rather than scheduling a separate appointment. Lodding can give the injection to get the patient numb, and then the dentist performs the 5-minute procedure. The patient is happy with the time saved, and the practice gets an extra procedure on the books.
The bottom line: If you want to add laser dentistry to the hygiene department, show your dentist the value and its role as a practice builder. “Lasers bring your practice to a whole other level. You’re not just treating the mouth; you’re treating the whole body,” Atkinson says. “When I do training in offices, the dentist often sees the hygienists fighting over the laser because they all want to use it. Prove to the dentist we not only want to use it, but patients are also asking for it. And if you have 3 hygienists using a laser at the same time, there’s going to be [a return on investment] immediately.”
Incorporating Lasers in Hygiene
Once a commitment to laser dentistry is established, you must determine the best way to incorporate the technology into your workflow. First, decide which type of laser works best for the practice based on the procedures you would like to add to your list of services, Atkinson says. Soft-tissue diode lasers work great in hygiene, but the dentist may also want to consider a hard tissue laser or one that handles both based on a vision for the technology. Once you settle on a type of laser and the attachments you may want, think about ideal features and start comparing options.
The goal is to eventually use the laser in every appointment, but Wallace suggests starting with patients you know will be receptive to the technology. Get those patients excited about laser dentistry and ask whether you may take before-and-after photos of their treatment. Post photos of successful cases on social media to get the rest of your patient base excited about the possibilities, as well as to attract new patients who see the benefits of the technology.
At first, you might want to add 10 to 15 minutes to each appointment, Wallace says. That way you won’t feel rushed or think you have to cut short the education portion of the appointment because time is running out. Remember that you do not have to do everything. Get comfortable with doing 1 new laser procedure first and build from there. Break it into manageable sections of what you can realistically accomplish in an appointment. Otherwise, you run the risk of becoming overwhelmed.
Wallace also recommends having a laser in every operatory. If there are only a few minutes left in an appointment and you must wait for a colleague to finish a procedure, chances are you will skip the laser, which means the practice and patient miss out.
Team members also should be in agreement on how lasers will be presented, Rodriguez says. Everyone should refer to procedures by the same name and be able to talk to patients about what treatments the practice offers and why they are beneficial.
Finally, determine what you will charge for each treatment and get the proper narratives and documentation prepared and in the system. “Beyond that,” Rodriguez says, “it’s committing to getting it done and engraining it into your process of care.”
Educating Patients
Talking to patients about the benefits of lasers will get them interested in the technology and more likely to proceed with treatment. Explain that you are using light energy that is going to allow the body to heal itself, Wallace says. Review the benefits, from shorter recovery times to reduced bleeding and sensitivity, and the results patients can expect to see after treatment. Educate them about the oral systemic link and where the laser fits into healing the entire body.
To get the best results, remind patients to make home care a priority. Wallace also recommends perio charting every patient rather than spot probing. This enables you to show patients how far they have come, and that the treatment is working, especially when they see pocket depths once at 4’s and 5’s falling to 2’s and 3’s.
When talking to patients about laser dentistry, Rodriguez suggests leading with health, not the technology itself. Do not just tell them their pocket numbers; let them know what those numbers mean in terms of their health. Explain periodontal disease’s effect on the entire body, how light therapy can help, and why it is a better option than medicaments.
“Talk about why the patient needs laser treatment and what’s going on today,” Rodriguez says. “Recognize where patients are in their perception of disease and meet them there.”
When patients see the results laser dentistry provides, they will understand that you are really doing something to get them to optimal health, Wallace says. With education, they will better understand the process of gum disease and why they are no longer in discomfort, dealing with bleeding gums, or trying to get that bad taste out of their mouth.
“It intertwines with making patients responsible for their own care,” Wallace says. “It makes them understand we’re working together with them to achieve the results they’re seeing.”
Moving Your Practice Forward
Lasers carry a certain wow factor. When laser dentistry is an option, it tells patients you are willing to invest in technologies that provide optimal care. It shows you care about their comfort and delivering an exceptional patient experience. Adding this tool to your armamentarium sets your practice apart, and that is vital to your success. Patients will start to see your practice as high tech, and that will become part of your brand.
Lasers also can renew your passion for dentistry, Wallace says. The technology represents an opportunity to offer patients better care, which is especially powerful for hygienists who feel stuck because what they are doing is not working. They see patients return with inflammation and discomfort, no matter what they do. Adding lasers to treatment will change that.
But to see real improvements in practice revenues and patient health, you must be prepared to implement lasers into every hygiene appointment, not just for the patients with bleeding gum tissue. It is never just 1 and done; you must continue to use the adjunctive treatment. When you make it part of the routine, not only will you see your patients reach and maintain optimal health, but you will notice a boost in productivity and a more robust bottom line.
“You have to understand it’s a commitment,” Rodriguez says. “It does take work and an adjustment in how you practice, but remember it’s a natural therapeutic and you really can’t go wrong. It’s all beneficial for the patient and the practice. All benefit.”
