Lasers in Pediatric Dentistry

LASERS IN PEDIATRIC
DENTISTRY
Introduction
● LASER is an acronym for Light Amplification by
Stimulated Emission of Radiation
● The term laser was first used in 1957 by Gordon
Gould.
History
● Maiman developed the first working ruby laser in 1960.
● Javan, Bennett, and Herriott in 1961 described the first gas
laser, helium-neon (HeNe).
● In 1964, Geusic, Marcos, and Van Uitert at Bell Labs
demonstrated neodymium-doped yttriuma luminum-garnet
(Nd: YAG) laser.
● In 1964, at bell labs, Patel developed the carbon dioxide (CO2)
laser.
● Argonion laser was developed in 1964 (Bridges of Hughes
Research Laboratories).
● In 1974 Er: YAG lasers were first introduced by Zharikov.
Classification
I. According to ANSI and OSHA standardization
CLASS l: Low powered laser which can be viewed by the naked eyes. Eg:
laser pointer
CLASS llA: Low powered laser which are hazardous if viewed more than
1000secs by the naked eye. Eg. He:Ne laser.
CLASS llB:Low powered visible laser which are hazardous if viewed more
than 0.25secs.
CLASS lllA:Medium powered laser which are normally hazardous if viewed

more than 0.25secs without the use of magnifying optics.
CLASS lllB:Medium powered laser which are hazardous if viewed directly.
CLASS IV: High powered laser which produce ocular, skin and fire hazards.
ll. Based on wavelength
1. Ultraviolet lasers (150 - 350 Nm)
2. Visible lasers (350 - 750 Nm)
3. Infrared lasers (750 and above)
III. Based on penetration power

4. Hard lasers/ Thermic lasers/ Surgical lasers - A longer wavelength producing thermal
effect, which cut the tissue by coagulation, vaporization and carbonization. These lasers have
been used for surgical soft tissue applications.
5. Soft lasers/ Athermic lasers - Provide cold thermal low energy wavelengths that stimulate
circulation and cellular activity and cause anti-inflammatory, muscle relaxation, analgesia and
tissue healing reactions.
IV. Based on pulsing
1. Pulsed lasers
2. Non-pulsed lasers
V. Based on the type of active medium used

3. Gas laser: A gas or mixture of gases is used as active medium. Eg: He:Ne laser, Co2
laser
4. Liquid laser: Ions or rare earth or organic fluorescent dye dissolved in liquid are used
as active medium. Eg: Dylase
5. Solid laser: Solid material are used as active medium. Eg: Ruby lasers, ND:YAG lasers
6. Semi-conductor laser: Semiconductor material are used as active medium. Eg:
GALLIUM: ARSENIDE lasers
Laser Device Components
The laser cavity existing at the center of the laser light consists of three
components:
1. an active medium
2. pumping mechanism and
3. an optical resonator
● The active medium is composed of a chemical element, compound or
molecules. Laser are named based on their active medium
■ (a) gas (CO2 laser)
■ (b) solid crystal (Nd: YAG, Er: YAG)
■ (c) solid-state semiconductor (diode laser)
■ (d) liquid (not used in dentistry).
● The pumping mechanism serves to pump energy into the active
medium.
● The laser cavity has two mirrors on either side of the optical cavity
Laser Tissue Interaction
● The light energy produced by a laser can have four different interactions with a target
tissue:
○ Reflection, Transmission, Scattering, and Absorption .
● When a laser is absorbed, it elevates the temperature and produces photochemical effects
depending on the water content of the tissues.
● When a temperature of 100°C is reached, vaporization of the water within the tissue
occurs, a process called ablation.
● At temperatures below 100°C, but above approximately 60°C, proteins begin to denature,
without vaporization of the underlying tissue.
● Conversely, at temperatures above 200°C, the tissue is dehydrated and then burned,
resulting in an undesirable effect called carbonization.
• Reflection: Beam redirecting itself off of the tissue surface, having
no effect on the target tissue
• Absorption: Amount of energy that is absorbed depends on the
tissue characteristics, laser wavelength and emission mode. Shorter
wavelengths are absorbed readily in pigmented tissue.
e.g. argon and longer wavelengths are more interactive with water
and hydroxyapatite
• Transmission: Laser energy passes directly through the tissue, with
no effect on the target tissue, e.g. diode and Nd: YAG lasers can be
transmitted through the lens, iris, cornea, anterior chamber, posterior
chamber, vitreous, and aqueous humors of the eye without affecting
them, yet can be absorbed easily by the tissues of the retina.
• Scattering: It weakens the energy and possibly producing no useful
biologic effect apart from curing of composite resins.
● Absorption requires an absorber of light, termed chromophores, which have a certain
affinity for specific wavelengths of light.
● The primary chromophores in the intraoral soft tissue are Melanin, Hemoglobin, and
Water, and in dental hard tissues, Water and Hydroxyapatite.
● Different laser wavelengths have different absorption coefficients with respect to
these primary tissue components, making the laser selection procedure-dependent.
● Photochemical interactions: Specific wavelength of laser light is absorbed by
naturally occurring chromophores that are able to induce certain biochemical
reactions at the cellular level.
● Derivatives of naturally occurring chromophores are used as photosensitizers
to induce biologic reactions within the tissue for both diagnostic and
therapeutic applications
● Photothermal interactions: Radiant light energy absorbed by tissue, substances
and molecules become transformed into heat energy, which produces the tissue
effect
● Photomechanical interactions: Include photodisruption or photodissociation, which
is the breaking apart of structures by laser light and photoacoustic interactions,
which involve the removal of tissue with shock wave generation
● Photoelectrical interactions: Include, photoplasmolysis, which describes how
tissue is removed through the formation of electrically charged ions and particles
that exist in a semi-gaseous high energy state
APPLICATION OF LASERS IN PEDODONTICS
1. Caries detection
2. Caries removal
3. Prevention of enamel and dental caries
4. Pit and fissure sealants
5. Bleaching of vital and non-vital tooth
6. Etching and bonding agents
7. Curing light activated resins
8. Cavity preparation
9. Pulp therapy
● The difference in scattering and polarization
between
sound and carious enamel can be exploited
LASERS in soft tissue surgery
1. Frenum revisions
○ Patients with bleeding and clotting disorders who require hemostasis during soft tissue
surgery benefit from diode, CO@ or Nd: YAG laser.
2. Pericoronal problems in erupting teeth and tooth exposure
○ Lasers can be used to ablate the involved tissue and expose the clinical crown of the tooth
3. Hyperplastic gingival tissue
4. Herpes labialis and apthous ulcer
○ Immediately relief symptoms at low power setting and defocused mode.
5. Lesion removal and biopsy
○ Bleeding is minimal and little or no post-operative discomfort
LASERS HAZARDS
1. Ocular
2. Tissue damage
3. Respiratory hazards
4. Fire and explosion
5. Electrical shock
1. Ocular hazards
a. Potential injury to the eye can occur either by direct emission from the laser or by reflecting
from mirror like surface
b. Potential of causing retinal damage because of the focussing effect of the lens and cornea
c. CO2 lasers can cause denaturation and coagulation of the proteins in the epithelial layer of
the cornea resulting in calcification and permanent blindness
2. Tissue hazard
a. Thermal interaction of the radiant energy with tissue protein

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LASERS IN PEDIATRIC

CLASS lllA:Medium powered laser which are normally hazardous if viewed

CLASS lllB:Medium powered laser which are hazardous if viewed directly.

III. Based on penetration power

V. Based on the type of active medium used

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