FAQ

Learn More About Advances In Dentistry

FREQUENTLY ASKED DENTAL QUESTIONS

HOW IS YOUR BITE?

If your bite is even and centered, it takes the load off of the teeth that could otherwise cause the breakage of teeth and restorations. Uneven contacts can cause toothaches, neck and shoulder pain, and headaches. Most dentists use blue marking paper to refine the bite, but studies show that this information is almost always wrong.

T-SCAN

In our office, we have incorporated the T-Scan, the most modern and up to date computerized software in the world. It allows us to create a realtime movie of your bite. We can tell which teeth hit first and how hard. Using the information from the T-Scan, we are able to refine your bite so that all of the destructive forces are removed, and you will find that your teeth last longer and feel better. Call right now to get this evaluation. It will be the Best $100 you will ever spend.

TEETH WHITENING OPTIONS

Many people are concerned about the whiteness of their teeth. We can now provide a number of ways to actually whiten your teeth.

BLEACHING

Bleaching provides rapid whitening, but does require periodic re-enhancement. The initial cost is about $250 with enough bleach to last the normal person about one year. The bleaching agent we use is a 20% Carbamide Peroxide with Fluoride. The custom trays are designed to prevent leakage of the bleaching agent onto the gums, thereby burning them. These cause much less sensitivity than the laser or ultrafast in office bleaching systems, and they give you the ability to touch up your smile whenever you want.

VENEERS

Veneers can not only whiten teeth, but the shape and arrangement of the teeth can even be changed. These are more expensive, but do not require re-enhancement to retain their natural beauty. Since Porcelain veneers can abraid or wear out the opposing teeth and cost about $1600, we usually recommend Composite Veneers, which often look better and cost about $800 each.

CROWNS

Crowns can also be used to enhance the shape and color of your teeth. They are usually reserved for teeth that are already in disrepair or that require more coverage of the tooth to provide additional strength. These usually cost about $1600. There are times, however, when we recommend large white fillings if the placement of the crown will compromise the longevity of the tooth.

DENTAL LASERS REVOLUTIONIZE DENTISTRY

What is Laser Therapy? For a long time now L.A.S.E.R. (Light Amplification by Stimulated Emission of Radiation) was an acronym and today a word of common use. The word LASER is the name of a device that projects intense radiation of the light spectrum. It produces a beam of light in which high energies can be concentrated.

Cold Laser light has unique physical properties, which no ordinary light has. The unique properties of coherence and monochromaticity are the key to why laser light is so effective compared to other kinds of light in pain reduction and healing.

Cold Laser therapy, also known as phototherapy and low level laser therapy, involves the application of low power coherent light to injuries and lesions to stimulate healing and reduce pain. It is used to increase the speed, quality, and strength of tissue repair, resolve inflammation, and give pain relief.

Laser therapy has been found to offer superior healing and pain relieving effects compared to other electrotherapeutic modalities such as ultrasound, especially in chronic problems and in the early stages of acute injuries. Laser therapy is a complete system of treating muscle, tendon, ligament, connective tissue, bone, nerve, and dermal tissues in a non-invasive, drug-free modality.

HOW DOES IT WORK?

The effects of laser therapy are photochemical in general and with super-pulsed lasers such as the Lumix also photomechanical. Photons enter the tissue and are absorbed in the cell’s mitochondria and at the cell membrane by chromophores. These chromophores are photosensitizers that generate reactive oxygen species following irradiation, thereby influencing cellular redox states and the mitochondrial respiratory chain. Within the mitochondria, the photonic energy is converted to electromagnetic energy in the form of molecular bonds in ATP.

It is obvious that, in order to interact with the living cell, laser light has to be absorbed by intracellular chromophores. Cell membrane permeability increases, which promotes physiological changes to occur. These physiological changes affect macrophages, fibroblasts, endothelial cells, mast cells, bradykinin, and nerve conduction rates. Cold Laser Therapy is often compared to "acupuncture with a laser beam". Currently, there are over 25 different cold lasers that have been cleared by the FDA for various types of treatments. Low level laser therapy (LLL), commonly referred to as cold lasers have, been proven completely safe in over 3000 worldwide studies. Many of those studies are listed below.

Cold lasers have been in use around the world for over 30 years and have been in use in the US for over 10 years. In most LLL treatments, the laser beam is use to stimulate the body's acupoints or damaged area in an attempt to increase the blood supply to parts of the body. The energy from the laser may penetrate as deep as 4 inches into the body based on the power of the laser and other variables. Cold Laser Therapy is considered an alternative therapy just like Acupuncture.

Cold laser treatments can often be combined with traditional treatment for even better results. Although some patients may be able to benefit from just one treatment, most patients need multiple treatments. In our practice we are utilizing The TerraQuant Solo Healing Laser, the most advanced laser for following applications: Hypersensitivity, Bone regeneration, Post-scaling pain, elimination of Inflammation Dry sockets, Cold sore & oral ulcers, TMJ disorders, Paresthesia, Post-operative tissue healing Implant integration.

The clinical and physiological effects are obtained by the way in which the tissues absorb laser radiation. This tissue absorption depends on the wavelength of the beam itself and the power to ensure that the laser energy reaches the target tissue at the necessary clinical levels.

The use of an improper wavelength laser would not penetrate into the tissue to reach the target area. Furthermore, even if one has a laser with the proper wavelength, if the device does not have enough power to drive the energy into the tissue, the target area may not realize the potential benefits.

Each type of laser emits light at a very specific wavelength which interacts with the irradiated tissue. It also acts in particular with the chromophores present in the tissue, but in a different way. A chromophore, intrinsic or extrinsic, is any substance, colored or clear, which is able to absorb radiation. Among the endogenous chromophores, water and hemoglobin, nucleic acid, and proteins can be listed.

HOW DEEP INTO THE TISSUE CAN LASER LIGHT PENETRATE?

The level of tissue penetration by the laser beam depends on its optical characteristics, as well as on the concentration and depth of the chromophores, which according to the wavelength, are absorbed at different percentages. For instance, water absorbs almost 100 percent of the laser irradiation at the 10,600 nanometer wavelength, the wavelength of the CO2 gas laser. That is the reason why this type of laser wavelength is used in surgical applications. Other factors affecting the depth of penetration are the technical design of the laser device and the treatment technique used.

There is no exact limit with respect to the penetration of the light. The laser light gets weaker the further from the surface it penetrates with a limit at which the light intensity is so low that no biological effect of the light can be measured. In addition to the factors mentioned above, the depth of penetration is also contingent on tissue type, pigmentation, and foreign substances on the skin surface.

Bone, muscles, and other soft tissues are transparent to certain laser lights, which means that laser light can safely penetrate these tissues. The radiation in the visible spectrum, that between 400 and 600 nanometers, is absorbed by the melanin, while the whole extension of the visible which, goes from 420 to 750 nanometers, is absorbed by composite tetrapyrrolics. In the infrared, which covers about 10,000 nanometers of the light spectrum, water is the main chromophore

. Fortunately, there exists a narrow band in the light spectrum where water is not a highly efficient chromophore, thereby allowing light energy to penetrate tissue that is rich in water content. This narrow band, which extends approximately from 600 to 1,200 nanometers, is the so-called therapeutic window. That is the reason why the therapeutic lasers in the market today have wavelengths within this therapeutic window.

The penetration index is not the same level throughout the therapeutic window. In fact, lasers in the 600 to 730 nanometers have less penetration and are suitable for superficial applications such as in acupuncture.

LASERS VS. LED

Light emitting diodes (LED) are just tiny light bulbs that fit easily into an electrical circuit. But unlike ordinary incandescent bulbs, they do not have a filament that will burn out. They are illuminated solely by the movement of electrons in a semiconductor material. LED’s produce incoherent light, just like an ordinary light bulb does. Light from LED’s have very little tissue penetration compared to laser light.

By applying the first law of photochemistry (Grotthus-Draper Law), which states that light must be absorbed by a molecule before photochemistry can occur, one can immediately conclude that light from LED’s would work only on skin level conditions, if at all. For conditions deeper than skin layers, one must choose light from a laser source.

PULSED VS. CONTINUOUS WAVE LASERS

In general, lasers diodes are either continuous wave or pulsed. The continuous wave (CW) diodes emit laser energy for the entire time it is electrically driven, hence its name. Pulsed diodes emit a radiation impulse with a high amplitude or intensity and duration of which is typically extremely short such as 100 to 200 nanoseconds.

Continuous wave lasers produce a fixed level of power during the emission. Although lacking the high peak power of a "true" or "super" pulsed laser, most continuous wave lasers can be made to flash a number of times per second to simulate pulse-like rhythms by interrupting the flow of light rapidly as in turning “off” and “on” a light switch.

Pulsed lasers, as the name implies, produce a high power level impulse of light for a very brief duration for each pulse. It is the high power level during each pulse that drives the light energy to the target tissue. Even though the pulse peaks at a high power level, there are no thermal effects in the tissue because the pulses are of extremely short duration. Therefore, the peak power of a pulsed laser is high compared to its average pulse power. By using pulsed lasers, one is able to more effectively drive light energy into the tissue.

The laser and electronic technologies required to use pulsed diodes are more advanced, and the diodes themselves are more expensive than the CW diodes. These are probably the main reasons why over 90% of the therapeutic lasers in the North American market are low power CW lasers. Some of these CW lasers provide power on the order of inexpensive laser pointers costing around $30 USD.

IS LASER THERAPY SAFE?

Yes. Laser therapy is a drug-free, non-invasive therapy with superior healing ability. However, since lasers produce a high intensity light, one should never shine the laser directly into the eye. Further, it is recommended that the laser device not be used directly on any neoplasmic tissue. Pregnant patients should refrain from laser therapy applied directly on the abdomen.

IS LASER THERAPY SCIENTIFICALLY WELL DOCUMENTED?

There are more than 120 double blind positive studies confirming the clinical effects of laser therapy. More than 300 research reports have been published. Looking at the laser therapy dental literature alone there, are over 300 studies. More than 90% of these studies do verify the clinical value of laser therapy.

A review of the research literature of studies that produce negative results one finds that low dose was the single most significant factor. By dose is meant the energy of the light delivered to a given unit area during a treatment session. The energy is measured in joules and the area in cm2. Assuming that the power of the laser remains constant during the treatment, the energy of the light will be equal to the power in watts multiplied by the time in seconds during which the light is emitted. Therefore, a laser with more power (watts) can deliver the same amount of energy (joules) in less time. If we use a pulsed laser, we can extend the above statement by saying that a pulsed laser with more average power (watts) can deliver the same amount of energy (joules) in less time and at deeper target tissues than continuous wave lasers.

Does Laser Therapy Cause Heat Damage or Cancer in the Tissue? No. The average powers and the type of light source (non-ionizing) do not permit heat-damage or carcinogenic (cancer-causing) effects. Due to increased blood, circulation there is sometimes a minimal sensation of warmth locally.

FEVER BLISTERS, APTHOUS ULCERS AND TOOTH SENSITIVITY

Dental lasers take advantage of the new diode lasers. If the laser is set in a non cutting mode, it can be used to treat fever blisters, apthous ulcers, and tooth sensitivity. The energy from the laser is able to stimulate the body's defenses to better fight some of the most vexing problems we have had to deal with in dentistry. The laser also helps kill viruses and, in about 25% of the cases eliminates recurrent cases of cold sores. This same energy also can help seal the tubules in the tooth that are exposed, causing sensitivity to hot and cold on your teeth.

The laser can be used to treat almost any type of sore in the mouth. When broader areas need to be treated, we use the healing laser or low level laser therapy.

GINGIVAL RETRACTION

These lasers can also be used to reduce the stress on teeth that is caused when we have to place cords around the gumline of crown preparations. We can create a small trough with no bleeding that exposes the edges of the tooth preparation so that our impressions are clean and accurate. This tissue remains healthy, and we do not have the recession that often used to occur with the cords.

SURGERY WITH THE LASERS

The laser works by using light energy to vaporize just a few cell thicknesses while stimulating the surrounding tissues to heal. The cutting laser has the ability to cut while controlling bleeding and discomfort. We still use anesthetics with the laser, but do not have to worry about post operative pain or swelling. This allows us to control the surgery in a manner unheard of previously. The biostimulation from the laser projects healing energy into the cells that charges the batteries of the cells and allows them to heal faster and return to normal at a much faster rate. The Laser surgery does take longer, so there is sometimes the need to balance its use with that of a conventional scalpel.

LASER BACTERIAL REDUCTION

Periodontal disease affects approximately 80% of adults and is a growing epidemic in our society. Understanding of this disease has increased greatly over the last few years. We now know that Periodontal Disease is a bacterial infection in the pockets around teeth. As such, we now not only treat Perio via removal of mechanical irritants and diseased tissue (your normal cleaning) but are also addressing the underlying infection that causes it.

Using the Laser in a non-cutting, painless mode, we place the glass tip of the laser in the pocket around each tooth. The laser energy vaporzies the bacteria preventing both peridontal disease, but also eliminating spread of bacteria into the blood stream during the cleaning. This elimation of the bacteremias is helpful for those that have prosthetic valves or joints.

Ask for Laser Bacterial Reduction at your next cleaning appointment. The cost is only $30.

LASER ASSISTED PERIODONTAL THERAPY

Periodontal disease can result in the destruction of the bone supporting the teeth. Utilizing the Laser we can remove the infected tissue within the pockets around the teeth. Once this tissue is gone, and the bacteria have been removed the body can begin to heal itself. Unfortunately the gum tissue grows faster than the bone. By using the laser at one week intervals we are able to control the down growth of the gum tissue while stimulating the up growth of bone. In several studies they were able to demonstrate the regrowth of the bone around the teeth. This is unheard of and if it actually works is one of the greatest advances in dentistry today.

The fee for this is generally in the $300 to $1800 range depending on the severity of the disease and the number of treatments necessary.

LOW LEVEL LASER THERAPY (LLLT)

MUSCULOSKELETAL PAIN SYNDROMES (CHRONIC AND ACUTE): LLLT has been shown to be effective in a variety of musculoskeletal conditions and associated pain presentations.

In Rheumatoid Arthritis, LLLT can benefit not only the pain of acute small joint inflammation but also the chronic pain. In a review article on rheumatology (3), some 18 papers were considered. All studies involved double-blind trials with LLLT in chronic rheumatoid, and reported significant improvement in pain (80% success rate in relieving pain). Upon comparing LLLT to a similar rate of pain attenuation using anti-inflammatory drugs (NSAIDs), the LLLT was free of any side-effects while 20% of patients treated with NSAIDs suffered unacceptable side-effects of medication. In another study of 170 patients with rheumatoid arthritis using LLLT (4), pain attenuation of up to 90% was noted.

Trellis et al (6) used LLLT for osteoarthritis of the knee in 40 patients. He reported a significant reduction of 82% of the patients with improved joint mobility. Among 36 randomized patients, with pain caused by cervical osteoarthritis, those who received Infra-Red and Low Level Laser treatment improved 75% compared with the group receiving mock treatment (31%). Similarly, a study of 60 patients with Cervical Osteoarthritis, Low Pulsed Laser was successful in relieving pain and in improving function.

The results of a study show that cervical myofascial pain is significantly improved at 3-month with Diode laser. A similar successful LLLT treatment has been described for whiplash injuries.

In a randomized study with 30 patients with supraspinatus or bicipital tendonitis, the results demonstrated the effectiveness of laser therapy in tendonitis of the shoulder. Another study with a patient population (n = 324), with either medial epicondylitis (Golfer's elbow; n = 50) or lateral epicondylitis (Tennis elbow; n = 274), and randomly allocated, provides further evidence of the efficacy of LLLT in the management of lateral and medial epicondylitis.

Treatment with low-level laser therapy (LLLT) was shown effective in treating Carpal Tunnel Syndrome pain. Another study, significant decreases in McGill Pain Questionnaire scores, median nerve sensory latency, and Phalen and Tinel signs were observed after treatment series with Low Level Laser Therapy. Patients could perform their previous work (computer typist, handyman) and were stable for 1 to 3 years.

In acute trauma there is a soft tissue injury comprising swelling, haematoma, pain and reduced mobility. Sporting injuries and domestic accidents usually involve damage to muscles, joint ligaments and tenclass. In the absence of bone fracture or other injury demanding priority treatment, LLLT should be instituted at the earliest opportunity. Kumar reported a comparative study in 50 patients with inversion injuries of the ankle. He found that compared to conventional physiotherapy, the LLLT treated patients showed a more rapid resolution of symptoms and an earlier return to full weight-bearing.

Fibromyaliga (FM) is characterized by widespread pain in the body, associated with particular tender points. It is often accompanied by disturbed sleep patterns, fatigue, headaches, irritable bowel and bladder syndrome, morning stiffness, anxiety, and depression. FM can cause a high level of functional disability and have a significantly negative effect on quality of life. One study suggests that "Laser Therapy is effective on pain, muscle spasm, morning stiffness, fatigue, depression and total tender point number in Fibromyalgia".

A randomized controlled study with 63 with non-radiating low back pain showed that LLLT significantly improved pain and function.

In summary, the bulk of published work to date supports the use of LLLT for treatment of a variety of musculoskeletal conditions and associated pain. Moreover, the LLLT proved to be not only more effective than conventional methods, but more economical as well. The added advantage of absence of side effects, non-invasive nature of therapy, and the ease of application, ensures good patient acceptance of the treatment modality.

LOW INTENSITY LASER THERAPY(LILT) FOR HEAD, NECK AND FACIAL PAIN. Prof P.F. Bradley

The clinical application of low incident power density laser radiation for the treatment of acute and chronic pain is now a well established procedure. This paper reviews the currently available English speaking literature and summarises a selection of serious scientific papers which report a beneficial effect following the treatment of a wide variety of acute and chronic syndromes whose main presenting symptom is pain.

Head and Neck Clinical Applications of LILT

LILT is proving useful in a wide variety of painful conditions in the Head and Neck, but the following are particular applications:

1. TM Joint Pain Dysfunction

2. Post Herpetic Neuralgia

3. Trigeminal Neuralgia

4. Painful Ulcerative Conditions

5. Pain of Advanced Oro Facial Cancer

The Ability of Low Level Laser Therapy (LLLT) to Mitigate Fibromyalgic Pain.

The CFIDS Chronicle Physicians' Forum Fall 1993

Douglas Ashendorf, MD, FAAPMR Newark, New Jersey

Results have suggested that the pain relieving properties of LLLT have been the most consistent benefit. The duration of benefit has varied from one hour to one week, and seems to increase as treatment progresses.

Other areas of improvement were not as clear. Improvement in sleep was observed with some regularity, although this was undoubtedly due in part to decreased pain. The "non-restorative" sleep complaints were less regularly improved. Improvement with regard to abnormal sensations in the limbs (paresthesia and subjective swelling) appears to be fairly consistent. Improvements in fatigue, mood, and headache.

Although the pilot study is incomplete, I believe that these early findings warrant the further investigation of laser therapy for patients with fibromyalgia. This is further supported by the relatively few and harmless side effects of this therapy, the fact that equipment and operating costs are reasonable, and the reality that there are few effective alternative treatments for fibromyalgia patients.

PHYSIOTHERAPIST SHOWS LASERS RELIEVE PAIN.

A physiotherapist at Royal Brisbane Hospital (Australia) recently received a PhD from the University of Queensland for demonstrating that laser treatment prompts the release of endorphins into the bloodstream. Endorphins are a type of natural morphine that dulls pain. Physiotherapist Liisa Laakso studied the effects of lasers on 56 people who suffered myofascial pain syndrome, a chronic hypersensitivity often secondary to a person's primary painful affliction, such as arthritis. Previous experiments linking endorphin release and lasers have only been done on rats.

In the study, Laakso applied different doses and wavelengths of a laser diode to "trigger points" on the body and took blood samples measuring endorphin levels in these subjects and a control group. The control group reported some pain relief - most likely a placebo effect - but endorphins were present. Those patients that underwent laser treatment reported pain reduction of up to 78%, and endorphins were present in their blood.

THE EFFECT OF INFRA-RED LASER IRRADIATION ON THE DURATION AND SEVERITY OF POSTOPERATIVE PAIN: A DOUBLE BLIND TRIAL.

Kevin C. Moore, Naru Hira, Ian J. Broome* and John A. Cruikshank

Departments of Anaesthesia and General Surgery, The Royal Oldham Hospital, Oldham, U.K

*Department of Anaesthesia, The Royal Hallamshire Hospital, Sheffield, U.K.,

General Practitioner, Pennymeadow Clinic, Ashton-under-Lyne, U.K.

This trial was designed to test the hypothesis that LLLT reduces the extent and duration of post-operative pain. Twenty consecutive patients for elective cholecystectomy were randomly allocated for either LLLT or as controls. The trial was double blind. Patients for LLLT received 6-8-min treatment (GaAlAs: 830 nm: 60 mW CW: CM) to the wound area immediately following skin closure prior to emergence from GA. All patients were prescribed on demand post-operative analgesia (IM or oral according to pain severity). Recordings of pain scores (0-10) and analgesic requirements were noted by an independent assessor. There was a significant difference in the number of doses of narcotic analgesic (IM) required between the two groups.

Controls n = 5.5: LLLT n = 2.5.

No patient in the LLLT group required IM analgesia after 24 h. Similarly, the requirement for oral analgesia was reduced in the LLLT group.

Controls n = 9: LLLT n = 4.

Control patients assessed their overall pain as moderate to severe compared with mild to moderate in the LLLT group. The results justify further evaluation on a larger trial population.

Address for correspondence: Dr K. C. Moore, Department of Anaesthesia, The Royal Oldham Hospital, Rochdale Road, Oldham OL1 2JH, U.K.

0898-5901/92/040145-05 $07.50

THE EFFECT OF INFRA-RED LASER IRRADIATION ON THE DURATION AND SEVERITY OF POSTOPERATIVE PAIN: A DOUBLE BLIND TRIAL.

Kevin C. Moore, Naru Hira, Ian J. Broome* and John A. Cruikshank

Departments of Anaesthesia and General Surgery, The Royal Oldham Hospital, Oldham, U.K

*Department of Anaesthesia, The Royal Hallamshire Hospital, Sheffield, U.K.,

General Practitioner, Pennymeadow Clinic, Ashton-under-Lyne, U.K.

Controls n = 5.5: LLLT n = 2.5.

No patient in the LLLT group required IM analgesia after 24 h. Similarly, the requirement for oral analgesia was reduced in the LLLT group.

Controls n = 9: LLLT n = 4.

Control patients assessed their overall pain as moderate to severe compared with mild to moderate in the LLLT group. The results justify further evaluation on a larger trial population.

Address for correspondence: Dr K. C. Moore, Department of Anaesthesia, The Royal Oldham Hospital, Rochdale Road, Oldham OL1 2JH, U.K.

0898-5901/92/040145-05 $07.50

EFFICACY OF LASER IRRADIATION ON THE AREA NEAR THE STELLATE GANGLION IS DOSE-DEPENDENT: DOUBLE-BLIND CROSSOVER PLACEBO-CONTROLLED STUDY.

Toshikazu Hashimoto, Osamu Kemmotsu, Hiroshi Otsuka, Rie Numazawa, and Yoshihiro Ohta, Department of Anaesthesia, Hokkaido University Hospital, Sapporo, Japan

In the present study, we evaluate the effects of laser irradiation on the area near the stellate ganglion on regional skin temperature and pain intensity in patients with postherpetic neuralgia. A double blind, crossover, and placebo-controlled study was designed to deny the placebo effect of laser irradiation.

Eight inpatients (male 6, female 2) receiving laser therapy for pain attenuation were enrolled in the study after institutional approval and informed consent. Each patient received three sessions of treatment on a separate day in a randomised fashion. Three minutes irradiation with a 150 mW laser (session 1), 3 minutes irradiation with a 60 mW laser (session 2), and 3 minutes placebo treatment without laser irradiation. Neither the patient nor the therapist was aware which session type was being applied until the end of the study. Regional skin temperature was evaluated by thermography of the forehead, and pain intensity was recorded using a visual analogue scale (VAS). Measurements were performed before treatment, immediately after (0 minutes), then 5, 10, 15, and 30 min after treatment. Regional skin temperature increased following both 150 mW and 60mW laser irradiation, whereas no changes were obtained by placebo treatment. VAS decreased following both 150 mW and 60 mW laser treatments, but no changes in

VAS were obtained by placebo treatment. These changes in the temperature and VAS were further dependent on the energy density, i.e. the dose.

Results demonstrate that laser irradiation near the stellate ganglion produces effects similar to stellate ganglion block. Our results clearly indicate that they are not placebo effects but true effects of laser irradiation.

Address for Correspondence:

Toshikazu Hashimoto MD,

Department of Anaesthesia, I Hokkaido University I Hospital N15,

W7, Kita-ku Sapporo, Japan 060.

LASER THERAPY 1997:9:7-12

SUCCESSFUL MANAGEMENT OF FEMALE OFFICE WORKERS WITH "REPETITIVE STRESS INJURY" OR "CARPAL TUNNEL SYNDROME" BY A NEW TREATMENT MODALITY- APPLICATION OF LOW LEVEL LASERS FOR PAIN

E. Wong G LEE J. Zu CHERMAN and D. P. MASON

Western Heart Institute and St. Mary's Spine Center St. Mary's Medical Center. San Francisco. CA. USA and Head and Neck Pain Center, Honolulu HL. USA

Abstract

Female office workers with desk jobs who are incapacitated by pain and tingling in the hands and fingers are often diagnosed by physicians as "repetitive stress injury'' (RSI) or "carpal tunnel syndrome'' (CTS). These patients usually have poor posture with their head and neck stooped forward and shoulders rounded; upon palpation. they have pain and tenderness at the spinous processes C5 - T1 and the medial angle of the scapula. In 35 such patients, we focused the treatment primarily at the posterior neck area and not the wrists and hands. A low level laser (100 mW) was used and directed at the tips of the spinous processes C5 - Tl.

The laser rapidly alleviated the pain and tingling in the arms, hands, and fingers, and diminished tenderness at the involved spinous processes. Thereby, it has become apparent that many patients labelled as having RSI or CTS have predominantly cervical radicular dysfunction resulting in pain to the upper extremities, which can be managed by low level laser.

Successful long-term management involves treating the soft tissue lesions in the neck combined with correcting the abnormal head, neck, and shoulder posture by taping. cervical collars, and clavicle harnesses as well as improved work ergonomics.

LASER THERAPY, 1997:9: 131- 136 09/97

PHYSIOLOGICAL RESPONSES IN CHRONIC PAIN PATIENTS. LLLT PROTOCOL. Scott D. Fender and David Diffee

Pain Research Group, Arvada, Colorado, U.S.A.

Use of Low Reactive Level Laser Therapy (LLLT) utilising helium-neon lasers has increased lately, especially in pain control. New protocols are being developed aimed at a complex of primary and secondary symptomologies. One of these protocols Stellate Ganglion Stimulation has shown in our research a unique set of developments. Targeting the area of the stellate ganglion is showing great promise in the rehabilitation of patients with a history of chronic musculoskeletal pain syndromes, but several patients with pre-existing psychological symptomology have exacerbated during the initial stages of utilization of this protocol.

Patients with a history of psychological diagnosis for dysthymia, anxiety, post traumatic stress disorder or minor diffuse brain injury have shown an exacerbation of these symptomologies during the initial phases of stimulation treatment. Overall, response to this form of therapy seems to be positive, but some patients require dermatomal and/or site-specific therapy to maximize outcome. With specific psychological treatment combined with a more conservative amount of stimulation initially, the increase in these symptoms shows a tendency to remit with the pain response. Our continued research is currently focusing on the mechanisms for this type of response as well as protocol refinement to maximize its effectiveness.

Address for correspondence:

Scott D. Fender DDS DAPM, 5275 Marshall Street, Suite 203, Arvada, CO 80002, U.S.A.

MECHANISMS OF THE ANALGESIC EFFECTS OF THERAPEUTIC LASERS IN VIVO.

L Navratil (1)and I Dylevsky(2)

1: Outpatient Department of Radiobiology, Institute of Biophysics, First Medical Faculty, and

2: Department of Functional Anatomy, Second Medical Faculty, and Faculty of Physical Education Charles University, Prague, Czech Republic

The analgesic effects in the course of application of therapeutic lasers to affected tissue have been described in a number of works in the literature. Although a few scientific-based reports have appeared, those on laser-induced analgesia are mainly clinical works describing the effect of the therapy, which, however, do not study the mechanism of the laser action. There are several different possible responses induced by non-invasive low level laser therapy (LLLT).

The purpose of the present communication is to review the arrangement and characterisation of these responses. By being aware of these effects, the laser therapist can acquire a physiological and morphological scheme making possible the appropriate choice of the site of application of LLLT, choice of the irradiation technique, and selection of appropriate doses.

Address for Correspondence:

Leos Navratil MD PhD, Department of Clinical Radiahiology, Institute of Biophysics, First Medical Faculty, Charles University Saln1ovska 3, CZ 120 00, Prague 2, Czech Republic.

LASER THERAPY 1997:9:33-40

Experimental Physiology (1994) 79. 227-234 Printed in Great Britain

CAN LOW REACTIVE-LEVEL LASER THERAPY BE USED IN THE TREATMENT OF NEUROGENIC FACIAL PAIN? A DOUBLE-BLIND, PLACEBO CONTROLLED INVESTIGATION OF PATIENTS WITH TRIGEMINAL NEURALGIA.

ArneEckerdal and Lehmann Bastian

Department of Oral and Maxillofacial Surgery and Oral Medicine, Odense University Hospital, Denmark

Neurogenic facial pain has been one of the more difficult conditions to treat, but the introduction of laser therapy now permits a residual group of patients, hitherto untreatable to achieve a life free from or with less pain. The present investigation was designed as a double-blind, placebo controlled study to determine whether low reactive-level laser therapy (LLLT) is effective for the treatment of trigeminal neuralgia. Two groups of patients (14 and 16) were treated with two probes. Neither the patients nor the dental surgeon were aware of which was the laser probe until the investigation had been completed. Each patient was treated weekly for five weeks.

The results demonstrate that of 16 patients treated with the laser probe, 10 were free from pain after completing treatment, and 2 had noticeably less pain, while in 4 there was little or no change. After a one year follow-up, 6 patients were still entirely free from pain. In the group treated with the placebo system, i.e. the non-laser probe, one was free from pain, 4 had less pain, and the remaining 9 patients had little or no recovery. After one year, only one patient was still completely free from pain. The use of analgesics was recorded, and the figures confirmed the fact that LLLT is effective in the treatment of trigeminal neuralgia. It is concluded that the present study clearly shows that LLLT treatment, given as described, is an effective method and an excellent supplement to conventional therapies used in the treatment of trigeminal neuralgia.

Address for Correspondence:

Arne Eckerdal DDS DOS Consultant, Department of Oral and Maxillofacial Surgery & Oral Medicine, Odense University Hospital, DK-5000 Odense, Denmark.

12/96 Rep. US X 8-10-12

LASER THERAPY, 1996: 8: 247-252

DOUBLE-BLIND CROSSOVER TRIAL OF LOW LEVEL LASER THERAPY IN THE TREATMENT OF POST-HERPETIC NEURALGIA.

Kevin C Moore, Naru Hira. Parswanath S. Kramer, Copparam S. Jayakumar, and Toshio Ohshiro

Post herpetic neuralgia can he an extremely painful condition which in many cases, proves resistant to all the accepted forms of treatment. It is frequently most severe in the elderly and may persist for years with no predictable course.

This trial was designed as a double blind assessment of the efficacy of low level laser therapy in the relief of the pain of post herpetic neuralgia with patients acting as their own controls. Admission to the trial was limited to patients with established post herpetic neuralgia of at least six months duration and who had shown little or no response to conventional methods of treatment. Measurements of pain intensity and distribution were noted over a period of eight treatments in two groups of patients each of which received four consecutive laser treatments.

The results demonstrate a significant reduction in both pain intensity and distribution following a course of low level laser therapy.

John Wiley & Sons. Ltd.

EFFICACY OF LOW-LEVEL LASER THERAPY FOR PAIN ATTENUATION OF POST-HERPETIC NEURALGIA.

Osamu Kemmotsu, Kenichi Sato, Hitoshi Furumido, Koji Harada, Chizuko Takigawa, Shigeo Kaseno, Sho Yokota, Yukari Hanaoka and Takeyasu Yamamura

Department of Anaesthesiology, Hokkaido University School of Medicine, N-15. W-7, Kita-ku. Sapporo 060, Japan. The efficacy of low reactive-level laser therapy (LLLT) for pain attenuation in patients with postherpetic neuralgia (PHN) was evaluated in 63 patients (25 males. 38 females with an average age of 69 years) managed at our pain clinic over the past four years. A double blind assessment of LLLT was also performed in 12 PHN patients. The LLLT system is a gallium aluminium arsenide (GaAlAs) diode laser (830 nm, 60 mW continuous wave). Pain scores (PS) were obtained using a linear analogue scale (1 to 10) before and after LLLT.

The immediate effect after the initial LLLT was very good (PS: <3 in 26, and good (PS: 7-4) in 30 patients. The long-term effect at the end of LLLT (the average number of treatments 36 + 12) resulted in no pain (PS: 0) in 12 patients and slight pain (PS: 1-4) in 46 patients. No complications attributable to LLLT occurred. Although a placebo effect was observed, decreases in pain scores and increases of the body surface temperature by LLLT were significantly greater than those that occurred with the placebo treatment. Our results indicate that LLLT is a useful modality for pain attenuation in PHN patients, and because LLLT is a non-invasive, painless, and safe method of therapy, it is well acceptable by patients.

Address for correspondence:

Osamu Kemmotsu, Department of Anaesthesiology, Hokkaido University School of Medicine, N-15, W-7, Kita-ku, Sapporo 060, Japan.

0898-5901/91/020071-05 $05.00

MECHANISTIC APPROACH TO GAAIAS DIODE LASER EFFECTS ON PRODUCTION OF REACTIVE OXYGEN SPECIES FROM HUMAN NEUTROPHILS AS A MODEL FOR THERAPEUTIC MODALITY AT CELLULAR LEVEL.

Makoto Yamaya*, Chiyuki Shiroto', Hiroki Kobayashi*, Shinji Naganuma*, Jyuichi Sakamoto*, Koh-Jun Suzuki*, Shigeyuki Nakaji*, Kazuo Sugawara* and Takashi Kumae *Department of' Hygiene, Hirosaki University School of Medicine. Hirosaki;. -Shiroto Clinic Coshogawara, Aomori: Department of Industrial Health. The Institute of Public Health, Tokyo. Japan

There have been many reports on the applications of low reactive level laser (LLL) therapy for pain attenuation or pain removal. Our group has reported previously on the effects of in vitro irradiation of LLLT particularly on the phagocytic activity of human Neutrophils, using luminol-dependent chemiluminescence (LmCL) for measurement of reactive oxygen species (ROS) production from human Neutrophils. However, the mechanisms of the attenuation of phagocytic activity of NEUTROPHILS by LLL irradiation is not yet full understood.

In this study. we used luminol-dependent and lucigenin-dependent chemiluminescence (LgCL) for detection of affected ROS producing process of human Neutrophils by LLL irradiation. Two soluble action stimuli, N-formyl-Met-Leu-Phc (fMLP) and phorbol myristate acetate (PMA), were used to avoid the possible influence of lag-time from recognition to uptake of particles at the ROS production.

In case of using fMLP as a stimulus, the maximum luminescence intensity of LULL was increased hut LgCL luminescence was decreased by LLL irradiation. When PMA was used as a stimulus, the times to reach the maximum luminescence intensity of LmCL and LgCL were shortened by LLL irradiation, but there was no effect on the maximum luminescence intensity of both.

These results suggest that LLL irradiation enhances the ROS production activity of human Neutrophils by the activation of the superoxide converting system, the active clement in which is mainly myeloperoxidase. LLL irradiation enabled a more rapid activation of the superoxide production system, NADPH -oxidase.

0898-5901/93/03011 1-06 $08.00

LASER THERAPY 1993: 5: 111-116

LASER THERAPY TAKES PAIN, DISCOMFORT OUT OF POST-CANCER CONDITION

LOW-LEVEL laser therapy promises to be a valuable weapon in the fight against lymphoedema, the painful and permanent swelling of an arm which frequently follows breast cancer operations. Doctors at Adelaide's Flinders University (FU) have conducted trials which have produced the first clinical evidence that infra-red laser can improve tissue conditions rapidly in the affected area.

Associate professor Neil Piller told the university magazine, Flinders Journal, that loosening the tissue encouraged the regrowth of lymph vessels. The results are very exciting," Dr Piller said. "This is the first time anyone specifically has set out to trial lasers in this way. Previously, information about the possible efficacy of lasers has come as a by-product of research into such areas as wound treatment and arthritic conditions, and even then, there has been very little work done."

Lymphoedema results from deliberate or accidental removal of lymph nodes or vessels. It affects about 15 per cent of women sometime after a breast cancer operation. In the FU trials, 15 women with prolonged or severe lymphoedema were given 16 half-hour laser treatments over 10 weeks. " All had arms swollen to between 140 and 180 per cent of normal volume. A scanning laser, focusing 2-4 joules of power to each square centimetre, was applied to the entire arm.

In all cases, the treatment reduced the amount of oedema, the volume of fluid, and the circumference of the arm above the elbow. Tissues in the upper and lower arm were softened and patients reported less pain, tightness and heaviness, and far greater mobility. "Giving them 16 treatments actually was overkill," Dr Piller said. "Since the trial ended, we have achieved significant results from just three or four treatments, or in some cases, one or two."

Diode Laser in Cervical Myofascial Pain: A Double-Blind Study versus Placebo

* F. Ceccherelli, * L. Altafini, * G. Lo Castro, * A. Avila, *F. Ambrosio, and * G. P. Giron

*Institute of Anesthesiology and Intensive Care, University of Padua, and the Associazione Italiana per la Ricerca e, l'Aggiornamento Scientif co, Padua, Italy

Summary

We present a double-blind trial in which a pulsed infrared beam was compared with a placebo in the treatment of myofascial pain in the cervical region. The patients were submitted to 12 sessions on alternate days to a total energy dose of 5 J each. At each session, the four most painful muscular trigger points and five bilateral homometameric acupuncture points were irradiated. Those in the placebo group submitted to the same number of sessions following an identical procedure, the only difference being that the laser apparatus was nonoperational. Pain was monitored using the Italian version of the McGill pain questionnaire and the ScottHuskisson visual analogue scale.

The results show a pain attenuation in the treated group and a statistically significant difference between the two groups of patients, both at the end of therapy and at the 3-month follow-up examination.

Address correspondence and repent requests to:

Dr. F. Ceccherelli at the Istituto di Anestesiologiae Rianimazione, via C. Battisti 267, 35121 Padova, Italia.

The Clinical journal of Pain 5:301-304

PAIN SCORES AND SIDE EFFECTS IN RESPONSE TO LOW LEVEL LASER THERAPY(LLLT) FOR PHYSICAL TRIGGER POINTS.

E Liisa Laakso Carolyn Richardson, and Tess Cramond

1: Physiotherapy Department, Royal Brisbane Hospital, Brisbane; 2: Physiotherapy Department, University of Queensland, Brisbane; and 3: Pain Clinic, Royal Brisbane Hospital, Brisbane, Queensland, Australia.

Clinically, Low Level Laser Therapy - LLLT has been used successfully in the treatment of chronic pain, but many have questioned the scientific basis for its use. Many studies have been poorly designed or poorly controlled.

A double-blind, placebo-controlled, random allocation study was designed to analyse the effect of second daily infrared (JR) laser (820 nm, 25 mW) and visible red laser (670 nm, 10 mW) at 1 J/cm2 and 5 J/cm2 on chronic pain. Forty-one consenting subjects with chronic pain conditions exhibiting myofascial trigger points in the neck and upper trunk region underwent five treatment sessions over a two week period. To assess progress, pain scores were measured using visual analogue scales before and after each treatment. The incidence of side effects was recorded.

All groups demonstrated significant reductions in pain over the duration of the study with those groups which received infrared (820 nm) laser at I J/cm2 and 5 J/cm2. demonstrating the most significant effects (p < 0.001). Only those subjects who had active laser treatment experienced side effects.

Results indicated that responses to LLLT at the parameters used in this study are subject to placebo and may be dependant on power output, dose, and/or wavelength.

Addressee for Correspondence:

E Liisa Laakso BPhty PhD, Physiotherapy Department, Royal Brisbane Hospital, Herston, (Queensland, Australia, 4029. 6/97 Rep. US $8-10-12

LASER THERAPY. 9: 67-72 67

Two wavelengths studied.

Best results with the higher powered infrared laser compared with, the lower powered red laser Wave- length Average Power Energy Density Power Density Energy Pulses Time Beam Spot size 820 25mW 5 J/Cm2 0.89 W/Cm2 0.14 J 5,000Hz 5.62 secs 0.89Cm2

LOW LEVEL LASER THERAPY(LLLT) OF TENDINITIS AND MYOFACIAL PAINS A RANDOMIZED, DOUBLE-BLIND, CONTROLLED STUDY.

Mimmi Logdberg-Anderssont (1), Sture Mutzell (2), and Ake Hazel (3)

1: Akersberga Health Care Centre,

2: Danderyd University Hospital, Danderyd, and

3: Vaxholm Health Care Centre, Stockholm, Sweden.

The purpose of this randomised, double-blind study was to examine the effect of GaAs laser therapy for tendonitis and myofascial pain in a sample from the general population of Akersberga in the northern part of Greater Stockholm.

176 patients (of an original group of 200) completed the scheduled course of treatment. The patients were assigned randomly to either a laser group (92 patients, of whom 74 had tendonitis, completed the study) or a placebo group (84 patients, of whom 68 had tendonitis, completed the study). All 176 patients received six treatments during a period of 3-4 weeks. Their pain was estimated objectively using a pain threshold meter, and subjectively with a visual analogue scale before, at the end of, and four weeks after the end of treatment.

Laser therapy had a significant, positive effect compared with placebo measured from the first assessment to the third assessment, four weeks after the end of treatment. Laser treatment was most effective on acute tendonitis.

Address for Correspondence

Sture Mutzell, Danderyd University Hospital 5-182 87 Danderyd, Sweden.

03/07 Rep US 10-12-14, 1997 By LT Publishers, U.K., Ltd.

LASER THERAPY, 1997:9: 79-86 Wave- length Power Energy Density Power Density Energy per point Pulses 904nm 8mW av (10Wpeak) 0.5-1.0 J/Cm2 (not given) 1J 4KHz x 180nS

THE EFFICADY OF LASER THERAPY FOR MUSCULOSKELETAL AND SKIN DISORDERS: A CRITERIA-BASED META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS.

Beckerman H, de Bie RA, Bouter LM, et al.

The efficacy of laser therapy for musculoskeletal and skin disorders has been assessed on the basis of the results of 36 randomized clinical trials (RCTs) involving 1,704 patients. For this purpose, a criteria-based meta-analysis that took into account the methodological quality of the individual trials was used. The studies with a positive outcome were generally of a better quality than the studies with a negative outcome. No clear relationship could be demonstrated between the laser dosage applied and the efficacy of laser therapy, or between the dosage and the methodological score.

In general, the methodological quality of these studies appeared to be rather low. Consequently, no definite conclusions can be drawn about the efficacy of laser therapy for skin disorders. The efficacy of laser therapy for musculoskeletal disorders seems, on average, to be larger than the efficacy of a placebo treatment. More specifically, for rheumatoid arthritis, post-traumatic joint disorders, and myofascial pain, laser therapy seems to have a substantial specific therapeutic effect.

Further RCTs, avoiding the most prevalent methodological errors, are needed in order to enable the benefits of laser therapy to be more precisely and validly evaluated.

Physical Therapy. 72(7):483-91, 1992 Jul. (60 ref)

LLLT USING A DIODE LASER IN SUCCESSFUL TREATMENT OF A HERNIATED LUMBAR/SACRAL DISC, WITH MAGNETIC RESONANCE IMAGING(MRI) ASSESSMENT: A CASE REPORT.

Tatsuhide Abe

Abe Orthopaedic Clinic Futuoka City Fukuoka Prefecture Japan X12' A 40-year-old woman presented at the Abe Orthopedic Clinic with a 2-year history of lower hack pain and pain in the left hip and leg diagnosed as a ruptured disc between the 5th lumbar/lst sacral vertebrae. The condition had failed to respond to conventional treatment methods, including pelvic traction, nonsteroid anti-inflammatory drugs, and aural block anesthetic injections.

MRI scans were made of the affected disc, showing it protruding on the left side through the aural membrane. The gallium aluminum arsenide (GaAlAs) diode laser (830 nm, 60 mW) was used in outpatient therapy, and after 7 months, the patient's condition had dramatically improved demonstrated by motility exercises. This improvement was confirmed by further MRI scans, which showed clearly the normal condition of the previously herniated L5/SI disc.

O898-5901/89/020093-03 $05.00

PHYSIOLOGICAL RESPONSES IN CHRONIC PAIN PATIENTS LLLT PROTOCOL.

Scott D. Fender and David Diffee

Pain Research Group, Arvada, Colorado, U.S.A.

Targeting the area of the stellate ganglion is showing great promise in the rehabilitation of patients with a history of chronic musculoskeletal pain syndromes, but several patients with preexisting psychological symptomology have exacerbated during the initial stages of utilization of this protocol. Patients with a history of psychological diagnosis for dysthymia, anxiety, post traumatic stress disorder, or minor diffuse brain injury have shown an exacerbation of these symptomologies during the initial phases of stimulation treatment.

Overall, response to this form of therapy seems to be positive, but some patients require dermatomal and/or site-specific therapy to maximize outcome. With specific psychological treatment combined with a more conservative amount of stimulation initially, the increase in these symptoms shows a tendency to remit with the pain response. Our continued research is currently focusing on the mechanisms for this type of response as well as protocol refinement to maximize its effectiveness.

Address for correspondence:

Scott D. Fender DDS DAPM, 5275 Marshall Street, Suite 203, Arvada, CO 80002, U.S.A.

0898-5901/92/040169-05 $07.50

CLINICAL APPLICATION OF GAAIAS 830 NM DIODE LASER IN TREATMENT OF RHEUMATOID ARTHIRITIS.

Kanji Asada, Yasutaka Yutani, Akira Sakawa and Akira Shimazu

Department of Orthopaedic Surgery, Osaka City University Medical School, Japan

The authors have been involved in the treatment of rheumatoid arthritis (RA), in particular chronic poly-arthritis and the associated pain complaints. The biggest problem facing such patients is joint contracture, leading to bony ankylosis. This, in turn, severely restricts the range of motion (ROM) of the RA-affected joints, thereby seriously restricting the patient's quality of life (QOL). The authors have determined that in these cases, daily rehabilitation practice is necessary to maintain the patient's QOL at a reasonable level.

The greatest problem in the rehabilitation practice is the severe pain associated with RA-affected joints, which inhibits restoration of mobility and improved ROM. LLLT or low reactive level laser therapy has been recognized in the literature as having been effective in pain removal and attenuation. The authors accordingly designed a clinical trial to assess the effectiveness of LLLT in RA related pain (subjective self-assessment) and ROM improvement (objective documented data).

From July 1988 to June 1990, 170 patients with a total of 411 affected joints were treated using a GaAlAs diode laser system (830 nm, 60 mW C/W). Patients mean age was 61 years, with a ratio of males: females of 1: 5.25 (16%: 84%). Effectiveness was graded under three categories: excellent (remarkable improvement), good (clearly apparent improvement), and unchanged (little or no improvement).

For pain attenuation, scores were: excellent - 59.6%; good - 30.4%; unchanged - 10%.

For ROM improvement the scores were: excellent - 12.6%; good - 43.7%; unchanged - 43.7%. This gave a total effective rating for pain attenuation of 90%, and for ROM improvement of 56.3%.

0898-5901/91/020077-06 $05.00

MECHANISMS OF THE ANALGESIC EFFECT OF THERAPEUTIC LASERS IN VIVO.

L Navratil (1) and I Dylevsky (2)

1: Outpatient Department of Radiobiology, Institute of Biophysics, First Medical Faculty, and 2: Department of Functional Anatomy, Second Medical Faculty and Faculty of Physical Education Charles University, Prague, Czech Republic

There are several different possible responses induced by non-invasive low level laser therapy (LLLT). The purpose of the present communication is to review the arrangement and characterisation of these responses. By being aware of these effects, the laser therapist can acquire a physiological and morphological scheme making possible the appropriate choice of the site of application of LLLT, choice of the irradiation technique, and selection of appropriate doses.

Address for Correspondence:

Leos Navratil MD PhD, Department of Clinical Radiahiology, Institute of Biophysics, First Medical Faculty, Charles University Saln1ovska 3, CZ 120 00, Prague 2, Czech Republic.

LASER THERAPY 1997:9 : 33-40

Experimental Physiology (1994) 79. 227-234 Printed in Great Britain

LASER'S EFFECT ON BONE AND CARTILAGE CHANGE INDUCED BY JOINT IMMOBILIZATION AN EXPERIMENT WITH ANIMAL MODEL.

Masami Akai, MD,1* Mariko Usuba, RPT,1 Toru Maeshima, Yoshio Shirasaki,2 and Shozo Yasuaka, MD3 'Department of Physical Therapy Tsukuba College of Technology, Tsukuba, Ibaraki, Japan Mechanical Engineering Laboratory, Agency of Industrial Science and Technology, TsuPuba, Ibaraki Japan. Yasuoka Orthopaedic Clinic, Mitaka, Tokyo, Japan

Objective:

Influence of low-level (810nm, Ga-Al-As semiconductor) laser on bone and cartilage during joint immobilization was examined with rats' knee model.

Materials and Methods:

The hind limbs of 42 young Wistar rats were operated on in order to immobilise the knee joint. One week after operation, they were assigned to three groups; irradiance 3.9W/cm2, 5.8W/cm2, and sham treatment. After 6 times of treatment for another 2 weeks, both hind legs were prepared for 1) indentation of the articular surface of the knee (stiffness and loss tangent), and for 2) dual energy X-ray absorptiometry (bone mineral density) of the focused regions.

Results and Conclusions:

The indentation test revealed preservation of articular cartilage stiffness with 3.9 and 5.8W/cm2 therapy. Soft laser treatment has a possibility for prevention of biomechanical changes by immobilisation.

Correspondence to:

Masami Akai, M.D., Department of Central Rehabilitation Service University Hospital, Faculty of Medicine, University of Tokyo 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan.

Lasers Surg. Med. 21:480-484, 1997.

HISTOLOGICAL AND CLINICAL RESPONSES OF ARTICULAR CARTILAGE TO LOW-LEVEL LASER THERAPY: EXPERIMENTAL STUDY.

I. RUIZ CALATRAVA, J.M.SANTISTEBAN VALENZUELA, R.J.G0MEZ-VILLAMANDOS J.I.REDONDO, J.C.G0MEZ-VILLAMANDOS, l.AVIGA JURADO

Department of Veterinary Clinical Pathology-Surgery, Faculty of Veterinary Medicine, University of Cordoba, Spain. Correspondence to 1. Ruiz Calatrava, Department of Veterinary Clinical Pathology-Surgery, Faculty of Veterinary Medicine, University of Cordoba, Avda. Medina Azahara, 9, 14005 Cordoba, Spain

Abstract

This study was carried out to evaluate the effects of low-level laser irradiation on experimental lesions of articular cartilage.

A standard lesion was practiced on the femoral trochlea of both hind limbs of 20 clinically normal Californian rabbits. These animals were divided into two groups of 10 individuals each, depending on the laser equipment used for treatment. One group was treated with HeNe laser (8 J cm - 2, 632.8 nm wavelength) and the other with infra-red (JR) laser (8 J cm - 2, 904 nm wavelength). In both groups, five points of irradiation to the right limb alone were irradiated per session for a total of 13 sessions, applied with an interval of 24 h between sessions. These points were the following: left and right femoral epicondyles, left and right tibial condyles, and the centre of articulation. The distance between these points was approximately 1 cm. The untreated left limb was left as a control. During treatment, extension angle and periarticular thickness were considered. At the end of the treatment, samples were collected for histopathological study and stained with: Haematoxylin-Eosin, PAS, and Done.

The results show a statistically higher anti-inflammatory capacity of the IR laser (p<0.0001). The functional recovery was statistically similar for both treatments (p<0.176). Histological study showed, at the end of the treatment, hyaline cartilage in the IR group, fibrocartilage in the HeNe group, and granulation tissue in the control limbs. Clinical and histological results indicated that this laser treatment had a clear anti-inflammatory effect that provided a fast recuperation and regeneration of the articular cartilage.

Lasers in Medical Science 1997, 12:117-121

PIEZO ENERGY REVOLUTIONIZES DENTISTRY

PIEZO SCALERS

Piezo scalers take advantage of high frequency vibration to destroy bacteria and to remove tartar or calculus buildups from teeth with substantially less discomfort. The energy is able to create ultrasonic frequencies that act like an ultrasonic water bath under the gums.

This flushes out the bacteria and removes them from even difficult to reach pockets under the gums. This same ultrasonic energy also acts like a miniature jack hammer to remove deposits from the surface of the tooth without traumatizing the gums. These scalers are 5 times more effective and substantially more comfortable than those used in year passed.

PIEZO SURGERY

The high frequency energy can also be used during surgery. It is used with a water spray that cools while the bone is cut. This type of surgey only cuts bone, but not tissues. This give us much better control, especially when we are working in and around the sinus area.

It is slower, so we often will combine several modalities depending on the phase of surgery or treatment that we are in.

DIGITAL X-RAYS THE RAYS OF THE FUTURE

One of the most exciting new areas of dentistry involves the use of DIGITAL X-RAYS. These new x-rays utilize a high speed computer and allow the x-rays to be taken with 80 to 90 percent less radiation. This dosage is so low that it barely leaves a reading on x-ray sensing equipment.

Not only is the radiation dosage low, but the amount of information that can be gleened from these x-rays is substantially greater. The contrast can be adjusted to improve diagnosis, and the x-ray can be colorized. This often shows things not otherwise detectable. This may prevent diseases from progressing much beyond the early stages because of early detection. Precise measurements can be made on the x-rays that are accurate to within 0.2 millimeters (the size of two or three hairs). The x-rays can also be magnified, giving detail and accuracy for the restoration of dental implants that exceeds anything we have had available before.

The greatest advantage is that the cost to the patient for these x-rays is the same as for x-rays on film that your dentist may now be using.

Dental implant — Dental Implants in Sequim, WA

Example of an x-ray of a dental implant.

Abcessed tooth — Dental Implants in Sequim, WA

Example of an abcessed tooth.

TEETH IN A DAY AND CT SCANS

THE TRUTH ABOUT TEETH IN A DAY

Dr. Brooksby, I see a lot of advertizing about "Teeth in A Day." Can you tell me about it. Does it work for everyone, and if not, how do you determine if you are a candidate.

WHAT IS TEETH IN A DAY?

"Teeth in a Day" is a treatment where a patient has dental implants placed and teeth installed on those implants the same day. It does not mean that you go in, and in only one day, they start and finish everything. There is a lot of work necessary to get the patient ready for that one day appointment.

The first thing that must happen is that the patient must be evaluated to see if they are healthy enough, have enough bone and that the bone is strong enough to have the implants placed immediately. When there is not enough bone or the bone is too soft, then the patient may have to have a special type of implant that is placed into the cheek bone just below the eye. This is a technique that has only been used for a few years and does not have a long track record or a lot of experience behind it yet. For those with bone that is too soft or insufficient for placement of dental implants, the patient must go through the conventional grafting and burying the implants for extended periods of time before the teeth can be attached to the implants. If you try and attach the teeth too soon, and the implant is overloaded and moves, the implant will fail.

WHO QUALIFIES FOR TEETH IN A DAY?

Many of the ads make it sound as though everyone can have "Teeth in a day", but the fine print of the ad indicates that it may not be for everyone. I taught a course to dentists several months ago in which we evaluated the CAT scans of every patient that came into my office during a three month period. There was not a single patient that qualified for "Teeth in a Day." I have been doing "Teeth in A Day" for about eight years. Even when I have patients that qualify, when they find that there is the potential for a higher failure rate, they chose to wait the four to six months normally required to assure a better, longer lasting outcome.

DENTAL CT SCANS

Dr. Brooksby, I have heard you talk about using a CAT scan before placing implants, but many of the places that I call indicate that they only need a Pano, not the more expensive CAT scan. What is the difference between the two, and why do you recommend one over the other?

CT SCAN VS PANOREX

A pano or Panorex is an xray taken by a machine that goes around your head and creates a two dimensional view of your jaws. It takes an average value of the scan and therefore magnifies the area by about 25%. This distortion can make it look like you have more bone than you actually have. Because it is two dimensional, it is unable to show you the width of the bone. It is possible for bone that is only the thickness of a matchbook cover to look like it is the same as bone that is as thick as your thumb.

A CAT scan machine can look just like a panorex machine, but it has the ability to make a three dimensional image that has no distortion or magnification. It allows us to look at anything in the head at any location in the head. We can look at the sinuses, the spine, the nose, or the jaw bone. We can measure the height, width, thickness, and density of the bone in any area. We can precisely see where the nerves are and where the bone has unusual shapes that can adversely impact our planned treatment. From the CAT scan, it is possible to make a model of the jaw and associated structures that is a fairly exact duplicate of the actual jaw. This ability allows us to determine, before we do anything, if the person is a candidate for implants, if there are tumors or if every thing is exactly as we need it to be to provide the optimum care. We can tell if the bone is soft and will require longer healing times or hard and able to support "Teeth in A Day."

FREE CT SCAN WHEN WE PLACE THE IMPLANTS

About five years ago, the first dental CAT scan machines were made that could be used in a dental office environment. When I first saw this CAT scan machine, I realized that this was the future of implant dentistry. I bought the twenty second machine made, becoming the first dentist in Nevada to have this technology available for my patients. These machines are more accurate than medical CAT scans and use much less radiation. A normal Panorex x-ray costs about $100. We charge $300 for a CAT scan. When I used to use medical CAT scans, it cost the patient $250 for the upper jaw, $250 for the lower jaw, and $250 for a scan of the TMJ's or jaw joints. The CAT scans we take now for $300 give us all of these scans and more. For the last five years, we have provided the CAT scans not only for our patients, but also for those of other doctors. When we place the dental implants, we credit the cost of the CAT scan back to the patient making the CAT scan, in essence, free.

WHAT IS AN ADVANCED SURGICAL PROSTHODONTIST?

Dr. Brooksby, I have heard that you are an Advanced Surgical Prosthodontist. What training have you had, and what is an advanced surgical prosthodontist?

LETS START BY DEFINING WHAT IS A PROSTHODONTIST.

A Prosthodontist is a dentist with advanced training approved by the American Dental Association in solving difficult dental problems. The training requires a two to three year residency after dental school. It is often associated with a hospital and a dental school. We spend the time in lectures on all areas of dentistry. There is usually a focus on treating the older, often medically compromised dental patient. We are taught to do thorough examinations of the head, neck and shoulders. We learn about the medications that are regularly prescribed for patients. We work with the oncologists treating cancer patients and in my residency we also trained with the very complex treatment of patients with head, neck and shoulder pain in addition to TMJ problems.

In addition to the Lectures, we had literature reviews that involved learning the details involving all types of dental treatment options. We learned that dentistry generally has twenty year cycles. Every twenty years they come up with the same new things that are tried and then fail. By learning what has worked and not worked over the years we are able to provide treatment and care based on what really is successful over the long term. Each literature review involved, on average 20 different studies that we had to read and discuss every single week.

We worked with patients that had difficult treatment requirements. We learned to diagnose and then develop comprehensive treatment options for the patients. We then discussed with the patients the options that were available and then provided the treatment for the patients. In my residency at the San Francisco VA Medical Center, the patients did not have to pay for the care so we were able to provide any and all options without worrying if the patient could or could not afford the treatment. This gave us much more experience with treatments that may only have been done occasionally if ever in other teaching environments.

In addition to the learning environment, we operated under the premise that you learn more as you teach. We therefore worked as instructors with General practice residents as well and teaching dental students. As I have practice over the last 33 years I have continued to teach dentists how to provide more complex treatment to their own patients. When asked why I teach others to do things instead of insisting that they send all of the patients to me for treatment, I answer that our goal is to improve the quality of treatment provided by all of us. As we teach these concepts we often gain a great understanding of the things that we can do to provide even better care for our patients.

There are three types of prosthdontist, the restorative prosthodontist, the surgical prosthodontist and the advanced surgical prosthodontist.

THE RESTORATIVE PROSTHODONTIST

The restorative prosthodontist generally solves difficult dental problems utilizing crowns, bridges and implants supported restorations.

THE SURGICAL PROSTHODONTIST

The surgical prosthodontist does the same things that a restorative prosthodontist does, but he also surgically places dental implants.

THE ADVANCED SURGICAL PROSTHODONTIST

An Advanced surgical prosthodontist is also trained to do bone grafting, sinus augmentation, placement of dental implants, and many of the more advanced surgical procedures required to prepare a patient for their new teeth. Some of the more famous advanced surgical prosthodontists include Dr. Carl Misch, Dr. Tom Balshi and Dr. Scott Ganz.

Dr. Brooksby received his Prosthodontic training from the San Francisco Veterans Hospital in conjunction with the UCSF School of Dentistry Prosthodontic program. Dr. Brooksby received his advanced surgical training in the Advanced Implant Study Group at Loma Linda Dental School. He has been practicing as a prosthodontist since 1990 and an advanced surgical prosthodontist since 1996. He has placed several thousand dental implants, performed over 300 sinus augmentations and hundreds of bone grafts in preparation for placement of dental implants and restoration of the mouth to normal function.

WHAT IS A NATTOKINASE AND WHAT IS A HYDROFLOSS?

HYDROFLOSS AND NATTOKINASE

Dr. Brooksby I have been plagued with continued tartar build up for years. I have tried the Sonic Care toothbrush, a Rotary tooth brush, a water pik and flossing, but still need frequent professional cleanings. Is there something else I could try that might work better?

WHAT IS THE HYDROFLOSS AND HOW DOES IT WORK?

Years ago, I was introduced to a device called the Hydrofloss. It looks like a water pik, but has a hydromagnetic supercharger incorporated into the unit. It essentially lines the pluses and minuses of the water molecules up in the same direction. This is not a normal state for the water. When it then hits the teeth is releases all of the pent up energy onto the teeth disrupting the bacterial plaque and the tartar buildup.

It is like a room full of kindergardeners being told to line up and remain perfectly still just before recess. Once the kids are told, they are released for recess, what kind of energy is released?

When I was introduced to the Hydrofloss, I wanted to know what studies had been done to justify their claims of superiority. The provided studies done at one of the periodontal training programs at a dental school. The head of that program figured it was just another water pik type of device that would not work. He designed a study in which he trained the dentists to evaluate the patients. He then provide the patients with a device, one had a fully functioning Hydromagnetic supercharger, and the other one was disabled. Neither the dentists nor the patients knew which units were which. When the head of the program tallied his results, he found that the supercharger group had a 60% reduction in tartar build up. He figured that something had gone wrong, so he recalibrated his dentists and then redid the study. The second time he only had a 49% reduction in tartar build up.

In my opinion, flossing is only about 5% effective. With a 49-60% reduction in tartar buildup, this is one of the most effective devices I have ever found. This, together with some of the techniques that we teach our patients, has been very effective at reducing tartar build up in a large number of our patients.

The Hydrofloss is available at Hydrofloss.com for about $130 plus shipping and handling. We buy them in bulk and pass the savings on to the patient by selling them in our office for $120.

NATTOKINASE THE ALTERNATIVE TO BLOOD THINNERS

Dr. Brooksby, I need to have some teeth extracted, but am on Coumadin and Plavix. My dentist talked to the clinic where I am being treated, and they refuse to take me off of the drugs. The dentist is afraid that with those drugs, I may not stop bleading after the extraction. What can be done?

Years ago, I began investigating alternatives to conventional medicine. It seemed that a lot of the treatments provide to patients involved medications with side effect that sometimes were worse than the disease they were treating. Many of the recommendation were made by a Dr. David Williams, a medical doctor in Texas that travels the world evaluating various forms of treatment and interviewing the doctors throughout the world on what they have found to be effective. He then reports on what he has found.

THE HISTORY OF NATTOKINASE

One of the doctors he visited with was a Japanese doctor at one of the medical schools in Japan. In the early 1980's this doctor had noted that the incidence of strokes, high blood pressure, and heart attacks was lower in the Japanese people. He began studying their diet by placing their food on plates full of blood clots. He found that a japanese drink called Natto, a fermented soy drink, completely dissolved the clot within a day. He isolated the substance that dissolved the clot and named it Nattokinase. Natto for the source and Kinase, which means it is an enzyme that eats things. They began with animal studies, and eventually human studies. They found that the Nattokinase taken twice a day dissolved, developing clots and lowered blood pressure by 10 percent without affecting the normal clotting that might occur during and injury. They decided to keep Nattokinase as a supplement instead of releasing it through a drug company to keep the costs of the Nattokinase affordable.

I asked one of the medical doctors why they do not recommend this in the place of Coumadin, plavix, and aspirin, and he said that since it was not FDA approved, if they recommended it and the patient had a complication they could sued. He did not want the risk.

In my opinion, and after watching patients, including my dad, use nattokinase for over 8 years with no adverse effects and with a substantial improvement in heart function, that this is a supplement that may be worth looking at. You can not take nattokinase with the other drugs because there interaction would not be good.

WHY WOULD A DENTIST BE TALKING ABOUT ALTERNATIVES TO BLOOD THINNERS?

If you needed to have a tooth extracted and did not want to be at risk for clotting, this would be my treatment of choice if the doctor refused to stop the drug for a few days.

The best place for getting Nattokinase, that I have found, is wildearthmarket.com, or you can call them at 1-800-819-6742 item number SKU: DB00125.

FRACTURED TEETH

DENTAL TRAUMA AND HOW TO FIX IT

Dr. Brooksby,

I was hit in the mouth this morning. I still see part of the tooth. How do you fix something like this. Please answer quickly.

Dear Quickly,

SMALL FRACTURES IN THE TOOTH

When a tooth breaks, it can break in a number of different ways, each requiring a different approach and each with a different chance of success. If a portion breaks off and it does not involve the nerve, in other words, you do not see red in the middle of the tooth, it can often be easily repaired with a tooth colored filling material, the same day. This blends well and looks very natural and is fairly strong. The cost is usually in the $2-400 range.

MEDIUM SIZE TOOTH FRACTURES

If the tooth breaks off and it is less than 1/3 of the tooth, but has a red spot in the middle, you have hit the nerve. This will require a root canal followed by a filling. Most dentists also recommend a crown, but in my opinion, this simply removes a lot more tooth structure, making it a lot weaker. The root canal can range from $800-1300 depending on whether it needs to be done by a root canal specialist or not. The filling is still in the $200-400 range.

LARGE SIZE TOOTH FRACTURES

If more than � o of the tooth breaks off, you may try the above options, but the success rate is a lot lower. Many dentists will do a root canal, post build up, gum surgery to lengthen the tooth, and then a crown. This can cost around $3000-4000. Often this weakens the tooth and may reduce the longevity of the tooth. Sometimes to as little as a year or two, but sometimes a lot longer.

If the tooth is broken off at the gum line, the success rate of restoring the tooth is really low. It is usually in your best interest to consider removing the root and replacing the tooth with an implant supported crown or a fixed bridge.

TOOTH FRACTURES OFF AT THE GUM LINE

The implant supported crown can take up to a year from beginning to end, and usually, you will wear a flipper for the healing time. The timing depends a lot on the size of the hole left by the tooth after it has been removed as well as the strength and amount of bone beyond the tip of the root for stabilizing the implant. Implants fail if they move at all. If the diameter of the root is 8 mm, and the average implant is 4-6 mm, then there will not be enough bone to support the implant. If you can get a long enough implant beyond the tip of the root with enough bone and it is strong, then you can place the implant at the time of the extraction. If the tooth has any infection around it, this can kill the implant and would normally mean a wait to heal before the implant is placed.

If you decide to do a bridge, this requires cutting the teeth on either side of the broken tooth down to little stubs and then rebuilding them with porcelain or porcelain fused to metal with a false tooth connected between. Often the bone will atrophy in the area where the tooth is removed, and a gap will often gradually appear under the bridge. There are ways of doing this that minimize the problem, but can take a lot more time.

WHAT TO DO FOR TOOTHACHES

Today's column is meant to be cut out and kept for the time when you may have a toothache. We will discuss the most common types of toothaches and the ways to treat them. This is meant as a guide until you get an appropriate diagnosis and treatment.

WHAT TO DO ABOUT A TOOTHACHE

There are three main causes of toothaches. Knowing which is which can save you a lot of grief and pain as well as money.

THE MOST COMMON TYPE OF TOOTHACHE IS CAUSED BY BACTERIA

Eating a hole into the center of the tooth. Once the bacteria get close to the nerve, it can cause sensitivity to hot, cold, and sweets. Once it hits the nerve and starts infection progressing into the bone, the real pain begins. The infection causes swelling of the tissues, which makes the tooth rise up out of the socket slightly. The high tooth now hurts even more as you bite down, causing more pain and pressure. This infection can break through the jaw bone and then spread through the soft tissues into the area around the neck and eventually close off the airway resulting in death.

Obviously, this is the most deadly type of toothache. The treatment of choice is to start on antibiotics and directly combat the infection and subsequent swelling. Since it takes two to three days for the antibiotics to reach the point of maximum effectiveness, waiting until you can no longer stand the pain is simply a guarantee that you are in for three more days of pain. Once the infection is under control, either the removal of the tooth or of the infection within the tooth with a root canal will eliminate the pain and the problem.

On our website, under the forms section, you will find a list of instructions for this type of dental emergency. It is worth printing out and keeping available.

THE SECOND MOST COMMON TYPE OF TOOTHACHE IS CAUSED BY REFERRED PAIN FROM THE MUSCLES OF THE HEAD, NECK AND SHOULDERS.

This type of pain may mimic the first. Often if you go to a dentist and he checks and finds nothing wrong, this is the most probable culprit. This pain is a referred pain from traumatized muscles that can directly refer pain to individual teeth. The most common way to diagnose this is to put slight pressure on the muscles of the head, neck, and shoulders. If you have an area that hurts when touched and, more importantly, causes pain in another area of the body, you are dealing with referred pain. Treatment may require physical therapy by a therapist that specializes in this type of pain. It may also require the fabrication of an appliance that can be worn in the mouth to stabilize the muscles.

THE LAST TYPE OF TOOTHACHE IS OFTEN CAUSE BY BITING TRAUMA.

The most common time for this to happen is after a recent filling or crown. It can also occur when you are under a lot of stress, and irregularities in the bite become more problematic. If this occurs the easiest treatment is to grind the high part of the tooth down so that everything hits more evenly.

Each of these types of toothache can be a major disruption in your life. We have the instructions for dental emergencies available under the forms section. If you have a problem, do not wait until the pain is more than you can bear. Toothache pain is some of the worst pain, and most pain pills do not even touch the pain if you let it get too bad.

OSTEOPOROSIS

Dr. Brooksby, I have been told that I have Osteoporosis, but I have heard that there are problems with osteoporosis medications that affect the jaw. Can you tell me what can be done? Waning away.

Dear Waning:

WHO DOES OSTEOPOROSIS AFFECT

Osteoporosis has often been classified as a disease of the older women, but it actually can affect people of all ages. Hard training athletes, men, and patients with chronic disease or hereditary, nutritional, and lifestyle risk factors may also be afflicted with osteoporosis. One of the biggest concerns is that the bones of the spine, wrists, legs, or hips may fracture more easily. The pharmaceutical companies have pushed the continuing education of medical doctors implying that without their medications, the patients will suffer these problems more frequently.

Many people believe that if they stop the cells that break the bone down, then that will keep the bone from breaking. The reality is that the break down of the bone is the first step in the remodeling process by which the body replaces old bone with new rejuvenated bone. On an x-ray, the new remodeled bone does not look as dense as old bone.

DRUGS USED FOR TREATMENT OF OSTEOPOROSIS

The most common group of drugs associated with treatment of osteoporosis is a family of drugs called bisphosphonates. These drugs work by interfering with the cells that break the bone down. It is incorporated into the bone and stops the cells that break the bone down from working. As the dosage increases, the number of cells that stop functioning increases. Since the drug is not eliminated from the bone for about 14 years, as it builds up, the rate of bone remodeling goes down. On an x-ray, this looks as though the bone is getting better when in fact it is getting worse. This accumulation of drug in the bone is directly related to how fast the bone remodels. The jaw bone, for example, remodels ten times faster than the other bones in the body. For this reason, the problems with the drug show up much sooner in the jaw bone than in other parts of the body. When the drug reaches a critical mass, the skin and gum tissues will no longer stay attached to the bone, and it falls of, and the bone begins to die. The only successful treatment is a Peridex mouth wash and cessation of the medications. Steroid treatment, together with the bisphosphonates, seems to make this even worse.

INCIDENCE OF BONE DEATH AND EFFECTIVENESS OF THE DRUGS

Dr. Robert Marx, one of the leading bone researchers in the world, has stated that the research provided by the drug companies has been difficult to reproduce by independent researchers. Dr. Marx was one of the first to recognize the correlation between these drugs and the dying bone in the mouth. The current incidence of dying bone is less than 2% of those that take these drugs, about the same as the incidence of a dry socket after a tooth extraction. He has also indicated that there is a test that can be done to quantify the risk of developing this problem from these drugs. When asked how effective these drugs actually are at preventing fractures, Dr. Marx said that it would take 300 women taking these drugs for three years to prevent one fracture.

ALTERNATIVE TREATMENTS

So what do you do? The leading researchers recommend eating a healthy diet rich in calcium rich foods and getting enough vitamin D. This requires exposure to sufficient sunlight for the vitamin D to work. Some of the highest sources of bio-available calcium in foods would include uncooked leafy spinach and yogurt. Light to moderate exercise may also help. Things to avoid include alcohol, caffeine, and smoking. Parathyroid hormone seems to be effective without the side effects.

TERRIFIED PATIENTS AND CONCERNS ABOUT DENTAL CARE EXPENSES

Dear Dr. Brooksby,

I NOTED IN THE LAST ISSUE OF THE ISRAELITE THAT YOU WERE AWARDED THE 2009 BEST PROSTHODONTIST IN LAS VEGAS AWARD.

Congratulations. I have heard your spot on KXNT about helping patients that are terrified. I have been terrified of going to the dentist for years, and now my mouth is starting to talk to me and I do not like what it is saying. HELP!

TERRIFIED DENTAL PATIENT

Dear Terrified,

I like your sense of humor. I am sorry to hear that you have had experiences that have terrified you of going to the dentist. While in dental, school I learned to use hypnosis to calm the fears of my patients. I was often able to do complex care with no anesthetic. Unfortunately, this took a lot of time and was not always predictable. Shortly after starting private practice, one of my friends needed dental work, but the anesthetic only lasted ten minutes, and he was not a good candidate for hypnosis. A local oral surgeon taught me to use a mixture of drugs to help calm and sedate the patient. This was the beginning of our use of sedation dentistry in 1993. I did not like the side effect of the barbituates in the mixture and tried working with out them. I found that using triazolam in the dose we used in the mixture was much safer and did not result in the depression of breathing associated with the mixture. We also found that it caused amnesia for most of our patients. This was usually a good thing. We began to use that regularly with our terrified patients and found that many would become so relaxed that they would go to sleep while we worked on them. Others would stay awake, but be very relaxed. People, while under the influence of the triazolam, would talk to us as though they were not on the medication and never did anything they would not do if not on the medication. Most would report at the next visit that it was the best visit they had ever had to a dentist.

We have also found that by simply being as gentle as possible that many patients have less discomfort and that this helps build a relationship of trust. This is ultimately the most important factor in overcoming the fear.

As an advanced surgical prosthodontist, I also have the ability to do most of the different types of dental care necessary to help you regain the confidence of a beautiful smile. We also use a lot of humor in our office. Most patients tell us that they have had more fun in our office than in any other office they have been in. A relaxed atmosphere of trust, the ability to provide the needed care, and the ability to help use medications that reduce anxiety and help you to relax. These are the things we do to help you to get back to liking the things that your mouth is saying to you.

AFFORDABLE DENTISTRY

Dear Dr. Brooksby,

I need to get my teeth fixed, but with this economy, I have been putting off going to the dentist. I know that you specialize in treating difficult dental problems, but I still need to be able to meet my other obligations. Is there any Hope?

Dear Hope,

As an advanced surgical prosthodontist, I am often able to offer options that allow you to improve your smile while still being able to meet your other obligations. Often doing nothing lets a small problem become larger and more expensive. We often develop treatment options that allow you to start with one part of the treatment and then gradually build up on that treatment to slowly move to where you would eventually like to be.

I am known in the community for not doing things that do not need to be done and treating you like I would like to be treated myself. Schedule a free consultation, and let's see what we can do to help you. There is no obligation, but we may be able to help get you started now to get things fixed and provide the best value possible. We wish all a Happy Hanukkah and hope your keep love for others in your life.

FOREIGN BODY REACTIONS!

WHY TEETH ARE LOST

Dr.Brooksby,

I try really hard to take care of my teeth, but one of my teeth has started to bleed and is getting loose. I went to a dentist, and he told me I needed to clean my teeth better. What more can I do? Frustrated.

Dear Frustrated,

ARE BACTERIA THE ONLY CAUSE OF TOOTH PROBLEMS?

In dental school, we were taught that bacteria were the cause of all dental problems from cavities to gum disease. We have discussed in other articles how decay can be cause not only by bacteria, but also acid saliva and excess stomach acid. In my thirty years of practice, I have met a lot of people that are meticulous in cleaning their teeth, yet one or two teeth start to have bleeding gums, pus, redness, and looseness. Many indicate that one day the tooth just came out on its own.

SOME TEETH ARE SIMPLY REJECTED BY THE BODY. While it would be difficult to create a study that could prove what I am about to say, I would like to suggest something as an alternative rationale for this type of problem. It is my opinion, that somewhere in the life of the tooth, whether due to trauma, bacterial contamination, or something else, the chemistry of the tooth changes, and the body ceases to recognize the tooth as part of the body. It then begins to try and sluff the tooth away. This is similar to the situation if a sliver were to get caught in your finger. It would begin to fester if you did not remove it. It would get red, swollen, full of puss, and eventually, it would come out, and then everything would return to normal.

I have seen a lot of patients where the tooth was part of a bridge. When we look at the tooth, it looks bad, and there is major bone loss evident on the x-rays. In many of those cases, when we cut the tooth from the bridge, the tooth literally pops right out of the mouth with no need for an extraction.

If this is the case, attempting to treat the tooth with antibiotics or leaving it alone to try and milk the tooth is futile. The longer it stays in the mouth, the more bone it destroys. It is best, in this case to remove the tooth, let the area heal for about 9 months and then replace it with an implant and crown.

IMMEDIATE IMPLANTS VS DELAYED HEALING OF IMPLANTS

Dr. Brooksby,

I have has several consultations regarding dental implants to replace a couple of missing teeth. What, if anything, do you do different? Inquisitive.

Dear Inquisitive,

Most of my patients come to me because they want teeth that will last a long time and give them the least amount of hassle. Many offices are advertizing immediate implant placement or placement of minimal numbers of implants to keep the costs low. Unfortunately, these have higher failure rates over the long haul. While there are times when these are viable options, those times are usually infrequent. We usually wait about nine months after the extraction for the bone to mature. Implants work better and last longer if they have a solid sound foundation.

We will begin growing more bone sooner if it is needed. We determine this need by using CT scans, which allow us to see the quantity and quality of the bone without resorting to surgery just to get a look see.

CEMENTED VS SCREW RETAINED IMPLANT CROWNS

When we make the crowns on top of an implant, we usually try and make it so that it can easily be removed to make repairs if something breaks. Most dentists will screw a coping or �abutment� on top of the implant and then cement a crown on top. If the crown breaks or the screw for the coping comes loose, they have to cut the crown off and then make a new crown. This substantially increases the cost later. Our crown can be screwed on and off without destroying the crown. Repairs are usually minimal to just a couple of hundred dollars, saving you a lot of money over the long haul.

There is a saying �penney wise and pound foolish.� For the slightly higher cost, why not have something that will last a long time, require minimal upkeep and be easy to repair. Dr. L. Scott Brooksby was selected as the Best Proshtodontist in Las Vegas for 2009, 2011, and 2012 by the United States Consumer Association.

If you would like to meet Dr. Brooksby or if you have any kind of dental concern and would like a fresh look at what choices are available to you, call and schedule a free consultation and lets see what we can do to help you.

HEALTH CARE REFORM

GOVERNMENT AND HEALTH CARE

Dr Brooksby,

I heard you speak at the Americans for Prosperity meeting on the 17th. What do you think of the current health care plan, and how will it affect dental care? Concerned

Dear Concerned,

INSURANCE COMPANIES AND DENTISTS

A big frustration for patients for years has been the requirement that their treatment be approved by the insurance company if they were going to pay for it. Patients that wanted white fillings instead of silver fillings were told that the company would only pay the price of a silver filling. Patients that had dentures that were poor fitting were told that they had to wait 5 years before they could get a new set of dentures. The insurance companies even went so far as to set not only annual limits, but also limits on the amount they would consider acceptable for reimbursement. This was all to save the insurance companies money.

A GREAT ALTERNATIVE TO DENTAL INSURANCE

Several companies, seeing that this was not to the benefit of their employees, established a direct reimbursement plan. The employees were allowed a certain maximum that the employer would reimburse for dental care. The employee could chose there own dentist and use that money for what ever dental procedure they felt served them best. They would pay for it, and the employer would reimburse the patient. GE was one of the largest users of this type of plan. One in which the free market was actually used to provide the best care for the patients.

It is a fact that some people can not get medical coverage on their own because of pre-existing medical conditions. In states where insurance companies are not allowed to exclude someone, the insurance premiums have skyrocketed because the cost had to be absorbed by someone, and the insurance company wanted to make sure their reserves were not affected.

GOVERNMENT IMPOSED HEALTH CARE

Now government has decided that the people are incapable of handling their own medical decisions and could not properly select insurance coverages. They want to take over the insurance programs and mandate the way things will be. Employers will be forced to provide insurance and absorb the costs themselves. This will force some employers to cut staff or reduce hours for employees to levels that are below those that require the insurance participation. The government will hire a ton of bureaucrats to monitor the employers and the insurance companies. They will also begin to tell us who gets what for coverage.

EXAMPLES OF GOVERNMENT IN HEALTH CARE

In many countries where the government has taken over health care, the wait to see a specialist or to get care can be months. When I did my specialty training at the San Francisco Veterans Administration Hospital, I experienced first hand the way government runs health care. I had a patient that had his teeth pulled with the promise of new, free dentures. After the teeth were pulled, the patient was informed that the waiting list for new dentures was 1 � years. I entered the VA system used to seeing 15-20 patients a day. Most of the dentists at the VA would see only 5 or 6 patients a day. Some only saw 2-4 patients a day. No wonder there was a 1 � year wait.

HOW DOES DR. BROOKSBY DEAL WITH INSURANCE?

How will this all affect me as a Prosthodontist? I currently am not a provider for any of the insurance companies. They do not recognize specialty care. While my fees for routine care like fillings, checkups, cleanings, etc. are actually lower than the insurance companies allow, do charge more for the specialty services that I provide. I spend a lot more time with my patients, especially when providing dentures, implants, crowns, bridges, and cosmetic procedures. I base my fees on the skill level and time required to provide those services. Often the insurance companies want me to accept as my regular fees amounts that are 50-75% less than what I now charge. The US post office insurance plan actually allows about $5 per filling when they are actually closer to $150-300 each.

My office files all insurance claims for our patients, and we work to help them get timely reimbursement. Usually, reimbursements are received within about 30-40 days. I do not accept the insurance companies low reimbursements as payment for my services.

My patients expect the best and do not want me to feel pressured to do less than that. I will not participate in any insurance plan instituted by the government. I will still provide the highest quality care to my patients, but will continue to do so for my regular fees. My patients do not wait for dental care. In the rare instance that a patient waits more than 30 minutes for me in my office, I reimburse them $10 for their time. Their time is as valuable as my time is. Most patients are seen at their scheduled times. There is not a long wait to get appointments. While many implant and grafting procedures take time for the body to do its part, we generally have patients in the same week they call, and they are never kept waiting if they have a problem.

I am one of those rare dentists that does not hide from my patients. They are all given my cell phone number, and on weekends I forward my office phone to my cell phone, and I carry a copy of the schedule with me. In our office, the patient is always the priority, and no government can duplicate that nor regulate it away from my patients.

BEST PROSTHODONTIST IN LAS VEGAS

Is it any wonder that Dr. L. Scott Brooksby was selected as the Best Prosthodontist in Las Vegas for 2009, 2011 and 2012 by the United States Consumer Association.

If you would like to meet Dr. Brooksby or if you have any kind of dental concern and would like a fresh look at what choices are available to you call and schedule a free consultation and lets see what we can do to help you.

A STUDY ON PATIENCE AND IMMEDIATE DENTURES.

WHY WAIT FOR IMPLANTS OR DENTURES

Dr. Brooksby,

I see all kinds of ads for immediate placement of dental implants with no waiting, yet I read your articles, and you say to wait. I want to do the right thing, since it is my mouth, HELP! Anxious

Dear Anxious,

THE MARSHMALLOW TEST

In the 1960's a psychologist decided to test a large group of five year olds. Each five year old had a marshmellow placed in front of him. He was told that he could eat it immediately, but that if he waited fifteen minutes, he could have two. Thirty percent waited, and the other seventy percent did not. That was the end of his study and he moved on.

Ten years later, he began to wonder about the kids that he had tested. He tracked them down and found that the thirty percent had higher grades and had progressed much more than the seventy percent. Twenty years from the original study, these kids were now the business leaders and had done well while the seventy percent were working for others pay check to pay check.

The conclusion was that those that learn to wait generally get a greater reward. Immediate satisfaction is not always long lasting satisfaction.

WHEN WILL WE BE ABLE TO COUNT ON IMMEDIATE IMPLANTS

I will gladly make you a deal. The day that science is able to have a man and a woman conceive one night and have a baby to play with the next day, I will be able to predictably do implants with teeth immediately.

Until then, it still takes nine months to grow a baby. It takes nine months for bone to regenerate. Placing a 4 millimeter screw into an 8 millimeter wide hole still does not create a good long term solution. I have been placing and restoring dental implants for over twenty years. I have tried most of the techniques people talk about, and I have found that if I try and mess with mother nature, she almost always wins. I find that if I work with her on her time line I get better results.

I have found that most of my patients would fit in the thirty percent group. They are not afraid to wait a little longer for a better result.

IMMEDIATE DENTURES OR SHOULD I WAIT?

Dr. Brooksby,

I am afraid that I am going to lose all of my teeth and my dentist says that I have to wait for three months before I get new teeth. Help! Horrified

Dear Horrified,

The only reason I can see for this type of scenario is if you have told your dentist that you want to keep the cost as low as possible, and you do not want to hassle with your teeth anymore. If this is not the case, you may want to consider a second opinion.

Usually, if the teeth need to be removed, we make new teeth that go in at the time the others are lost. This way, you never go without teeth. The supporting gums shrink as the bone remodels, and the teeth get more and more loose. We refit them and tighten them up to make them more comfortable. After about six months, we make new better fitting teeth and substantially improve the smile.

The reason the dentist wanted you to go without teeth for three months is to avoid the cost of the first set of teeth and the refittings. The disadvantage of this approach is that you are left socially crippled for months, and then you do not adapt as easily to the new teeth. The first set of dentures are training dentures. They can also be used later as spares in case something breaks and you need something to wear.

ALTERNATIVES TO DENTURES

There are also times when some of the remaining teeth can be saved. Often there are a multitude of options that are never presented or explored. If you look at our website at drbrooksby.com you can find more information on the other options that are available. These may include partial dentures, overdentures, bridges, and dental implants

There is a saying �penney wise and pound foolish.� For the slightly higher cost, why not have something that will last a long time, require minimal upkeep and be easy to repair.

Dr. L. Scott Brooksby was selected as the Best Proshtodontist in Las Vegas for 2009, 2011, 2012, 2013, 2014, and by the United States Consumer Association.

Call 360-207-2133 For Additional Assistance

Call For An Appointment

BROWSE OUR WEBSITE

CONTACT INFORMATION

680 W Washington St. Suite E102, Sequim, WA 98382

360-207-2133

drscottbrooksby@gmail.com

BUSINESS HOURS

Call For An Appointment