Bringing a hard- and soft-tissue laser into a pediatric practice

Background: I was sitting in a CE course next to an alumnus of my pediatric dental residency who has a very successful practice in the Woodlands outside of Houston, Texas. He had lectured in a practice management course I’d taken before, and I thought he had some really great ideas, so I decided to see what other morsels I could squeeze out of him. I decided to be professional about it, and I passed him a note like I was in elementary school. (OK, I admit it: I was still passing notes in junior high and high school. We didn’t have cell phones to text with back then!)

I asked, “With all of your valuable dental experience, what are the three things you can’t live without?” He mentioned his favorite compound topical, his favorite composite instrument, and his hard-tissue laser. What?! A hard-tissue laser? I had to see this for myself!

I flew to Houston to see Luke Skywalker in action, and I was amazed. Class II restorations with no local anesthetic … no shot … and no tears. My mind was blown. He said that it was the best decision he ever made and that he was getting ready to buy a second unit for his associate so he wouldn’t have to worry about it being tied up.

I bought a Fotona LightWalker in 2012 and have never looked back. There was no learning curve on anesthetic-free dentistry—just a learning curve on doing dentistry by sight rather than by feel. Right now, I just wish I had the new-generation unit. If I had the new unit, I think I could do pedo crowns without anesthetic. I’ve done a handful with my unit, but I’ve only had the confidence to try it on the best patients. Class II composite? All day, every day. No anesthetic. The key is not that you’re working any faster or doing better technical dentistry. The key is that you’re doing dentistry without anesthetic. In my world, that is everything.

But the thing is: The parents beg me to see them too. I just laugh that off, saying, “You’re too big for my chairs.” I had one dad say, “That’s like finding out there’s a better way to breathe.” Other parents have said, “It’s almost not fair. There should be some kind of punishment for cavities, but they love to come see you even for fillings.”

The new-generation unit is on my Christmas wish list … and in my future. My anesthetic expires and has to be thrown away as it is. I can’t imagine how little I will use with a newer unit.

That’s not all, though. It also works for soft tissue. I had a teenager recently who had decay on the occlusal surfaces of No. 18 and No. 31, but she still had pretty good opercula covering the distal end of the occlusal table. I just used thelaserto trim those back. Since the patient was older, I decided to see if I could experiment. I explained to her that I usually use topical anesthetic prior to trimming the tissue but that I had been told that it’s not always necessary. I asked if it would be OK to use topical on one side and not on the other. She agreed. I told her to let me know if it wasn’t comfortable, and we would stop and use topical. We did both sides. On one side, we used topical. On the other, we didn’t. She said it was a piece of cake. Not only did I finish one side without anesthetic, it was easy. It was like airbrushing the tissue away.

Supposedly, there are many more applications for the laser, but they are not ones that I use in pedo, so I will not comment on them. For the hard-and soft-tissue procedures that I do use the laser for, it’s invaluable.

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Jon McClure, DDS, is in private practice at McClure Pediatric Dentistryin McKinney, Texas. After attending Baylor College of Dentistry and practicing general dentistry for two years, he realized that he needed to specialize in pediatric dentistry, so he returned to Baylor for a two-year residency program. When he is able to travel, he loves to take part in mission trips and has been on over eight trips to Mexico to provide free dental care at orphanages and churches.