by Patti A. Sooy, BS, RDH
Do you have a diode laser sitting in a corner of your office collecting dust? If so, get out the Endust and a dust cloth, and prepare yourself for some terrific soft tissue results.
In most states, hygienists are allowed to use lasers as part of their periodontal program, but tend to shy away from routine use. Even after a certification course, hygienists are not sure how to use the laser in a patient's mouth or incorporate the laser into their daily schedules. Common questions can include: How do I choose patients for laser use? How do I charge for the laser? What codes do I use?
Hygienists can use a soft-tissue laser in two ways. First, you can use it on every patient in your practice for bacterial reduction. The diode laser is set on a low wattage in a pulsed mode and without an initiated fiber (will not generate heat, only light). It is then used in the sulcus of every tooth in the mouth, prior to stirring up subgingival bacteria during the hygiene visit. This greatly reduces the chance for upper respiratory infections and cross contamination for both patients and providers.
Second, after the evaluation of the periodontal structures and debridement with ultrasonic scalers and hand instruments, you are ready for laser-assisted periodontal therapy (LAPT). The laser is set to a continuous mode and the fiber is initiated (creates heat). Any areas in the mouth with pocketing and inflammation will benefit from LAPT, which is a type of curettage.
The diode laser can differentiate between necrotic tissue and healthy tissue due to pigment and edema. The hygienist is able to selectively remove granulated tissue from the lining of the diseased sulcus with minimal anesthetic, bleeding, and discomfort.
How do you know when the pocket is clean? It's like baking a cake and checking with a toothpick to see if it's "done." If the fiber comes out goopy, it needs more time. If it comes out clean, it's done.
At this time, there are no specific codes for laser use, thus regular prophylaxis and periodontal fees should reflect laser use. Every patient can benefit from the diode laser during a hygiene visit, so selection is easy. It's up to you to explain these benefits and to integrate it into your schedule.
If you need help brushing up on your techniques, find a professional to help. If you just need to brush it off and use it in your daily routine, then I challenge you to do it. Your patients will really appreciate the long-term benefits. So give them the opportunity to praise your skills as "the laser hygienist," and you, too, will reap the rewards of healthier patients.
Patti A. Sooy, BS, RDH, has been a practicing hygienist for more than 20 years in Washington state. She is the founder of Dynamic Hygiene, a hygiene consulting group and co-owns Hi-Tech Hygiene, a company dedicated to the integration of soft-tissue lasers into the hygiene schedule. Patti is a speaker, consultant, author, and expert in the business of dental hygiene. She continues to work in private practice as a soft tissue specialist, restorative hygienist, and business manager. She can be contacted at (509)235-4042 or [email protected].