WRITTEN BY Jean G. Furuyama, DDS, FAGD, FADI
You might say I came into laser dentistry through the back door. It started in 1995 when my partner and I split up. We’re still good friends, but he could not seem to build his practice enough to both buy me out and make a living. I, on the other hand, always loved my “toys,” and when we were partners I felt a little restricted having to watch pennies. So when we split up, I went shopping at the Greater New York Dental Meeting Convention with money to burn. Well, not really. But I did visit the Kreative booth, where they were hawking a new concept called air abrasion.
The whole concept of minimally invasive dentistry and going after those pit and fissure cavities before they turned into serious problems really appealed to what I believed. I decided then and there to get their whole package. Within two weeks I had a new air abrasion unit, a rather large suction box with a hose that looked like an elephant’s proboscis, and an HGM argon laser.
It was like I had died and gone to heaven. I just loved my new toys, and my patients did too. I was so busy doing “painless” dentistry that I didn’t realize my assistant and I were both developing persistent coughs. It got so bad that I decided I had to stop doing the air abrasion. I seriously thought about just selling my practice and moving to Florida. But, hey, if you play golf as poorly as I do, and you’re going to get frustrated anyway, you might as well get paid for it. Besides, I really didn’t want to fade off into the sunset. I love dentistry too much.
So when I came across the Biolase booth at the next Greater New York Convention, I listened to what they had to say. The price tag was pretty high - $45,000 - but it meant I would be able to continue the minimally invasive dentistry my patients expected. Not only that, but it could do all sorts of stuff my air abrasion couldn’t. I was hooked. I forked over the $45,000 and became the first dentist in Manhattan to own the Waterlase. My staff was happy, because it meant I wasn’t going to retire (I had to work to pay for this extravagance). My patients were delighted, because they could continue having “painless” dentistry. And I was in seventh heaven.
The bottom line? Far from being an expense, the laser turned out to be a real investment. With very little external marketing, our gross production increased more than $100,000 the first year. I can’t even imagine what it might have been if we had advertised more. But I had enough patients, and I wasn’t really interested in getting more new ones. However, I was interested in becoming more efficient, and the laser helped.
The laser allows me to do fillings in multiple quadrants in one sitting since I don’t need to use anesthesia most of the time. This means fewer appointments for patients and more efficient use of chairtime. We’re also able to do procedures we might have had to refer out to specialists in the past, such as frenectomies, biopsies, and ridge reductions. All of this helps the return on investment.
A word about return on investment. Whenever I buy a piece of equipment, I consider the ROI. Sometimes the return is not financial. Sometimes it just makes my life better. But most of the time the consideration is whether the new equipment will make my work faster, easier, and (most important) more comfortable for the patient. I also consider the length of time my purchase will take to pay for itself. With an expensive item like a laser, I thought it might take four or five years, though I was pleasantly surprised it took less than a year for my laser.
A word of caution. I’ve found that the laser is great for the “normal” patient. I am now doing a lot of sedation dentistry which attracts phobic patients, most of whom don’t want to “feel anything.” I don’t try the laser on them. I tell my “normal” patients that they will feel something when we get into the dentin, but that 95 percent of my laser patients prefer the laser to having a shot. However, I tell them, don’t be a martyr. You can always have a shot and don’t hesitate to ask for it if you need it.
Also, we have found that lasers provide a window of opportunity of about two minutes when we can finish a prep with a drill and the patient will have no pain. I now routinely use the laser to start the prep and take out the last deep decay with a 330 bur or a pointed diamond for those narrow areas of decay.
When I do use burs, I am careful to peck at the decay rather than bear down on the drill. This should also be done with anesthesia to avoid postoperative pain, but sometimes we are less apt to be thoughtful of the pulp when the patient is anesthetized.
If you are thinking about acquiring a laser for your practice, there are a few things I recommend. Together, they will add about $15,000 to the price of the laser, but they will just about guarantee you will improve your ROI. First is the ADA’s sealant picture, which shows incipient decay and how it is sealed over with a sealant. We used to think that was the way to go, but now we recommend taking out those little areas of decay before we seal the tooth.
Next, buy a good intraoral camera. These can now be acquired for a reasonable price secondhand. I still prefer the analog Accucam to the digital ones, but almost any camera will do. Give patients a tour of their mouths. For questionable stain, tell your patients you have a laser scanner (i.e., DIAGNOdent®) which can determine whether the teeth need to be sealed or filled.
After you review the X-rays, have your patient look at the monitor to see cavities the X-rays miss. This time, tour the mouth with DIFOTI®, which is a computerized transillumination device that shows interproximal decay and recurrent decay around fillings better than X-rays. Patients love it because they can see their mouths in real time on the monitor without the dangers of radiation.
The last thing I highly recommend investing in is the Isolite system. I tell the patient it has a rest to bite on (i.e., the bite block) and a suction part that keeps debris from going down the throat better than the little saliva ejector. It also has a light so I can see better. It keeps saliva off the tooth better than the rubber dam, which is particularly important when I am cutting with a laser since the nooks and crannies created by the laser make it difficult to wash off the saliva that will inhibit the bond.
Once you have your systems set up, you will have the patient load to make laser dentistry feasible. Lasers open up an entirely new and exciting world in dentistry. They are the most versatile and best investment you can make for your patients. Enjoy! ■
Jean G. Furuyama, DDS, FAGD, FADI
Dr. Furuyama is a past president of the American Association of Women Dentists. She owns a group practice in Manhattan, N.Y.C. You may contact Dr. Furuyama by phone at (212) 683-6260 or email [email protected].