Definition & Overview

Laser curettage is a method considered primarily for the treatment of periodontal diseases. It is an effective way to remove colonies of different bacteria thriving in small pockets located at the base of teeth. If left untreated, the condition can have an adverse effect on oral health and compromise the immune system.

A periodontal disease starts when these bacteria, often found in plaques, infect the areas around the teeth and form the hardened substance called tartar. This leads to the inflammation of gum tissues and affects both the tooth and underlying jawbone. The initial therapy for this condition involves the manual removal of plaque and tartar build-up, termed periodontal debridement. However, there are cases in which bacteria are not completely removed by the procedure and periodontitis recurs chronically. This would entail the use of laser technology to kill off the remaining bacterial colonies and promote healing of the diseased gum and teeth. Some dentists and dental hygienists, however, prefer to use laser even during the debridement process.

Recent advancements in laser technology have greatly improved the treatment and management of periodontal disease. Lasers that are currently in used for the treatment of this condition include diode, Nd:YAG, carbon dioxide laser, and argon. Laser curettage is generally considered a safe procedure to restore good dental health and hygiene. It is also associated with strong homeostasis with less tissue charring or blackening. Bleeding is also significantly reduced.

Who Should Undergo and Expected Results

Laser curettage is recommended for:

  • Patients suffering from periodontal diseases, both in moderate and advanced stages. Examples include adult and juvenile periodontitis, chronic gingivitis, and trench mouth.
  • Those who experience tooth loss and deep tooth pockets
  • Those who experience pain and gum bleeding due to inflamed tissues
  • Those with decay of soft tissue within the periodontal pocket
  • Patients who need to undergo dental procedures but are allergic to anesthesia or are taking blood thinners
  • Patients with gum recession, persistent bad breath, or experience pus discharge from the gum

Positive outcomes are generally expected from laser curettage procedures. These include:

  • Faster healing period, with improved tissue regeneration and no associated adverse outcomes
  • A greater possibility of saving the affected tooth and halting the damage to the underlying jawbone
  • As bacterial colonies are removed from periodontal pockets, the procedure, coupled with excellent oral hygiene, can prevent the recurrence of the condition
  • A reduction in the depth of periodontal pockets, making it easier to brush and floss

How is the Procedure Performed?

Laser curettage is performed as the tip of the laser device is placed on the gingiva or the soft tissue lining the teeth. A sweeping motion is done as the tip moves in the periodontal pockets, angling it away from the tooth. This movement removes bacteria in all parts of the pockets and any diseased tissue.

The dentist typically determines which type of laser to use depending on the condition being treated. The light beam emitted by lasers has a unique wavelength, determined by the medium present in the laser device. Biologic tissues absorb this wavelength, with the degree of absorption varying from one tissue to another. In a procedure where pigmented tissues need to be removed, diode lasers are typically used while carbon dioxide laser is determined to be most effective in reducing bacterial colony on soft tissues. Meanwhile, working on hard tissues requires erbium-based lasers as it can easily cut through structures with its higher wavelength.

The absorbed light is transformed into heat and tissues either warm up, coagulate, melt, or vaporize. Heating diseased soft tissues at 100°C or more vaporizes its water component, making it easier to remove while the healthy part of the gum is left intact and undamaged.

Performing laser curettage requires the use of special glasses or goggles to avoid harming the eyes due to the extreme brightness of the laser beam.

Depending on the extent of the infection and decay, the treatment may last for at least an hour and the patient may be scheduled for additional sessions to effectively address the problem. Patients are then instructed to use oral rinses and avoid spicy food following this procedure.

Possible Risks and Complications

Laser curettage carries a risk of damaging the gingival sulcus, the space between the tooth and the gingival tissue. Often undetected during the time of occurrence, this complication damages the dental pulp and the root canal.

Reference:

  • The American Dental Association
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