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TO TELL THE TOOTH : Read Dr. Pietrini's current monthly article

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To Tell The Tooth
Read Dr. Pietrini's current monthly article from the Fra Noi newspaper.


Laser Techniques...

Dr. Pietrini writes a monthly column for Fra Noi, an Italian newspaper. Articles related to the topic of Laser Techniques are featured below. Click here to view this month's article


Look Ma, No Cavities by Dr. Pietrini
A few years ago, Crest toothpaste had commercials with children running home from their dentist yelling, "Look Ma, no cavities!" For nearly fifty years, fluoride has been added to community drinking water, toothpaste and mouthwash and dental offices have made topical applications available. The number of cavities that develop in children and adults has been drastically reduced. Today, the most common place for cavities to occur is in the deep grooves and pits of teeth.

Recently, a new laser has become available for detecting cavities. The bacteria found in the decayed portion of the tooth gives off fluorescence in the tooth, which is measured by the laser. After the tooth surface has been cleaned, a red laser light is directed to the surface of the tooth through a special tip, and a fluorescent signal is sent back to the laser. The signal comes out as a number on the instrument on a scale of 0 to 99. The higher the number, the more decay below. This allows the dentist to predict whether or not a tooth needs a filling or a preventative sealant. Early detection of cavities translates to easier, less complicated treatment. Since the laser does not produce any heat the scanning of the teeth is painless.

Within the last few years, several types of lasers have been developed that can effectively remove decay and prepare teeth for fillings, thereby reducing the need for the dental drill. The laser light is highly absorbed in water. The water content is higher in decay than it is in healthy dental hard tissue. Depending on the energy settings of the laser, the decay removal can proceed more rapidly than the removal of the tooth structure. This precision will allow for healthier tooth to remain, while removing the disease.

When the dentist scans over the tooth with the tip of the laser and an accompanying water spray, the patient will hear a low popping sound. Most patients relate that this sound is less annoying than that of the dental drill. Dentists report that they are able to treat more than 90% of the cases without dental anesthetics, so your dentist can treat several teeth in one visit. Bonded fillings can be placed, cured and polished allowing you to resume normal activities immediately. This treatment is suitable for children and adults.

Research has shown that certain types of lasers can be used to treat dental enamel and reduce the progression of decay by as much as 85%. While this work has only been done in the laboratory, the results are promising. It will be necessary to conduct human studies to confirm these laboratory assessments.

Nothin' Against You Doc, But I Hate Dentists by Dr. Pietrini
Dozens of times over the past years, patients have stated to me "nothing' against you doc, but I hate dentists." Often this comment has led to amusing dialog. In this and future columns I would like to start with some of the lighthearted conversations I have had with patients and friends. My staff has a difficult task of screening telephone calls, making sure that I am available to other doctors and patients, yet attempting to determine which are nuisance calls. Some of my friends have tried to create confusion by using phony names or titles such as Tom from the IRS. One such caller identified himself as Mike from Oakmont. Thinking it was my friend who worked in the Oakmont Office Center, I told my receptionist to tell him that if he could wait, that I would be with him shortly and to tell him I had dropped my laser down a patient's throat and I was attempting to remove it. Much to my surprise when I answered the phone the person on the other end was not my friend, but someone named Mike from Oakmont Securities. Before turning down his sales pitch, I had to quickly explain that the patient was doing fine and that it was just a joke.

In the 1980's a dentist, Dr. Terry Myers and his brother Bill, an ophthalmologist, began experimenting with lasers used in eye surgery to see if they might be adapted for dental procedures. In May 1990, the first laser dedicated for dental use received marketing clearances from the FDA (Food and Drug Administration). The resulting marketing effort that followed brought an awareness of lasers in dentistry to the public and to dental professionals. Groups of dentists joined together to form laser organizations. Today the Academy of Laser Dentistry is an international society of nearly 700 dentists from approximately 30 countries, with the Italian Chapter being among the largest outside the United States. In a little over ten years, lasers can now be used for patient care in oral surgery, periodontal care (treatment of gum disease), removal of decay, immediate curing (in seconds) of tooth-colored fillings and whitening of teeth. In 1992 I was privileged to be among a group representing dental practitioners, academia and industry that met at a workshop at the University of California, San Francisco to draft the "Curriculum Guidelines and Standards for Dental Laser Education," which we revised in 1998. The Academy of Laser Dentistry provides certification courses for dentists and their staffs to insure the safe and proper use of lasers in dentistry. For further information, please contact the Academy at 954-346-3776, e-mail address at and their website at

In future articles, I will explain more about the various types of dental lasers and their current as well as future uses.

Light Up Your Life by Dr. Dennis R. Pietrini

On the plane coming back from the 10th annual conference of the Academy of Laser Dentistry, I was listening to a song recorded a few years ago by Debby Boone—You Light Up My Life. I thought that it was a natural transition to this month’s article, since dental lasers utilize various wavelengths of visible or invisible light, which is converted into energy capable of being used in virtually every aspect of dental treatment.   Twenty-five countries were represented at this year’s meeting. The first two days of the conference are dedicated to testing and certification of dentists and staff followed by the scientific sessions, which take place over the final three days. Most of the presentations relate to the current uses of lasers in dentistry; however, each year researchers bring us up to date on the latest developments. I am amazed that these people have the vision to not only see dentistry as it is today, but as it will be in the future.

For more than fifty years, fluoride has been added to drinking water, toothpaste and mouthwash resulting in a dramatic reduction in the number of decayed and missing teeth in patients of all ages. Prior to fluoridation, cavities were easier to detect by visual inspection, because the enamel was weaker leaving larger holes in the teeth. Today, instead of relying solely on x-rays and explorers (dental picks) to find cavities, new imaging technology is being employed and developed. The Food and Drug Administration (FDA) has recently approved two optical diagnostic systems for detecting decay—the DiagnodentTM and the DiFotiTM.

The DiagnodentTM is a laser, which is used to scan the deep grooves and pits in teeth. Bacteria in the decay produce porphyrins, which fluoresce when the light from the laser is activated. A digital score helps the dentist determine if decay is present and if treatment is necessary. This system is not effective in locating decay between the teeth. The DiFotiTM (digital fiber optic transillumination) system utilizes a bright light, which is transmitted through the tooth to create a computerized image of the tooth to determine if decay is present between the teeth. It is not very useful in detecting decay in the deep grooves and pits.

Researchers at the University of California San Francisco are currently developing a system known as polarization sensitive optical coherence tomography (PS-OCT). By using an invisible wavelength of infrared light, a computerized image can be captured. It appears that the PS-OCT system will be able to create images of decay in all aspects of the teeth as well as under fillings. Another promising use of this technology will be in diagnosing the condition of the bone and gum structures around the teeth and in the soft tissue of other areas of the mouth. In the not too distant future it will be possible to scan the mouth to create a virtual map, which may be used in the detection of a variety of oral diseases.

The Popcorn Filling by Dr. Dennis R. Pietrini

Lorraine has been a patient in my office for nearly thirty years. She is a happy-go-lucky senior who has had a variety of dental care throughout the years ranging from oral surgery to root canal therapy to dental implants. Needless to say she has experienced, first-hand, a lot of the changes that have occurred in dentistry in her lifetime.

At a recent visit for a routine examination and cleaning, I discovered that she had a cavity that extended between her teeth, near the gumline. Since she lives more than an hour from my office, I suggested to her that I could prepare the tooth and place a tooth-shaded filling immediately. She wanted to go out to lunch with her daughter and wanted to know how she would feel afterwards. I explained to her that I could use my newest laser that generally allows me to do the cavity preparation without the need for a local anesthetic. To do this procedure with the drill would have undoubtedly been uncomfortable.

Before using the laser, I explained that it made a popping noise and that while we use a water spray, the interaction between the laser and the tooth surface emits a slight odor. Upon completion of the preparation, I asked her if she noticed anything during the treatment. Her amusing response was, “It sounds and smells like popcorn popping.” The total time to prepare the tooth and place the filling was approximately ten minutes, allowing plenty of time for Lorraine and her daughter to stop for lunch.

The advantage of using either a dental laser or an air-abrasion device instead of the dental drill is that both machines reduce the heat, vibration and loud noise associated with the drill. The cavity preparations produced by these devices are ideal for minimally invasive dentistry and for placing tooth-shaded, bonded fillings. In addition, when the cavity extends near the gumline, the laser does not cause irritation or bleeding of the tissue, so that a clean, dry filling can be placed. 

A few days after I treated Lorraine, she sent me a note thanking me for saving her a return visit. She commented, “I love my new popcorn filling.”





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