The Brilliance of Lasers in Dentistry

Hi, everybody. I'm Dr. Sandhya Moldovan, periodontist and nutritionist. Welcome to the Holistic Dentistry Podcast, the show that gives you the tips and tools to detoxify your mouth for a healthier body as we explore together the.

Root cause of disease.

Remember, you're not healthy until your mouth is healthy, so take care of it in the most natural way.

Hi, everyone. Welcome to today's show. I'm your host, Dr. Sandhya, and I'm very, very excited about today's topic. We're going to be talking about lasers in dentistry. And with me today is Dr. Cyrus Elakis. Welcome to the show.

Thank you for having.

Yeah, I'm excited to talk to you about this topic because a lot of practitioners are still not using lasers. And I want to kind of decode for everybody. Why is it important? What is it going to do for somebody listening who goes to the dentist? And I want to start with giving people a little bit of background about you. We're working together at Beverly Hills Dental Health and Wellness, and you are a biological dentist, and you finished a neuroscience degree at ucla and you did some research on brain mapping, neurophotonics, bone regeneration. Sounds awfully cool. So talk. Tell us a little bit about that research. Like, because it actually photons and lasers go hand in hand.

Yeah, they definitely go hand in hand. Interesting enough. You know, I guess I've always been a nerd growing up, and, you know, I've always been drawn to things like that. Basically, the research had to do with, you know, cancers in the brain in terms of what can we do to delineate what's. What is cancer, what's not cancer. So it really came down to optics. You know, cancers, they. They feed on, they require a lot more nutrient and essentially food in order to survive. So you can essentially give it a dye which would essentially paint the cells a certain color. So you would work in the either ultraviolet spectrum or infrared spectrum, and the brain would essentially light up. And you could see, let's say you're doing ultraviolet. So you would take these chroma forms that were from scorpions, and it would paint the cells blue. And that way you could tell, okay, what's cancerous, what's not. In order to. When you're doing neurosurgery, see what you're removing, what you're not. And that was a lot better than just kind of looking at it. And you could be more careful with what you're removing, what you're not removing. So, yeah, interesting.

You were. You were interested in Technology at a really young age.

Definitely, yes.

So. So you became laser certified. Of course, you're also IAOMT certified in smart, the smart technique. And you're a big advocate for minimally invasive biomimetic modalities in dentistry and basically keeping things to a minimum. And really, you know, being a patient advocate.

Yeah, you know, I, I like to do just. It's very simple how I do that series, how I would want it done on myself, you know. Yeah, I think the easiest way to do it is would you do this on yourself? If the answer is no, then you shouldn't do it.

That's a very basic, great philosophy to live by for sure. So let's talk lasers. What are lasers for? People listening?

So we would have to go back to the fourth grade with the electromagnetic spectrum. So if you guys remember, there's different spectrums of like, you know, you have the gamma rays and the X rays and then all the way to the radio waves and somewhere in between is visible light. Okay. So on the end with the gamma rays, it's where the wavelengths are the shortest, meaning the power is the strongest. Okay. That's when the kind of radiation here that's called ionizing tends to be dangerous. The whole ultraviolet avoiding sunlight, you know, gamma rays in space making, you know, dangerous for astronauts. And then you have, you know, on the lasers in which we tend to do dentistry, tend to be on the wavelength a little bit longer than visible light, longer being, you know, and less ionizing. So a lot of people think, you know, radiation and stuff, they get scared. Well, this is a non ionizing radiation. So it's not like Chernobyl which causes radiation, or the beams of the sun which can cause radiation. But it's an amplified technology of this laser to essentially accomplish what it needs to accomplish.

You bring up a good point because I think a lot of people are scared of lasers in general. Oh, how is this going to affect me? Is it going to cause cancer? Because there's radiation, but it's the wavelength that actually can be healing for ourselves because we are all energy at the core of it, right? So we have these atoms which, which are, if you look at the energetic level, we're invisible. And they get affected by the different types of radiation that we apply. So there's nothing to be afraid of. That's the number one message I want to put out there because we heal via energy, right?

And I think it's interesting because he was thinking, okay, if it's more powerful, it means it's penetrating more. But that's not necessarily true because the whole red light therapy we do, the near infrared red therapy, we use all that is longer wavelengths, less power, but they penetrate your skin deeper and gets into areas of, you know, muscles and things that it can promote healing and regeneration. And this is all, you know, technically less power than visible light, but it can still promote so much healing.

Absolutely. I mean, there's simple things out there, even on the market that people can buy, like red light therapy that can be used for, let's say, for the skin, for acne, for collagen building. You know, there's actually, we have also at Beverly Hills, the laser cap that people can use for hair regeneration. So basically, the different wavelengths, including even red light, can create a certain benefit to promote cellular repair and regeneration. So what kind of lasers have you used? Or. There's so many different kinds of lasers out there, but I think maybe we should just talk about the ones that, you know, we have in our practice because we have so many of them used for different purposes. Sure.

There's, you know, there's argon lasers, diode lasers, erbium lasers. We mostly use the water lace, which is an erbium laser. So in terms of what you want to accomplish with laser and dentistry, right, you're working with bone, you're working with teeth, you're working with gums. All of these have different spectrums of what they absorb. So you want to get to a point where you can accomplish what you want to accomplish. You want to be able to ablate the disease, but you don't want to damage the other areas. Now, we essentially, when you're working between bone, mostly made of hydroxyapatite, so you want to find something that absorbs water and hydroxyapatite really well. There are lasers that cut faster than the ones we use. But the issue with that is you have to be a lot more careful.

Okay.

You can have something that's called carbonization, where when you overheat it, what you end up getting is burning and that damages the tissue. So even though the laser we use can be a little slower, it is definitely on the safer side of things in terms of how dentistry, we believe, should be done.

Yeah. And even sometimes with, let's say, as simple as a diode laser, if the dentist or hygienist is using that laser, it's not certified like we are, and they just go and pick up a laser and use it. They can actually burn teeth.

Oh, yeah, yeah.

So. So it's. It's super important to. To learn the tool to have if you're a dentist or hygienist listening to this, we highly encourage you to look into lasers and dentistry, but make sure you know how to use these tools properly. Definitely, yeah. So do you use lasers for fillets?

Yes. So in terms of the spectrum of what lasers do in terms of dentistry goes. So with fillings, I think it can be a wonderful tool. It's important to know the limitations of dentistry, of lasers when it comes to dentistry. So if it's a giant filling, you know, no one's going to go in there with a laser and try to remove a giant filling. You're going to use traditional, you know, drill or doing a crown prep. There's just stuff that laser can't do. But in terms of a lot of fillings. Okay, let's go back to the minimalistic aspect of how we like to do holistic dental care. Because I think if you're using the word holistic, it should encompass minimally invasive dentistry that just goes hand in hand. Our patient, fool, they take the least amount of drugs, least things they want to put in their body, these things done to their body. Kind of like how we would do with me and you.

Yes.

So lasers love decay. Okay. That's just they like the path of least resistance. When you're working with a drill, especially a high speed handpiece, you don't necessarily know how much you're taking away the laser energy. You know, the decay has the most water in it. It's the softest. The laser likes the path of least resistance. So you can go in with a laser. You know, it's not like Star wars where you turn on the lightsaber and it just cuts through it. Actually, it's like a little more difficult than you'd think it is in the beginning, which is why a lot of dentists don't like to use it, at least in the beginning, because it takes time. Takes time to learn how to use it. You have to be slow, you have to be patient. But what you end up getting is this beautiful filling with decay removed and excessive tooth structure doesn't get removed. Pretty much goes and removes just what needs to be removed. And also, when you're working with a high speed handpiece, what you get is something called a smear layer. Okay. So like debris.

Dirt. Debris essentially from pulverizing teeth.

Right. And it gets impacted and forms this like, layer, which is not great for bonding, it's not great for composites to stick onto. So generally, what you'd have to do in dentistry, you'd have to go and put this phosphoric acid on it to remove it. Okay. That can cause sensitivity on teeth. So, you know, especially after, like, you have a filling. Okay. It's been a week, two weeks. So sensitive with a laser, you don't have a smear layer. It removes it completely. So you have this dent in surface that just ready to be bonded with. Yeah.

Pretty incredible.

Yeah, that's. That's one of the things I'm a big fan of with that laser is able to do.

I was thinking about this patient that we have. You know, with these, they get cavities right at the gum line. And sometimes holistic people eat a lot of fruits and dried fruit. They get plaque at the gum line, and then they don't clean it well, and you get cavities at the gum line. So I would think the laser would be a great way to treat. We call these Class 5 fillings, that area, especially at the gum line, to clean out that decay and actually get, you know, bonding down.

Oh, absolutely. I think. I think class fives over all the fillings. Class fives and the ones on top of the teeth, those stand out the most in terms of what I like to use, you know, in terms of the water lace for. Definitely.

Yeah.

And even, you know, the ones that go under the gums, you know, so there's. There's cavity that goes under the gums. And generally how it's done is traditionally you just kind of drill in there and put some composite and hope for the best. Really? Everyone knows it's not everybody knows. But, you know, the whole, you know, if you have blood contamination, water in there, that's not good at all. And that filling is not going to last more than one or two years. So laser is wonderful at opening up the gum a little bit to just access it better. Give yourself a much better filling in that area.

Absolutely. So there's things with a laser that you do that you cannot do with any other tool in the practice, Am I right?

I would say so, yes.

Now, especially when it comes to kids. Do you see kids in your practice?

We see some kids occasionally, yeah.

I think, you know, as you mentioned, right on top of the tooth, there's grooves, especially in the back teeth, where I often black and live there. So if somebody was to look in their mouth and look in the mirror, they sometimes see a black line in the middle of the teeth. Especially if the kids are, you know, they've gotten their adult dentition, let's say, 8, 9, 10, 11 years old, they eat candy now they're getting this black roof there. Would you use a laser to treat an area like that?

So I would. And one of the wonderful things about that is if you hold the laser above the tooth for a little bit about 60 seconds to 90 seconds, what that ends up doing is essentially overriding the nerves in the pulp and causing the tooth to lose some sensitivity. And in that way, you can avoid putting anesthesia, you know, needles, and just the solution and stuff. So that, I think, is a wonderful way if you can do dentistry without anesthesia, because no one likes getting shots. Kids definitely don't like getting shots.

Yeah.

You know, and you say black lines, but we all know as dentists that sometimes you open it up and it is just a volcano in there, because that's what it's like with enamel. It's the hardest surface. So sometimes you'll look and you think, okay, this looks tiny. And then once you remove the enamel, you look underneath, and it is just a big cavity just waiting in there that you couldn't see was underneath your tooth. So, yeah, I would say lasering, in terms of both the removal and accessing, that is definitely the way to go.

Yeah. So I like to talk a little bit more about that concept that you just mentioned, that once you open things up, there's like a huge cave underneath. And, you know, for people listening, sometimes they look, oh, it's a small, little dark spot. And, you know, sometimes I hear people blaming the dentist. They took too much tooth structure. So let's talk a little bit about the layers and the structure of a tooth and why, when you open things up, all of a sudden there's a big cave.

Sure. So the first layer is the enamel layer. That is your hardest layer. Okay. That's the part where, you know, you don't have any sensitivity. Generally speaking, it would be weird if you ate food, and it would hurt every time you ate.

Yeah.

And underneath that layer is the, you know, the tension layer. And so when you have recession on your tooth or tooth wear in your teeth, it's just like, you know, it's kind of always sensitive to cold and stuff. You've probably worn down to that tent and layer.

And we have patients like that that we do.

And, you know, the deepest layer is the pulp chamber. That's where the nerves live. That's where the blood supply is. That's where if cavity gets to that point, you know, generally it goes. Okay. You either need a root canal or an extraction.

Yes. So what happens is the enamel being so strong, bacteria finds just a little Fissure to get into the softer part of the tooth, a layer. And that's. That's when we see cavities kind of spreading all the way sideways.

So in terms of when you go to the dentist and they say, oh, you have three cavities, and you say, oh, well, I don't really feel anything. And then say, okay, that's fine. You know, if you're proactive, you can get them done. You can get this done while you don't feel anything. Luckily we caught it. Or you can wait until it hurts, and then you need a bigger filling.

Or potentially even a root canal or.

There you go.

Exactly. So never wait until it hurts. Especially now with a laser, which is amazing. And I have experienced a laser in my own mouth. And it's true. You don't need numbing, which is the amazing part. And I think if we get the right frequency of energy on the cellular surface, which is basically the indented, then we can surpass the anesthesia. Because really, I think when we're using the burr and creating that friction and that heat, that's when the nerve really reacts.

Oh, yeah. And even, you know, let's say the filling was big, the decay was big. Changing up the setting, changing up the frequency, and just, you know, having it on the tooth itself, you know, on a lighter setting, can definitely help with pain, you know, receptors in terms of getting the tooth to just calm down. Sometimes if the patient goes, hey, you know, this feeling was pretty sensitive. I know it's a lot done. They'll come in the next day, two days later, and we'll just put some laser therapy, five minutes on that tooth, and they'll feel so much better. I think that, to me, is an area of laser dentistry that really, really shines rather than just dismissing it. Oh, it'll go away. Oh, the pain will go away.

Yeah.

It's like, yeah, sure, you're going to heal, but why not, you know, have something to make the patient heal faster? Why does it have to be, oh, it'll get better?

Yes.

Why can't we make it better?

Yes. Well, for people that don't have lasers, they can't.

But.

But I think that's the beauty. And that is an aspect that only lasers, you know, can do for a tooth. You know, Advil only works so far, but I think really energetically speaking, we can calm down the nerve with the laser. We don't have anything else in the office that does that.

Oh, yeah. And even with TMJ pain, you know, patients, over time, a lot of patients A lot of, you know, our practice, there's. There's a lot of women in our practice. I'd say maybe 80% of our practice is women. Yeah. And they have. Women have a five times higher propensity.

For TMJ issues because our worry center is just more, you know, we worry more exactly the jaw.

No, I agree with that.

Yeah.

It's just interesting because I always love using the laser therapy on the tmj. You know, it's not invasive. You don't need any aesthetic. I think it's a beautiful adjunct of therapy. Or even after, like a long dental appointment where you've had your mouth open for a while.

Yeah, absolutely. So basically, that's a simple treatment. For those of you who've never experienced laser. For PMJ treatment, we actually don't even touch the skin. We basically gently walk the. The laser beam, not even probably, I would say, a couple centimeters away from the skin, sometimes even more, depending if people start to feel a little warmth in the area. And we do treatments anywhere from like 5 to 15 minutes over the area of the TMJ and people report opening their jaw better, the pain dissipating, having more openness in the area of the tmj.

Yeah. You know, we even our hygienist, Vena, like, I see her in the office using it on her shoulder and just dentistry is hard on your body, so.

That's right.

Yeah, we, we like to use it, definitely.

Yeah, absolutely. And now we have, you know, a new laser, the Voltana laser, which has an ND yag and that actually penetrates deeper. So for pain therapy, in terms of the wavelength being in the 2900s, it's going to actually penetrate better and deeper for the tmj.

Oh, wonderful.

Nice. Now, you mentioned that you use a laser in other ways, so. So what other ways other than cavities do you use a laser for?

So, you know, think of ulcers, also known as canker sores. You know, we have patients who come in just for that. They like, okay, I'm getting one, you know, and we can just use it for, you know, five minutes in that area. And the way it heals is just dramatic compared to doing nothing. Now, obviously, when I see Aptos ulcers, I like to look at a little bit more root cause. I like to think, okay, why are they getting teeth? You know, is there SLS in their toothpaste, what's going on? And generally getting off, that can be helpful. But there's just some patients that no matter what their diet or Genetically more predisposition to it, that it definitely does help or even herpes outbreaks. You know, there's something called the prodromal phase, which is the tingling phase of you can kind of feel like you're getting something. And if you do, if you catch early enough, if you do it during the prodromal phase, you can avoid getting that painful vesicle outbreak altogether.

Yeah, it's part of the thing. When you're heating up the tissues, you're also killing the viral particles. So the best time to do it is at that place for that reason. So the tissues can heal. And I use it a lot also post surgical, the laser to help people heal faster. Even as something as simple as being a light therapy in itself. Whereas the red, infrared, heat, that actually can be very beneficial for post operative healing.

And you know, we can also add the aspect of direct bulb tapping. So let's say you're doing this filling. Okay. Let's say it gets really big and it gets to the point where, you know, you're like, okay, you can see the pulp, maybe it starts to bleed a little. You've had decay pretty much into the pulp chamber. And you'll know that because you know a tooth will start bleeding. Okay. A lot of dentists, traditionally, what they'll do is, okay, well, you need a root canal. You know, I like to try out something called direct pulp capping. It's traditionally how that's done is you take a material that has calcium in it, you pack it in there. Okay. You wait for it to stop bleeding. You know, you pack it in there, cross your fingers and you hope for the best.

Yeah. Because what's, I mean, the reason why we put the calcium there is for the tooth itself to take that calcium and create tooth structure. Exactly.

Right.

I think that's the point of it. Yeah.

Right. So traditional methods with pulp capping, the research shows that over five year survival rate has about 50 to 60% chance.

That's pretty low.

Pretty low.

Okay.

Now with lasers, if you're doing the direct pull capping with lasers, okay. It's showing that you have about an 80 to 90% chance of successfully direct pole capping. Wow. Now that is a big difference in terms of, you know, is this who going to need a root canal? Is the tooth going to need an extraction? That is like. Because it's not the, the laser itself. Okay. When you're working with, let's say the water lace. Okay. The way it ablates the water, it causes ozone particles, it generates ozone particles, which as we Know, is very antibacterial. It cleans the area very, very, very well. And so it gives you the best chance of not having pulpitis, not just using a drill and blasting particles into the pulp.

Yeah. Bacteria and everything, which are gonna irritate the nerve for sure. Very interesting. So you're not actually. When you're doing. When you're using the laser over the nerve, which is the pulp, AKA you're not actually removing any nerve tissue, or you're not. You're just kind of calming down the nerve. It also has that analgesic effect that you mentioned.

Yes.

That sterilizes the side, and then you still do the calcium over the top of that. Yes. Okay.

Yes, that's still necessary. But the laser does a really good job at doing the best you can to clean that area. And let's say, hypothetically speaking, okay, this ends up a little too decay. A little. You know, let's say it doesn't survive. It's not 10%. And let's say you don't want the tooth extracted. Implant. You want to try a root canal.

Yeah.

Now, me and you are very big on root canals to begin with.

Yes.

But one of the main reasons is that, you know it. A lot of bacteria forms and stays in that tooth. Traditionally, you use bleach. Right. Use bleach to kind of put it in your canals.

There's a lot of people. I still are using that right now.

That removes about 50% of bacteria. Okay. With laser. Using laser during endodontic treatment, you can get that reduction to about 99.7%.

That's pretty amazing. That's very high from what we know today, just for pulp camping. Right. I mean, so many dentists run into this problem, going after a cavity. That's huge. Getting close to the nerve. So it seems to me that lasers for pulp capping should be the standard of care. Such a huge difference. 50% versus 80%. That's huge. It's a disservice to the patient to treat a big cavity without having a laser.

I agree. I think, realistically speaking, I think what it comes down to is a lot of people are both kind of stuck in their waist in terms of. Well, I've done it this many years, and this has been fine. And also, these machines are not cheap. You know, there are some practices that if you're, let's say, working on a lot of patients, you know, you don't really have the time to spend and getting the laser out because the whole setup takes time. You know, training takes time to learn. So it is definitely a lot that maybe some providers, they just. They don't really want to go through the hoops of learning it or they feel like it's not suitable for their practice. But, you know, luckily enough that I work under you and I get to use all these cool toys and feel like I'm doing the best job I can for a patient.

Yeah.

So I feel very, you know, blessed to be working here.

Oh, I'm so glad. You know, and I think it's the power of a team, because we see as a team, we can address so many more things. You know, we have the luxury of being able to buy more things that we can all utilize. So, you know, I'm very blessed to have a great team, you being part of the team. This is also informative. Anything else you want to add here as a last message about lasers?

So I would say that we can't fully have a laser talk without you spending a little time talking about maybe the perio aspect of lasers, like lbr, how it helps you with surgery. I think that's, you know, that would be a very good adjunct in terms of.

Yeah, I mean, you know, I've been a laser user now since I was a resident at ucla. I still remember bringing the first laser in from biolase. I think it must have been 2002 around that time. And it was the first laser that was introduced at ucla. And I remember like, okay, well, let's experience this. And I had a mole cut off my skin with no anesthetic.

Oh, wow.

It was pretty amazing. I do feel anything. And you know what's fascinating? I was looking at the scar. It was this pedunculated, you know, or bowl that I had on my skin. And it's just no bleeding number one. And the body almost didn't realize that something was missing for a while because usually after we cut something off, there's inflammation that sets in, produce healing, and close the hole. As I'm watching this hole on the side of my body, and I was like, still a hole. There's no inflammation. So I can realize after a while, I started to get a little inflammation, started to gap, bridge the gap and close it. But it's pretty amazing. So fast Forward the next 20 years. I learned how to do laser periodontics. I. I don't do flap periodontal surgery, and I haven't done it for a very long time because lasers allow me to do periodontal procedures without picking up.

A scalpel, which that's a big deal because everyone knows you know, you kind of flap and you're going to get bone loss no matter what.

Yeah, absolutely. And I also like that photobiomyodulation, the healing power of the lasers, as I'm doing other work that automatically just happens past the tip so we can have an effect, an effect on the tissues around the tooth past the tip of the laser. A positive effect of healing. And of course, our hygienists are laser certified in the practice and they do laser bacterial reduction, which is a procedure that for people that have gum inflammation, they. They help to clean the area and also use that power of healing to help the tissues get healthy. So, you know, we use lasers basically in all departments. Yeah. So I'm sure we'll have more episodes on the laser, that we'll go into more detail about different things because I think this is just our first show. We haven't talked about lasers yet, so.

Oh, yeah. You know, with the sultana coming up with the sleep apps and all this, there's definitely a lot.

Probably have a clear worth of shows. So. Cyrus, thank you very much for being here.

Thank you so much for having me.

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Thank you so much for joining me this week. Please make sure you check out the show notes for any links mentioned in the show. If you like today's show, please invite your friends to listen as well. That would mean a lot to me. Do you have a question you'd like me to answer? Message me on Instagram. DoctorsAnda, this is Dr. Sandra that. And remember, your mouth is the gateway to your health, so take care of it in the most natural and best way possible.