The Unexpected Truth About Deep Cavities: Can Laser Therapy Prevent Root Canals? with Dr. Diego

Hi everybody, I'm Dr. Sanda 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 another episode on The Holistic Dentistry Show. I'm your host, Dr. Sanda Moldovan, integrative periodontist and nutritionist. And today I have a very special guest, Dr. Virginia Diego, who's been a biological dentist for many years. We work together both at Beverly Hills Dental Health and Wellness and at our sister office in Encino. And she's not just a regular biological dentist. Besides the fact that she uses oral microbiome reset, oral DNA test, testing, and she's very gentle on her approach in using ozone and cavity control. She is laser certified. Not many biological dentists are laser certified. So today we're here to talk about how we can avoid root canals, how we can use lasers in order to achieve amazing outcomes even with teeth that we thought were hopeless. So, uh, Dr. Diego, welcome to the show.

Hi, thank you for inviting me to your show. This is the second time I'm invited, So I'm very, very excited to share some new information.

Great. Well, I'm glad you're here. Before we dive into lasers, you know, over the years now, I know we have some new dentists that are listening to this show or new dentists to integrative dentistry and biological dentistry. So if you were to tell them, okay, what do you love most about biological dentistry? You know, what would that be?

So what I like about biological dentistry is we use natural approach, right? What does that mean? We don't use toxic materials. And patients seem to like that because they respond pretty well with the materials that we use. One of them being obviously not using metal in the mouth, right, like mercury fillings. On the contrary, helping remove mercury fillings out of the mouth, and patients are very appreciative about that because they feel much better. They don't feel any more fatigue or brain fog.

Now, prior to you becoming biological and following biological principles, were you working in a traditional dental office?

Unfortunately, I was putting amalgam fillings, you know, and that broke my heart once I started doing research on how it could affect the body. We were putting amalgam fillings on young kids, babies, which was really disturbing because now you know through research that has neurological effects on a child as well. So yes, I was a traditional dentist before because that's what they teach you in dental school, right? No one will tell you don't use this because it's toxic or whatever. Right. So yes, unfortunately, yes. That's how I started as a traditional dentist.

Yeah. But we don't know what we don't know in the beginning. And I was taught the same thing, you know, yeah, mercury fillings are good. And oftentimes we're placing them on these mannequins and, you know, without gloves because it was a mannequin.

With no protection.

With no protection. So you can imagine how much mercury vapors we inhaled starting in dental school.

Yes, definitely.

So, uh, looking back, right, uh, the way you look at a patient today? Back as a traditional dentist, you were just focusing more on teeth, but with biological dentistry, how do you see the health of a patient evolving?

Well, in biological dentistry, it's not just focusing on the mouth like we're trained, right? We're just trained to drill, drill, drill. But now we're looking at overall the body as a whole and how everything starts in the mouth, right? And how it affects the rest of the body, like bacteria migrating, moving around, and how can we help the patient with that. So it goes in conjunction when using supplements and using more natural approach like disinfecting with ozone, ozone water, ozone gas, ozone oil, right? And so we see that there's actually a good response by using ozone, and patients are not getting any secondary effects with ozone. So that's actually pretty awesome and pretty good.

Yeah, I'm glad you brought that up because I know we also have patients listening to this, and a lot of patients are afraid of ozone. You know, ozone is toxic.

It's—

we talk about ozone in the atmosphere, but really, you know, like, how do you use ozone? You mentioned ozone water, ozone oil, gas. How do you use ozone in day-to-day dentistry?

So we use ozone, for example, in fillings, right, after removing a decay. I always like to disinfect the area with ozone before sealing with a nanoceramic filling or even cementing a crown. We use it during gum therapy, during cleanings, right? We use ozone in infected areas to help heal with some of the symptoms that— is pretty incredible in using in dentistry, and we have really great results with ozone.

Yeah. And you mentioned cavities. So I don't know about you, but I see more and more cavities starting up again in younger people. Do you see that?

I feel like the reason why is because of processed food. Processed food has, you know, so much sugar in it, right? And so I feel like, yes, we do see it more on youngsters. But believe it or not, these newer generations are getting very curious about natural approach as well. So the newer generations are seeking for more effective treatment, more gentle treatment, less invasive. And so yes, we have that to offer by using lasers. Lasers are very gentle in the mouth with hard and soft tissue. So I like to use lasers, especially like, for example, in a deep decay.

Let's step it back a little bit, back to ozone. So, you know, you like to use ozone. So let's say, okay, somebody has cavities that needs to be treated by you. You drill, right? Use a drill, or do you prefer to use a laser? Okay, but when do you decide to use one versus the other?

So first I take a look at the decay and analyze it and to see how deep the decay is, right? If it's something that is really getting close to the nerve, then I like to use both ozone gas with the laser and ozonated water. So all those three elements are very important. When dealing with the decay. If the decay is superficial, then we can use other products that can arrest the decay, right? Like a baby decay. What does that mean? That it's only just forming in the enamel and we could arrest it so we don't have to drill just because it's a, you know, an existing decay. So all of that will make, you know, will help me decide how I'm going to approach the treatment.

Yeah, so when you're using, they'll say, the laser, right? The cavity is really deep. When you get close to the nerve, what's the difference between using a laser versus using a drill?

Well, the drill, as we know, is pretty aggressive. You know, when we use a handpiece, we're using a handpiece that has a speed between 100 to up to 200 RPMs, right? So there's so much we have control of that. Yes, we can do it slowly, but nevertheless, still aggressive as opposed to the laser. At least for us that we use the Waterlase, we are removing the decay pretty much with water, right? We use a wavelength of 2780 nanometers. So that's the wavelength that we use. And it's actually pretty gentle to tissue, hard and soft.

So yeah, you know, the drill rotates. So in the process of that rotation, it actually pushes the decay deeper in the tubules. So it creates an irritation to the nerve and it pushes air, right? All that spinning, that centrifugal force pushes air and debris into the tubules towards the nerve, and the nerve gets infected and people end up with pain. Now, the laser, you know, and I'm a laser user as well, I don't use it for cavities, but I use it for periodontal disease. What I love about laser is that they remove microns at a time, and they don't have that push of air towards the nerve to where the bacteria now, which is, you know, 10 to 50 microns, can easily go through these tubules all the way to the nerve. And once the bacteria is in the nerve, you're gonna get inflammation. That's, that's a guarantee, right? Lasers don't do that. So, you know, you mentioned the, the— we use Biolase, the water laser, Right? That's what you're certified in?

Correct.

Yeah, so, you know, some people actually ask the question, if you're using a laser, do you still need to be numb?

That's a very good question. It really depends on the patient first and on the decay. I personally would not recommend not using any kind of local anesthetics if it's a deep decay, for example, right? Yeah, and by the way, when Dr.

Diego mentions the word decay, she means a cavity.

Cavity. Yes, sorry. That's okay. Another second for cavities. Okay, so when that happens, patients will like to try it without numbing, and some patients actually don't feel much pain, discomfort, maybe sensitivity, but not pain. Other patients, they're like, yes, you know, I do feel something, I feel a minor discomfort. So that's when I decide to encourage the patient to have local anesthetic. So it would really depend on the decay and on the person. We are all different, so we all handle pain differently, right? So yeah, but that's a, that's actually a good question. We have patients that come in and say, do you think we can try it without numbing? By all means, I'll do it, and I start slowly, right? We never want to torture our patients, and you know, and if I see that they're doing fine, then we continue, right? So yeah, it will vary in person. Yeah, by person.

Now, You know, a lot of people hate the sound of the drill and, you know, especially that high-pitched noise. Yeah, I was like, trauma.

It's true.

So what is the sound of a laser when you're doing cavity work?

So it sounds like popcorn sounds. I always tell patients, you know, it's gonna, you know, you're gonna probably hear some popcorn sounds, and they prefer to hear that than the high, you know, high pitch of the handpiece because it brings back memories. You know, they were tortured in a dental chair when they were kids. So popcorn sound, it's not bad for them, right? So yeah, that's usually what you hear with the laser. You might not even hear anything at all, but yeah, that's nothing compared to a handpiece.

I actually love that analogy, popcorn sound. The only thing we need is a popcorn maker in the office so we can really get the smell going as well.

Absolutely, yes.

We're gonna become a very popular office to have popcorn.

Yes, absolutely, yes. I prefer that than, you know, like they say, than the torture of a high, you know, high piece.

Now I know, I know that Waterlase has a couple different handpieces to use and different tips. One of them is called Turbo, the other one is a regular. Which one do you like to use to remove cavities?

Turbo, for sure. The Turbo actually has a nice angle to it that you could focus and just center your laser into the decay as opposed to the other handpiece I would use more for like soft tissue, like for example, doing a frenectomy, right?

Or like a tongue tie release. Yeah.

Yes, exactly. Tongue tie release. So more like for soft tissue.

Perfect. Now, would you say like somebody's going to be in the chair about the same amount of time when you're using a laser? Does it take longer for them to sit in the chair, or the same amount of time?

Or sometimes I have to use a combination of both, the handpiece with the laser. So what the handpiece does, it allows me to first do an entrance, a pathway entrance into the decay, right? And then the laser, I start using it where we're getting very close to the nerve, because, you know, we want to be gentle. So that's when I start using the laser. That's one. Second, if it's a decay that it has only gone into dentin can not deep near the nerve, then yes, I can do it with the laser, but sometimes it can take a little longer than a regular handpiece because again, handpieces are aggressive. So, you know, so that means yes, they're a little bit more faster than lasers, but they're more aggressive as opposed to the laser. It takes a little while, but you know, sometimes it depends. I could decide to do both of them at the same time so we don't leave the patient too long on the chair because, you know, patients get nervous, they get anxious, and all they want to do is just get this over with just as fast as they can and just move on, right?

Of course, myself included, if I have to sit in the chair, for sure.

Exactly, yes.

Now, once you clean out the decay or cavity, let's say it's, it's close to the nerve, okay, what do you do after you use a laser?

So we protect the nerve. Right, we always want to protect the nerve from inflammation, and so what decay can cause is inflammation on the nerve. So in order to do that, we put a protective— we call it a liner, right? And so what the liner does, it protects the nerve, but it also stimulates some repair cells.

What's in this liner exactly?

So it could be calcium, just like what you can find in, you know, toothpaste, right? Calcium and also nano hydroxyapatite. So all of this is very important for the nerve and for, so, the repair cells. So after I put the liner, then what we do is, well, before all of that, like I mentioned earlier, is ozone. We want to actually disinfect really well with ozone gas. And then after that, then we go ahead and do the liner or base. And then after the base, then we finally put either it could be an onlay, or which is a 3/4 of a crown, or a ceramic filling.

Yeah. Definitely. So let's say somebody comes in in pain, right? Just sensitivity to cold. They're in pain when they eat food. I just want to define the pain because not all pain is created equal. So, so maybe this is something we can talk about. And then you take an X-ray and the person is in pain. And then do you predictably turn around these patients that are sensitive to cold, let's say, and maybe the sweet sensitivity? Can we predictably reconstruct a tooth? Let's say cavity is not in the nerve to where they start having to— they can regenerate tooth structure because that's what happened.

Yeah, yeah, free. Yes, absolutely. We've had recently a patient who came in, had sensitivity on the tooth, and it's not due to decay, believe it or not. It's sometimes wear and tear of the tooth, right? So what happens is from all, or from the grinding as well, creating cracks. But this patient actually was a grinder that created, we call it abfractions, which means like little dips on the side of the tooth that you start creating like crevices. And these crevices get deeper and deeper and deeper that they're reaching a very sensitive area, which is your root area. So what we do is we start using lasers. To kind of soothe the tooth down, right? The nerve, because it's been, you know, it's been traumatized from all this grinding. And then we seal these crevices with bonding. So we've had patients that actually had no more sensitivity because we've dealt with the laser and we've covered it with nanoceramic fillings. So yes, that actually is not necessarily targeting decay, but you know, also targeting You know, like crevices, abfractions, and it's been very successful in stopping, you know, sensitivity. And of course, a combination of night guards, right?

Yeah, yeah, absolutely. If somebody's clenching, we have to do that. So how, how long does it take? Let's say on an average, right? And does it differ from person to person once you treat somebody with a laser and you treat these deep cavities that are close to the nerve? By the way, do you give them any homeopathic support? Nutritional support during this time?

Yeah, so when we see situations like this, we explain the patient is actually a therapy. So this is a therapy. So what we, what I like to do first is allow the tooth to repair on its own, and it takes 3 months. We know that for a fact, for, you know, the research. So we like to leave it on a temporary filling. In this case, you know, we leave it in a temporary filling and then we wait 3 months. To see how the tooth is going to react to the therapy. And so we know that 3 months it takes for repair cells to start stimulating, right, and start to protect the nerve area and the dentin area. So once we do that, the patient comes back and they will notice a difference and say, now I have no pain, I have no sensitivity. And we still have to do a vital testing just to make sure that the tooth hasn't died either, of course. But most patients do pretty well. And then after that, then we can finally do a final restoration on it, like put an onlay or a filling.

Okay. So you put a temporary kind of restoration or a temporary crown or onlay, whatever it is, filling, and then you wait until the patient is pretty much symptom-free before you finalize. Is that correct?

That is correct. Yeah. We have to let the to heal on its own because it can. That's the beauty about our body. They could heal on their own. We just need to stimulate it, right? Yeah. And after that, then we offer supplements. We do have supplements that help also with the repair and strengthen the enamel and dentin, right? Yes. So I know some of these supplements, you know, you've designed to help patients strengthen their enamel. One of them being also using a toothpaste that has nano Nano, sorry, nano hydroxyapatite as the main ingredient.

Yeah. And you know, it's nice that you have this approach to deep cavities because you and I well know, and a lot of patients that are listening to this that have unfortunately experienced this, the dentist automatically says, even you need a root canal, like so immediate, right? You have pain, you need a root canal. I'm not even gonna go to get a root canal. So fast we run to root canals in a lot of other offices.

I think that's very, very corporate oriented, right? That, you know, just treat it with a root canal. Now what I, what I like about when we work as a team, we take a CT scan and you immediately read it to see, you know, is it truly even near the nerve, right? Because in a two-dimensional traditional X-ray, you can't really tell. You assume, right? Because you just see that dark shadow getting near the, the inner part of the tooth. But when you see a 3D scan, you're like, oh, wait a minute. No, we could actually save this tooth from a root canal, right? Let's do some therapy first. So that's what I like when we work together, because you and I put our heads together when we see patients when they come with difficulties with, like, for example, a deep decay or an unknown reason why they have pain on the tooth, and you can't identify a crack on a two-dimensional. So you look through your, you know, 3D image, and sure enough, they either have a crack or Unfortunately, you can have other issues too, as well, like maybe a pathology in the bone or an infection, right? So yeah, that's like the part.

I mean, I really think, you know, with the advancements in 3D technology, 3D imaging, the images are so crisp nowadays that I think in the near future is going to be the standard of care for diagnosing cavities. And right now it isn't. You still take the 2D x-rays and we can't see sometimes, you know, we get scatter on 3D, especially if people have metals in their mouth. That's better. But I know with the advancement of software technology and 3D imaging, that soon we'll be able to diagnose cavities so much better using 3D imaging.

Absolutely. And it, and you know, I think it happens every day where patients come in, they come in with their own copy of their x-rays taken at a previous dental office, right? They share it with us and they say, what do you think? You know, they're telling me that, you know, I don't have any decay. And I say, okay, well, that's interesting. Let's take a look with the CT scan. Sure enough, they have a hidden decay, sometimes that's like right underneath the gum line, sometimes, right? Or they have reabsorption, right? Root reabsorption or of that sort that sometimes is so hard to see in a 2-dimensional x-ray. So I'm glad that we use that in our office, the CT scan. It's available there for our patients. And then if you know, for a second opinion, why not? We send it for radiology, right? UCLA radiology for, why not a third opinion to say, hey, you know, what else can you find on these teeth or on the bone or on the tissue that maybe we cannot interpret it with our eyes, but why not have a third pair of eyes to look at it? Yeah, absolutely.

And I do think anytime we got deep decay that's not under a mercury filling because of the scatter, we've got to take a CT scan because just bitewings, and that's what most dentists do. They take these just cavity detection x-rays, they're called bitewings, and they don't see the apex of the tooth or the roots. Is there root inflammation? And that's the beauty about the CT scan. Can we actually—

Yeah, yeah, absolutely. Yes. I mean, you get to see everything with that CT scan. I remember even seeing patients to get the report back where they're actually looking even in their airway. You know, that's crazy. Like we tell them, do you know that you have calcifications here? You know, in one of your glands, salivary glands, carotid too. And they're like, what? And it's like, yeah, you got to check with your doctor. So, you know, it's more than like you said, looking in the, about teeth and in the mouth. It's, it's overall your whole body, your health. Yeah.

So true. So, okay. So you mentioned, okay, we're doing laser. We're going to do ozone. We're putting a liner with hydroxyapatite. To help the nerve and to structure, to mineralize that area. And then you're filling it. You mentioned nanoceramics. And so for nanoceramics fillings, but you know, what's your favorite filling if you have one? Or why do you choose nanoceramics instead of, let's say, another filling, another white filling?

Well, because these are plastic-free and we know that they, when you have plastic-free fillings and more of a ceramic filling, nano-ceramic. They are less likely to cause tooth sensitivity, they are less likely to break, and less likely to have a secondary effect on the body. So, and they're very durable. They're really good also when it comes to aesthetics. If you have a chipped tooth in the front, right, and you want to help by repairing it with bonding, they're very durable and they blend in really nice with the shade of the tooth. And, you know, in the office we've been using the Admira, right? So it's actually pretty good quality.

Now, I know patients are, you know, and I know you've heard this from patients, they're scared about nanoceramics. But, but this is my take on it, and then I would love to hear yours. For me, you know, when you're bonding that filling in, when you're curing it, there's no release of nanoceramics out of that filling. They're bonded there. None of these nanoceramics are traveling anywhere. So I don't understand why people are are like scared of that. What are your thoughts on that?

Well, as soon as we apply that material in the mouth, right, and then we cure it, it hardens, right? And so it's not like compared to metal. Like metal, you're releasing mercury vapor when you're chewing against it, and that's toxic. So that's much way better and more safer than, let's say, even also plastic. Because you are swallowing in some way these particles, these plastic particles in your body. So I'd rather go better on that route. And that's why it's more of a non-toxic way, right? A non-toxic approach.

I 100% agree with you then, you know, because there's a lot of people out there who still have mercury fillings in their mouth, but they're afraid of nano ceramic fillings, which to me, as you said, mercury is so much more toxic. Than nanostrapping. Yeah.

Yes, absolutely.

Very good. So what other advice? This has been so enlightening. I know for a lot of people listening that maybe are dealing with deep cavities, it's going to be super, super good for them to know this so they can find a laser-trained dentist or maybe come see you at our Encino or Beverly Hills office.

Absolutely. I am welcoming everyone out there who is seeking a second opinion. A natural approach, right? If you've been told that you need a root canal and you just don't feel like, uh, you want to give your tooth a second chance, right? Why not give it a second chance by using lasers and avoid a root canal? But we can definitely take care of you in Encino or in Beverly Hills. And I myself, I'm there, I'm in Encino Tuesday, Wednesdays, and some Thursdays. So yeah, and It will be great to meet you all and take care of you.

Awesome. That's very welcoming of you, Dr. Diego. And, you know, I know that, you know, you're so thorough and gentle. You extracted my tooth. I was very grateful for that. You know, you did a great job.

Yeah.

Yeah. It just— me for myself, my tooth was already dead. Sadly, we couldn't save it with a laser. I remember taking a CT scan and looking at it. I'm like, oh my God, I have a dead tooth. Yeah, and to tell you the truth, looking back, this was my upper right molar, right? The dentist drilled on it. She said, oh yeah, it was deep, it was a deeper cavity, it was underneath a small filling and it had a little fissure in it, and she used the drill. But I so wished she used a laser instead, you know, because I think my tooth would have had a different fate. So, yes, yeah, so, so unfortunately, you know, I was also a victim of Just using the drill, not the laser. But now we have better technology. Any words of wisdom here or last minute words for people that are listening that are maybe afraid of the dentist or maybe a preventative tool that you like to use to prevent cavities? Anything at all that you want to share?

Oh yeah, absolutely. You know, I myself, I'm afraid of the dentist and have a dentist, but I think we all tend to have that fear, especially if you had a bad experience in your childhood. So in this office, that's why we offer the lasers, so because it's less invasive, it's more gentle. I like to work in a very, you know, less stress, less anxiety environment myself, and so that's why we take our time with our patients. We don't rush through treatment, and then we could offer also, for example, nitrous if it makes you a little bit much better and comfortable. We also do sedation to our patients as well. And so all of that is being offered to help with the patient through this, you know, dental treatment. So yeah, and also I like to recommend my patients using some of your products, and one of them being the probiotics. It has helped me with my dry mouth. So if anyone out there has dry mouth, I highly, highly recommend the probiotics. Using it 2 to 3 times a day after you brush, or even like right now that I'm talking so much and I have dry mouth, I pop in a probiotic and it helps moist, you know, the mouth but also break plaque buildup. So it's one of the products that I always recommend to all my patients is the probiotics. It's actually pretty good, and I've tried probiotics from other brands, they're not the same. I will have to say yours has been the best. So far, and some patients also say the same, like, you know, you're right about the dry mouth. And, you know, it's, it's again, all of this is a therapy, right? It's not going to get rid of the dry mouth. At least for me, I cannot get rid of it because I have an autoimmune disease, but at least it helps me protect from future cavities. And, and, you know, so I think it, it's really a wonderful product.

Yeah. Thank you. Thank you for that advice for everybody. And, uh, You know, I'm glad you love the product. I don't pay you to say that, so I have to say that. With that, I thank you very much for being on today's show and really talking about deep cavities and what you as a consumer should be asking about. And know that there's another solution. Root canals are not the answer every time. As a matter of fact, most of the time we can probably save the tooth. Until next time, keep smiling, everyone. 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 @DrSandaMoldovan. This is Dr. Sanda Moldovan, and remember, your mouth is the gateway to your health, so take care of it in the most natural and best way possible.