Q&A: Dr. Samuel Low and Laser Dentistry

Richard Gawel
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Today’s dental office looks completely different from the offices of a generation ago—or even just a decade ago—thanks to advances in technology. Laser dentistry is leading this revolution, enabling fast, easy, and pain-free care for a growing variety of indications. As vice president of dental and clinical affairs at Biolase, Samuel Low, DDS, MS, MEd, is at the forefront of this cutting-edge phenomenon, and he recently shared his insights about laser treatment.

How can new technology impact a dental practice?  

When you purchase technology, you can purchase it maybe for your convenience. Or, you can purchase it because you’re an early adopter and you just love it. My thought would be not to purchase technology unless it is going to give you a direct revenue stream. That’s the difference between diagnostic technology and therapeutic technology.

For example, if you get a digital scanner, you have to decide if it is going to provide better care for your patients, or if it is going to provide you with additional revenue. Or both? So to me, it’s a difference. 

Now if you don’t mind, let me get into my passion, which is lasers. If I purchase a laser, it is a direct added revenue stream for me that I did not have before. I highly recommend that if you’re considering getting a laser, you aren’t trying to replace those procedures necessarily that you already do with something you already have.

If I’m managing a small business and I’m trying to grow, I would want to get into other areas that I had not been managing. Those areas would be those things that I referred out or those things that I kept in house but performed very conservatively.

So if I’m going into the exhibit hall at the Chicago Midwinter Meeting and I’m looking at purchasing technology, I would ask myself if I am buying it because everyone else is purchasing it, or if I’m getting it because it can help me in my practice. There are four criteria that dentists should examine before buying new technology:

  • Will it give me an added revenue stream?
  • Can I learn it easily?
  • Can I incorporate it into my practice easily with my team? In other words, who’s going to maintain it?
  • And, do I really get a return on the investment?

I am somewhat concerned that we may be following the medical model where hospitals take the hit from the technology, but we as dentists must take the hit for the technology. In other words, we may be purchasing it, and it may be increasing our bottom line overhead, but we may not be seeing a true net return on the technology that we purchased. 

You’re drawing a distinction between technology that might increase the efficiency of something you are already doing versus technology that lets you do something new?  

Exactly. Now yes, they can comingle. But for the most part, if I was a young practitioner, I would be listening to my bottom line. 

You may be aware that there is some data demonstrating that overhead has been increasing 1% a year for the last 10 years. In other words, if you look at our overhead a decade ago, it averaged 10% less than it is now. So, wait a minute. If our overhead percentage is going up every year, why is that? It’s probably the cost of doing business, because everything else is going up—but not at that level. My point is that you have to be careful and be smart in what you buy and ensure that it is truly creating new revenue. 

Let me give you another example—general dentists who buy a CBCT. They aren’t necessarily buying that cone beam to assist them in creating better patient results. Every general dentist I’ve ever talked to who bought a cone beam bought it for one objective, and that is to be able to place implants and place them effectively as a new added revenue stream.

So how can lasers be used to open up new revenue streams? What new treatments can lasers be used to perform?  

Let’s look at it from the standpoint of my bias, being periodontics. Patients are afraid of periodontal surgery. All you have to do is go on Google to see it. If you can do a periodontal surgery with minimally invasive procedures, to where they get up the next day and go to work, where they take absolutely no opioids whatsoever, only over the counter medications, then everything shines for you. 

First of all, if you are a general dentist, you may be doing procedures that you have not done before. Either you’ve contained them in your practice with conservatism, or you’ve referred them out. Second, you may have more revenue because the revenue source for a periodontal surgical procedure in early and possibily moderate periodontitis is more compared to non-surgical perio. For periodontists, the case acceptance will be higher for surgery due to the minimal invasive nature for the proceures. So right there is a huge increase in profitability. 

If you look at endodontics, the vast majority of endodontics is done in a general practice. Why is that? The huge technology gains in endo in the last 10 to 15 years. Apex locators. Obturation. All of the things that have made endo so much more effective and easier for general practitioners is why they’re doing it. That’s what I foresee. I foresee that laser will be the standard of care in managing periodontal patients with general dentists utilizing lasers for patieint conditions they feel they are competent with and periodontists performing procedures for complex patients similar to other specialties.

We also unfortunately are seeing a significant number of sick implants. In other words, implants have been placed, and now they aren’t doing well. The only response for that has been to literally take the implant out and try to place another one. But what if I gave you technology, which we have, with a laser that can save these implants? A general practitioner can save these implants and continue to have the trust of the patient and not go through taking the implant out, putting another implant in, and hoping for the best.

Another procedure that practitioners are sitting on is the aesthetic crown lengthening that patients want—in other words, taking gummy smiles and making them look fantastic, even sometimes without veneers.

Then there are tongue ties, along with airway and lactation issues. These issues usually are ignored or they are treated with blades, with bleeding and postoperative discomfort. But a general dentist can do these procedures in two to three minutes with a laser, and that baby or child, or that adult with a speech impediment, can go home and the next day get up like nothing ever happened. 

So there are myriad procedures that can be done with a laser that aren’t replicating what general dentists already do but are totally new income streams.

Considering the speed with which these procedures happen, along with the painlessness and bloodlessness, do you see laser dentistry as a marketing advantage for these practices?

Anyone who purchases technology but doesn’t market it is being short sighted. You should never add technology to your practice unless you totally believe in it. If you purchase technology and it isn’t all over your website, including patient testimonials, and if it isn’t all over your office from the time your patients walk into your door to the time they walk out, then you aren’t getting the full benefit of that technology, especially lasers. We expect anyone who purchases a laser to have their marketing materials focused on it. Otherwise, they aren’t taking advantage of the patient’s perception of your practice as a techno-practice.

Lasers are gaining acceptance in the market at large. But it’s still a new technology for many dentists. They might not even know what types of lasers are out there. Could you break down what types of laser technologies there are?

One of the major reasons why dentists don’t understand lasers is the fact that there is minimal laser technology in dental schools, so everything dentists know about lasers has to come from outside of dental schools. So, I break lasers down into two categories: soft-tissue lasers and hard- and soft-tissue lasers. In other words, soft-tissue lasers can only work on soft tissue, and hard- and soft-tissue lasers can work on hard and soft tissue. Soft-tissue lasers generally include diode and Nd:YAG lasers. Hard- and soft-tissue lasers generally include erbium and carbon-dioxide lasers.

What kinds of procedures can these different types of lasers perform?  

If you only wanted to do non-surgical periodontics, you potentially could do it with a diode. It would take you a fair amount of time, and you would be limited to certain case types. But if you wanted to treat all periodontal patients, that means also managing the bone, the root, and the soft tissue. Then you would elect to have an erbium laser.

So for me, it has to do with versatility. It has nothing to do with the brand name. It’s just dollars and cents. If I’m going to go into laser technology, I’m going to want to do as many procedures as I can to get the return on my investment. And that is where the erbium wavelength comes into play, because it does everything. It does tongue ties. It does gingivectomies. It makes people look good while at the same time it manages implantitis and peri-implantitis. And, for certain procedures, it can do restorative dentistry.

Lasers seem to have come so far over the past few years. Do you see that growth continuing with new procedures being discovered or lasers getting more powerful and versatile?

If anything, lasers will become more user friendly. They also may continue to do more procedures that we’re unaware of. About the only thing that I can see as an example of potential hard-tissue treatment would be veneers and crown preps, though I don’t see that coming anytime soon.

But what I do see, however, as a major, major area for lasers beyond what we’ve discussed is something called photobiomodulation. In the medical literature, it’s going on like wildfire. I’m talking about using lasers to accelerate wound healing or decrease temporomandibular joint disorder pain. We already have a laser for that now.

I see the use of laser energy in dentistry from the standpoint of possibly even affecting decay, enhancing stem cells, improving would healing, and treating oral mucositis—the kind of infections that you get when you’re undergoing chemotherapy or radiation therapy. You’re going to start to see that laser will be the standard of care in managing post-cancer patients for all of the lesions and ulcerations that occur in the mouth. In my mind, if there is an area that is the strongest in moving in innovation, it is photobiomodulation. 

Considering this broad range of uses that lasers have, where can dentists get brought up to speed on them if dental schools aren’t teaching these technologies?

The best generic way is the Academy of Laser Dentistry. And the reason I say that is because it isn’t linked to anything commercial. In fact, I was just on their site, and they have an area advising new users what to look for if they are considering purchasing a laser. So, there are those things out there. 

Also, you have done a wonderful job of publishing good, objective articles about purchasing lasers, laser scenarios, what you could do with lasers, and what is out there. I recommend using commercial websites as well, whether it’s Biolase, Convergent, Fotona, or some other company. I know Biolase for sure has a significant amount of information for potential new users about the technology of lasers. 

Speaking of Biolase, what is Keep Drama at the Movies?

It is an innovative social media campaign. Let’s face it, and I’ve lived with it for 40 years, but there is a lot of anxiety out there about going to the dentist. We’ve even seen this in political polling, where people would rather have a root canal than vote for some candidate. So we’re trying to change that perception.

For instance, let’s say someone asks what you did this morning, and you say you went to see your dentist. Drama often follows, doesn’t it? People will start telling you how much they hate or love going to the dentist.

So what Biolase is doing is demonstrating that going to a dentist doesn’t have to be dramatic anymore. Many restorations, many of the procedures that can reduce tooth decay, can be done without local anesthesia. They can be done with a laser because a laser can numb teeth. Especially children. If I was a pediatric dentist or someone who treated children, I would have a laser tomorrow morning, because I would be able to manage all of their dental caries—and to a certain extent, young adults too—without any local anesthesia. But the drama isn’t just the children. It’s also the parents taking the children to the dentist. 

What we’re suggesting is this. If you want drama, go to the movies. But please, don’t expect to see drama when you visit a practitioner who has a laser. So that is the campaign. We want to take the pain and anxiety out of dentistry through lasers. Right now, the data suggests that only 40% to 45% of patients see a dentist annually. That is woefully low. And the primary reason, if you read the surveys, is fear and anxiety. Our mission is to change that perception with lasers.

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