ald2013 a Nano-oral medicine - Academy of Laser Dentistry · Anterior tooth trauma in the primary dentition: incidence, classification, treatment methods, and sequelae: a review of

Lawrence Kotlow DDSBoard Certified in the Specialty of Pediatric Dentistry

Albany, New York USA

ald2013

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Nano-oral medicineTherapeutic biomodulating

laser care

Lawrence Kotlow DDS340 Fuller Road

Albany, New York12203

Website : KIDDSTEETH.COM

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LLLT

Low Level Laser

Therapy

Laser Therapy

Laser Biostimulation

Cold Laser Therapy

Soft Laser Therapy

Light Therapy

Photo Therapy

Photobiomodulating laser treatment described by many different names

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Magic or Real

Science ?

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Anecdotal or Scientific

Lawrence Kotlow DDS 4

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No heat is generated Like photosynthesis

PhotoBiomodulation effects in nature and medicine

Sun TanningVitamin D synthesisNeonatal JaundicePsoriasis & vitiligo

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In the USA:Off label use

Low Level lasers are considered by the FDA as NSR medical device that poses

NONSIGNIFICANT RISK (NSF) to patients

No FDA -IRB (Institutional Review Board) review is required if the off label use is used to treat patients and is not part of a research project involving humans


aToday open your mind and begin to

think outside the box


A resonating laser (harmonizes, soliton wave formation) piggy backs effects) which combines 8 LEDs

red and blue light and 12 Laser Diodes cluster470-940 nm @ 3-9 joules per cycle Mode 1= reduces pain, reduce inflammation = use with injuriesMode 2= relaxes nervous system ,opens glandsMode 3 = antiviral, antibacterial, immune system stimulated

2 Stimulating Lasers:660nm InGaAIP Diode @ 50 mw 2.2 joules/min Class

3a; acupuncture points, cycle =3 minutes808 nm @ 500Mw GaAIAs Diode = 18 joules/minute

Class 3b invisible infrared, bone and teeth, joints

PBM lasers used in my office

Lawrence Kotlow DDS

Q1000

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Indirect effect: Biostimulation Non-Surgical: does not produce heatVisible and non-visible wavelengthsContinuous & gated pulseRigid tipsHand held units :very portablePainlessReduced use of drugs for pain control

Photobiomodulation (LLLT) in a Pediatric Dental Practice

The red and near infrared light (600nm-1000nm) commonly used in LLLT can be produced by laser or high intensity LEDs. The intensity of LLLT lasers and LED's is not high like a surgical laser. There is no heating effect.

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2. *Stimulates natural biological processes preventing cells from operating in an acidic(redox) state to an alkaline state to perform optimally.

*Jan Tuner DDS Low Level lasers in dentistry pg. 263 principles & practice of laser dentistry Convissar 2010

For additional peer reviewed articles

8612009 different references in the text book written by Jan

Turner & Lars Hode“Laser Therapy : Clinical Practice and Scientific

Background (2002)-WWW.Prima –Books.com


1. Lasers that operate using energy densities below the threshold where irreversible changes in cells occur.

• After a traumatic cellular injury: PBM reduces what is called “oxidative stress” ,basicly the mitochondria in damaged tissue produce “nitric oxide” that (competitively displaces O2 ,creates Hypoxic cells) binds to the “Cytochrome c oxidase(COX), resulting in oxidative stress, this in turn reduces ATP production. The LLLT (red and Near-infrared , 650-1100nm range )energy is absorbed by the cytochrome c oxidase displacing the problematic nitric oxide thus reduces this oxidative stress and allows for increased ATP formation. Thus quicker cell repair.

How Does PBM work ? Very briefly (James Carroll, visit Thorlaser.com)

• Uses light energy which can be absorbed in the form of photons from both PBM and superluminous diodes to create cellular and biologial effects in the body.

• Absorbed by the Mitochondria within the cell• Power Plant of the cell where ATP is produced

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HOW PHOTOBIOSTIMULATING LASERS WORK

(James Carroll, visit Thorlaser.com)

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Analgesia

LLLT creating a nerve block. Higher irradiance / energy treatments can induce an analgesic effect by disrupting fast axonal transport in small diameter fibres, in particular nociceptors. This temporary (reversible) inhibition of A-delta and C fibre transmission reduces tonic peripheral nociceptive afferent input and facilitates reorganisation of the modulation of synaptic connections. Repeated treatments lead to a reduction in central sensitisation.

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analgesia

traumatic injuries

gag reflex

oral lesions

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Reducing nauseaControls gag reflex Reduces the need for numbing & mandibular blocksImproved numbing when local is usedMaintaining tooth vitality after traumaReduces post-traumatic swellingImproves soft tissue healingTreatment of herpes & herpes type lesionsTMJ discomfortMuscle trismis : releases tight musclesReduction in bleeding

Procedures completed in my office using photobiostimulation


Chinese Name: Hegu (English translation: Joining Valley)Location: On the dorsum of the hand, between the 1st and 2nd metacarpal bones, in the middle of the 2nd metacarpal bone on the radial side.

Classification: Yuan-Source point of the Large Intestine MeridianCommand Point of the head and face

Hegu- acupunture point

Diseases of the head and face: i.e. external pathogenic headache ,congestion, swelling and nasosinusitis, toothache in the lower jaw, trismus , swelling of the face, facial paralysis

• 4-8 Joules• Between thumb and first finger• This is the main switching point for acupuncture system

Migraine headaches


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Acupunture + Photobiomodulating laser treatmentP6 (Nei guan meridian point)=reduce gag reflex

1.# Agarwal MD et al Acupuncture and ondansetron for postoperative nausea & vomiting after laparoscopic cholecystectomy Canadian Journal of Anesthesia June 1, 2002 49:554-560

2.# Dundee JW; Yang J Jr Prolongation of the antiemetic action of P6 acupuncture by acupressure in patients having cancer chemotherapy Soc Med (England) June 1990, 83(6) 360-3621.#

3.Schlager A. et al. Laser stimulation of the acupuncture point p6 reduces post operative vomiting in children undergoing strabismus surgery, BR.J Anaesth 1998;81:529-32

Salt NACL

P6- Acupressure Point is located in adults on the anterior surface of the forearm, approximately three finger widths down from the first wrist crease.(children about two+ fingers)

660nm probe,3-4 joules one

minute at the P.6 point reduces gag

reflex in many patients

Isolite placed onpatient with

gag reflex problem.

Lawrence Kotlow DDS

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The gagger !

Lawrence Kotlow DDS14

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A photobiostimulating effectReduced local anesthetic requirementsAllows for using High Speed handpieceSuccess rate 80-90 percent of the patients

30 seconds to 2 minutesNon-contactNon-thermal

Creating laser initiated hard tissue analgesia with hot lasers

DEFUSED LASER ENERGY

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★ Using hot (surgical) lasers to produce photobiostimulating effects


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Lawrence Kotlow DDS Response of one child

aPhotobiomodulation (LLLT) in a Pediatric

Dental Practice

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22Increased uptake of anesthetic agent (can also be used to get rid of numbing more quickly) Reduction of swelling if you injure a blood vessel during

injection

Effective patient management


Reduction in the need for a mandibular block

6/4/20126/4/2012

6/6/20126/6/2012

Facial Trauma Q1000 mode A

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Trauma to upper anterior teeth

660 nm laser probe for 2 minutes

Dental and soft tissue trauma benefits

1.# Erickson F; ASCD J Dent Child. 1995 july-Aug; 62(4) 256-261

Anterior tooth trauma in the primary dentition: incidence, classification, treatment methods, and sequelae: a review of the literature.

2.#Andreasen JO : Endod Dent Traum, 1998;Feb;14(1) 31-44 Sequelae of trauma to primary incisors.I.Complications in the primary dentition

Lawrence Kotlow DDS

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Trauma to upper anterior teeth , partially extruded

2/15/ 2006

3/10/ 2006 5/15/ 2006

1/28/2008

660 nm laser probe for 2 minutes

1 month3 months

2 years

Lawrence Kotlow DDS

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5 days post trauma

9 mo post trauma

Initial trauma

2 years post 2 months post trauma

Traumatic injury to primary teeth In many cases normal effect of trauma causes primary

teeth to devitalize in 2-6 weeks after traumatic injury. Laser 1 minute (day 1 and day 3) = vitality remains

Maintain tooth vitality(660nm)

Lawrence Kotlow DDS

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Partial avulsion of lower central incisors and fracture of buccal plate of bone 11/3/2010


14 month old infant 11/3/10

11/3/10 11/3/10

11/3/10

11/3/10

11/5/10

11/5/10

660 nm4 j/minute

lingual & buccal

11/24/2010

19 days

2.5 days

6 days

After suturing2.5 days

6 days

Facial trauma


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Lawrence Kotlow DDS

Tooth had 660nm laser placed for 2 minutes on partially avulsed left central incisor. This was repeated on day 4 and day

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Week sixWeek two 17 months

Partial avulsion of maxillary central incisor

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Photobiomodulation (LLLT) in a Pediatric Dental Practice

Mode 1, three minutes; 660 probe intraorally 1 minute

TMJ pain & long appointments

intraorallyDirectly over TMJ area

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Mode 3-one minute each cheek, intraorally 660nm probe 30 seconds on large lesions

Parent said excellent relief that night

4 days later returned almost lesion free

Viral & herpes like lesions

1.#Watanabe f, et al Usefulness of Low-Level Laser for Control of Painful Stomatitis in Patients with Hand-Foot-and-Mouth Disease Journal of Clinical Laser Medicine & Surgery. Dec 2003, Vol. 21, No. 6: 363-367

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Laser Pulp therapy

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Journal of laser Dentistry 2008 Vol 16 No.2 Pg 75-77

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Erbium'Lasers'and'Pulp'therapy

•Kimura'Y,'Yonaga'K,'Yokoyama.'Histopathological,changes,in,the,Dental,Pulp,Irradiated,by,Er:YAG,Laser:,A,preliminary,Report,on,Laser,Pulpotomy.,,J'Clinical'Laser'Med'&'Surg.'2003,21(6)345D350'

•Henson'T.'Velez'E.'Clinical'evaluation'of'pulp'therapy'using'a'dental'lasers'unit'(an'ongoing'study'clinical'evaluation)'San'Antonio(TX)':Univ'Texas'Health'Science'Center'at'San'Antonio;'2003D2007

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Using'the'Erbium:YAG'laser'(2940'nm)'for'

Pulpotomies'on'primary'teeth

Over%nine%years%of%successful%treatments

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'Erbium:YAG'Lasers

• Lasers'are'an'effective'alternative'for'treating'pulps'with'the'additional'the'

benefits'of'providing'pulp'therapy'without'the'need'to'introduce'chemicals'into'

children’s'systems.'

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The American Academy of Pediatric Dentistry defines a pulpotomy as when the coronal pulp is amputated, and the remaining vital radicular pulp tissue surface is treated with a medicament such as formocreosol or ferric Sulfate or with electrocautery to preserve the radicular pulp’s health.

Pediatric Dentistry Reference Manual: Guideline on Pulp Therapy for Primary and Young permanent Teeth Vol 28, No 7 2006-2008 pg 145.

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Pulp Therapy using the Erbium:YAG 2940 Laser

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''Elimination'of'chemicals It'has'been'demonstrated'that'small'amounts'of'

formocreosol'may'be'absorbed'and'distributed'throughout'the'child’s'body'within'minutes'of'its'use'at'the'pulpotomy'site.'

Pashley'EL,'Myers'DR,'Pashley'DH,'Whitford'GM.'Systemic,Distribution,of,CCFormocreosol,from,formocreosolCtreated,pulpotomy,sites.,,J'Dental'Res'59(3):603D608,MArch'1980

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Pulpectomy Pulpectomy is defined as a root canal

procedure for pulp tissue that is irreversibly infected or necrotic due to caries or trauma

Pediatric Dentistry Reference Manual: Guideline on Pulp Therapy for Primary and Young permanent Teeth Vol 28, No 7 2006-2008 pg 145.

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Rational'for'treating'vital'and'non>vital'pulp'exposures

• The'objective'of'either'procedure'is''to'maintain,the,tooth,or,teeth,involved,,functionally,,and,painlessly,,without,pathology,,,until'the'primary'tooth'(teeth)''can'normally'be'exfoliated.'

• A'permanent'tooth,'until'the'tooth'is'adequately'developed'for'the'root'canal'completion.'

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Lasers&studied&for&use&as&pulp&therapy

• Studies'using'the'Nd:'YAG'lasers'have'examined'the'potential'benefits'

for'pulp'therapy'and'indicate'that'the'laser'can'be'used'without'any'

detrimental'effects.''

1.'Liu'H,'Yan'MN,'Zhao'EY,'Chen'L,'Liu'HW.'Preliminary,report,on,the,effect,of,

Nd:,YAG,laser,irradiation,on,canine,tooth,pulps,.,,Chin'J'Dent'Res.'2000Dec;3(4)'

63D5

• Nd:'YAG'lasers'appear'to'be'a'successful'alternative'to'formocreosol'in'

pulp'therapy'of'primary'teeth.

2.'Odabas'ME,'Bodur'H,'Baris'E,'Demir'C.'Clinical,,radiological,,and,

histopathologic,evaluation,of,ND:,YAG,laser,pulpotomy,on,human,primary,teeth.,,

J'Endo,'2007'Apri;33(4):415D21

• Carbon'Dioxide'lasers'have'also'been'shown'to'be'effective'in'treating'

pulpal'tissue'without'creating'damage'in'the'radicular'portion'of'the'

pulp.'

Posterior(and(anterior(pulpotomy

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Pulpotomy'

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Posterior pulpotomy w EZ-PEDO ceramic crows

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Evaluation'of'patient'treatments'completed'over'a'5'year'period.'

(4000'teeth)

•Seeing'children'by'age'1'year'hopefully'will'prevent'most'pulpotomies'!

•Most'primary'posterior'teeth'which'require'pulpotomies,''on'average'occur'around'4D5'years'of'age.

•Most'of'these'teeth'will'exfoliate'or'require'removal'at'10D11'years'of'age'

•Keeping'a'tooth'for'5'years'would'be'an'excellent'result'in'most'instances.

Erbium:YAG(laser(pulpotomies

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9/3/20046/13/2007

7/12/2004 8/22/2006

2'y''9m

2'yrs

Lawrence''Kotlow''DDS'''2012

Examples%of%successful%treatment%Erbium:YAG(laser(pulpotomies

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9/1/2004

2/21/2007

10/30/2002 6/1/2006

2y.6m''

3y'7'm


Additional(pulp(therapy

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1/2/2003trauma

5/12/2006

3yr'5mo

6/11/2003 12/5/2007

3'yr'5mo


Pulp(Therapy

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1/9/2003 6/11/2007

1/9/2003 6/11/2007

8/24/20064'yr5'mo'

4'yr5mo'


Post(5(years(Pulp(therapy

4910/30/2007

10/30/20078/30/2002

8/30/2002

5'years''2'months

5'years''2'months

Five(years(of(Pulp(Therapy9/3'/2002 10/23/2007

5'years''+

9/3%2002

10/23/2007

10/6/2006

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9/30/2002

9/30/2002 3/27/2008

3/27/2008

5'years'6'months

5'years'6'months

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Infected(non?vital(primary(teeth((Lares(PowerLase)

Initial''lesions 2'months'post'treatmentPatient'treated'with'amoxicillin'250/5cc'for'10'daystooth'lazed'for'approximately'30'seconds'using'Er:YAGat''20'Hz'and''80mj'with'water.''Tooth'stable'and'asymptomaticNo'sign's'of'recurrent'infection'at'this'time.'New'bone'formation.

Lawrence''Kotlow''DDS'''2012 52

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Deep second or third degree burn day 3-7 using laser since day 3

Day 3/ 1st treatment Day 4/ view after 24 hrs & 2nd treatment

Day 5/ view after 48 hrs & 3rd treatment

Day 6 view 72 hrs & 4th treatment

Day 7 /view after 4th treatment

Q1000 Photobiostimulating Laser Approx. 4 J /min 3 minutes

Day10 /after 5 treatments

Day 13 /6 laser treatments

Day 18 after 7 laser treatments


Q1000 Photobiostimulating Laser Approx 4 J /min 3 minutes

1 year post burn


5 weeks post burn

Pet after tumor removal followed by dogbite

3/25/2010

3/25/2010

6/4/2015/9//2010

11/18/2010

1.5 months 2.5 months

10 months


2/8/2010

12/28/09 12/30/09 1/4/10

1/4/10q1000 mode 1 and medx mode a

Cooking-oil burn 12 2009


Thank you for you interest and time today


Documents

ald2013 a Nano-oral medicine - Academy of Laser Dentistry · Anterior tooth trauma in the primary dentition: incidence, classification, treatment methods, and sequelae: a review of