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THE NEXTDDS Student Ambassador Blogs

Intro to Dental Lasers

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 This week my class completed our hands-on laser lab as the culmination of our introductory course.  This course satisfies the laser proficiency training requirements for the Nevada State Board of Dental Examiners.  We practiced with a diode laser on a hotdog which most of us cut our names into and then a pig jaw on which we performed troughing around the crowns of the teeth.  All along, I have been excited for when we actually got to have this thing in our own hands.  We have seen several videos on the spectrum of dental lasers available and discussed the range of capabilities of each.  Due to cost limitations and the relatively limited uses of the hard tissue lasers, the diode laser is the most common laser in private dental practices today.  With its recent price drop of nearly 75%, it is becoming more widespread and purported to replace electrosurge units and retraction cord respectively for soft tissue cutting, hemostasis, and tissue management during impressions of crown preps. 


In clinic, we routinely use the standard monopolar electrosurge unit for most soft tissue cutting.  We occasionally use it to trough around a prepped tooth but only minimally due to the risk of damage to the cementum, the periodontium, and the alveolar bone.  The machine itself looks so dated and explaining to your patient that you need to “ground” them for the procedure seems archaic and illicits an anxious response almost immediately.  I was so eager to see this slick new diode laser in action, confident it would put our old electrosurge to shame.  I was so disappointed!

Granted, my time with this laser was brief and my patient was a tubesteak and a bloodless pig jaw.  Still, it was not very impressive.  My (very) limited experience included only one power setting and about five minutes but has lead me to believe that not only is the laser more expensive, it also cuts MUCH slower, it often DOES require some sort of anesthetic, and it requires additional training for all staff, expensive certifications, safety glasses for everyone, and a room prepared and designated for its use.  It seems like a wasted additional expense other than for the gimmick factor.  “Laser dentistry” is being advertised everywhere and our patients want the latest, assuming it’s the greatest.  From the didactic portion of the class I have learned that it is safer to use a diode laser around implants as the elevated temperatures caused by the electrosurge can inhibit osseointegration.  Additionally, the laser can be used around other intraoral metals as it does not conduct like the electrosurge.  However, I feel that you can use a scalpel and some viscostat more predictably and decidedly cheaper for those rare instances.  The electrosurge is much simpler and less expensive in all other circumstances.  It seems there is a lot of potential for dental use of lasers but the one I tried did not live up to the hype.

Caring for patients dealing with addiction

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As healthcare professionals we are to care for the wellbeing and health of our patients. We decided a long time before ever starting dental school that our career would consist of serving others to the best of our ability. These statements are easy to make on paper but not always as easy to put into practice every day in clinic. Patients and doctors alike can be happy, grouchy, tired, impatient, hungry, and even angry. We all bring a little of the rest of our lives with us wherever we go, however inconvenient it may be. Many patients also struggle with unhealthy addictions that need to be considered and sometimes addressed in a clinical setting as well. That is where it falls on us as professionals to remember that we are here to help our patients in any way they need. 


Many everyday people struggle with addictions. It’s a fact and although it is easier to pretend it isn’t a problem or to call it “taboo” and just never bring it up, we  as doctors need to foster a relationship of trust. We need to be open minded and realize that not everyone has the same situation we do. Not everyone has had the opportunities we have had just as we may not have had the opportunities that many of our patients may have had.


Our attitude towards patients dealing with addiction must be one of care, patience, and understanding. As a people, we generally know from body language and from reading between the lines when someone is or has passed judgment on us. We use this perception to learn who to trust, who is our friend, and who is really looking out for us. Our patients do the same thing and although a doctor may try to seem indifferent or non-judgemental, the patient usually knows who is lying and who is sincere. This is why our attitude must be sincere and we as the provider must genuinely be open to understanding the difficulties in our patients lives. Ultimately, we have to be on the same team as our them, even if we do not agree with their lifestyle choices. They have trusted us with the task of maintaining their health and it falls on us to treat each individual with the respect and dignity they deserve.



By providing sincere care, not just a procedure or service, and to the best of our ability, we will build a rapport with our patients; they will come to trust our intentions, and even better, our advice. It is difficult for anyone to confess an addiction to drugs, an eating disorder, alcohol, or whatever it may be to another person. When this does happen and your patient lays out their situation, your initial response can be a relationship defining event. Will the patient see a look of judgment, disgust, or pity in their doctor’s face? Or, instead will they see the response of a caring friend who is saddened and empathetic, but upbeat and optimistic in their desire to genuinely, help. It is up to us to not pass judgment on them and kick start their healing process by gaining their confidence in our commitment to care.

The most important Investment

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Ask yourself this: Why does our profession have a high tendency toward lower back and neck pain? Most of us subconsciously tend to lean toward the patient/manikin when providing treatment to improve visualization or practicing on a typodont. Moreover, students tend to rotate and bend their heads to better visualize the maxilla, instead of better positioning the patient and using indirect visualization (i.e., using a mirror). As dentist age and it becomes more difficult to see small objects, they tend to lean in further, placing more strain on the neck and lower back. Use of loupes helps improve visualization but also forces the dentist to sit upright due to the focal distance of the loupes. When the dentist is wearing loupes leans in closer to the patient, the field of view blurs (goes out of focus), subconsciously forcing them to sit in a more upright position to bring the subject into focus. 


Another fix to prevent lower back pain is for the dentist to position himself or herself in a chair in the proper stance. Many chairs have a “Saddle Design” that designed for a clinician in mind. Investing in a good ergonomic chair those forces, you not to lean over the patient can also pay off long-term when used adequately. For instance:  

Knees should be lower than Hips 

You should position your torso 45 degrees to your hips  

Your cervical portion of your spine should be parallel to the thoracic portion 

Following these three easy steps and utilizing loupes should be the first investment into your career as they are investments in your body and career. Optimal seating position can mean less money sent at the chiropractor. Both loupes and a good chair can reap great returns on their investments.