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213 J O U R N A L O F L A S E R D E N T I S T R Y | 2 0 1 1 V O L . 1 9 , N O . 2 PRACTICE MANAGEMENT Practice Management with Dental Lasers Vipul Kumar Srivastava, MDS; Shally Mahajan, MDS, Lucknow, India J Laser Dent 2011;19(2):213-215 INTRODUCTION In our experience, a dental patientin a modern office has certainexpectations: treatment should beless painful, more precise, less inva-sive with less bleeding, betterhealing, and fewer appointments.Fortunately, the practice of dentistryhas been revolutionized andmodernized so that our procedureshave become more patient-friendly.Over the last few decades lasershave rapidly emerged as veryhelpful, high-technology tools. Theyhave become an important aspect of our everyday lives, ranging from ourcomputer printers, laser pointers,compact discs players, militarydefense programs, entertainment,and now in our practice of dentistry.This paper discusses some of theimportant issues associated withlasers in dental practice manage-ment: the benefits of adopting lasersin a dental practice, what the clini-cian must know before purchasing alaser, revenue generation, safetymeasures, marketing, and updating yourself and your staff.We hope that this article widensthe horizon and also answers some of the queries of many dentists world-wide who are a bit apprehensive of introducing lasers as an armamen-tarium in their daily practice. BENEFITS OFADOPTING LASERS Over time, modern dentistry hasevolved to a minimally invasiveapproach where the main aim isconservation of maximum toothstructure along with its function.The rapid development of lasertechnology has led to its use inperiodontics, restorative dentistry,pediatric dentistry, aestheticdentistry, dental implantology,endodontics, orthodontics, prostho-dontics, and oral and maxillofacialsurgery.Lasers are not new to dentistry– preliminary investigations dateback to 1964 – but many practi-tioners are apprehensive tointroduce them into their dailyclinical practice.The benefits of adopting a laserto increase dental practice are abun-dant. An anxious patient feels moreconfident, without the noise or vibra-tion of the drill or smell of conventional dental care, and withthe fact that much of the treatmentcan be performed with ‘no anaes-thesia’ or ‘needle-free’ dentistry.These factors could transformpatients who were resistant toconventional treatment into oneswho readily accept treatment.Moreover, it is possible to performdentistry in all quadrants, therebysaving valuable time, especially inpediatric patients, and mentally andphysically challenged individuals.Parents especially appreciatekeeping their children happy. If apatient’s experiences with the laserare positive, then the practice willgrow in numbers due to increasedreferrals. Lasers are especiallyhelpful in geriatric patients as thetechnology makes the proceduremore tolerable and can help over-come some of the barriers toproviding dental care including severe dental complexity, multiplemedical conditions, and diminishedfunctional status. In short, laserscan enable the dentist to renderbetter-quality dentistry. BEFORE PURCHASINGDENTAL LASER Before purchasing a dental laser,the practitioner should sort outlaser issues like the ergonomics of the instrument as well as the appli-cations to his or her practice.Currently, with the different typesof lasers available, a choice can bemade according to their clinicalindications for use.For example, the erbium lasershave a potential of replacing the drillin selected situations; the carbondioxide laser is a valuable tool inoral surgery; the diode and Nd:YAGlasers can perform minor soft tissuesurgery; the argon laser can be usedfor soft tissue surgery and compositecuring; and most lasers can beadjunctively used in periodontaltherapy and esthetic dentistry.So, if the clinician’s practice isfocused primarily on soft tissueprocedures, any of the availablewavelengths are excellent choices.The addition of an erbium laser willenable a practitioner to furthercomplete a greater number of proce-dures on both hard and soft tissues.Studies have shown how patientsprefer the laser’s comfort and lack of noise and vibration, and literaturehas demonstrated benefits such asdisinfection and reduction of pulpaltemperature compared to a high-speed bur. More recent articlesdiscuss such benefits as potentialenamel hardening, reduction of Srivastava and Mahajan Vipul Kumar Srivastava, MDSShally Mahajan, MDS 214 J O U R N A L O F L A S E R D E N T I S T R Y | 2 0 1 1 V O L . 1 9 , N O . 2 PRACTICE MANAGEMENT sensitivity, and photobiomodulationeffects, including pain relief,decreased inflammation, and accel-erated wound healing.Dental lasers have becomesmaller, more portable, and easy tomanipulate within the oral cavity,thus increasing their popularityeven more. An important question frompotential purchasers is will there bea return on the substantial invest-ment required for a dental laser?Numerous articles have been writtenabout practice integration and justi-fication of the costs associated withlaser use. We have personallydiscussed this aspect with variousauthorities over the world and haveyet to find a dentist whose practicehas declined after the effective inte-gration of lasers within the practice.Further, the current prices of lasershave decreased so that a diode lasernow costs approximately $5000 USD. REVENUE GENERATION Dentists are constantly looking forways of improving their dentalpractice. We seek to acquire thelatest technology to speed upproduction, hire only the verysmartest employees, and keep upwith all the trends. One of thefastest and most sustainableapproaches to a more profitablepractice is increased production.In our practice, we have learnedthat patients are willing and moreopen to the idea of knowing aboutlaser treatment; and, if given achoice, they happily accept it. Whenwe utilize the laser in rendering treatment to the patient, we charge afee either per tooth, per quadrant, oraccording to the duration of theprocedure being performed. In ourexperience, the patient is not reluc-tant to pay a little more since he orshe is being provided the best dentalcare available with maximumcomfort. With these additionalcharges, we have found that thelaser can pay for itself in a relativelyshorter period of time. So, it is a win-win situation for the entire practice. SAFETY MEASURES While the laser is a powerful anduseful instrument, there are somepotential hazards in its use. Sosafety becomes an integral part of providing dental treatment withlaser instrument. Various jurisdic-tions, standards-making bodies,legislation, and government regula-tions have defined laser safetyprotocols for the dentist, patient,and staff that must be followed inthe clinical practice. Among them: USA ORGANIZATIONS The American National StandardInstitute (ANSI) provides guidancefor the safe use of laser systems byspecifically defining control meas-ures for lasers.The U.S. Food and Drug Administration (FDA) and itsCenter for Devices and RadiologicalHealth (CDRH) together stan-dardize the manufacturing of laserproducts and enforce compliance.The Occupational Safety andHealth Administration (OSHA) of the U.S. Department of Labor stip-ulates the requirements for a safeworkplace environment. REGULATIONS INEUROPE The International ElectrotechnicalCommission (IEC) 60825-1 is thehighest internationally acceptedEuropean standard for laser safety.Worldwide, appropriate safetymeasures such as a designatedlaser safety officer, device safetymechanisms, protective eyewear,masks, nonreflecting instruments,warning signs, and restricted accessof any unauthorized person in theoperating area are some of protocolsthat should be implemented beforethe commencement of any proce-dure with dental lasers. MARKETING One of the most important aspectswhich cannot be neglected whilediscussing practice managementwith dental lasers is ‘marketing.’ Theword marketing is too often confusedwith selling. It is rather an art of creating genuine customer value andmaking the patient aware of thequality and service being provided.In our opinion, marketing is criticalfor a successful dental practice.Marketing can be conducted off-line (traditional media), online, or viaword-of-mouth. Off-line marketing can be very far-reaching but caninvolve huge investments comparedto the other two methods mentioned.Tri-media (advertising through printads, television, and radio) haveproven to be effective means of adver-tising and increasing productawareness. For example, newspaperscontinue to be used actively and arewidely circulated by many printmedia organizations. Moreover,professional marketing companies,personal practice publicists, andpromoters can be involved to promotethe laser practice on a larger scale.Online marketing includese-mails, Web sites, and other formsof social networking. One particularadvantage of online marketing overtraditional forms of advertising isthat it can easily reach a hugenumber of individuals in a short spanof time. Plus, the advertisement lastslonger, is unlimited, and can be easilychanged or customized as needed.Word-of-mouth marketing isprobably the best form of advertise-ment for any dentist. This kind of advertising simply requires excel-lent customer satisfaction withouta single penny being spent. It canbe accomplished right in the dentaloffice.However, we recommend acombination of all the threemethods to take advantage of thebenefits of each, with prudent useof marketing funds. A goodexample is the use of direct mail inorder to lead customers to the prac-tice’s Web site. UPDATING YOURSELFAND YOUR DENTALTEAM Knowledge is today’s most impor-tant and effective competitive Srivastava and Mahajan 215 J O U R N A L O F L A S E R D E N T I S T R Y | 2 0 1 1 V O L . 1 9 , N O . 2 PRACTICE MANAGEMENT advantage. In an era characterizedby rapid change and uncertainty,successful organizations depend onknowledge as their principal way tocreate value and ongoing growth. Various Continuing DentalEducation (CDE) programs,lectures, workshops, conferences,and courses are available to helpthe dentist and staff learn andmaster laser techniques. The Academy of Laser Dentistry (ALD)is one such organization devoted toclinical education, research, andthe development of standards andguidelines for the safe and effectiveuse of laser technology worldwide.Founded in 1993, ALD includesamong its members top clinicians,academicians, and researchers inall laser wavelengths. The mainobjective of these courses and acad-emies is to understand laserphysics, and promote safe andeffective use of lasers on patients. CONCLUSION Lasers are the key to our futuresuccess. They are high-technologyand state-of-the-art instruments.The introduction of lasers will defi-nitely unlock doors for us toperform a wide variety of dentalprocedures to benefit our patientsand our profitability, thereby taking our practices from good to great. ACKNOWLEDGMENT Our special thanks to Dr. Donald J.Coluzzi for motivating us to writethis article. AUTHOR BIOGRAPHIES Dr. Vipul Kumar Srivastava gradu-ated from Manipal University, andreceived his master’s degree inconservative dentistry from theRajiv Gandhi University of HealthSciences (RGUHS) India. He hasreceived laser training from theSharjah University Laser Training and Research Center (SULTARC)in the United Arab Emirates, ALDItaly, Istanbul, and a master’sdegree from the InternationalSociety for Oral Laser Applications(SOLA) in Vienna, Austria.Currently he is working as an Associate Professor in the BabuBanarasi Das University College of Dental Sciences in Lucknow, India.He is an active member of theIndian Endodontic Society, IndianDental Association, and Academy of Laser Dentistry. Dr. Srivastavamay be contacted by e-mail at
[email protected]. Shally Mahajan graduatedfrom RGUHS in India and receiveda master’s degree in OrthodonticDentistry from RGUHS. She ismember of the Indian OrthodonticSociety and the Indian Dental Association. Currently she isteaching as a Reader in theBBDCODS in Lucknow, India. Shehas received additional training inaesthetic dentistry, orthodontics,and laser dentistry. Dr. Mahajanmay be contacted by e-mail
[email protected]. Disclosures: Neither Dr. Srivastavanor Dr. Mahajan has any financialinterests with any manufacturers. SUGGESTED READING 1.Coluzzi DJ, Convissar RA. Atlas of laser applications in dentistry. Hanover Park, Ill.: Quintessence,2007.2.Lackey AD. Practice benefits of laserdentistry. J Calif Dent Assoc 1991;19(11):30.3.Coluzzi, DJ, Rice JH, Coleton S. Thecoming of age of lasers in dentistry. Dent Today 1998;17(10):64-66, 68-71.4.Myers TD. Lasers in dentistry: Theirapplication in clinical practice. J Am Dent Assoc 1991;122(1):46-50.5.Goldman L, Hornby P, Meyer R,Goldman B. Impact of the laser ondental caries. Nature 1964;203(4943):417.6.Freedman G. Buyers’ guide tolasers. Dent Today 2003;22(11):136,140-144.7.Weiner GP. Laser dentistry practicemanagement. Dent Clin North Am 2004;48(4):1105-1126.8.Manni JG. Dental applications of advanced lasers (DAAL tm ) .Burlington, Mass.: JGM Associates,Inc., 2007.9.Coluzzi DJ. Lasers in dentistry[letter]. J Am Dent Assoc 2004;135(6): 696-697.10.Coluzzi DJ. Lasers and soft tissuecurettage: An update. CompendContin Educ Dent 2002;23(11A):1104-1106, 1108-1111.11.Coluzzi DJ. An overview of laserwavelengths used in dentistry. DentClin North Am 2000;44(4):753-765.12.Coluzzi DJ. Fundamentals of dentallasers: Science and instruments. Dent Clin North Am 2008;48(4):751-770.13.Rizoiu I, Kohanghadosh F, Kimmel AI, Eversole LR. Pulpal thermalresponses to an erbium,chromium:YSGG pulsed laserhydrokinetic system. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86(2):220-223.14.Kato J, Moriya K, Jayawardena JA,Wijeyeweera RL. Clinical applica-tion of Er:YAG laser for cavitypreparation in children. J Clin Laser Med Surg 2003;21(3):151-155.15.Kimura Y, Wilder-Smith P, YonagaK, Matsumoto K. Treatment of dentine hypersensitivity by lasers: A review. J Clin Periodontol 2000;27(10):715-721.16.Ross G, Ross A. Low level lasers indentistry. Gen Dent 2008;56(7):629-634.17.Rosenberg S. In vivo lasers. Takeyour practice to the next level. Dent Pract Rep 2003;11(9);48-49.18.Piccione PJ. Dental laser safety. Dent Clin North Am 2004;48(4):795-807.19. American national standard for safeuse of lasers in health care facilities. ANSI Z136.3-2005 . Orlando, Fla.:The Laser Institute of America,2005.20.Sliney DH, Trokel SL. Medicallasers and their safe use . New York:Springer-Verlag, 1993.21.Myers TD, Sulewski JG. Evaluating dental lasers: What the clinicianshould know. Dent Clin North Am 2004;48(4):1127-1144. n n Srivastava and Mahajan
