Today I publish my interview with Professor Samir Nammour about the origins, role, evolution, and future of laser dentistry. I had the great honor to talk to Professor Nammour and he did a wonderful job explaining the role of laser dentistry for the average person.
I talked to Professor Nammour at the World Federation for Laser Dentistry congress in Sao Paulo, recently. That article of the event contains more work of Professor Nammour as well, such as his super important research on light therapy for cavities.
But back to my interview with Prof Nammour. You can read my full interview below - and hopefully, you'll also be convinced that laser dentistry is an extremely important development:
Introduction: Professor Nammour's Background
Bart Wolbers: Professor Nammour, we're at the WFLD (World Federation for Laser Dentistry).
Professor Nammour: Former President, and Chairman of International Relations and Legal Affairs [of the WFLD].
Bart Wolbers: And you're professor, right?
Professor Nammour: And the chairman of the European Inter-university group of EMDOLA (the European Master Degree of Oral Laser Applications). In 2004 we started. And actually, currently, there are six European universities from five different countries. We're grouping our efforts to deliver the highest level possible of care. Nobody is perfect. And each university has some expertise. So when we group several expertises together we can aim higher. This is our group effort to deliver the highest level of care.
Europe is currently leader in this effort. Europe founded our group. Europe paid money for that in the beginning.
Bart Wolbers: And you're also working on a more global level right now, right?
Professor Nammour: Yes, European, six universities, we offer common courses to all our students. These universities offer courses dedicated for dentists, to learn to use the laser in the correct way, and with daily practice, because laser can really offer a higher quality of treatment.
Why Courses And Education Are Necessary For Applying Laser Therapy Correctly
Bart Wolbers: But maybe for the audience, we cannot just any tool, or any wavelength, or any power output, right? There needs to be lots of education and that's also something I've noticed, well, the evidence base for some protocols, whether it's a gingivectomy, or pulpitis, or whatever, there are a few protocols that are well established with pre-created parameters, whether you treat patients or not, it would be important for the average person to understand we cannot just try a tool and then try to treat with light therapy because you won't get the correct outcome.
Professor Nammour: Good question; that's really very important. How would I say it, I'm simplifying the description, with the laser as an excellent tool. So, a dentist cannot just listen to the salesperson and then use the laser in the clinic.
The dentist should have at least some courses to know how the laser will act, why I will use a certain procedure, and the value, and side effects. So when we follow the courses we can use the laser in the excellent way. And we respect in our education at our university that it's not really a salesman way. In the university we've based our protocols on evidence.
You know, we base our protocols on cold scientific evidence. And even then we repeat our application if we see it's positive [for corroboration]. And if we see it's positive, we start our education. So we repeat everything. We read, we try, and we start. We have a lot of applications. The final goal is the health of the patient.
The patient, the quality of treatment, etc is primary, because at the university we're not private. We don't care. My salary won't change, if I say black or white, it's the same. So it's the quality of the evidence base for a procedure and if they use it in the correct way and this is the role of the university. This procedure seems to be easy, but we aim to have this effect, and we stop cutting, for example, at this and this level. And each step is discussed, when we can start, and the second step, etcetera, etcetera.
The education is really structured with knowledge, education, and science. And as you said, the minimum of courses is necessary.
The History Of Laser Dentistry: How The Use Of Lasers Evolved The Last Few Decades
Bart Wolbers: Professor Nammour, can you tell me a little bit about the history of laser dentistry? Because the growth is exponential - the number of publications - and we're very happy about that. But the field started a few decades ago and was much smaller.
Professor Nammour: I'm lucky that I started in '83.
Bart Wolbers: I wasn't born yet.
Professor Nammour: And I'm still active. I would like to spread the awareness over different fields. With the laser, we started in 1983 in the UK for oral surgery applications. And in France for hard tissues. Those countries are leaders in this field.
So, we have 1) hard tissues, 2) soft tissues, and 3) photobiomodulation. So, soft tissue oral surgery in the 1980s, the early 80s. Hard tissues started in France in 1980, '81-' 82. The photobiomodulation applications in dentistry started in 1985.
In the beginning we had no photobiomodulation, only CO2. So we mainly used this laser with a lot of success, a lot of benefit, a lot of added value, we use it just for direct or undirect pulp capping, to preserve the vitality of the nerve, to avoid making root canal treatments. This process is to avoid a fracture because we can lose it.
So, we use the CO2 just to regenerate, sterilize. In the beginning, I verified and adapted the laser procedure on dog experimentation trying to regenerate the dental bridge and to preserve pulp vitality by direct pulp capping. That scientific evidence is well-known now, it started like that. Back then we didn't have any scientific evidence. Now, main applications have a precise procedure.
You know, in the beginning, we started on dogs to measure the pulp temperature increase during dentin or pulp irradiation in order to have a safe protocol. You know that the pulp tolerates an increase of 3 degrees Celsius before hypertermia or necrosis occurs by severe inflammation. And this development then led then slowly but surely to a good result.
So it was CO2. In 1988 we received, from the US, the Nd:YAG laser [which has a 1,064 nm wavelength]. We started talking about Er:YAG in Germany. And in 1996 more and more diode. And now we have blue, since some years - in the past, it was with Argon, with gas, but now with the appearance of diodes prices have become more democratic and cheaper, if I can say that.
So the evolution was fantastic in this way. And, photobiomodulation also started in 1985. In 1988 I heard about this technique. But, humans are special. We need to see an immediate effect. Otherwise we believe it's a fantasy, a gadget, etcetera. At that time, I didn't believe in its efficiency.
But really, photobiomodulation is helpful, it's really efficient. I'm sure that the space exploration will need photobiomodulation to heal, to regenerate. So now photobiomodulation is really in use more and more in all medical fields. This is photobiomdulation - at the beginning, they said, it's a fantasy, you're a clown, it's nothing.
Many People Cannot Believe The Photobiomodulation Effects Until They See The Results For Themselves
Bart Wolbers: I'm in a Facebook group and there are 12,000 people in there. Most of them use photobiomodulation but as a consumer. And the dentists in there, even from the US, they never use photobiomodulation, and they don't know the scientific evidence, and they tell me in the group that it's all placebo. That's what they tell me, they don't believe it.
Even though 20% of all photobiomodulation studies are on oral health, right, of maybe 10,000 studies.
Professor Nammour: You know, there's lots of scientific evidence that it works. I can ask somebody and let them see the effect immediately. So in 1988 I thought this technique is a gadget or something, as I could not believe it.
In 2008, I read the applications, and I said, I will try [photobiomodulation] and it was really helpful, in any field. Any extraction when you're having surgery, when you have a trauma. Even with a TMJ disorder, we use it for two minutes and then you can open the mouth immediately. It's not fantasy. So, photobiomodulation, we cannot imagine [the extent of the effect].
But you have two kinds of photobiomodulation, red and near-infrared. Usually, red is really well absorbed in the oral mucosa, such as in cancer patients. These patients are suffering a lot from ulcerations and the difficulty to eat. And, the mouth is really [bad], you can cry when you see it. We can use red light successfully and we have an immediate effect.
Infrared light is less absorbed by soft tissue and we use it mainly for bone treatment and to regenerate periodontal bone, etcetera. In such cases it's better to use infrared because we can go deeper into the tissues.
So, red has superficial action, especially for soft tissue. Infrared is specifically for bone, such as osteonecrosis treatment, or osteoregeneration, etcetera.
Bart Wolbers: So the laser is really valuable for dentistry.
The Future Of Laser Dentistry Applications And Why Lower Prices Allow For More Laser Dentistry Access
Bart Wolbers: And now, my last question, Professor Nammour. Where do you see the lasers going in the future of dentistry?
Professor Nammour: Excellent question. You have a pertinence in your questions, I like it, I really like it. You are a professional.
I feel, because I'm a dinosaur. I started doing pulp preservation with long pulses in the mouth since 1983, with the goal of not kiling the nerve. I feel that the future will be for the short pulses, nonosecond or femtosecond. Because with short pulses like that, we reduce the heat generated in tissue, which means that discomfort etcetera will be reduced.
And we can use that pulsing for surgery, so cavity preparation and oral surgery. Any oral surgery, as we can cut bone and we can prepare teeth without a drill. It's really important and this is what I feel.
The problem is actually current now, is the price. The price is still high so any dentist cannot buy it. This is a real handicap for the moment. The price is still high, and when the prices becomes a little bit lower, everybody will use it, I'm sure.
It will be our future because we will use one machine for all applications - that is my dream. This was my dream 40 years ago. Now that dream becomes reality. This already exists in the US, I saw in a study that they're working with 810 nm and when you reduce [the pulsing] lower than 1 microsecond, it becomes ablative. Absorption becomes less important.
1 microsecond equals 1/1,000,000 of a second.
1 femtosecond equals 1/1,000,000,000 of a microsecond, or 1,000,000,000,000,000 of a second!
These are very tiny numbers that most people have a harder time grasping intuitively. But once you start working in the microsecond or femtosecond pulsing rates, there's thus a very small amount of time between the activation of the light and deactivation. Check my blog about light therapy pulsing if you want more background info!
Bart Wolbers: I saw they have an 808 nm machine here, that can be used for ablation.
Professor Nammour: We can then cut the enamel without cracks. All wavelengths become ablative, when you are under 1 microsecond. So a nenosecond or femtosecond. This is the future. This is what allows for treatment without destroying the teeth.
So the problem right now, with current technology, is to conduct, to deliver the light to the target. So you take the pulsing into nano or femto, lower than 1 microsecond, will be the future challenge and I hope I'm still alive to see it. I'm 67 with lots of experience.
Bart Wolbers: Very young!
Professor Nammour: With all lasers this is an advantage. I saw the evolution each time with a new laser, a new technique, and many new applications, and now this.
There have indeed been quite a few interesting publications on the very low Hz pulsing paramters in laser dentistry - if you're curious to learn more, check some the following studies:
1) Femtosecond laser dentistry for precise and efficient cavity preparation in teeth
2) Femtosecond Laser for Cavity Preparation in Enamel and Dentin: Axial Wall Taper Related Factors
3) The Effect of Femtosecond Laser Treatment on the Effectiveness of Resin-Zirconia Adhesive: An In Vitro Study
4) High-Precision Implant Cavity Fabrication Using Femtosecond Lasers
5) Optical penetration models for practical prediction of femtosecond laser ablation of dental hard tissue
You can find a lot more research on this topic on PubMed if you wish so!
Conclusion: The Role Of Laser Dentistry In Daily Practice
Bart Wolbers: Is there anything - any last thing - you want to say?
Professor Nammour: Dentist or non-dentist?
Bart Wolbers: Non-dentist
Professor Nammour: Laser increases the quality of the treatment. Any treatment with lasers will be of higher quality. For the moment we can do everything without lasers for 80% of the results. For example, when we use lasers for the same treatment we have more than 100%. And lasers will further increase the quality of treatments in the future. So for the future, the laser is essential, a necessity for any treatment.
Bart Wolbers: And, yes, looking at the Randomized Controlled Trials (RCT's) etc, whereever you look, whether it's gingivitis, or TMJ, or endodontics. In the last few weeks I had to read the literature on this topic. And now I can see that everywhere–not everywhere but almost everywhere–there is a level of evidence for light therapy in dentistry.
Professor Nammour: Now we have precise protocols. We have a gold standard for dentin hypersensitivity, TMJ, and so forth, and it becomes easy. I'm happy for the young dentists.
Bart Wolbers: Professor Nammour, thank you so much!
Professor Nammour: My pleasure!
This is a post by Bart Wolbers of Light Therapy Insiders. Bart finished degrees in Physical Therapy (B), Philosophy (BA and MA), Philosophy of Science and Technology (MS - with distinction), and Clinical Health Science (MS), has had training in functional medicine, and is currently chief science writer.
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