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ePaper created 2016-12-19, 09:18:41 | version 1.38.0
10 Dental Tribune Asia Pacific Edition | 12/2016 TRENDS & APPLICATIONS Pedonomics: lasers in paediatric dentistry By Dr Imneet Madan, UAE We live in an era in which time is the basis for many decisions: what saves time is what gets chosen. In- troducing better technology helps to work with time economics in paediatric dentistry. The recent term coined for this perspective of expanded thinking is “Pedo- nomics”. Pedonomics refers to the impact of the changing world of paediatric dentistry in the dental practice.1 Time economics goes hand in hand with pedonomics. The selec- tive niches of dentistry are ex- panding far more today than in the past years. Few reasons that account for the need of this level of advanced healthcare are:2 1. Some parents who have their children later in life are referred to as drone parents. These par- ents self-educate a lot via social networks and extensive inter- net research. With less inherent trust in healthcare providers, they generally form a strong opinion about the dental care of their children and are most demanding of their paediatric dentist. 2. This category of parents are often techno-savvy and are quite updated with latest tech- nologies. They appreciate a “no pain, no drill, no memory” den- tistry. 3. Caries rate in dentistry is ever- increasing, with a heightened frequency of cariogenic diet and a decline in caries prevention. 4.There are more and more gen- eral dentists that would “do the job” and only if it is misman- aged, would they refer the child tothespecialist.Increasedavail- ability of advanced technology can put an end to this trial practice. Lasers as game changers Lasers are introduced as ex- cellent instruments in everyday dentistry. However, the idea of dentistry is generally connected to discomfort and pain in children’s minds. Any treatment trend that can help our practice to remove this connection by the use of con- temporary technologies can in- crease patient referrals and treat- ment acceptance. Although the hand piece does remove the dental decay, it may also cause abrasion of the tooth structure and a significant amount of discomfort that may not be taken very well by the children. In addition, the vibration and noise of the drill could be unpleasant to young ears, thereby lasers can prove a better tool as they do over- come all these fears of drill den- tistry.3 Additional benefits must far supersede the costs and invest- ments when it comes to complet- ing the laser requirements of any practice. Patients’ perception of laser dentistry Generally, the treatment ap- proach in paediatric dentistry is much different from adults. With Lasers bringing the additional benefits of no contact, no pres- sure, no drill, no anaesthesia and thereby a less negative perception of dentistry, higher success rates are likely to be seen. This is cer- tainly because of an increased degree of satisfaction of the pa- tients. Marketing protocols help us to see a larger number of patients per day, but to have these patients accept the proposed treatments better, it is advisable to introduce to them tools that can truly help. As applicable in any field, an ex- perience that exceeds the expec- tations will motivate the patients to keep appointments, accept rec- ommended care and hence allow to build up positive clientele. Laser indications in dentistry Medicine began to integrate lasers in the mid-1970s for soft tissue procedures. The first laser specifically for dental use was a neodymium-doped yttrium alu- minium garnet developed in 1987 and approved by the Food and Drug Administration in 1990.4 Benefits • Less thermal necrosis of adjacent tissues is produced with lasers than with electrosurgical instru- ments.5,6 • Haemostasis can be obtained without the need for sutures in most cases.7,8 • Little or no local anaesthesia is required for most soft tissue treatments.9–13 • Reduced operator chair time has been observed when soft tissue procedures have been com- pleted using lasers. • Lasers feature decontaminating and bactericidal properties on tissues, requiring less prescrip- tions of antibiotics post opera- tively.9,10 • Lasers provide relief from pain and inflammation associated with aphthous ulcers and her- petic lesions without pharmaco- logical intervention.13 • Erbium lasers can remove caries effectively with minimal in- volvement of the surrounding tooth structure because caries- affected tissue has a higher water content than healthy tis- sue.5,7 • As erbium lasers have no direct contact with hard tissue, the vi- bratory effects of conventional high speed handpieces are elim- inated, allowing tooth prepa- rations to be comfortable. As a consequence, anxiety in both children and adolescents is re- duced.9,11,14,15 Lasers and profits in dentistry Lasers allow the dental prac- tice to balance well between busi- ness and dentistry. Offices that in-corporate lasers in their prac- tice have a unique psychological and promotional advantage over those who fail short to offer such services. Lasers are definitely the foundation of creating a referral- based practice.16 Benefits that add to the prac- tice are always important, but how actually does one convince oneself to accept the resulting expenses for the practice. Usually, lasers are considered high invest- ments and any high investment must prove reasonable enough to be accommodated in the practice. Return on investments with lasers can be easily pre-calculated. In general, laser treatments can cost 35 to 40 per cent more than the usual appliance, this calculation done for a return period of two to three years can yield on the investment. Mathematics in pedonomics The introduction of lasers into the practice should be made in an orderly and precalculated man- ner. Proper financial planning will help ensure the successful intro- duction of laser and help to yield its benefits better. Calculation of economics used in paediatric den- tistry and thus making decisions in favour of economic benefits to the practice are the basis of pedo- nomics. The concept of pedonom- ics and the time-economics model are based upon the profitability per unit of chair time which is the most important factor in deter- mining the -financial future of the practice. Pedonomics work on the presumption that the profit mat- ters, not the income.16 Laser costs Cost is the primary determi- nant in any acquisition. In the most common manner, it is de- fined as the amount or equivalent paid or charged for something. It is termed as price in the economic language. Another important fac- tor here is the opportunity cost. It is the added cost of using re- sources (as for production or spec- ulative investment) forms the dif- ference between the actual value resulting of using this opportu- nity and that of its alternative. Opportunity costs is a major determinant as it describes the following: 1. Cost of the acquisition of a laser. 2. Costs incurred when not having the laser, which include: loss of © Monkey Business Images/Shutterstock.com LaserFilling ConventionalFilling OneSurface 785 577 TwoSurface 895 706 ThreeSurface 976 784 Morethanthreesurface 1,082 847 Table 1: Number of patients treated with laser vs. conventional approach. Other procedures 1 LaserCosmodent Cosmodent 2250 1800 2 LaserFrenectomy Frenectomy 3100 2500 3 LaserSealant Sealant 550 450 4 LaserPulpectomy Pulpectomy 2100 1850 Table 2: Cost comparison in UAE Dirhams between laser and conventional treatment. OneSurface 785577 TwoSurface 895706 ThreeSurface 976784 Morethanthreesurface 1,082847 22501800 31002500 550450 21001850