Some experts believe routine dental visits
would be less anxiety-provoking
for children -- and adults --
if new laser technologies for treating
cavities were more widely available.

YOU WOULDN’T know it, but Mary Fran Faraji had a mouthful of cavities when she was growing up and had each one filled with the dreaded dentist drill. “I have memories when I was young ... extreme discomfort,” she says. “It made me avoid the dentist for many years of my life.” But now that she’s got four cavity-prone kids, what’s a mother to do? She’s headed back to the dentist again, this time with her 9-year-old daughter, Mimi, who has her second cavity. For Mimi’s first cavity, she had the drill.

Arnot: “When I say dentist, what’s the first thing you think of?”

Mimi: “Fillings.”

Arnot: “Fillings, drills, needles, pain? Not a lot of fun?

Mimi: “Nope.”’

The Faraji family dentist, Ed Romano, is now offering a new technology for certain types of cavities — technology that claims to be a painless alternative to the drill.

It’s a new Food and Drug Administration-approved laser for cavities that doesn’t work on existing silver fillings or crowns in adults but works well for all kinds of cavities in children and simple cavities in adults. Advocates say Novocain isn’t usually necessary so there are no shots, and visits with this laser are said to be pain-free.

Romano: “We can go in and remove decay in its infancy and be very precise about it.”

THE LASER VS. THE DREADED DRILL

What’s the difference between the laser and the drill? Everyone knows the grinding sound of the dentist’s drill. Metal, moving at a speed of 250,000 RPMs, cuts into the tooth and decay. Because of the power and vibration, it can cause discomfort, especially if it hits a nerve. Novocain is highly recommended. With the new erbium lasers, there’s only a gentle tapping sound. There is no friction or vibration and little chance of nerve damage, especially with small cavities, so Novocain usually isn’t necessary.

Arnot: “So is it really, zap you’re in, and zap you’re out — no swelling, no numbness, no pain?”

Romano: “In 98 percent of the cases. yes.”

Arnot: “And the 2 percent?”

Romano: “The fact that they don’t have a drill and that whole whining noise, they’re happy anyway.”

Clinical studies reviewed by the FDA show these lasers to be safe and “as effective” as the drill for small- to moderate-sized cavities in adults and all kinds in children. But trips with this laser could cost more. While Romano and others don’t charge extra for a visit with this laser, some dentists could charge “laser fees” up to $45, depending upon the procedure, and the difference may not be covered by insurance.

NO NEEDLES

But Mimi isn’t thinking about the cost. The thought of a pain-free cavity is enough for now. She and her mother allowed “Dateline” cameras to follow her through the procedure. There were no needles, only goggles for protection.

Romano to Mimi: “You are going to feel some water come out ... and some tapping on your tooth.”

And no grisly sound of the drill. Romano focused the laser on Mimi’s decayed tooth. And after about six minutes, Mimi was smiling.

Arnot to Mimi: “So how was it?”

Mimi: “Good.”

Good but not great. While there was no puffy numbness or drooling like she had with the drill, Mimi said she felt a bit of pain this time. But Romano, who consults for laser companies and teaches dentists how to use lasers, has seen a lot of patients go through the procedure.

Arnot: “So how do you think Mimi reacted to this compared to the drill?”

Romano: “I think she did great. I think if I did the same thing with the drill, Mimi wouldn’t be smiling right now.” But not many dentists are using these new lasers yet. Less than 200 of these erbium lasers have been sold to a field of approximately 150,000 practicing U.S. dentists. And many of the dentists we spoke to believe that the erbium lasers, while safe, in many cases are too limited and not as efficient as the drill. And unless they can replace the drill, many dentists aren’t willing to make the investment. But Romano thinks it’s just a matter of time before dentists catch on. He believes as the technology develops, more and more dentists will invest in one. Besides, he thinks, patients are the ones who’ll have the last word.

Romano: “Patients are going to demand it. If you are going to a guy who’s giving you a pain-free filling versus a guy who’s giving you a needle and a drill, what would you rather sit through?”

The ADA finds the erbium laser technology “promising,” and the group is “cautiously optimistic” about future developments in the field of laser dentistry. Meanwhile there are several other companies with similar lasers awaiting FDA approval.

Dr. Bob Arnot is NBC’s chief medical correspondent.