Use of Lasers for Pediatric Dental Patients

Board takeaway

• Choose a laser by the tissue, clinical task, and wavelength after obtaining didactic and hands-on training.
• AAPD accepts lasers as an alternative or adjunct for pediatric hard- and soft-tissue care, including patients with special health care needs.
• Use wavelength-specific eye protection, plume control, and fire precautions.
• Potential benefits do not guarantee painless treatment, replace every conventional instrument, or establish universal pediatric settings.

Tissue interaction

• The active medium produces a specific wavelength; tissue chromophores determine absorption.
• Most cutting is photothermal: water vaporizes above 100°C, enabling soft-tissue ablation.
• Erbium hard-tissue removal uses expanding steam to fragment surrounding material (spallation).
• 9,300 nm CO₂ interacts with water and hydroxyapatite mineral components, allowing enamel/dentin ablation.
• Power, frequency, emission mode, thermal relaxation, cooling, delivery system, and chromophore concentration influence the response.

Select by application

The source table lists applications; it does not establish superiority or procedure-specific pediatric protocols.

• Soft-tissue examples include contouring, frenectomy, gingivectomy, operculectomy, and biopsy where listed for the selected laser.

Wavelength and tissue determine the application

Safety before activation

• Identify a laser safety officer: information, equipment/accessory inspection and maintenance, and implementation of safety procedures.
• Patient, team, and observers require wavelength-specific eyewear throughout use; reflected/scattered beams threaten eyes and skin.
• Plume may carry viruses, toxic gases, chemicals, and other infectious or carcinogenic material. The policy specifies infection control, a 0.1 µm filtration mask, and high-speed suction.
• Sparks plus an oxidizer-enriched atmosphere and combustible materials can cause fire. Examples include dry gauze, throat packs, cotton/paper, hair, petroleum/alcohol products, rubber dams, and nitrous masks.
• Viral-lesion treatment in immunocompromised patients risks aerosol transmission; palliative medication may be more appropriate.
• Consult state boards for applicable laser safety regulations.

Benefits and uncertainty

• Precise tissue interaction; less adjacent thermal necrosis than electrosurgery.
• Soft-tissue procedures often achieve hemostasis without sutures; faster healing, less discomfort/analgesic need, little or no local anesthesia, and shorter chair time may result.
• Decontaminating effects may reduce postoperative antibiotic prescribing.
• PBM produces effects without thermal ablation. Used for prevention/treatment of mucositis associated with chemotherapy, radiation, and transplantation; may reduce surgical, traumatic, or preparation pain.
• Ulcer/herpetic-lesion pain and inflammation may improve, but pediatric laser choice and therapeutic parameters need further study.
• Nd:YAG, erbium, and 9,300 nm CO₂ may reduce anesthetic requirements for tooth preparation. Analgesic mechanisms remain uncertain.
• Noncontact preparation avoids handpiece vibration and may reduce anxiety. Higher water content supports selective removal of carious tissue.

Limits and evidence

• Multiple wavelengths may require multiple units; equipment and training are costly.
• Lasers cut at the end only, cannot ablate metallic restorations, and prepare cavities more slowly than high-speed handpieces. Conventional finishing may be necessary.
• Policy development used literature review plus expert/consensus input; no formal recommendation-strength grades are supplied. AAPD calls for further pediatric safety, efficacy, and application research.

Common board traps

Answer aloud

How would you select a laser for caries removal?

Match wavelength and tissue absorption to the procedure, with appropriate operator training.

• Erbium or 9,300-nm CO₂ lasers have listed hard-tissue applications.
• The 10,600-nm CO₂ entry is for soft-tissue applications; CO₂ units are not interchangeable.
• Cavity preparation can be slower and may need conventional finishing.

What must be ready before a laser frenectomy?

Confirm a suitable unit, trained operator, and complete laser-safety measures before activation.

• Safety-officer procedures and wavelength-specific eyewear for patient, team, and observers.
• Plume control with high-speed suction and the policy's filtration-mask precautions.
• Fire precautions for oxidizer, ignition, and combustible material; ordinary eye protection is insufficient.

Would you laser a viral lesion in an immunocompromised child?

Consider palliative medication because laser-generated viral aerosol can transmit disease.

• Pediatric lesion-specific laser parameters remain uncertain.
• Antibacterial effects do not remove viral plume risk.
• Avoid presenting ablation as universally safe or established.