BioPhotonics spoke with Dr. Donald Patthoff, who practices general dentistry in Martinsburg, W.Va., and is editor of the Journal of Laser Dentistry and co-author of the book Dental Ethics at Chairside: Professional Obligations and Practical Applications. Patthoff is also the co-founder and co-director of the Foundation for Photobiomodulation Research (PBM Foundation). He discusses the need to educate practitioners and their patients about the safety and effectiveness of photobiomodulation and other laser treatments in dentistry, even as the treatments gain acceptance.

What common misconceptions exist about photobiomodulation and laser therapy in dentistry?

The most common misconception within all the health care professions in the U.S., and not just in dentistry, is that photobiomodulation, or PBM, doesn’t work and is overhyped. However, an increasing number of scientists and clinicians, and a growing part of the general population, are claiming it does work — not just for reduction of pain and swelling but also for faster healing of acute wounds, and for clearing up long-standing chronic wounds and various other chronic conditions. Laser uses have been growing in dentistry since the FDA gave its first marketing clearance for a few specific dental treatments in early 1990. Many dentists, however, still claim lasers are no more effective than other treatment interventions.

What can organizations such as the Academy of Laser Dentistry and the PBM Foundation do to educate the public and normalize the way laser treatments are described in the dental community?

The Academy of Laser Dentistry (ALD) originated in 1991 at the first user group meeting of the few dozen dentists who purchased the first FDA-cleared laser marketed specifically to dentists. Then, in 1993, three organizations — the American Academy of Laser Dentistry, the International Academy of Laser Dentistry, and the North American Academy of Laser Dentistry — merged to form the unified ALD. The founders agreed to create a distinct professional nonprofit group to explore the safe, effective, efficient, and ethical uses of laser technology and techniques in dentistry. They realized immediately that they would need to agree upon a method with which to begin assessing the common norms for the uses of the lasers and their different techniques within various dental settings for specific conditions. In the early 1990s, dental schools were not using or teaching the use of lasers in dentistry, as a norm; nor did any dental organization claim to be an authority about their uses. Until now, each laser company has continued to advance the many parameters and applications of their devices based mostly on their own research, and by using investment dollars and outside governmental and nongovernmental grants. The missions of ALD and, subsequently, the PBM Foundation, are grounded in professionalism, research, and assessing the safe, effective, efficient, and ethical uses of lasers in dentistry to determine how lasers, light-emitting diodes, and broadband light impact oral health and well-being. These organizations also provide education about how lasers are used for treating periodontal, endodontic, orthodontic, and many other oral health conditions, including temporomandibular conditions. This education requires setting up and conducting conferences and special-focus meetings, publishing in peer-reviewed journals, working with educators, and the groups who credential schools and other dental specialty organizations. It also requires collaboration with state dental licensing boards and multiple federal and international regulatory bodies involved with device and health safety and management of public dollars and public policy.

PBM has been accepted as a treatment for oral mucositis. What lessons have been learned that can advance the use of the technique for other oral treatments?

The major lesson is that developing a reasonable course of action — one that is sound at the quantum level and capable of taking PBM to a stage where it makes an actual impact on a specific condition — is a complex and costly process. Multiple disciplines are involved. And it requires the willingness of each to ask the others questions. All must acknowledge that no single person or entity or government can do this on its own. Because this kind of effort bore fruit for the treatment of oral mucositis (sores and swelling in the mouth) via the laser, a milestone was laid for explaining the observed phenomenon of laser uses for other dental conditions. It also showed that the needed academic expertise, technology innovation centers, and the social/cultural infrastructure can be put in place for other conditions to be treated via lasers. Dentists who are currently using lasers are in the best position to adapt their own devices to their individual preferred practice expertise through their experience with techniques such as photobiomodulation. We already see unique and new treatments becoming available. A recent issue of the Journal of Laser Dentistry included much of this information. A quick, yet not inclusive, list of potential treatments made possible by photobiomodulation would include quicker healing, uses in sleep apnea protocols, reduction of COVID-19 brain fog, improvement of speech disorders, treatments of dry mouth, adjunctive uses in the treatment of patients who are medically compromised because of medications and physical limitations, and patients with behavioral and fear disorders.