Interview

Graeber: Hello
Ryan: Hi doctor Graeber?
Graeber: speaking
Ryan: This is Ryan i was calling about the interview
Graeber: Yes I am ready
Ryan: I just have six questions to ask you
Graeber: sure
Ryan: ok so my first question is, are kasers more or less effective than drills in regards to cavity
removal and why?
Graeber:Ok umm when you say effective you could mean that one of two ways first if you are
comparing drills which we call handpieces by the way to a laser or other device the dental hand
piece is still the most efficient device it is much faster however little known is the damage that it
does when we say damage it actually causes micro cracks inside of the structure so dental drills
are used to cut typical cavity preparation which is inside of the tooth it can often cause micro
fractures which can eventually lead to what we call leakage of the restoration and eventually
these cracks begin to propagate you know you ever see a piece of wood that has a nail near the
end of a piece of wood and if it is to close as the wood dries out it will begin to split along a line
on the same plane as the screw or nail well that is what happens microscopically inside of teeth
and this is not a very well known of an effect amongst the profession I support that and i can tell
you that when I work within a microscope while I am doing dentistry you can actually see these
cracks if you use either an infared device to look at teeth diagnostically or magnification with a
blue dye that kind of seeps into these cracks and makes this very visual that cracks that make
their way to the outside become very feign with bacteria or things like coffee or wine or things
like that and tea also they will stay in these cracks and when teeth are overloaded when biting
or biting down on something that is a little to hard like an unexpected olive pit or cherry pit or a
kernal of popcorn the teeth will always break along these lines so when you use a laser or a air
brace or a bracing device it is much slower than a dental drill but it is not capable of putting
cracks into the teeth
Ryan: Ok so it has less long term effects?
Graeber: Yes so it is a safer instrument for maintaining the integrity of the tooth
Ryan: but it is just not as quick and fast
Graeber: right not as efficient as a dental drill
Ryan: Ok so in periodontal therapy would you consider lasers again more or less effective than
the traditional methods of cleaning?
Graeber: well the purpose of using the laser in a pocket well lets just back up a second there
are two different types of lasers that are used in a pocket one laser will take all soft tissue lasers
do you need to know which one
Ryan: no not right now
Graeber:Ok umm the soft tissue lasers their purpose is to warm up the bacteria to 53 centigrade
which denatures the proteins of the cell and generally prevents cell division kinda of like cooking
an egg and so that is the understanding the mechanism not enough research has been done to
really prove that however anybody who uses lasers sees a dramatic change in how fast the
tissue heals when the laser is used and we see and we know that there are less bacteria in the
lower part of the pocket and we know these lasers have an anti inflammatory effect and the

level of infection is associated with inflammation and that is a cardinal sign of bacterial
inflammation if you will there is another kind of laser called an erbium laser that is capable of
cleaning the hard deposits off off the teeth and also because it is attracted to water has a role in
the reduction of bacteria so we have two different classes of lasers if you will that alter bacteria
in infected pockets and can remove dead bacteria and calculus on the gum line
Ryan: Ok so would this be a two step process using the soft tissue laser and the erbium laser/
Graber: umm you could you would probably if you were using it to remove calculus you would
not need an additional wavelength just to kill off a few more bacteria it might be one of the
things you have to be worried about when treating human beings especially in very thin tissues
is the build up of heat you cant spend all day long you have to be very conscious of not raising
the temperature because you can cause bone to be destroyed and the pulp can be overheated
and that tissue is very soft very tender and susceptible and if you raise the pulp temperature
about five degrees centigrade then you will cause irreversible damage so the uses of lasers in
the pocket or on and around teeth the protocol for operating must be very strict and one must
always be conscious of overheating the structure We have to be very cautious and we have to
use very little power of lasers so that we would avoid that kind of overheating
Ryan: so do these lasers put people at greater risks during operation than classical dentistry
methods do
Graeber:the lasers that are used in dentistry only have one precaution and that is eye protection
because they all all of the lasers used in dentistry have the potential of causing eye damage
The only problem is always protecting patient, doctor and assistant and any observers from
reflected laser energy
Ryan: ok so do these lasers require more effort in learning how to operate them than drills do
Graeber: Well because we operate slower and more precisely I would say that they're easier to
use and an easier to learn than classical instruments
Ryan: do you have to do any classes to prepare to learn how to operate a laser?
Graber: Umm when you in dentistry in most states once you have achieved a dental license you
don't have to have certification in most of our conventional or laser treatment sometimes you
have to have certification unless you make use of intravenous sedation in almost every state
that requires a license and i cant think of anything else other than any time you leave the area
of general dentistry and into specialty dentistry it is every dentists responsibility to make sure
they have efficient training and experience if you will regarding specialist activities no body
requires east of the Mississippi at least that I am aware of certification in dentistry having said
that i dont think it is wise for anybody to pick up an instrument that they have not been trained
in most people recognize that
Ryan: so do you think the lasers are worth the money because they are obviously not cheap?
Graeber: well some laser have been on the market for as low as $2000
Ryan: oh wow I was not aware of that
Graeber: well most people think that they are all atleast $100,000 and they are not the first on I
bought 25 years ago cost me $50,000 Ryan: yea because the lowest i saw was $30,00
Graeber: well in todays dollars the is $200,000
Ryan: wow that is pretty expensive
Graeber: so when they first came out they were beyond the ability for most practices to own
today the average price will arrange I have seen them for as low as $1,500 all the way up to

$115,000 so I will tell you the one for $1,500 can do everything the one for $115,000 can do one
comes with training and the other one doesnt not that the training isnt worth $113,500 there are
other types of lasers that are very expensive to manufacture that will arrange from $50,000 and
$85,000 and those are what we call the free running pulse lasers and they use rare earth
elements in them to produce the lasers wavelengths and each of those rare elements could cost
up to as much as $10,000 and they are the size of a cigarette everything that goes into lasers is
very sophisticated it is a man made form of energy produced at a specific wavelength using rare
earth elements so you have a lot of specialty equipment and money that has to go into research
so lasers that are very inexpensive and that is under $25,000 are all known as diode lasers and
diode lasers are what is known as semiconductors we have them in our cell phone which you
know costs peanuts $7 a piece you are probably sitting under an LED light that costs $7.50 the
change over the last 20 years is the move to semiconductor lasers which are the least
expensive because they are very simple the more you spend the more complex they get Ryan:
so what does this complexity what is it used for why would you spend a lot of money on one
laser when you can spend a smaller amount of money on another?
Graeber: the diode lasers can only be used on soft tissue and the wavelengths can only be
absorbed by colored tissue so the inside of the mouth being some shade of pink so they work
very well of gum tissue on lip tissue on cheek tissue and things of that nature half of what we do
is work on teeth so the lasers that are capable of working on hard tissue are $50,000 as they
are far more sophisticated they are different wavelengths
Ryan: well that is all the question I have
Graeber: ok well will we be continuing
Ryan: well we will if I have any more questions
Graeber: what do you plan on doing beyond this
Ryan: I plan sending out a survey or interviewing other laser dentists to get their opinions too
and I also want to get non laser dentists opinions on the lasers also
Graeber: well that will be very interesting I will say this that once you pick a laser you will never
put it down. however i will tell you that it seems to be very difficult for the non laser users to
understand the value of using a laser over conventional methods
Ryan: I find that very interesting actually
Graeber: well here is what i tell them i tell them that we dentists have been overly trained and
poorly educated and if you are taught to do things a certain way and this way has been working
for 100 and some odd years you are reluctant to venture out on your own without an awful lot of
compelling evidence do you drive yet
Ryan: No I am about to drive though
Graeber: Ok well can you imagine if someone told you you know if you drove on the left side of
the road it would be much better and you go hmm I dont know about that you know it is kind of
like that professionals who are very highly trained people who are very conservative type of
people dont look for new ways of doing things more often tou will hear that between the lines I
have been involved in the field for 25 years primarily because I was looking for something to set
me aside as being different than my colleagues I am still a very conservative person in the
treatments that I give but I like to serve my patients in a less distasteful way laser allow me to
do and people who are treated with lasers want nothing to do with anything else really because
they will come back and say how did you do that you took blank out of my mouth and I felt
nothing

Ryan: yea because most of the time when you go to the dentist you have weeks of inflammation
and pain
Graeber: yes so if there is way of doing it without all of that i will do it because I want the very
best for my patients and if lasers happen to do that and they make it easier for people then that
is what I will do but I am dedicated because I thought being a dental patient sucked I was turned
off so that is what kind of motivates me and i think that there is a large segment of every group
that loves technology and lasers are that they are the latest and greatest
Ryan: yea revolutionary
Graeber:Anytime i can help you again just contact me
Ryan: well thank you for your time
Graeber: it was a pleasure speaking to you
Ryan: you too
Graeber: well have a wonderful holiday season
Ryan: you too
Graeber: by
Ryan: by