Laser safety officer: a vital role for dental assistants.

Lasers are fast becoming the instrument of choice for many dental procedures and the role of laser safety officer (LSO) is paramount for incorporating this technology in a safe and effective manner. As a partner in the delivery of dental care, the dental assistant has an opportunity to assume the expanded role of appointed LSO for the dental practice. The primary document regarding laser safety is the nationally recognized American National Standard for the Safe Use of Lasers in Health Care Facilities (ANSI Z136.3). (1) It is imperative that all facilities using lasers obtain and apply this standard as an integral part of their safety program. (2)

This is where you, the dental assistant, can be the leader in laser safety for your office. Your doctor will spend much time on education and dollars in purchasing equipment to incorporate laser technology. But you as the trained LSO can help pave the way for successful implementation, primarily by overseeing safety but also in understanding the technology in order to train staff and educate patients. Your role is important and should be taken seriously. The Academy of Laser Dentistry (ALD) is your partner in acquiring these skills and certifying your knowledge to deliver this vital role. The ALD adopted the Curriculum Guidelines and Standards for Dental Laser Education (3) and maintains the training and certification programs ready to help you achieve the status of LSO. Many have already been certified in the ALD's 11 years of existence, including my two dental assistants whom I rely on daily to provide the functions of LSO. It's not easy. The certification program is the same as for the dentist except for simulating treatment with the laser device. There is even an Advanced LSO certificate. If this sounds like something interesting, read on. I'll give you the basics on Laser Fundamentals, Types of Lasers, Laser Tissue Interaction as well as Laser Safety. Learn even more by contacting the ALD at www.laserdentistry.org or call 954-346-3776. They will give you information on ALD's Recognized Course Providers who can train you during the year or at the ALD's Annual Meeting in New Orleans April 3-6, 2005.

Laser Fundamentals

Laser is an acronym for Light Amplification by Stimulated Emission of Radiation. The word "radiation" in the acronym does not refer to ionizing radiation, as produced by X-rays but to thermal radiation. Thermal radiation is nonionizing, nonmutanigenic and doesn't require monitoring devices. Basically, laser light is a focused beam of intense, single colored light that does not disperse and is uniformly absorbed with minimal loss of energy.

Types of Lasers

Lasers are characterized by the type of material used to produce the laser light, also called the lasing material. For example, the C[O.sub.2] laser produces laser light by exciting atoms of carbon dioxide gas. Er:YAG lasers produce energy by exciting the Erbium (Er) atoms in a crystal of Yttrium, Aluminum and Garnet, abbreviated as YAG. Lasing materials can be crystals, gases or semiconductor (diode) materials, each determining a unique wavelength or color of light emitted from the laser. The wavelength of each lasing material is unique and is described in terms of nanometers (nm) or one-billionth of a meter from the visible (400nm-700nm) to the invisible infrared (700-10,000nm).

Laser Tissue Interaction

It is the wavelength of the laser light that determines the nature of the interaction with different biologic tissues. When the light strikes tissue it is either: transmitted, scattered, reflected or absorbed. Absorption determines if tissue is cut, coagulated, or vaporized. The energy or power of the laser light, expressed in watts, determines the effect on tissue. Therefore, the type of laser, its power and the absorptive characteristics of the target tissue determine the clinical result. The search for optimum clinical results is the reason why so many different lasers exist and why no one wavelength can provide therapeutic results for all tissue types.

Laser Safety

Before installing a laser device, a laser safety program should be established according to the ANSI Z136.3 standard: (4) the program must be outlined in written policies, procedures for training, laser use, maintenance and service. This program is centered on the manufacturer's safe operation instructions that incorporate recommendations for training, maintenance and safe use. A designated laser safety officer (LSO) is appointed to supervise this program. The dentist may designate her/himself or any member of the dental team to be the LSO. Currently, there is no national certification requirement for LSO. However, the Academy of Laser Dentistry has a certification program designed for the LSO in both the Standard and Advanced Proficiency. The ALD recognizes dental assistants as one of the appropriate members of the dental team to be able to obtain LSO status.

Laser Safety Officer Responsibilities

Safety is everyone's concern. Dentists and hygienists using lasers must be familiar with the manufacturer's safe operating procedures. However, the person designated as the LSO retains responsibility for being familiar with all laser systems in use in the facility. The LSO is also responsible for evaluating treatment areas, recommending and approving personal protection equipment (primarily safety glasses), posting warning signs, implementing standard operating procedures, supervising training of staff, laser maintenance and calibration, incident reporting and maintaining documentation according to OSHA and ANSI.

Summary

In closing, the LSO is a vital role for dental assistants and one that will expand as laser use increases. The Academy of Laser Dentistry (ALD) is your source and resource for information and certification in order to garner this status. Together with the ALD, dental assistants will have the knowledge and skills to implement a successful laser program within individual practices. The members of your profession must not lose this opportunity to further their education. Laser dentistry is gaining acceptance because of the benefits not only to the practice but to patients. Dental assistants can and should provide this vital role in the safe and effective delivery of this technology so that the best care is delivered.

References

(1.) American National Standard for Safe Use of Lasers. ANSI Z136.1-1993. Orlando: Laser Institute of America; 1993.

(2.) Trokel S. LIA Guide to Medical Laser Safety, ibid; 1997.

(3.) White JM. Curriculum guidelines and standards for dental laser education. In Featherstone JDB, Rechmann P, Fried D (eds): Lasers in Dentistry V. San Jose, CA. Proceedings SPIE 3593. Bellington, WA, International Society for Optical Engineering, 1999:110-22.

(4.) American National Standard for the Safe Use of Lasers in Health Care Facilities. ANSI Z136.3-1996. Orlando: Laser Institute of America; 1996.

Dr. Janet Hatcher Rice is an author, lecturer and laser enthusiast who practices Laser and Cosmetic Dentistry in Bristol, Tennessee. A graduate of the Medical College of Virginia, Janet is the current President of the Academy of Laser Dentistry and is a Past President of the American Association of Women Dentists. She was a dental assistant early in her career and is excited about the role assistants can play in promoting the safe use of laser technology.