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Dr. Jean Furuyama uses dental laser on Mollie Kissner. Photo -Neil Samson Katz

Like other doctors, most dentists crave to be loved by their patients. But with the screeching drills, painful tooth gougers and elongated needles, patients have never visited the dental office in exactly a positive frame of mind. Now, new laser technologies are aiming to replace the scary utensils with a mostly painless ray of light for many common procedures like fillings and root canals. The lasers operate by stirring up water molecules, causing them to form microscopic explosions. When applied to gums, teeth and cavities, the explosions vaporize the area, acting like a drill or a knife. The laser also stimulates the blood, a process that has a cauterizing effect, which makes healing faster and the process cleaner.

Mollie Kissner, a 91-year-old Manhattan resident, sees the laser technology as a vast improvement over the drilling and gouging when it comes to excavating cavities. "The drilling. Oh, how I hated the drilling," she said. "I took it for granted that it had to be done. You had to suffer through it."

These days Kissner chooses to have her cavities fixed with a laser. Her dentist, Dr. Jean Furuyama, was one of the first to use dental lasers in New York.

On a recent visit, Furuyama eased Kissner into a chair and fit her with protective glasses big enough for Elton John, since stray laser light can damage the eyes. She packed Kissner's mouth with cotton swabs and applied topical anesthetic. Then she swiped the laser wand back and forth, above the surface of her tooth, and cleaned out the cavity, which is work typically done by a drill.

Other than hearing a loud knocking sound when the laser was turned on, Kissner could feel nothing happening during the five-minute procedure. "Are you drilling the right tooth," she joked with Furuyama.

Most surprisingly, applying the laser numbed the tooth for several minutes allowing Furuyama to finish the procedure with a traditional drill, which is faster than the laser. At no point was Kissner injected with an anesthetic.

"If I had to have drilling, my fists would be clenched in pain," said Kissner. "Now I can walk around without feeling anything. I don't have to go home and suffer through the pains you have to go through with drilling."

While lasers are typically portrayed in Hollywood as deadly ray guns or planet-saving transmitters, the medical field has transformed a low-powered variety into highly accurate surgical tools.

Dental lasers were introduced in 1991 for use on gums, but the first models performed poorly. Since then, the sophistication, variety and application of the technology has grown. Today, they are being used for everything from cleaning out cavities and root canals to reshaping gums and whitening teeth.

Dentists are quick to point out that lasers will never completely eliminate the need to drill or inject anesthetic to numb an area of the mouth. Some procedures just take too long with lasers, and many dentists still feel more comfortable performing involved procedures, like root canals, with traditional tools. Lasers are also not usually used to remove metal fillings, since they can heat up the metal to painful temperatures.

The big surprise is that, despite what seem to be obvious advantages, only a small percentage of dentists are using the technology. The Academy of Laser Dentistry has seen membership double in the last five years. But that makes for only 1,100 members out of the nearly 130,000 dentists in the country.

"The dental community is conservative in its approach to change," said Gail Siminovsky, executive director of the academy. "Many aren't convinced yet, and some lasers are quite costly."

Indeed, at $15,000 for simple models and $60,000 for the most advanced, the machines are not priced to move. By comparison, a traditional drill costs $500. The high price may keep the technology away from dentists that serve lower-income communities for some time. "Low-income patients or those seen in community health clinics are the least likely to benefit from new technology," said Dr. Amid Ismail, who studies economic access to dental care at the University of Michigan's School of Dentistry.

Medicaid does not pay more for procedures done with lasers. "They keep chopping the costs down," said Dr. Daniel Delcastillo, a dentist in Miami whose office handles over 5,000 patients each year. "It's forcing dentists to do high volume, and I don't think that equipment is for high volume."

Some dentists charge more for laser procedures, although the Academy of Laser Dentistry advises against that. Many doctors forego extra fees in the hope of bringing in new patients instead. "If it can do 50 percent of what I keep reading about, it's going to make my job a lot more interesting," said Elliot Rogoff, a dentist in Millburn, N.J., who recently purchased a high-end laser system. "I think the generation coming up will not know from the needles or the drill."

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