An assignment for DH Theory 1 was to create an annotated bibliography for a research topic of our choice. This project was designed to challenge our critical thinking and decision making skills. I chose to research dental lasers and their effectiveness in the removal of oral lesions. It was interesting to compare different literature on this subject, and I had a lot of fun determining what articles were valid based on the evidence provided.

1. DENTAL LASERS
Kalvin Smith
DH Theory I
March 4, 2019

2. THE SITUATION
A 48-year-old patient presents in your dental office with a benign
oral lesion. She has scheduled an appointment with an oral surgeon
to have the lesion surgically removed. She mentions to you that she
read an article on Facebook about dental lasers being used to remove
lesions like hers. The patient is curious if she should stick with her
plan to have her lesion surgically removed or if making an
appointment for laser removal would be better.

3. PICO QUESTION
For adult patients, are dental lasers more effective than traditional
methods for the removal of oral lesions?

4. THE RESEARCH
PROCESS
Finding and Evaluating Sources

5. SOURCE 1- THE MATERIAL
Asnaashari, M., & Zadsirjan, S. (2014). Application of laser in oral surgery. Journal of
lasers in medical sciences, 5(3), 97-107.
oResearch Type: Randomized clinical trials
oSample sizes in these trials ranged from 20 to 148 patients meeting the necessary
criteria
oCollected data was used to test the efficacy of lasers in the removal of oral mucosa
lesions, oral benign lesions, and oral cancer.
oFindings:
oCO2 and diode lasers prove effective in the treatment and/or removal of oral
mucosa lesions, such as lichen planus and oral leukoplakia, with “minimal pain and
swelling compared to a ‘cold knife,’ or scalpel” (Asnaashari & Zadsirjan, 2014).
oAs for benign oral lesions, the authors found that lasers were effective at removing
mucoceles with a quick recovery time and no relapse.
oThe authors concluded that lasers are an efficient therapeutic treatment option for
oral cancer.

6. SOURCE 1- THE
EVALUATION
oWas the PICO question answered? Yes
oThe trials conducted found that lasers are effective and result
in a quicker, less painful recovery time than traditional
methods of lesion removal, such as a scalpel.
oValidity of Research
oThe research process began with small case reports,
progressed to clinical studies, and finally moved to
randomized clinical trials.
oThe research is far from over, but these findings prove that
lasers are becoming more commonplace and have been
effective in oral lesion removal.
oPresent to Patient?
oThis is article is easy to read and provides lots of good
information about dental lasers vs. scalpels. I would
definitely reference this article when answering my patient’s
question.

7. SOURCE 2- THE MATERIAL
Gabrić et al. (2015). Comparison between Diode Laser and Conventional Technique
for Soft Tissue Oral Surgery. Research Journal of Pharmaceutical, Biological and
Chemical Sciences. 6. 1913.
oResearch Type: Control study
oIncluded 29 participants with oral fibromas
o Study group: 5 men and 11 women (average age of 44) treated with diode lasers
o Control group: 6 men and 7 women (average age of 45) treated with a conventional scalpel
oCompared the results of dental lasers and scalpels for the removal of oral lesions
oFindings:
oPatients in the ”laser” study group had significantly less bleeding and swelling, as
well as less pain and a higher satisfaction rate with their procedure than those in
the “scalpel” control group.
oThe authors conclusion: “Based on the results of our and other authors’ studies we
might conclude that high power diode lasers should be employed in everyday oral
surgical procedures due to coagulation effect, sterilization of the surgical site,
minimal or no swelling and significantly reduced postoperative pain” (Gabrić et al,
2015).

8. SOURCE 2- THE
EVALUATION
oWas the PICO question answered? Yes
oThe authors concluded that dental lasers
can and should be used for the removal of
oral lesions due to the many benefits they
provide over traditional scalpels, such as
less pain and bleeding.
oValidity of Research
oThe authors should continue their research
with new groups, as the group sizes used
are relatively small.
oPresent to Patient?
oI would show this journal article to my
patient because it includes input from the
patients involved in the study. There is a
great comparison of scalpels and lasers in
the article that would support the PICO
question I am asking.

9. SOURCE 3- THE MATERIAL
Miyasaki, M. (2017). How to improve patient care with laser dentistry. Modern Dental
Network. Retrieved from
http://www.dentalproductsreport.com/dental/article/how-improve-patient-care-
laser-dentistry?page=0,2
oResearch Type: Case report
oThe author discussed his own experiences using lasers to remove oral lesions from
individual patients.
oFindings:
oThe author discussed the simplicity of diode lasers to remove a “benign growth of
hyperplastic tissue due to irritation from a removable partial denture’ (Miyasaki,
2017).
oThe benefits of dental lasers listed in this article center more around how lasers
would improve an office rather than how the lasers can benefit patients with oral
lesions.

10. SOURCE 3- THE EVALUATION
oWas the PICO question answered? No
oThe author never discussed traditional methods of oral lesion removal and failed to
provide enough research to support his beliefs about the efficacy dental lasers.
oValidity of Research
oThis article has no validity, in fact, it could be considered more of an opinion piece
than a case report.
oEven though this article was found on Ebscohost, it seems like something that could
be found while scrolling through Facebook.
oPresent to Patient?
oI would not use the information provided by this article to answer my patient’s
question, as there is not enough research in it to confirm or deny the effectiveness
of dental lasers over scalpels.

11. SOURCE 4- THE MATERIAL
Munisekhar et al. (2011). Conventional scalpel vs laser biopsy. Jaypee Journals.
Retrieved from
http://www.jaypeejournals.com/eJournals/ShowText.aspx?ID=1996&Type=FREE&
TYP=TOP&IN=_eJournals/images/JPLOGO.gif&IID=168&isPDF=YES
oResearch Type: Pilot study- a small scale preliminary study
conducted in order to evaluate the feasibility, time, cost, and the
design of future research.
oThis study was “carried out to evaluate the effect of lasers on the peripheral
architecture of the suspected oral lesions” (Munisekhar et al, 2011).
oFindings:
oThe authors listed the pros of dental lasers over scalpels to be less bleeding,
reduced risk of infection, minimizing the need for suturing, and less pain.
oThe one downside of dental lasers, according to the authors, is that lasers bring the
risk of irreversible damage caused to oral tissues due to heat.

12. SLIDE 4- THE EVALUATION
oWas the PICO question answered? Not completely
oWhile the authors believe dental lasers may be the future of oral lesion removal, the
research provided in this article is not enough to prove or disprove the
effectiveness of dental lasers over traditional methods.
oValidity of Research
oThe authors of this article are quick to point out that their current research is not
enough to validate the effectiveness of dental lasers over traditional scalpels.
oA case study with a larger sample size is in the works for the authors, as they hope
to solidify their research.
oPresent to Patient?
oThis is the first article I have found that discussed any risks associated with dental
lasers. For this reason, I would show this article to my patient. However, I would
stress the fact that the research in this article is in the beginning stages, so the
validity could still be in question.

13. SOURCE 5- THE
MATERIALOrtega-Concepción, D., Cano-Durán, J. A., Peña-Cardelles, J. F.,
Paredes-Rodríguez, V. M., González-Serrano, J., & López-
Quiles, J. (2017). The application of diode laser in the treatment
of oral soft tissues lesions. A literature review. Journal of
clinical and experimental dentistry, 9(7), e925-e928.
doi:10.4317/jced.53795
oResearch Type: Meta-analysis
oA literature review of articles published in
PubMed/MEDLINE, Scopus, and the Cochrane
Library databases between 2007 and 2017 was
performed, specifically for the use of diode lasers
for oral lesion removal.
oFindings:
o“The diode laser is a minimally invasive technology
that offers great advantages, superior to those of
the conventional scalpel, such as reduction of
bleeding, inflammation and the lower probability
of scars” (Ortega-Concepción et al, 2017).
oThe authors also found that the application of
diode lasers in the soft tissues is a safe and
effective method for the removal of lesions like
fibromas and epulis fissuratum, as well as the
accomplishment of frenectomies.

14. SOURCE 5- THE EVALUATION
oWas the PICO question answered? Yes
oThe conclusion determined by the authors is that dental diode lasers are “an
effective and predictable method when performing surgeries in oral soft tissues, are
clearly superior to the conventional scalpel, and have numerous advantages over
other types of lasers” (Ortega-Concepción et al, 2017).
oValidity of Research
oThe research provided in this article presents as valid because multiple studies,
mainly controlled studies and double blind studies, found dental lasers to be
effective.
oI also believe in the validity of this article because meta-analyses are at the top of
the EBDM pyramid.
oPresent to Patient?
oI would certainly show this article to my patient because it is full of vocabulary
words my patient will need to know regarding oral lesion removal via dental lasers.
The studies combined in this meta-analysis compare the pros and cons of lasers
and scalpels, which is exactly what my patient wants to know.

15. SOURCE 6- THE MATERIAL
Pang et al. (2010). Laser Energy in Oral Soft Tissue Applications. Academy of Laser
Dentistry. 18(3):123-131. Retrieved from
https://www.laserdentistry.org/uploads/files/members/jld/JLD_20_2/JLD_20_2_P
ositionPaper_Soft_Tissue_Applications.pdf
oResearch Type: Case series and Animal study
oThe authors compared the risks and benefits of lasers for the removal of oral soft
tissue lesions.
oThe animal used in the animal study was a beagle dog.
oFindings:
oThe benefits of dental lasers found by the authors include: minimally invasive,
improved hemostasis, reduced bacteremia, and less pain, including without local
anesthesia.
oThe one risk recognized in this article was the heat put off by the laser, which
comes in at approximately 100C. “If the laser is allowed to get any higher than this
temperature, irreparable damage can occur to the tissues” (Pang et al, 2010).

16. SOURCE 6- THE
EVALUATION
oWas the PICO question answered? No
o The authors of this article never mention
traditional methods of oral lesion removal,
which is half of the PICO question.
oValidity of Research
o The research provided in this article has yet to
be proven valid because only a small case
series and animal study have been conducted.
o There is a long way for these authors to go
before their research will be found valid or
invalid.
oPresent to Patient?
o I would not show this article to my patient
because there is no mention of traditional
methods of oral lesion removal, such as
scalpels.
o If the PICO question is not answered, this
article does not benefit my patient.
Lasers or
scalpels?

17. SOURCE 7- THE MATERIAL
Prabha, C., & Shreshtha, S. M. (2017). An insight into Lasers in Periodontics: A Review.
International Journal of Community Health & Medical Research, 3(1), 59–65.
https://doi.org/10.21276/ijchmr.2017.3.1.13
oResearch Type: Case report
oThe authors compared dental lasers to conventional scalpels for the removal of oral
lesions on soft and hard tissues in the oral cavity.
oFindings:
oAccording to the authors, “Compared with the use of a conventional scalpel, lasers
can cut and reshape the oral soft tissue more easily, with no or minimal bleeding
and little pain as well as no or only a few sutures, thus being a viable alternative”
(Prabha & Shreshtha, 2017).
oDental lasers have been found to be a viable alternative to lesion destruction,
incisional and excisional biopsies of both benign and malignant lesions, irradiation
of aphthous ulcers, coagulation of free gingival graft donor site, and gingival
depigmentation.

18. SOURCE 7- THE EVALUATION
oWas the PICO question answered? Yes
oThe authors compared scalpels to dental lasers and found that dental lasers result
in less bleeding and pain, as well as more ease in the removal process than
traditional scalpels.
oValidity of Research
oI would consider this source to be valid, however, more research needs to be done
to verify the authors’ current findings.
oLarger test groups need to used in order to move up the EBDM pyramid.
oPresent to Patient?
oI would present this article to my patient because the PICO question was answered,
and the article describes the different types of lasers used in dentistry in detail. I
feel like my patient would genuinely learn something from this work.

19. SOURCE 8- THE MATERIAL
Verma, S. K., Maheshwari, S., Singh, R. K., & Chaudhari, P. K. (2012). Laser in
dentistry: An innovative tool in modern dental practice. National journal of
maxillofacial surgery, 3(2), 124-32.
oResearch type: Randomized double blind study
oStudy group consisted of 64 patients that were re-evaluated 7 days after their oral
lesions were removed.
oThe objective of this study was to compare dental lasers and scalpels in the removal
of oral lesions.
oFindings:
oPositive results were found for the removal of soft tissues lesions, such as aphthous
ulcers, herpetic lesions, and even squamous cell carcinoma.
oThese results included less pain and a faster recovery time than what is typically
found with surgical (scalpel) removal of these lesions.

20. SOURCE 8- THE EVALUATION
oWas the PICO question answered? Yes
oThe authors concluded that dental lasers result in less pain and a faster recovery
than scalpels, making them more effective.
oValidity of Research
oCompleting a randomized double blind study suggests that many other studies
have been done to lead the authors of this article to a higher point on the EBDM
pyramid.
oFor this reason, I would determine the information put forth in this article to be
valid, however, more research should be completed to confirm the validity without
any doubt.
oPresent to Patient?
oThe PICO question has been answered, so I would present the information in the
article to my patient.

21. CAN THE PATIENT’S
QUESTION BE
ANSWERED?
Using the Research in Practice

22. RESEARCH IN PRACTICE
oThe majority of the peer-reviewed articles I found are still in the
beginning stages of research. I can provide the patient with the
information I have collected, but an exact yes or no answer cannot be
given at this time.
oI began the research process with an open mind, as I did not have an
opinion on dental lasers. The sources I found have lead me to the
belief that dental lasers are an effective method of oral lesion
removal, however, I have yet to determine if they are more effective
than traditional methods.
oI will continue to follow the research on this topic as it progresses.

23. ANNOTATED BIBLIOGRAPHY
Asnaashari, M., & Zadsirjan, S. (2014). Application of laser in oral surgery. Journal of lasers in medical sciences,
5(3), 97-107.
The authors of this article collected data from randomized clinical trials to test the efficacy of lasers in the
removal of oral mucosa lesions, oral benign lesions, and oral cancer. They found that CO2 and diode lasers
prove effective in the treatment and/or removal of oral mucosa lesions, such as lichen planus and oral
leukoplakia, with minimal pain and swelling compared to a “cold knife” (scalpel). As for benign oral lesions,
the authors found that lasers were effective at removing mucoceles with a quick recovery time and no relapse.
Finally, the authors concluded that lasers are an efficient therapeutic option for the treatment of oral cancer.
Gabrić et al. (2015). Comparison between Diode Laser and Conventional Technique for Soft Tissue Oral
Surgery. Research Journal of Pharmaceutical, Biological and Chemical Sciences. 6. 1913.
The authors of this case control study compared the results of dental lasers and scalpels for the removal of
oral lesions. They reported that diode lasers tend to lessen the degree of inflammation after the removal of a
lesion more than scalpels. It was also reported that scalpels tend to leave more damage to the tissues than
lasers.
Miyasaki, M. (2017). How to improve patient care with laser dentistry. Modern Dental Network. Retrieved from
http://www.dentalproductsreport.com/dental/article/how-improve-patient-care-laser-
dentistry?page=0,2
The author of this case report discussed his own experiences using lasers to remove oral lesions. I would not
use this article alone to complete my research on this topic. He spoke of using the laser to remove a benign
growth a patient’s mandible. He discussed the efficacy of the laser in the removal of the lesion and the quick
recovery time.

24. ANNOTATED BIBLIOGRAPHY CONT.
Munisekhar et al. (2011). Conventional scalpel vs laser biopsy. Jaypee Journals. Retrieved from
http://www.jaypeejournals.com/eJournals/ShowText.aspx?ID=1996&Type=FREE&TYP=TOP&IN=_eJournals/images
/JPLOGO.gif&IID=168&isPDF=YES
The authors of this control study reviewed the uses of lasers and scalpels in dentistry and oral surgery and compared
the risks and benefits of using dental lasers. The authors found that the biggest risk of lasers is the irreversible damage
caused to oral tissues due to the heat of the lasers. The advantages, found by the authors, of lasers over scalpels are
less bleeding, reduced risk of infection, minimizing the need for suturing, and less pain. The authors also determined
that of all of the types of dental lasers, the CO2 laser is the “best” for oral soft tissues, followed by the commonly used
diode laser.
Ortega-Concepción, D., Cano-Durán, J. A., Peña-Cardelles, J. F., Paredes-Rodríguez, V. M., González-Serrano, J., &
López-Quiles, J. (2017). The application of diode laser in the treatment of oral soft tissues lesions. A literature
review. Journal of clinical and experimental dentistry, 9(7), e925-e928. doi:10.4317/jced.53795
The authors of this article created a meta-analysis to discuss multiple studies, conducted between 2007 and 2017, on
the usage of diode lasers, the most commonly used lasers in dentistry, for the removal of oral lesions. All the articles
found the diode laser to be effective in the elimination of lesions in the oral soft tissues. According to the authors’
findings, diode laser offers numerous advantages compared to the conventional scalpel, such as a lower intraoperative
bleeding, a lower swelling of the area, better coagulation and scarring, no need of suture, reduction of surgical time and
lesser degree of postsurgical pain. In addition, the laser instantly disinfects the surgical wound.

25. ANNOTATED BIBLIOGRAPHY CONT.
Pang et al. (2010). Laser Energy in Oral Soft Tissue Applications. Academy of Laser Dentistry. 18(3):123-131.
Retrieved from
https://www.laserdentistry.org/uploads/files/members/jld/JLD_20_2/JLD_20_2_PositionPaper_Soft_Tissue_A
pplications.pdf
The authors of this case series compared the risks and benefits of lasers for the removal of oral soft tissue lesions.
The benefits found by the authors reflect those found by the authors of other articles in this list, such as minimally
invasive, improved hemostasis, reduced bacteremia, and less pain. The biggest risk, again, was the heat put off by
the laser, which comes in at approximately 100C. If the laser is allowed to get any higher than this temperature,
irreparable damage can occur to the tissues.
Prabha, C., & Shreshtha, S. M. (2017). An insight into Lasers in Periodontics: A Review. International Journal of
Community Health & Medical Research, 3(1), 59–65. https://doi.org/10.21276/ijchmr.2017.3.1.13
The authors of this case report compared dental lasers to scalpels. Compared with the use of a conventional
scalpel, lasers can cut and reshape the oral soft tissue more easily, with no or minimal bleeding and little pain as
well as no or only a few sutures, thus being a viable alternative. Laser surgery occasionally requires no local
anesthetic, or only a topical anesthetic. According to the authors, it is viable alternative to various soft tissue
procedures such as frenectomy, gingivectomy and gingivoplasty, de-epithelization of reflected periodontal flaps,
removal of granulation tissue, second stage exposure of dental implants, lesion ablation, incisional and excisional
biopsies of both benign and malignant lesions, irradiation of aphthous ulcers, coagulation of free gingival graft
donor site, and gingival depigmentation.
Verma, S. K., Maheshwari, S., Singh, R. K., & Chaudhari, P. K. (2012). Laser in dentistry: An innovative tool in
modern dental practice. National journal of maxillofacial surgery, 3(2), 124-32.
The authors of this article begin by defining the different types of lasers that are available for use in dentistry, such
as CO lasers, Nd: YAG lasers, erbium lasers, and diode lasers. They then discussed the use of the lasers in the