Laser Safety Officer: Seize the Opportunity

Laser Safety Officer: Seize the Opportunity
November 2006
Janet Hatcher Rice, DDS
Contemporary Dental Assisting

The Role of the lso is Paramount for Incorporating Technology Safely and Effectively. by Achieving lso Status, Dental Assistants can be a Valuable Asset to the Practice.

Abstract
Lasers are becoming the instrument of choice for many dental procedures. As dentists incorporate this new technology, dental assistants need to be educated to seize the opportunity of being designated the workplace laser safety officer (LSO). The role of the LSO is paramount for incorporating technology safely and effectively. By achieving LSO status, dental assistants can be a valuable asset to the practice.

Learning Objectives
After reading this article, the reader should be able to:
Ô understand that lasers are named for the active medium inside the device.
Ô explain basic information on laser fundamentals.
Ô describe how lasers achieve their effects on tissue.
Ô identify safety precautions recommended by the American National Standards Institute.
Ô recognize the potential hazards in using lasers and the LSO's authority to monitor, evaluate, and enforce the controls of laser hazards.

Laser is light, and "LASER" is the acronym for Light Amplification by Stimulated Emission of Radiation. White light consists of all different wavelengths or colors traveling in different directions. Laser light is light of 1 color, monochromatic, hence 1 wavelength. This wavelength is made to travel in 1 direction. Each laser device has a unique wavelength described in nanometers (nm). Stimulated emission occurs when an atom that has absorbed a quantum or photon of energy and is in an excited state is made to release the photon, and the re?leased photon and the excited photon stimulate 2 or more excited atoms, thus producing a chain reaction. This photon chain reaction produces a brief, intense flash of light to form a laser light beam.1 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 (does not disturb DNA), and doesn't require monitoring devices. Patient contraindications can exist, which should be evaluated before laser use, but pregnancy would not be one. Simply put, laser light is a focused beam of intense, single-colored light, which does not disperse and is uniformly absorbed with minimal loss of energy.

Types of Lasers
Laser devices are named for the type of core material (atoms, elements, or compounds) used to produce the laser light, called the "active medium." For example, the CO2 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
The active medium exists as a crystal, gas, or semiconductor (diode) material. Each emits a unique wavelength or color of light from the laser. The unique wavelength of each lasing material is described in nm, which are one-billionth of a meter, from the visible (400 nm to700 nm) to the invisible infrared (700 nm to 10,000 nm).2

Laser Tissue Interaction
Many factors contribute to the effect laser light has on biologic tissues. The wavelength, the power of the laser device, the beam diameter, the time the beam is left on the tissue, and the properties of the target tissue are some of the factors that determine the nature of the interaction with different biological tissues. When the laser light strikes tissue, it is either transmitted, scattered, reflected, or absorbed. Absorption of the light into tissue is what is desired. The wavelength determines absorption of certain components of the target tissue, such as water content or hemoglobin. This absorption determines if targeted tissue is heated until it coagulates, or vaporizes. Besides heating the target tissue with laser light, called photothermal effect, laser light can affect teeth and bone by producing a shock wave or photoacoustic effect that explodes the tissues, creating a crater.3 Therefore, the type of laser device, and the absorptive characteristics of the target tissue will determine the clinical result. The search for optimum clinical results is the reason why many different laser devices exist and why no single 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 American National Standards Institute (ANSI).4 ANSI is a nongovernmental organization that provides guidance for the safe use of laser and laser systems by defining control measures. The Laser Institute of America (LIA) serves as the publisher of primary documents regarding laser safety, including the nationally recognized series called the American Na?tional Standards for the Safe Use of Lasers (ANSI Z136.3). Document Z136.3 states: "It is imperative that health care facilities using lasers obtain and apply this standard as an integral part of their safety program." It further states that there shall be a designated Laser Safety Officer (LSO) available for all circumstances of operations of a laser.5

These documents provide a thorough set of guidelines for implementing a safe laser program. Basic guidelines according to both the Occupational Safety and Health Administration (OSHA) and ANSI are available. How?ever, the LIA offers a wide array of products and services, including training, training videos, and warning signs as well as the documents. OSHA is concerned primarily with ensuring worker safety. Laser installations are subject to OSHA review; and the LSOs, documentation, protocols, and staff training are required.6 The OSHA Instruction Publication Guidelines for Laser Safety and Hazard Assessment lists 4 basic categories of controls: engineering controls, administrative controls, protective equipment, and special controls based on ANSI recommendations.

Engineering controls center on the manufacturer's particular mechanisms inherent in each device, such as on/off switches with key or computer code, protective housing, flashing light when in operation, emergency cut off, and protective foot pedal.

Administrative controls include designating an LSO to supervise this program and writing standard operating procedures. Administrative duties also include posting warning signs, providing protective devices, and educating and training others. The dentist or any member of the dental team may be the designated LSO.

Protective equipment for personnel includes eyewear, clothing, masks, and glasses; and may include screens or curtains.

Special controls can include maintenance and repair, fire, or explosion.

Safety is everyone's concern. Dentists and hygienists using lasers must be familiar with the manufacturer's safe operating procedures, which must be included with the laser device. The designated LSO is responsible for:
Ô being familiar with all of the office's laser systems and their proper use,
Ô monitoring and enforcing the control of laser hazards,
Ô evaluating the treatment environment,
Ô recommending and approving personal protection equipment, such as safety glasses (Figure 1),
Ô posting warning signs (Figure 2),
Ô implementing standard operating procedures,
Ô supervising training of staff,
Ô maintaining and sterilizing the laser delivery components (Figure 3),
Ô reporting incidents, and
Ô maintaining documentation according to OSHA and ANSI.

The 2 most important issues of safety are the use of laser glasses and high volume evacuation. Laser safety glasses for the provider, assistant, and patient are required whenever the laser is in use. Laser safety glasses must have side shields, be the appropriate optical density, and specifically filter the wavelength being used. High volume evacuation removes the potentionally hazardous smoke plume from the immediate operating site as the smoke plume can still contain live virus. High volume evacuation also cools the site, which provides an extra advantage.

Laser Safety Officer
The dental assistant can be the leader in laser safety for the office. The dentist will spend much time on continuing education and many dollars for laser equipment. As the trained LSO, the dental assistant can help ensure successful implementation primarily by overseeing safety, but also by understanding the technology, training staff, and educating patients. With proper training, the dental assistant should be poised to deliver this unique service within the dental workplace. LSO status can be placed on the dental assistant's resume, thereby increasing his or her responsibilities and potentially increasing remuneration.

Currently, no national certification is required for an LSO. However, the Academy of Laser Dentistry (ALD) provides a certification program designed for the dental LSO in both the Standard and Advanced Proficiency. Standard Proficiency consists of a 75-question test and a hands-on practical that allows for prompting by the testing personnel. Advanced Proficiency is a 150-question test and a hands-on practical that does not allows for prompting by testing personnel during the hands-on test. The ALD recognizes the dental assistant as one of the appropriate members of the dental team to obtain LSO status. The ALD adopted the "Curriculum Guidelines and Standards for Dental Laser Education"7 and maintains training and certification programs to help you achieve the status of Standard or Advanced Certified LSO. The certification program is not easy. In fact, it is the same program the dentist takes for his or her Advanced or Standard Profici?encies except the dentist must simulate treatment with the laser device. Because dental assistants are not licensed to use lasers in clinical treatment (except for bleaching, detecting caries, and other nonablative procedures in some states), they are not required to simulate treatment. The LIA primarily trains medical personnel; only the ALD specifically trains dental LSOs. However, the ALD's certification program is recognized by LIA.

Conclusion
The LSO is a vital role for dental assistants and one that will expand as laser use increases. Together with the LIA, ALD, ANSI, and OSHA, dental assistants can develop the knowledge and skills to help implement a successful laser program within individual dental practices. This article hopefully peaked your interest and provided some insight into the intriguing world of lasers. With laser dentistry gaining acceptance in all areas of dentistry because of its benefits to practices and patients, dental assistants must seize the opportunity to further their education.