TABLE 1

	Lower	Upper
Disinfectant	limit	Limit	Typical

Chlorine dioxide	0.099%	0.9%
Stable chorine dioxide
Sodium chlorite
Hydrogen peroxide	0.1%	30%	4.6%
Alkaline peroxides	0.1%	30%	4.6%
Providone iodine	0.1%	15%
Peracetic acid	0.05%	6%	0.08%, 4.5%
Acetic acid	0.01%	10%	6.5%
Chlorite	0.1%	2%	0.4%-0.6%
Sodium hypochlorite	0.1%	5%
Hypochlorous acid	0.01%	0.1%
Sodium chlorate	0.0002%	0.002%
Bio-compatible	0	25%
alcohol
Citric acid	1%	75%
Chlorohexidine	0.05%	20%
gluconate
Silver ions	0.9mg	2 mg
Fluoride ions	0.15%	0.5%
Copper ions	*	*	*
Zinc ions	*	*	*

* Use in quantities recommended as acceptable by the Environmental Protection Agency (EPA)

When used, for example, during procedures, item concentrations (by volume) may be chosen as listed in Table 2.

TABLE 2

	Lower	Upper
Disinfectant	Limit	Limit	Example

Chlorine dioxide	0.001%	0.099%
Stable chorine dioxide
Sodium chlorite
Hypochlorous acid	0.0001%	0.009%
Silver nitrate	0	0.6%
Eucalyptol	0	0.9%
Menthol	0	0.5%
Thymol	0	0.7%
Bio-compatible alcohol	0	12%
Chlorohexidine gluconate	.05%	20%	0.12%
Silver ions	0.0015 mg	0.9 mg
Fluoride ions	0.0001%	0.15%
Sodium fluoride	0.05% or	0.2% or
	225 ppm	990 ppm
Stannous fluoride	0.1% or	0.4% or
	244 ppm	1000 ppm
Copper ions	*	*	*
Zinc ions	*	*	*

* Use in quantities recommended as acceptable by the Environmental Protection Agency (EPA)

Regarding the exemplary concentrations set forth above, and in the context of any implementations described herein, wherein for example fluids having different fluid properties (e.g., quantities, compositions, or concentrations) are output by one or more of (a) the same fluid output at different times or (b) different fluid outputs at the same or different times, the different fluid properties may be achieved by way of operation of a controller (e.g.,controller125 of FIG.3) and/or by operation of a user, for example, switching between one or more fluid-conditioning canisters or cartridges.

According to a typical implementation, a first fluid conditioning cartridge may be coupled to a fluid (e.g., water) supply line using any means recognizable as suitable by those skilled in the art, to deliver a first conditioning agent, such as a disinfectant at an in-procedure concentration. The concentration provided by the first fluid conditioning cartridge to the fluid supply line may be altered using any means suitable for achieving such an effect, such as by operation of acontroller125 under the influence of a pre-programmed or real-time input. In other implementations, the concentration provided by the first fluid conditioning cartridge to the fluid supply line may be maintained substantially constant for so long as the first fluid conditioning cartridge remains connected to the fluid supply line, which can be only during a procedure or for the duration of a day, week, month, and the like.

A second fluid conditioning cartridge may be coupled to the fluid supply line using any means recognizable as suitable by those skilled in the art, to deliver a second conditioning agent, such as a disinfectant at a between-procedures concentration. For example, in one implementation the first fluid conditioning cartridge for delivering the first conditioning agent may be decoupled from a point on the fluid supply line and the second fluid conditioning cartridge (e.g., having a similar construction and/or connecting structure) may be coupled to the fluid supply line at the same point. In accordance with another implementation, the second fluid conditioning cartridge may be coupled to the first fluid conditioning cartridge or to the fluid supply line while the first fluid conditioning cartridge remains connected thereto. Operation of either one of the first fluid conditioning cartridge and the second fluid conditioning cartridge, or combinations of both, may be selected by operation of a controller, by manual action from a user, by pre-programming, by an input from a user, or by combinations thereof.

The concentration provided by the fluid conditioning cartridge to the fluid supply line may be altered using any means suitable for achieving variances in fluid concentrations, such as by operation of acontroller125 under the influence of a pre-programmed or real-time input. In other implementations, the concentration provided by the fluid conditioning cartridge to the fluid supply line may be maintained substantially constant for so long as the fluid conditioning cartridge remains connected to the fluid supply line, which can be only during a procedure or for the duration of a day, week, month, and the like.

One exemplary implementation may comprise a laser system with a first conditioning cartridge connected to, for example, a fluid (e.g., water) supply line for the deliverance of a first conditioning agent (e.g., an in-procedure concentration of disinfectant) during procedures throughout the day.

According to certain implementations, the first conditioning agent can be delivered throughout the day (e.g., continuously so that all fluid, such as water, that is drawn from the fluid supply line is conditioned) regardless of whether or not a given procedure or type of procedure is being performed. In other implementations, the first conditioning agent is delivered only during procedures or at selected (e.g., predetermined or real-time selected) times under the control of, for example, one or more of a past or present input, such as a user input, whereby, for example, the user can select a non-conditioned fluid (or a different concentration of fluid, or a fluid having one or more different properties) to be delivered at various times. At the end of the day (or at some other time, such as at the end of a procedure or the end of a week) a connected first fluid conditioning cartridge may be decoupled from the fluid supply line with a second conditioning cartridge being connected thereto instead for the deliverance of a second conditioning agent (e.g., a between-procedures concentration of disinfectant) for disinfecting equipment (e.g., the fluid supply line and/or other lines). A manual or automated disinfecting procedure may then be performed. At a subsequent point in time, such as the following morning, the second fluid conditioning cartridge may be replaced with the, or another, first fluid conditioning cartridge for the deliverance of the first conditioning agent. At any point following the disinfecting procedure, such as at any time prior to a procedure, the lines that were disinfected using the second fluid conditioning cartridge may be flushed or purged using, for example, a non-conditioned fluid or a fluid conditioned with the first conditioning agent.

For individuals with high risk for dental caries a higher percentage of sodium fluoride is recommended during procedures. For example, about 1.1% acidulated NaF (5000 ppm) or 1.1% neutral NaF (5000 ppm) can be used in certain embodiments. One or more of the concentrations listed in Tables 1 and 2 may be effective in certain embodiments for facilitating one or more of biofilm removal and viable count reduction of bacteria. In another embodiment an amount of stable chlorine dioxide or sodium chlorite during patient treatment may be between 5 ppm to 150 ppm. Between procedures as a purge the amount may be between 50 ppm to 1,200 ppm. Other ranges may include between 100 ppm to 150 ppm or more specifically between 10 ppm to 300 ppm. Chlorine dioxide may be released from a two component system. In this case a first component may be sodium chlorite, for example, and a second component may be an acid such as citric acid, ascorbic acid (e.g., vitamin C), phosphoric acid, carbonic acid, lactic acid as well as others.

The disinfectant (e.g., antibacterial or antiseptic agents) described herein may be applied, either intermittently or continuously, during, or at or near completion of a medical or dental procedure. Air and water used to cool and assist with tissue cutting or drilling within a mouth of a patient or at any other surgical site, for example, is often vaporized into the surrounding air to some degree. The air and water also may be projected onto a tissue target surface or onto adjacent instrumentation. According to the present invention, a conditioned disinfectant solution may also be vaporized with the air or water, and may condense onto surfaces of the tissue target or onto adjacent dental/medical instruments and equipment within a dental/surgical operating room. Any bacteria growth on these moist surfaces may thus be significantly attenuated as a result of a presence of the disinfectant on the surfaces. In accordance with another aspect, disinfectant (e.g., antibacterial or antiseptic agents), such as a liquid or solid dissolvable in liquid, may be applied (e.g., sprayed), for example, during procedures (continuously or intermittently) to decontaminate (e.g., provide an anti-microbial effect on or within) an area of interest (e.g., a patient's mouth or surgical site) and/or clean the air and/or water tubes. The disinfectant may comprise one or more of, for example, chlorine dioxide or stable chlorine dioxide (sodium chlorite plus acid) or any other disinfectants, antibacterial or antiseptic agents listed above or in combination with ions, such as silver, fluoride, copper, or zinc ions, equivalents thereof, and combinations thereof including bio-compatible base or carrier mediums (e.g., water and other surgical fluids). Other combinations may comprise a disinfectant (e.g., antibacterial or antiseptic agents) or medicament or flavor with one or more of the following substances: vitamin C (ascorbic acid), vitamin E, vitamin B₁(thiamin), B₂(riboflavin), B₃(niacin), B₅(pantothenic acid), B₆(pyridoxal, pyridoxamine, pyridoxine), B₁₂(cobalamine), biotin or B complex, bioflavonoids, folic acid, vitamin A, vitamin D, vitamin K, aloe vera, a natural anti-inflammatory, antioxidant or anti histamine remedy, and other such ingredients and solutions. In other embodiments, the disinfectant may comprise, for example, ions, such as silver, copper, or zinc ions, equivalents thereof, and combinations thereof, which may or may not include bio-compatible base or carrier mediums (e.g., water).

While, according to certain aspects of the present invention, the above-listed items can be used individually, other aspects of the present invention can comprise combinations of one or more of the above-listed items with or without disinfectant ions. Other embodiments may comprise combinations of two or more of the above-listed items, wherein such combinations may be formed with or without disinfectant ions. Concentrations of the above-listed items may be chosen as follows:

Chlorine dioxide (e.g., sodium chlorite plus acid), which may be desired as a disinfectant for its affordability and efficacy, may be used during the aforementioned procedures at adequate concentrations without adverse side effects. That is, chlorine dioxide is relatively nontoxic at low concentrations and so can be used during procedures as well as, for example, for purging lines between procedures. The chlorine dioxide can be combined with, for example, silver ions (see acceptable range above).

A hydrogen peroxide based solution for disinfecting may be used alone or in combination with other disinfectants. For example, hydrogen peroxide may be used in combination with peracetic acid (in concentrations ranging from about 0.05% to about 4%, e.g., 0.8% by volume when used between procedures) or acetic acid (in concentrations from about 0.01% to about 10% by volume when used between procedures) or in combination with silver ions (see acceptable range above).

Sodium hypochlorite can be combined with, for example, citric acid (1% to 75% by volume when used between procedures) and/or with disinfectant ions.

According to another feature of the present invention, when disinfectant is routed in fluid through lines during a medical procedure, the disinfectant stays with the fluid (e.g., water) or mist, as the water or mist becomes airborne and settles (i.e., condenses) on surrounding surfaces within the dental operating room. Bacteria growth within the lines, and from the condensation, is significantly attenuated, because the disinfectant kills, stops and/or retards bacteria growth inside the fluid (e.g., water) lines and/or on any moist surfaces.

The introduction of disinfectant, antibacterial or antiseptic ions, may be carried out for purposes including:

1) Disinfection of fluid lines, thereby reducing biofilm and/or keeping bacterial count low;

2) Decontamination (e.g., causing ions to act as an anti-microbial agents) of a tissue target that is being worked on (e.g., cut, ablated, or decontaminated) with, for example, a laser device prior to, during (continuously or intermittently) and/or at completion of a medical procedure, such as, for example, irrigation with fluids (gas or liquid) during a laser procedure;

3) Projection of disinfectant ions onto a surface of targeted tissue (hard or soft) thereby temporarily or permanently embedding the ions into the surface or deeper into tissue in order to decontaminate or treat the tissue. For example, ions such as fluorine ions may act long term as a anti-microbial agent or may perform other functions, such as caries prevention;

4) Application at completion of a surgical procedure as an anti-microbial agent before a wound is closed or covered with a restorative material; and

5) To project and cover material (e.g., hard or soft tissue) or to embed into material (e.g., hard or soft) compounds, ions or particles to coat or attach to such material (e.g., hard or soft tissue) through surface tension, adhesion, micromechanical retention and the like. Embedding may include simultaneously remodeling of hard or soft tissue as disclosed in U.S. application Ser. No. 11/033,032, filed Jan. 10, 2005 and entitled ELECTROMAGNETIC ENERGY DISTRIBUTIONS FOR ELECTROMAGNETICALLY INDUCED DISRUPTIVE CUTTING, wherein benefits such as caries prevention and the like along with ion benefits may be obtained. Other products used to decontaminate may include other types of ions such as Al, Ca, Ce, Mg, Sr, Sn or Ti. Such products are described in, for example, U.S. Pat. No. 6,827,766 (e.g., see, for example, the abstract and Col. 2, 122 to col. 3, 162), the entire contents of which are expressly incorporated herein by reference. Still further, silver ions may be incorporated into water or another type of fluid, or a colloidal solution (e.g., colloidal silver aggregate) that contains silver particles may be used. Copper or zinc may or may not be used in place of silver in these instances. Silver particles (e.g., ions) can be about 20 Å, 10 Å, or less in diameter (e.g., about 8 Å in one embodiment). In another formulation, a colloidal silver aggregate can have zeta potential (i.e., can be formed as colloidal silver having a higher charge density (or concentration) than is normally obtained with a similar number of single silver ions dispersed through a fluid). This type of colloidal silver aggregate has been used for wound dressings or wound care. Silver can provide extremely small particle sizes for permeating cell (e.g., pathogen) membranes in order to accomplish a variety of antimicrobial actions (e.g., actions disabling a pathogen from reproducing).

With regard to the use of colloidal silver aggregate as a disinfectant, EPA recommendations should be followed where applicable. EPA studies have shown that an amount of silver intake in order to be at risk for argyria (a permanent dark discoloration of skin caused by over use of medicinal silver preparations) is 3.8 to 6 grams of silver. According to another EPA guideline, a critical daily dose of silver for a 160 pound adult is 1.09 mg. This dosage is well below the critical daily intake for the development of argyria as recommended by the EPA. One teaspoon of 5 ppm colloidal silver contains about 25 micrograms of silver, or 0.025 milligrams of silver. Six teaspoons, the equivalent of one fluid ounce, therefore contains 0.15 milligrams of silver.

The FDA has approved antibacterial silver for food industry applications. An article appearing at http://www.silvermedicine.org/ag-ions-1.html reported that, AgIONS Technologies incorporated received approval by the FDA in October 2003 for use of antibacterial silver in the food industry. The FDA informed AgIONS Technologies that the product had been added to the FDA's list of food contact substances. The AgIONS Type AK product was comprised of 5% silver contained within an inert crystalline carrier. When subject to small amounts of moisture, AgIONS begin to release silver ions, which then act to eliminate bacterial growth on treated surfaces. AgIONS was specifically designed and engineered as a surface treatment system, with wide applications in the food processing industry. Since most food processing plants have a zero tolerance policy for bacterial spoilage, the use of silver to treat surfaces and equipment used in food processing was expected to greatly reduce bacterial growth.

One embodiment of the present invention uses only nontoxic silver salts combined with fluid (e.g., water) as part of a fluid conditioning process as described herein.

Silver or other ions (e.g., copper, zinc, fluoride, etc.) may be combined with other disinfectants (e.g., chlorine dioxide, peroxides, and/or other medical/dental disinfectants, such as hypochloric acid), for disinfecting water lines. For antiseptic applications (i.e. for application to tissue), silver ions may be combined with antiseptics. The silver ions may operate to have combined action with radical oxygen toxic species (ROTS), examples of which may include peroxides (e.g., hydrogen peroxide). ROTS also may be combined with antioxidants (e.g., selenium or vitamin E) in some medical/dental applications.

U.S. Pat. No. 4,915,955 discloses a product used to disinfect dental (e.g., water and/or air) lines (e.g., purge water and/or air lines one time), which may comprise, for example, hydrogen peroxide (5%) and silver ions. A reprint from http://silverdata.20m.com/h2o2.html reports that “[a]ccording to Water and Science Technology,Volume 31 5-6, a 1000:1, solution of colloidal silver to hydrogen peroxide is sufficient to increase the efficacy of colloidal silver by up to 100 times under some circumstances (which may remain unknown) against bacterial infections.”

Water, including ingredients that may be preservatives (or have at least partial preservative properties) that imbue the water with bacteriostatic properties, may be employed in some embodiments.

Chemicals that may be incorporated into water in order to prevent growth of microorganisms (i.e., to introduce bacteriostatic properties into the water) include:

- 1) Sodium chloride (NaCl);
- 2) Sugars such as sucrose, dextrose, and fructose;
- 3) Organic acids such as acetic acid (vinegar), lactic acid, citric acid, propionic acid, ascorbic acid, benzoic acid (also called benzoates);
- 4) Nitrates and nitrites; and
- 5) Oxides such as sulfur dioxide, ethylene oxide, and propylene oxide.

According to an embodiment, fluid containing ions may be sprayed before, during (continuously or intermittently), and/or after tissue cutting, wherein, for example, the concentrations may differ at different times (e.g., those of Table 1 being applied during a procedure and those of Table 2 being applied before or after the procedure). In other embodiments, the fluid may be sprayed at completion of a procedure after tissue is cut. Spray may be delivered during (continuously or intermittently) or after cutting and/or may be delivered before covering tooth, bone or other tissue with for example a protectant. Biocompatible amounts may be applied, for example, using ion concentrations similar to those used for employing ions to protect wounds in the prior art. In hard tissue when a cut is covered, although ions may stay entrapped, their effect normally will be harmless. (See, for example, amounts of silver ions used for burn wounds, which is incorporated herein by reference.)

The information provided herein may be applied to treatment of both hard and soft tissues. Recipes for obtaining colloidal suspensions of silver and other ions in aqueous solution are available in the prior art. For example, recipes for compounds that include antibacterial cations such as silver, zinc, copper, etc. are described in U.S. Pat. No. 6,759,544, which recipes are included herein by reference. Additional exemplary recipes appear in the following, the recipe contents of which are incorporated herein by reference:

http://www.silver-colloids.com/Reports/cpr25/cpr_—25.html

http://www.silver-colloids.com/Reports/reports.html

http://wwwjnj.com/news/jnj_news/20030325_—105204.htm

http://wwwjnj.com/news/jnj_news/20040413_—120700.htm

http://www.burnsurgery.org/Modules/nano/p2/sec2.htm

U.S. Pat. No. 6,827,766, the entire contents of which are expressly incorporated herein by reference, includes a description on formulation of nanoparticle biocides in forms of sprays, fogs, aerosols, and the like.

U.S. Pat. No. 6,051,254, the entire contents of which are expressly incorporated herein by reference, discloses a pharmaceutical formulation comprising an amoxycillin hydrate that may, when made up in an aqueous solution, be applied according to an implementation of a method of the present invention.

Another aspect of the present invention may comprise a method of delivering ions (e.g., disinfectant and/or other ions) to a target surface, details of which are disclosed in U.S. application Ser. No. 11/033,032, filed Jan. 10, 2005 and entitled ELECTROMAGNETIC ENERGY DISTRIBUTIONS FOR ELECTROMAGNETICALLY INDUCED DISRUPTIVE CUTTING. Particles, which may comprise selected types of ions (e.g., silver, copper, zinc, fluoride or other ions), may be projected onto the target surface. According to an exemplary embodiment, an air spray, fluid spray or a combination spray of both air and fluid (e.g., water) may be used to project particles (e.g., disinfectant ions, other ions, and/or ionic compounds) onto the target surface before, during (continuously or intermittently) or after a procedure in order to allow the particles to attach or adhere (e.g., to micromechanically bond) to the surface. For instance, particles (e.g., disinfectant ions) may be fed into a gas line (e.g., an air line of a handpiece) and delivered to a target surface under pressure of air (with or without simultaneous application of liquid) to thereby project particles onto and/or into the target surface. According to one implementation, the surface may or may not be remodeled as described, for example, in the above-incorporated application, wherein the remodeled tissue layer may be more resistant to caries formation. The process further may stimulate formation of secondary dentin and/or may cause the surface to exhibit antibacterial properties. According to another aspect of the present invention, a lamination layer may be applied over a target tissue surface so that the tissue surface is laminated with various ionic compounds and then remodeled with a laser. In a modified implementation, the tissue may be laminated and remodeled at the same time. Either a wet or dry environment may be employed to implement ions into the tissue.

As examples, ions from a list including silver, copper, zinc, fluoride, calcium, phosphorous, hydroxide, combinations thereof, and ionic compounds including one or more of the preceding, may be selected that may, for example, enhance caries prevention. As another example, compounds containing ions, such as sodium fluoride, stannous fluoride, copper fluoride, titanium tetrafluoride, amine fluorides, calcium hydroxide, silver compounds, copper compounds, zinc compounds, combinations thereof, and the like, may be selected. It should be noted that some of these compounds may be compatible with soft tissue, and some may be compatible with dentin, enamel, or bone only. More particularly, compounds having, for example, a fluoride ion may be effective as anti-caries and desensitizing agents. In accordance with one example, fluoride may act to desensitize dental tissue to effects of, for example, heat and cold. In modified embodiments, compounds including, for example, calcium may aid in forming an anti-bacterial surface. In still further embodiments, remineralization of affected dentin may be enhanced by employing, for example, calcium hydroxide or zinc oxide. These compounds may be delivered, for example, through water or other biocompatible fluids that may, for example, contain salt, are sterile, and/or are low in bacterial count.

The ionic compounds may be applied simultaneously (continuously or intermittently) with application of a laser beam, thereby achieving placement of ions and, at the same time, optionally remodeling surface tissue and impregnating ions into a remodeled layer of tissue. Alternately, an area to be treated first may be sprayed continuously or intermittently with one or more ion-containing compounds, such as a topical fluoride preparation, followed by subsequent application of laser energy.

While this invention has been described with respect to various specific examples and embodiments, it is to be understood that the invention is not limited thereto and that it can be variously practiced with the scope of the following claims. Multiple variations and modification to the disclosed embodiments will occur, to the extent not mutually exclusive, to those skilled in the art upon consideration of the foregoing description. Additionally, other combinations, omissions, substitutions and modifications will be apparent to the skilled artisan in view of the disclosure herein. Accordingly, the present invention is not intended to be limited by the disclosed embodiments, but is to be defined by reference to the appended claims.