July 15, 2024

Incorporating the PerioLase® MVP-7™ into the Hygiene Department

Marika Lockhart, RDH

PLAY NOW:

Marty Klein 00:07
Welcome to Dentistry for the New Millennium. I’m Marty Klein, training manager at the Institute for Advanced Laser Dentistry. My guest today is Marika Lockhart, RDH. Today I’ll chat with Marika about how she has incorporated the PerioLase MVP-7 into her role as a hygienist and advice that she has for practices looking to use the PerioLase at lower power settings in their hygiene program.

Marty Klein 00:33
Before I begin, I’d like to stress here up front that hygiene laser laws do vary state by state and province to province, and some states do not allow hygienists to use lasers at all. So be sure to check the Dental Practice Act in your state or province to be sure you’re up to date with current regulations.

Marty Klein 00:53
And that said, welcome to Marika. So happy that you’ve agreed to be my guest today.

Marika Lockhart, RDH 00:59
Thank you, Marty. My pleasure to be here.

Marty Klein 01:01
Wonderful. So let’s start from the beginning. Tell me how long you’ve been a hygienist.

Marika Lockhart, RDH 01:07
I’ve been a hygienist for 20 years now, and I was a dental assistant for a number of years before that.

Marty Klein 01:14
Okay, so I know that you have plenty of experience with the PerioLase MVP-7. At what point did you start using that or incorporating the PerioLase into your own hygiene practice?

Marika Lockhart, RDH 01:27
Well, I was lucky enough that my one of my very first jobs that I was a hygienist for actually had a PerioLase and they brought me through the training program for hygienists on how to use it. So I’ve been using it almost 20 years.

Marty Klein 01:44
Oh wow, that’s quite a long time. So for those who aren’t familiar with how the PerioLase might work in the hygiene setting, because usually we talk about it being used for LANAP dental surgery, which is doctor-dedicated and limited to dentists and specialists.  What do you use the PerioLase for?

Marika Lockhart, RDH 02:06
Well, the main thing that I actually use it for is a procedure called Laser Pocket Disinfection, which basically helps control the bacteria in a pocket and reduce inflammation. It’s great for bleeding spots, but I also use it for a number of other things, one of those being if a patient, let’s say, has bitten his cheek and they have a large aphthous ulcer, I can use that as a hygienist to help reduce that swelling and help it heal quicker. It can also be used, and I have used it on cold sores, like herpetic lesions on the lip. That would have to be done in the pre-dromal stage. So those are probably the top three things that I use it for.

Marty Klein 02:55
Okay, and you mentioned Laser Pocket Disinfection, and I understand that part of the LANAP surgical procedure also disinfects or has an ablation component. Can you describe just how Laser Pocket Disinfection is different from the full LANAP protocol?

Marika Lockhart, RDH 03:14
That’s a great question, Marty. Basically, Laser Pocket Disinfection uses the PerioLase at a much lower setting and in parameters that a hygienist can use. LANAP in itself is actually a laser surgery setting. It’s used at a much higher wattage. And that is something that only a licensed dentist can do. It is not allowed by a hygienist in any type of criteria in any of the states. Also with LANAP, a patient will definitely be anesthetized with local anesthetic. The great thing with Laser Pocket Disinfection is I can generally do this without ever having to numb the patient. I don’t even have to use topical anesthetic because it’s a much lower setting. However, it is definitely enough to help kill the bacteria in a pocket and help reduce inflammation.

Marty Klein 04:12
Okay, so let’s talk about Laser Pocket Disinfection versus scaling and root planing, or can you tell us a little more about maybe which patients are candidates for one versus the other? How do you decide what to do?

Marika Lockhart, RDH 04:27
Well, scaling and replaining as a hygienist generally is done on patients that might have deeper pockets, but they will also generally have a lot of calculus. Tartar is another word for it, underneath their gum lines. So they will generally, these patients will generally need to be anesthetized because it would be uncomfortable for them to do deep scaling with a metal instrument or ultrasonic a lot of times if they’re not numb. Laser Pocket Disinfection is generally focused on the tissue. It doesn’t necessarily remove calculus in itself, though it has been shown to help kind of loosen it, but it is mainly strictly for the tissues. So if there’s a bleeding area, it’ll help reduce that inflammation and bleeding. And because it penetrates about six millimeters past the actual tip of your laser fiber, it can really get into the deep pocket areas. Sometimes a hygienist can’t reach like between the roots or something and help kill that bacteria. But it will not remove tartar, so it’s not necessarily in place of scaling and root plaining. However, I would like to point out at this point because I worked for doctors that do LANAP, LANAP in itself actually does respond much better if a patient hasn’t been scaled and root planed prior.

Marty Klein 06:02
Okay, so you’re saying that if you have a patient that is a potential candidate for LANAP, are they sometimes the same candidates that you might otherwise look at for scaling and root planing, or how do you decide then what a good case for LANAP is?

Marika Lockhart, RDH 06:20
So basically, if a patient came in, let’s say if they were a new patient to our office and they saw me first, and I saw that they had a lot of deep pockets, maybe they have some mobility, meaning looseness on teeth, their bite is off maybe, and that they have a lot of tartar, rather than scale and root plane them off the bat, because if they need LANAP later, it won’t respond as well. I will generally either just do a full dental hygiene assessment, or I will do some scaling in the presence of inflammation, which is basically a term for people that have some bleeding, and then I will have them have their reevaluation with the doctor that I work for to see if they need LANAP.

Marty Klein 07:14
So it’s kind of like a handoff or a passing of the baton to, and correct me if I’m wrong here, but then when the doctor comes in to discuss a little more about LANAP, that patient will have already maybe been talked to a little bit about it by you or you’ve made them maybe warm up a little bit to the idea, some of the benefits of it. Is that right?

Marika Lockhart, RDH 07:38
Correct. Many times and now I’m going to use an example because this is probably going to be what how most hygienists will see a patient is they’ll have that patient that they’ve been maintaining for a long time but the pockets aren’t really getting better maybe a couple got worse and I will tell the patient, you know, you’re kind of getting past the point of a periodontal maintenance appointment you’re looking at possibly needing LANAP, so I open the door with that conversation, however I can try Laser Pocket Disinfection and that is in my scope of practice and we’ll see how it responds in four to six weeks with Dr. So-and-So and then the doctor will reevaluate them and if things have gotten better they might just stay, you know, as a periodontal maintenance patient with me or they’ve already known that everything that I could possibly do has been done and they’re much more receptive to having the treatment by the doctor.

Marty Klein 08:46
So really it’s like each patient is being given the best care at some point between you and the doctor based on what they need. Are you ever concerned that a LANAP patient that is taken therefore out of the hygiene program is somehow a loss to you? Or how do you reconcile your patient versus a LANAP patient that you don’t see for LANAP?

Marika Lockhart, RDH 09:14
Well, the one thing is, is if they do have LANAP, they are not going to be necessarily a loss because they are going to return as a periodontal maintenance patient and maybe they work just a prophy every six months before. Now, I will be seeing them every three months for a periodontal maintenance and part of that can also be some adjunct Laser Pocket Disinfection. The other thing is, I know some hygienists are concerned about not having scaling and root planing maybe because they get a bonus from that. I’ve been lucky enough that I basically have worked and negotiated that I just work a fair daily wage for my dentist, you know, no matter what type of procedure I do. So, I have no problem with scaling and root planning being taken away from me.

Marty Klein 10:08
All right, regarding the PerioLase itself, do you use the same PerioLase as the doctor does or does it roll between operatories or how does that work for you?

Marika Lockhart, RDH 10:23
PerioLase is very portable, which is great. So yes, I have had both experiences. I’ve had the experience of sharing it where it rolled between operatories. The only time it didn’t work out was if the doctor happened to be doing LANAP at that moment. But I’ve also worked in a practice where we had more than one. We had our regular PerioLase and then we had one that was strictly for the hygiene department to use. Either way, it’s very portable and it’s quick and easy to set up. It only takes like two minutes, not even two minutes to get it going, I would say.

Marty Klein 11:05
I’m curious now of your overall impressions of LANAP. You said you’d been working with the PerioLase and with a LANAP doctor for quite a while. So can you talk to me a little bit just about your impressions of those patients that have had LANAP? You’re in the business of dental hygiene. What clinical outcomes have you seen over the years in patients?

Marika Lockhart, RDH 11:28
Well, let me tell you, when I first started working in a LANAP practice, I was a skeptic because it hadn’t been around that much and my thought to myself was, I’ll believe it when I see it. But when I saw these patients – these were existing patients that I had seen before and had LANAP and they came back – I was amazed compared to traditional surgery. Number one, patients can treat the whole mouth, both sides within a week, which is ideal and what is taught in most periodontal programs. Number two, there’s really no downtime. So the patients are compliant. They’re happy. They’re not having sensitivity. When I see them for a cleaning, they’re thrilled. The main thing that I see is how well and how quickly the tissues heal and respond. And I have actually seen with my own eyes bone regrowth on x -rays. This is the actual bone that has regrown that was lost in furcation areas or in a vertical defect. And that was something that was really amazing to me.

Marika Lockhart, RDH 12:41
The other thing that I’ve seen is how quickly Laser Pocket Disinfection could make a difference, too, when I was able to see with my own eyes with a patient just two days later. So this laser actually is selective and targets inflamed and bad tissue and does not harm healthy tissue, which is one of the greatest things about it.

Marty Klein 13:05
Is pocket disinfection done to patients who have not had LANAP or have had LANAP done?

Marika Lockhart, RDH 13:14
Both, actually. So I have patients that I have done Laser Pocket Disinfection that have not needed LANAP, but let’s say they come into my chair and they have an area that bleeds more easily, you know, the tissue is a little puffy, a little inflamed, but they don’t necessarily have a bunch of tartar or anything. They just maybe aren’t doing so great with plaque removal and it’s just the area that’s reacting. The Laser Pocket Disinfection can just be used in that spot and if it responds, then no, they don’t need LANAP. I use it for patients after they’ve had LANAP if there are individual areas that might have some inflammation and bleeding. So I do use the laser as an adjunct for Laser Pocket Disinfection if they have a localized area when they’re coming in for their regular three-month periodontal maintenance and post-op. So I use it in both. I almost use it on every patient I see.

Marty Klein 14:22
Wow. Well, that actually leads me to one of my last questions here. I understand that you recently moved to a different state and that the practice that you’re working in currently is not a LANAP practice, does not have a PerioLase. Can you tell me about how that changes your approach to your own hygiene program?

Marika Lockhart, RDH 14:46
Yes, I miss my PerioLase desperately. I have actually had some patients that came in that had some deeper pockets and bleeding, but I felt they really, I would not have done scaling and root planning on them necessarily because they really didn’t have any tartar under their gum line. It was mainly more if I could have just zapped it with the laser and reevaluated them and had the doctor check the bite and maybe do a bite adjustment that they would have responded well. I’m lucky enough that the practice that does not have the PerioLase, they are big on occlusion and they actually are now, because they’ve heard me talk about it so much and received some literature, are considering buying a PerioLase.

Marty Klein 15:39
Okay, that’s good to hear. So if you were speaking directly to another hygienist in a practice like your new one that does not have a PerioLase and they were considering it, what could you say to that person in your experience to help them understand what a game changer it could be?

Marika Lockhart, RDH 16:01
Oh, I would tell them this is going to get rid of those areas that are always pesky on a patient. You’re not going to have to numb them to do S/RPs. I don’t know any hygienist that actually loves to do S/RPs. If you’re a hygienist and your dentist is considering buying the PerioLase to do LANAP, I would say you’re going to love it because you’re going to be mainly doing periodontal maintenance patients. They’re already cleaned up, now you’re maintaining them. They’re happy. They don’t leave your practice to be referred elsewhere, never to come back, which a lot of times would happen if a doctor didn’t do the procedure was a patient would be referred out and then you would maybe see them once a year for a checkup, but you as a hygienist wouldn’t see them because they were getting their cleanings at wherever they had their treatment done. It might look like something’s being taken away, but all these patients will stay in your practice on a three-month recall and because they’re already cleaned up, it makes it great. It makes your job easy and patients love you for it.

Marty Klein 17:16
We love happy patients. That’s what it’s all about, especially happy periodontal patients, which in other forms of surgery might not be as happy. Well, thank you so much for your time today, Marika. I’d like to invite those listening, if you’ve not already, to subscribe to this podcast so that you don’t miss any episodes. We’ve also recorded and released over 50 other podcasts with different guests, so you can find those wherever you download your podcasts or at http://lanap.com/podcast.  And if you’re listening to this podcast and already have a PerioLase MVP-7 laser and would like more information on training for hygienist procedures, like we discussed in this podcast, more information can be found at http://iald.teachable.com.

So, Marika, thank you again for joining me today. It’s been a pleasure.

Marika Lockhart, RDH 18:17
Thanks so much, Marty.