Global perspectives: The LANAP® Protocol in Australia

Transcription: 

Marty Klein: Welcome to Dentistry for the New Millennium. I’m Marty Klein, Training Manager at the Institute for Advanced Laser Dentistry. My guest today is Dr. Chris Barker, a periodontist in Brisbane, Australia. Dr. Barker graduated from dental school at the University of Adelaide in 2004 and completed his doctorate in clinical dentistry, specializing in periodontology at Griffith University in 2014. He has been a junior lecturer and clinical tutor at the University of Adelaide and Griffith University. Today we’ll talk about his road to using the PerioLase® MVP-7™ for the LANAP® Protocol in Australia and his assistance in launching the Fight Gum Disease Initiative in Australia earlier this year. Dr. Barker, thanks for being my guest today.

Dr. Chris Barker: It is my absolute pleasure. Thank you very much for having me.

Marty Klein: Certainly! You came to training for the LANAP® Protocol in the spring of 2019 and you probably had a bit of a different road from some of your American colleagues getting to that point. So let’s start with how you first became aware of LANAP®, and then what pushed you to come for training?

Dr. Chris Barker: Sure, so my story is probably a little bit more convoluted than most people. The background is I was a general practitioner for the best part of about 10 years before I elected to go back and do my full doctorate in periodontology, which is the requirement in Australia for registration. During the end of my program, like all good graduate students, I went to the conferences with the ambition of meeting periodontists and trying to line up a job. One of the periodontist I met there was periodontist called Dr. Brian James, who you may remember, is one of the pioneers of bringing LANAP® into Australia. He was one of the first periodontists to do so. He and I got talking, and he started that thought process. Down the track, in about 2018, I was selected to go on an advanced training program with EMS. I met another periodontist over there, Dr. Wendy Gill, who is also another periodontist in Australia who uses LANAP®. During that training program there were extensive discussions. She basically cemented my conviction that I needed to incorporate this, because I had just started my own practice with the definitive ethos of trying to get people to hang onto their teeth, and trying to maintain their quality of life. The next step from there was then trying to budget for that exercise, then trying to find an appropriate training date, and the rest is history from there I guess.

Marty Klein: So it sounds like you were heavily influenced by those two periodontist. Did you have any initial concerns or objections? Or were it was their word enough for you?

Dr. Chris Barker: Given the strength of their reputations and way they explained it to me, the strength of their word was really quite important. Obviously I went and did my own due diligence on the training, the background. I was very lucky. I worked with another dentist at the time, a guy called Dr. David Cox, who was a pioneer in Australia for the use of lasers in general dentistry. I had trained under him for the better part of 3-4 years and had learned very quickly that using the appropriate laser or equipment for specific jobs was the key to success. So, you know, everyone says, “A laser’s a laser…” and unfortunately, the rest of us know, who maybe had more exposure, that’s not true. You do need specific equipment for specific tasks. So from that point of view, yes, it was about reputation, but it was more about how it advanced and how their patients felt at the end of that process.  I have never had anyone say, “Thank you” at the end of periodontal surgery in my career. From my point of view, trying to find alternative methodologies to still get decent results and help people stabilize that disease without that postoperative discomfort was a really winner for me. It basically just came down to accumulation of a series of events and concepts that got me over the line, I guess.

Marty Klein: Now, as you know, there’s only one way for a dentist to get trained on the LANAP® Protocol, and that is to fly to Southern California for the live, in person, hands-on training, which for you is a bit more of an ordeal than somebody who already lives in the U.S. Was that a hindrance at all having to fly to the U.S. for training?

Dr. Chris Barker: Not really. There was a series of other obstacles, really that were, I thought were a bit bigger. The big one is the culture in periodontology in Australia is very influenced by European heritage, and the awareness of the use of lasers in specific periodontal work is very limited. The support within my peer group was very limited except for Brian and Wendy, of course. Then the other one is, with the greatest respect, that the Australian dollar is not as strong as the American dollar. At the time it was trading at, like 65 U.S. cents, so it was that next step of making that investment to get to the U.S. The actual travel time, and the way they structure toward the end of the week, didn’t really impact me that much. It was more about being prepared to stand out from my peers and say, “Okay, this is the road I’m choosing,” and then obviously making that investment. Once I got over those two obstacles, everything else flowed pretty quickly. I mean, the training alone itself is first-rate. You don’t get that sort of hands-on training in many other skill sets. I mean, you go to one-day conferences or you go to workshops. It’s not 2-3 days of solid back-to-back-to-back. “You need to do this… Let’s reinforce this… Here’s the hands-on… Here’s the patient… Now here’s the instructor sitting right over your shoulder.” I have actually taken some elements of that, because in Australia I am involved in training some general dentists in the use of implant surgery. I’ve taken a couple of those concepts that from the LANAP® training protocol of really hands-on, really reinforcement and applied it, and it definitely does get a much better result.

Marty Klein: All right, so you got to that point of various obstacles and the investment and the time that it would take, and you now are LANAP® trained. It’s back in your office, and you have a lot to prove. What was your experience out of the gate, and then at what point were you convinced that this was indeed the right avenue for you to go down?

Dr. Chris Barker: So recruiting my first dozen patients probably took me the best part of one or two months after the machine arrived. I had to get the machines shipped to Australia, and they’re pretty efficient but, you know, it’s still a bloody big distance. After the 1st 12 we got the hang of things, it started to pick up. The first six months, I was doing maybe one case a week. I was still developing my reputation, trying to educate other dentists and my potential referrers that this was an option on the table, doing a bit of website work to try and educate the average potential patient, that this was an option on the table. I’ve gotta be honest over the last six months, short of a pandemic, I’m now doing I don’t know 1-2 cases every day. I think today is a doubleheader. It really has begun to take on a road of its own. I would call it the snowball effect where, yes, it started off a little bit more interesting, but I think we’re up at 200 patients now in my potential first year, which by all standards apparently is pretty good. It has taken on a world of its own and it’s just going from strength to strength. To the point now where we’re having trouble that I’ve only got so many spots left on my timetable for LANAP® sessions, because I allocate two or four hours for these sessions, until the end of the year. That’s before we even had our Christmas rush! So we’re now coming to the other side of that question, which is “How do you fit everything in, in a certain amount of time?” And that’s why I’m drinking very strong coffee.

Marty Klein: I should point out that when we’re recording this, it’s 8:30 a.m. your time. It’s later in the day here in the U.S., so I’m catching you at the beginning of your of your workday. You mentioned patients and educating the patients in Australia. There’s not as many LANAP® providers on your continent, so was that an uphill battle? Or is that, as you mentioned, becoming easier? What is the patient awareness of LANAP® like in Australia?

Dr. Chris Barker: Very limited. So to give you a point of reference, there are two periodontist, myself and Brian James on the East Coast of Australia that are LANAP® certified. There are some general practitioners as well that have the LANAP® endorsement, but there’s only Brian James and myself (for perio). So within the Proactive Perio website, we’ve had to put some emphasis on that. It has been a very significant journey with regard to educating dentists that this option is on the table. I am finding now a lot of patients are also doing their own due diligence because as soon as you tell a patient, “We gonna do conservative debridement,” that’s one thing. As soon as you turn and say, “and then we might have to do periodontal surgery, and this is what it involves.” You just see the eyes light up like a kangaroo in the headlights. It just goes, “Are you kidding me? We still have to do that?” Then they’ll go online and do their own research. I’m not gonna lie, I’ve had to use a lot of the American resources. Sometimes the patients will ask me some questions because of the cultural idiosyncrasies between Australia and the U.S., there are some differentials. There are some things I’m allowed to say in Australia, and there are some things I’m not allowed to say in Australia that relate to the material provided by the American market. But I’m lucky. It’s been an uphill journey, but it is once again taking on that snowball effect where it is developing, and awareness is definitively improving.

Marty Klein: And what about the clinical results? It’s all well and good, you’re getting more and more patients, but have you also seen for yourself in your own hands that it’s working clinically?

Dr. Chris Barker: I’ll never go back. You’ll have to pry that thing out of my cold, dead hands!  Listen, the results are that much better clinically in terms of appearance. We’ve had some meta-analysis studies and, they might say are clinically recession and probing depths…Yeah… I’m not in a position to comment on that when I’m still going back through my own numbers, but from a patient experience in terms of lack of postoperative discomfort and sensitivity, you’re not gonna have any conflict there at all. In terms of that initial four and six week, you know, color, texture, firmness, adherents, all the classical signs of gingival health appearing, it is definitively, from my point of view, a much better outcome. But here’s the kicker – it’s the patient experience. I have only had maybe one or two patients ever say, “Oh, I had sensitivity after this.” In comparison to what my previous periodontal surgery, and indeed some very deep conservative debridements on some very heavily affected patients. They just be going, “Chris, I can’t touch cold water,” and this is like three weeks down the road. I think trying to get people through that journey and making it as easy as possible for them alone has to be the point that you go, “This is going to help that many more people.” Particularly when we have someone in Australia who has a high level of dental fear and anxiety, for whatever reason. They are frequently the patients that have not attended the dentist. They are frequently the patients that their disease is further progressed and requires further intervention in order to try and stabilize the condition. They’re the ones that you really want to try and avoid any postoperative sensitivity or discomfort to the Nth degree, because you’re worried that you’re just going to psychologically reset them back into a bad place. This is just one of those tools that you can get someone through a journey, short off knocking them out under a general anesthesia, and get them back on the track to trying to have some sort of periodontal oral health, and if nothing else, quality of life. I think from that point of view you’ve got to go from that holistic viewpoint.

Marty Klein: And have you now had patients say, “Thank you” after their surgery?

Dr. Chris Barker: I actually get bottles of alcohol. I never got that beforehand! If that’s got to be the benchmark, I am ahead of the game. I actually get people coming in, and I get gifts, which I never had that before.  For me, it’s like, “Okay, this is fantastic. Okay, what’s next?” The patient acceptance and patients being thankful afterwards is definitively right up there, so at least you feel good about what you’re doing.

Marty Klein: I want to switch gears over to the Fight Gum Disease campaign. The IALD initiated it originally in the U.S. eight years ago, celebrating Gum Disease Awareness Month in February. This year you lead the charge to bring that to Australia. I’d like to hear a little more about what led you to do that and how that launch went this last February.

Dr. Chris Barker: The reason I did it matches the ethos of the practice. Proactive Perio is the ethos of the practice. We’re trying to make people retain their teeth and have an improved quality of life. The reality is, there has never been any sort of education for public awareness in Australia about gum disease. It’s always bean between the clinician and the patient, and many, many patients have commented previously, “I wish I knew about this earlier. Why is your association or professional body not educating us on this now?” Apart from the fact explaining gum disease has its own problems because it’s not as straightforward as we’d like it to be. It was one of the few programs I’ve seen that has gained traction, obviously in the U.S. it has a track record, and over the time they have refined their own techniques in delivering that information and that message to the people. I had spoken to Rachel Moody on my initial training program about bringing this to Australia, and they are pretty keen, obviously, to support and help you get the message out there. The launch itself was quite small and soft, but that was by design because, like I said, I have to respect the cultural idiosyncrasies of working in the Australian market. We focused it mainly on my referral base and local clinicians at this stage of the game, mainly dentists of course, just to get their initial feedback, and that was really quite positive. They went, “This is fantastic. I could send my patients here. We’re going to start doing it.” We’ve had to do some significant refinements on the Australian variant of the Fight Gum Disease website and that’s been a process into itself. Next year, I think, is the year where I can really begin to sink my teeth in. We’re developing those contacts, we’re now going to go maybe a little bit more broad spectrum, potentially try and hit some of the mass media channels such as radios or TVs. Maybe going outside the dental world and maybe involving some of the general medical practitioners and allied health clinicians to say, “Hey, listen, this is something we want you to be aware of.” Maybe during Fight Gum Disease, you encourage your clientele to go visit the dentist or potentially fill out maybe a questionnaire. So it has been a small, soft launch, but I really do think it’s going to be, I keep referring to a snowball, but that’s about the best analogy I have with regards to development public awareness. Small steps, but I do predict much bigger things in the future, potentially as more people get on board as well. If nothing else, it’s a public awareness campaign. What do we have to lose? We’re only improving people’s knowledge about what the impact of periodontal disease really can be.

Marty Klein: Yeah, there’s really no downside to getting more of the word out, and I’d like to thank you just on behalf of the IALD for taking that charge overseas, so to speak. I do want to mention the websites for that fightgumdisease.com here in the US, I believe it’s fightgumdisease.au?

Dr. Chris Barker: fightgumdisease.com.au for the Australian variant.

Marty Klein: Very good. Well, I also want to point out your website that is proactiveperio.com and invite our listeners here to subscribe to this podcast, if you haven’t already, so that you don’t miss any episodes or at LANAP.com/podcast. They’re all available there. Dr. Barker, thanks so much for making some time for us in your morning and being our guest today.

Dr. Chris Barker: It has been my absolute pleasure. Thank you.