Offering the LANAP® Protocol in multiple offices

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. Erez Cohen, a general dentist in New York City. Dr. Cohen is a lifelong New Yorker, attended Brooklyn College and graduated from NYU College of Dentistry. He’s been a LANAP®-trained clinician since 2020. Dr. Cohen, thanks for being my guest today.

Dr. Erez Cohen: Thanks for having me, Marty. Glad to be here.

Marty Klein: So, I understand you’ve been offering LANAP®, actually in multiple practices, interfacing with several different general dentistry offices since you got trained. How did you originally come across LANAP® and then what made you motivated to do this?

Dr. Erez Cohen: Yeah, that’s a great question. How it all got started. So yeah, I work in a bunch of different offices now. I work for a few different practices. I have my own practice now doing LANAP® and LAPIP™ and pigment removal, you know, all the good stuff. And, you know, I was first turned on to LANAP® when I met my buddy who was a periodontist, who happened to get trained in it. And I remember we were riding the subway and he was telling me about LANAP® and I just couldn’t believe it.  I was in awe and it was one of those moments that I was like, oh, I gotta open an office one day and hire you. And then fast forward in a couple years and the pandemic hit and I was wondering what my next move was. And somehow or another, I came across LANAP® again, found out that general dentists actually invented it and that I could get trained, and that I could become a LANAP® provider. And I basically knew that was the next big thing that I was going to be doing for my dental career, for the foreseeable future.

Marty Klein: I find that interesting. You knew about it, but it was almost the pandemic and how that shifted things that made you maybe think, I need to do something different. Did you know that GPs could get trained before that moment?

Dr. Erez Cohen: I hadn’t known, no. So, if I had known when my buddy told me about LANAP® for the first time that GPs could do it, I have a feeling I would’ve started a lot sooner. When the pandemic hit, I was doing a pretty cool job going into the pandemic. I was working on a mobile dental unit that was doing kind like upscale PPO mobile buses. So that was a fun gig. But I got to see a lot of technology in that job and I got to see how quickly they were moving. And it was such a great precursor to LANAP® because when I was presented with this opportunity to buy a laser and get trained and, you know, do all that, I was just like, you know what? I’ve had a great example working at this company where they move really fast, bringing on tech that they really believe in very quickly. And it was like a no-brainer for me. I made the decision rather quickly.

Marty Klein: So there are many different lasers out there. Was it the fact that it was a laser or was it the treatment of perio that got you the most interested from what your friend was telling you all about?

Dr. Erez Cohen: You know, I look at it as like the laser is, it’s kind of like the bonus. It’s kind of fun that I get to use a laser in my practice all the time now. But it’s really about what it does. It’s about the perio work. You know, when I was in dental school when I was in NYU, I remember, you know, it’s funny, I have like a lot of like, just, there are only a few moments that I can think of where things were like very clear and very memorable for me. And the time that my buddy told me about perio was one of them, when he told me about LANAP® rather was one of them. The time that I realized I was going to buy a machine and just jump into it, it was another, and the one before those two was when I was sitting at NYU and they were showing us before and after slides of osseous surgery cases.

And I just remember thinking like, they’re so excited about how clean and healthy the tissue is. And I was like, on the one hand, that’s something to celebrate, but then I would see all this gum recession, you know, and, and it killed me. I was like, I can’t do that to somebody. There has to be something else. There has to be something better. So yeah, when LANAP® came into my purview, it was more like, oh, this is the answer to that question I had back in dental school all those years ago. And it satisfies it. So it’s a really exciting thing for me to be doing that I know I’m using an improvement on the technology every day and providing a great service. And also one of my big things is, I love healing people. So the fact that I can be impacting people’s overall health also in a, in a pretty broad way is a really gratifying element of the procedure.

Marty Klein: So to continue chronologically with your story, you had a, well, kind of high expectations. It sounds like you decide to invest in this, you come to training. What was your first move coming out of training? You now can do this, you have a PerioLase® to accomplish LANAP®, but where are you going to do it? How did you approach that next step after training?

Dr. Erez Cohen: That’s a great question, <laugh>. It started off as; I had high expectations, but I also just knew, there aren’t so many things in life that are that clear, at least for me. When I found LANAP®, I was like, this is it. It doesn’t matter how I figure this out, it just has to happen. <laugh>. That’s been my approach ever since. So, I found a practice that was looking for a GP that also had a GP that was already doing LANAP®, and I was interviewing there and I told them, I will take this position and I will buy a laser the same day that I say yes to this position because I know that I need to be in a place already doing this. So that was super helpful. That got me started, that gave me my legs.

I learned LANAP® there. I learned how to talk to patients about it. I learned even more about the procedure and I learned about adjunct services I could be offering with LANAP®. You know, kind of how the whole, how it comes together as a unit where it’s not just get in there, use the laser, get out, you know, you really want to create follow-up care that’s going to work very well for the patient and keep them in a successful place with their oral health. You know, I’ve used sedation now. That’s something I really like using, minimal oral conscious sedation is a great adjunct for this treatment. Then it kind of just evolved, you know, I found some practices that were interested and it’s an interesting conversation when you meet someone who has their own practice that has never heard of LANAP® because dentists don’t really like taking big risks necessarily. I think I’m on the other side of that. I heard this technology existed, I was just like, I don’t know what it is, but something in my soul is telling me this is it. I have to convey that to a GP or to a practice owner when I speak to them. And I have to really show them why bringing LANAP® to their practice is less risky than not bringing it. And that’s kind of where the conversation has gone for me.

Marty Klein: Does it help as a GP talking to another GP’s practice?  Can you, in a sense, speak the same language?

Dr. Erez Cohen: Yeah, absolutely. So it definitely helps that I can enter the conversation at the point where I can meet them at their treatment planning mind and their practice mind. I’ve been in a lot of practices over the years. I worked as a GP for about six or seven years, and I got to see a lot of different practices. The Medicaid, PPO, fee for service, all different types of backgrounds were run by different types of people. And let’s be real, LANAP® is actually not a great fit in every single office, but when you find the right office for it, it is a beautiful treatment to be offering to the patients. It’s a great service for the GP to have in their arsenal now when they’re offering complete treatment to a patient. So, it’s been a really great thing for me to create those alliances with other GPs who speak the same language as me and then can bring this in and, you know, they’re not perio, so, and they might be placing implants already, so they don’t really always want a periodontist in the office for all that they can do. And that’s, that’s where I come in.

Marty Klein: Well, right. And a lot of GPs will refer out to periodontists their periodontal disease and maybe don’t have as much of an interest in treating perio in their own practice. Is that a challenge that you’ve had to overcome in terms of when you’re having those conversations to discuss treating periodontally compromised patients within your own practice?

Dr. Erez Cohen: Yeah, that’s exactly true. There are a lot of practices that would rather not deal with Perio in-house and they’d rather send it out. And I have those arrangements also. I have some places where I’m a contractor, I go to their office and I’m their in-house LANAPer. And that really works as long as they have enough demand and they’re interested in it enough, and they know how to communicate the message of what LANAP® is to their patients, but for others, it actually works better for them to refer out to me, to my office. That’s why I like having my own office, but also being a contractor, essentially what I’ve seen it really come down to for a lot of practices is, they, first they have to believe, they have to really trust. And, once I show them some x-rays and tell them about the cases, I’ve been doing over the years already, that pretty much everybody’s a believer.

It’s hard to deny the science <laugh>. There’s proof. You know, I just took an X-ray the other day. It was a three-month post-op on a hopeless tooth that the patient wanted to try to keep. And, as in my practice, I chose that we were going to actually just treat the whole mouth, treat every single tooth. We weren’t going to jump to conclusions for extractions just yet. Give it some time. And, after three months we see a lot of bone has regrown already and it’s just undeniable. You know, the tooth is stable now. So, yeah, GPs definitely like to have it in their practice when they understand it enough and when they have a good appreciation for perio and when they know that they’re going to be talking to a lot of their patients about perio, and it’s not just a one-off case here and there.

Marty Klein: You know, you’ve talked about perio a lot. Obviously, that’s the subject of what we’re talking about, but it’s obviously especially important to you. Did you ever consider continuing and becoming a periodontist yourself?

Dr. Erez Cohen: Yeah, I love perio. You know, I started off my career working for a couple of practices where it wasn’t mentioned at all. And I had these little musings back when I was in dental school. I was like, maybe I should go to a perio residency. That could be really cool. But, you know, osseous surgery, as it was before I knew about LANAP®, was not something that I really wanted to do. I thought it would be really exciting, but I still couldn’t reconcile the whole, a lot of the recession, the painful post-op recovery period. So going back to what my career was like, I worked in a couple of practices, no perio was mentioned, and then I got to a practice where I was really given great guidance and they instructed me that pretty much most adults have some sort of perio starting. And, there are always cases where people are really taking good care, they have great genetics and there’s no issue. But after that doctor gave me that guidance, I really did start noticing how prevalent perio was. And I think without her guidance, I actually never would’ve realized how important it was until maybe even years later. So I’m very grateful for that. And it gave me a certain perspective of, okay, we need to treat the foundation. Like the foundation is really important. It’s all good to treat all the fillings and do all the crowns and all the other work that we need, but what can we do to really keep their periodontium intact? And what’s so cool about LANAP® is that you’re not only stopping the disease, you’re reversing the direction of it. Like we’re growing bone back. That, to me, is like Star Trek-level stuff. It’s amazing. <laugh>.

Marty Klein: Yeah. You mentioned earlier even hopeless teeth or just turning around situations that were once deemed or condemned, let’s say. Has that been your clinical experience in terms of saving hopeless teeth? Have you had some of that?

Dr. Erez Cohen: Yes, absolutely. I’m continually surprised. So, I try to take an approach of, I want to work with the general dentist, the GP who is administering the overall treatment plan of this given patient. But I do usually recommend; Hey LANAP® is a full-mouth procedure. Why don’t we treat everything even, you know, the teeth that look pretty hopeless, and why don’t we just see what happens? Why don’t we give it those six to nine months and see if these teeth can in fact recover, if we can regrow bone, if we get stability. And that wasn’t my attitude at first. I used to think more of, okay, there are hopeless teeth, you take them out and I’ll get everything back up to health. You know that can really benefit from LANAP®. But because I had a few cases in the beginning where I had patients who really wanted to try to save everything, I remember the first one, I remember what it was like, I worked on this guy’s mouth and treated his periodontal disease. He came back a few weeks later, I speak actually a little bit of Spanish, so I end up treating a lot of Spanish patients as well. And he came in and I thought there was a little bit of a language breakdown because he was telling me this tooth that I thought had to come out was doing really, really well. And I was like, wait, did I misunderstand this <laugh>? And then he started saying in English, he’s like, the job is very good. It’s great <laugh>. And I just remember looking at the X-ray, I’m checking the stability of a tooth. And, you know, it was just a few weeks later and we went from a +3 mobility to a +1. So it’s really incredible stuff. I get to watch this stuff happen every day now. And, for me, it’s given me a very exciting purpose in the dental field.

Marty Klein: Can you tell me a little bit about doing LANAP® with patients who, maybe patients around blood thinners or just other comorbidities? I understand it’s pretty versatile or you’re able to treat more patients than you otherwise could with say osseous surgery. Is that accurate?

Dr. Erez Cohen: Absolutely. Yeah. There are so many patients who come my way who have hypertension, cardiovascular disease, they’re on blood thinners. They, a lot of patients unfortunately who suffer from diabetes end up having oral manifestations in the form of periodontal disease. So there’s always a, a hesitation to treat. Before I had LANAP® training and before I had the laser, there was always this question of, well, well what do you do? You know, like how do we, how do we stop this? Like this is, this is moving quickly. We, I guess we have to get medical clearance and take them off of their blood thinners and, but that puts them at risk and we really don’t want to put their life at risk, but at the same time, we need to treat their oral disease. So, you know, I’ll tell you just from a personal experience, my stepdad, is on blood thinners and I treated him, and he had a lot of bleeding before he came to me. And that evening or the next day, he said he had no more bleeding, and we were able to control the bleeding during the treatment. Throughout there were no real issues. You know, he bled a little bit more than I would say your average patient because he’s on blood thinners. But it was very well controlled. There was no concern on my end, the entire procedure. And then from there, I’ve just noticed every single patient I treat who was on blood thinners, no issues. So, it’s a really great treatment to offer to patients who are on blood thinners. They’re trying to take care of one area of their life and we don’t want to put that area at risk by doing dental treatment.

Marty Klein: We’ve talked so far exclusively about LANAP®, which as you mentioned, as a full-mouth procedure. But have you used your PerioLase® around implants at all or, any other procedures aside from LANAP®?

Dr. Erez Cohen: Yes. I actually have. So yeah, LANAP® is kind of where it all started. That to me was the main treatment. And then I started finding cases where people have All-on-X restoration. So they have between four to six implants per arch and a fixed denture on those implants. And, you know, a significant percentage of people who have those type of restorations end up coming back and they need some help with the implants. The issue is you really don’t want to have to take an implant out and put it back in once you have this whole fixed denture that’s supposed to rest on a specific configuration of four to six implants. So I found that the offices that I work with right now who offer these treatments at scale really appreciate having me in their arsenal because when a patient comes back and they have some problems, whether it’s difficult home care, or if it’s more genetic predispositions or possible, maybe the bite is a little off and we don’t realize it until it’s a little late with one of the implants. They like having me there to be able to offer LAPIP™ treatment so that I can treat the implants. And again, getting great results there. The tissue changes are almost instantaneous. Specifically with implants, because you have this direct vision and it’s just about five or six implants that I’m looking at, at once, and you see a lot of the tissue, you can see the tissue change while you’re working. And it’s amazing. I’ve spoken to my assistants and they’re like, wow, I can’t believe it looks so much better midway through the procedure and it only gets better and better after that.

Marty Klein: So all of this that you’re describing must help answer a burning question I had because your website, which I’ll go ahead and plug now, which I would already do, but it’s www.wavelengthdental.com, which obviously is a play on the fact that lasers have a wavelength. So you really have built this chapter of your dental career around offering laser dentistry. You mentioned earlier that you were hopeful to be able to do that, but without putting words in your mouth, it sounds like it really took off as you hoped it would. It really was a feeling that you had <laugh>.

Dr. Erez Cohen: It did, yeah. It’s one of those things that, I’ll be very honest, I’ve had a lot of different drives over time. Some of them are bigger than others. Some projects are more interesting to me than others. I’m a very creative person. I don’t know if I’ve ever told anybody at the LANAP® headquarters that I’m also a musician. I write pop music and I perform; I tour with an acapella group around the world. It’s a lot of fun. So, I always have a lot of creativity going on for myself, and I always have new ideas, new projects, but LANAP® was probably one of the clearest, one of the biggest ones that I’ve ever, that’s ever kind of crossed my path. And once I found it, I knew it wasn’t a matter of if, it was just; has to happen and each day, each week, each month, I’m going to find a new way to make it work because this is what I have to be doing in dentistry now.

Marty Klein: Well, I can only imagine in New York City transporting your PerioLase®, you work out of different offices, you have your own practice. It’s not like you can just put it in your briefcase and walk right into the next office. Are you able to move it around without a lot of challenge?

Dr. Erez Cohen: Yeah, for the most part. Yeah, it’s pretty good. I don’t mind, I’m also very much in hustle mode right now, so it doesn’t create a problem for me. But you’re right, I am moving. I go to a lot of different places, for within the city, thank God for Uber, that helps a lot. <laugh>, Uber and Lyft are my saviors. And when I go to further locations, it’s really as simple as just putting it in the car and loading it the right way. I do find that it’s like raining every day that I have to take it out. <laugh>,

Marty Klein: <laugh> Murphy’s law.

Dr. Erez Cohen: Yeah, exactly. But overall, it’s a pretty great experience, but it’s actually pretty fun to show up to a practice and bring this super high-tech laser in, and all of the staff are just like, wow, you brought the laser with you. That’s so cool. You know, and it’s like, yeah, that’s one of the things I do. This is part of the job and it’s just fun to see everybody’s reaction. People really seem to, you know, especially once they see the results, they’re, they’re believers and it’s, it’s really great to just work with so many people who understand the benefits and want to help make it bigger and bigger and more well known so that we can just treat more and more people and really get this disease under control.

Marty Klein: Well, thanks for your time today. I want to encourage everyone listening to this to check out your website, www.wavelengthdental.com  There really is a whole lot of LANAP® on there, as you’ll see when you visit. That’s all about Dr. Cohen and his New York City practice. If you’re listening to the podcast here and have not yet subscribed, please do so. All of the episodes that we’ve released and all future episodes will go on the website, www.lanap.com/podcasts. Dr. Cohen, thanks again for taking some time out of today to share your story with me.

Dr. Erez Cohen: Of course. Thanks so much, Marty. It’s been a pleasure.