The PerioLase® pied piper of New York

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. Neal Lehrman, a periodontist in New York, New York. After completing dental school at the State University at Stony Brook, Dr. Lehrman completed his training in periodontics and implantology at UMDNJ, now Rutgers University. He currently serves as a certified instructor with the IALD. Dr. Lehrman, It is a pleasure to talk to you. Thanks for joining me today.

Dr. Lehrman: My pleasure. Thanks for having me.

Marty Klein: Now on the podcast, we invite our guests to tell their LANAP® story starting from the beginning. So I know you purchased in 2007. Probably took a little bit of time before that when you first heard about LANAP®, can you tell me about your story right from the start?

Dr. Lehrman: Actually it was not a lot of time, funny that you should ask that. I had a partner at the time who I no longer practice with, but I’m still very close with, who was a general dentist in Middletown, NY named Dino Napoletano, and he was using the PerioLase for about…less than a year I think, prior to me actually becoming a LANAP® surgeon. I would watch him every day and he would tell me all these fantastical, magical, mystical things that were supposed to happen. Here I was fresh out of my residency a few years out of school, in fact, it was 2006, not 2007 that I started, and I would look at him like he was half crazy and he would say, “No, take an X-ray, she’s gonna grow bone here or look at this, we’re going to fix this.” At the time LANAP® was much newer in terms of the dissemination of information, if I could call it that because they were so, so far fewer practitioners doing the procedure. I kinda never gave it a second thought except to think, “Well he’s a general dentist, I’m a periodontist, we get along great. I don’t want to step on his toes, but I think he’s out of his mind.” The Christmas dinner that year we were at a restaurant and I remember because it was the only time in the 12 years that we practiced together, we ever had an argument. We were sitting at a table in a restaurant with all of our staff, and I just looked at him and I said, “You’re out of your mind. You’re not re-growing bone. You can’t even spell the word periodontics,” and he was fit to be tied. We kind of shook hands and said, “You know what? Let’s not argue about it.” And the next morning for no reason other than I thought, you know what? Maybe I’ll give it a shot. I called and I bought a laser. The rest is have been a remarkable journey ever since then.

Marty Klein: The next morning after an argument, you told him he was crazy. What changed in your mind?

Dr. Lehrman: I just thought, you know what, maybe I don’t know everything. I don’t know. I just, I had never. To wit, I was out of my residency. I had a lot of student loans at the time. I paid less than what it costs now, I’m sure. But it was still a hefty amount, and I never purchased something that large before and I had no idea. I was calling all my friends. Nobody knew what was going on. They never heard of this. “Oh, it’s a scam.” The truth is I had seen other laser companies come through all the dental study clubs and lecture and I always got the sense that they were just selling something. I never got a sense that there was any consensus that this would work or what they were doing was anything more than a gimmick. But I just did it. I think there was a six month or they’re even might still be a six-month guarantee. So I figured you know worst comes to worst, I’ll return it.

Marty Klein: Yeah. There is still a six-month clinical results guarantee. You said you’d called around to other periodontist. You also mentioned that there weren’t as many periodontist doing LANAP® at the time, which is true. This is before the Dr. Yukna, and later Nevins, histology had even come out. Was there any other periodontist that was giving you a boost on the side that, hey, this works?

Dr. Lehrman: No, but if you understand general dentistry and periodontics are two very different fields, even though we’re both dentists. General Dentists are much more in touch or on top of what’s going on and what’s coming down the pike. When you’re a specialist in your own office and you’re at the time (I don’t practice this way now) at the time, you’re focused only on getting referrals, there’s really no source of information other than your colleagues to know what new materials are out, what new ideas are going on. So I would just called up, I summon the witches coven, so to speak, and I said, “Guys what’s the story on this?” And nobody had ever heard anything about it.

Marty Klein: All right. So you took the – sounds like – a bit of a leap of faith. What were your first impressions starting to do it in your own office?

Dr. Lehrman: So, it was really interesting. Part of it was… if I could backtrack and circle back to something you asked me. I think part of the reason, and I don’t think I did it consciously, but I became a periodontist to place implants. When I was in dental school that was the dawning of the age of dental implantology. It was dentistry at its sexiest: all this ridge augmentation and amazing procedures to regrow bone and surgery and regenerate. But what they don’t tell you were all the hassles that come with dental implantology: from managing the cases, to setting up the cases, to the communication between offices, to the failures, right? Then where do you go? I had very quickly soured on the idea that I was going to spend the rest of my professional career just drilling holes in people’s heads and putting screws in them. Now to wit, I do place a lot of dental implants, but it’s not the focus of what I do. So I went to the training, I think the next month I bought in December of 2016 and I went in January to Denver of 2017.

Marty Klein: This is 2006?

Dr. Lehrman: Oh, I’m sorry. Yeah, I went in ’07, right in January in Denver. It was far and away the best CE course I had ever taken, bar none, from the way we were treated to just the way it was organized. I helped, I have a bit of a pied piper, if I could say this myself. I convinced about 11 of my friends to purchase PerioLases. They just kind of looked at me like, “OK, he must know what he’s talking about” and the first thing I would always tell them is “It’s the best CE course you’re ever gonna take.” That was the reason to go.  I came back and I still didn’t really understand the technology. I didn’t really understand the mechanism of healing, to be honest with you. I don’t put that on Doctors Gregg, then McCarthy and Doctor Dawn Gregg. I just don’t. I think my head was someplace else. My first case was a gentleman who was sent to me to have all of his teeth removed so he could have implants for a denture. And if I tell you, Marty, his teeth could have been pulled out by looking at them too hard. It was a mess. He was a Supreme Court justice up in the county where I was working and I said, “Look, I just got this laser, I can’t promise you anything, we could try this and if in six months it doesn’t work. So I’ll take out your teeth.” I saw this gentleman a month ago, so it’s now, how many, 15 years? He’s now 90. He has all of his teeth. And not only does he have all of his teeth, four months after I treated him, I got him into orthodontics because his teeth were all in different positions and that’s all you need to know. The rest is as they say, history.

Marty Klein: Yeah, that’s amazing. You mentioned in there that you had referred quite a few doctors to us.  Just on this podcast series, I’ve had several guests name drop you as an influencer for them to incorporate LANAP®. So I don’t know what you’re telling them, but or maybe what you’re showing them, I should say, probably cases that you’ve had over the years.

Dr. Lehrman: Look, the truth of the matter is I am, it sounds self-serving, so I have to apologize ahead of time. I’m relatively simple. I want to go to work, I want to have fun and I want to come home. I long ago ceased to want to be the biggest rockstar periodontist on the planet. That is not my thing. I’m focused on my family. I have a lot of interests outside of what we do clinically. Although I love being a periodontist, I happen to love going to work every day. When I started seeing results that I couldn’t understand, but that were repeatable even despite my lack of understanding, it was only a question of when I would get up to speed understanding what was going on. But that was kind of after the fact. I think, you and I know each other, I didn’t document my cases. I have a library of over 11,000 photos. I think I’ve completed some 4,000 cases. Not as full-mouth cases, but procedures.  In the time that I’m doing these procedures, I photographed everything. I work with a microscope, so it makes it easier for me. I can photograph on the fly. I don’t have to take time out of my procedures to do this. But I early on understood the power of, don’t want to call social media because it isn’t for marketing, but in terms of internal social media, sending cases to my colleagues, having them comment, looking at things, looking at changes in tissues, comparing them. It was a very good way of communicating. I happen to be dyslexic, so reading for me, it’s very difficult. But I’m a very visual person in terms of looking at photos, I can pick things up very quickly. My need to do that for myself may have influenced my friends and my colleagues.

Marty Klein: You had mentioned. You want to come into work every day and have fun. Does the PerioLase® or some of the procedures you do with it help you have fun at work?

Dr. Lehrman: Well considering that 97% of what I do involves turning on the PerioLase®, it would have to be. I place a scant few implants a year. I used to place many, many, many implants a year. Had a very, fairly busy practice. Now if I place tens, not even hundreds of implants, that’s a lot for me during the year. That said, a majority of the cases that I was treating to extract teeth and place implants, I just treat with the PerioLase® and 9 times out of 10 they come out beautifully. I don’t even think twice. It’s not a stressful way to work. The technology works, and I know everybody says it and it sounds kind of trite, but it is a formula. It’s a cookbook, it’s a recipe. If I get it correct. You follow it and it works every time and when it doesn’t work, look, you did your best. You know, that’s just the way it is. So I’m very it’s kind of comfortable with work. You know, I look at things that everybody else looks at and says, “There’s no way,” and I go, “What are you talking about? We can save your teeth even if there’s no bone on them and they’re floating in space.” I’m like, “What are you talking about? You want to lose your tooth?” Then they say, “No,” and I say “I’ll see you on Tuesday” and it just works. It works well, patients are very, very happy.

Marty Klein: You mentioned earlier about taking a ton of photos and also about sharing cases. And I wanted to point out or tell listeners who don’t already know that you co-founded TheWavelength.org, which is a website, and the newsletter specifically…I’ll just let you tell the story. Can you tell me a little bit about The Wavelength and how it came into being?

Dr. Lehrman: Well, there was nothing out there and there was no way to communicate. People were constantly calling me saying, well what should I do about this? And again, nothing to do with me per se. But I was an early adopter, I think I qualify, and as a periodontist. And my door was always open, so to speak, because I always believed that if you had information that could help me, I’m happy to help you. There’s really…nobody owns anything.  People were constantly calling me and emailing me questions what should they do? And I figure, you know what, why don’t we have like a meeting place, outside of Millennium Dental. To be fair, it was to be refereed by us so it was not bought and paid for, so to speak. It was, it’s all done for free by us and it was just a way for LANAPers to communicate and share their experiences. And it grew, we had three or four years where we were putting out issues and doctors were sending us fascinating cases that are now called, I believe, Value Added Procedures, if I’m correct?

Marty Klein: Yep, or VAPs

Dr. Lehrman: VAPs. So we were doing things expanding the envelope, which is really our tagline, knowing that marketplace of ideas. We wanted to talk about not just the basic cases, which are by the way, fascinating to look at. Just the fact that you can effectively wave a flashlight at somebody and regenerate their jawbone – That’s pretty damn cool. But we were doing all these cosmetic cases. I have to a lot of cosmetic procedures with the PerioLase®.  Actually, I would say 50% of what I do is using that wavelength and the way it’s engineered from Millennium, it’s remarkable for all these cosmetic cases that we do. People were starting to send us cases and it just grew and grew and grew. Unfortunately, we both, we have to stop it. Went a hiatus for a few years because there were some things going on, but we’re just finishing up. We finally kind of reprising it in a different way. We have some interesting surprises coming up.

Marty Klein: Well, great. Once again for those who would like to keep tabs on that, the website is thewavelength.org. You can see all of the previous issues on there. I also want to shift over to those Value Added Procedures that you mentioned. I know you use your PerioLase® for quite a lot of procedures other than LANAP® and LAPIP™. Osteonecrosis treatment for example. Can you share with me an example or two of how else you use your PerioLase®?

Dr. Lehrman: Well, it’s wonderful at detailing my car, does a wonderful job. [laughs]  I don’t know what the phrase is, perhaps you can help me along with this: That invention… necessity is the mother of invention or is that it? So I do. I would say my phone rings and more than 50% of the people that call want to know about depigmentation procedures and by that I mean people of color who have uneven gingiva uneven dark gums, whether they’re completely dark or they’re spotty. Now I would say a third of that, I do a lot of lip depigmentation. If you’re a person of color and you don’t like the way your lips or gums look or if you don’t have, there’s no contrast, it’s very difficult to wear certain shades of makeup, and there may be other sociological issues that I’m not aware of, although I hear them from time to time. I do an enormous amount of depigmentation procedures. They are remarkable. In fact at Rutgers, a few weeks ago we’re in the middle of finishing up an amazing case with the residents. 16-year-old inner city kid, is a remarkable kid, I think he’s going to Harvard actually. It’s just an amazing kid, had a rare dental condition. They were getting him ready with the prosthetics department at the dental school and they did whatever periodontal surgery was necessary to get him there. But he had very blotchy and uneven gingivia and gums. And we went in and we I came into that part of the case for the depigmentation and he looked at me and at a post-op and said, “You know, I’m only 16, but you’ve changed my life and that is worth everything!”

As far as cancer cases. Well, once you understand the mechanism of how the PerioLase® works and how the energy is delivered, and you understand that everything that we do is really boiled down to the same thing, which is essentially getting good wound healing, so why not try and look at anything that has a problem with wound healing and use this laser to try and effect a positive change?

I have a close friend at Sloan Kettering, which is a large cancer hospital in New York City, many are familiar with it, and a case was sent to me. Then before you knew it, rather than remove people’s jaws, we are able to effect incredible healing. It was controversial in the sense that Millennium did not put out the laser for this. There was nothing kind of wrong with it, but it wasn’t studied. There’s a lot of money that goes into the medical aspect of this and the surgeons and I got a lot of pushback from a lot of people for, you know, that I was a crock and I was…I had no idea what I was doing…I had no research. I would say, “Well, the research with regards to the bone healing and the wound healing we do have from Millennium. What difference does it make how I’m applying it?” The other thing that I had going for me is that I don’t really listen to anybody, so I don’t really care what anybody was saying about me. And that said, how many years later I’m following over 100 cases, which is a very significant number of osteonecrosis, osteoradionecrosis cases, and we’ve never lost a jaw. We have never lost a jaw, which is remarkable because they were all scheduled to have parts of their faces removed, and you can only imagine how devastating it is.

Marty Klein: Yeah, that’s amazing. I do want to ask about one other angle here of your story, which is you mentioned that you’re on faculty there at Rutgers, that the 16-year-old that you saw was over at the university. So in addition to all your private practice successes, you helped bring LANAP® to the university curriculum at Rutgers. Could you tell me a little bit about how that happened and your role there?

Dr. Lehrman: Yeah, that’s funny actually. It took a while. The idea started earlier. In fact, Drs. Gregg, Dr. Dawn Gregg & Bob Gregg, came out and we all had dinner when the idea was just a kernel. I have to be totally honest, it was completely because I was bored teaching in the residency and I was like, well, I don’t want to come here. I don’t do osseous surgery, which is the gold standard of periodontal surgery up until now. I don’t do that anymore in my practice, so I can’t in good conscience teach the residents how to do this because I think it’s a waste of time. As far as implants go, there were a slew of professors there who were my professors, they don’t need me to be teaching that, you know, they taught me. So I thought, what would make it fun to teach? Why don’t we do bring LANAP® here. I will tell you when you go into the clinic, all the residents want to do is LANAP®. All they want to do are cases. It has to do with me. Now many of the instructors are [IALD] instructors and they’re all LANAPers and they all late in their careers, all switched over and became LANAP® clinicians. So it kind of sparked this little revolution which really changed the tenor of the department. I really do think that just what I like doing and in a different sense that the demographic of patients is changing, the need for osseous surgery is changing. People are keeping their teeth longer. People growing up today are not going to need full-mouth implants like they did 20 years ago, 25 years ago. Right? Those patients are either treated or no longer with us, Right? But anybody my age or younger, they have a broken tooth. They have two broken teeth. They need an implant, but they don’t need 20 implants. The idea of training people to think in terms of taking all their teeth out seems backwards to me. I wanted to create an environment where there would be positioned appropriately upon leaving the program to do what was relevant in today’s marketplace.

Marty Klein: Well, we’re going on five years or so of residents at Rutgers getting trained right in school with LANAP®, and that is thanks in large part to your influence on that school. We do need to wrap up here, but I do want to give a plug to your website for anyone listening that would like to know more about your LANAP® practice as you described. The website is laserperionyc.com. If anyone listening here has not yet subscribe to this podcast, please do so or visit any of the podcasts so far at lanap.com/podcast. Dr. Lehrman, You’ve been such an integral part of the LANAP®ƒ story and I want to thank you for sharing yours with us today.

Dr. Lehrman: Oh my pleasure was a lot of fun. I’m glad we did this.