Treating diabetics with the PerioLase® MVP-7™

Transcription: 

Marty Klein: Welcome to Dentistry for the New Millennium. I am Marty Klein, training manager at the Institute for Advanced Laser Dentistry. And today we’re speaking with Dr Craig Long from San Antonio, Texas. Dr. Long graduated from the University of Missouri School of Dentistry, and has published papers and lectured on laser periodontal treatment both nationally and internationally. He’s a certified instructor with the Institute for Advanced Laser Dentistry. Here we’ll talk about when and how he first started using his PerioLase® MVP-7™, what it was like completely moving practices to a new state, and what he’s learned when using the PerioLase® to treat patients with diabetes. Dr. Craig Long, thanks so much for being here today.

Dr. Craig Long: Thank you.

Marty Klein: I want to start just from your early days of LANAP®. Specifically when and how did you hear about the technology and what made you decide to adopt it in your practice?

Dr. Craig Long: Well, I was introduced to a LANAP®, almost by serendipity, like many of us are. This was back in 2001. I was a member of a study group in Missouri and we would have various speakers come in about every quarter. As it turns out, one of the other fellow dentists had heard of Dr. McCarthy and Dr. Gregg and their work with the PerioLase®. Of course, when I showed up for the meeting, I had no idea what they were talking about. So I got to meet Dr. McCarthy, who came in with this laser and showed us some results. He was showing us slide after slide after slide. Of course, that being the early days, we weren’t really tuned into lasers. I don’t think anyone in the group was, but my thoughts were that day, “If this guy is really true to what he’s talking about, and all these slides are actually the truth – which we’re all skeptical as practitioners – that’s something I’ve never seen before.” One of the things that impressed me about Dr. McCarthy was his sincerity and his passion. He just believed in this laser, and he believed in so much that he said, “Well, buy the laser from us, and if you don’t like it, you can send it back in six months,” and he showed us various techniques that he used. I did have at that time a hygienist who was somewhat familiar with lasers, more than me. She was all for promoting this in our practice. So, long story short, I purchased the laser, brought it back to my practice, and started using it without a lot of clinical background.

That was before Dr. Yukna had even really published his papers concerning the histology of the PerioLase®, and I saw patients remarkably changed. I had never seen anything like that, and I’ve been practicing dentistry for over 20 years at that point!  Most of my patients were not willing to do flap surgery. Most of the time I referred it out to a specialist (I’m a general practitioner), because my patients would come back and say, “I wish you’d never sent me there!” There was that part. Did they have good results? Yes, they did. But they didn’t really appreciate the experience. So I thought, maybe this is a good alternative to bring to patients. Maybe they’re going to be able to have good results and not go through a lot of the procedures that that the traditional surgery brought to us: post-op discomfort, extended soft diets, time off of work. The PerioLase® answered all those questions for us. You could do it, basically, in a couple of visits. There was no stitches. There was no cutting. There was no bleeding. The patients came back and said, “You know what? I wasn’t in pain all that much.” I actually started decreasing my pain control protocol after using the laser for a couple of months because patients didn’t need it. What I was seeing was unbelievable clinical results.

Marty Klein: This was back in?

Dr. Craig Long: This was back in back in 2001/2002. I actually got my laser in 2002. That was back when there was only one sales rep if I remember, I think, Rusty. So, he delivered the laser himself, we started up and running, and, of course, my staff looked at me like I was crazy. I remember the day that I had one of my assistants, one of the skeptical assistants, about two years after us starting using the laser says, “How did we ever practice without this laser?” We use it for a variety of reasons besides just LANAP®, of course. We would use it when we had problems with deep restorations around gum tissue and that sort of thing. Long story short, when I started doing clinical evaluations of my patients (because there wasn’t a lot of published research at that time), I would see bone growing back, just like Dr. McCarthy; just like a lot of my other colleagues that purchased the laser in the study group. I would call them up. I said, “You’re seeing what I’m seeing?” “Yes, we are!” So we started understanding that the laser was pretty predictable, pretty consistent, and the post-op complications were extremely minimal. So it was a win-win all the way around. Needless to say, I wasn’t gonna send my laser back! I haven’t for almost 20 years I’ve been doing LANAP®.

Marty Klein: I understand a little down the line you moved to a different state, different part of the country, and you brought your PerioLase® with you. How did that go for you and specifically with the education in your new practice, I believe in Texas, of the PerioLase® and LANAP®? Can you tell us about that?

Dr. Craig Long: Yeah. My business model at that time was I really wanted to move to Texas. My current family was living there and I thought, “Okay, I like Texas weather and so I’ll just think I’ll migrate.” All my children were grown and had moved away at that point. My model is that I didn’t want to really start a new practice. I thought, “I think there’s a great need for the PerioLase® in any office.” It’s sort of like Dr. Dawn Gregg will say, “I can’t understand why every dentist isn’t doing this protocol.” And so I would propose to the dentist that were in that area, in San Antonio, “I have the PerioLase®, I have the expertise, I’ve been doing this for a number of years, I believe I had published a paper at that point in Dentistry Today of some of my clinical case studies, and would you like me to bring this to your office?” It was kind of a journey where some offices, as I found out, we weren’t really a good fit and some of them were excellent fits. So what I was basically doing is bringing the laser in, treating their patients. We had a fee agreement that would work, and I really didn’t have to worry about the administration part of the practice. I had already done that, and this was kind of going to be in my later years of dentistry.

At that point, I’ve been practicing over 25 years, but I still love dentistry. I love doing LANAP® because I saw patients’ lives changed, and that’s what has got me so passionate about this. You’d have a patient who would come in with certain health issues, and you see those health issues get better by doing LANAP® treatment. Of course, that would work with traditional surgery as well, but the LANAP® was just so much more accepted by the patients. It was very rewarding, and after a time it was like any dental practice. The owner of the practice that I was working with, he wanted to see the results too. Of course, like in many practices in the world of dentistry, if you’re hygienists are happy, everybody’s happy. That was what I really noticed. The hygienists would come back and tell me and the other dentist, “I’ve never seen things like this. I’ve never seen a patient come back three months after any sort of surgery and look like this. It looks like their gums are mature, there’s very little inflammation, and there’s very little bleeding. Even their plaque control isn’t that great, but there’s something going on here that we’ve never seen before.” After that, it was pretty much an easy proposition to work in that office because everyone started to believe in it.

What’s fortunate in all the years that I’ve done LANAP® at least it’s in the mainstream more. I’ll go to an office, and typically what I have to do is introduce myself, do a lunch and learn, and educate them about LANAP®. Well, some of the offices never heard of what I’m talking about. A lot of offices on the other hand have heard of it, and they’re very interested in it, but they didn’t know exactly what it was all about. That was pretty rewarding as well. So that was some of my journey of introducing that procedure in San Antonio. There weren’t that many dentists or periodontists doing LANAP®. When I first started doing that, there was only about three in the city. Now it’s grown, obviously, because the laser’s more accepted in the dental world by practitioners. I now associate with about five offices, and I do procedures through their office and the patients that they have, so it works out very well. Win-win.

Marty Klein: Yeah, very good. Now I know gum disease is linked to many different health concerns, but I understand you published a clinical report specifically on LANAP® and diabetes relative to a patient that you treated. Can you tell me more about that patient and your experience with those two things?

Dr. Craig Long: Yes, I had a patient that came in, I believe, this was in February of 2016 and he had been a patient for quite some time in this practice that I associated with. He came in with gums that were very swollen. He had good plaque control, but there are very swollen from inflammation. They almost look like fibromas around the margins of his teeth. He had deep pockets, of course, and bone loss everywhere. One of the systemic factors that I noticed with this patient was that he was diabetic, and his blood sugars had been out of control for the last two or three years on all sorts of medications to try to control that. He did tell me that his position was very frustrated at times because his HbA1c level, which is the level that test the blood sugar for the last several months in a patient, was very high. In fact, his was over 11, and of course, we like to see around the six or below. He wasn’t a smoker. He was not anything but a social drinker. So everything was pretty much boiled down to the diabetes, which I had read many papers on. There’s been research done of the links of periodontal disease and diabetes, and so I said, “Well, here’s what we need to do. We need to do the LANAP® surgery on you and we will see, but I’m very interested to see if you will become more stable with your blood sugar after the LANAP®.” We went ahead and did that. And, of course, we saw in the LANAP® procedure the typical prediction that we see with LANAP® now. It’s a very predictable procedure. If you follow the protocol, it works. So we’re starting to see his gingival tissues shrank within two months. He looked relatively normal. We know it from Dr. Yukna’s study at 3-4 months, we’re having new attachment. Of course, we didn’t probe. It’s not my protocol to probe until 9 to 12 months after a surgery, but we could take X-rays and we could see bone regeneration. Within 3-4 months I could see quite a change, which, in my experience that was pretty early. Well, the patient and his recall appointments told me that he went back to a physician and his HbA1c level dropped three points. If you drop half a point in HbA1c, that’s noticeable, and the physician, his doctor said that he was just blown away, he said, “We haven’t seen it this low in you in a couple of years.” He continued to improve and has done well to this day, and his diabetes is in much better control and more stable. I have seen this happen not on just that patient. I’ve seen a number of patients who said that their diabetes improved greatly after getting rid of the oral infection, which makes common sense. I’ve had one or two patients through all the years of doing LANAP® that actually got off their oral medication (Metformin is usually the one that’s used) and went only to a diet-based type of control for their blood sugar, which is wonderful. I don’t think I’ve seen any other protocol in my years of dentistry other than laser treatment that actually improves the diabetic condition of the patient as well as the PerioLase®.

Marty Klein: I bet you see that a lot where you practice specifically.

Dr. Craig Long: I do in South Texas, you know, of course, we have the Hispanic culture, and I believe genetically they fight diabetes a little bit more than a lot of the other cultural populations. Of course diet plays a huge role in all of the population as far as causing type 2 diabetes. I see a lot more diabetic type 2 issues in South Texas than I did in St. Louis, Missouri. I am treating patients almost weekly with LANAP® at this point in my career, and I would say over half of them are diabetic. Here’s one of the things that I have found that I think is very good practice for me. If I have a patient that would come in and they have the beginnings of, let’s say, type 3 periodontal disease (which is the most ideal for me to treat, not type 4), they are even very inflamed and maybe a type 2/type 3 patient, but if they have diabetes, I’m going to do the laser on them much sooner than I would have done traditional surgery. I will jump on the PerioLase® to try to get ahead of the periodontal disease and help their diabetes, so that’s a tipping point for me. A patient comes in and says, “Yes, I’m diabetic.” I see a lot of inflammation. Bone loss is becoming prevalent in his X-rays and also in the probing depths, then I will use the PerioLase®. I see an improvement almost significantly and almost… it’s just very predictable. It’s going to happen. They’re going to get better!

Marty Klein: Very good. Well, Dr. Long, thank you so much for sharing your perspective and your story with us.

Dr. Craig Long: Appreciate it. Good talking with you today, Marty.

Marty Klein: Thank you. If you’re interested in more information about the Dentistry Today article or diabetes case study discussed in this podcast, you can visit LANAP.com and click on the research tab at the top.