When should key opinion leaders recommend a product?

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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. Steven Brown, a periodontist in Philadelphia, Pennsylvania. A graduate of Temple University School of Dentistry, Dr. Brown earned his certificate of proficiency in periodontics and adult orthodontics from University of Pennsylvania School of Dental Medicine, making him the first in the country acquire this rare double specialty. He currently holds professor positions with both of his alma maters. Today we’ll talk about how he got started with LANAP®, how he has to carefully approach product recommendations that he gives, and his involvement with the North American Society of Periodontists. Dr Brown, Thanks for being my guest today.

Dr. Steven Brown: I’m happy to be here, and thanks for inviting me.

Marty Klein: So how did you first hear about the PerioLase® MVP-7™ and LANAP® and tell me a little bit about your road to deciding to incorporate it into your own practice.

Dr. Steven Brown: In the early years of my practice, I was frustrated because I had been trained by some of the best to be a periodontal surgeon extraordinaire. And in spite of my presumed surgical skills, I was seeing all too many patients coming back after two or three years, requiring more surgical intervention. I’d been looking for a less invasive and more predictable approach to dealing with periodontal disease for some time.

Marty Klein: So did you have any particular influences in making the call to start doing it for yourself?

Dr. Steven Brown: Yes, I did. There were two people in particular: Dr. Tom McCawley from Fort Lauderdale, Florida, and Dr. Joe Nemeth from Southfield, Michigan. Both are very close colleagues, great friends, and people who I hold in high regard. They’ve been trained about six months before me. I trust them a lot, and they basically said to me, “Don’t ask any questions, like Nike, just do it!” and I did and I haven’t looked back. It was one of the most profound changes in my practice in my entire career.

Marty Klein: That sounds counter intuitive to at least a lot of the periodontists I’ve spoken to over the years in terms of not asking questions. It seems that sometimes it is very difficult to get on board to do something new like this. That wasn’t the case.

Dr. Steven Brown: Actually, that’s more than norm rather than the exception. But I’ve been really kind of frustrated. First of all, it’s important to note that most of my colleagues and most of the people in the dental profession when they’re dealing with periodontal disease, they are looking at treating pockets, and the bottom line is that you can treat pockets. But if you cut them away in theory so that you can keep the mouth clean, you left the teeth long, you left big spaces, there’s sensitivity in the roots. The reality is you haven’t treated the cause, you’ve treated the effects. That in itself is counterintuitive.

Marty Klein: And so how is LANAP® different from that?

Dr. Steven Brown: Well the LANAP® procedure targets bacteria. If we understand the periodontal disease infection, it’s caused by known bacteria, those bacteria can be identified. The laser light energy is attracted to colors, and the bacteria that are known to cause periodontal disease, if one were to grow them in a microbiology lab, would be red, yellow, orange and black. The laser light energy is attracted to those bacteria because of their colors. In fact, lasers are used to take off tattoos, and it works because the tattoos are colored, and when it does that it kills them on contact. The most amazing thing is it can kill them in the tissue, in the pocket, alongside the roots, just about anywhere. And it is no collateral damage to adjacent tissues. That, in itself, is a profound difference from conventional periodontal surgery.

Marty Klein: So it sounds like you were looking for clinical results, not specifically to become a laser dentist. It was more about the outcome. Did you find that outcome to be as your colleagues told you, and as advertised in your own hands?

Dr. Steven Brown: I will tell you that I was astounded because I had been trained with conventional surgery and my patients were astounded. I mean, the reality is that we were able to treat people, and I was used to giving patients routinely narcotic postoperative medications, and patients were coming back and telling me that the most they had taken was perhaps ibuprofen, Advil or Tylenol. And that was amazing in itself! Patients were getting better, they were getting thorough treatment, and they were having none of the side effects that are commonly associated with conventional cut and stitch periodontal surgery.

Marty Klein: So you get the outcome you’re looking for, the patient gets the outcome they’re looking for, and maybe are more likely to accept treatment in the first place. Has that been your experience?

Dr. Steven Brown: As a matter of fact, when you explain this treatment to them and how it works, believe me, they get it. Their eyes light up. We’re in a period of time now where it doesn’t matter what part of dentistry or medicine you’re involved in. Everybody wants non-invasive, reversible types of procedures. I don’t care whether it’s arthroscopic surgery or robotic surgery. Everything that we are doing today in the medical and dental profession is focused on minimally invasive procedures, and the laser is a clear cut example of exactly that.

Marty Klein: Why do you think it’s been a slow process, then? You speak about it glowingly here, but a lot of your periodontal specialist colleagues have been skeptical, or slow to adopt this over the years. Why do you think that is?

Dr. Steven Brown: Well, you hit on it just then. We doctors in general are very slow to embrace new technologies, which tend to challenge that which we’ve become comfortable with. In other words, if we’re comfortable with conventional surgery, changing is a big problem. It’s very, very difficult. And no matter what the evidence is, we tend to do what we’re comfortable doing and what we do very well. I’m not here to say that conventional periodontal surgery isn’t being done well by lots of people and getting good results. But let’s face it, If Christian Barnard had waited for it to be published in the textbook, the first heart transplant may never have been done. By the time something is published in a textbook, it’s old school, it’s ancient history.

Marty Klein: One organization that you are a part of, I believe your core member, is the North American Society of Periodontist, or NASP, and most members of that group, to my knowledge, are now LANAP® doctors. So was that similar to your story where it was kind of a domino effect in within that group? Can you tell me more about the group in general?

Dr. Steven Brown: Yeah. First of all, you need to know a little bit about this group. The North American Society of Periodontists has been around probably for 35 years. We fly under the radar screen and not many people know about us. The interesting thing about this organization, which I have been intimately involved with for many, many years in fact, my wife and I are the people who coordinate the annual meeting every year. That annual meeting is by invitation only, and we invite about 50 periodonists, because it’s a meeting in which everybody shares with everybody else what’s going on. The truth of the matter, with respect to the laser, is people were talking about it, myself and others, and I believe that the level of commitment of the people in this organization want to see something that makes life easier, is better for the patient is more efficient. Because one of the things about this group that’s unique is, they are not all about clinical periodontics, there really about the business of practice. This is good business to introduce new technologies that work, that favor the patient, and that are easily able to be marketed, because people find out about it, whether it’s through your website or through talks that you’ve given. The people in this group tend to be high profile, periodontists from across the country.

You know, there’s been a great deal of resistance in general among periodontists and others to these new technologies, and I’m reminded of what Arthur Schopenhauer. He was a German philosopher, and what he said was: all truth passes through three stages. First it’s ridiculed, and I definitely experienced that. Second, it is violently opposed by your colleagues, and then after that, it’s accepted as being self evident. So I went through all of those stages. In fact, when I first started, which was more than 11 years ago, I had real trepidation because I have a relatively high profile in the periodontal community, I teach as you said at a couple of different universities, and here I was going off and doing something that was by no means conventional. In fact, when we first started using the system, I had Ray Yukna was one of my teachers, and he did some of the best early research on it. I literally brought him to Philadelphia before I presented it so that he could present it as being somebody with gravitas, so to speak, that would be interested in talking to a group of dentists who had never heard of this stuff. So it was a process, and as I said before, it’s been one of the best things that I’ve ever done. It’s been great for my patients. It’s been great for my practice because we’re known as people who are caring and using noninvasive techniques. We have thrived and prospered because of taking on this new technology.

Marty Klein: You mentioned just then that you have a relatively high profile. I imagine that means that you have to be careful of the technology that you integrate as you have a lot of colleagues holding you accountable.

Dr. Steven Brown: Right. I’m reminded of Shakespeare. He talked about the slings and arrows of outrageous fortune. Basically, I caught a lot of slings and arrows in the early days. But you know what? After a while, if you keep doing the same thing, if you keep telling the truth, over and over and over again, your word becomes law. And most of my colleagues now look to me for assisting them in being able to change their focus in periodontics.

Marty Klein: I do want to mention one other item here, and that is a LANAP® case series that you authored, was in 2013 Clinical Advances in Periodontics. Can you tell me more about how that came to be and how it was put together?

Dr. Steven Brown: Yes, this was really, Marty, a labor of love. That particular addition of Clinical Advances in Periodontics was dedicated to my most significant mentor and friend, Dr. D. Walter Cohen. And when I was asked to write a paper, I did it without reservation. One of the things about Dr. Cohen that was so remarkable, early on in the seventies, before I really understood what he was saying, he said something to the effect of, “In the future the practice of periodontics is not going to be about resective procedures, in other words, cut away procedures. It’s going to be about plastic and reconstructive procedures.” and nothing could have been more prescient than that. I was able to adopt this very comfortably because of the background that he had given. So when I was asked to write a paper, it was my pleasure to contribute an honor to contribute to something that was to honor one of my mentors

Marty Klein: I’m looking at the article now. And it’s even called “The Mentor Issue.” So there were many that Dr. Cohen had mentored that contributed. For listeners of the podcast, if you’d like to see that article, you can at LANAP.com/research. I also want to mention Dr. Brown’s website, https://www.theperiogroup.com/, for more information about Dr. Stephen Brown. For any listeners here who haven’t yet subscribed to this podcast, please do so either wherever you download your podcasts or at LANAP.com/podcast. Dr. Brown, thank you again for joining me today and sharing your story.

Dr. Steven Brown: It’s been a great pleasure. Thank you, Marty.