Hi there. You are listening to the Perio Patient Podcast, a podcast for my patients and anyone else who cares to listen. Dr. Ben Young here, and I am a periodontist in private practice here in beautiful San Antonio, Texas.
The title of this podcast is: About LANAP
For many of you the acronym LANAP is familiar because you have looked at treatment alternatives already as to how to treat periodontal disease. This podcast today relies on you knowing just a little bit and I would start you back with my presentation A Tooth Has Four Parts – which you can see on the Home Page of my website, dryoungperiodontics.com.
It runs fifteen minutes and explains essentially what periodontal disease is in a way to answer the question for patients – what you have to know to manage your own care. Periodontal disease or periodontitis is a chronic condition and requires that you are seen periodically. The video explains where you need to go, at what frequency, and also, what to expect when you get there.
Also, in that video I break out periodontal therapy into two treatment categories. The first I call active treatment and the second I call supportive therapy or treatment. When someone is in active treatment, it means they have problems that place them in the active disease category and the objective is to get them as quickly as possible into the health and stability side of the line dividing disease and health.
Supportive therapy is the ongoing effort to keep people on the health and stability side of the line – and also, to monitor and identify if and when someone is having a a problem that drops them back into the disease category. Think of it as a flare up.
With all of that background in mind, let’s talk about the benefits as well as limitations of LANAP or Laser Assisted New Attachment Procedure.
I understand this means something to dentists and may not mean much to you, so we will get into this in a moment.
First, however, there is a good website for you to know about. I will put a link in the description information below, — and this is lanap.com.
So, what is meant by Laser Assisted New Attachment Procedure? This procedure, which has FDA approval by the way, has shown through studies that looked at the microscopic changes following treatment that showed – not reattachment of soft tissue to roots at the base of pockets where the disease was actively removing both soft and hard tissues, but new attachment. This meant that it was shown that new cementum and periodontal fibers were observed above a notched line where there was once a pocket following the particular laser protocol using a particular laser – the one those of us who were trained in this procedure use.
Can other lasers accomplish the same result? Not predictably – for a very specific reason. The word “laser” is also an acronym and means Light amplification by stimulated emission of radiation.
Now by light, it is more than visible light, it is within the spectrum of energy physicists call electromagnetic radiation. Here is how one online dictionary describes what a laser is:
It is: a device that generates an intense beam of coherent monochromatic light (or other electromagnetic radiation) by stimulated emission of photons from excited atoms or molecules. Lasers are used in drilling and cutting, alignment and guidance, and in surgery; the optical properties are exploited in holography, reading bar codes, and in recording and playing compact discs.
So here is where it got really interesting for me. I discovered that the frequency of the energy altered the absorption of the beam into different substances and that the particular laser used in the equipment I work with is focused specifically on soft tissues as opposed to hard tissues. This is important because it will not – unless misused – damage the hard tissues of the cementum, bone, root substance dentin. It will not cut into enamel. Other types of lasers can cut through hard tissues, this one does not. What it does do is kill the bacteria that nest in the tissues around the pocket. It also removes dying cells. So it is a narrow beam that penetrates healthy tissue, turns on quiet cells nearby to begin the healing process, and reduces some nerve pain. So the energy from the laser is focused down to run through a flexible fiberoptic line that works in a wet environment (think saliva and blood) and kills the organisms within the pocket and within the surrounding tissues, that are not affected by mechanical cleaning methods alone.
Think of it this way. Before laser, the treatment of periodontal disease involved two basic methods – mechanical and chemical. Mechanical methods involve cleaning roots with hand instruments and ultrasonics, and chemical involves killing organisms with antibiotics, for example, as well as mouth washes. Because of the nature of this particular disease, we have found that when the destruction is greatest, we need to use combinations of approaches. This describes the escalation of treatment from non-surgical – meaning deep cleanings, we call scaling and root planing – to surgical where the soft tissues are mechanically moved away from roots and bone in a surgical procedure in order to have access and treat bone defects by contouring the bone or grafting bone back. All of this requires a large area of soft tissue involvement – meaning a lot of healthy tissues have to be injured in order to access a very focused problem area. When using on mechanical and chemical options, this is often necessary. And please do not misunderstand me to be saying the laser substitutes for these other two methods of treatment. It does not. But adding laser to the other two alters the way we can treat this disease – especially initially – when we are working to reduce the inflammatory response.
LANAP by definition – and it is a registered trade-marked protocol that is full-mouth in nature – changes the other two treatment options – beginning with non-surgical deep cleaning and escalating when indicated to surgical procedures – to something very different.
LANAP provides the opportunity to introduce a combination of the three methods of care into one event. Instead of someone coming multiple times to have deep cleanings or scaling and root planing, followed by an examination that then determines where periodontal surgery is now indicated, followed after this by possibly different surgical procedures spaced over multiple appointments – because recovery from full mouth surgery can affect someone’s ability to eat food comfortably – we can now reduce all of this to a few simple visits.
The benefits to this approach are:
- Fewer office visits. For example, if I take someone who ultimately needs full mouth surgical care, it can take usually two visits for initial scaling and root planing (because many insurance companies will not pay for full mouth scaling and root planing – even by a periodontist), followed by a re-examination appointment, followed by two to four surgical procedures, interspersed with post surgical care visits. All combined, this can easily be a total of ten appointments. And somewhere along the way, dental insurance will likely max out. My LANAP protocol for a patient with the same problems just described will be four visits – and one of these visits, may actually be accomplished, not by me, but by the dental hygienist in the other dentist’s office.
- Less pain. Because the laser has a biostimulatory affect to the tissue and because the area affected by the treatment is focused just around the teeth where the specific problems are, and because there is usually no suturing involved, the level of discomfort from a laser procedure is similar to having your teeth thoroughly cleaned. There may be a little tenderness following but most reports, and the experience I hear from the patient I treat, is that is was not a big deal at all. Yes, you are numbed for the procedure, but in my office most patient do not need to be sedated. All of this goes to benefit 3.
- Less expensive compare with the classic periodontal approach.
However, and this is a Biggy. Dental insurance does not cover LANAP.
For over three years I attempted to submit this procedure with the existing and only insurance codes available to me, and what I found was that insurance companies would routinely deny coverage. Some would send back a statement that laser is experimental. This is an excuse and frankly untrue – as evidence by the fact that it as the only FDA approved procedure I’m aware of in dentistry. Placement of dental implants is not FDA approved, for example – and I’m not saying it needs to be. But what I am saying is that there was enough evidence for the Food and Drug Administration to approve the LANAP approach to treating periodontal disease. And why was this approval sought? Because systems are entrenched redundant bureaucracies and research through universities often run extremely slow. The upside to slow and deliberate is public protection. The downside to slow and deliberate is that new and better approaches can be overlooked, sometimes for decades. So lasers are no longer experimental, but some insurance companies have not changed their policies for twenty years and don’t plan to. And what is so interesting to me in all of this is that the LANAP procedure resolves periodontitis faster and at lower cost which would result in a healthier general population. Perhaps, insurance companies calculate that more patients who would not go through classic periodontal therapy would seek this approach and this would result in them paying out more in care. Keep in mind, the insurance company is happy when treatment is difficult and slow because there is a high likelihood that patients will not go through care and therefore will not use the insurance money.
So, again, LANAP is less expensive compared with conventional care, but not covered by insurance. This resulted in many patients, who expected their insurance company would at least cover some of the cost were disappointed and found themselves having to pay for the care out of pocket. Most said it was better than going through the alternative form of therapy, but it was still very frustrating.
Finally, I decided that I would do two things. First, I would admit that the insurance companies were not anytime in the future going to cover LANAP or other laser assisted procedures – because there are currently no codes available to submit claims and no one is pushing for this. And secondly, I would lower my fees for this procedure. In other words, it isn’t connected in any way to insurance and so I no longer have the administrative headaches trying to get the insurance companies to pay anything for this procedure.
So, it’s true, if a patient is dead set on having their dental insurance company cover their periodontal therapy to the maximum extent, then they will go the route of more appointments and the rest in some other office – because I’m convinced this is the best treatment available to handle most periodontal cases.
On the other hand, if they want the active disease addressed and quickly reversed with greater overall comfort and fewer dental visits, then they will see the benefits of paying this part out of pocket. When they do it this way, then other procedures I provide that are covered by their dental insurance, assuming I am a provider for that company, will be handled through dental insurance. In addition, it frees up their remaining dental insurance to be used for other dental care they may require from their comprehensive dentist. And always keep in mind, you insurance has a maximum per year. You need to find out what this is in order to know whether or not dental insurance will really play a significant part of your overall dental care in that particular year.
Finally, let me briefly talk about one, what I consider, a down-side hassle when it comes to having the LANAP procedure. And by the way, if it is not a full mouth procedure but uses the same protocol, then there is another term Millennium Dental Technology has trade marked and that is LAR – Laser assisted regeneration. Frankly I often use the term 0sseous regeneration procedure. Whatever it is called, whether it is a full mouth procedure and something more localized, I will still ask you to go on a liquid diet for three days followed by a soft mushy food day for seven more days. For a total of ten days, you are asked to modify what you eat. In addition, I will ask you not to brush or floss the treated area. For a full mouth procedure that is no brushing or flossing full mouth. For a localized procedure, you can certainly continue routine care in untreated areas.
Why the request? Because the laser, during the procedure goes through two passes – on two different settings. The first setting is the bacteria kill setting. This comes before the mechanical cleaning of the roots. The second setting is a blood warming setting. In other words it is not cautery. It is not burning blood vessels to stop bleeding and in the process kill cells, it causes a more rapid coagulation of the blood in the pocket – which then seals the pocket preventing bacteria from recolonizing as before. This buys your body time to heal absent bacteria – and this is what results in the amazing results we find months later.
So at first, it sounds like a hassle, but on the other hand, it results in a more comfortable recovery because you are not mechanically moving the gums around the teeth and opening up pockets – by chewing solid foods or brushing and flossing – for a total of ten days. Instead, I will have you on an antibiotic and a mouthwash that will take care of the bacteria.
After ten days, you can return to routine brushing and flossing (gentle – read my book) and normal foods.
At three months you will have a light overall professional cleaning – this can be accomplished by the dental hygienist in the comprehensive dentist’s office. After six months I will go in a gently evaluate pockets so we can finally learn what has been the result of the laser assisted procedure. Let me say, however, that I am well aware of many who are waiting even longer before probing. This can certainly work but I am of the opinion that we need to move into the supportive care phase sooner than later after LANAP.
I think this is enough for now – but if you would like to hear the results of patients I have treated, take a look at a YouTube video I made where I go over the charting results – before and after – it’s quite remarkable. I will have a link to this video in the show notes below. Also, let me encourage you to go back and check out my website if you have not in a while.
It has been updated with the podcasts accessible more by topics. For example, this podcast will soon be found under the Periodontal Treatments with Laser Assist Tab.
This has been The Perio Patient Podcast and I am still Dr. Ben Young. Thanks as always for listening.
If you have questions or comments, please send them to me through the comments section below this episode wherever you listen to this podcast. And please, if you find this helpful, give the podcast a 5 star review. This is how you help me connect with more people who may benefit from my services. And thank you to all of you who let me know you are listening when you come in for your appointments. I really appreciate it.
Have a great day. Bye for now.