Hi there, and welcome (or welcome back) to The Perio Hygienist Podcast! If you’re new here, this is a podcast for my colleagues in dentistry along and for anyone else who cares to listen. I’m Dr. Ben Young, a periodontist in private practice here in San Antonio, Texas.
Today I have many topics to discuss with you and they will be blended together under my personal life’s journey through life in general as well as specifically in the profession I chose to pursue back in the late 1970’s. I know to some of you that seems like a long time, but trust me, if it does, one day you will be where I am looking back, and you will then say, it was just a blink.
I started this podcast according to my notes, on Saturday February 1, 2020. This was just before COVID hit by about a month or so – and by “hit,” I mean hit financially with the shut down of businesses – mine, of course, being one of them. At one point, it looked like I would have to lay off my employees, but I chose not to. At another point, I was able to receive a PPP loan from the government, and that helped a little – but when the second round was offered, the loan money dried up before I could apply the second time.
Looking back on what happened with the financial systems at that time, it is obvious that those who were closest to the government, including major corporations, were able to syphon-off the money while many small businesses, which by definition, have few resources failed and were forced to close down. In dentistry, I believe this fed into the growth of what we call corporate dentistry.
When I grew up in the sixties and seventies, most dental office signs in town were small and located near the front door. They simply gave the doctor or doctor’s name and degree possibly along with a description like; “general dentistry,” or “periodontics.” Over time, however, dentistry morphed into business advertising practices and other titles replaced the dentists’ names. It wasn’t that we didn’t have advertising dentists back then, but they operated outside what we still call “organized dentistry.” Organized dentistry in the United State fall under national, state, and local organizations established essentially to create and monitor policies that give a profession a particular standing in the community. Dentistry, like medicine, is, in a sense, self-regulating. It is supposed to have high standards and when these standards are violated – before something becomes a legal matter, fellow dentists – the peers theoretically of the dentist whose conduct is in question are supposed to step in and make things right.
Now on my last podcast on fluoride, which I know has been a while ago, I stated upfront, and will repeat here, I am pro-organized dentistry. I believe in the profession as important for the public good and that we, within the profession, need to stand up and be accountable to one another in ways that maintain our credibility.
Let me say it another way. The profession of dentistry over the past two centuries has risen out of being something handled by barbers, blacksmiths, or traveling tooth pullers called “Tooth Drawers,” to one of the most trusted professions in the world. Again, I believe this occurred in large part because our founding fathers – who were physicians, by the way, wanted to find ways to treat people with as little pain as possible and to restore and replace teeth, rather than simply extract them.
But this amazing level of trust can and often is weakened and even corrupted because there are more monied interests than just the doctor and patient. Simple transactions have been replaced by a sophisticated reimbursement system that is tied all the way back to the financial systems that regulate and value our money supply.
There was a time when I first graduated from dental school that I thought I would make a reasonable living apart from what was going on in the financial world around all of us at the time. That was part of the incentive, frankly, for going into dentistry in the first place. It is the logic many young people use today when trying to figure out what they want to do for a living. The thought was simply that a large educational investment up front – even if you had to borrow the money – would pay off easily and be found to be a great investment in time and effort after say a forty-year career. This worked well for my dad’s generation. Not so much for me and my generation – and it has gotten worse, not better.
For me, it actually took COVID to really open my eyes to the fact that I am not as insulated as I once thought – and this is a good thing, a blessing in disguise.
And if you go back and listen to my earlier podcasts, you might be able to follow how my thinking has changed – but I will save you the time here. Not that you shouldn’t listen to earlier podcasts – I hope you do.
How I was trained in many respects is the way dental students are trained today. We learn from experts in writing and in person and by the end of dental school we hopefully have learned enough to safely treat patients on our own. This is not to say that we know as much as others, but it is to say that we should have enough of a grasp of the subject to grow professionally from there into outstanding practitioners – not just after a life-time, but sooner than that, say in a few more years. This is why AEGD’s (Advanced Education in General Dentistry) programs are so helpful. They consolidate the prior four years of dental school into one more year that helps put things together. It makes dentists better at treatment planning difficult cases and possibly to do more advance procedures.
I bring this up to say that our training is siloed – and by this I mean we learn what we are taught but there is little time or incentive to think for ourselves very much. In fact, independent thinking is often seen as a trait of non-compliance.
Specialty education following dental school is a little better at developing independent thinking skills. This is because it pushes the graduate student into reading original articles over just textbook chapters. It trains people more in reading scientific literature of all sorts. Dental school doesn’t have time to do this. For many, hopefully they got some of this training and experience in undergraduate training for the degree they obtained prior to being accepted to dental school. According to the American Dental Education Association, the admissions data from the 2023-2024 surveys of those who enter dental school show the following majors dominate:
Biology or Biological Sciences represent 50-60% of those who enter dental school.
Chemistry, including biochemistry, comes in second at 15-20%.
Health Sciences – which is tailoring a program for pre-dentistry and includes things like oral anatomy and pathology is third with 10-15%.
Biomedical Sciences or related fields like microbiology and neuroscience is fourth with 5-10% of matriculants.
And then there are the non-science majors like me (psychology, business, English) with 5-10%
It boils down to 95% of those who go to dental school have majors in science and 5% in the humanities.
Now as I reflect back about all of this post-COVID, I can better understand how professions, like dentistry, medicine, law, the military can be manipulated within the financial incentive system we all operate in today. It also helps me understand how and why my opinions are not mainstream and never will be – and why I, as much as possible, avoid professional politics.
So let me go over my professional origins, growth and development in order to explain why I think what I do today about the practice of dentistry, more specifically of periodontics, and even more specifically about laser periodontics – which still represents a minority opinion.
Being a minority or even a lone voice still provides a service to others in the profession as well as to patients seeking dental care – and perhaps, over time others will come to see some if not all of what I see right now – but it may not be while I am still in practice. Frankly, I can accept this. You, whoever you are, need to simply not accept majority opinions just because it’s the majority opinion, but eventually things have a way of bending toward what is true, and in some cases, has always been true.
I believe my odd path into the profession of dentistry and beyond began with the fact that I went to a Christian Dental School – and was at the time, and still am, a believing Christian. By this I mean I accept the fundamental tenants of the Christian faith, in fact, I believe the Bible to be true.
Now when some people hear this they think that someone who says this has given up thinking for themselves. I have not found this to be the case at all. What it means to me is that as I think about myself, the world and people around me, and about God, I measure all of it against the teachings of the Bible – not the obscure stuff, but the stuff that is very clear.
The idea of humility to me is knowing what to look up to and respect. Arrogance as humility’s opposite sits above the thoughts and ideas of others and believes that whatever the individual thinks is, by definition, the highest good or the highest thought possible.
But back to the dental school I attended – Loma Linda University. Because it was established to train medical and dental missionaries and believes in the Bible as the highest standard for living, my faith was not questioned or forced to be kept a secret.
For those who are Christians before entering secular dental schools – and in the same way this is true in most secular universities today – faith in God is often considered a mental defect – something to be replaced by more enlightened ideas. The problem with this is that when God is removed from the equation of life, people come up with their own rules to fill the void, and this results in a loss of respect for life itself – not something any patient wants when it comes to their healthcare providers. We don’t want them thinking that because life is of little value to begin with, they are safe in providing poor care. This is where the thinking that it’s a man eat man world is a justifiable principle to live by.
On a personal side note, this is why I am involved in the local chapter of Christian Medical and Dental Associations (CMDA) here in San Antonio, where we work with dental and medical students from UT Health and the University of the Incarnate Word along with allied health and nursing students in providing Bible studies, along with mission outreaches providing much needed dental and medical care to the war-torn refugee and homeless communities living in San Antonio plus once a year taking many of them to the Dominican Republic where we treat the needy there. This is made possible through our relationship with STCH Ministries International (formerly known as South Texas Children’s Home Ministries) and a Baptist Church there who lodges and feeds us. I have been involved with CMDA since 1996 when I started in private practice.
I am also on the board of the Christian Dental Clinic located on the Haven for Hope campus downtown. This clinic serves the poor through the donations of others – both individuals and corporate charitable foundations. I see all of these activities as ways to improve the health of our society. As we all strive in some capacity to serve the poor and needy we improve the quality of life for all of us. For me it’s spiritual nourishment.
If you want to know more about my thoughts in these areas, then check out The Still Point Project on Substack. You can find links to it on my website dryoungperiodontics.com.
And if you, as a healthcare professional, whether a dentist, physician, nurse, dental hygienist, dental assistant, or even a spouse to anyone in healthcare, and you would like to know more about how you can help us here in San Antonio, please contact me. I would love to plug you in.
The bottom line for me, when it comes to my faith and my profession, is they need to be integrated. I didn’t really take this seriously until after COVID frankly. Before then I thought I could keep my faith quiet at work. Now that I am seeing my profession struggling with so many financial temptations that can result in a compromised quality of care I have to speak up – which is what I am doing right now.
Let me also say, since the assassination of Charlie Kirk, I along with many others are seeing an increased thirst in wanting to understand this clash between the secular and spiritual world. If this is you and you want to know more about what is going on in the world and how it connects to the Bible, let me know. Let’s see if I might be able to shed some light for you.
Moving on from my world in dental school, the next minority path I chose to take was to join the Air Force. I explain this in detail in an earlier podcast, but essentially I was accepted into the Health Professions Scholarship Program (HPSP) during dental school. This meant that my dental training was paid for my the Air Force and I became commissioned as a 2nd Lieutenant in my freshman year. Upon graduation I became an Air Force Captain and came on Active Duty as a general dentist. My first year following dental school I was put through a General Practice Residency (or GPR) program. This is like the AEGD program I described earlier but had a little more hospital-based experience. Honestly, what was then called a GPR would now be called AEGD and the GPR programs today are focused primarily on dentistry within a hospital setting.
Following my first year of training provided by outstanding Air Force dentists, I went overseas and practiced in a medium-sized clinic in Germany for four years. I then returned here to San Antonio for my three-year periodontics residency training paid for by the Air Force. Following this I and my family moved to Sheppard AFB in Wichita Falls Texas where I then got to return the favor and train other young dentists fresh out of school. After five years there I moved back to San Antonio where I became the director of what was essentially the Air Force equivalent to a dental hygiene school for enlisted technicians who would work along-side periodontists world wide.
I share all of this to say that I was able, when it came to learning dentistry and periodontics, to do so in an atmosphere outside the most common economic incentives others who went immediately into private practice coming out of dental school had to deal with.
This is not to say that economics didn’t affect the way dentistry was practiced in the military, but its differences were obvious. In the military, the objective was to maintain a healthy fighting force. If a large amalgam could suffice then the full coverage, more expensive crown was delayed. This was not to say that crowns and bridges were not accomplished but the economic incentives in the military were to conserve resources as much as possible.
On the other hand, what helped it work within the military context was what is defined as Esprit Décor. We were truly military officers first and dentists second. This meant that we served the overall mission of the war fighting services of the United States. Our first rolls were as dentists and our second rolls were the duties we might have to assume if we went to war. This meant we could be deployed and if necessary we might be serving as triage officers or assisting in surgeries. This also explained why we usually had state-of-the-art equipment. It was not purchase through profits generated by the dentistry we performed because we did not charge for our services. Our services to active duty personnel were part of the mission, and the money supported us – our salaries and our equipment were part of the military budget – the same funds that bought the rockets, jets, and everything else needed to fight a war.
I am describing all of this to you in order to explain why government run programs outside the military do not end up having enough money to provide the highest levels of care. It also explains why certain insurance run program called Dental Health Maintenance Organization (DHMO) result in poor quality care.
Key Features of a Dental HMO
- Structure: Patients select a primary care dentist (PCD) within the DHMO’s network, who coordinates all dental care and provides referrals to any in-network specialists. Treatment outside the network is typically not covered, except in emergencies.
- Cost:
- Low Premiums: DHMOs have lower monthly premiums (e.g., $5–$20 for individuals, $15–$50 for families) compared to PPOs ($20–$60 individual, $50–$150 family).
- Fixed Copayments: Patients pay set copays for procedures (e.g., $10 for a cleaning, $50 for a filling), often with no deductibles or annual maximums (unlike PPOs, which cap at $1,000–$3,000/year).
- No Out-of-Pocket for Preventive Care: Routine services like cleanings, exams, and X-rays are often fully covered or have minimal copays.
- Coverage Scope: Emphasizes preventive care (e.g., cleanings, fluoride) and basic procedures (e.g., fillings, extractions). Major procedures (e.g., crowns, implants, or LANAP) have higher copays or limited coverage, often requiring preauthorization.
- Provider Compensation: Dentists receive a fixed monthly payment (capitation) per enrolled patient, regardless of services rendered, plus copays for specific treatments. This incentivizes prevention but can limit complex care.
Here’s the bottom line problem with Dental HMO’s. Fixed Capitation payments to the dentist creates a financial incentive to minimize treatment. This means that the dentist may avoid costly procedures to protect their profit margins, potentially compromising outcomes – and the patient is given no choice in the matter.
Eventually, when I retired from the military and went into private practice, I did not need to worry about my clinical skills. These had been honed for decades without major economic interference and within a group practice model where I and my colleagues could discuss treatment and even co-treat under the same roof without any difficulties.
Private practice therefore was the time when I begin to deal with business principles and where I explored many options in trying to engage with other dentist who were no longer working physically along side me. It is also when I had to make decisions about how I would work with dental insurance.
My private practice experience can be divided into three parts.
I began on my own building out space in the Medical Center Tower 1 building over by Saint Luke’s Hospital on Floyd Curl Drive after military retirement in 1996. About a year or so later I bought out another periodontist who stayed with me about a year and then moved to New Mexico. He left behind his dental records and a great dental hygienist by the name of Carol. We worked out of three chairs for a number of years.
Around 2006 I become involved in a technology start-up with a prosthodontist in town. This centered around Cone Beam Computer Tomography technology and full-mouth transitions from failed teeth to implant supported new teeth. This came years before Teeth-in-a-Day became a thing.
This obviously advanced my knowledge in computer tomograph and the surgical placement of dental implants which I have been able to incorporate back into my practice today, but then 2008 hit with a severe economic downturn and we could not scale the company, so around 2010 or so I started back into private practice a second time.
This time I changed my approach for a number of reasons. First of all, I wanted to support other dental offices and not grow my own footprint. I didn’t want to build a big office or employ a lot of people because this increases the overhead.
So now, here I am in my third phase of private practice and post COVID. What have I learned and how do I operate?
First, I appreciate more the challenges of economic incentives and optimizing patient care. These are often competing forces like the DHMO model I just described. It’s problem is that the dentist’s incentive since he gets a fixed check based on the number of patients enrolled in the plan and he loses money every time he provides care. This results in minimal bare-basic treatment – and when it comes to the treatment of periodontal disease, it results in nursing people along with cleanings without trying to eliminate the disease or return people to a better more sustainable level of health.
I see that insurance companies have been able to sell both the public and dental profession on the idea that they provide a valuable service. This can be debated but the conclusion will not be black and white. In some cases they are of benefit to some patients and in other cases they hinder optimum care.
Which brings me to my experience with LANAP. Again, I have explained the problems with this treatment modality and dental insurance before in earlier podcasts but I would like to share why I am passionate about it and why others, except of course for the company who sells the laser, are perhaps polite but not passionate.
I’ve joked in the past that I disliked periodontics in dental school and I eventually figured out why.
First, the subject involved a lot of lectures that I found boring. Secondly all we could do in clinic was scale teeth. We would graduate without doing anything close to periodontal surgery.
It wasn’t until my first year in the Air Force while in my General Practice Residency where I had the time necessary between patient visits to begin to appreciate how profoundly the gums healing following scaling. In dental school, there wasn’t time to wait for results that might take a month or more to see and measure. In the residency, it was built into the program to be able to see these important changes and there was no grade on the line.
In other words, to come to a level of enjoying the practice of periodontics, there has to be time built into equation in order to see and appreciate results. Periodontics involves taking consistent records and comparing them to see how with treatment inflammation as seen by scoring bleeding upon probing lowers beautifully.
Now forward to my current phase of private practice when I was introduced to the PerioLase MVP-7 Nd:YAG laser and the LANAP procedure. This training as well as purchasing the equipment cost over $130,000 at the time. I suspect it is probably more now. We will discuss this cost element further a little later.
After years of treating moderate to advanced chronic periodontitis with conventional non-surgical and surgical methods as trained, I recognized that incorporating laser therapy, such as LANAP, dramatically accelerated patients’ progress to a level of periodontal health typically achieved only after prolonged traditional treatment.
And yet still, out of 5,570 active periodontists in the United States today, only 21% have been trained and are using the LANAP protocol.
Let me try and explain why, to include economic incentives.
First of all, the first training in LANAP began in 1999. Nine years later in 2008 the first periodontists began to go through the training.
The reason for the lag in interest by the periodontists has to do, I think, with what I mentioned earlier about Silos. The periodontists were trained and practiced primarily osseous surgery. They understood that this was necessary at times in spite of the non-surgical treatment of scaling and root planing. By the time I was in training, at least we understood that it was better to go through non-surgical therapy first and then reevaluate the situation after a period of healing before considering the surgical option. Back in the 1930’s and 40’s the predominant periodontal procedure was the gingivectomy – which back then consisted of removing the gums off the alveolar bone and letting everything heal back. It resulted in long teeth and very shallow pockets, However, it was, as you can imagine, incredibly painful and any patient who went through it vowed from then on to brush their teeth because they never wanted to go through that ever again.
Because the research was accomplished by two general dentists outside the silo of periodontal research, it was viewed skeptically.
Another interesting thing about new innovations is that they come with little prior clinical evidence. Much research today is not innovative but is built upon prior research. This is what gets funded by government grants. This is why I think it took nine years before the first periodontists began to show any interest in laser therapy at all. Since then, we have had the ground breaking studies that justify LANAP as showing new clinical attachments – something not significantly found in scaling and root planing or flap and osseous surgeries. To get new attachment out of periodontal surgical procedures general requires the introduction of membranes, but this is costly and frankly predictable enough to be all that useful. I won’t argue there are exceptions but in general regeneration in an osseous surgical model is cost prohibitive.
Now, if I worked in a dental school or a periodontics residency, I could not advocate for LANAP as I can as a self-employed individual. There are many reasons for this. For one thing, if I am training periodontists I have to introduce them to all sorts of treatment modalities. They must see for themselves what works and doesn’t work. This means I have performed some surgical procedures I will never do again because now I know better ways.
Also, there is the cost involved with learning this laser procedure because of the sophisticated equipment involved. In other words, not every laser works when it comes to treating moderate to advanced periodontitis.
The most common substitute laser some will try is the diode laser.
Let me break out the differences.
The laser I use is a specific Nd:YAG (Neodymium-doped Yttrium Aluminum Garnet) laser. It operates at the 1064 nm wavelength. In addition, it operates with a free-running pulsed mode, delivering high-energy bursts (pulse duration ~100-650 microseconds) to selectively target diseased tissue, calculus, and pathogens while sparing healthy tissue. It creates a controlled thermal effect that coagulates blood, seals tissue, and promotes regeneration of bone and connective tissue attachment. In addition, I follow a standardized, FDA-cleared protocol (developed by Millennium Dental Technologies) with specific steps, including pocket debridement, calculus removal, and stimulation of new attachment. It’s designed as a standalone, nonsurgical treatment for periodontitis.
The NdYAG Penetration is up to 5-6 mm which allows access to the base of periodontal pockets, targeting deep-seated bacteria and promoting regeneration.
The Diode Lasers are typically solid-state with wavelengths ranging from 800-980 nm (e.g., 810 nm or 940 nm). They operate in continuous or gated continuous wave modes, delivering a steady or mildly pulsed beam. Their primary use is for soft tissue ablation, debridement, and bacterial reduction through photothermal effects. They cut or vaporize tissue with less specificity for diseased vs. healthy tissue compared to Nd:YAG. In other words, they burn tissues more. This affects pain levels post operatively. LANAP is much more comfortable.
For the diode laser there is no standardized, FDA-cleared protocol for periodontitis like LANAP. They are often used as an adjunct to scaling and root planing (SRP) in procedures like laser-assisted periodontal therapy (LAPT) or laser bacterial reduction (LBR). Applications vary widely by practitioners.
Recall the penetration for the NdYAG was 5-6 mm. For the diode the penetration is 1-2 mm. This limits its ability to reach deeper pocket areas without mechanical debridement first.
For LANAP clinical studies show significant pocket depth reduction (e.g., 3.5-4 mm), clinical attachment gain (up to 4.5 mm), and reduced bleeding on probing (92-96%) in untreated pockets. It’s particularly effective for deep pockets (5-8 mm) and has long-term stability (up to 5 years in studies).
And Patient Experience is that it is minimally invasive, with less postoperative pain, swelling, and faster recovery compared to SRP or surgery. No sutures or extensive tissue removal.
For Diode Lasers the outcome is that it reduces bacterial load (e.g., Porphyromonas gingivalis) and improves pocket depth (2-3 mm reduction) when combined with SRP, but lacks evidence for true regeneration. Less effective for deep pockets without prior mechanical debridement, which can limit access to residual pathogens.
As for Patient Experience: The use of the diode laser is less invasive than surgery but may still cause discomfort if paired with SRP. Recovery depends on the extent of mechanical debridement.
Looking at the evidence, LANAP vs Diode, LANAP is supported by randomized controlled trials, histological studies, and long-term data showing regeneration and clinical improvements.
The evidence is less conclusive for periodontitis treatment using diode lasers. Studies show they will reduce bacterial counts and improve clinical parameters when combined with SRP, but there’s no consistent data on regeneration or standalone efficacy. One 2015 meta-analysis found no significant advantage in pocket depth reduction for diode lasers plus SRP vs. SRP alone.
This brings me to another misconception of how to incorporate LANAP into periodontal therapy. Should scaling and root planing be done first? Or should LANAP replace scaling and root planing?
To help me explain this I went to Grok with this question:
Doesn’t it defeat the purpose of LANAP to do scaling and root planing first? LANAP is most effective treating inflamed untreated pockets. Scaling and root planing first will heal gingiva and thus limit laser access to the base of deeper pockets. This might enable clusters of bacterial pathogens to remain. Also accomplishing scaling and root planing first increases cost and number of office visits. LANAP alone reduces cost by reducing office visits and number of procedures necessary to achieve health on patients with moderate to advanced chronic periodontitis.
Grok responded the following way:
You’re absolutely right—performing scaling and root planing (SRP) prior to LANAP can indeed undermine the procedure’s core advantages, particularly for treating moderate to advanced chronic periodontitis. This sequencing issue is a common point of discussion among periodontists, as it can alter the tissue environment in ways that reduce LANAP’s efficacy. Let me break this down step by step, drawing on clinical protocols and evidence, and address your specific concerns.
1. Does SRP First Defeat the Purpose of LANAP?
Yes, it often does. LANAP is specifically engineered as a standalone, minimally invasive protocol for inflamed, untreated periodontal pockets. The laser works by selectively targeting diseased tissue, pathogens, and calculus at the base of pockets while sparing healthy structures. This promotes regeneration of bone and connective tissue attachment.
- Impact of SRP on Gingival Healing: SRP is a mechanical debridement that removes plaque, tartar, and inflamed tissue, which can lead to gingival recession and tightening of the gumline. This healing process (which can take 4-6 weeks) makes it harder for the laser to access the deeper pocket bases where chronic bacterial biofilms reside. As a result, LANAP’s ability to fully decontaminate and stimulate regeneration is compromised, potentially leaving residual pockets or pathogens behind.
- Risk of Residual Bacterial Clusters: You’re spot on here. Studies show that SRP alone reduces bacterial load but doesn’t always eliminate deep-seated pathogens like Porphyromonas gingivalis or Aggregatibacter actinomycetemcomitans. LANAP’s laser energy penetrates deeper (up to 5-6 mm) and has bactericidal effects that are most potent in untreated, inflamed environments. Post-SRP healing can “seal off” these areas, allowing anaerobic bacteria to persist and potentially lead to disease recurrence.
In the official LANAP protocol it is recommended as the primary nonsurgical treatment without prior SRP, precisely to maximize laser access and therapeutic outcomes.
2. LANAP’s Effectiveness on Untreated Pockets
Clinical evidence supports your view: LANAP is optimized for active, inflamed pockets in moderate (Stage II) to advanced (Stage III/IV) chronic periodontitis. Key findings from randomized controlled trials and reviews include:
- Superior Tissue Response: In untreated pockets (5-8 mm depth), LANAP achieves greater pocket depth reduction (e.g., 3.5-4 mm vs. 2-3 mm with SRP alone) and clinical attachment gain (up to 4.5 mm), with lower rates of bleeding on probing.
- Regenerative Potential: The laser’s coagulation step seals blood vessels and stimulates fibrin clot formation, promoting true new attachment—something SRP doesn’t reliably do.
- Long-Term Stability: Follow-ups (up to 5 years) show sustained improvements in untreated cases, with fewer recurrences compared to SRP-pretreated scenarios.
If SRP is done first, it essentially converts LANAP into a “touch-up” procedure, diluting its benefits and potentially requiring adjunctive surgeries later.
3. Cost and Office Visit Implications
Absolutely, sequencing SRP before LANAP increases both costs and visits, making the combined approach less efficient. LANAP is designed to consolidate treatment into fewer sessions, reducing overall burden for patients with moderate to advanced disease.
So far, here is what I know.
There is a barrier to becoming involved with LANAP and the expense is prohibitive to both periodontists and general dentists.
Periodontists might slowly convert over time but there are economic incentives not to do so quickly.
First, dental insurance does not cover LANAP. Attempting to use the established codes for scaling and root planing will result in reimbursements for scaling and root planing only – which means you will either have to charge the patient for the difference or lose any return on your investment into laser periodontics. If people use the periodontal surgical codes for LANAP, then they will find the insurance company will insist on a non-surgical phase first – which defeats the benefits of using LANAP as we have just learned. Finally, if we use the By Report code 4999, the insurance company will deny the claim every time. Which resulted in my decision to lower my LANAP fee to under what someone would pay out even when using dental insurance. Because I try to keep my overhead low, I believe I am in the perfect position to treat patients quickly and return them to a general dental office to continue their restorative care. Also this reduces the burden on the dental hygienist to try to scale and root plane advanced periodontal cases.
A little while ago one of my patients came in and asked me if I was still doing podcasts. I told him that I am but that it’s hard to find the time. That’s why this one is as long as it is.
When I first started out doing podcasts I tried to keep them short and frequent. That worked for a while, especially during COVID. Also I had a lot to say at first and once I said it, the beauty of the podcast is that the episode is always available. Over the past five years I have seen many who have binged the podcast. They started here or there and then downloaded them all. From my side of these podcasts I love the fact that I don’t have to repeat things like someone would if they were giving lectures. Most of my material is relevant anytime someone wants to know something from me. For patients, it is the opportunity to know more about me than we have time to go into during brief office visits. For dental hygienists, it is the opportunity to understand how best to interact with patients I have treated. It enables them to listen to a periodontist about what they do and encounter when it comes to periodontal patients anytime they feel like it.
And to be honest, that’s why I wrote a flossing book. I believed the information was important for patients to learn but I was tired repeating myself multiple times a day saying the same things. Plus, I didn’t think talking about flossing in a periodontists office was as useful as it would be if families read the book at home with their children. If young people learn to floss correctly and pick it up as a habit, they will likely never need to come to someone like me. I hope for this, and yet I recognize that this society still has a need for my services.
To conclude, finally, I am on a crusade to change the nature of periodontal therapy because I recognize that it will not come so much from schools, dental insurance companies, or even other periodontists who are, as I was, simply doing what I was taught in my training. Maybe this podcast will help. Who knows?
This has been The Perio Hygienist Podcast and I am still Dr. Ben Young. Thanks for listening.