Q: I am 25 and have found out I have juvenile periodontitis. I’m presently in Montreal Canada and you seem to be the nearest dentist to me who does the LANAP procedure. I’d like to get some more information on LANAP and also would like to know what a consultation entails before I make the drive to your facility.

I welcome hearing back from you.

A: We have shifted our approach to treating juvenile periodontitis away from aggressive traditional surgery (which we performed for over 20 years with reasonable success) to the laser approach. The laser surgery results in our office have been extremely successful and the procedure is certainly more patient-”friendly” than older procedures which involved cutting and sutures. Please see our web site for more information on laser surgery. We usually perform laser surgery in one appointment.

We would need to do a clinical examination, review your medical and dental history, take a set of quality digital x-rays, and put together a custom treatment plan for your situation. If you are traveling a long distance to our office, as many patients do, and we determine that you need laser treatment, we will try to schedule it the same day or early the next day for your convenience. If you have a current digital full mouth series done in Montreal and have them emailed as JPEG attachments, then we would review them in preparation for your visit. This may shorten your initial consultation and help us properly schedule your actual treatment.

For more information, please call our office and we can help you and answer all your questions.

Q: How would a periodontist determine whether I might be a candidate for laser gum surgery?

A: By conducting a thorough clinical exam and reviewing a quality full mouth series of low exposure digital x-rays.

Q: How to stop bleeding gums?

A: It’s also called gingivitis. If x-rays and a clinical exam confirm that the cause is soft tissue only, it can be reversed with good home care – flossing, brushing, and a good professional cleaning. If the cause is periodontitis – bone loss underneath the gum tissue – that has to be treated with the laser or other modalities. Depending on the severity, laser treatment might be able to reverse or at least stabilize the situation and regenerate new bone. We can also use the laser at an earlier stage to prevent the disease from going into an advanced stage.

Q: How effective is ARESTIN® in treating gum disease?

A: ARESTIN® is a powder like antibiotic that we used to place underneath the gum tissue. For many years our office used almost every injectable antibiotic product that seemed reputable and available, but we had to repeat their use every two or three months. We don’t need to do that anymore because of the laser protocol. The laser takes care of the infection and regenerates the bone.

Q: Generally speaking, is there a pocket depth beyond which LANAP would not be of clinical value?  For instance, if I had an 11 mm pocket, would LANAP be able to reduce it?

Also, does your office provide any form of sedation for the anxious patient, or would one have to get that from their primary care physician?

A: LANAP and our customized laser surgeries cover a wide range of periodontal issues. We have treated teeth with 3-15 mm pocket depths. There are a number of factors that are considered when suggesting a procedure (too numerous to explain here). Each patient is evaluated and given all their options. We always attempt to treat in the least invasive way possible.

We use oral sedation in our office. You would have to be escorted by someone to and from the office.

Q: First, a big “thank you” for hosting a forum like this to answer all our questions . . .

Can LANAP be done on a “site specific” basis, vs. doing it in “quadrants” or “full mouth”?

And, are the results permanent?  That is, if one maintains a proper home cleaning regimen, will the bacteria re-populate?  (I ask this because I’ve repeatedly read that there is “no cure” for gum disease.)

A: >Can LANAP be done on a “site specific” basis, vs. doing it in “quadrants” or “full mouth”?

Excellent question. If the full mouth protocol is followed precisely, then it is considered LANAP. Full mouth is usually indicated when there are several areas around the mouth that show disease. We do our full mouth LANAP cases in 1-2 visits maximum. They are usually completed within 7 days. Most of our patients have the LANAP done in one visit and that seems to work very well.

If we are treating an isolated periodontal area of breakdown and the rest of the mouth looks perfect, then we would call the procedure “Localized Laser Periodontal Surgery”.

>And, are the results permanent?  That is, if one maintains a proper home cleaning regimen, will the bacteria re-populate?  (I ask this because I’ve repeatedly read that there is “no cure” for gum disease.)

As with any periodontal procedure we have done over the last 26 years, our goal is to stabilize the disease. If home care and professional maintenance are followed, then the odds are very high of retaining your teeth and periodontal health. We have been maintaining our patients for over 26 years and the people who followed our maintenance schedule have fared very well. The same has been true for our laser cases. In fact, the laser cases seem to do better than our traditional surgery patients. We even see this improvement 3-5 years post op. Bacteria are always present in healthy gingival crevices in normal or healthy gum tissue. If the tissue becomes diseased, the bacteria shift over to the destructive type which can cause the disease to become active again. The concept is to eradicate the disease and prevent it from another burst of activity.

The laser has been shown to be our best preventative tool to date to get rid of the disease and keep it away.

Q: During my recent cleaning my teeth were probed by the hygienist and apparently there were 7mm pockets towards the back of the two molars adjacent to where my wisdom teeth are partially erupted. These are the only pockets I have and would have had my wisdom’s removed earlier if I knew there was such activity but my previous dentist missed it. I have read that is extremely common to have pockets due to wisdom tooth eruption, especially if they are impacted and are pulling the tissue away from the tooth. So my multi part question is :

1. Does a 7mm pocket next to an erupting wisdom tooth necessarily mean bone loss or is there a chance bone loss has not occurred yet? Trying to figure out whether 5mm+ automatically equals bone loss.
2. There is currently inflammation due to the impaction plus whatever else terrible is going on. Is it common for a pocket to appear 7mm in depth due to tissue inflammation.
3. What usually comes first? The wisdom tooth extraction or the adjacent pocket treatment?

As you can see I did a little research but I know my limits and am acknowledge I need best-in-class professionals on my side. Thanks in advance for your response.

A: It is common to have periodontal pocketing and inflammation between the wisdom teeth and the adjacent 2nd molars. Most of the time, there is bone loss present. Depending on the individual clinical situation and evaluation of x-rays, our first step is to decide if removal of the wisdom teeth is necessary. If it is, then we would extract the wisdom teeth first and then treat any remaining periodontal pocket issues with the laser.

Q: Dear Dr. Linden,

First of all I want to thank you for taking the time to answer so many people’s questions! I have found your site to be very informative. I am 32 years old and at my most recent cleaning visit the hygienist informed me that I have several 4mm pockets and one 5mm with some bone loss around the tooth with the 5mm pocket. I also had some cavities that needed to be filled. Needless to say I am a little scared about my dental health, so I started doing some research on periodontal disease and came across the LANAP procedure as well as other procedures for treating periodontal pockets. When I went back for my fillings I expressed my concerns to my dentist and asked if he would suggest that I seek further treatment. I was a little surprised when he told me I just needed to floss more often and that we should re-evaluate my condition at my next six month cleaning appointment. I have also noticed that after having my teeth cleaned I have a space between two of my lower incisors that was not there before. I know that you cannot possibly provide a diagnosis without doing an exam on a patient, but I just want to know if I should get another opinion on my situation. I have been seeing this dentist for a number of years and do trust him, but I just am very concerned with my oral health. I am afraid of the possibility of losing my teeth at an early age and want to be as proactive as I possibly can be. I have found a few dentists in my area that offer the LANAP procedure, and am wondering if this procedure could possibly be beneficial for treating/reversing early gum disease.
Thank you very much for your time,

Emily

A: Dear Emily,

I would recommend seeing an experienced periodontal specialist in your area to evaluate your condition. It is always better to be safe rather than sorry later on.

It would be desirable if the periodontist has been trained in the LANAP procedure and has had experience using the ND/YAG laser for a few years.

Best of Luck

Dr. Linden

Q: Can you cure a periodontal fistula?

A: A fistula is a hole in the gum with an infection (pus) in it. Sometimes we gently place a “gutta percha” point in the fistula – a rubbery material that’s used for root canal filling. It’s radio-opaque, so you can see it on an x-ray. This enables us to see where the fistula is going. If it’s going to the root of the tooth, it’s probably a root canal problem. If it’s going to the side of the root, it could be a cracked root (which the laser usually can’t treat), or gum disease. I had a recent patient with a fistula present. The front tooth had a deep pocket. I treated it with LANAP and I also went into the fistula with the laser at a reduced power setting. Periodontal fistulas respond very well to the laser. We have treated many of these types of infections with great success.

Q: Can LANAP surgery remove calculus?

A: The LANAP protocol includes the removal of calculus. The laser itself does not remove calculus. Calculus is removed with ultrasonic and various instruments.

Q: Can I have laser dental surgery during pregnancy?

A: Ideally, elective work should be done before the patient becomes pregnant if possible. Otherwise, we wait until after the pregnancy. But if there is an infection in the mouth, we have to take care of it, no matter what, with clearance from the patient’s physician. There is something called “pregnancy gingivitis”. If someone has preexisting gum disease and they get pregnant, it gets very much out of control. If treatment is essential, we prefer to treat during the first two trimesters, not the third. Cleanings from a trained Periodontist are recommended during pregnancy to avoid problems and infections. Laser treatment can be done as well.

Q: At 84 years old and with periodontal disease for the last God knows how long now, spent $4,000 in the eighties to resolve it, but it came back. Now I’m afraid I might have to leave my right arm at the D. M. D. M. S. D. And at this point of my life, when most of my money, it seems, is tied up in China, what should a Vet do?  Wait until my teeth start falling out, and make a necklace?  And not only that, you’re in NJ & I’m in PA. Just my luck. Hesh

A: Dear Hesh: Before you make a necklace, let me try to save some of your teeth. We treat people from all over the world. PA is right next door to us. Don’t give up hope.

Q: Will I have gum recession after the laser surgery?

A: Laser surgery does not cause any recession of the gums around the natural teeth or crowned teeth.

Q: Is it OK to go swimming after periodontal surgery?

A: I wouldn’t recommend it. If I use the laser, I would prefer that you wait a couple of hours before being under water, or getting water in your mouth.

Q: I recently had LANAP procedure. Now they want me to get a fitted teeth guard or tray. I am 70 years old and have never had a problem with grinding my teeth. Do I really have to have the guard? I have trouble sleeping now and this will probably be flung across the bedroom at some point.

A: Since I am not the treating Periodontist in your case, I cannot make this professional judgment. However, I can say that night guard therapy is very common following the LANAP procedure. Please check with the doctor who did the LANAP procedure.

Q: I realize that everyone heals at a different rate, and can have markedly different outcomes, from a given procedure — all dependent on things like genetics, current state of overall heath, etc. But I am very curious about the pace, and extent, of post-operative results — be it Localized Laser Periodontal Surgery, or LANAP.

In other words, is it reasonable to expect a 9 mm pocket to “heal” into a 3 mm (or less) pocket?

And, would it (the destined level of healing) happen in a week, a month, a year. . . ?  Will healing time be linear (e. g. slow in the first 5 days, faster in the next 10). . . ?

A: There are many factors that determine the rate of healing that we don’t fully understand. We have many cases that have healed in a matter of months and some cases took up to 2-3 years to see significant healing and bone fill. In our periodontal laser practice, we have treated diseased pockets that have exceeded 10mm+ and have seen reductions down to 3-6 mm with radiographic bone fill. However, whenever we have teeth with extremely deep pockets (like 9mm), we always explain to the patient that the prognosis is guarded but we can possibly have success if the laser protocol is followed carefully and we don’t encounter issues in healing.

Q: I had laser surgery July 27th for a 9 mm gum pocket (with abscess). I went for periodontal maintenance cleaning yesterday- Oct. 13th. The hygienist found drainage at the site. I was told to gently swab the area with antibiotic rinse several times a day. Is this drainage unusual after this period of time?  I had not noticed any drainage or anything unusual prior to cleaning. Today the area is sore. Would like a reply on this drainage and I thank you.

A: From your description, it sounds like the area is draining again and perhaps the periodontal defect might require additional treatment. I would recommend an updated digital x ray to see what is happening around the tooth and bone. It is difficult to diagnose in this forum without actually seeing your situation. However, I would follow up closely with the treating doctor so he or she can make the appropriate decision.