Q: I had all my gums grafted 6 weeks ago and just started have a bad taste in my mouth. I had 6 weeks of antibiotics.

A: You had all your gums grafted 6 weeks ago? Did you have bone grafts? Soft tissue grafts? Why were you on 6 weeks of antibiotics? Did you have any oral infections during this time? Do you have a periodontal packing in your mouth? Are you under the care of a qualified periodontist? Did you have any post-operative visits? The taste could be related to an infection in your mouth, or medications that you are taking. I strongly suggest you follow up with your periodontist as soon as possible to find out the source of your “bad taste”.

Q: I had the LANAP procedure done in November and am completely happy with the results. My doctor did some grinding to correct the way my teeth “fit” together, not just the bite, but the width of the six front upper teeth. I have been wearing the retainer as instructed and was told that I could just wear it at night now. My problem is that after a couple of hours there is a noticeable gap between my two front teeth, so I wear the retainer almost all the time. Will this problem resolve itself or is there something else that needs to be done?

A: You might want to have some of your teeth evaluated for bonding/splinting to retain the teeth twenty four hours a day in the correct position. I would suggest discussing this with your periodontist in more detail.

Q: I know one needs to wait 6 months after LANAP laser surgery before probing, but how long do patients have to wait after LANAP before they can get routine cleanings done on their teeth? Thank you!

A: We wait 12 months to probe. We are always cleaning our patients supra-gingivally (above the gum line) throughout the post-operative period. As needed, we will instrument sub- gingivally after 3 months.

Q: How do you handle severely fearful or phobic patients?  Is it possible for the first visit to be just to meet the Dr. and discuss the issue up front rather than having an examination?

A: Yes. We can discuss your situation if you like and perform the examination another day or even that day IF you feel comfortable. There is no pressure. We will be in a relaxed and non-threatening environment.

Don’t worry.

Please speak to my staff when you call and mention this response.

Best,

Dr. Eric Linden

Q: Gum Attachment: Healing of the gum may occur within a few days. Does this mean that there also will be complete attachment of the gum to the tooth root in this period of time? In addition, where there was a 7mm pocket depth, when would ligament formation be expected to be completed, in most cases?

A: If you are referring to epithelial attachment in the absence of a long junctional epithelium, then this could take weeks, months, and in some cases years.  We also might get incremental attachment (connective tissue) over time as well. This is based on human histological studies already completed and our clinical cases over the last 7 years.

Our clinical cases have shown radiographic regeneration with an intact lamina dura in as little as 3 months, and we also have cases that, over a period of several years, continue to show bone changes ultimately leading to an intact lamina dura with bone fill. We know we have reached our limit when we see an intact lamina dura.

It is impossible to know the exact histological changes that occur without taking block sections on our patients, but the current evidence shows changes histologically as early as several weeks.

Are you a periodontist or doctor?

Q: LANAP: The regeneration and healing time, of course, differ among patients. In your experience, what is the time range for complete healing around tooth/teeth?

A: From the patient’s perspective, the healing from laser periodontal surgery is rapid, virtually painless, and takes only a few days. From a bone regenerative perspective, bone growth continues for several years after the laser procedures are performed and followed up with close maintenance and occlusal adjustments as needed.

Q: I am having a bridge replaced and having LANAP done. Should I have the bridge replaced before or after LANAP? Thank you so much!

A: I would suggest you consult your Periodontist regarding the bridge situation. This should have been discussed at your consultation visit. However, most of the time we have the teeth temporized before we have the restorative dentist place the final bridge. Also, please check to see if you need crown lengthening. This is not part of the LANAP procedure.

Q: I was told I need conventional gum surgery for 6mm pockets. I had double hip replacements a year ago and am concerned about the potential effects of the gum surgery. Amoxicillin will be prescribed for before and after, but he won’t use the laser, as he said the disease is down to the bone. Wouldn’t laser be better with my hip replacements?

A: We try to utilize laser periodontal surgery whenever possible. (Yes…it would be a more desirable method to treat your gum disease.) We routinely use the laser to treat patients who have prosthetic hips, knees, and other prosthetic body parts. Additionally, we follow the antibiotic guidelines to cover our patients to avoid any post-operative infection. We treat the bone with the laser so we are not concerned about any of the issues you have discussed.

Q: How much does LANAP surgery cost and is that the best solution for gum disease?

A: The best solution for the treatment of gum disease is based on an accurate diagnosis, comprehensive examination, and review of a quality set of digital x-rays. The course of treatment can only be determined by examining the patient. The cost of treatment varies from patient to patient and according to the severity of disease. When possible we utilize the laser approach (including LANAP), but it is important to note that we often combine different modalities of treatment customized for each patient. Treatment fees would be discussed at the consultation visit.