Nearly 20 years ago Renata Jastrem of St. Petersburg went to a periodontist to have her gum disease treated. He cut open her gums with a scalpel so he could scrape her teeth clean and remove pockets of infection. Then he stitched her gums together and sent her home to heal, warning her to keep food out of the wounds.
"I was out of circulation for a week just because of the bleeding," she recalled.
Her gum problems gradually returned over the years, and she recently went to Dr. Robert J. Yu, a St. Petersburg periodontist, to repeat the ordeal.
Instead of surgery, Yu suggested doing the procedure with a thin laser, barely wider than a copper wire, which he would slip between her gums and her teeth. With the laser he could accomplish everything he could do with traditional surgery, he said.
He could kill bacteria growing below the gum line and remove their by-products, a hard substance known as calculus that clings to the teeth and contributes to the inflammation typical of gum disease. He could remove any diseased gum tissue while leaving healthy tissue alone. There would be little bleeding or pain, he told her, and no stitches.
"I was a little skeptical," Jastrem says, "but I decided to try it on one area where there was bleeding and infection. After a few hours, when the Novocain wore off, there was no pain, no bleeding. For me it was a piece of cake."
Laser gum surgery sounds too good to be true, which may be one reason periodontists have been reluctant to adopt it. For another, the equipment is very expensive, and the long-term results have yet to be documented by rigorous scientific studies.
Yu was skeptical at first, but once he tried the new technique, he decided it was the future of periodontal treatment. "It was hard for me to believe it, but now that I see the results I'm converting my practice to laser surgery," says Yu, one of several Tampa Bay area practitioners performing the procedure. "This protocol has revolutionized periodontal surgery, but only recently have periodontists started to grasp what this means."
The protocol Yu has adopted involves equipment developed by Millennium Dental Technologies of Cerritos, Calif., founded in 1994 by two dentists, Robert Gregg and Delwin McCarthy. Their PerioLase, a laser designed for soft tissues, was approved by the FDA in 2001, and it is used for treating infected gums with the laser-assisted new attachment procedure, known as LANAP.
"Patients are jumping on board," says McCarthy. "The challenge comes with those periodontists and dentists holding to the traditional technique, which has been taught in dental schools for decades. All of the research and study has been aimed at making traditional surgery the standard of care. To have a couple of upstart general dentists like us come into specialist organizations and tell them to try this . . . well, they've tried to marginalize us."
McCarthy contends that LANAP is not merely as good as traditional gum surgery, but far better. Gum disease gradually causes teeth to loosen because infection and the accumulation of calculus separates the teeth first from the gum and then from the bone in which they're rooted.
Recent research, according to McCarthy, shows that teeth cleared of calculus with the LANAP procedure actually grow a new layer of cells known as cementum on their roots, allowing the teeth to reattach to the bone.
"Ligaments hold the tooth in, and they have to be attached to cementum on the surface of the root," says McCarthy. "You can see that a new layer of cells has grown on the roots, and the fibers attaching to it are visible."
JURY STILL OUT
The dental establishment has adopted a wait-and-see position regarding LANAP.
"There's a lot of data — published studies with long-lasting results — that shows traditional therapy works well," said Dr. David Cochran, president of the American Academy of Periodontology. "Lasers are a new therapeutic approach, but the results are pretty poorly documented at this point, so I'll have reservations until I see more documentation. I don't think we're at a point where people think this will replace traditional therapy."
Dr. Michael P. Rethman, chairman of the American Dental Association's Council on Scientific Affairs, also would like to see more evidence on the safety and effectiveness of LANAP.
"I take no joy in getting in the way of new technology," he says. "I am biased toward new technology, but it's important that what is prescribed for patients has good scientific backing. The makers of the LANAP laser have done preliminary scientific studies, but they're preliminary. I wish there was more."
In addition to resistance from the dental establishment, the cost of the LANAP equipment and the training that Millennium requires — about $70,000 plus air fare to and from Cerritos — has cooled enthusiasm for the procedure among dentists and periodontists.
"Most dentists can't even dream of purchasing something like that," said Yu. "The rate of return they're going to see is not going to be high enough to justify buying it unless they're doing (LANAP) on a daily basis."
Millennium has been selling slightly more than 200 units a year and has trained more than 1,000 practitioners to use the system, but McCarthy believes sales will increase as more patients hear about the new procedure.
"The patients see what this is all about and they get it right away," he says. "It's the practitioners who are the stumbling block."
Dr. Gregory G. Langston, the first periodontist in St. Petersburg to install Millennium's LANAP equipment, has been praising the procedure since he began performing it a year ago.
"I love the results," he says. "The treatment is minimally invasive, requiring no incisions and no stitches. It allows us to treat our patients with much less discomfort, and dramatically shortens recovery time. Patients can go back to work the same day or the next day."
Renata Jastrem says she was delighted to learn during a recent followup visit to Dr. Yu that her swollen gums had shrunk and looked very healthy.
"I have had no problems at all," Jastrem said of the procedure. "My gums are much, much better than before — nice and tight and healthy — and I have never experienced any pain. It's wonderful — I've had no problems whatsoever."
Tom Valeo is a St. Petersburg writer specializing in health and food. He can be reached at firstname.lastname@example.org.