November 2, 2020

Global Perspectives: Bringing the LANAP® Protocol to Puerto Rico

Frances Herrero, DMD, MS

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Marty Klein:  Welcome to Dentistry for the New Millennium. I’m Marty Klein, Training Manager at the Institute for Advanced Laser Dentistry. My guest today is Dr. Frances Herrero, a periodontist in Puerto Rico. Dr. Herrero graduated from the University of Maryland residency program and received her Certificate in Advanced Graduate Studies in Periodontology. Prior to that, she received her BA degree in biology and her Dental Medicine Degree from the University of Puerto Rico Medical Sciences campus, where she graduated top of her class. Today we’ll talk about her road to using the PerioLase MVP-7 for the LANAP protocol and the opportunities and challenges with bringing it to Puerto Rico as the first LANAP-trained clinician in the territory. Dr. Herrero, thanks for being my guest today.

Dr. Frances Herrero:  Hi, Marty. Thanks for having me.

MK:  So take me back first to when LANAP first entered your radar screen and tell me a little bit about the sequence of events that led you to becoming trained in 2019.

FH:  The first time I ever heard about LANAP was during my residency, not because we were trained on it, but because patients actually asked about it. One of these patients was a young, very good looking and sweet lady that was diagnosed at that time with generalized aggressive periodontitis. She was under 35, maybe 33, and she had around 50% of bone loss around all her posterior teeth. The thing is, after she met me, she told me she was going to visit another periodontist in the city to get a second opinion on LANAP. Because I didn’t know about this protocol back then and how it could have helped her, I didn’t encourage her to go through with the LANAP. Instead, she stayed with me in residency. She went through all the initial phase and then I did a couple of quadrants of resective periodontal treatment. Without a doubt, today I would have recommended the LANAP protocol on this young lady and any other patient that would have gone to the residency in her situation. Another experience that I encountered during residency was when my co-resident, Dr. Nika Guy, trained in LANAP the month before our graduation. Because she was associating with a LANAPer in South Carolina, she was highly recommended to get trained. It was a very fast-growing, highly successful treatment modality that patients were seeking in her area, and she really couldn’t go back home and have a successful practice without being able to provide LANAP. During her training, we realized that some schools were already offering LANAP training to the residents, and that if we didn’t do the training ourselves after residency, we could have stayed behind in technology. That’s something that neither of us wanted, right? So that was two very significant experiences I had during training. Then I was very skeptical, to be honest. I was not at all interested in lasers when we had classic literature or any presentations on lasers itself. It really wasn’t one of my favorite topics, but I was very intrigued when Dr. Guy did the laser training herself.

MK:  So you’re in Puerto Rico now, but in between residency and today you practiced in Cincinnati with Dr. Michael Toms, who is a LANAP-trained clinician. Can you tell me how you first became associated with him and how it was working with LANAP for the first time in his practice?

FH:  My husband had been accepted in a two-year fellowship program in Cincinnati, so I knew from the beginning of my third year in Baltimore that we were moving to Cincinnati after graduation. I didn’t know anybody in the Midwest, so I was a little concerned about finding a job. During my third year, Dr. Myron Nevins, a very well-known periodontist, visited my program and gave us a lecture on periodontal disease and his experience over the years. It was then when my chairman, Dr. Oates, asked him if he knew someone in Cincinnati that could offer me a job. Knowing that it was going to be part time because I had plans of becoming a mother, and for a short period of time because our plans were to move back to Puerto Rico after he finished his fellowship, my chairman, Dr. Oates, asked Dr. Nevins if he knew someone in Cincinnati that could offer me a job to which he said, “Yes.” He called Dr. Toms and explained how he had met a lady in Baltimore, and asked him if he was interested in hiring a recent graduate. Dr. Toms’ practice was very busy at that time, and he was actually thinking about hiring some help even though he had not started actively recruiting.  I was not trained in LANAP at that time when I started working for him in January of 2019. Before we moved to Cincinnati, we met for dinner in May. When I realized that he had great results with LANAP and he told me that almost 100% of his patients he treated with LANAP protocol, I became a little bit concerned about how I was going to be able to treat his patients, actually. It was okay. It was fine. I started working for him in January. Right away, I was evidencing with my own eyes and the probe the incredible results that his patients were coming back with: significant reduction in pocket, reduction in mobility, increase in gingival thickness and health right away. So, honestly, every patient that I started evaluating in his office, I recommend LANAP. Even though I couldn’t do it, I told every patient, “Look, Dr. Toms can really help you with this protocol. I can’t do it. But if you’re here and Dr. Toms can offer it for you, go ahead and do it.” So I realized that if I was gonna be working for Dr. Toms, I was going to have to do something in order to start doing the LANAP myself. I started making phone calls to California and trying to find the budget, and I was blessed enough to have Dr. Toms make arrangements and send me to California in March of 2019, just a couple of months after starting working with him.

MK:  Okay, so you had heard of LANAP in residency, you have now seen with your own eyes in Dr. Toms’ practice how it’s working for him, and you get trained. Were you able to hit the ground running? Were you able to replicate those results right away as a brand new LANAP-trained doctor?

FH:  To be honest, the first couple of patients I think I was too conservative, maybe too afraid to give them too much energy. So I had to redo maybe one case, but after that, it was so easy to get the same results, at least clinically. To be honest, I did leave a year before starting to do the protocol itself, but the periodontal health that I could see in my patients was just incredible, and especially the comfort that the patients feel after this protocol compared to traditional periodontal treatment.

MK:  So you were there about a year, you said. You’re now, as we mentioned, down in Puerto Rico. I believe you’re the only LANAP-trained clinician in the territory, and you’re working with your father, who’s also periodontist. Is he receptive to LANAP?  Has he used laser treatment at all?

FH:  So I moved back home four months ago, but I received the laser itself only a month ago. I am the only LANAPer in Puerto Rico, but not the only periodontist with a laser. A lot of dentists do use lasers for soft tissue, for frenotomies, but I don’t know that there’s a lot of knowledge here about the LANAP for periodontal regeneration. My father has not used lasers, no. He’s an excellent clinician, but with a more traditional background. But he was right away, very happy with the idea, and he embraced the idea of bringing this new treatment modality not only to our practice, but to our country.

MK:  You had mentioned that the awareness is not so high.  Is that one of the main challenges that you foresee bring LANAP into Puerto Rico? Are there other challenges ahead?

FH:  Correct. So I think the main challenge is gonna be able to reach a big number of patients and doctors and explain to everyone what this entails. There is a huge need of periodontal treatment in Puerto Rico, if we compare to the United States. The main challenge I foresee is being able to switch the dentists and the periodontist mentality that lasers can actually achieve and can help reach periodontal regeneration. I think that most dentists have a very traditional mindset and have skeptical mindset that I know it’s gonna be a challenge for me to change, just as it was for myself. My plan is to gather patient pictures and radiographs and eventually start to do conferences in order to actually demonstrate the results that we can achieve with LANAP.

MK:  OK. Are there any other differences leaving a practice on the mainland, USA in Cincinnati and starting in Puerto Rico?

FH:  The main difference between the practice that I worked in Cincinnati and what we have here in Puerto Rico is the remuneration. So in Cincinnati, it was a fee for service, and it was easy to pay off, as you say, the laser training and the laser itself. But in Puerto Rico, most patients use their dental insurance, and we do accept a couple of insurances. So the remuneration is much less. That’s gonna be one challenge being able to maybe get the second laser machine for the other practice that we have. But in terms of the patient’s health and patients, acceptance is pretty much the same.

MK:  Well, very good. I think we’ll leave it there. I’d like to follow up with you maybe a little later. Maybe next year, when you have been using LANAP a little bit longer in Puerto Rico. We’re excited to have you there with your PerioLase MVP-7 and wish you continued success. I do want to point our listeners to your Facebook page for your practice, should they be interested in learning more. On Facebook you can search for Herrero Periodontics, and it should come right up at the top. If any listeners have not yet subscribed to this podcast, please do so wherever you download your podcasts or at LANAP.com/podcast. Dr. Herrero, thanks for taking the time out to share your story with me today.

FH:  Thank you. Can’t wait to get back to you in a year, that’s right!