January 25, 2021
Managing Medically Compromised Patients
David R. Scharf, DMD
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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. David Scharf, a periodontist in Babylon, New York, on Long Island. Dr. Scharf attended both college and dental school at Boston University, where he graduated cum laude. He completed his specialty training in periodontics at New York University. He’s a diplomate with the American Board of Periodontology and fellow of the Academy of Osseo-Integration and currently serves as a Certified Instructor with us at the IALD. Dr Scharf, thanks so much for being my guest today.
Dr. David Scharf: Thanks for having me, Marty. It’s a pleasure to be on the show.
Marty Klein: Now, you first came to training on the LANAP Protocol in 2008. So I’d like to start with how you first became aware of LANAP and then the process by which you decided to get trained.
Dr. David Scharf: Sure. So I had read Ray Yukna’s study in the IJPRD, and that year at the AAP meeting, Ray presented his material, and I walked out of the lecture and I was impressed with what he showed. I ran into a good friend of mine, Dr. Tom McCawley, in the hall. Tom’s a periodontist down in Florida. He’s published material on the LANAP at this point, and I knew he had the laser. We started to chat and I said, “Hey, Tom. Ray showed some pretty impressive stuff. Does it really work like that?” And he – I will never forget it – Tom grabs me by the shirt collar, like, grabs me by the tie and pulls me close, and he goes, “Just get it.” Just like that. I know Tom would never steer me wrong. I’ve known him a long time. He’s a good friend, so I just got it. I figured I didn’t have a whole lot to risk because of the six-month clinical money back guarantee. And that started my journey in LANAP.
Marty Klein: It was just that easy. You trusted colleague told you to get it.
Dr. David Scharf: You know, he told me to get it. I was so convinced that when I walked away from Tom, I said, “Jeez, you know, if I ever need a perio procedure, if I had a pocket that needed addressed, I guess I would just fly out to Florida and see him.” And then I took, like, two more steps and I said, “Dummy, if that’s what you’d want for yourself, you’ve got to investigate this technology and get involved with it,” and the rest is history.
Marty Klein: Dr. McCawley was a guest on this program, if any listeners would like to hear from him as well. I also want to mention that the Dr. Yukna histology study that you mentioned in there can be found online at LANAP.com/research, for any of you that would like to see that for yourself, whether or not you have a colleague to pull you by your collar.
Dr. David Scharf: If someone’s unsure, they could come to New York and I’ll pull him by the collar. Just have them fly down. I can pull them and tell them. <laughs>
Marty Klein: Now, going into that moment had you used lasers for any other dental procedures previously, and if not, was that any sort of barrier for you and getting started?
Dr. David Scharf: You know, I had never used lasers before, and truthfully, I knew nothing about lasers. I couldn’t understand why we couldn’t just have one laser to do everything. I literally knew nothing about it, but I was confident that the training would be adequate. I was impressed that the laser wasn’t shipped until we had training, and I was impressed that I would have some hands-on training. So it wasn’t a concern at all for me.
Marty Klein: Did you learn the differences between lasers? Or, in other words, you said that one laser might be able to do everything, right? Why is that not true?
Dr. David Scharf: Well, that’s the key, because it’s all about the wavelength, as I learned in BootCamp on day one. So I think by the time I was eating lunch on day one, I understood why you can’t have one laser. You can’t have a Swiss Army knife laser, and that’s why, when I see advertisements now for this laser or that laser that can do everything, I just shake my head and say, “How can they be making this claim?” But the wavelength of the PerioLase is the wavelength to treat soft tissue problems, to treat periodontal disease. It’s not a hard-tissue laser, it’s not for cutting cavity preparations. I learned that lesson pretty early, and now it’s abundantly clear to me.
Marty Klein: So you got trained, as we mentioned in 2008, and you went back to your practice. Your PerioLase arrived and you started using it. Tell me about what happened next. What was the reaction from your patients? What were the first cases like, using it in your hands?
Dr. David Scharf: I was ready to go right after training. I didn’t have any hesitancy, and I knew that I was going to be getting the laser, so had had sort of stacked up a few cases in advance. Interestingly, the very first patient I used it on, he came in three months later, after we finished. The result was great. It was just like in training. I was very happy with what I saw, and he was in for his first three-month hygiene visit, and I said, “Let me just take an X-ray.” And it was actually a lower incisor, and I had vertical bone growth on the lower incisor, and I checked the X-ray I took from another angle, and I’m like, “Holy cow. This stuff really works.” This is a patient that years ago had had traditional periodontal surgery. So I knew he need re-treatment, I knew he’d be a good person to do the first case on. I was just, you know, I was hooked at that point. I was impressed with the results, and I’ve been doing it now 12 years, I guess, 2008 to 2021, so I’m in year 13 now. I have to tell you, the results still astonish me. I go into the hygiene room for the one-year hygiene check, the hygienist has probed, and it’s not uncommon, in fact, it is common to have patients who had 7,8,9,10 millimeter pockets at the end of the treatment have no more pockets, have 2, 3, some isolated 4s. But the change in health is just dramatic, and it never ceases to amaze me. It’s really very, very impressive technology. And in my own practice, I could tell you it has completely replaced flap surgery. Here and there I still have to do crown lengthening, obviously, but for periodontal pocket reduction, LANAP is my go-to method.
Marty Klein: Sounds like you’ve grown to expect those results; they’re no longer that remarkable.
Dr. David Scharf: I sure have. Now we have a case where when I don’t get the results I want, I’m astonished, and then we have a gentle interrogation of the patient. Turns out, they have their night guard, but they’re not wearing it, they keep it on the shelf. Or they’re not using the mouthwash that we prescribe, but something went awry where they haven’t followed the formula. Like we say to the students in training, like I say to the patients, if you follow the recipe, the recipe works. We know LANAP has three parts. It’s the laser treatment, it’s the occlusal adjustment, and it’s the night guard. I like to say when I teach Evo 1, that LANAP is actually an inclusive therapy that has a laser component to it, so we really have to pay attention to the occlusion and the bite guard. But do I expect those results, and almost without exception, if the patient hasn’t gotten the result we want, it’s either that they didn’t allow me to do occlusal adjustment or they haven’t been wearing the night guard or keeping up with the maintenance. But if you follow the recipe and Grandma says, use this flour, use these chips, use this much butter, the cookies always taste the same, and if you follow the LANAP recipe, it works. It’s been time tested by just thousands and thousands of dentists and probably hundreds of thousands of procedures by now. So I don’t deviate, and that’s what I tell the patients. That’s what I tell the students when they come for training. Just follow the recipe and it works. Don’t reinvent the wheel.
Marty Klein: You mentioned something in there about, “It’s an inclusive procedure with a laser component.” It is often misunderstood as just a laser treatment, but in reality there are 26 steps to the overall LANAP protocol and a laser is only one component.
Dr. David Scharf: You know what’s interesting is, sometimes I have patients come in and they say “Yeah, I saw a dentist and he’s gonna do a laser treatment for me,” and I know that that dentist isn’t doing LANAP. They have a different laser or they’re using a diode laser or something. I try to educate the patient and tell them that this is the only method that has histological verification, that we have new attachment. It’s the only method that supported with data and way more data than when I started. There were certain some data, but now there’s an abundance of data. You know, sometimes the patients, as patients like to do nowadays, enter into it what I call a therapeutic negotiation. They don’t necessarily want to do all of it. They don’t wanna wear a night guard or they don’t want to have their bite adjusted if it’s indicated, and it’s not indicated in every patient, but certainly those bites need to be adjusted to be successful. I say to them, “We can do what you’re saying, but you’re not getting LANAP, and we don’t know what the outcome is going to be.”
Marty Klein: So what was the feedback that you had from your colleagues from the rest of the dental community when you first incorporated this? And has that changed in the dozen years since?
Dr. David Scharf: Yeah, so that’s pretty interesting. So I was the first periodontist on Long Island to have the laser. And some of the first feedback I got was a buddy of mine sent me a letter that another periodontist had sent out to almost every dentist on Long Island, saying, “Hey, you may have heard about this laser and I’m not for it and here’s why. And it’s not approved by the AAP, and I only do tested therapies for my patient, blah, blah, blah, blah, blah.” It couldn’t have been more negative, and that actually was a positive, because then a lot of these dentists called me up and said, “Hey, tell me about this laser that you’re doing.” I figured I could sort of fly under the radar for six months or so before I really saw the results myself and then talk to my colleagues about it. But he sort of forced my hand and made me talk about it sooner. That generated quite a few referrals, and it really couldn’t have come at a better time. If you think back to 2008, remember what the economy was like then? We were going off a cliff. So it did two things that it generated quite a bit of referrals from my dental colleagues. Also, it generated quite a bit from patients who were looking for an alternative to traditional cut & stitch flap surgery. So it was just tremendous for my practice at the time, and it’s continued to be that.
Marty Klein: And has that changed over time? Have some of your referring dentists or other periodontist softened their views?
Dr. David Scharf: 100%. First, my most vociferous critic is now a PerioLase user, so that’s terrific. He sort of saw the light, as it were, and realized to incorporate this therapy into his practice, as have a number of other periodontists on Long Island. I’ll tell you, interestingly, there’s a big group practice near me that brings a periodontist in and that periodontist actually refers me patients to use the laser on. He’s enough of a gentleman to his patients to say, “You know, I could do this with surgery,” and it’s usually the way more advanced cases. You know, one thing about LANAP is when the case is almost at the edge of being lost as most periodontist know, to make a flap many times you end up losing teeth that otherwise you wouldn’t. Because the PerioLaseis so conservative, I find I can keep teeth that otherwise I would have taken out, if I was doing flap surgery. And this other periodontist actually knows that as well. How he learned that, I don’t know. But he’ll actually refer me patients from within this general practice where he’s the periodontist they bring in. So that shows you the power of this technology.
Marty Klein: Now I know that you have some expertise in managing medically compromised patients, and I’ve heard from other clinicians that LANAP is great in that regard. Can you tell me a little more about how the LANAP protocol relates to medically compromised patients?
Dr. David Scharf: Of course. So the issue always, with many patients, is bleeding. People take Aspirin, they take Eliquis, they take Plavix. It seems that those drugs now are almost as common as the statins, and the consensus from our physician colleagues seems to be, “Don’t take these patients off the medication.” You have a situation where they don’t want them coming off the Eliquis and they can’t have epinephrine, and those would make for some pretty messy surgeries, for sure. The beauty of the PerioLase is you don’t have to take patients off those anticoagulants. You know one of the settings is after we do the laser, we achieve what’s called hemostasis, and it uses the heat of the laser to cause the blood to coagulate. Basically, it doesn’t use the intrinsic clotting factors from the blood, it uses the heat of the laser, much like you cook an egg in a frying pan, the heat causes the proteins to aggregate, and that’s how the laser causes a clot around the teeth. So I’ve always sort of treated those patients because they needed treatment, but sometimes we would do more scaling and root planing than flap surgery and medically compromised patients, if we thought the bleeding was gonna be an issue. But now we could do the PerioLase and really get tremendous results, results equivalent to surgery with much less invasion. You know, you have a fragile patient, I just never enjoy doing flaps on those patients. The discomfort of the post-op period when you do traditional flap surgery is a stressor on that patient. The beauty of LANAP is, as we say in training, the feeling of wellness is almost immediate. I used to dread the post-op call, the night after surgery when I did flap surgery. Now I love it because they say, “Wow, you’re really worked in there today, but I feel nothing.” So I think we’re still treating the same patients we always treated, but we’re treating them in a much less stressful manner, which is better for the patient and better for us.
Marty Klein: That’s great. The PerioLase MVP-7 is used primarily for the LANAP protocol, but it can do other things, too. And I understand you use your PerioLase for at least a couple of other procedures. Could you tell me about those?
Dr. David Scharf: We do. My hygienist is also trained. She has taken the course, so she’ll do a laser periodontal disinfection, which is a low power setting, on the PerioLase that’s a non cutting setting so hygienists are authorized to use that in our state. It’s a way to disinfect the pocket during maintenance therapy. For me, it’s been a real workhorse in terms off frenectomies and mucosal releases. There’s actually an orthodontic practice by me that sends me all their frenectomies, because they love that they could tell the mom it’s done with the laser, we don’t put any sutures in, the kids are really comfortable afterwards, super quick, and it’s bloodless. Everybody’s happy. I also used it quite a bit after I do connective tissue grafting, many times we want to release the mucosa from over the graft, and it’s just super for that. It’s quick. There’s no blood. It’s comfortable for the patients afterwards, so the adjunctive procedures have certainly been nice. It’s nice to have that relationship with the Ortho practice, because it generates other referrals from them as well. Those are my main uses. I know other people use it for other procedures, but for me, that’s probably the extent of it.
Marty Klein: Well, I would like to give a plug to your website. You certainly have a vast experience in using your PerioLase and as an instructor again with the IALD, you have passed that forward and trained many other doctors. Your website is drscharf.com. If you are listening to this podcast and have not yet subscribed, I’m not sure what you’re waiting for, but you can do that as well as check out all of the episodes of this podcast that are available at lanap.com/podcast. Dr. Scharf, Thank you again for taking some time out of your schedule and sharing your expertise with me.
Dr. David Scharf: Thank you, Marty. And, you know, to anybody listening that’s on the fence, I would just say to you what my friend Tom said to me, some 13 years ago now, “Just do it!” You know, we’re over the point where this is considered experimental or there’s only one or two people in the area that do it. I think the worst thing for anybody is to be on the wrong side of the technology curve. People don’t necessarily want to be on the leading edge or the bleeding edge, but this has become mainstream therapy now, and I would encourage anybody to look into it. Anybody that wants to talk to me, personally about my experience, please feel free to call me. I’ll be happy to speak with you about it.
Marty Klein: Thank you again.
Dr. David Scharf: My pleasure.