September 7, 2020
Microbiology & the LANAP® Protocol: An Early Laser User’s Experience and Research
Tom McCawley, DDS, FACD
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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. Tom McCawley. A graduate of the University of Illinois, College of Dentistry, Dr. McCawley holds a specialty degree in periodontics from Boston University School of Graduate Dentistry. He is a past president of the Florida Society of Periodontics and has been a visiting lecturer to the graduate periodontal residents at Nova Southeastern University, College of Dental Medicine on the microbiology of periodontics for over 20 years. Today we’ll talk about his long history with dental lasers up to and including the PerioLase MVP-7 for the LANAP protocol and his research endeavors along the way. Dr. McCawley, thanks so much for joining me today.
Doctor Tom McCawley: Well, thanks for having me on. It’s an honor.
MK: Well, you have the unique perspective of having a long history with lasers and dentistry, longer than most anyone. So I first want to ask you to take us back all the way to the beginning, how you first became interested in dental lasers and what the first one that you used was.
TM: Well, I got interested in lasers back in 1989. Actually when I read an article in Dental Economics: a dentist in Canada wrote about his experience used in the Pulsemaster laser, Nd:YAG laser, and since I had a big interest in the microbiology of periodontal disease and treating the cause of disease – not just the result – the idea that that you could put 1000 degrees centigrade in the pocket for 1 /10,000 of a second and not do any damage was quite intriguing. He was in Windsor, Canada, which is right across the border from my good friend Joe Nemeth, so he and I went to visit him in early 1990. We said, “It looks like this can work and won’t do damage at least.” So we put an order in for the Pulsemaster, and the first day it was approved in the United States, we got it. So we had the first Pulsemasters in the country, so that’s basically my story.
MK: That was in 1990. The PerioLase came out 1999. You started using it in 2008, so there’s quite a lot of daylight there between all of that. Can you take me through your next steps in using lasers and specifically the Nd:YAG wavelength?
TM: We were always intrigued by the Nd:YAG laser because it’s made for perio because its attraction to black pigmented bacteria and its ability to go into the tissue to kill bacteria there. So we actually did conference calls for a couple of years trying to figure out how to use the laser in 1990 & on. We were getting pretty good results with it, but, you know, I got a lot of pushback from the local periodontists that even wrote a letter to everybody. I decided that I’d better try to produce some studies on it. In 1992 I did a study of the laser, and in that study, I did it with Dr. Cobb, and we got complete elimination of A.a., P.g., & P.i. in 8 out of 13 cases. We continued to use that, but I noticed we were getting pocket reduction, but we weren’t getting the kind of regeneration that LANAP was publishing. You know, with Dr. Yukna’s studies, etc. So I begin to investigate it. In fact, I read everything known to man. I called about 10 or 12 periodontist about it. I even got the due diligence award at one of your meetings for my investigation of the laser, and then I decided to get one on the way to the airport. I did say to my wife, “I hope to heck I know when I’m doing!” So it’s worked out well for me.
MK: So it sounds like you really did your due diligence and you were already more educated than most on the wavelength and the treatment of perio with a laser. But you didn’t incorporate LANAP right away. So what was it that finally turned the switch for you in 2008 to start doing LANAP versus previous to that?
TM: Well, the literature and studies by Dr. Yukna, etc. and I started seeing lots of things and I was talking to some people. After I talked to a bunch of them and they said it was working, I said, “I think it’s time to give it a try.”
MK: And what did you see then? Once you came through training and started using LANAP in your own practice, did it match what you were led to believe, or what you had studied? What were your first results and how of have those results continued for you?
TM: Well, I was somewhat skeptical because you know, you gave a six month guarantee, but I said, “Wait a minute you have to wait nine months to see the results.” So Drs. Gregg & McCarthy gave me a nine month guarantee! But anyway, I saw really excellent results along the way, which is obvious. In fact, just last week, my son, Mark and I each had separate cases that had, like, 13 millimeter pockets in a site that went to four millimeters with some bone growth. So we love the laser.
MK: Wow 13 millimeters. That’s almost hopeless.
TM: Yes, these were teeth that the dentist who referred it said it was hopeless. I told the patient it was probably hopeless, she said, “I want you to try to save it”. I said, “Okay,” and there you go. So that’s the beauty of this. You can save teeth that most people would extract, and we try to save most of them, but this one was beyond the apex. It was a test, even of my thoughts.
MK: You mentioned earlier your interest, an early interest, in the microbiology aspect of Perio, and then microbiology aspects of lasers. So I’d like to find out from you what started that interest and did the interest in microbiology come first or your laser use?
TM: Well, the interest in microbiology came first. I trained at Boston University, who had Sig Socransky, one of the great microbiologists, was right there, so that got me interested in it. Then the Paul Keyes thing came along and I got interested in using the microscope, so we now always use a microscope to test people’s bacteria. Then we test them at the end, so using the laser with other therapies we can actually cure periodontal disease, and the laser is certainly part of it.
MK: Now you published a study several years ago with your son Mark, whom you referenced as well, and also Dr. Thomas Rams. It was relative to the bacterial kill of the PerioLase MVP-7. Can you tell me more about how that study came about and a little more detail about it?
TM: Sure. Well, LANAP and diodes, and all of them, were making claims that the laser killed the bacteria, but we had no evidence. It was just a hypothesis that the heat surely would kill. It made sense. But, you know, where is the proof? So I kept waiting for a university to take it on or something. Finally, I said, “I guess I’m gonna have to do it.” So we did like 26 teeth before and after, and it was a major undertaking, really. It probably cost me over $20,000, and the amount of data that my son put together. Then Dr. Rams was invaluable in writing it up and helping us get it published. But we actually showed that in 85% of the cases, the LANAP technique eliminated all the cultural bacteria in the pocket, which was a breakthrough, actually because that’s never been shown before. All scaling studies that have ever been done showed plenty of bacteria left afterwards. I mean, thousands of samples, and we showed that in this sample we could get rid of the bacteria 85% of the time, which was really remarkable. Although we haven’t published it (an extension of the study), we went out seven months with this, and most of the bacteria were still gone.
MK: So you have this study and are looking to publish it. I understand it was not the easiest road to get it to publication. Can you tell me about that?
TM: Well, we had kinda finished the study and presented it at the American Academy of Dental Research back in 2014. But then we gave it to the Journal of Perio and the International Journal of Periodontics & Restorative Dentistry. The reviewers, they give them out to a bunch of reviewers, and they all poo-pooed it! One of them said, which is really remarkable, “There’s nothing new here.” Are you kidding me? Nothing new? It’s the only study EVER to show that you could kill the bacteria in the pocket. So it took us several years and diligence by Tom Rams to finally get it published in the Journal of the International Academy of Perio. It took four years to get it published.
MK: Is that typical when trying to get a study published?
TM: Well, it is if you try to get a laser published and a lot of the periodontists don’t like it.
MK: So just from a philosophical standpoint of conducting research, what are your motivations to even do it? You know that it works for yourself. You could just continue using it in private practice and go on your merry way. So why, bother? Why go to the effort? What is your motivation for doing it?
TM: Well, being a pioneer in this I took a lot of flak, so that motivated me to try prove that the thing did work. Since I was interested in microbiology, I’m going to see, you know, does it really kill all the bacteria in the pocket?
MK: Do you have any other studies up your sleeve or anything else you’re working on at the moment?
TM: We have one that we’re working to get published now. We did a study of the first pass of the laser, just one pass only because we’ve done ultrasonic. We’ve done the full protocol. We want to see what the first past did. The first pass actually left bacteria behind. It did a fairly good job, but it left some bacteria behind. So we feel that you need all three steps to actually eliminate the bacteria. We’re trying to get that published, and again, we’re having a little trouble, but I think we’ll eventually get it out there.
MK: Well, hopefully it won’t take four years to get it done.
TM: No! We also, just for interest, we did some work with LAPIP, and we’ve done six cases of LAPIP, and this is unpublished, in five of them we did get rid of all the bacteria. It works on LAPIP the same way it works with LANAP.
MK: That’s excellent. Just for anyone listening not sure LAPIP is LANAP, but around implants for peri-implantitis. I do have just a couple questions left, and this is just changing gears from studies. And that is that most years, LANAP trained clinicians are invited to an annual study club, and you have attended either all or almost all of them. So I’d like your perspective, having attended a great number of them, what a LANAP clinician can gain from attending the annual study club.
TM: Well, I’ve attended almost all of them, I think. I don’t think I’ve missed any of them. The reason I go is that every time I learn a little something, or I re-learn some of the things that I’ve forgotten. It re-motivates me and reminds me of the difference I’m making for patients using LANAP and LAPIP.
MK: Also regarding study clubs, I know we’re not doing the National Study Club this year, but we do offer virtual study clubs and when we can have meetings again, we’ve also been known to do regional study clubs in different parts of the country. So keep your eye on your inbox if you’re a LANAP trained clinician for upcoming opportunities. On that note of the COVID-19 crisis, I did want to give you an opportunity to speak for a moment about a book that I understand you’re working on or have just published about The Survival Guide for COVID-19. Is that accurate?
TM: Yes, I’ve just virtually finished and sent it off. I’ve written a book for dentists, COVID-19 Survival Guide. It really focuses on not just the disease. It focuses somewhat on the disease, but the aftermath of disease: the effect it has on our spiritual, mental, relationships, health, and all of the different healths and tries to inspire people to feel better about the future of periodontics, but more so, the future of their own lives.
MK: Where do you anticipate that being available?
TM: That would be available on Amazon and we may let people know about it some other way.
MK: Okay, very good. While I do want to let listeners know about your website in the meantime, and I’m guess that your COVID-19 Survival Guide information will be there eventually, so that is mccawley.com. I would like to point out that many of the articles discussed within this podcast can be found at LANAP.com/Research. I invite you the listener to subscribe to this podcast if you’ve not done so already. You can also find us LANAP.com/Podcast. Dr. McCawley, thanks so much for being my guest today.
TM: Thank you for having me. It was a pleasure.