November 9, 2020
The LANAP® Protocol in the U.S. Navy
Jeffrey R. Wessel, DDS, 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. Jeffrey Wessel, a periodontist in Cincinnati, Ohio. Dr. Wessel received his Doctor of Dental Surgery degree from the University of Michigan, School of Dentistry. He then completed his postgraduate periodontics residency training and master’s degree in oral biology at the Ohio State University College of Dentistry. Following completion of training, Dr. Wessel began active duty service in the U. S. Navy, ending up at the Walter Reed National Military Medical Center, where he served as the periodontics residency program director for the Naval Postgraduate Dental School. Today we’ll talk about his road to using the PerioLase MVP-7 for the LANAP Protocol, specifically in the Navy, and training it to postgraduate residants in Bethesda. Dr. Wessel, thanks for being my guest today.
Dr. Jeffrey Wessel: Thank you very much, Marty. It’s my pleasure.
MK: So your story is a little different from most clinicians we’ve talked to. You were not in private practice when LANAP came into your world, but with the Navy. So can you just take me back to when LANAP first came on your radar screen and the sequence of events that led you to become LANAP trained in 2015?
JW: Well, I had heard about LANAP, I had heard about the PerioLase, but really didn’t have any first-hand experience with it. When I transferred to my duty at Walter Reed National Military Medical Center, the chair of the Periodontics department was interested in it and saw some benefits in bringing it to our active duty Navy personnel. The Navy actually wasn’t the first military branch to have the LANAP protocol incorporated into their dental treatment programs. It was actually the U. S. Army who began with the LANAP protocol in 2012. When I transferred the Walter Reed, my mentor, and the chair, like I said, was Captain Thu Getka. She had a remarkable vision for bringing this not only to the Navy on an initial basis, but really developed a plan so that it would have long-term sustainability. We researched the LANAP Protocol, saw that it would be a beneficial treatment option to be able to provide to our active duty population, the ability to provide treatment in an efficient and timely manner to them, especially with the high operational tempo, as we would say, recurrent deployments and things like that to provide our sailors and Marines with the optimal periodontal health that we could.
In 2015 Captain Getka worked with the staff there at Walter Reed to develop a plan to bring the LANAP protocol to the Navy. We looked at it from a point of not just training doctors initially, but how would we continue to train new periodontists and other periodontists in the Navy as LANAP providers? In addition to providing initial training through the Institute for Advanced Laser Dentistry, Captain Getka had the vision of actually training Navy periodontists to become certified instructors, and that’s really the uniqueness of her vision that led us to be able to provide a sustainable LANAP protocol and treatment option for sailors and Marines for years and years to come. Several Navy periodontists, myself included, got our initial LANAP training out in Cerritos, then we began the instructor training. After we received our initial training and began our instructor training, the vision was to train future Navy periodontists, including Navy periodontal residents actually at the Walter Reed National Military Medical Center in the Naval Postgraduate Dental School, instead of having all of our Navy providers travel to Cerritos or another BootCamp location.
We actually had our first Navy BootCamp at Walter Reed in 2016, and it was certainly an honor to have Dr. Robert Gregg and Dr. Dawn Gregg come out and serve as the certified instructors for that training. It was a very special event for everyone involved to see this new venture really take shape and really come to life for the Navy. Then there was an even more special occasion, I think, if you will talk to the Drs. Gregg about it, is that actually, while they were there for the Navy BootCamp in March of 2016 was when LANAP received the FDA approval for True Regeneration. So we got to see them get the news and all the behind the scenes efforts that really took place there to get the word out to the not only the LANAP community, but the entire dental community.
MK: Very good. I do want to go back a little bit in that story you were getting LANAP trained yourself for the first time in 2015. Going into training did you have laser experience at all? And either way, how did the training prepare you to become a laser clinician?
JW: Yeah, I had very minimal laser experience. I had received some training in my residency on a diode laser and had used diode laser very infrequently for just some soft tissue procedure. I had no training on other wavelengths or types of lasers, so the training that I received as part of my LANAP continuum was remarkable. I was actually a little intimidated going in – new technology, something that I really didn’t know a whole lot about. I was really impressed by how comprehensive the training was and how easily I learned the technology and was able to apply that technology very effectively clinically and in a timely manner. But the learning curve was not very hard to really become proficient in my practice, so I was very impressed by that. With the training it’s not just clinical, you get a very good background in laser physics, which I know doesn’t sound very exciting when we’re thinking about it, but I think that it’s such an important component of the training continuum. I was really, really pleased by how I was able to become so comfortable so quickly.
MK: You had a lot of weight on your shoulders getting trained, then going through instructor training, then helping to launch the training off site or remotely at Walter Reed. Can you tell me if there were any particular challenges or hurdles getting that off the ground and then a little about how that works for residents already in at Walter Reed? How does LANAP fit into their curriculum?
JW: Well, the as far as the challenges with any federal organization certainly the funding and the contracts and things like that were very challenging to get into place. We worked with sort of Big Navy, the Navy Medicine, and Logistics Command to put in a very comprehensive contract that not only covered the PerioLase machines, but also covered the training expenses as well as the long-term extended warranty expenses. Again, that was part of the initial vision that really gave this sustainability over time. As we implemented this, not only in the training program, but across the Navy, we certainly encountered some challenges there as far as getting approval for use of these lasers at various medical and dental facilities, not only across the United States but across the world. Each military installation/medical facility is governed by what we call instructions or certain orders that they must follow. What we found was that regulation on use of dental and medical lasers was very different from base to base and command to command. We spent a lot of time developing sort of very standardized instructions, protocols, things like that that could be used across Navy medicine. That was a lot of the initial legwork that we found challenging. Each location that has any sort of medical or dental laser needs to have a laser safety officer. Well, in the military laser safety officer is a little different than what it may be in a private dental clinic. To become a laser safety officer in the Navy we had to have some of our dentists and periodontists go through an official laser safety officer training, which not only included medical and dental lasers, but also, if you think about where lasers were also used within our military, weapons systems, and navigation systems. So some of our periodontists got some very unique education along the way. As far as incorporating this training into our residency program, we thought about how can we most efficiently and effectively train the residents, and also do it in a cost-efficient manner for the government, and for the military? The way we implemented it is that we started training our third-year residents, and we would provide them BootCamp training early in their third year. And we worked very closely with the Institute for Advanced Laser Dentistry to sort of slightly modify or accelerate the training continuum so that we were able to provide them their Evolution 4 and Evolution 5 training right before they graduated. We felt that it was would be best to have the residents fully trained in the continuum prior to graduation so that they could then go out to their new duty station and immediately be fully trained LANAP clinicians, and that seemed to work out very, very well.
MK: Can you tell me about some of the student reactions to this? I know some of the Navy doctors who got trained on LANAP then go out to a duty station. But you’re also training, as you just mentioned, students in residency and those students you got to continue to mentor along the way. What were some of their feedback after they received the training?
JW: A lot of them were very, very positive. Most of them had no prior dental laser experience, so again, it was a new technology for them. We always found the residents very inquisitive and seeking out new educational opportunities. They very much enjoyed going through the process or the journey. I think a lot of them found it very challenging initially to incorporate learning this protocol, while at the same time they’re still trying to hone their initial surgical skills and things like that. We found that they got good guidance and instruction and that they were able to pick up on things very quickly. I think it was really helpful for them when they’re following their BootCamp education, and when they were doing some of their initial cases, to have a certified instructor be there with them for those cases. That was a really unique thing, because most clinicians will go through training, go through BootCamp, and then go back to their own practice and, sort of be on their own. Being able to have that extra guidance really made a big difference. You really could sort of see that light bulb go off, and that that was really enjoyable to see.
MK: So I understand that naval personnel moved around, sometimes to different locations. Was that a challenge at all? Making sure there was a PerioLase where each trained periodontist was, or vice versa?
JW: It was sort of like a little chess game initially to figure out where we were gonna have the PerioLases. We wanted to send them to not only some of the larger bases, where there was potentially a greater need. But as part of our decision-making process, we looked at not only patient population, but we also looked at prevalence of periodontal disease, and the number of periodontal surgeries that were being done in different locations. So we wanted to send the PerioLase to the highest need areas first. So we had certain places where we wanted to send a PerioLase and certainly had to make sure that the next person that was gonna be arriving at that duty station was LANAP trained. We had to make some sacrifices. We always say in the Navy, “Where you go next is certainly going to meet the needs of the Navy.” Some people may have not been able to go to a certain location at a certain time because they hadn’t received their LANAP training yet, but when I left the Navy in 2018 we had up to, I think, almost 25 PerioLases at 22 locations across the world, across the globe. We had implemented this technology not only stateside, but also Naples, Italy, Okinawa, Yokosuka, Atsugi, Japan. So it was really starting to spread across the real breadth of the Navy bases across the world.
MK: Well, that is impressive. It also sounds like a great amount of effort and work to get that all coordinated. Looking back, was all that effort worthwhile? Is implementing LANAP as you mentioned worldwide with the Navy paying off?
JW: I think it definitely is. I think that from my experience, just the benefit that it provided to our patients. You know, I always say that our military patients are the most deserving patients in the world, and to see the positive reactions that we got from patients…I always found my patients were very grateful for any treatment we provided, but even to see the positive reactions, the positive impact it had on their life, I think it really did pay dividends. Some people may not think that the prevalence of dental disease or gum disease is very common in our military populations. It is probably more common than you think. You may think that well, “These people have free dental care they shouldn’t have any of these problems. They should show up for all their appointments.” One thing that sort of, not surprised me, but I always found very thought provoking while I was in the military, was that a lot of our sailors and Marines were so dedicated to what their job was, what their mission was, that they would sacrifice their dental appointments to meet their other obligations. So we had more disease there than we would like to see. Being able to provide comprehensive treatment in such a timely manner with such a quick recovery, paid huge dividends. To go back to your question, I think, yes, it was definitely worth the effort.
MK: So you had mentioned that you separated from the Navy in 2018. You’re back in private practice. I’m just curious how often you yourself use the PerioLase now back in private practice?
JW: I use it on a weekly basis. I found that again, it’s a very good treatment modality/technology to have available in my practice. My office staff has been very welcoming of the technology, and I think that they can see the benefits that it provides our patients, see the positive patient outcomes and positive patient reactions that we get when we use it. The practice I went into did not have any laser technology there, but there was a very smooth transition, not only for me but for also my office staff.
MK: Good. And you continue to be a certified instructor for the IALD, now in Cerritos as opposed to the Navy, but we appreciate you being able to continue to train students. I do want to give a plug to your website for anyone interested in learning more about you or your practice in the Cincinnati area. That’s wesselperio.com. And if anyone listening has not yet subscribe to this podcast, please do, so that you don’t miss any new episodes wherever you download your podcasts or at LANAP.com/podcast Dr. Wessel, thank you so much for taking the time out to talk to me today.
JW: You’re very welcome. Thank you again for the invitation.