July 20, 2020
The PerioLase® MVP-7™ and TMD, Occlusion
Jeff Dolgos, DDS, FAGD
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Marty Klein: Welcome to Dentistry for the New Millennium. I am Marty Klein, Training Manager at the Institute for Advanced Laser Dentistry, and today we’re speaking with Dr. Jeff Dolgos, a general dentist practicing in Orchard Park, New York, near Buffalo. Dr. Dolgos earned his dental degree from the University of Buffalo and currently serves as a certified instructor with the Institute for Advanced Laser Dentistry. Today, we’ll talk about his journey with LANAP and the PerioLase, how they relate to his specialties with TMJ and occlusion, and his experiences both in a group and solo practice. Dr. Dolgos, thanks for joining us today.
Dr. Jeff Dolgos: Thanks for having me, Marty. It’s a pleasure to be here.
MK: So tell us how you first heard about LANAP, the PerioLase, and what moved you to incorporate it into your practice at the time.
JD: So back in 2005 I went to a lecture, a combination lecture that was being given by Mike Melker and Danny Melker that was about the relationship between periodontitis and occlusion. That was on my radar because of my background going through the Pankey Institute, where I first learned about a potential connection between those two things. So in the middle of that lecture, during lunch, a man got up and he presented a study that was a big board, and it happened to be Dr. Yukna’s study. The man that got up to present was Dr. Gregg, Dr. Bob Gregg. Fast forward a couple weeks I was asking people on the Pankey message board if anybody had ever heard of this PerioLase and the person who responded to me first was my instructor for my first course down at Pankey Institute, Bill Gregg. And he told me that, yeah, he doesn’t have a PerioLase, but he is very familiar with the company and its owner because it’s his brother. So that really charged up my confidence in this machine, and I decided right there that I was gonna give it a try.
MK: At that point, did you have other laser experience?
JD: I had never used a laser before at all. I had heard of an Nd:YAG laser once, but I had absolutely no idea of the differences between one laser and another. This was my first foray into laser dentistry.
MK: So you purchase the PerioLase, you go to training. The training program is spaced out over the course of a year with three different visits or components to it. Tell me about some of your experiences and training and how that helped you with your usage and ultimately success with PerioLase.
JD: So I found the training program to be phenomenal. I decided I was gonna go to the Pankey Institute because I wanted to go to what I consider to be the best. My experience at Pankey was great. We were always well taken care of, and the education was top notch. I found a very similar environment here with Millennium. I would say the first 3 days of BootCamp changed my dental career. One of the things that I was very interested in was the nature of light on a kind of a tangential note. I had about a year previous to that become a Reiki master, so I was very interested in energy and light on kind of a different level, over in the sort of alternative medicine sphere. Learning about light in terms of the physics of it helped me make a lot of connections as to why this laser energy and this technique in particular might be helpful when we’re trying to bring about healing in the human body. So when I went back and started treating patients and started seeing really good results, where prior to having the laser I was struggling with periodontitis, that was a big confidence booster for me. It helped a lot having some spacing between the BootCamp, the first 3 days, and having six months to treat some patients, come back, and ask some questions about some of the hiccups and some of the problems that I have had over my first few experiences with surgeries. Then that fifth day, the E5, which is a year later, I think for me was the tip of the iceberg where I felt like I had learned an awful lot, but there was so much more to learn. That’s what drove me into the instructor training program because I felt like there was an opportunity for me to be able to take my level of knowledge and deepen it and broaden it, and maybe even, if I could make my way through the program, be able to teach us and help other people come on board.
MK; I believe that was in 2008, you became an instructor, so that’s been a fair amount of time. You’ve seen a lot of students over the years. Has there been a change or a trend in some of the students that you first started instructing and teaching LANAP to at that time versus today?
JD: It seems to me that at the beginning of my mini-career of teaching as a certified instructor for the Institute for Advanced Laser Dentistry that many of the students or attendees that were coming through still had some significant resistance, and the questions that they would ask would be questions in order to poke holes in the protocol or in order to call into question the validity of some of the research that has been done up to that point. Over the past decade, when I have seen, is a pretty substantial change in the nature of the questions that are coming across. People are asking questions now with what seems to me more of an intent to learn and an inquisitiveness, where before it seemed like there was almost a combative style that would come out with some of the people that would come through BootCamp, even though they had already taken the big step of purchasing a laser.
MK: You mentioned going to the Pankey Institute. I believe one of the big topics there that is covered quite a bit is occlusion and that you’ve taken that on as a particular specialty, so to speak. Occlusion, of course, is a big component to of the LANAP protocol. Was that easy fit for you? Is that one of the reasons that you took to LANAP and occlusion? I know that could be a touchy subject with a lot of dentists. What have you seen in that area?
JD: At the Pankey Institute, one of the things that you first learn – back when I went through, it was called the continuum, and at the second level, C2, Continuum Level 2 – you learn how to make bite splints. One of the things that they teach is that when you make a bite split for a patient, frequently you’ll see an improvement in the health of the periodontal structures and maybe even a decrease in mobility of teeth that were previously mobile. So I already was aware that there was a connection because I had seen that happen in my own practice with my own patients. What got me to flip a switch when I saw that presentation at that study club meeting in Chicago in 2005, was seeing Dr. Gregg present the words “cementum-mediated new attachment.” What I wasn’t aware of was the potential for a regenerative process to happen, which is maybe connected to making significant adjustments to the occlusion. The adjustments that we do in LANAP, as most people are aware of, can sometimes be significantly more aggressive than what we’re used to when we’re just addressing and adjusting occlusions in order to improve the mechanics of the bite relationships. So different philosophies of occlusion often have different end goals and clinical objectives. Sometimes the objective is to allow free-er movement to take pressure off jaw joints. Sometimes adjustments are made to better distribute forces so that chewing is more efficient. Other times, like with LANAP, bite adjustments can be made in order to reduce or even eliminate excessive forces on teeth that are in periodontal distress.
MK: I see a lot of resistance to the occlusial adjustment component of the LANAP protocol. I’m not a clinician, and it’s easy for me to understand why the occlusion needs to be adjusted to help the underlying root surfaces regenerate. Yet there is a significant amount of pushback against that. I’ve never quite understood why the significant pushback. It seems so obvious to me that you would not want to disturb the healing.
JD: I would say I can only speak from my own perspective. But when I was in dental school, I remember being taught, being programmed, to worship at the altar of enamel. So we thought of enamel as this hallowed substance that you wanted to preserve at all costs. We weren’t taught as much respect for bone and periodontal structures. It seems to me, as I reflect back, that we were taught about periodontal structures that once they’re lost, they’re gone. You don’t have hope to regenerate them. At least you have enamel. It’s the same thing with enamel, though once the enamel is lost, it’s gone. So while the body can destroy the periodontal structures, it’s us who often destroy the enamel structures. I think we can get very cautious and tentative about removing too much enamel. In addition to that, most of us dentists have at least reservations, if not nightmares, about patients calling us with sensitive teeth. So it’s a big thing for a dental practice. If you’ve got patients calling you constantly with sensitive teeth, it’s very annoying, and it could be very stressful because those are people that aren’t happy with you. So the last thing we want to do with periodontal procedure is cause sensitivity in teeth.
What we, as instructors, have to continually get across to people, is that it’s an inverse relationship that we see. We see adjustment as: if you adjust enough, you’ll avoid, or sometimes eliminate, that sensitivity post-surgically. If you do not adjust enough enamel, meaning remove enough enamel, from these teeth that are in trouble, you almost always will have sensitivity, and the solution to the sensitivity frequently is taking away more enamel. So as dentists, we just think about enamel as this substance that protects teeth and makes them less sensitive. Which is true, but it’s different when we’re talking about teeth that are periodontally compromised, and they continually are beat up and moving around in their sockets, and they’re inflamed and hypersensitive because of the occlusal issues. So that’s just one of those paradigm shifts that we have to get across to students as they come through BootCamp.
MK: I’m gonna switch gears a moment. I know that you’ve worked in both group practices and solo practices. Can you maybe share a nugget or two of a benefit of having a PerioLase in each of those environments?
JD: There are definitely pros and cons to group practice over solo practice as it relates the PerioLase. In my experience, the hardest thing in solo practice is getting the word out there. So there has to be a bigger focus on marketing efforts, and there has to be a bigger focus on trying to find referral sources. As a general dentist, it’s a little bit more difficult because other dentists typically wouldn’t refer a periodontal issue to another general dentist. In group practice, you’ve got a large audience, so to speak, of hygienists – larger than you would in a solo practice – to market to. So you’ve got an internal mechanism through which that group can refer patients to you. So the advantage of being in a group practice is that there’s less of a need for you to go out and market yourself specifically out to the public, because you’ve got a bigger audience within a group. But within a group, you may have a little more restriction in terms of having to participate with insurance companies, or even having patients accept care – accept treatment plans – that might be a little more comprehensive than what they’re used to.
MK: You’re in a solo practice now, and just as a reminder near Buffalo, New York, we don’t have a lot of LANAP practicing doctors in the Buffalo area. Are you getting referrals? You mentioned a GP to a GP might not be referring a lot of perio to you, but do you have that happen, or is it all driven by your own marketing efforts?
JD: I’d say for me at this point it’s about half-and-half, and I definitely wouldn’t say I get a lot of referrals, but people who know me and know I have this laser will send me patients, both general dentists and occasionally periodontists. If there are specific problems that they want addressed, or if they have patients who have already found this laser procedure this LANAP procedure online and ask about it and are looking for a dentist to offer that procedure.
MK: Your practice is called Buffalo T. M. J. Do you use your PerioLase for more than LANAP? It seems like you might be using it for other things with that emphasis in your practice.
JD: So I never would’ve bought the PerioLase if I didn’t intend to do periodontal surgery with it. I’m not sure if I was in the TMJ practice back then, when I bought the PerioLase, that I would have even had it on my radar. But after buying the PerioLase and then falling into basically this TMJ-focused practice, what I find is that we’re using the PerioLase every day. It’s on, and biostimulation is administered on multiple patients every single day, because it’s such a powerful palliative tool, because it’s so good at reducing inflammation and helping muscle tissue let go, and just overall helping people feel better in a very non-invasive way. So for me, the PerioLase is my first choice as a palliative therapy in the treatment of TMJ dysfunction.
MK: I have to mention that biostimulation is an off-label use. It’s not an FDA-cleared use for the PerioLase, although certainly it is used off-label that way by many practitioners. I do want to give a shout out to your practice website in case you’d like to learn more about Dr. Dolgos and his practice in Orchard Park, New York. There’s two different websites: BuffaloTMJ.com and also Buffalolasergumsurgery.com. Thank you, Dr. Dolgos, for chatting with us today.
JD: Thanks, Marty. It was great being here.