Dr. Robert Gregg has been using lasers clinically since 1990, including CO2, FRP Nd:YAG, FRP Ho:YAG, surgical Argon, CW diodes and Er:YAG. He has lectured both nationally and internationally on the subject of clinical laser applications. In addition to authoring several peer-reviewed articles on the clinical applications of FRP Nd:YAG for endodontic and periodontal uses, he is an author of the “Curriculum Guidelines and Standards for Dental Laser Education,” versions 1992 and 1998.
Dr. Gregg obtained his Mastership and Educator’s Certification in the Academy of Laser Dentistry, as provided for in the Laser Curriculum Guidelines. He was appointed as a peer-review member of the Dentistry Today CE Editorial Board and Leader in CE. A co-developer of the FDA-cleared PerioLase® MVP-7™ pulsed Nd:YAG laser, he also developed and patented the LANAP® periodontal protocol and the LAPIP™ protocol for peri-implantitis. Dr. Robert Gregg is an Adjunct Professor at Rutgers School of Dental Medicine.
Dr. Dawn Gregg has extensively lectured nationally and internationally and published on the subject of the LANAP® procedure and the clinical laser applications of the PerioLase® MVP-7™. Most notably, Dr. Gregg recently published the SPIE article on the LAPIP™ protocol entitled, “Pulsed Nd:YAG Laser Treatment for Failing Dental Implants Due to Peri-implantitis.”
A member of Omicron Kappa Upsilon Dental Honor Society, Dr Dawn Gregg is responsible for ongoing initiatives with dental curriculums where the LANAP® and LAPIP™ protocols are being taught, including Rutgers School of Dental Medicine, University of Kentucky College of Dentistry, the University of California, San Francisco, and the United States Army and Navy. She is also an Adjunct Professor at Rutgers School of Dental Medicine.
Dr. Gregg is a fourth generation dentist after her father, grandfather, and great-grandfather, each of whom practiced in California’s San Fernando Valley, and one of seven dental professionals in her family, so far. An honors graduate of the UCLA School of Dentistry, Dr. Gregg has maintained a thriving private practice that focuses on treating periodontal disease with the PerioLase® MVP-7™ for the LANAP® protocol.
VIDEO - DUwHF #973 - LANAP
AUDIO - DUwHF #973 - LANAP
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Howard: It is just a huge honor for me today to be podcast interviewing Dr. Robert Gregg and Dr. Dawn Gregg all the way from Cerritos, California, which is near Long Beach in California. Dr Robert Gregg has been using lasers clinically since 1990 including CO2, FRP Nd: YAG, FRP Ho: YAG, surgical Argon, CW diodes and Er: YAG. He has lectured both nationally and internationally on the subject of clinical laser applications, in addition to authoring several peer-reviewed articles on the clinical applications of FRP Nd: YAG for endodontic and periodontal use. He's an author of the Curriculum Guidelines and Standards for Dental Laser Education, versions '92 and '98. Dr. Gregg obtained his Mastership and Educator's Certification in the Academy of Laser Dentistry as provided for in the Laser Curriculum Guidelines. He was appointed as a peer-review member of the Dentistry Today CE Editorial Board and leader in CE, a co-developer of the FDA-cleared PerioLase MVP-7, pulsed Nd: YAG laser. He also developed and patented the LANAP periodontal protocol and the LANAP protocol for peri-implantitis. Dr. Robert Gregg is an Adjunct Professor at Rutgers School of Dental Medicine. Now Rutgers School, is that the old New Jersey? Is it called Rutgers anymore?
Robert: It's Rutgers now.
Howard: What? What did it used to be called?
Robert: It used to be called...
Dawn: UMDNJ. University of Dental Medicine, New Jersey.
Howard: Yeah. My roommate at Creighton, Gary Esoldi, one of the greatest dentists ever, he's an artist. He could draw you. He could look at you for one minute, turn around and draw you to where everybody who knows you. That's where he went. So I still, I'm giving away my age.
Howard: Dr. Dawn Gregg, who just spoke, has extensively lectured nationally and internationally and published on the subject of the LANAP procedure and the clinical laser applications of the PerioLase MVP-7. Most notably, Dr. Gregg recently published the SPIE article on the LAPIP protocol entitled "Pulsed Nd: YAG Laser Treatment for Failing Dental Implants Due to Peri-implantitis". A member of Omicron Kappa Upsilon Dental Honor Society, who refused my application every time I asked for it. Dr. Dawn Gregg is responsible... I'm just kidding. Dr. Dawn Gregg is responsible for ongoing initiatives with dental curriculums where the LANAP and LAPIP protocols are being taught, including Rutgers School of Dental Medicine, University of Kentucky College of Dentistry, the University of California, San Francisco, and the United States Army and Navy. She's also an Adjunct Professor at Rutgers School of Dental Medicine. Dr. Gregg is a fourth generation dentist after her father, grandfather, and great-grandfather, each of whom practiced in California's San Fernando Valley, and one of seven dental professionals in her family, so far. An honors graduate of the UCLA School of Dentistry, Dr. Gregg has maintained a thriving practice that focuses on treating periodontal disease with the PerioLase MVP-7 for the LANAP protocol. My Gosh, fourth generation dentist. So you think it's some recessive gene they haven't identified yet?
Dawn: It must be because I swore I wasn't going to do it, and look at me now.
Howard: Well, you know, it's funny because, whenever I lecture in Dental School, I always say, "Raise your hand if someone in your family is a dentist". And anywhere from 25% to a third, a quarter to a third raise their hands. But in economics they taught me, when I was getting my MBA, that when you go around the world, like United States, like everybody talks about the Fortune 500, which doesn't even employ 12% of Americans. The backbone of America, 80%, is small business, twenty-five employers, less do a million, and you go around the world, it's the family business. But I've lectured in India and stayed at a dentist's house where there are, I think twenty-seven dentists in the family because they have that nuclear family, you know, they live with grandma and grandpa. The whole family lives together. And I was in Brazil, I think it was twenty-seven in India and I think in Brazil it was thirty-five. Thirty-five people in the extended family.
Howard: By the way, I'm a big fan of the nuclear family. You know, America always thinks they do everything great, and I think they're great in medicine, military, insurance, banking, finance, music and movies. That is where you're clearly number one around the world, but your education is 38th. But these twenty countries of about a billion people that kick all their kids out at eighteen and then when grandma starts drooling they put her in a nursing home. I think 4,5% of all Americans will end up dying in a nursing home. But the other six billion people, it's called the nuclear family. When you go to work, when you're a woman working, who's babysitting your kid? Grandma, grandpa. So, I like the nuclear family better, but that's not what we're talking about today. I have wanted you guys on the show for a thousand days and every time I send Bob and Dawn an email, they reply back "Who is this?" But I finally got them to come on the show.
Howard: The only guy I ever got to come on this show and talk about LANAP, was my periodontist buddy up the street, Allen Honigman.
Robert: Okay, yes, Allen.
Howard: And his views on this show have been amazing because everybody wants... You know, when you're making a decision to buy this anesthetic or this bonding agent or whatever, it's an easier decision, but when you're going to buy a laser for six figures... So, when people go on Dentaltown, we look at all the data, when they're searching and reading about LANAP or CAD/CAM or something that's going to cost more than a hundred grand, they'll stay on the site for like two and a half hours. They'll do a search for LANAP and they'll read for like two and a half hours or they'll do a search on CAD/CAM, they might come back.
Howard: So a lot of the users just go to Dentaltown, today's active topics. Kind of like reading the morning newspaper, like "What's everybody talking about today?" I noticed when they go search for like a bonding agent, they might stay on the website ten, fifteen minutes. But man, when it's a laser, a CAD/CAM, a CBCT, they're going to be on there for hours. So thank you so much for coming on the show since you invented it. This is dentistry uncensored. We don't talk about anything that everybody agrees on. The number one thing no one agrees on is these young kids that are coming out of school, they read these ads that implants have a 90% success rate, but then there's people publishing that within sixty months, 20% of implants have peri-implantitis. At nine years, that it's 40% and the periodontists don't even have an agreed upon protocol to treat peri-implantitis. If you talk to ten different periodontists, they'll just throw up their hands.
Howard: So, podcasters are usually younger. I always say, "Send me an email, Howard@dentaltown.com". "Tell me who you are and where you live, what country, what do you think about this show?" And 25% are still in dental school. The rest are all under thirty. I only get like one email a week that says, "Dude, I'm as old as you". So I tell my guests "A quarter of it is dental kindergarten and the rest are thirty and under". So, what do you do when grandpa comes in? He loves his implant. He can eat a cheeseburger, he could eat ribs, everything's fine, no pain, and he's got mush around an implant?
Dawn: Well, LAPIP protocol is using the PerioLase MVP-7 around ailing and failing implants. And it really can be any stage of that from inflammation around an implant to bleeding separation. And the great thing about it, is it's patient friendly and it's very conservative in that it's a tissue preserving treatment. There is no cutting away at the height of the implant. There's no use of any exogenous materials. You don't need to place any sutures. It's just creating an environment to regrow bone and healthy tissue around the implant. And it follows the basic features of the LANAP protocol which is used around ailing and failing teeth, which is to remove the diseased epithelium aligning inside the pocket, killing bacteria. Getting down to the bone modification, getting bleeding from the bone and then creating a clot, kind of like blood JELL-O alsmost. It's a very durable, strong clot that's created with heat, so you don't have to rely on the patient's ability to clot. In fact, you don't even have to take them off of blood thinners, if they happen to be on them. When you create this clean environment around the implants, we're seeing a lot of success growing bone back around an ailing or failing implant.
Howard: I got to do a shout out to Allen Honigman because I realize that was the worst first question, because the first question should have said, "What is LANAP and how on your journey... what was going on in your world, your life?" I'm sure 90% of my home is listening right now. Maybe they've heard of it. But I want to give a big shout out to Allen Honigman, because when did that first come out? When did LANAP first come out. And when do you think Allen got on board?
Robert: Well, I developed LANAP back in the early nineties and we got our first FDA-clearance for LANAP in 2004, so you can start the clock at 2004, I suppose.
Howard: Because I will tell you, when I was in school '84 to '87, University of Missouri-Kansas City, there was one oral surgeon that was doing a bunch of implants. And all the faculty during the lectures would refer to him as the butcher, crazy. He was doing (unclear 10:00) frame, subperiosteals. One guy called him like the butcher from langer hand or I don't even know that means. And then, in those early years, a lot of the early implantologists, they'd have their first case fail and the board would take their license away. And I know a couple of these guys that lived as jet sets, successful doctors with happy patients and, and they died alcoholics and depression. And when Allen Honigman started using the LANAP, that's exactly what it was like in Phoenix from the other periodontists.
Howard: They'd be like "Oh yeah, he's doing that Voodoo LANAP shit and blah, blah, blah, blah, blah". And he just held his ground and he kept singing at work and he kept doing it and now everybody's like, "Yeah Allen, he's so smart". He was the first guy that did that. He pioneered it in the valley and it's like, "Dude, you were throwing them under a bus ten years ago. So don't tell me how smart Allen is. Why don't you say you're an idiot?" And humans know what they know, but they never know what they don't know. And when people tell me they pioneered this or that in dentistry, I always say, "Well, show me the arrows in your back because if you don't have twenty arrows in your back, you didn't do shit in dentistry". I mean, whenever you try to change anything in dentistry, it's the most conservative bunch you'd ever meet in your life. And my two older sisters are nuns and they are liberal compared to dentists to see any change, you know what I mean? So Robert, what was going on in your life? How did your journey ended up inventing LANAP? And tell the dental kindergartners what LANAP is and what it stands for, and now the new LAPIP?
Robert: Well, let's start with the journey, because I think it's appropriate for the young dentists to understand. I was five years out of school and I had reached what I felt was clinical competency. I remember I was cutting a crown prep on tooth number three at three o'clock in the afternoon and I was starting to doze off. So I thought, wait a minute, I got to do something to inject some energy, some additional training into my career, my practice. I looked at a interceptive orthodontics. I took the Branemark implant course, but none of those really inspired me. And that's right about the time the first pulsed Nd: YAG came into the marketplace. And I said, "Now this will change the way I interact with my patients and maybe do some things I can't do otherwise".
Howard: Now what was that one called?
Robert: That was the dLays 300 from American Dental Lasers.
Howard: American Dental Lasers. That was $50,000.
Robert: Right. And I pointed up for that and it had no training, so I had to figure it out along with our study club. We had to form a study club to figure out how to use the dLays 300. And I developed this protocol for LANAP, which stands for Laser Assisted New Attachment Procedure. And most people don't know an attachment from, I guess, a gingival graft. They don't really understand what new attachment means, because we think, well if we tighten up the pocket or the tissues and they're pinker, then we've got regeneration, new attachment. And that's not the case. New attachment refers to connective tissue, bonded to the cementum which is bonded to the bone. And that then extends into the new bone. And that is a unique healing event. In fact, very few products have that as an FDA-clearance, which we obtained last March of 2016.
Robert: So, it's a methodology for regenerating bone around teeth in a full mouth protocol, so it's hope for hopeless teeth and hope for hopeless patients. So that they have a chance to keep their teeth a little bit longer so that if in the eventuality they do need implants in the future, they're in a much better position, with much more bone than they would've been had they had an extraction and graft an implant.
Howard: So how many people are using LANAP now?
Robert: Over twenty-two hundred around the world. Most of them are in the United States, but we have Guam, Virgin Islands, Italy.
Howard: And how many periodontists are there in the United States? What is it, about five thousand?
Robert: Yeah, that's the full membership. We have about a third of the active periodontists as customers.
Howard: So, of your twenty-two, you said twenty-two hundred?
Howard: So, of the twenty-two hundred. What's a third of five thousand? So how many of those are periodontists then?
Robert: Well, half of our customers are periodontists.
Howard: So, you got eleven hundred periodontists using it?
Howard: That is no small feat. I mean, don't you think that's a conservative bunch?
Robert: Yes, it is. And the reason that they purchased and invested is because of the human histology studies we've done. So we are in the most conservative group that you can be in in dentistry, when it comes to periodontal treatment.
Howard: Well, you and I, I got out of school... What year did you get out of school?
Howard: Yeah, and I was '87. You were 1984, I was 1987 and Dawn was 2012.
Howard: Funny because, do you agree or disagree with this? Of all the nine specialties, I think periodontal changed the most because when I was in school and the first five or six out, it was all quadrant surgeries and it was all HEMA sections and mesial root plugs and endo. It was all periodontal surgery. Then everybody realized, well, hell, if this is the way to treat periodontal disease with forceps and sunshine and pull that damn tooth, throw it away and plug in titanium. And after fifteen years of that people are starting to see, wow, well that's not really working. And now I'm seeing my periodontist friend is coming back, and it started, they said, with their friends and family, like the mom was in there and they're like, "Well, I don't want you to pull her tooth and do an implant. I want you to try to save her tooth." So, it looks like, titanium doesn't cure periodontal disease, does it?
Robert: No, it does not.
Howard: So, what do you tell these dental kindergartners who are in school who were reading ads and all these journals that say implants have a 90% success rate. What would you say to that ad?
Robert: Well, you have to look at the research and the research coming out of Europe shows that implants have, like you mentioned, a 40-60% failure rate at nine years. So, what are you gonna put that implant in for? They're also more likely to fail on a patient that has active periodontal disease that isn't being addressed. And that's a very common thing that we're hearing, is that doctors are seeing a patient that has periodontal disease, but they take a tooth out, put an implant in, and they expect that to do well and thrive. And in fact, they don't do well. They fail at an even higher rate, almost twice the rate as a healthy mouth.
Howard: A 40-60% failure rate, that's a wide margin. If someone said "Pin it down tighter". What do you think the number would be?
Robert: Pin it down tighter?
Howard: Yeah, at nine years. What do you think the body of the literature would say at nine years? What percent fail? What number between 40 and 60%? You think it's closer to 60 or closer to 40?
Robert: I don't know. I'm just referring to the Scandinavian research that's just come out. It depends on what you call failure. Ailing or failing implants?
Howard: But it's hard to describe what's failure because the research coming out on the oral-systemic link, I mean just because the implant is solid, you do oral DNA analysis, you got all these oral DNA tests, you got all these bugs in there and it seems like every month you see more literature saying it's associated with all these other diseases. So, it's got to get healthy or it could be linked to all other stuff. Of course, the older dentists, especially the older ones on Dentaltown keep saying, "Yeah, I made coffee this morning and the sun came up. I can't believe my coffeepot made the sun come up. It's a correlation,
Howard. It's not cause effect." How much of this oral-systemic link that's always in all the newspapers and journals going around, how much of that you think is correlation versus cause and effect?
Robert: Well, right now we don't really have cause and effect. We have correlations like you said. But you can look at some studies, like Marjorie Jeffcoat did a study on preterm babies, and those that were successfully treated, meaning they actually reversed the gum disease, had about a 90% chance of delivering a baby at term. Whereas if it wasn't treated or it was unsuccessfully treated, it was down around 20-30%, so it's a big difference. So, we do know that there's a correlation, a causation if you will, in some cases.
Howard: So, in premature babies, would you say it's causation then?
Dawn: That's in the literature.
Howard: Who was that ADA executive director for a decade, then I think he went to Aetna Dental Insurance. Was it Brenner? Do you remember him?
Robert: That doesn't ring a bell.
Howard: I listened to one of his lectures and then I had lunch with him afterwards and he was saying, "You know, in America, money's the answer. What's the question?" He goes to the lowest low hanging fruit on this oral-systemic link deal is absolutely going to be preemie babies because when you drop a three pound frog, it's a million dollars cash. And if we can get these girls in there and screen them and get their periodontal taken away, you're talking about saving upwards of a million dollars. So, you were saying, if the woman had gum disease and wasn't treated, she had 90% chance of early delivery, is that what you said?
Robert: No, if they're successfully treated, it's 90 percent chance of delivering at term.
Howard: Okay, what if it's not treated?
Howard: 20-30% what? Deliver pre?
Robert: No delivery at term.
Howard: Deliver at term. So, 70% are a preemie and you know, it's one thing when your baby is only five pounds. But man, when that baby gets down to under a couple of pounds, that's a million dollars.
Robert: Well we had an interesting experience. There was one patient who had a stillborn baby. Staci Woo is her name. It's on Youtube. We did an interview with her.
Howard: Can you find that? Staci Woo?
Robert: Staci Woo.
Howard: Woo. W-O-O?
Robert: Yeah, I think so.
Howard: Stillborn baby.
Robert: And when the baby was stillborn, family asked for an autopsy and went to, was it Creighton or Case Western?
Dawn: Case Western.
Robert: Case Western, and they found that the baby's organ systems were infiltrated with a periodontal pathogen. I forgot which one it was. So, there was a direct cause and effect there. It was the first time that there's been a proven link from gum disease to a stillborn. When we we're able to get her to do an interview on Youtube, you would've thought the ADA and the AAP would have rallied around and said, "Hey, we need to do something about this". We didn't hear a peep. Neither organization took an interest in that story.
Howard: Did you post that video on Dentaltown?
Robert: No, not on Dentaltown.
Howard: Would you post it? By the way, I'm a big fan. You've had fifteen hundred posts since 2002. Thank you so much for that. I'm seriously a huge fan of your posts. Would you think that should go under pediatric dentist, oral-systemic link or periodontal disease?
Dawn: Probably a couple of them.
Robert: Oral-systemic to be sure.
Howard: Well, so there's fifty categories. Oral-systemic is under health, so click health and go to oral-systemic link. But anyway, on a Youtube video, when you're playing a Youtube video, you put share and you got a link if you want to email or text it. But the button next to it is embed and you click embed and then it's got the code and then when you're making a post on Dentaltown, there's this little Youtube icon. You click the Youtube icon and pace that embed code there and then the video is right there. But anyway, we're kind of in the early days of this still.
Robert: I think we're seeing more and more correlations and I think it's just a matter of time before, like the Jeffcoat study that we have and Staci Woo, that we actually see causation.
Howard: Well post that. Will you post that video and then the study afterwards?
Howard: And it'll be under oral-systemic link, so go to health and oral-systemic link and post it there. That is amazing. So then when did you come out with LAPIP? You said LANAP, that you got FDA-clearance in 2004.
Robert: Correct. Well, LAPIP was a parallel development. So, while we're treating patients for LANAP, we weren't distinguishing that per se with implants, we were treating it the same time. But as this awareness and this problem became more pronounced for implants, we decided to give it a special name, so it could distinguish itself as a standalone procedure for an ailing and failing implant, as a single implant approach versus LANAP, which is a full mouth approach. So, for an implant, you can treat just the implant that's affected. In periodontal disease, we consider that a full mouth infection, that the entire mouth is involved. So we want to kill the bugs, just like we want to kill all the termites. We want to attend the house, not just the garage.
Howard: So, explain how you think LANAP actually works as a science. How do you think it actually works? What do you think is going on?
Robert: Well, I think there's quite a bit of mythology about LANAP. There's a lot of misinformation about LANAP. LANAP isn't about sticking a fiber in a pocket and killing some germs. That's not really the main therapeutic effect. It is a protocol, or a recipe if you will. And if you want to have the outcome of true regeneration, you have to follow a sequence of steps. You need to first remove the diseased epithelium lining. You need to disinfect. You need to remove the calculus after root surface. You need to stimulate the bone to release stem cells, Mesenchymal cells. You want to use a different setting at the same time you're doing that in order to get a stable fibrin clot. And when you get a fibrin clot that seals, it's like a membrane when you put in a graft of some sort.
Robert: So, it's like full mouth GTR if you will. So just like with GTR, you have to follow the steps. If you miss a step, you're not going to get the result. So, it's not just firing the laser in the pocket. Because you could. I used to say, I still say it, that if you give me a paperclip and a source of heat, I can probably reduce some inflammation, but I'm not going to get a great result, a predictable result, a consistent result. Because what's my source of my heat? Is it a match? Is it a butane torch? Is it an alcohol torch? How hot is that paperclip? And so when we see doctors trying to get a result with the diode, they have no idea what the (inaudible? 26:13) and the PerioLase is very sophisticated in that it has a jewel counter, a power meter, and a known number of therapeutic light dose that we deliver to tissue in order to get true regeneration outcome.
Dawn: So, the parameters are known to the clinicians so that the clinician can adapt or change the parameters within healthy combinations or safe combinations to adjust to the patient who's hemorrhagic, maybe (unclear? 26:44) excessive tissue versus your dense fibrotic smoker patient, where the tissue looks completely different and responds differently as well.
Robert: So, we developed the protocols and the parameters for the PerioLase for all types of clinical presentations from the dense fibrotic, to the most (unclear? 27:04) advanced case types. So, the MVP-7 refers to the seven pulsed durations that are fully adjustable by the clinician. With proper training, they know when to use which pulsed duration and what's the indication for those pulsed durations. And how do you stop a haemorrhagic pocket? And how do you deal with other types of tissue? We have different biotypes or genotypes depending on how you want to talk about the thickness of the tissue.
Howard: When you're using the laser light amplification, stimulation, emission of radiation. Does that alter the tooth surface or the implant surface?
Robert: Well, that's a great question because we were told back in the nineties by some people like, you probably remember one of your mentors, Charlie Cobb.
Howard: He was my teacher.
Robert: Yes, I know. He published a study that showed that Nd: YAG burned roots. And we never saw that in our clinical experience. So, we were fortunate enough to run across Ray Yukna from LSU, periodontist and a world renown researcher and he says, "You know, if you're going to make some claims that you're getting regeneration or whatever, you need histology to demonstrate that". And he challenged me to do the histology and I said, "Sure, let's do it". But in my mind, I wanted to prove that we weren't injuring the root surface and we weren't killing the pulps and anything after that was, you know, gravy.
Robert: So, that's what happened. We did the human histology and to my not real big surprise, but my satisfaction, there was no injuries to the root surfaces, no burning, no jarring, no pitting, no cratering. And same with the pulps, there was no damage to the pulps. But, there was a big bonus is that six out of six of the experimental teeth in a controlled study with a blinded examiner, six out of six showed cementum mediated new attachment. And two of them showed bone regeneration. So, he was blown away.
Howard: Who was that? What was his name?
Robert: Ray Yukna.
Dawn: And that was after just three months.
Howard: Ray, how do you spell Yukna?
Howard: And he's University of Alabama?
Robert: No, he was at LSU. He is now a Colorado at Aurora.
Howard: So, then how are you and Charles Cobb?
Robert: You know, we get along.
Howard: Did he ever change his mind on it, or...?
Robert: I think one on one, he'll tell you that it does work, but I think he's got a constituency that wants to hear otherwise. But I get along with him. He actually went to Georgetown for his anatomy and that's where I went to school. That was Georgetown.
Howard: They closed Georgetown down. Was it because you two went there and after you two graduated they said, "This has got to stop".
Howard: They did close dental school, didn't they?
Robert: Yeah. In '92.
Howard: Georgetown, Emory, Fairleigh Dickinson, Northwestern, Loyola.
Howard: God, when we got out of school, they closed down seven. So now when these people are starting to freak out because they're adding dental schools like, dude, you know, when the first 10 years out they closed down seven, now they've added some. But well, I tried to get Charlie on the show and he goes, "No, it's too controversial". I said, "Dude". I mean, he's got to be sixty. I said, "At your age, who gives a shit? It's dentistry uncensored. Come on the show and talk." "No, it's too damn controversial." (unclear? 30:51) his email box will fill up again.
Robert: Well, yeah. And here we are, how many years later from his first published paper like that? Twenty years later. And the science has now supported that the LANAP protocol with the Nd: YAG actually does work and works profoundly to get a true regeneration of the cementum, periodontal ligament and the bone. He's having a hard time reconciling what he said over the years with what the science is now showing. That it works.
Howard: It's called an inconvenient fact.
Howard: Nothing pisses me off more than a fact that destroys the bubble you live in.
Robert: That's right.
Howard: So, in a practice. So, you're a periodontist and you buy a LANAP, what percent reduction in your quantitative surgeries, would you see? I mean, is this something that's more niche and boutique that you'd use on 10% of the cases, halve the cases? How does this change a periodontist practice?
Robert: Well, they pretty much abandoned conventional blade surgery.
Howard: So, they just stopped blade surgery?
Robert: Yeah, for the most part.
Howard: For the most part.
Robert: They can't resist the urge to cut something, so they might, you know, lay a flap on the retromolar pad or something like that. But, what we're hearing is practices that were all GBR or GTR based have completely stopped doing that except in those small percentages.
Howard: You said GBR or GTR?
Howard: Come on guys. In dental kindergarten, they might not know what that means.
Robert: Yeah. Guided Tissue Regeneration. Well, you put a bone graft in or (unclear? 32:42) and condition the root surface with some sort of acid, ETA or something. And then you put a membrane over, (unclear? 32:50) through it and you get some bone degeneration. And it works, but it's a...
Howard: You said GTR and GBR?
Robert: Yeah, they're the same, one and the same. Guided Bone Regeneration or Guided Tissue Regeneration.
Howard: And if a periodontist gets a LANAP, those two procedures kind of disappear?
Robert: Yes. As well as conventional osseous surgery, there's just not a need to do that anymore.
Dawn: Well Howard, there's no harm in doing LANAP. See, there is no reduction at the height of tissue. There's no increasing the length of the tooth, long sensitive teeth. You are doing a very conservative approach. So, after it's all done, and the patient is healed and doing great, if you find a localized area that you want to go back in and do a retreat, you can retreat it with LANAP. You could retreat it with a conventional surgical technique. A lot of the periodontists are combining LANAP and doing distal wedges conventionally, as surgical technique that remains conventional. So, you start out with LANAP and you don't lose any ground and you might gain everything that you need.
Robert: Yeah. Number one is, patients accept LANAP far more often on a scale of about three to one compared to conventional osseous, so it's a patient preferred procedure since we're not cutting and sewing and not reducing the height of the tissue and exposing root surfaces.
Dawn: Which is a huge benefit for the periodontist because typically they are referral-based office where they're relying on their GP's to refer patients. But the LANAP practices, those (unclear? 34:36) with the PerioLase MVP-7, they are getting patients that are being generated within their practice. Those patients, they're doing LANAP and are going out and telling their friends and family.
Howard: So, it reminds me of William Shakespeare when he used to describe elderly people as long in the tooth. You remember that?
Robert: Oh yeah.
Howard: Yeah. And now the college university plagiarism software, you know, they get it digitally and then they run it through a scan to see what percentage is plagiarism. Have you just heard about that?
Howard: Well, did you hear about Shakespeare?
Howard: Did you hear about it with William Shakespeare? They ran all his Shakespeares through that stuff and they found another man long before him that he borrowed heavily from.
Robert: Oh wow. I didn't hear that part.
Howard: Yeah, because I remember when I was at Creighton, one of the things my instructor said to me, that "The more you study Shakespeare", he said, "You almost would think it was like a group of people because it was too much volume of work". No one could see how one guy could do all that and now it looks like they might have found the answer to that.
Howard: So, what about postoperative pain? Because when you talk to the marketing people and they survey Americans, this is what many people, and a study from UCLA that new (inaudible? 35:52). But basically, for thirty years it's very consistent that half of Americans are afraid of the dentist. The pain, the fear, all that, the shots. And the other half are afraid of the cost. And that really you can break down America into two markets. I'm either afraid you're going to hurt me or I'm afraid of the bill. What's the pain like afterwards of four quadrants of osseous blade surgery versus LANAP?
Robert: Oh, night and day. There's a lot of pain and morbidity associated with conventional blade surgery. With LANAP, almost nothing. We don't prescribe any opioids. And Motrin is about all that we have to give. It's a very...
Howard: Well that's no fun. The only reason they want surgery is for the opiums.
Robert: Yeah, there you go.
Howard: How come you're not, I mean, the president of the American Association of periodontists uses LANAP, Dr. Steven Daniel. I mean if you only got eleven hundred of the five thousand periodontists and they're all doing quadrant surgeries, and I've seen this for thirty years. And I can't tell you how many patients have come back to me, like the periodontist did the right side and they say, "Dude, you'd have to stick a gun to my head to go back and do the left side". That's why I always tell "Doctor", I say, "You got to do full mouth surgery". Because dentists, they start off at a dental kindergarten, they do one tooth dentistry and then after five or ten years they start doing quadrant dentistry, but the most they can get is like one side of the mouth and I'm like, "Dude, next door to you is an oral surgeon, he numbs up all four quadrants every single day". I mean, how would you like to get a bypass? And they say, "Well Howard, you're pretty fat. You ate a lot of bacon, you need a quadruple bypass. So, we're going to schedule you for one valve a month, for four months." I mean, wouldn't you want to just go in there, flay you open one time and do it? Because I always thought for thirty years, that those periodontists should know better than to quadrant the flap on the right side and then think they're going to come back for the left side. Because I can give you a hundred names today, of a bunch of people in the last thirty years that never went back for the other side. Same thing with wisdom teeth. They'll come in for wisdom... I say "I'm not pulling one because you'll never come back for the other three. It's all or none. That's your choice. What do you want to do?"
Howard: So, if the president, Steven Daniel, which by the way, you got to get him to come on the show. I mean, God, how much better marketing would that be to follow you with him, because if the other four thousand periodontists aren't using it and they have to do procedures with Vicodin and Percocet and all that stuff. I mean that's huge. I mean, how excited were you when the president, when Steven got his LANAP? How excited were you?
Robert: Well, he wasn't president when he bought. He bought back in the day when he was a brand-new trustee and he's worked his way up to be president. But at this moment in time, three of the four executive committee members are LANAP trained, and half of the trustees are LANAP trained. So, we've got quite a lot of penetration, but also, we've had a number of past presidents that are LANAP trained. And it's interesting that some like to talk about it and some don't. I've often wondered why they don't like to talk about it more because one on one they'll tell you that results are great, it's fantastic. "Well, hey, would you like to do a testimonial?" "No, that's okay." So, they're under a bit of peer pressure from the organization to not talk too much about it, if you will.
Howard: Why do you think that is? Why would you think that is?
Robert: Well, what do you think about organized dentistry? Do you think that they catered to the top 10% or the doctors in the middle? They pretty much deal with, you know, their core membership are not necessarily high end driven. So, a lot of the constituents within organized dentistry, they're not going to be able to or want to invest in the time and training. So that's one of my thoughts.
Howard: Well, my team was very excited that I finally got you guys to come on the show. And by the way, I mean really this is a big deal for us. But gosh darn, everybody's been emailing me. Howard Goldstein, the head of CE says Honigman made us a course on LANAP, but he wants you to make it. He said that he wants the man himself who invented it to make an online CE course. By the way, our online CE courses we’re at four hundred and seven courses that are coming up on a million views because old guys like us, we go to a convention and the millennials, they have an iPhone and they have Apple TV and they come home and throw the online CE up on their big screen. And then they don't have to take notes because all they got to do is go back and play it or whatever.
Howard: And then my editor, Tom Giacobbi, who, by the way, shout out to Tom Giacobbi, today is his eighteen year anniversary of the editor of Dentaltown magazine. A lot of people always send me stuff and they'd say, "Hey, will you print this in Dentaltown?" It's like, "Dude, the only reason you've stayed there eighteen years because he's a dictator". He's never asked me my thoughts on an article one time. I mean, my management style is, find the smartest people you can find and get the hell out of their way. And these dentists that don't delegate, they don't realize that you're going to die someday. So, if you don't delegate until the day you die, the minute you die, everything you created just falls apart. I mean, you're good at it. When you die, you're going to delegate a 100%. So, start delegating it now to see how your team is doing. But Tom Giacobbi, and the editor is Sam Mittelsteadt, they both want an article from you guys too. So, if you build us an online CE course and do an article on Dentaltown, I think it'd be huge. And you got to get that guy, Steven Daniel, to talk about that.
Howard: And then the other thing, I'm in several dental schools a year. The students tell me that when they're studying periodontal disease, that when you're an academic school, they say that their colleague leaders like Steven Daniel of the American Association of Periodontists, that they don't believe that there's an agreed upon protocol for treating peri-implantitis. But there is for a pulpotomie and a chrome-steel crown at a pediatric dentist, there is for wisdom teeth, there is for root canals. And they asked, "Why is that the only one of the nine specialties that doesn't even have an agreed protocol on their number one disease?" How would you answer that?
Dawn: Because nothing's worked reliably and everything's been tried, from the most conservative to the more aggressive surgical grafting. You name it, kitchen sink, try everything approach. No matter what's been tried, it's not successful. It's say hit and miss 50-50 chance that it'll work. And that's not what we're seeing with LAPIP. It's much more successful than that. And that's a challenge.
Robert: We have an oral surgeon in Texas, Gary Schwartz, who's documented his peri-implantitis cases treated with LAPIP. And he has a 90% success rate. And he defines it.
Howard: What's his name?
Robert: Gary Schwartz, McAllen, Texas.
Robert: Sounds rights.
Howard: Gary Schwartz. Oral surgeon where?
Robert: McAllen, Texas.
Howard: Mc Clelin?
Robert: Yeah, south Texas. Near the border.
Howard: I'm a 100% Irish. He sounds like he's a drunk Irish guy. Are you sure?
Robert: He's a fun guy.
Dawn: You would enjoy him.
Robert: He's got a ranch and he raises trophy deer and trophy bass. So he's got quite the outdoorsman.
Howard: Wow. And what's he saying from oral surgery that on his peri-implantitis he's got what percent success rate?
Howard: Wow. So, then the next question is, and I hear this all the time. They're coming out of school. We were in (inaudible? 44:29) two Sundays ago. And those kids, it's a private school. I mean there's kids walking down there, $400,000 in student loans and a lot of them are starting to get smart because of social media in Dentaltown. A lot of people think, well, you know what? I'm just going to get a job at corporate and pay off my student loans and I'm just going to do that and be mister mom or whatever. What they don't realize is that if that was a great idea, why does the average dental student only work in those places one to two years? I mean, the turnover rate as an associate, and don't throw Heartland and Pacific and Aspen under a bus because, say 80% of the associate jobs are in private practice and nobody keeps their millennials.
Howard: And it's not even just dentistry. If you look at the FANG stocks, Facebook, Apple, Amazon, Netflix, Google, Microsoft, they have the same thing. Their average millennial only stays one or two years. They stay the shortest at Apple, one year. So, when everybody's saying how great Jeff Bezos is, (unclear? 45:34) his average employee here. And the one that keeps them longest is Facebook, which is two years. And in corporate, the longest guy keeping associates is actually Rick Workman of Heartland Dental. And every kid that stays there two years longer, I ask them the question, "Why have you stayed so long?" And he says, "Because the continued education is amazing. If I stay here five years, I'll get my fellowship, my diplomat, I'm getting all this training". They're looking for mentors. And as soon as they get a job and they find out they're in a Medicaid mill and they're not learning anything, they're gone.
Howard: And it's the same thing when they go work in Silicon Valley. You know, once they start working on a project, it's really fun, exciting and growing for a year or two. And then they find out that they're just going to keep doing that same shit for the next ten, twenty, thirty years. And they're like, "Screw that, I just got an offer from Uber. I'm going to go work on driverless cars." And then they go work at Uber on driverless cars. Once they figure all that shit out, then they're like, "Well, hold on, I want to go to Apple and work on e-commerce". They want to keep intellectually growing. They're looking for mentorship, and all that stuff. But they say to me, "Howard, I worked for this place two years. I worked for this associate. Screw it. I'm going to set up my own practice, but I graduated $350,000 student loans. I just bought a practice for six fifty. I'm twenty-nine years old, I'm under a million dollars. Do I really have to get a 100,000 dollar CBCT, a 100,000 dollar LANAP and a 100,000 dollar CAD/CAM?" And then all those three could have been a hundred and fifty thousand. So, if they go buy a CAD/CAM, a CEREC Sirona, say buck quarter, buck thirty. What's the LANAP costing these days with the training and everything? The whole package.
Robert: Well, I'm glad you brought that up because there's a lot of misunderstanding about our pricing options. We have five different pricing options from seventy thousand to a hundred and twenty-five thousand and anywhere from $1,500 a month on a lease to $2,000 a month on a lease.
Howard: Let's repeat that. Seventy thousand to one what?
Robert: One twenty-five. Not one thirty-five, one twenty-five.
Howard: Okay, and then the leasing (unclear? 47:41) was what to what?
Robert: Fifteen hundred to two thousand depending on what your value proposition is, or your price point is.
Howard: And how long is that lease? Sixteen months, or seventeen?
Howard: Sixteen months?
Dawn: Yes, sixteen months, but there are often several different options.
Basically, it can be customized to whatever you want or need to do.
Howard: So, if you got an implant today and bought LANAP when it was finally paid off, then you could use it for the peri-implantitis on yourself.
Robert: Well, we also have a financing program that's six months to six ninety-five, so it really allows the doctor to ease in. And what they'll find with LANAP and LAPIP is that it's pure profit with one patient a month. You don't have to build up a reservoir of patients and then all of a sudden now it's starting to pay off. Because you're doing full mouth one half, one visit, half another side, another visit within a week. And you're talking about $4,000 to $6,000 in revenue for $2,000 a month lease payment.
Howard: They did learn in business. So basically, when a millennial looks at a number, like they'll say, okay, it costs (inaudible? 48:56) that you're thinking of that as a balance sheet number. A balance sheet is your assets, say LANAP equals your liability what you want it minus equity you have into it. But that's not how you look at things. Same thing as real estate. I'll buy your house for a billion dollars. I'll buy any house in America for a billion dollars if the terms are a dollar a month for a billion months. Because I'll rent your damn house out for a thousand dollars a month. And they're always looking at the price of a house. They're always saying, "Well this house is two seventy-five, I really what the one that's three twenty. But I think I'm going to go for the one, dude, what is the interest rate and the terms?
Howard: I mean, those are statement of cash flow numbers, a profit and loss, a P&L statement of income. That's for third party tax collectors, the IRS if you're publicly traded the SEC. It's got artificial numbers, depreciation of taxes. The only thing you want to master is your statement of cash flow. And every damn dentist I know has a CPA that only gives them profitable (unclear? 50:02). The only thing your CPA does is give you a stupid number for your taxes. And the only reason you need a balance sheet is when you're going into your divorce. So, you need a statement of cash flow which nobody gets. And that's why the biggest takeaway I can give you is that every single dentist that changes their CPA to CPA firms that only do dentists, like the American Academy of Dental CPA, Tim Lott is the guru in there, and once you switch your CPA, then they can show you how this technology affects your statement of cash flow. Like a lot of dentists say, "Well, I'm going to buy a CAD/CAM because if I buy a service you don't want to have a lab bill and then I'm going to get rich". And then I'm like, "Hold on spanky, hold on, let's sit down".
Howard: And they got data on eight thousand dentists. And they can say of these eight thousand dentists, so now you should lump supplies and lab they'll combine because your lab bill goes down, but you're buying a lot of $15 blocks. And you used to take an impression, (unclear? 51:07). Now they're sitting in that chair for two hours or three. But on a statement of cash flow numbers, if the payment is fifteen hundred to two thousand a month, tell me exactly what that person could do in their office that month to get that fifteen hundred back to cover their payment. Fifteen hundred to two thousand, and then get maybe another fifteen hundred to two thousand to increase their return on asset, which is their dental office.
Robert: Well, the average general dentist has approximately three patients a month that they should refer or that does need periodontal treatment, such as LANAP. So, if you work those numbers, three patients times say $5,000, that's $15,000 and we're talking minimum numbers here because there's a lot more diseases out there than most dentists appreciate. So, you're talking $15,000 to pay off a $2,000 loan payment.
Dawn: Those would be the three patients in a GP's practice that they would send for conventional surgery to the periodontist or for LANAP.
Robert: That won't go.
Dawn: That won't go. But all of the periodontal patients in a GP's office, those that you would conventionally do scaling and root planing on, those are all candidates for the LANAP protocol. So, it's those three you would have referred out plus the ones that you would be keeping in, but maybe doing a scaling and root planing. Do you want repairing as a healing event or do you want regeneration as a healing event? That's a question for your patient to answer.
Howard: And you know, you just said something very genius. For years I had a prescription pad by every single phone called getting to yes. And when someone called and we said, "No", we tracked all of our nose. Because a lot of dentists they'll say, "Well, how do I get more new patients?" I'll say, "Well first of all, you don't need any new patients, you lost all your patients". I mean, you go into a town of five thousand, and here's an old man, Henry, who worked from twenty-five to sixty-five. You got twenty-five new patients a month for forty years. And he still needs to do patients. I mean, everybody in the county has gone and left him three times, they all come and leave him for a decade and then go back because he's the low hanging fruit. But like they'll say, "Do you think I should see them on Saturdays?" And I'll say, "Well, how many people ask you a month if you're open Saturday or evenings?" They'll say, "Well, do you think I should take this insurance?" "Well, how many people a month ask you?"
Howard: And then it's the same thing with referrals. I mean, I ask these dentists, "Okay, last year, 2017, how many sets of wisdom teeth did you send out?" "No idea." "How many molars did you send out?" "No idea." "How many cases for periodontal surgery?" "No idea." Then I'll say, "Well, what are you studying?" And so "I'm studying veneers, I'm going to be a cosmetic dentist". And I said, "Well, how many veneers did you do last year?" "I never did any." Okay, so you've never done veneers and now you're going to be a veneerologist? And, if you're sending out 100,000 dollars a year in perio or 100,000 dollars a year in molar, 100,000 dollars in perio, I'd start there. It's business in three words, it's supply and demand. They don't even measure what's coming in and leaving, what's coming in the front door and referring out. And if you can't measure it, you can't manage it. But what do you think the average general dentist? Well, if you've got five thousand, we could do the math. There's five thousand periodontists. And how many patients do you think they see a week for surgical procedures, not routine hygiene?
Robert: A week? I would think in terms of days. They'd probably see four a day...
Howard: Four a day? For how many days a week they think there are four or five?
Robert: Let's say a four-day work week.
Howard: Okay. So, then you would take sixteen times five thousand, and then there's only a hundred and twenty-five thousand dentists who work thirty-two hours a week or more. There's thirty thousand specialists who work thirty-two hours a week or more. There's two hundred and eleven thousand dentists living in America that have a license to practice dentistry. But a lot of them are retired or disabled. So, if you took sixteen times 5,000, which I can't do in my head, then you should be able to figure out the number of referring cases per dentist.
Robert: Correct. And we've talked about the periodontists that the LANAP protocol is suitable for them, but LANAP is suitable for the GP as well. They can realize these numbers, we train them so that they can get the results that the periodontists get. In fact, we have a joke that we have to un-train the periodontists from some of their paradigms so that they can appreciate this new technology and not to do certain things like remove the granulation tissue. GP's will do things like occlusal adjustment, which is part of the protocol and periodontists have a hard time with that. So actually, GP's can do quite well in terms of clinical outcomes.
Howard: So, go through it. So, there was a wide range at this lab costs between $70.000 to $125.000. Explain the range, the training. If someone says, "I want to do this", walk them through it.
Robert: Well, that's another great question because people think that the training is expensive, but this is a post graduate type of training. So, if you go to the Pankey Institute and you go through five evolutions or five continuum's, you're spending about $30,000. Well guess what? That's about how much our training is for five evolutions. So, we're competitive with the other training organizations that are out there, but at Pankey they don't pay for your room. We do for our students. They don't pay for your meals. We do. And we also pay and cover the transportation costs and the hotel. So, we are up...
Howard: What about drinks and weed because they just legalized weed out there. You get your choice. It all used to be beer and wine and now it's beer, wine and a bong?
Robert: It's all included.
Howard: By the way, I would change one thing on your pitch though, because I firmly believe watching people for over thirty years, if you don't do the procedure once a week, you're not going to get profitable at it. People get into sleep apnea and then they do send home test like once a month or they'll do an implant. It's like they never reached critical mass. If you don't do something once a week, you never get profitable on it. And if there's five thousand periodontists, they work four days a week. They see four procedures a day. They're doing thirty thousand procedures. A hundred and twenty-five thousand dentists, that means the average dentist should be referring four cases. That'd be four cases. What was the unit? Five thousand periodontists, sixteen a week. That'd be four cases a week. So now there's a hundred and twenty-five thousand dentists, so five thousand periodontists, four times four, sixteen a week. That's thirty thousand procedures a week. So, a hundred and twenty-five dentists on average are referring four a week, but you need to keep all the math. They do one a week because I wouldn't want to get a vasectomy by some guy who did it every other month. I wouldn't want to get it.
Dawn: Howard, periodontal disease is one of the most common diseases in the United States, in the world. So, if 85% of the population has some form of gum disease, that's what you're going to see more often in every one of your patients. So, if you're looking for one thing to do that most of your patients need, it's going to be gum disease treatment. And doing LANAP for regeneration as the healing event is huge. So, you were talking about the associate who wants to branch out and start their own practice. I can relate to that breaking out of my dad's practice and we were growing steadily, just fine. But it wasn't until I brought LANAP into the practice that we just took off. And I let people know that we were offering this LANAP protocol and people would come out of the woodwork from far away just to get this done. And my GP office, I ended up doing so much perio. I had to hire an associate GP to do the rest of the dentistry I couldn't get to. As well as specialists. I mean I hired three specialists and a full time GP and kept all the perio in my hands and the select cases and the patients that I wanted to treat, and our profit went up huge. LANAP was and is the most profitable thing that I do in the practice.
Howard: And Howard Goldstein wanted me to remind you that, you think you're all that and a bag of chips because the president of the ADP, Dr. Stephen Daniel uses LANAP, but Howard Goldstein says that he uses LANAP and that he is more all that and a bag of chips. Now you should be telling everybody that the director of Dentaltown online CE uses LANAP and that should be all. He says, "How much more influenced does it get then that?"
Robert: Well, regards to Howard.
Howard: Yeah. So, by the way, if you do want to do an online CE course, he's firstname.lastname@example.org. I'm Howard@dentaltown.com. But let me go back to the training though because you don't sell a laser. It's by Millennial Technologies, right? The laser?
Robert: Well isn't it kind of interesting that the company's name is Millennium and the target market now for so many of us is the millennials? I just kinda got a kick out of that because I think about that.
Howard: So, are you Millennium too?
Howard: Oh, I didn't know that. So, you own Millennium Dental Lasers? Is that what the name is?
Dawn: Millennium Dental Technologies. Millennium Dental technologies.
Dawn: Is the company. And that's the company that manufacturers the PerioLase and MVP-7. And then there is a separate and distinct corporation called the Institute for Advanced Laser Dentistry. And that corporation is responsible for the research and training. And you were asking about the training. The training is...
Howard: Is that the one in Colorado?
Dawn: Well we do training in Cerritos, Colorado, in New York and it changes depending on the season where we offer the training. Every month we train in Cerritos and then depending on the season, it's either in Colorado also or in New York also. And, as the training director for the Institute, I get to oversee fifty certified ILD instructors who are trained to provide hands-on training to doctors who come through the training program. It's five days of training, three upfront, Thursday, Friday, Saturday in a row. You come get trained, you treat live patients. So that's the other thing that our training does. We provide the patients for doctors to treat. They're actually doing the treatment, we're there to hold their hand and so they get to see how the energy interacts with the tissue and that's going to be different for different patients. So they have live patient experience for four out of the five days of training. The fourth day of training is six months after the first three and then the fifth day of training training is six months after that. So there is repetition and there's also introduction of new concepts and new training efficiencies, new treatment applications for the PerioLase as well.
Howard: Well, you know, I don't smoke pot, but just for the millennials, they'd have to go to Cerritos or Colorado if they want to have recreational pot. In New York, you actually need a prescription. Do you put a little asterisk on there for the millennials that they'll have to, do you provide a doctor on site to write them prescriptions? That's what I'm asking.
Robert: Well, they don't need him here in California.
Howard: I know, but when you train in Cerritos and Colorado you don't need it. But if they take your course from New York, do they realize when they get off the plane they're going to need a prescription?
Robert: No, I don't think so. But that's why we encourage them to come to Cerritos because we're central. We're what do they call it?
Dawn: Ground Zero for LANAP.
Robert: Yeah, Ground Zero for LANAP.
Howard: Ground Zero for LANAP. So, how's it going? Is your company, is it growing? Flat? Shrinking? Is it exploding? I would think you've got a lot of wind in your sails at this point.
Robert: Yeah, we'd been growing steadily since 2001 and we're on a uphill slope. It dipped a little bit right after 2008 recession, and doctors could not qualify for leases and loans. I remember we lost around twenty-one signed customers because they couldn't get financing. So that's starting to loosen up now. And it has been for some years. So, we are back on another growth curve. And I think it's important to understand why we're in this. We're in this to change the standard of care for treating gum disease and have more patients being treated. Because the treatment rate is around 3-4% of the patients that need it and we have two hundred million Americans, more actually, let's call that a round number, two hundred million Americans with periodontitis. Half of them have moderate to severe, 40% don't know it, and only 3-4% are getting treated. So, if we can cause an increase utilization rate, much to the chagrin of the insurance companies, this is what's happening. We're bumping the utilization rate up for periodontal disease treatment and that's been the goal from the very beginning, as well as getting LANAP into the dental schools and the periodontal probe residency programs, which we're doing now at Rutgers and UCSF Colorado and also the...
Dawn: The army and the navy and the air force shortly as well. Now the huge boost came in 2016 I think, to move us into the university environment. The academics. When we got the FDA-clearance for regeneration, we are the only dental laser and protocol that have science to prove regeneration and that's with human histology. That's the only way you can prove it, and we're the only company who has that. And I think on the heels of that has been a huge boost in the academic environment to acquire this and to start training residents. Those programs are so competitive now because the doctors coming in to those programs want to be trained on the LANAP protocol.
Howard: So, what about buyer's remorse? Do you do still offer a six month money back guarantee?
Robert: Yes, we do. And it's a clinical guarantee on the results. Meaning if you're not getting 90% of your patients and their pockets reduced by 50%, then we'll buy it back.
Howard: Say that (inaudible? 01:06:18) repeat that.
Robert: If a student has gone out for the six months trial period and they're not getting 90% of success in their patients and their pockets, at least 50% pocket reduction by regeneration, not by amputation, then we'll refund the money for the purchase price. And we've done that two times out of twenty-two hundred doctors.
Dawn: Most people like Allen Honigman would tell you, "You'd have to pry that PerioLase out of my cold dead hands before you can have it back".
Robert: But we also have for the nervous, someone will say, well, six months isn't enough. I need a nine month. Okay, it's going to be better results at nine months than at six, so all right, if that's your sticking point, let's do that. We've had other doctors say, "I want twelve months", and really by the time they hit six months, they're saying "Wait a minute, I already see the results".
Howard: My four boys are twenty-two, twenty-four, twenty-six, twenty-eight and I have a thirty-year money back guarantee on all four of my boys and they're not honouring the contract that I signed for them at birth. Final question. I can't believe we've already gone ten minutes over. Another question that really bothers the kids when they come out of school is, there's now over six hundred dental implant systems. Being on the other end of this, treating dental peri-implantitis, do you think some implants are more susceptible to peri-implantitis or not? Or has that nothing to do with it? And if they asked you "Come on, you treated peri-implantitis on probably a hundred different implant systems". She doesn't want to go study a hundred. I mean if you went to gosh darn Cologne, Germany last year, there were a hundred and forty-five implant companies that had a booth at Cologne. Narrow it down for them. Are you seeing more disease on some implants than others?
Robert: No, it doesn't matter.
Howard: It doesn't matter?
Robert: It doesn't matter what the implant, the protocol is the same. You follow the protocol, you get the results. And let me tell you something that a lot of dentists don't understand and it's why I think the relatively closed pocket treatment that we do is working. There's been some studies, one Tom Wilson published and a couple others that show that there's metal corrosion, titanium corrosion in the soft tissue. And one of the possible causations in failing implants is this corrosion is the problem. So if you do flap and you put graft material and then you put the same tissue flap with the corrosion by-product right up against it, well, it's going to fail. So why is it that we're effective around implants? We don't make a vestibular releasing flap and push the tissue away. We keep the tissue near the tooth and we go around the tooth with the laser, and I believe that's part of the reason we're extremely successful. We're not treating the implant the same way others are treating it. We're treating both sides of that pocket, the soft tissue and the titanium. And it does not matter what kind of implant it is We are still getting results.
Howard: I’m a big fan of laser, I don't know if you know this, but I actually had laser hair removal. That's why I'm bald. And it's been extremely effective now for over thirty years. I just want to end on one note. If you walk out my house one way about a block, there's an orthopaedic surgeon, a friend of mine, and you go out the other way about three blocks, there's another one. And the one thing those guys do all day long, we're talking about 20% of implants have peri-implantitis at five years. You ask any of them when they give you a hip or knee or anything, they say "Five years". And dentists always say "Oh, you get an implant, you'll take it to heaven". Well, that's not going to happen. And the fastest way to satisfaction, satisfaction equals perception of what's going on, minus what I expected.
Howard: Like when I get done doing a root canal, you don't tell people, "Oh yeah, you'll be fine going back to work". I lower their expectations. I say, "Dude, when this anaesthetic wears off, I hope you have a pistol because you're going to want to suck on it. I mean, you're probably going to wish you never been born when that wears off." So, they're like ground zero. Like, oh my God. Then they come back a week later and say, "Howard, you're not going to believe it. I didn't even hurt. I took like one pill." Every time I pull out a tooth, I hold that bloody tooth in front of them and say "Look at the hook under that root. It was hooked back up underneath your cheekbone. I swear to God, when this anaesthetic wears off, you need to find a cliff. You're probably going to want to dive off it." You lower their expectations. How long does that implant lose?
Howard: You know what, I don't care if it's a knee, a hip, when you start replacing parts, when the human body eith titanium, you're probably going to get about five years. Maybe you get longer if you'd take care of it, if you come in here every three to six months and get your teeth cleaned. If you quit smoking, you joined a yoga class. I mean, I've always noticed that implants last longer in a yoga instructor than in Irish alcoholics who live in a barn in Kansas. But lower people's expectations. And also, you'll be much happier in life if you lower all the expectations around the people around you.
Robert: One of the things that we say with the PerioLase MVP-7 value propositions, we understate and over-deliver. LANAP is what pays for the laser, but there's many other procedures you can do. And I just posted the other day an enamel caries removal on Dentaltown to remove the organic debris with the PerioLase and then put in a preventative resin filling.
Howard: We're so over, we got to go, but I just want to say one thing more from the MBA training. That is why you look at the Fortune 500. No one ever is appointed a CEO that comes from sales because sales people do what they do because they over-promise and under-deliver. So, the Fortune 500 doesn't promote anybody to CEO from sales because those people are freaking sociopaths, they're insane and they never deliver. You always want to bring someone in from accounting, finance. If you make a product, you should be the engineer. You should have worked on your product, but you have marketing people over-promise, under-deliver, and the way you handle patients, staff, everyone around you under-promise and over-deliver.
Robert: Right, well check out that post on enamel caries removal on Dentaltown. I'm getting some interesting responses, like "Why would you do that?" and "What's the point?"
Howard: Well, email me the link to that. I got to run. Email me the link to that post and I'll push it out on social media today.
Robert: Okay, will do.
Howard: Hey, it's a huge honour. I've known you guys for thirty years, and how many times have we run into each other at conventions and speaking, and all that stuff?
Robert: Well, you've been to our clinicians meeting in Cancun and you and May are in a picture for my avatar.
Howard: I know. You do that just because it makes you look so much more handsome.
Robert: Well, yeah, it makes me want to not have hair.
Howard: But hey, seriously, thanks so much for being a pioneer. I know dentists are a rough and ruly crowd and you guys proved them all right in the long run and a big shout out to Allen Honigman, because man, he stood there like a soldier. Ten years ago, it was brutal. Now he's laughing all the way to the bank. So, thank you so much for coming on this show.
Robert: Thank you! It was a privilege.
Howard: (inaudible? 01:13:52)