Patient Interview: What to Expect After LANAP Surgery

If you have been diagnosed with moderate or severe gum disease, you shouldn't feel too guilt-ridden about it; you happen to be in good company. The U.S. Surgeon General estimates that 50% of the adult population in the United States suffers from moderate to severe "periodontitis," known to most of us as gum disease, and 80% of them don't even know that have it.

A healthy smile with pink gums.
A healthy smile with pink gums. | Source

In this patient interview we will discuss:

  • Symptoms and Diagnosis
  • Costs of LANAP Surgery
  • The patient experience during LANAP Surgery
  • Patient experiences during recovery at one, two and four weeks following surgery
  • Meals and restrictions while recovering from LANAP

Choosing LANAP Over Dentures

Once you know you have a problem, it's time to make a plan to recover your oral health. Untreated, severe gum disease results in gum recession, bone loss and eventually tooth loss. Those invisible pockets of bacteria between your gums, teeth and their roots will progress, forming bacterial toxins that continually destroy healthy tissue. Additionally, oral inflammation has also been linked to heart disease; recent studies have shown a positive correlation between tooth loss and heart disease. The more missing teeth one has, the greater the extent of heart disease.

For most people diagnosed with periodontitis the options include tooth extraction with a bone graft, followed by implants once the extraction sites have healed, or oral surgery to remove the infection while deep scaling and root planing is simultaneously performed. Both options are very expensive, costing $2000-$12,000.00, depending on the number of teeth involved. An "all-on-4 implants" denture can give patients a beautiful, healthy looking new smile. However, if you have a nice smile already, you will probably prefer to keep your own teeth for as long as possible. Keeping your natural teeth requires surgical intervention.

Traditional oral surgery involves cutting open the gums, cleaning and scraping the gums, then suturing them closed for a painful and lengthy healing process that can last up to a week. On the other hand, dentists practicing LANAP therapy assert that you can have half of your teeth and their roots cleaned, with the infection removed, in two hours, and be back at work the next day, with minimal discomfort. Then two days to one week later, complete the second half of your treatment plan.

To help you make an informed choice for your oral health, we interviewed one patient, who underwent LANAP therapy to share her experiences with the diagnosis, treatment and healing process of her severe periodontal disease. Here are Amy's experiences with a full mouth LANAP treatment plan and its aftermath.

Healthy tooth with healthy gum and bone levels compared with moderate periodontitis. Teeth begin to loosen as the bone levels erode.
Healthy tooth with healthy gum and bone levels compared with moderate periodontitis. Teeth begin to loosen as the bone levels erode.

What Were The Circumstances of Your Diagnosis of Periodontitis?

"I went to the dentist to see about correcting a tooth that had turned dark following a root canal. I was simply planning on getting a crown to cosmetically correct the condition. As this was my initial visit to this dentist, he did a full mouth x-ray series. My x-rays told a grim story.

There was an active infection under the dark tooth. It had probably been there a long while, and the bone structure for the surrounding teeth had been compromised as well. That tooth was a total loss and would have to be extracted with a bone graft put in place, for a future implant. Since the bone loss on the surround teeth was substantial, they would not be strong enough to support a bridge.

Worse yet were my back teeth, where there was more substantial bone loss visible on the x-rays. Intraoral photos showed that the gums looked red and swollen back there too. The doctor recommended full mouth LANAP surgery to try to save six or seven compromised teeth and improve the overall health of my gums."

What Symptoms, If Any, Were You Experiencing?

"In hindsight, there was occasional bleeding when I flossed the back teeth, and some sensitivity on teeth to cold drinks where the gums had receded. But I never had bleeding gums from brushing.

I thought these changes were just a natural part of aging, now that I am in my early fifties. Now I see that these gradual changes were indications of a bigger problem."

Bleeding gums are a common symptom of Periodontitis
Bleeding gums are a common symptom of Periodontitis | Source

Have You Experienced Any Of These Symptoms?

  • Bleeding Gums When Flossing
  • Bleeding Gums When Brushing
  • Sensitivity to Hot and Cold Beverages
  • Halitosis
  • Loose Teeth
  • Answer Choices 1, 2 and 3
  • All of The Above
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Healthy Gingiva
Healthy Gingiva | Source

Is There Anything In your Medical History That Would Predispose You To Periodontitis?

"Yes, I am a smoker, and my mother had to have this surgery when she was in her mid-fifties. So there may be a genetic component in my pathology.

I understand that stress can impact the bodies ability to fight-off infections, and I have been under substantial stress over the last six years. Worse, I have a tendency to clench my teeth when I am stressed-out. Tooth grinding or clenching are also risk factors.

I am not on any medications, so that is one risk factor I avoided."

What Was The Cost of LANAP Surgery

I was quoted $6000.00 for the full mouth LANAP, and another $4,000.00 to extract the infected tooth, add a bone graft in the extraction site and eventually install the implant with a crown. Fortunately I had opted for the more robust dental insurance plan offered through the Affordable Care Act on the government's healthcare marketplace. With this plan you need to wait six months into coverage for major dental work, but if you can wait, it is very helpful.

My dental Insurance through TruAssurance covered $2,000.00 of the LANAP procedure, but that left another $4,000.00 I did not have on hand. So, I ended up having to finance the balance of the cost of my treatment for four years like I would a car, through Care Credit."

Included in the $6,000.00 fee:

  • Full Mouth LANAP
  • 3 Bottles of prescription strength Chlorhexidine mouthwash to be used twice daily for a 1.5 months
  • 2 Ultra soft toothbrushes
  • 5 Follow-up visits to check on the healing progress (weekly for 2 weeks then biweekly)
  • One polish a month after the procedure

"What is not covered under my treatment plan are the quarterly dental cleanings over the next year. Every three months I will need to have a cleaning, then at the end of the year, we will reevaluate the health of my gums, and see if the maintenance schedule can be changed."

Video Clips for LANAP procedure - Viewer Discretion Advised

How Did The LANAP Procedure Go? Did You Experience Pain?

"I really did not know what to expect going into the surgery. They only thing I knew was that a laser was going to be part of the process; not knowing what to expect caused me some unnecessary anxiety. As I said before, my mother had had the traditional surgery 30 years earlier, and was in terrible pain for a week."

"My procedure was scheduled to do the uppers on a Tuesday and the lower jaw that Thursday. I wanted to get this all done and out of the way as soon as possible. You can also do one side, and then the other side, which can make it easier for you to chew on one side of your mouth after the first half of the procedure."

Step 1: "The LANAP began with lots of tiny lidocaine injections. He called them "flea bites." These numbed the area a little prior to the big lidocaine injections. Next he came back with a syringe and began injecting larger amounts of lidocaine. This was actually the most painful part of the procedure. I also verged on a panic attack, I momentarily lost the ability to tell if I was breathing or swallowing; there was a lot of water being pushed into my mouth and being sucked out to remove the excess lidocaine from the injection sites. My throat went numb and I could not tell it I was inhaling water or air. I held up my hand for a minute, the panic passed, and then everything proceeded normally, I suppose, from there. It took about 20 minutes for me to become fully numb."

Step 2: "Once my upper jaw was numb, he started with the laser across my upper jaw, over both the exterior and interior gum line. There was an observer present for my procedure, so I believe I got more information on what he was doing than I might have without an observer. He explained that the first "pass" with the laser, loosens the gums from the teeth and roots, and begins to breakdown the bacteria that had been hiding in the pockets there. This part of the procedure took about 20 minutes."

Step 3: "Once the gums are open, the dentist makes a second pass, interior and exterior, with a power scaler. As he explained to the observer, Steve, the power scaler was able to remove the calculus and disrupt the biofilms while it was also being irrigated. Steve was duly impressed, saying things like 'That's Amazing!' Apparently there is a lot of blood and debris during this part of the procedure that is sucked up by the assistant along with the irrigation water.

For the most part, I just felt the pressure of the power scaler, enough that I knew which tooth he was working on, but felt no actual pain. However, there were two teeth that had very deep pockets, 12's on the perio probe, where I did feel the nerve, as you would with a very cold drink on a sensitive tooth. I raised my hand, received more lidocaine in that area, and then he proceeded; after each additional injection I was pretty much pain-free again. He made the comment that I processed painkillers quickly. The scaling was the longest part of the procedure at about 25 minutes."

Step 4: "Once the dentist completed the debridement, he made a second pass across the gumline with the laser. Here he explained to Scott that the laser was causing the blood to boil and coagulate. The second laser pass lasted about as long as the first pass, and then we were through. I left the practice about 2 hours after I entered it."

"I really never experience any pain during the procedure or afterwards, just a sore sensation. They recommend that you take ibuprofen whether you feel pain or not to help reduce any inflammation. That seemed to take care of any pain; I never felt that I needed a prescription strength painkiller. Nobody should feel anxious about the procedure, just be sure your dentist is not going to be stingy with the lidocaine during the surgery!"

"Another thing, as you are not going to be put under, and only receive local anesthetic, you can drive yourself to and from the procedure."

The burning away of the gum line with the laser had resulted in gum recession. I had lost about a half millimeter gum line, which created tiny gaps at the crowns of my teeth

What Did You Notice Immediately After The Procedure?

"There were several things I noticed immediately following the surgery.

  • My gums were now a very dark red color
  • The grey film, which the refer to as the "Band-aid" which forms between the gum line and the teeth was not yet there. That did not show up until the following morning
  • The burning away of the gum line with the laser had resulted in gum recession. I had lost about a half millimeter gum line, which created tiny gaps at the crowns of my teeth. This resulted in an issue for me later on where stringy foods, seeds and black pepper kept getting lodged up there. A situation made worse by the fact that I was still not allowed to use dental floss until a month after the LANAP. Over the next year the gum recession may improve, only time will tell.
  • The only pain I felt was a sore ache, no real pain. My teeth were very tender to chew even a baked potato.
  • Some of my teeth were now very, very sensitive to cold or hot."

Before and After with Deep Scaling and Root Planing via LANAP.  One Year Later.
Before and After with Deep Scaling and Root Planing via LANAP. One Year Later. | Source

Week One into LANAP Recovery

"During the first week I was not allowed to brush or floss my teeth. On the first day following the surgery the "Band-aid" or grey line between the teeth and gums made things look a little hairy.

You must rinse with the Chlorhexidine twice a day for a full minute, gently so as not to dislodge the gum from the teeth. You also rinse with warm salt water to reduce soreness. The Chlorhexidine is blue and begins to stain your teeth, since you are not brushing. By the end of seven days, my mouth looked very nasty. Delivery men were staring at it with a kind of horror. If you have to go to work and see people, I recommend scheduling the procedure on a Monday, then your first follow up the following Monday morning, first thing. You will want to stay out of sight on days five, six and seven after the procedure.

Pain was minimal, although I did continue to take ibuprofen 3-4 times a day to help reduce swelling and inflammation. It took care of any pain.

I did not experience any noticeable bleeding of the gums, although I occasionally had a faint taste of metal in my mouth that may have been an iron taste from blood in my back gums, where the deepest pockets were. I am told that is normal."

"You cannot exercise strenuously or lift anything over 40 pounds. Walking is about as much exercise as is recommended."

I survived on ice cream, yogurt, angel hair pasta, soups, mashed potatoes and scrambled eggs with various cheeses melted in with them. Even a baked potato felt too "tough" to eat the first 5 days after surgery.

Meals During Week One of LANAP Recovery

"When they told me no meat for a week, I nearly fell out of the chair. I have meat at almost every meal. Everything had to be mushy or mashed. No seeds, meat that can get caught between the teeth and nothing crunchy. No candy or cookies or fried foods. I lost seven pounds the first week."

You can have baked fish, however the Chlorhexidine puts a sweet taste in your mouth that permeates everything. Sweet fish was very off putting to me. I survived on ice cream, yogurt, angel hair pasta, soups, mashed potatoes and scrambled eggs with various cheeses melted in with them. Even a baked potato felt too "tough" to eat the first 5 days after surgery. You need to be careful with the ice cream as the cold can cause spine tingling shivers if it hits the wrong tooth.

If you want more mushy variety, you can hit the baby food isle at the grocery store and load up on mashed peas, carrots and Stage One meals.

Avoid any spice with heat, or you will regret it. Any pepper would light my mouth up for hours after eating it, and my gums would look redder and more inflamed."

Week Two Following LANAP Surgery

"This week began with my first follow-up visit on day 7 after he first surgery. During this visit he found thing were progressing nicely; the gums were tight against the teeth. The tested my bite on the back molars, and ground down a few areas to promote better healing for the future."

"I was okayed to begin brushing again, however the Sonicare will have to wait a year before I can use it again. No mechanical toothbrushes of any kind. One must brush lightly in gentle circular motions, and try not to loosen the gum line from the teeth, Flossing was still out."

I was also allowed to begin eating more normal foods. Still no candy or anything hard, no seeds or stringy meats. My first meal included McDonald's french fries. They were actually tough to eat. My sensitivity faded over the next week. However sensitivity to cold remained up to 6 weeks after the surgery."

Would You Recommend LANAP Surgery to Others Who Are Considering It?

"Yes! My only hesitation would be the cost of it. The discomfort was not a problem, and I feel that at six weeks, my gums feel healthier and my teeth feel stronger in their place."

"One other thing, I used to love spicy foods. Now I can't even tolerate mild chili. My mouth burns for hours. Hopefully this fill fade in time, but it tells me the healing process is still in full effect 8 weeks after the surgery."

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    James Wilson (Health Reports)17 Followers
    10 Articles

    James Wilson has worked in the dental technology field for over fifteen years, advising dental practices on intraoral imaging technologies.

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