February 22, 2021
Jonathan R. Tiger, DMD
Marty Klein: Welcome to Dentistry for the New Millennium. I’m Marty Klein, Training Manager at the Institute for Advanced Laser Dentistry. My guest today is Dr. Jonathan Tiger, a periodontist in Pomona, New York. Dr. Tiger earned his dental degree at the University of Medicine and Dentistry of New Jersey, now Rutgers University, and his periodontal training at Nova Southeastern University. He earned diplomate status with the American Academy of Periodontology and serves as a Certified Instructor with us at the IALD as well as a clinical assistant professor of dental medicine at Touro College of Dental Medicine. Dr. Tiger, thank you for being my guest today.
Dr. Jonathan Tiger: My pleasure, Marty. Happy to speak with you.
Marty Klein: So this podcast is coming out in February, which is Gum Disease Awareness Month, and you are a periodontist, a specialist in the mouth, and I’d like to ask you to talk a little bit about your view on the role of oral health as it pertains to overall wellness.
Dr. Jonathan Tiger: That’s a great point, Marty. Definitely one of the things that attracted me to the use the laser in the first place was the connection between oral health and systemic disease. As more and more research comes out all the time connecting diabetes and heart disease and arthritis and all sorts of connections that we have to the oral environment, I was definitely looking for something that was going to give me a more effective bacterial cleanse in the mouth. As good a job as we were able to do, you know, cleaning with old school flaps and clean outs, as we used to do in garden variety of classical periodontics, one of the things that attracted me to using a laser was the depth of the kill of bacteria that we’re able to obtain with the laser. The more bacteria we kill, obviously we’re able to, hopefully affect the systemic condition as well. So that was definitely one of the things that heightened my interest in the laser in the first place.
Marty Klein: The conversation about overall wellness and gum disease, is that something that you need to speak with about patients on a regular basis? How well did they understand that?
Dr. Jonathan Tiger: Depends on the patient, but definitely a lot of patients do come in having heard things from friends, or on the news, or on the Internet, things that they’re concerned about and it’s definitely a big driver of treatment, more than it was when I first started treating periodontal disease back in my early days when I finished my residency program. Definitely. People are definitely more aware of what’s going on in their mouth now than they were back then.
Marty Klein: Why do you think that is? Why are patients now more aware of that, do you think?
Dr. Jonathan Tiger: I think it’s just based on the availability of knowledge to them. I was just talking about this with my family the other day, about how people just know more things now because they have access to more information. Obviously, it’s good and bad. Sometimes they come in and they think they know more than you and their Doctor Google search allows them to tell you what’s what. But at the end of the day, the fact is that they’re stimulated to know and, you know, an educated patient is not necessarily a bad patient, as long as you can educate them in the right way and make sure that the information that you’re giving them and that their using his proper information.
Marty Klein: Well, if anyone listening here would like more information on Gum Disease Awareness month, I invite them to go to fightgumdisease.com or on Facebook at FightGumDisease. You can find a whole page there with lots of information. I want to get back to your story, Dr Tiger, and how you found LANAP. And then kind of going back to the beginning of how it first came onto your radar. What had you heard about LANAP prior to deciding to come to training? And then what was it that made you want to get trained yourself?
Dr. Jonathan Tiger: Interestingly, you know, I’m definitely a late bloomer when it comes to technology. I’m young, but I’m like an old school young guy. I definitely was not very aware of what was going on out there when I first was introduced to the laser. It was really just a simple knock on the door of a rep. He really just was very persistent in a good way about how he was trying to bring this technology into my office and how it would help my patients and help my practice. It took him, pretty sure 12 – 15 months of him coming around to finally convince me that it was that that it was the right thing for my practice, and it was time for me to take the plunge. And I did take the plunge.
Marty Klein: So, Anthony is a sales rep. I would assume, and maybe I’m wrong here that you also did some of your own due diligence rather than just Anthony’s persistence. Did you?
Dr. Jonathan Tiger: Well, of course, yeah. In the beginning, it was just a rep telling me things like you said, but when someone keeps telling you something, eventually you kind of look into it yourself. And definitely I started to do research online about different types of lasers. Again, as I said, I really had no experience with lasers, so I didn’t even…I knew you could do little frenectomies and you can maybe help take impressions by cauterizing some tissue with a laser. But I really don’t know at all what that meant and what the function of the laser itself was or how it worked. I really didn’t.
Marty Klein: What is something that you wish that you did know about the capabilities of lasers at that point that might have helped you understand it better what you learned in training.
Dr. Jonathan Tiger: At that time? It would have been nice to know that it’s something that you can use as a as a regular modality to treat periodontal disease. You know when you go through your periodontal training, you’re pretty much shown whatever it is that your instructors show you, what they know, what they learned, and what they’re willing to pass along to you. But to see that there’s other ways to treat periodontal disease would have been for me, obviously, as a periodontist, would have been would have been amazing at that time.
Marty Klein: Well, today, periodontal postgraduate residents at Rutgers, your alma mater, for your dental degree anyway, are getting that. So maybe you’re a little bit of a wish come true then.
Dr. Jonathan Tiger: That’s right. That’s right, I guess, at the time it wouldn’t have helped me because I didn’t go there for postgraduate training. But, yeah, it’s really great that the new generation of periodontists are having at least the ability to decide if they want to use this modality. If they choose not to, that’s their decision. You know, in my opinion, obviously not a great decision, but it’s nice to be to have different options. As we learned in training, let’s say eye surgery was done a different way back then, but everyone knows now you can have LASIK, and you could do all sorts of eye corrections with a laser that are better. As things evolved and technology changes, why not embrace what’s good and what’s able to help all your patients?
Marty Klein: Well, certainly, LASIK is a well understood household term. I’ve seen in many clinicians have seen LANAP being more and more understood, or at least on the radar of more patients. Do you? Do you see it going that way as well? Could LANAP become a well understood term in the future by all patients?
Dr. Jonathan Tiger: It’s definitely a possibility that I could tell you for sure. In my experience in my practice, I’ve definitely had a large percentage of patients that have come in strictly because they want LANAP. They don’t even know necessarily…They know what it means, obviously because of the research that they did. They don’t know fully what it means. But they know that either they’ve had classic periodontal surgery before or other types of periodontal surgery before, and they’ve been told that they need treatment and to continue again because they’ve had a relapse of their gum disease, and they’re not willing to go through that iteration of treatment again. They basically use the words, “I am not doing that again.” So at that point, they’ve done their research and they’re coming to me and asking me for it. I don’t even have to sell it to them. It’s something that they want, and they want to see what I can do for them in that realm.
Marty Klein: Well you first came to LANAP training in 2013, so seven, almost eight years ago. Can you tell me a little more about how the clinical results have looked in your practice over time, since you first came out of training and all the way through to today?
Dr. Jonathan Tiger: Sure, in the beginning, as with any new thing that you do, you’re nervous about it because you’re convinced that it’s gonna work, but you still haven’t done it yet. Then you get the patients to come in and do it, and then you have to wait to see the results. The initial results are fabulous. The patients are usually very comfortable after the procedure, and the way that the tissue response to the lasers is excellent. But then you still have to wait 6, 12 months for bone regeneration and things like that. As the time goes on and the cases keep piling up, you keep seeing, improvements that you wouldn’t necessarily believe were possible before you before you trained and saw the science behind it and how it works. Then it actually makes a whole lot of sense. I have patients that are young that needed it, patients that are older that needed it and, you know, there’s no differentiation. It’s good for any patient who has periodontal disease or peri-implant disease. If they need treatment for that, this this is a good modality for it and give them other options.
Marty Klein: Have you tracked at all some of those earlier patients or patients that you originally treated 6-7 years ago? On the whole are they still doing pretty well?
Dr. Jonathan Tiger: Absolutely! For sure they are. There’s definitely patients that I treated in my infant stages of coming out of training that I’m still treating because as periodontists, we see patients every 3, 4, 6 months, depending on the patient. That’s great because we’re able to follow those patients along the way and see the results. I just had a lady, one of my first patients that that I ever treated with the laser was actually a dentist’s wife, and she had a tooth number 30 that look just really terrible on the X-ray. I didn’t even necessarily…I wasn’t, like, running to treat it, but she did not want to extract the tooth. So we did it.
We treated it with the laser, and I’m pretty sure that was literally one of my first cases. Eight years later, it happens to be that we just had to remove the tooth now for a different reason not related to bone loss. It was more of an endo problem. We give her eight more years on that tooth, that I would bet if I showed most people the radiograph of that, what it looked like eight years ago, they would say, “There’s no way that tooth is gonna be there eight years later.” So, you know, I definitely have “long term” results, at least for me. My longest possible term is eight years, because that’s how long I’ve had it for. So I’ve definitely have patients that have had that.
Marty Klein: Now have you used your PerioLase MVP-7 for procedures other than LANAP over the years, and if so, what have they been? And what kind of results do you see?
Dr. Jonathan Tiger: I use it for frenectomies. I just did, actually, last week on an eight-year-old boy, he was tongue tied. So his lingual frenulum needed to be excised. And for that patient, I mean, this was perfect, you know, a little bit of anesthetic, a couple of seconds with the laser and done. No blade, no stitching. I mean, it was really great for him, but it certainly has the indications there. And I’ve definitely used it with my hygienist in conjunction with maintenance for pocket disinfection. As we talked about before, the depth of the penetration of the light energy that you can get on the bacterial kill with the lasers helps with that. And patients who have persistent pockets, five millimeters, with some bleeding. We find that we do this laser treatment for them during their maintenance therapy, and the next time they come back there, they’ve resolved that pocket and the bleeding is has gone. So I’ve used it for that. As a periodontist, I’m not necessarily gonna use it for all the other indications that you have in terms of restorative things that it could be used for, but all the periodontal applications. I’ve used it for extraction sockets to get hemostasis, to contain bone graft material. It has a plethora of applications that you wouldn’t necessarily think about when you’re looking at it initially, but as you go through it and you see that there’s all sorts of other cool things that you could really do with it, it’s great.
Marty Klein: How about around implants? Have you tried it for LAPIP, Peri-implantitis procedure?
Dr. Jonathan Tiger: Sure, I’ve always said implants are great until they’re not which, as we go further and further into the implant universe with years of more experience, we see that there are just problems that developed. The idea of opening a flap around an implant and trying to detoxify an implant surface and get full degranulation of the area to remove all the infected tissue, it’s just not a very fun thought. So this modality of being able to do it and hopefully use the power of that inflamed tissue with the growth factors that are present there, try to turn it back in our favor is a much better – at least in my hands – a much better way to try to help peri-implant disease. I’ve had some good results with it.
Marty Klein: Excellent. Well, I will wrap this up there. I wanna thank you for your service to us as an IALD instructor as well as everything you do in your own practice to fight gum disease, so to speak. I do want to give a plug to your practice website. If anyone else would like to learn more about you, that is tigerperiodonticsandimplants.com. If you’re listening to this podcast and you have not subscribed, please do or go to LANAP.com/podcast. All of our previous episodes can be listened to there. Dr Tiger, thank you again for being my guest today and sharing your experience with us.
Dr. Jonathan Tiger: Thank you, Marty, for having me. And I look forward to seeing you at a training event at some point in the future.