Ask A Question

Dr. Linden will be happy to answer any questions related to periodontics (gum disease, implants, etc.) as long as they are general in nature. He will be unable to answer questions about specific periodontal issues which would require a personal examination (unless, of course, you live in the vicinity and visit his office). Dr. Linden's answers to your questions are offered for educational purposes only, and are not intended as a substitute for professional periodontal care. Your name and email address will be kept confidential and will not be posted along with Dr. Linden's answer, nor will they be sold to third parties or used for any purpose other than to notify you that the answer to your question has been posted to this blog.

Please verify.
Validation complete :)
Validation failed :(
Can you have scaling and probing done after 4 areas had lanap done 3 month ago?Generally speaking we do not recommend this course of treatment after having full mouth LANAP.
~Dr Gums
6 Jan, 2019 11:00 PM
I have gum disease. I just went to a dentist today for the first time in 14 years and plaque was removed from my teeth. I have an appointment in November to have scaling done, but due to the deep pockets it is likely they will suggest traditional periodontal surgery as this office does not perform the LANAP procedure. My question is this: could LANAP be performed in lieu of scaling? Or should have the scaling performed, and then seek out someone, you perhaps, to perform LANAP after the scaling? “It is advisable at this point to have an evaluation with a certified laser periodontist before your scaling appointments; a periodontist who has experience with all the wavelength lasers available.

It might not be necessary to go through the scalings if you are a candidate for laser surgery. Either with an ND/YAG ( such as LANAP ) or Erbium or CO2 Laser.”
23 Oct, 2018 12:10 AM
I have peri-implantitis with severe bone loss. I still want to save the implant if possible. Do you have successful experience treating a situation like this using mechanical debridement combined with LASER decontamination?

Peri-implantitis is one of our specialties. There are numerous options with lasers. You would need a consultation to determine which technique would be best for your situation.
3 Mar, 2018 10:06 PM
I have receding gums and pockets. What can be done about this?Recession can be treated with a variety of techniques. You would need a consultation to determine which technique would be best for your situation.24 Jan, 2018 3:50 PM
I had LANAP about 10 days ago. I now have a hole between tooth 2 and 3 on the lingual side. Food packs in there. My dentist told me that the clot probably fell out, that it will heal by secondary intention, and to keep it clean. About how long will it take to heal? Is there a way to repair the hole?My suggestion is to wait and let things heal. Your dentist should know what to do after the healing phase. Each person heals differently so ask your Periodontist what he/she suggests as a next step, if necessary.1 Nov, 2017 5:27 PM
I had a full mouth LANAP procedure performed 5 years ago. Since then, I have switched dentists and my new dentist says I need perio scaling and root planing. I was told by my LANAP dentist not to allow probing due to the possible disruption of the healing process. My new dentist wants to probe. Will the probing, scaling and root planing ruin any of the progress the LANAP procedure has made by reattaching the gum to the tooth? Could scaling and root planing actually be detrimental to the LANAP progress made in 5 years? Is there a LANAP protocol for post LANAP procedures? Thank you for your response!There is no problem to probe after 5 years post LANAP. We re-evaluate all our patients annually. IF any issues develop, then we look at all our options including conventional therapy or laser therapy (perhaps with a different wavelength utilizing some new protocols we have been using and researching).19 Oct, 2017 6:05 PM
What determines which sections of the mouth need LANAP? I don't want to be charged for services in sections of my mouth that don't need treatment.LANAP is a full mouth procedure. 10 Oct, 2017 11:51 PM
Yesterday I had the stitches taken off my gum graft @ 3 weeks. A white blob of tissue came off too, exposing a big hole between two front teeth. When I was in the chair she said that I had some "extra" tissue and that it should right itself in 6 to 8 weeks. When I got to my car I saw a gaping hole just below said extra tissue. Will that the extra tissue move down and connect with the tissue remaining from where the white blob was in the papilla area? Or is this the way it's going to be forever? I'm really upset.I don't know your history and haven't examined you. I would need to examine you personally to answer these questions. Since you were treated recently by your Periodontist, I recommend that you report the situation to him or her and ask whether you need to be seen.7 Oct, 2017 1:46 AM
I've been given an estimate of $1200.00 for conventional gum surgery. Can you provide a ball park figure for the laser procedure?Individual situations differ so much that it’s impossible to answer this question online, in a general way. Please call the office - - and we can give you a more individually-tailored answer.31 Aug, 2017 11:39 PM
Is Occlusal Adjustment a required part of the LANAP procedure? I want the laser but I don’t want my teeth ground or bite adjusted. Can I still get the treatment?If you are having the LANAP protocol, then by definition, an occlusal adjustment is a mandatory part of the procedure. This is ethically and legally the only way to fulfill the LANAP protocol requirements.

If you are having another type of Laser procedure with another wavelength, and calling it localized laser periodontal surgery, then there might be variations in the occlusal adjustment.
19 Aug, 2017 11:52 PM
I just had LANAP on the right side of the mouth and will have the left side done tomorrow. The Periodontist did occlusal adjustment on most of the teeth and ground one tooth down a lot so the point is now flat. I am worried the teeth were ground too much as the bite no longer touches on that side and that to balance my mouth, the left side will have to be ground just as much. Is this normal procedure? Will those ground teeth now be prone to cavities because the enamel is thinner?Since you are currently under the care of a periodontist (your question indicates that you are receiving treatment today) and he undoubtedly has examined you carefully, Dr. Linden is not able to advise you. If in the future you need further periodontal care, Dr. Linden would be happy to conduct a proper examination and provide whatever care you may need.15 Aug, 2017 6:53 PM
Will taste buds come back after LANAP Surgery?Taste buds should not be affected by the LANAP procedure. However, your Periodontist should review some dietary restrictions with you.23 Jul, 2017 7:53 PM
I am about to have an allograft on my lower gums. I know post op there are strict instructions, and I know the first week or so i can’t do much. But what is a good time frame in which kissing becomes OKand safe?Your periodontist should let you know about kissing during your post-operative healing visits.23 Jul, 2017 4:26 PM
I received today LANAP surgery in two (upper) quadrants. I received printed post-op protocols and verbal instructions from my dental surgeon and the protocols in general seem to be less cautious than most that I read online from other periodontists. The aspects that concern me the most are flossing/brushing and diet.

My gum surgeon says soft food is ok right off the bat (no need for the sub-soft "mushy" level), with, of course, emphasis on no nuts, nothing crunchy. Is that ok?

Further, I've been told that I can rinse the entire mouth with warm salt water but to do so by shaking it around the mouth rather than suction/"swishing". Protocols from other periodontists advise not to warm salt water rinse for a week. Also, other sites say to not brush the area treated for a week, whereas my surgeon said that if you brush down from the gum line (not brushing the gum line, just the teeth), it's ok. What my gum surgeon says makes sense vis-à-vis the intention, but with such a difference in protocol, I wanted to ask.

One reason I'm particularly concerned aside from the obvious is that I am a woodwind player (sax & flute) and harmonica player (hence positive and negative pressure) and my teeth and gums are extra important to me.

Which begs another question - my gum surgeon said I only need to take "three or four days" off from playing my instruments. Given the concerns over effective clotting and the restrictive protocols all over the web, I guess I'm looking for a little more assurance that that's alright. I would like it to be alright - I based my calendar obligations on it - but reading all the "extreme" protocols online has led me to ask.
I would advise you to go back to your treating Laser Periodontist for the correct post-operative instructions customized for your situation. Regarding the “soft food; no nuts” part of your question, we stay conservative, and would agree with your gum surgeon’s recommendations, particularly since both upper quadrants were done. By the way, why were the two upper quadrants done, vs. upper and lower on one side? Generally, the latter is easier for eating and oral hygiene, because you can chew on the side that wasn’t done. Regarding brushing, here’s my advice: No brushing for 7 days. On days 2-7, wipe gently with a Q-tip. Warm salt rinses after 2-3 days (gently, as you describe). Regarding playing your musical instruments, I am a woodwind player myself, and we treat a lot of musicians. Stay away from reeds and mouth pieces for 5-7 days. Your intuition is correct.
13 Jul, 2017 12:55 AM
I recent had a gum infection and it was recommended to me that I get LANAP. That procedure was completed 3 weeks ago. I'm due for my checkup next week. In the meantime, though, I noticed today that my gums seem infected again. There is a white pus coming from behind the gums if I apply any pressure. The surgeon who performed my LANAP guaranteed me that there was no chance of reinfection, but what I'm seeing would say otherwise. The clot never appeared to have broken since my surgery and only once did I have any bleeding in the location of the clot. That bleeding was extremely minimal.

Is what I'm seeing normal for a post LANAP patient?
Is it possible the infection came back?
Is it likely I will need another round of LANAP or, if the infection is back, could it be covered by another round of antibiotics?
We do not typically see infection after laser surgeries. I would suggest asking your periodontist why you’re having recurring infections. If necessary, get a second opinion.
8 Jul, 2017 12:37 AM
On the recommendation of my dentist, who said I had some bleeding and maybe need a deep cleaning, I visited a periodontist. Why, after one visit, would he say that I need osseous surgery? I just read that that would be something one would only need if scaling and/or root planing didn't work.Each situation presents differently, but if pockets are deeper, then many times surgical intervention is needed in the earlier stages of treatment. I would suggest exploring your options with a qualified laser periodontist.2 Jul, 2017 7:04 PM
What can prevent someone from being able to get braces after having a gum graft and what can be done if the graft didn't take or not enough of it took?You need to have that area reevaluated and if necessary, get a second opinion.15 Jun, 2017 7:24 AM
I have a 12-mm pocket on a tooth with a root canal, I have a gum infection and would choose LANAP to treat it. All my other teeth are fine this one just died it's a front canine and there was no pain i just didn't catch it. After lanap will bone grafting work? Tooth is still solid but if bone doesn't regrow this seems to be the way to go.A 12-mm pocket is very deep. With a prior root canal, this might be a difficult tooth to treat. Sometimes the root canal procedure can fracture a tooth. There could be occlusal (biting) trauma. There could be other systemic medical/dental issues that need to be addressed. I strongly suggest an examination by a qualified laser periodontist.14 Jun, 2017 10:16 PM
I underwent gingival grafting 1-2 years ago. I was recently told by my dentist that gum recession has recurred. In previous discussions with my periodontist I was told that it is highly unusual for patients with gum recession to require repeat grafting once the initial grafts take. What is the frequency of developing gum recession despite gum grafting? Also, I do not feel I am an aggressive brusher. What other factors may be contributing to continued recession? There is a family history of gum recession.With that family history, you might be predisposed genetically to recurrent gingival recession problems. However, you should be under the close supervision of a periodontist who can determine whether intervention would be necessary.17 May, 2017 4:08 AM
Dr Linden,

I'm in my mid-30s. I have advanced periodontitis with bone loss, most severely in 5 teeth that are mobile. One (first molar # 26?) had a recurrent periodontal abscess a while back, with swelling/bleeding/pus etc., and very significant bone loss. My dentist advises gum surgery and extraction of this tooth. Also, possibly a bone graft and implant. But the dentist is unsure if the bone graft would work given the severe bone loss and positioning of the tooth.
Questions regarding Lanap:
1) Does it totally remove the calculus below the gums as traditional gum surgery aims to do? If not, even if it kills bacteria during the procedure, would the calculus that remains deep below create infection/problems down the road?
2) In the case of severe bone loss/abscess and loose tooth, is Lanap clinically proven to help regenerate bone and tissues as well or better than a bone graft? My issue with the bone graft is it might not be effective and extraction is a last resort, especially if it’s hard to crown/fill the empty gap while we wait for the bone to grow etc.
3) Have you seen cases where Lanap has been used effectively in significant bone loss areas and preserves the tooth without extraction, even when traditional gum surgery can’t?
4) For Lanap, is the Nd:Yag the main instrument used?
5) Why most patients still undergo traditional gum surgery vs. laser if the pricing is quite similar?
Many thanks
These questions have to be answered during an in-person consultation. To give you a thorough answer on the web, I would have to write pages. We spend a lot of time sitting with patients, explaining to them tooth-by-tooth exactly what the rationale is and what their treatment options would be, whether a laser approach, a traditional approach, or a combination of the two. This is important, because something this detailed needs to be tailored to each individual patient. Even if detailed online responses to one patient without an examination were possible, they could easily mislead other patients who would receive different advice and recommendations in their personal consultation. We take many things into account: tooth position, mobility, the patient’s medical and dental history, whether they smoke, are diabetic, are taking medications, are clenching, wear a night guard, their age, are under stress, hormonal issues, … everything plays into it.
26 Apr, 2017 6:45 AM
I am having LANAP surgery done in Colorado in a couple of weeks. I play ice hockey and wear a mouth guard. How long do I have to wait before I wear a mouth guard to protect my teeth?That’s up to the treating laser periodontist. Generally, it can be anywhere from five to seven days post-LANAP.16 Apr, 2017 3:42 PM
I had LANAP treatment 3 days ago on half my mouth. I pressed my lower lip firmly against the inside of my upper teeth pushing outward and I'm afraid I may have done damage. How would I know if I dislodged any of the clots?You might not know. I would suggest a visit to your periodontist or laser dentist and have them take a look.22 Mar, 2017 9:26 PM
Will I be able to golf 3 days after pocket reduction surgery?Why not? Hopefully you’ll get a hole in one!15 Mar, 2017 9:48 PM
I had LANAP surgery 1 year ago, since then I have lost 2 teeth and 3 more have severe mobility. Is this a normal result?It depends on your treating periodontist’s initial diagnosis and treatment plan. I suggest consulting with him or her to determine the prognosis of your teeth.23 Feb, 2017 11:55 AM
It has been 5 years since I had LANAP surgery on my whole mouth. I had a lot of gum loss. Is it ok to have scaling and root planing done now as maintenance? I don't want to undo everything the LANAP surgery has done, but it has been 5 years and I am not having any problems.It’s hard to answer this question without examining you. I recommend revisiting the periodontist who did your laser surgery, or seeing another periodontist regarding the necessary treatment to maintain your mouth.21 Feb, 2017 1:12 PM
I had laser surgery 2 months ago. Everything was fine, but suddenly, I have pain that extends to my right ear and right eye. It happens at the end of night, causing me NOT to sleep. I have tried Orajel, Sensodyne, Ibuprofen, ice - nothing helps. Any ideas if it’s a complication from the laser surgery?I suggest returning to the treating periodontist so they can check the area, take an x-ray, and diagnose the problem.21 Feb, 2017 10:07 AM
I wear an upper partial denture and I am considering having laser surgery on my remaining upper teeth. My question is. will the surgery affect the fit of the partial? Will I require a new one? Generally, laser surgery should not affect the fit of a partial denture after surgery. However, if your gums are highly inflamed, puffy, and swollen, and the surgery reduces that to a healthy state, the partial denture may have to be adjusted to fit properly.19 Feb, 2017 5:34 PM
I had laser gum periodontal surgery. My biggest problem is bad breath and an awful, metallic taste. The smell is so bad my family is telling me that when I breathe through my nose they still can smell it. It is 6 days today since surgery. I was told not to floss yet. I am so depressed about this. I work with people and I can barely even talk to them because i know my breath is soooo bad. I am crying for help. Please let me know if I can floss now and what I can do? HELP!I would check back with the periodontist who did the original LANAP surgery. He or she can advise you as to when you can start to brush and floss. We don’t typically see this problem in our patients.7 Feb, 2017 2:14 AM
I just had my LANAP surgery a week ago - all the mouth at once. I traveled to do it because in my country it is not available, so it's been a bit hard to find out what to do after. After 10 days, my doctor here saw me, but didn't much know how to proceed, so she told me to start brushing gently. Is that correct? Also, I don't know yet if I can chew, which has been a bit of a nightmare. When can I chew after LANAP? And finally, I had braces, so at the end of my treatment I had to use a mouth guard. The other question is, when can I resume using that mouth guard?It’s too bad you couldn’t have continuity of your treatment. However, typically patients can start on a soft diet 5-10 days after LANAP surgery. Night guard therapy and soft food chewing are resumed after a post-op visit and clearance from the periodontist.4 Feb, 2017 11:43 PM
Can natural remedies be used to treat periodontitis? I've heard that increasing fat soluble vitamins A and D, eating a ketogenic diet, oil pulling, and rinsing with warm water and sea salt can help to regenerate gums. Is there any truth to this?There have been no clinical trials or studies to prove the efficacy of many of the things you mentioned, but in conjunction with laser therapies or perhaps even some traditional therapies some of them might be beneficial. You should discuss this with your periodontist in light of your individual situation.27 Jan, 2017 6:55 PM
I had a tooth extraction (#9) after a bike injury. A ceramic implant was placed and failed because the implant was too big for my jawbone. A small titanium implant was placed several months later and that has taken. However, after two extractions, my gums have receded considerably.

Do you recommend that I look into gum graft surgery prior to or after the restoration crown is placed?
Each situation presents differently.

Scenario #1;

Implant placed, later uncovered, and a temporary is made. After approximately 2-3 weeks and the area in question is examined and if there is a need to augment tissue, then the periodontist can perform soft tissue augmentation procedures around the temporary and get the esthetics to everyone’s satisfaction. After several weeks of healing the final crown is made to copy the temporary exactly. Case Complete. Everyone is happy with result.


Implant placed, soft tissue is built up or augmented and then implant is uncovered and a temporary is made and the soft tissue is sculpted at that visit. Wait several weeks, evaluate, further augment (if needed) and then final crown.

In both scenarios you might need multiple augmentation procedures to get the aesthetics where you would like them to be.
11 Jan, 2017 4:08 AM
My grandson had deep cleaning procedure on Wednesday morning. His gums were cut and he has been bleeding since. He was just given a transfusion because of the blood loss. How can we stop the bleeding?If he is bleeding this profusely, he should go to the emergency room at your closest hospital.31 Dec, 2016 4:57 AM
I am in my early 30’s. One periodontist (A) wants to do LANAP for my entire mouth in one day and remove four lower front teeth. Is it good practice to do it in one session? Also, he would not do any bone grafting at that time as he wants first to remove all infection and then maybe at the time of implants he will do bone grafting.
However, another periodontist (B) suggests LANAP in two sessions 4-5 weeks apart. He would also do extraction and bone grafting at the time of LANAP.
Which perio is following the norms for LANAP, perio A or perio B?
The LANAP procedure is by definition a full-mouth protocol. It can be done in one to two visits. Both periodontists seem to be on the right track in terms of scheduling. Bone grafting for implants and extractions could be done at any time. Bone grafting would only be done for implants – not for teeth that are being treated with LANAP. So extractions/grafting/implants and the LANAP protocol are two separate procedures that can be done at the same time.
17 Dec, 2016 6:50 AM
Is it normal for a molar to smell where periodontal flap surgery was performed? No pain or puss or swelling.Usually a bad odor would indicate an infection or perhaps a buildup of plaque and bacteria. You should have this checked by your periodontist immediately.24 Nov, 2016 8:06 PM
Do crowns come off during LANAP surgery? I just had LANAP surgery and my back molar where I had a crown due to a root canal is black.I’ve never seen a tooth or a crown turn black after a laser treatment. Crowns typically do not come off during LANAP unless you have specific temporaries placed in your mouth.5 Nov, 2016 6:40 PM
My son has no upper lateral incisors but my husband and I have them. Could there be a hereditary reason for my son not having them?Can’t say for certain, but there could be an hereditary component.26 Oct, 2016 4:34 AM
For about 2 months, I have had mild inflammation on a limited part of my gum above tooth number 6 in the left maxillary. I used hexachloride solutions 2 times a day but it hasn’t worked so far. What should I do? Does it need clinical examination before prescription?There are many things that could cause the inflammation that you are describing. It could be lack of good gum tissue, periodontal disease in the area, the position of the tooth in the arch, or perhaps oral hygiene issues. Therefore, I recommend a thorough clinical examination with a certified, experienced laser periodontist before using anything.20 Oct, 2016 5:42 PM
In looking into having orthopedic work because of spacing issues and missing teeth, mostly in my lower jaw, I've just been told by my regular dentist that my lower front teeth are moving, that they need to come out as they will eventually fall out, and to forget orthopedic work. I have swelling in the gums around one tooth and that one is loose. I can't believe extraction is my only opinion. Can you help me Dr. Linden?I urge you to see a qualified laser periodontist as soon as possible for an evaluation to determine which teeth can and can’t be saved.16 Oct, 2016 1:41 PM
Long-term steroid use over many years has reduced bone in my jaw. I was hoping that as most of my teeth are either loose or painful, I might be able to get implants on the National Health Service. This was never explained to me. I was on extremely high doses of prednisone for 13 years. I have two false teeth - one at top in the front, one on bottom, and two side teeth you can't see. I urgently need help and advice. I cannot smile and it hurts to eat. What are my options please?You need to see an experienced laser trained & certified periodontist as soon as possible for a treatment plan evaluation.15 Oct, 2016 1:48 AM
My gums have receded lately due to stress and bruxism, and I am so worried. I'm only 21. Will they ever grow back? I have been brushing and flossing gently, gargling with sea salt, and using Gengigel. Will the non-keratinized gum tissue eventually keratinize and revert to healthy pink gum tissue again?You should see an experienced laser-trained Periodontist who will evaluate your occlusion (bite) and adjust if there is any trauma. Your oral hygiene techniques need to be observed to confirm you are correctly brushing and flossing. It is possible your gum line might get some creeping attachment or regrowth of that tissue. You might need some further periodontal augmentation procedures to make up any deficits. The Periodontist is the expert to make that decision with you.14 Oct, 2016 12:00 AM
I have a permanent denture on four implants on my bottom jaw. It was done three years ago and I am now having a lot of pain were the implant is. I'm concerned.I would certainly recommend checking back with your Periodontist who placed the implants as well as the restorative dentist who made your denture. Between the two treating doctors, I think they can figure out what the problem is. It could be a minor adjustment or issues with the denture or the implants themselves.5 Jul, 2016 12:50 PM
I have upper dentures that literally fall out of my mouth. I need a sinus lift and bone regeneration. Plus 6 implants. I was told $20,000 for the lift and bone regeneration and $19,000 for the denture. My bottom teeth are not in good shape but I will not have them done for fear of not keeping any denture in my mouth. I do use adhesive but they loosen very fast. I can't afford $40,000 for my top and God knows what the bottom will cost. Are your procedures just as expensive? And what do you see as my options?I can answer general questions online, but I cannot accurately or responsibly answer your specific questions without a professional examination, including digital x-rays and a CT scan. I could then discuss your options with you.12 Jun, 2016 1:39 PM
Dr. Linden, I have three questions:
I had 'traditional' laser treatment in November which helped for a while. In April I went back to the same dentist, who did a gingival flap root planing. This actually worsened the situation and felt too invasive. Then my regular dentist referred me to LANAP treatment, which I did last week.
Was it ok to have LANAP only one month after flap root planing?
Out of excitement or whatever reason, I did not properly read or listen to post-op instructions and only followed a soft diet and not a liquid diet for the first 24 hours. I did not chew in any way on the treated side, but now, reading about the importance of the blood clots, I am afraid I undid a large part of the treatment or made it much less effective. How concerned should I be? Does the treatment have to be redone?
Thanks for your answer.
In general, we don’t do scaling or root planing before LANAP, but there may always be individual exceptions to general rules. Your periodontist evaluated you. I did not. So he or she should be able to make informed decisions based on that examination which I cannot based on a brief web query.
Regarding your having eaten soft food during the 24 hours after LANAP treatment, there are too many unknowns for me to offer an informed opinion based on the information provided. Liquid diet is not always mandatory, and definitions of “soft” may vary widely. You really should check with your treating periodontist to see if what you ate had any effect on your LANAP treatment.
5 Jun, 2016 2:19 AM
I had two LANAP treatments, one half mouth on 4/14 and the other half on 4/21. When can I have a glass of wine?If you are on a medication which should not be mixed with alcohol, then you should not drink wine. If you are not on any such medication, then having a glass of wine shouldn’t be a problem.1 May, 2016 11:26 PM
I had LANAP done 4/25/16 and stuck to the soft diet, but when I ate a soft piece of bread four days later I noticed the white clot around a molar was gone. I am afraid I undid the clot and the tooth may get re-infected. If so, what can be done?I would suggest that you have your periodontist take a look at the area in question and determine if anything needs to be done.30 Apr, 2016 9:30 PM
What is the average cost of full mouth laser surgery? What is lowest the procedure can cost and what is the highest?The best solution for the treatment of gum disease is based on an accurate diagnosis, comprehensive examination, and review of a quality set of digital x-rays. The course of treatment can only be determined by examining the patient. The cost of treatment varies from patient to patient and according to the severity of disease. When possible we utilize the laser approach (including LANAP), but it is important to note that we often combine different modalities of treatment customized for each patient. Treatment fees would be discussed at the consultation visit.24 Apr, 2016 5:30 PM
How is it determined whether or not tissue is diseased? I believe I have some pale-colored, unhealthy tissue between my teeth. Will LANAP work on this type of tissue even if it's not reddened?The laser targets diseased tissue. If the laser periodontist uses the appropriate settings, then the procedure will be successful The tissue does not have to be red to be ablated. The pulse settings and technique (critical) should accomplish the objective.22 Apr, 2016 7:25 PM
I have a very slight history of cavities over the last several years. But, I had LANAP procedure on all of my teeth December 2014/January 2015 primarily because my teeth were becoming somewhat loose. All of 2015 I was seeing the periodontist for monthly/bi-monthly visits, and I was released in January 2016. X-rays were taken in January 2016 showing I had 5 cavities, two of them under existing crowns. My dentist filled the cavities in March 2016. Now, in the middle of April I went in for a cleaning and learned that I have two more cavities (found by the dental tech during the cleaning). I hardly ever had cavities, but now since LANAP - Seven Cavities? Is there a correlation? Neither my extensive experience nor any known research has ever shown a correlation between LANAP and cavities. Perhaps the extra attention given to your teeth since you began LANAP treatment has revealed cavities that were developing undetected?20 Apr, 2016 8:46 PM
I'm told that my tooth #9 sits in less than 50% of normal bone. Am I a candidate for bone regeneration? The tooth doesn't hurt, although I do treat it very carefully, e.g., if I am called to bite down with front teeth, I bite (also carefully) with #8 only. Thank you.Every situation is different. You may be a candidate, but I cannot answer confidently without seeing your x-rays and examining you. 20 Apr, 2016 2:48 PM
If I need a bone graft during flap surgery (recommended by my periodontist) and she plans to use human cadaver bone, is there a risk of infectious disease or rejection? There is only a little bone loss. Won't I develop some bone growth without the graft? The bone loss is not at the roots.Cadaver Bone grafts are safe as long as the bone is purchased from a licensed vendor. Each bone batch is labeled and sealed with tracking numbers attached to the bottle. This is part of your medical record and should be made available to you if requested. We have been using this type of bone for over 30 years. It is up to the Periodontist to determine when bone grafting is needed. I suggest you discuss this before your surgery so you have a clear understanding of your options.15 Apr, 2016 4:31 AM
What can a person do if they need a gum graft but they were told there is not enough blood supply to effectively get one? This is a graft that effects the person’s confidence when they speak and smile and needs to be done in the very front of this person’s mouth above one of her front teeth that is an implant.Anybody can get a graft wherever it is needed. The question is whether the graft would go over the root surface, and whether it’s the right choice for the aesthetic zone of the mouth. I’ve never heard of inadequate circulation preventing a graft. I would need to actually examine you to give you a more definitive answer.14 Apr, 2016 11:06 PM
I am 68 years old only have 3 bottom teeth grouped together. I was thinking of getting implants but would rather keep the 3 teeth with a new partial denture. What would I need to do to hold on to those 3 teeth? What is your recommendation? We’d have to do a full evaluation on the three remaining teeth to determine the bone level, the health of the gum tissue, and the stability, and whether the three teeth can withstand a partial denture, considering the pressures of eating, biting, etc. You still might need some implants to supplement the three teeth. We’d need x-rays and a full clinical exam to make that determination. 7 Apr, 2016 5:15 PM
This procedure of pin hole rejuvenation... Is there any contraindication to the periapical of the gum tissue? Does the tissue reattach, and what are the standard perio probe pockets once treatment is complete?You should address your question to Dr. John Chao, who developed it ( Apr, 2016 12:48 AM
Can LANAP laser be used for gum pocket reduction safely around gold crowned teeth?
22 Mar, 2016 8:46 PM
I had bone grafting done on my bottom 2 front teeth 3 weeks ago. The stitches are scheduled to come out in 5 days. Am I OK to chew tobacco right now? Or do I need to wait till my stitches are out? Yes, I know chewing is bad for my health. It’s a bad habit. Thank you!!I’m afraid that my professional opinion, buttressed by abundant scientific research, is so strongly opposed to tobacco products, that I cannot condone your resuming the use of chewing tobacco, now, in 5 days, or ever. For both your short-term and long-term health, you really should quit.20 Mar, 2016 10:29 PM
My gum is receding along my implant. The gum is bleeding a little and when you press on it, a smelly, pussy discharge comes out. I have tried garlic, coconut oil, flossing, brushing, mouthwash, and nothing seems to work. Can you please recommend something to clean this area before I see a dentist? Possibly it is failing, or there is infection, but I would really like to try a dentist’s recommendation to clean it first. Thank you kindly for your response. Diane (P.S. the implant is at least 18 years old.)This could be a large infection. You need really need to see an experienced periodontist who deals with peri-implantitis. Any lower level of professional care is a risk.18 Mar, 2016 4:42 PM
I had gum graft surgery a month ago. The graft sites are pink and seem to be healing well, other than they're not covering as much of the recession as I had wanted. Can the grafts be contoured or pulled up or down, if you will, to cover more of the exposed tooth? I feel like my teeth still look too long. I'm only 23, so this bothers me. I was told my recession was due to brushing too hard, paired with already thin gums and orthodontic work.Without examining you, it’s difficult to give you a precise response. However, there are many instances in which we do gingival gum grafts, then 4-6 months later we are able to move the tissue coronally, to try to cover more of the exposed root. However, the treating periodontist should review this with you and explain your options. They would know best, based upon what they did with the initial grafting. You may wish to get a second opinion if not satisfied.10 Mar, 2016 5:06 AM
I had a fractured tooth that was extracted. Because of the extensive infection, I needed significant bone grafting to rebuild my jaw. The tooth next to the extraction was severely compromised. The recovery has been a nightmare and I had little information or support. During the process, I experienced some painful episodes and pulled on my teeth. I think my gum was pulled or torn from the inside. I am experiencing some soreness and some clear draining. Will this eventually heal itself (like a cut on your skin does) or will it have to be sutured? Is there anything I can do to help? I don't want to lose the other tooth. It feels pretty rock solid underneath the draining.You need to call the surgeon who did the extraction so that they can reevaluate the healing and determine the next best course of treatment. If you are not satisfied, seek an option from a Periodontist.9 Mar, 2016 8:32 PM
I’ve always gone to the dentist every 6 months. Now that I'm 55 my dentist insists that I need deep cleaning rather than a regular checkup every 6 months, but that’s really expensive. So my question is, can’t I just get regular cleanings from a different dentist? Wouldn’t that be better than nothing?Why is your dentist now suggesting deep cleanings? Maybe there is bone loss due to periodontal disease that was newly diagnosed. If deep cleaning is really necessary, it doesn’t make sense to go to another dentist just to avoid it. I would seek a second opinion from a qualified laser periodontist and see what options they would suggest.24 Feb, 2016 8:20 PM
I am to have surgery on a rear molar because of a pus pocket that developed. The dentist says there is partial bone loss. He told me he can clean the pocket and make it easier for me to keep the tooth area cleaner. He also says for $1200.00 more he can clean all the way down to the root and that in some cases there has been bone regeneration after this procedure. Am I wasting my $1200.00 dollars?It sounds like the doctor gave you two options. It’s not clear to me why he wouldn’t just deal with the whole area definitively. It’s also not clear to me from your description what procedures he is suggesting, and why he’s offering two options. So I’m afraid I can’t give you a better answer without seeing you clinically and diagnosing you with x-rays and an exam.12 Feb, 2016 5:22 PM
I have Periodontal disease with pockets ranging from 4mm to 9mm with most being 8mm to 6mm. The front upper 8 and 9 are in bad shape. One is loose. The worst pocket is 9mm with a lot of bone loss. There are a few teeth with recession. In the past, I had the old-fashioned “cutting the gums” on one side, and other procedures, but after that I was irregular in going to the dentist. So the pain and problems started. The pain stopped one week after recent scaling and my bite is normal again. My teeth are tighter.
I have lost quite a lot of bone across my entire mouth - about 2/3 to 50 percent. What can I do to now fix the bone issue? Now most teeth are solid in the bone and nice-looking on the outside - no redness, bleeding etc. Ever since a deep scaling two weeks ago it’s MUCH improved. Even my front teeth are not as bad.
I have a few decisions to make financially. My funds are limited. I cannot do both implants and LANAP at this time. If I lose my front teeth I want to be able to do bridges, but I’m hoping the laser with a bone treatment will prevent me from losing them. Here in Florida the price for laser is outrageous and I do not trust my local Periodontist. Should I wait and see, since in your blog you claim LANAP rebuilds bone. Can you explain how it does so? I was told by my new dentist it does not work. He had it done. Do you add something to help build the bones and can you explain?
I am eating well, taking Calcium and Vitamin D, and doing all I can to get the disease under control. I have decent teeth and do not want to lose them. I also use a Waterpik and am taking care of my teeth. I’m going to try Calcium Therapy which is supposed to control the disease and strengthen teeth and bone.
Can your office quote ball park prices if you get my x-rays and cat scan (if my dentist will release them) and recent scaling paper work for evaluation?
I’m glad to hear that you’re taking a more proactive approach to your periodontal health, and that scaling has helped you. Your dentist is mistaken or misinformed about the efficacy of LANAP. There is plenty of scientific evidence indicating that it can be very effective in dealing with periodontal disease. See for details and references. As with many things, there is a wide range of expertise among LANAP practitioners. Some may own the equipment and use it occasionally in their general dental practice. We specialize in laser periodontics. Our practice uses all the different dental lasers – four different wavelengths. We also teach other periodontists how to use them.
With each patient, we determine which laser or surgical methodology (or combination of different modalities) will be best, always favoring the laser if possible, since it is not invasive and painful as conventional surgery tends to be, and recovery time is negligible. So it may well be that a laser procedure such as LANAP would help you, but as I’m sure you realize, I can’t accurately or responsibly offer diagnoses over the internet. I, or another qualified Periodontist, would need to conduct a comprehensive examination, and review a quality set of digital x-rays in order to determine the best course of treatment for you.
While LANAP can be an important methodology for preventing further bone degeneration, additional procedures may be needed to regenerate bone. See for more details. Please call our office to discuss what the treatments you may require might cost. Even then, without actually examining you and reviewing your x-rays, cat scan results, and scaling results, it will not be possible to give you a precise estimate.
1 Feb, 2016 1:43 AM
Hi, I am super embarrassed about the condition of my mouth. So much so that I think it has reached a severe state. I have gum problems, broken teeth, and loose teeth. I am so, so embarrassed and dentists tend to further embarrass people. I know what I did wrong. I was homeless for a while and suffering from depression among other things. I need medicine and care. I am getting headaches from it now, I think. I’m wondering if this is the right place for me. I really need someone who isn't going to embarrass me further or even worse, not have the right experience to turn my situation around. Please advise.We can help you so don’t feel any embarrassment. The first thing for you to consider, is to call the office and discuss with our highly experienced staff how to proceed to start the process getting you evaluated. Once we get you in our office for the initial consultation, we can plan your case with all the possible options available. Don’t despair. This is what we do.26 Jan, 2016 10:56 PM
I currently have some inflamed gums - three fronts in my lower arch. I have no bone loss. There appears to be one 6mm, one 5mm, and a 4mm. All my other teeth are 1, 2, 3, and a couple of fours. One dentist thought I had the beginning stages of gum disease (I assume he meant periodontitis.) He was shocked when he saw my mouth as I’m only 22. In one part in the front, the triangle part of my gum can be pulled away from my teeth. It’s no longer connected. This is where the 6mm pocket is. My teeth are also super crowded there, which may have played a part (although not sure), as i have two impacted wisdom teeth that i need to have pulled. Another dentist assures me that it’s not that big of a deal. He did scaling and root planing. One more quadrant remains to be done. He reassures me it’s not periodontitis, but I’m still scared. He says maybe it could have been due to hormones or something else. I know i have no bone loss but my gums have receded a bit and the fact that that piece is so loose on my teeth frankly scares me. Could this really just be gingivitis as I have no bone loss? If scaling and root planing doesn’t work as it should, what would be my other options? Will I need surgery? If so, what kind? I just want to make sure I start saving up money for the worst case scenario, as I’m a poor student, but this is way more important at the moment.
I’m doing a lot of research and taking extremely good care of my mouth as I don’t want to lose my teeth :(.
Any info will be appreciated.
Periodontal disease can affect anyone at any age, so being only 22 doesn’t exempt you from it. As you may know from reading my website, I specialize in laser periodontics. Our practice uses all the different dental lasers – four different wavelengths. We also teach other periodontists how to use them. With each patient, we determine which laser or surgical methodology (or combination of different modalities) will be best, always favoring the laser if possible, since it is not invasive and painful as conventional surgery tends to be, and recovery time is negligible. So it may well be that a laser procedure such as LANAP would help you, but as I’m sure you realize, I can’t accurately or responsibly offer diagnoses over the internet. I, or another qualified Periodontist, would need to conduct a comprehensive examination, and review a quality set of digital x-rays in order to determine the best course of treatment for you.
23 Jan, 2016 5:37 PM
I had LANAP surgery over a year ago, and the results are great except for around one molar where it didn't work. My periodontist wants to try traditional surgery, but I don't understand why it would work if LANAP didn't. Also, I have had 3 gum grafts and the recovery was horrible and slow, so she opted not to do the 4th one because of my abnormally slow healing. Should I get a 2nd opinion?It’s always wise to get a second opinion, especially if you’re feeling any uncertainty as to how to proceed. You are justified in questioning whether traditional surgery would work where LANAP didn’t. Without examining you, I cannot speculate as to why LANAP did not work around that one molar, nor can I guarantee that a follow-up LANAP procedure would solve the problem. But from my professional experience, I can say that it might. Again, I would advise getting a second opinion from an experienced laser periodontist.18 Jan, 2016 10:27 PM
Good morning. I just left the dentist and have been told that I need connective tissue graft surgery. Is there a less invasive alternative – perhaps laser surgery - with shorter recovery time?It may be that a laser procedure such as LANAP would be an alternative to the proposed surgery, but to know for sure, I, or another qualified Periodontist, would need to conduct a comprehensive examination, and review a quality set of digital x-rays. Our practice uses all the different dental lasers – four different wavelengths. We also teach other periodontists how to use them. So with each patient, we determine which laser or surgical methodology (or combination of different modalities) will be best, always favoring the laser if possible, since it is not invasive and painful as conventional surgery tends to be, and recovery time is negligible.18 Jan, 2016 4:18 PM
I have a root canal done and fitted with a porcelain crown on my UL (No. 14) molar. During a recent visit for routine cleaning, my dentist informed me that I have a 7mm pocket reduction and asked me to consult a Periodontist. Upon consultation, the Periodontist informed me that I would require flap surgery. Based on his assessment, it is the initial signs of Periodontal issues. I feel no pain at the present time. Would LANAP work better than flap surgery/sutures in this instance? Will this pocket issue affect my crown, which is only a year old? All other areas of my teeth are fine except No. 14, which has a 7mm pocket and bled slightly during a probe. Your thoughts and comments please.It may be that a laser procedure such as LANAP would obviate flap surgery, but to know for sure, I, or another qualified Periodontist, would need to conduct a comprehensive examination, and review a quality set of digital x-rays. Our practice uses all the different dental lasers – four different wavelengths. We also teach other periodontists how to use them. So with each patient, we determine which laser or surgical methodology (or combination of different modalities) will be best, always favoring the laser if possible, since it is not invasive and painful as conventional surgery tends to be, and recovery time is negligible. 12 Jan, 2016 3:11 AM
I had some itching in my gums throughout my mouth. I saw a periodontist, and he told me that I had periodontal disease. So, I had a full mouth LANAP procedure done in July, 2015, but days after the procedure, I started experiencing the same terrible itching throughout my gums again. I went back to my periodontist, he said that it couldn't still be bacteria because the LANAP surgery removed it. He prescribed antibiotics and a few days later, the itching stopped. But the itching returned after two days. What could possibly be the problem? I went back to the dental office to get a cleaning, and I told the dental technician about the itching and asked her to take a culture of the bacteria (especially in my upper right area which is where the itching is continuous). She did imaging of the bacteria, and she showed me on a screen that there was little to almost no bacteria floating around. I am at a loss. I spent too much money to still have the same itching that caused me to see the periodontist in the first place. Do you have any idea what could be the problem? I have put a little apple cider vinegar on my tooth to relieve the itching, and that seem to help. Is there anything else I can use to get rid of this itching? My dentist suggested that maybe it could be allergies, but I am not allergic to anything, nor have I eaten anything out of the ordinary. What do you suggest?Itching is typically an allergic response. Your problem doesn’t sound bacterial, because, as you say, you had LANAP and a follow-up analysis of bacteria in your mouth. You should probably see an allergist, if for no other reason than to rule out that possibility. You might be allergic to something you would never suspect.31 Dec, 2015 6:18 PM
My tooth #15 has an 8mm gum pocket and a little bone loss. The tooth is solid in place. At age 78, do I need bone grafting?It depends on your clinical exam and X-rays. Your age is not a factor. You should consider laser alternatives if you qualify.29 Dec, 2015 8:27 PM
Do I have to have Scaling and Root Planing if I am going to have LANAP?Unlikely. Generally, scaling and root planing are not done prior to full mouth LANAP.17 Dec, 2015 1:47 AM
I have been recommended for dental surgery for receding gums. Can this be fixed with laser surgery?It depends on a number of clinical parameters. At the very least, the procedures can be used in conjunction with the correct laser.14 Dec, 2015 1:20 PM
Hello. I feel so discouraged. I needed a gum graft on my lower left canine tooth and my braces came off. I went to a doctor here in Wichita Falls, Texas. He has done it three times and every time the stitches pull through and the graft slips. He said he will only try once more and has no idea why it is doing this. I have followed all directions and have been extremely careful. I don't want to lose my tooth. Should I go pay another $3,000 in Dallas and risk it not working again? Thank you for your time.Is the doctor who performed this procedure a Periodontist? If so...ask him whether, if he were to try once more, he would do anything differently than what he did the first three times. If you cannot get the success you are looking for, then a second opinion from a Periodontist, preferably one who specializes in laser technologies, would be a prudent idea.11 Dec, 2015 9:20 PM
Hello Eric, I am wondering if it is OK to have a cleaning slightly under the gum line at 5 months post-op from LANAP? I figured I should at least wait until 6 months. Would you please let me know how you feel on this?
Thank you so much!
Periodontal cleanings 5 months post-op LANAP are safe. We recommend keeping most of these cleanings “supra gingival “, that is, “above the gum”, if possible. However, if there is calculus or buildup slightly below the gum, we do want that removed gently.
10 Dec, 2015 5:27 PM
When you get your gums cut, how long will it take for them to grow back, if they ever will?This is a broad question. There are different reasons why you might have your gums cut, such as traditional flap surgery (gingivectomy), where excess gum is removed. In many instances, once you remove the tissue, it will never regrow. We try not to do resective (gum cutting) surgery if possible and instead use various laser approaches which preserve and regenerate the soft tissue and bone.7 Dec, 2015 10:56 PM
How fast does gum tissue grow or restore itself? I heard one-half millimeter per day or per week. I have a hole in my gum (exposed bone) the size of a pencil eraser. How fast should the gum tissue fill in? My gums are pretty healthy.If there is a hole the size of a pencil eraser, as you’re describing, then that needs to be looked at by a periodontist, because that’s not a normal occurrence. If it can heal, it will do so differently than regular gum healing after laser or traditional surgery. I can’t make any definitive judgements based on the description that you provided. I don’t know how or why this hole developed. There could have been some trauma. Ordinarily, gum can regenerate a quarter to a half millimeter per day, but I couldn’t say in your particular case without examining you.3 Dec, 2015 1:00 PM
Hi Dr Linden, I have recently had LANAP treatment. The second half of my mouth was completed 7 days ago. The first half went well. Healing fine. Looks great. The second half looks terrible. Unimaginable pain that is increasing daily. As of yesterday, I no longer can drink water of any temperature, and the mouthwash has begun to burn like acid. I am extremely worried that the mucous membranes won't heal if they are not hydrated. I returned to my periodontist yesterday and expressed my concerns. He said It looks OK, and would see me in 10 days. Do you feel I need a second opinion? It appears that all personal experiences on the internet are blocked unless featured by a dentist. So I have no one to compare my story to to see if this is normal.Yes. I would seek a 2nd opinion. Obviously I can't offer that without examining you, but I recommend that you check with another periodontist with a solid background in LANAP and related laser technologies.2 Dec, 2015 2:34 AM
I started seeing a periodontist several months ago after being referred by my GP for severe periodontitis. The 1st thing done was periodontal probing and the results were with almost all 6-10mm pockets. The course of treatment was a gross debridement followed by scaling and root planing., I returned four weeks after treatment and the depths had improved some but not close to where they need to be. His next recommendation was to perform a full mouth LANAP in 2 sessions. So I went ahead and agreed. The upper and lower were completed about 3 weeks ago and the right is scheduled for next week.
Since the initial pocket depths were so deep, should he have just recommended LANAP to start and not the scaling and root planing? I feel like he knew it wasn't going to work, but this was a way to get an extra $1,500 for the procedure. The hygienists were talking about the next step while one was doing the scaling and root planing. The other issue is that they scheduled what they call a therapeutic maintenance cleaning 2 weeks after scaling. When I asked them what this was they indicated it was a double check of their work to make sure they didn't miss anything. To me I shouldn't have had to pay for them to recheck their work.
I feel that LANAP really involves a scaling and root planing as part of the procedure and knowing that there was no way that the initial scaling and root planing was going to resolve my issue, it should not have been done.
I feel like I might be getting taken advantage of with unnecessary procedures.
Your thoughts would be much appreciated.
Thank you
You probably do need a second opinion, but I can’t ethically or accurately offer one online. I would have to examine you. Since you probably don’t live in my area, I would recommend an experienced laser periodontist who is familiar with all laser procedures and has published or lectured.
24 Nov, 2015 2:12 AM
Hello! I had gum grafting done two weeks ago on my 4 teeth on the lower right side. I thought that the grafts would be placed at the area of the teeth where my gums had receded so much but instead, my periodontist placed them at the base of my gums where they meet the cheek area. I have a long, deep "pocket" that runs the entire length of my gum area. Is this normal? Food is getting caught in the area constantly. Will this fill in? My periodontist sort of brushed over my question about it.

Thank you!
You need to have your periodontist take a look at the healing and evaluate the placement and quality of the gum tissue grafted and determine whether any secondary procedure is needed.
19 Nov, 2015 5:56 PM
I have osteoporosis and recently had a lower molar removed. I still have a deep hole and visible bone, excruciating pain and a disgusting taste in my mouth. I also can't eat anything other than soft food. Should I be concerned?I’m afraid this is one of those questions that can’t responsibly be answered without an examination. I recommend that you visit the doctor who extracted the molar and get his advice.11 Nov, 2015 3:36 PM
Can LANAP be performed on just a limited area (let's say just in the back, for instance) or is treating the whole mouth required?If the Periodontist calls it LANAP, it is by definition a full mouth protocol. If it is an “isolated” area of laser periodontal therapy, then it sometimes referred to as Localized Laser Therapy and not LANAP. I hope this helps.2 Nov, 2015 5:08 PM
I had crown and bridge preps of my entire upper arch. I was told that my gum grows over my temporaries and has to be cut away to accommodate permanent crowns. I've never heard of this happening. How true is this and under what conditions would this happen? How worried should I be about resection and having a huge gap at the line?You would need to be evaluated by a Periodontist as to why the tissue is overgrown. If I were to perform that evaluation, I would also contact your general dentist or Prosthodontist with regard to your treatment plan. We treat patients with all gum issues. I would also need a full set of digital x-rays to help me evaluate what's happening that can't be seen visually.28 Oct, 2015 9:05 AM
I have severe bone loss, but my periodontal disease is under control. Do you think it is ever safe for someone with severe bone loss to receive orthodontic treatment to straighten teeth which have drifted out of place over the course of periodontal disease, using either invisible lingual or traditional braces? Is it true that moving the teeth and bone causes bone to regenerate and thus helps keep the teeth stable in the long run?Before you have Orthodontic treatment, you would need to be evaluated by a Periodontist to evaluate the extent of Periodontal bone loss. This would include a full set of digital x-rays. I cannot judge what is happening without evaluating you properly.28 Oct, 2015 12:44 AM
Based on my limited understanding, flap surgery seems to be a more invasive version of scaling and root planing. In other words, flap surgery seems to include deep cleaning and more besides. If this is really the case, then why would a dentist recommend BOTH scaling and root planing AND flap surgery? Also, when is flap surgery indicated? Many thanks in advance!We try to avoid flap surgery and use laser therapy when possible. There are a few situations where a scaling alone would be beneficial. However, if you need flap surgery, then more than likely you would be a candidate for laser surgery, which is less invasive.8 Oct, 2015 11:36 PM
How long after a gum graft surgery should I wait before kissing?The answer might vary according to the situation. You should consult with your periodontist who did the procedure.5 Oct, 2015 6:05 AM
Since January 2015 I have had a sharp pain in my left lower jaw and a burning in my mouth. I was seen by my dentist, ENT doctor, neurologist and internal doctor. Nobody was able to find the reason. Do you think I might have a gum disease?It’s possible, but I couldn’t say for sure without examining you. I suggest you consult with a laser-trained periodontist.3 Oct, 2015 11:25 AM
Hi Dr. Linden,

I recently had regular (non laser) AlloDerm grafts on 5 lower front teeth. I wasn't aware that apparently prior to doing the grafts they remove some of the healthy gum tissue. Unfortunately, now the gums on the two lower front teeth are lower than they were before and there's scarring around the gum line. The periodontist wanted to redo those two front teeth for more coverage but I'm afraid it will just make it look worse. Does laser gum surgery ever cause scarring? If I were to have that area retouched would it be better to try laser surgery rather than risk having it look worse? My regular dentist advised me that the scarring might be permanent but prescribed Clobetasol gel to see if it would help with inflammation.

Lasers are not the primary tools for AlloDerm or gingival grafting. Lasers are used as an adjunctive during the grafting procedure. If the original grafts need to be further augmented, then your periodontist should give you the options to improve the situation.
29 Sep, 2015 6:41 AM
What are the causes for gum irritation and pain? Patient suffers from gingivitis and oral decay on lower jaw. Sensations originating from molar region on the left area.There are many reasons (too numerous to list here) that can cause gum irritation and pain. It would be advisable to see an experienced laser-trained Periodontist and get a complete evaluation with a diagnosis and treatment plan.23 Sep, 2015 11:47 PM
I am getting a bone block graft and I am wondering if a future pregnancy would affect the outcome of the bone build up? Are there any steps to ensure that a future pregnancy would not compromise the graft and implant site?Although the research has not shown any negative association between bone grafts and pregnancy, I would suggest completing all work at least 3-6 months prior to getting pregnant. The hormones will change with the pregnancy and could have some effect on the healing.20 Sep, 2015 6:06 AM
I just had a gum graft on my front lower teeth three days ago. I have a pretty severe over bite and notice that when I bite down, my top teeth bump into my lower gums. How can I prevent this and will this prevent my gum graft from being successful? I am still eating only soft foods (mashed potatoes, mashed avocado, soft tofu).I would follow up with the Periodontist who performed the gum graft procedure and inform him/her about this issue. It would not be advisable to have your teeth hitting your gums. Did the Periodontist have you wear an appliance?19 Sep, 2015 1:24 AM
My dentist informs me I'm a candidate for this procedure. Once the surgery is performed, how long do the regenerated gums stay that way before another procedure is needed? Thank you.If you are referring to the LANAP procedure, generally, it would be a one-time laser surgery with multiple follow up visits.3 Sep, 2015 3:40 PM
Hi Dr. Linden--I just went to a periodontist for the first time and was told that I have 2-3 mm of bone loss throughout my upper and lower jaws and associated gum recession. He also told me that I am not a candidate for bone or gum grafting because the bone loss and gum recession are relatively even throughout my whole mouth and there are therefore not "attachment points" for grafts. I haven't seen this discussed online and have read a number of forums where dentists advise that anyone in good health can get grafts. Can you comment generally on the feasibility of gum or bone grafts for people who have widespread recession--not just recession in one area of the mouth? Thanks!This answer is complicated for the average patient to understand. Each patient has to be evaluated based on clinical measurements of the gum height, amount of recession, radiographic bone loss, amount of remaining “keratinized” gum tissue , and attachment levels. In other words, get a complete evaluation of all the above parameters by a skilled periodontist so a diagnosis and appropriate treatment plan can be created for your situation.3 Sep, 2015 5:13 AM
What does laser gum surgery do that a deep cleaning won't do? I have a gum pocket of 8 and would prefer doing a deep cleaning if at all possible due to the high cost of laser surgery. Needless to say, my dentist did not do a good job of explaining this to me. This is a very significant question that requires a long explanation…however for purposes of this forum, generally if you have a pocket of 8mm or so…it is impossible to do a “deep cleaning” and think that the scaler can access these areas and “cure” the problem. This type of pocketing is aggressive and it would not be surprising if you have other areas of periodontal breakdown in your mouth also.

My suggestion: Consultation with an experienced laser trained periodontist, full mouth series of digital x-rays, and a thorough diagnosis and treatment plan that makes sense to save your teeth.

There are ways to pay for the treatment but at least find out the best way to achieve success.
29 Aug, 2015 1:11 AM
How soon after the LANAP surgery can you get your teeth whitened?Generally, 3 months at the earliest if your healing, oral hygiene, occlusion and general progress are satisfactory. Ultimately, the decision should be made by your laser Periodontist. 24 Aug, 2015 5:03 PM
What is the worst case scenario if the bone is disappearing between teeth 8 and 9?Why wait for the bone to disappear? Investigate your options to save your teeth! I strongly suggest a consultation with an experienced and reputable Periodontist who offers all the latest modalities, including laser technology, including different wavelength lasers. Worst case scenario… you lose teeth if do not do anything.19 Aug, 2015 8:30 PM
What is the logic behind abstaining from dairy products for 48 to 72 hours after tooth extraction and bone grafting?None, unless you are taking antibiotics in the tetracycline/doxycycline family. It is suggested that you LIMIT your intake of dairy products not just for 48-72 hours but for the duration of the 7 day regimen.18 Aug, 2015 11:59 PM
I underwent laser gum surgery. But I didn't close my eyes during the treatment. Could this have harmed my eyes? Please answer and help in this regard.You should always have laser glasses on when having laser gum treatment. Did you have glasses on during the procedure? If so…no issues. What type of laser was used?12 Aug, 2015 3:31 PM
I’m experiencing chronic gum inflammation with no resolution. I’m currently undergoing testing to find the root cause. My major medical influence was chemo for non-Hodgkin’s lymphoma, which has been in remission for three years. Six months following the chemo, I began experiencing gum redness. I have been to a periodontist for regular cleaning. Recently my gum recession and pain became exacerbated. I need help. I am a native of New York with insurance from FDNY. My husband was affected from 9/11 and we needed to relocate to Florida. I will come to NY for treatment. I need the best person with gum disease issues. I don’t want to lose my teeth and I’m tired of discomfort and pain. Please can you help me find answers?We would like to help you but need a lot more information and it might easier if you call the office and speak to our staff. We utilize a number of therapies including lasers which might play a big role in your treatment. It would be wise to get a solid diagnosis and definitive treatment plan so you can get resolution of your issues.11 Aug, 2015 10:27 PM
Can I go to swimming if I have a pulpitis?I would check with your endodontist and see what they say regarding exercise and swimming.6 Aug, 2015 3:25 PM
Hi Dr.Linden
If someone has very loose teeth, can he still receive LANAP treatment since we know the procedure requires laser cut out diseased tissue around the teeth, wouldn't it be too dangerous if we treat loose teeth that's already lost too much gum tissue? Also, if there were gum recession presenting before LANAP, how could we fix gum recession after LANAP? Can we preform pinhole technique after LANAP or we need to wait until the healing process complete?

Q: Hi Dr. Linden. If someone has very loose teeth, can he still receive LANAP treatment? Since we know the procedure involves the laser cutting out diseased tissue around the teeth, wouldn't it be too dangerous to use on loose teeth that have already lost too much gum tissue?

A: If the teeth are determined to be salvageable, then stabilization might be necessary and LANAP can be performed safely. We strongly suggest a very experienced laser Periodontist to perform this type of case you are describing.

Q: Also, if there were gum recession presenting before LANAP, how could we fix gum recession after LANAP? Can we perform the pinhole technique after LANAP or do we need to wait until the healing process is complete? Thanks.

A: Generally, we would do laser surgery first and then wait 8-12 months and see if the patient is a candidate for gingival augmentation.
30 Jul, 2015 2:43 AM
I had osseous laser surgery on many teeth one month ago. I’m healing well, but a cavity I had prior to this surgery is hurting. How soon after surgery can this cavity be filled? Thank you.We always recommend any cavities (caries control) be taken care of as soon as possible. So if you are in pain we would recommend getting out of pain as soon as possible. Hopefully, you will avoid a root canal. We try to take care of these areas before LANAP or any kind of laser surgery.29 Jul, 2015 10:40 AM
I have been told that I needed the LANAP procedure as well as the regular surgery on my gums to remove the bacteria. Is this common? I have pockets that range from 3-6mm. Will my gums recede more than with one procedure? Will my bite become off? Will my front gap widen? Will I need a mouth guard because of the procedure? Can the LANAP procedure get rid of all the bacteria without using conventional surgery along with it? How bad does the problem have to be in order to use both procedures? Should I get a second opinion?Q: I have been told that I needed the LANAP procedure as well as the regular surgery on my gums to remove bacteria. Is this common?
A: More than 75% of the population has some form of periodontal disease. It is common that gum therapy is required to stabilize gum disease. This might involve the use of laser technology. It is not common for a periodontist to perform both laser and conventional surgery to treat gum disease itself, but perhaps, in addition to treating your gums, your Periodontist wants to perform an extraction, gingival graft, or dental implant, which would involve non-laser procedures.
Q: I have pockets that range from 3-6mm. Will my gums recede more than with just one procedure?
A: Not if LANAP is performed by an experienced and well-trained Periodontist.
Q: Will my bite become off?
A: Your bite should feel better and your gum health should improve after the occlusal (bite) adjustment is performed as part of the laser protocol.
Q: Will my front gap widen?
A: It should not occur UNLESS you need pre-operative stabilization of your teeth. Your Periodontist should know this before performing Laser Surgery.
Q: Will I need a mouth guard because of the procedure?
A: Typically, patients have a night guard made 6-8 weeks after the laser procedure is completed.
Q: Can the LANAP procedure get rid of all the bacteria without having conventional surgery along with it?
A: Yes…significant bacterial reduction occurs after LANAP. There should be no need for both conventional and laser surgery to attain excellent results unless, as I mentioned above, other procedures are needed for an extraction or dental implant. Without knowing the details of your particular case, I cannot say why you were told you might need both.
Q: How bad does the problem have to be in order to justify using both procedures?
A: It depends on the individual case. I would need to review your digital x rays and perform a clinical presentation for an accurate diagnosis. But again, unless issues other than gum disease are being dealt with, generally, there is no need for both procedures.
Q: Should I get a second opinion?
A: You should always get a 2nd opinion from an experienced periodontist who has been doing both laser and conventional therapy for at least 8-10 years.
28 Jul, 2015 2:23 PM
Dr. Linden, is it safe and/or helpful for patients to rinse daily with OTC hydrogen peroxide? I've read it can cause black hairy tongue and irritate tissues. I've also read it has antibacterial properties and has been used in periodontal protocols. I'm a new RDH so I want to be prepared with an educated response if a patient asks about this. Thank you in advance for your time and expertise!We do not recommend the use of hydrogen peroxide intraorally. Many studies have shown mutagenic changes in oral tissues with additional side effects on the tongue and soft tissues. Most of the early protocols from the 1970's used peroxide in some form. The Keyes technique was a popular regimen. However, as the studies came out about the side effects, we eliminated the use of hydrogen peroxide.19 Jul, 2015 2:09 AM
I had the Lanap gum surgery 6/5/2015 and was told it was OK to floss. However, it is very uncomfortable to do so. Should I stop? When I hit my gum it bleeds.I would suggest checking with your laser periodontist who performed the procedure to assess why you are having bleeding? Did you have bite adjustments?17 Jul, 2015 7:19 PM
I had a full lower gum graft done 2 weeks ago and it's not healing well. My periodontist just suggested oral steroids to help with healing. Good idea at this late date. Think it will help?We do not use steroids in our practice. We use our lasers to promote healing. However, with that being said, I would follow your Periodontist’s recommendation since they did the work on your mouth.15 Jul, 2015 10:45 PM
Three implants on my lower jaw were attempted and failed. The implants keep causing the gum to get infected. I have little bone left. Is there any solution for me?This is difficult to answer without seeing you for a clinical exam and evaluating your cat scans.9 Jul, 2015 11:19 AM
I am scheduled for laser surgery next week. My front tooth is slightly loose and has shifted. How soon after the laser treatment can I get this fixed?Sometimes we splint very loose teeth before the laser surgery. The splinting can be done anytime to stabilize the teeth.9 Jul, 2015 12:05 AM
I had a crown lengthening on a tooth. Can an implant be done on that same tooth?Did you lose the tooth? If so, if there is enough bone remaining, the answer is yes for an implant.7 Jul, 2015 10:03 AM
I had crown lengthening done last year. I was told my old crowns of 21 years were ill-fitting, so after the lengthening the dentist put new ones in. They felt big and bulky so he redid them. Now he put much thinner crowns in and after three months my gums are inflamed. He scheduled me for retreatment of the lengthening because he said my bone grew back. Have you ever heard of bone growing back or are these thin crowns the culprit and he finds it cheaper to redo a surgery than to replace four crowns?Your situation sounds confusing to me. Where is the bone? Do you have “biologic width”? Did the dentist do a crown lengthening before the new crowns? Were you in temporaries for 4-6 weeks post operatively? It is not typical to crown lengthen teeth after crowns are fabricated, particularly after the crowns are redone.6 Jul, 2015 10:02 PM
What is the cost of laser surgery?This is difficult to answer without examining you in person. Fees vary based on case diagnosis and geographic area. Please see and then, for additional information, please call our office.4 Jul, 2015 10:10 AM
Hey! I am having gum graft surgery July 9th, 2015. I am extremely nervous and I was wondering after my surgery how many days should I not talk. I know my mouth will be sore and I know if I talk it could hurt my stitches. Thanks for much!My best suggestion is to review the post-operative instructions with the Periodontist performing this gum graft procedure for you. It is standard protocol to review all this information with the patient before their surgery. I do not know your specific case and therefore would have to defer to your treating Periodontist.20 Jun, 2015 8:54 PM
I have a cleft palate and have receding gum lines. I am scheduled to have traditional gum graft surgery on six lower teeth. What is the risk of infection due to a slightly open palate? Some of my gums are at a 1 or 2. Would laser gum surgery be possible/better for me due to the issues with my palate? I was told by a second dentist that laser treatment was not for receding gums, due to the fact that lasers are used to remove tissue, and that the only way to add tissue was through cadaver tissue or grafting. Is this true? My appointment is on Monday for the traditional gum graft procedure. Please let me know ASAP.An opening to any space is always vulnerable to infection. During gum graft surgery, the laser option, if used by an experienced and well-trained Periodontist, can be extremely useful to treat the donor and recipient sites for control of bleeding and bio-stimulation. This helps minimize any potential negative effects of “traditional" flap surgery. It is important that the correct laser wavelength is used.17 Jun, 2015 4:32 AM
Hello, I was just told that I have a serious case of gum disease. My periodontist wants to give me laser surgery on only the top portion of my mouth. He said it would cost me $4,000. Is this a fair price for such a surgery or do you think I can get it for a little less? Thank you.This is difficult to answer without examining you in person. Fees vary based on case diagnosis and geographic area.29 May, 2015 12:05 AM
My periodontist wants to repair several areas with gum grafting (1-2 teeth in each area). I have had five surgeries so far, and every time there has been a failure on one or both teeth. The periodontist keeps having me back to do repairs, but the repairs fail also. She has mostly used donor tissue but at least once used my own tissue. This process is expensive, painful, and time-consuming, and it keeps me from working and eating for various periods while I recover. I feel I am following all the recovery rules. Is it normal to have partial or total failure on 100 percent of my surgeries? I am losing heart. What would be a good next step? Thank you.It is rather unusual to have so many failures, but it is possible. Without examining you myself, it’s difficult for me to offer more specific advice. I suggest you speak to your Periodontist and ask her what she would suggest you do based on the treatment options you face at this point. Perhaps she could give you some other alternatives.25 May, 2015 11:58 PM
Can you kindly tell me if LANAP causes gum recession? I have a fixed bridge in the 6 upper teeth and I am concerned about recession in that area, as my bridge is only 5 years old. Thank you.If the LANAP protocol is done exactly as we teach it (with all the safety guidelines) then you should not have any recession around your bridge area. Strict adherence to the steps and amount of energy used by the laser is critical. An experienced practitioner with this protocol should be able to tell you how many cases they have done and how long they have been performing laser surgery in the esthetic zone with the results they have seen with their patients. (Photos would be extremely useful to see.)
If the gums are swollen (pre-op) then the gums will get firmer and will not be bleeding or appear puffy anymore.
20 May, 2015 11:55 PM
Hello, my name is Lauren. A few days ago, due to tooth decay, I had a crown lengthening on my back molar on my bottom jaw. I also had a supernumerary tooth extracted between that crown-lengthened molar and the one next to it. I had my teeth corrected a few years ago and I wear my Essex retainers every night. When will it be ok to wear my retainers again? Thank you.I would suggest you speak with the Periodontist who did your surgery to determine when it would be safe to wear your appliance.18 May, 2015 3:32 AM
The gum below my wisdom tooth has been swollen for the past week. The tooth has a filling in it and is decayed near the gum. Whom do I see to have it extracted?I would recommend an Oral Surgeon.6 May, 2015 9:31 PM
If a patient is interested in orthodontics but has periodontal pockets in several parts of the mouth, would they be a good candidate for orthodontics?The potential for orthodontics is present. However, you need to have your periodontal pockets treated, and be stable and cleared periodontally to have braces or orthodontic treatment or Invisalign. 4 May, 2015 9:39 PM
If there is recession after LANAP, does it mean that the procedure didn't work? I had the first half of my mouth done in March and the second in April, and there is gum recession around 3-4 teeth.LANAP, if done correctly, should not cause any recession. We train doctors to use the correct amount of laser energy per tooth. Not having recession is one of the advantages of LANAP over traditional surgery.4 May, 2015 11:55 AM
My bottom tooth #30 has mobility to it. I can't get bottom braces yet. What's going to happen?Sounds like you need a periodontal evaluation to determine what is going on before braces can be placed on your teeth.30 Apr, 2015 4:20 PM
When surgery is needed, is it a lot less painful if the doctor gives an inferior alveolar and Gow-gates mandibular nerve block injection to avoid going into hard tissue for anesthesia?If local anesthesia is given correctly and patiently, it should be with minimal discomfort for the patient. Use of a topical gel helps before the local is administered.25 Apr, 2015 8:48 PM
Is it safe to place Arestin in an area of inflammation with signs of bleeding and a 7mm pocket on an implant tooth with no mobility? Radiographs show signs that all threads are in the bone. Also, what are your thoughts about probing and scaling implant teeth due to the suction and disturbing it, etc.?Arestin is an option, although in the last several years we have been using a variety of lasers for implant mucositis and peri-implantitis. (We don’t use Arestin anymore as it is not necessary when you use lasers.) We always check our implants with light probing unless we suspect any disease or breakdown.24 Apr, 2015 3:59 PM
Hi, my sister had LANAP surgery done in about October of last year, (2014). She asked the doctor whether or not a splint should be applied in order to keep her teeth straight, but he told her “no” many times. She just found out about two weeks ago, around the beginning of May, that her teeth were very crooked. I never noticed this because my sister is very shy when it comes to her appearance, but when she showed me her current status, I was very shocked. My sister had very straight, perfect teeth, but now they are very crooked. I would like to know whether or not a splint was necessary? Thank you very much for your time and your answer will be greatly appreciated.Without having examined her and considering that she probably had full mouth or half mouth LANAP done, it’s not uncommon for some people to need some splinting before or after LANAP surgery. Based on the information you’re providing me, it’s possible that your sister may need to go through some Invisalign orthodontic treatment to straighten out her teeth, and then splint them. Each case is different and some patients need pre-op stabilization and some after treatment. LANAP actually “tightens” up the teeth.22 Apr, 2015 2:29 AM
I have a burning drainage coming from the roof of my mouth at my teeth.This requires an immediate appointment with a periodontist to evaluate what kind of infection you have. 15 Apr, 2015 12:29 PM
Help! I got 2 estimates, one for $6,800 after my insurance covers $1,000. This periodontist does the whole mouth at once under general sedation. The other, a dentist, would do half mouth first, then the other half 10 days later, using a regular injection for numbness. He would charge $4,000 after my insurance covers $1,000. Which one should I choose? Money is tight!Hi Matilda,

I would choose the dentist who best suits your needs, in whom you feel the most confidence, and who answers all your questions.

Have you researched them?

Which Periodontist do you feel most comfortable with?

Good luck with your choice.
11 Apr, 2015 12:17 AM
I am wondering about the longevity of LANAP treatment. Assuming good oral hygiene, do most people avoid needing further treatment? I know you probably can't answer specifically, but do you see the need for re-treatment often? Sometimes? Rarely? Any studies on this anywhere?We have been performing and teaching laser techniques, including LANAP, for nearly a decade.

Other than Dr. Lloyd Tilt's Tooth Survival studies, no studies have been completed and published, although more soon will be. But based on observing my patient population over 27 years of periodontal/implant practice, I believe that with laser therapy over the last decade, there has been a greater resistance to breakdown in the periodontal disease process, compared with our "traditional" surgery patients. This doesn't mean that the "traditional” approaches were not effective, but it shows that with the laser, we can attain superior results in a much more efficient way and decrease significantly the invasive nature of traditional surgery that involves cutting and suturing. This is possible in a majority of cases, but of course the best course of treatment can only be determined after a detailed oral exam, review of a full set of diagnostic digital x rays, and appropriate diagnosis.

I should note here that we use LANAP in a majority of cases, but we have seen superior results through using additional lasers, often in combination on the same patient. These include ND/YAG, Erbium, CO2, and diode lasers. We will soon be publishing data on these innovative techniques we have developed, and will be presenting clinical findings at the next American Academy of Periodontology (AAP) meeting in Orlando, Florida in November 2015.

Also, please realize that there is no "magic bullet" to treat all periodontal cases, but over the last 10 years, these various laser approaches have proven to be an extremely effective modality for long term stability.
3 Apr, 2015 4:32 AM
My husband (78 years old) has had no teeth for 10 years now, and complains of swollen gums. What do you think? You should see a specialist (preferably a Periodontist) for a complete exam and review of his medical history. When was the last time your husband had his denture checked for correct fitting?2 Apr, 2015 6:16 PM
My upper tooth on my left side, two back from the eye tooth, has been capped for years. The gum has receded upwards. It is bad enough now that It effects my smile. Any natural remedies that I can try?Hi Eileen,

I would suggest a consultation, including an x-ray, to look at the area on the upper left side.

Recession indicates that there is a periodontal issue which would need further evaluation.

In the meantime, you can rinse with salt water rinses, ¼ teaspoon in 8 ounces of room temperature water 2 times a day.

Please give our office a call, 201-307-0339.
2 Apr, 2015 2:16 AM
My dentist told me I need my last six teeth removed but in order to get false teeth I would need a bone graft. Do periodontists do bone grafts?Periodontists not only do bone grafts, they also perform extractions, implants, gum surgery and laser procedures. However, the periodontist needs special training to use lasers, and experience is a plus. In fact, when doing extractions with or without bone grafts, we routinely use the laser, which decreases post-operative discomfort and swelling significantly.25 Mar, 2015 8:12 PM
A month ago, I was told I was over-brushing, and needed to get an electric toothbrush. Which I did. A month later, when I went in for a cleaning, the hygienist told me my gums were receding, but that it was minor with 1-2mm of my tooth root showing in various parts, mostly in the back. When she poked around in my mouth, she said mostly 3’s, whereas a month earlier they had been mostly 2’s, with a couple 1’s and a few 3’s in the back. They mentioned nothing of gum disease, and attributed the recession to brushing too hard, advising me so get a pressure sensor toothbrush and monitor my gums with future cleanings. I will be doing that. They told me my gum loss was minor, but I am not okay with the loss. My questions is, at what stage does gum grafting become an option? Can minor cases such as mine be considered? Is there a possibility I can heal the gum tissue that has been lost with “proper care”?Gum grafting depends on the amount of good keratinized attached gum tissue that’s present around the tooth, whether there’s an active recession, whether there’s bleeding, whether there’s inflammation, position of the teeth in the arch. Those are the main criteria. Regarding whether a minor case such as yours can be considered, if you have recession, you’re always a candidate for consideration for grafting. It’s not likely you’re going to be able to regenerate that lost gum tissue on your own. We don’t have any procedures that you could do at home that would enable that gum to grow back up on the tooth.21 Mar, 2015 10:05 PM
I have severe gum disease and I'm scheduled for a LANAP surgery but my dentist wants to remove 23-26 because of an abscess on 24. I read that LANAP allows you to save the teeth. Is my situation different?It’s possible, with LANAP surgery, that we can save teeth – particularly tooth #24 – the one in question. However, without seeing your x-rays and doing a clinical examination, it’s virtually impossible for me to say whether this tooth can be saved or not with LANAP. But it is possible.17 Mar, 2015 6:09 AM
Dr. Linden--what are the pros and cons of having gum graft surgery vs. the pinhole procedure in a young person (23 years old)? Thank you.There are pros and cons. It depends on the amount of good healthy gum tissue that’s present. It depends on the position of the teeth in the arch. It depends on the thickness or thinness of the gum tissue. Either procedure in many cases can be done. In certain cases there are advantages to the pinhole procedure. You would have to be examined. But safety is not a issue with either procedure. 12 Mar, 2015 1:40 AM
I am planning to have gum grafting surgery for my lower teeth 20, 21, 22, 23, 24, 25, 26, and 27 with IV. I have severe recession on one tooth and other teeth have severe to less severe recession. So, my doctor recommended to do the surgery for 20-27 teeth on the lower. How much does this procedure cost? I live in Sacramento, California.Fees vary greatly, depending on the difficulty of the procedure, the patient, and the amount of surgery that might be involved. There is a fee for sedation. Usually, if insurance covers it, it’s per tooth. There are codes for that. Fees will also vary by region of the country and between doctors. It depends on the clinical presentation and your x-rays. If your doctor already recommended this surgery, didn’t he or she give you a cost estimate?12 Mar, 2015 12:34 AM
I need a pinhole procedure on teeth 21-28 due to gum recession. Do you do that? Is there an alternative laser treatment that would stop gum recession? What is your approximate cost? Thank you.For many years we have performed a variety of procedures that are similar to the pin hole patented procedure. We use those procedures in addition to the laser for the treatment of gum recession. Each patient is different and requires a thorough diagnosis before the options are presented.6 Mar, 2015 12:16 AM
I had pocket reduction surgery two weeks ago along with a bone graft. I still have stitches. My teeth around the area are still hurting and it's causing headaches. Is that normal?It’s not particularly normal. There could be a number of factors. The healing response. Are you a smoker? Are you diabetic? Is the tooth in traumatic occlusion, which would mean the tooth is high when you bite your teeth together? You could be traumatizing the tooth and causing irritation. You could have some food caught underneath the stitches. There could be a little infection brewing. As you can see, there could be a number of causes. You really should be checked.4 Mar, 2015 5:42 PM
I am a 40 year old woman and I have several broken teeth and now I have three bumps on my gums. I have no insurance and my mouth is really bothering me. What should I do?I would certainly see a specialist. Since money is an issue and you have no insurance, maybe a clinic or a dental school in your area. Many doctors, including myself, have payment plans which are American Dental Association-approved, such as CareCredit and Springstone. And Lending Club. There are always options if you really need to have some work done. I would definitely recommend treatment with bumps on your gums.28 Feb, 2015 3:36 PM
I had a graft done about three days ago and have been wearing my regular retainer to cover the stitches on my palate. Yesterday I took the retainer out just to rinse it and there was a terrible taste. My breath has also smelled bad the past couple days. Is a bad/taste smell normal or should I worry about infection? Thank you.The retainer needs to be cleaned and disinfected. If it was sitting in there to cover stitches over a period of time, it can develop plaque and bacteria. You can do a gentle rinsing in the mouth to see if there’s any residual plaque around the stitches. You can always have the doctor who did the graft take a quick look to make sure you don’t have an infection.26 Feb, 2015 4:03 PM
I had two wisdom tooth extracted eleven days ago. I am still not able to open my mouth and I am experiencing extreme pain increasing as time passes. What would you recommend to a person experiencing this on their follow up?I would certainly go back to the surgeon who extracted the tooth to make sure there’s no infection or dry socket. Warm compresses in the TMJ area might be indicated. If your doctor has the appropriate kind of laser, he could do bio-stimulation that will help the inflammatory response.26 Feb, 2015 1:32 AM
What is the cost of having the entire mouth treated with LANAP laser? Is there still the possibility of losing teeth after the process?The cost of doing full mouth LANAP depends on the patient, the extent of their disease, your location in the country, the doctor and the extent of his/her experience. As long as you have a good initial diagnosis and treatment plan, your periodontist should know if there’s a questionable tooth, and they should let you know that before doing the LANAP surgery. There’s always a possibility of losing teeth. There’s no procedure on the planet that can be guaranteed 100%. My patients, at least, know up front if I feel that there’s a tooth that’s on the edge, so there are no hidden surprises at the end.25 Feb, 2015 5:20 PM
Dear Dr. Linden,
I am a 41-year old female with very severe, advanced periodontal disease. Very loose teeth/bone loss/ visible calculus/tartar buildup/dental phobia (bad experience as a child). I finally went to a dentist around 2005. He initially indicated full extraction. Then he referred me to a periodontist. The periodontist told me that I'd probably lose my front teeth (upper & lower). He also did a scaling/root planing in 2 separate appointments. He gave me IV sedation due to my fear of the procedure/pain. It didn't work! After the first time, I told him it didn't work well and he upped the dosage for the 2nd time. It still didn't work. I remembered everything. It was terrible. Interestingly enough, after the two procedures, I would be really groggy and sleepy the next day. I ended up not going back. Was so fearful. Fast forward to now. Some teeth are very very loose (although none have fallen out). I know you would have to see x-rays, but might LANAP work for me or what? I would like to find a compassionate provider. Don't know exactly what to do.
Thank you for your time. I appreciate this site.
God bless you.
LANAP and other laser approaches may very well help in your situation, as they have with many, but of course, I would need to evaluate you in my office to offer a more specific prognosis. Laser procedures are relatively painless, compared with scaling and root planing, and many other conventional procedures, so IV sedation would not be necessary or desirable.
23 Feb, 2015 7:37 PM
I have gum disease and am closely followed by my dentist. My only reservation is the cost. I simply do not have the money. Do you know of any dentists (Atlanta, GA) area who offer payment plans? Our insurance is horrible and only covers 10%. I have thought about a dental college. Thoughts? And are laser treatments better?
We offer a couple of payment plans: In most cases, LANAP (laser periodontics) will be the superior treatment method. See You can try reaching out to a local Dental Society to get a referral to a Dental School in your area. Perhaps one will offer laser periodontics.
18 Feb, 2015 5:50 PM
Can your gums be swollen or feel swollen from the inside even if you can't see or feel the swelling with your hands?The answer is yes. It also sounds as though you need to go to a qualified Laser Periodontist for evaluation.17 Feb, 2015 8:14 PM
I currently have braces, however I have excessive gum tissue. I wanted to know if an orthodontist usually lasers the gum tissue while a person has braces or after a person has had the braces removed.The laser procedure can be completed either with or without the braces, depending on the case. The procedure should be completed by an experienced Periodontist (gum disease expert) with using a laser that has multiple wave lengths.13 Feb, 2015 6:53 PM
I notice I have ONE tooth (my right canine) that is mildly receding due to brushing too hard. It is sensitive if scraped, but fine brushing is OK. Can this be fixed? Thanks!You would need to be examined by an experienced periodontist to determine if you would qualify for a periodontal procedure to fix the gum recession you are describing. There are a number of different surgical techniques that could be utilized depending on the clinical presentation.11 Feb, 2015 6:04 AM
Why does periodontal treatment cost so much ($9600), and why doesn't the care provider offer financing?The price you quote is by no means standard or static. The cost of periodontal treatment can vary widely according to the degree of care your condition requires, and of course that can't be determined without examination and x-rays. A periodontist is a specialist who has received training and who uses equipment far more sophisticated than that possessed by the average dentist. It's sort of like the difference between a general practitioner and a heart surgeon. Hence, costs are higher than those to which you might be accustomed. We do offer financing, through Springstone and CareCredit. Please see for details on that, or call our office.2 Feb, 2015 11:54 PM
I need a gum grafting for one of my teeth. I have been on Boniva for two years and have been told that may cause risks. I am scared to death and don't know what to do. I had a consultation with a specialist in periodontal and implant. I also read about pinhole procedure. Would that procedure be less risky?Both grafting and pinhole are acceptable and viable procedures. Your periodontist will have to weigh the pros and cons of the two procedures and the possible risk, if any, your medications may have.29 Jan, 2015 5:41 PM
A couple of months into my orthodontic treatment I had a frenectomy done. Now I am 10 months into my treatment and my gap has fully closed but now I have a chunk of gum tissue lying over my teeth where the gap used to be. It moves around when I brush. I am not sure why I have this piece of excess gum tissue.I'm afraid I can't help you with this without examining you. Perhaps you’d like to come in for a consultation? I suggest you go back to the surgeon who did the procedure to have him or her check it. What sort of doctor did the frenectomy?19 Dec, 2014 2:15 PM
Can crown lengthening result in sprained tooth syndrome?Medically, this condition is called "trauma from occlusion". Crown lengthening is not known to cause this. The tooth may be in trauma...meaning "too high" on the bite, irrespective of crown lengthening. If you have experienced “sprained tooth syndrome”, as you call it, it is probably due to another issue. I would recommend an examination by a laser-qualified periodontist. 7 Nov, 2014 3:32 AM
I had an overcrowding problem on my bottom teeth as a kid before I got braces, so I had to get two bottom premolars removed. Everything looks great and I've had no problems. A dentist sent me to get all my wisdom teeth out and made a bad call by not looking at my file closely and seeing that I needed to leave my two bottom wisdom teeth in so they would come in to be beneath my top back molars, preventing super eruption. Since I was young I did not know to get a second opinion and now I am suffering with what to do. They have dropped some and I am sleeping in a splint to put pressure on them to keep them in as long as I can. I really want to get implants on the bottom to prevent it from happening any worse and shave down the part of the tooth on the top that has dropped some so they will be even with the rest. I am debating whether to get two implants on my bottom but I just read that laser tooth re growth may be a possibility for the near future and I am now confused on what I should do. I don't want to wait any longer but I really wish it were already available and am wondering if I would even be a candidate for the laser re growth treatment. I do not want to see any bone loss with my jaw structure either. PLEASE help me make a smart decision. Price is not an issue I am desperate and will do whatever is best.If you need to have implants in the space, you should probably have them done. Laser regrowth refers to areas around existing teeth or implants. Currently, the laser can’t grow bone in areas where there are no teeth. I could give you a much better-informed opinion if I were to examine you in my office. If you are able to travel to the New York/New Jersey area (presuming you are not already in the area) you might want to consider that option. Then you will have a treatment plan that you can pursue with confidence. 26 Oct, 2014 1:09 AM
What is the cost of LANAP treatment in Bangalore, India?I somewhat doubt that LANAP treatment is available in India, but please submit the “Find a LANAP® Dentist in Your Area” form on and they will tell you if it is. If it’s not, keep in mind that some of my patients have traveled from as far away as Thailand to get the best treatment available. If you can travel to the US, I would be happy to see you. Regarding the cost, it’s hard to give you an estimate in a public forum. If you are interested, please contact our office and we can give you a range of typical costs, but the actual cost would depend on your particular situation, and I could not determine that without a proper examination, which I can only do in person.25 Oct, 2014 3:24 PM
I was just told by an oral surgeon that because the pocket is so deep (8mm), the implant may not take and I would need a sinus lift. Would I be a candidate for the LANAP to add bone and then get the implant?It is possible to save teeth that have deep pockets using advanced laser methods. It is also useful if the Laser Periodontist has different wavelengths to utilize as needed.

It sounds like you would benefit by having an experienced, certified, Laser Periodontist complete a full evaluation of your mouth to determine the best course of treatment. A full mouth evaluation includes a full series of digital x rays and a comprehensive oral exam.

Every patient presents with a different clinical picture.
20 Oct, 2014 2:06 PM
A 42 year-old female patient, after initial periodontal therapy, still has mobility of teeth. How will you decide whether to go for occlusal equilibration or splinting?Are you a Periodontist?

I would incorporate a definitive periodontal treatment plan in addition to stabilization and or splinting depending on the course of treatment.

An example: If we have generalized periodontal disease with concurrent mobility, we often incorporate laser therapy and simultaneous occlusal adjustment and splinting if we have evidence of secondary occlusal trauma, pathological movement, or fremitus.

Night guard therapy to follow in 6 weeks.
15 Oct, 2014 2:26 PM
I had gum surgery 3 months ago. The doctor removed skin from the roof of my mouth and grafted it onto the front bottom. This is the second time I've had it done. I already had a frenectomy, but what is left was pulling the gums away from the teeth. My question is, my teeth in that area have felt sore and achy ever since and I am wondering if this could be a result of the gum surgery. I went to see him and he said that my teeth are just sensitive. I use Prevident every night. I am wondering if he caused a new problem. What would you suggest?I would suggest you go back to your Periodontist for a follow up. He should be able to answer any questions you have regarding the healing from the gum grafts and any other subsequent sensitivity. It should be obvious if there are any other issues that need to be resolved.14 Oct, 2014 7:34 PM
I had LANAP surgery performed six days ago. Is it common to experience tenderness and slight swelling of the mandible? I know that #'s 18 and 19 are severely compromised due to bone loss. Unfortunately, the LANAP surgery performed on the UR resulted in necrotic tissue formation on #'s 4, 5, and 6. Thank you for your time.It is unusual to have tenderness and swelling 6 days post op LANAP. I am not certain why you had “necrotic” tissue on 4, 5, 6? Are you certain it wasn’t fibrin? Did your LANAP-trained laser Periodontist take photos?13 Oct, 2014 3:20 PM
I have what I think is pretty severe periodontal disease but have not lost any teeth yet. I would like to get pregnant sometime in the near future and would like to get my mouth under control first. How long do you think a person should wait after having LANAP to try getting pregnant? Also, how do I go about finding a qualified professional to do this procedure? (I live in Minnesota so unfortunately, travel to New York/New Jersey is not an option for me.)
You can have LANAP before you get pregnant pending an examination and review of your x-rays to verify that you are a candidate. LANAP would be of great benefit for a safer pregnancy and gingival health.

I would suggest seeing a LANAP-trained Periodontist in your area. Contact Millennium Dental Technologies in Cerritos, California. Click the blue link on that says “Find a LANAP Procedure Trained Doctor.
9 Oct, 2014 5:21 PM
OVER THE LAST 10 YEARS I have had my lower gum on the right side fill up with blood and fill my mouth with blood, and then it would be fine for a while. I have seen oral surgeons and they have tried to say it was small blood vessels in my gums. They cut away pieces of my gums in order to remove the problem. I need help! Do you have an answer?Your situation is quite unusual, and I’m afraid that I couldn’t give you a helpful or responsible answer without conducting a clinical exam. 7 Oct, 2014 3:12 PM
Recent X-rays identified bone loss for 2 teeth in lower jaw (I am 78). Now I have a slight pain in my jaw on the right side. Could this be periodontitis?Periodontitis can present with one or many of the following symptoms:
1- pain
2- bleeding
3- drifting of teeth
4- mobility of the teeth
5- bad taste
6- swelling of the gums
7- discoloration
8- foul odor

If you have any of these symptoms, it advisable to see a laser-trained periodontist.

1 Oct, 2014 8:27 PM
I had a tooth extracted a month ago with a plan to place immediate implants on 6, 8, and 9, but I decided not to risk failure, so bone graft preservation was done instead. Now I don’t know if an implant can be placed in 6 months, which made me think the risk of immediate implant may have been a better choice.Implants can be placed either as an "immediate" placement at the time of extraction or after the tooth is removed, bone is grafted, and some appropriate laser treatment is performed in the extraction socket. We usually wait a minimum of 3 months or perhaps longer if we performed a sinus augmentation at the time of extraction. There are a variety of approaches and these options mentioned are both predictable. Each person is different and requires a thorough diagnosis and treatment plan to choose the best path for success.16 Sep, 2014 7:20 PM
I am a 46 year old woman. At age 12, a permanent tooth was extracted, leaving a hole in my lower right side. Braces to spread the roots to make room for an implant were recommended. My question: if I don’t get an implant, what will happen to my teeth and gums in that area as I age? Thank you for your time.If you have a space that is created for an implant, the "downside" of leaving it alone is the possibility of teeth moving into the space, further bone loss in the site, and hyper-eruption of the upper teeth in the opposing arch.

If you retain all the teeth in their current positions, then the only downside is the bone loss.

Is there a medical reason you cannot have an implant placed? They are over 90% successful.
12 Sep, 2014 2:08 AM
Hi -- I have deep pockets around one tooth due to it coming in rotated -- it's always been that way. I recently saw a periodontist who recommended, after only a visual exam and x-rays, that it needs to be extracted. The tooth isn't dead or causing me trouble. I'm trying to delay/avoid extraction and wonder if gum grafts or other gum surgery can, in general, slow bone loss. Thanks!To answer this question responsibly, I would need to conduct a comprehensive examination, and review a quality set of digital x-rays. But speaking generally, the laser approach (including LANAP), often obviates extraction. We have a good track record of reducing pockets and halting bone loss. We customize our treatment for each patient, often combining different modalities. Please read our website for a more detailed explanation of the superiority of laser modalities over conventional surgery for treating most cases.8 Sep, 2014 1:09 AM
Dr. Linden...I have composite bonding on my top and bottom front teeth. I see my dentist every six months for checkups and cleanings and now he says I may need extensive periodontal work done. He says because of the space between my teeth and gums bacteria has formed in my tooth pockets. He says that when he does scaling and root smoothing I will need porcelain veneers, which are smoother with less spacing between tooth and gum. My dentist is known for trying to ring up the bill. I can’t afford one thousand dollars per veneer. Does what he says sound plausible? Thanks for your time.Your dentist may be right, but without examining you myself it’s impossible for me to say. It does sound though, like you should consult with a periodontist as soon as possible – preferably one skilled in laser periodontics.24 Aug, 2014 3:02 PM
I had a tooth extracted about 3 weeks ago now (back left molar), and at extraction site I now found a soft red lump. I don’t have really any pain at the site though. Should I be worried, and should I see my dentist? Or can you recommend any home suggestions? Please see your doctor as soon as possible. It’s not possible to diagnose this without an examination.17 Jul, 2014 11:13 PM
Hello, I have had braces for almost a year and am getting them removed in the following weeks. I would like to know how long I have to wait after I get my braces removed to have laser gum surgery to aesthetically improve my smile. Thank youA few weeks after the braces are removed, have your Laser Periodontist do an evaluation to determine the timing and type of procedure needed for the esthetic surgery.15 Jul, 2014 5:51 PM
If I had a deep cleaning on the 2 right quadrants of my teeth, is it possible to have no pain afterwards or did they not do a thorough job? They numbed me good but after the numbness was gone I didn't have any pain or discomfort. I feel like the girl who said it was only her 2nd time, failed to do the job as it should have been and it is expensive. Please reply. Thanks, CherriMost of my patient’s express the same thing after laser and even conventional surgery. Don’t worry, an absence of pain doesn’t mean the procedure wasn’t effective.7 Jul, 2014 1:02 PM
I had a small gum graft over a year ago. Could the operation have caused the loss of smell I experienced some time afterwards? My sense of taste has not returned to full capacity after the use of chlorhexidine 12% for about four months. I can smell some unpleasant smells like fish and some altered smells but not food smells. I would really appreciate some light on this matter.The altered taste is most likely from the long term use of chlorhexidine. The senses of taste and smell are interrelated. If you read the product insert, it is one of the side effects listed. Gum grafts do not cause this condition you are describing.1 Jul, 2014 1:18 PM
Just did LANAP 2 days ago. My gum looks like it has food particles/calculus on it, is that part of the healing process?Impossible to tell you what you are seeing. I suggest you call your Periodontist who performed the LANAP procedure and have them take a look at your mouth.14 Jun, 2014 3:01 AM
I am 55 years old and had my Frenulectomy a few days ago. My dentist said my gum will be swollen for a few days. It was hurting bad so I went back to him two days after the surgery. To my dismay, he told me that it will take at least two weeks for the wound to heal. My face looks bad with a swollen jaw, like I have mumps. He did not prescribe any medicine to heal the wound faster. Can you recommend a medicine to take or put on my wounded gum to heal it faster? Appreciate your kind help. It really hurts.Did you have an experienced periodontist perform this procedure? Did they use a laser? Did you ask your periodontist whether you needed any antibiotics? Was the area infected? Are you a smoker, diabetic, or do you have a significant medical history? Was this done on the maxilla or mandible? Were there complications during the procedure? You should ask your treating doctor these questions and request medications.11 Jun, 2014 7:11 PM
It has been determined that I have periodontal decease and the beginnings of bone loss in several of my teeth. I was referred to a periodontist who did scaling and planing, but now wants to do occlusal equilibrium in order to right the alignment of my bite. But I was planning to have braces to fix teeth which have moved since the progression of the disease and bone loss. Is this putting the cart before the horse? Won't my bite change after the braces anyway?If you are planning to have orthodontics, are you cleared periodontally to go ahead? Are there any remaining pockets around your gums? If so, what has been suggested to you for definitive treatment? Occlusal adjustments are needed if you are undergoing certain laser protocol treatments. It might be that the Periodontist wants to remove the "bad contacts" before you go to the orthodontist. Certainly orthodontics will change your bite also. I would suggest asking your periodontist and orthodontist why an occlusal equilibration is necessary?10 Jun, 2014 7:43 PM
Dear Dr Linden, My periodontist has recommended LANAP. How long does it take to recover and how much does it hurt? How does it compare to dentures as a treatment option? Does Reflux Dystrophy syndrome effect recovery and can my RDS spread to my mouth from having LANAP done? I am desperate for answers.If LANAP is followed to protocol and performed by an experienced laser periodontist it should not be a painful procedure. Your reflux syndrome should not be a factor in your recovery. Please check with your physician to confirm this and get a clearance. Please follow up with your Laser Periodontist who should know these things if they have experience with LANAP.6 Jun, 2014 12:15 AM
My hygienist has been doing full mouth laser treatments with my periodontal cleanings every 3 months. Do I need to be concerned about potential side effects, and do you advise having this procedure done on this time schedule ongoing?What type of laser are you having treatments with? Wavelength? Power setting? Pulse duration? Joules deposited? Light dose? What are the pockets measuring?4 Jun, 2014 1:08 AM
Can a root canal or gum transplant cause bad breath odor? I had both of these procedures done in the same year & since am having a problem with bad breath, my husband is telling me. I asked my regular dentist if these procedures could have anything to do with this, & he said he had not heard of this being linked before. I have always taken care of my teeth. I have tried different mouth washes & mints, but nothing seems to work. My dentist recommended baking soda toothpaste & thought it might be caused from allergies & sinus, but would get better after allergy season. Nothing is working. Do you have any suggestions? Thanks!We need more information to help diagnose your situation:

• Are you getting drainage from any root canal leakage or gum pocket?
• Are you brushing your tongue and flossing effectively every day?
• Are you a mouth breather? Spices in your diet? Alcohol?
• Do you take medications? Smoker? Medical issues?
• The bad taste could also be related to your sinuses or post nasal drip.
• Have you been checked out by an ENT specialist? Have you seen a Periodontist?
26 May, 2014 2:57 PM
Hello Doctor. I have NUP (Necrotizing Ulcerative Periodontitis) and have been researching treatment options. There are three that I've been investigating, and I'm unable to distinguish differences between them. Similarly, I am having trouble finding the clinically proven effectiveness of each option. Can you help me understand the difference between RPE therapy, LANAP, and ultrasonic scaling? Many thanks for any help you can lend!We need more information regarding your current Periodontal situation.
• Do you have radiographic bone loss?
• Do you have current full mouth digital x rays?
• Have you been diagnosed by a Periodontist? If so, what is your case type?
• Have you ever had any prior Periodontal treatment? Do you have pockets? Mobility?
• Do you have any significant medical history issues? Are you taking any medications?

All the above are critically important to answer your question regarding treatment options.
22 May, 2014 9:20 AM
I had LANAP performed February, 2014. I am in need of a follow up cleaning. I do not want to return to the original periodontist who performed LANAP because I was accidentally burned with the Yag laser. I am planning to see another periodontist but she does not perform LANAP. Are there any special instructions for follow up cleanings etc. post-LANAP? Thank You, Lee AnnThe cleaning and follow up consists of:

1- supra-gingival cleaning with ultrasound
2- no periodontal probing for one year
3- no sub-gingival scaling
4- follow-up occlusal adjustments
5- no manipulation of the gum tissue in any way

It is better to see someone who is trained to do LANAP They should understand the standard post-operative regimen, particularly in the first year following the full mouth protocol.
20 May, 2014 3:16 PM
Why should you brush your teeth 2-3 times a day? What kind of disease could you be prone to (likely to get)? One is gingivitis but the other is inferior to the site of the teeth.Gingivitis can lead to Periodontitis (bone loss). You should brush at least twice daily to keep your mouth clean. Practicing good oral hygiene is good for your mouth, teeth, and your general health.20 May, 2014 7:43 AM
What percentage of patients that present for periodontal surgery have burnished calculus on root surfaces?A significant number of patients presenting for conventional open flap surgery have burnished calculus. The exact percentage has not been quantified in any research article that I am aware of. Most of our Periodontal Laser cases are done closed (without a flap) so it is difficult to know in these cases.5 May, 2014 7:47 PM
How long does your mouth hurt and how severe is the pain after a LANAP procedure? Are there any long term bad side effects from this procedure? I am very scared to have this done and want to know if I am making the right choice to have it done.If you have the full mouth LANAP protocol done by an experienced, well-regarded, gentle Periodontist, then you should experience no discomfort at all during the LANAP procedure. The administration of the local anesthetic should be done gently and you will be fine.

There are no long term side effects from the LANAP procedure if done according to the protocol. The discomfort afterwards, if any, is minimal.
30 Apr, 2014 6:28 PM
After my gum surgery, the tooth that was loose still feels loose and is held together by the stitches. Will I lose the tooth?I’m afraid it’s impossible to answer this question without examining you. You need to check with the periodontist who did your gum surgery regarding this issue.30 Apr, 2014 3:17 PM
Hi Dr. Linden. My dentist informed me today that I have a tooth on the bottom next to the eye tooth which has a 6mm pocket. He states that the tooth is mobile, not loose! He would like me to have the LANAP procedure done on this. However, I do not like to be numb. He states I could be numb for about eight hours since that whole side has to be numb. I do not want to lose my tooth but I do not want to feel numb along the whole side of my mouth for 8 hours. He also stated the LANAP procedure takes about an hour. Is that correct? Thank you. Hope to hear from you. Has your NYC office opened as of yet?If LANAP is the indicated procedure, we can also use a shorter acting local anesthetic so the numbness doesn’t linger for many hours. We always keep our patients comfortable and you will not feel anything during the procedure. The time to complete LANAP varies from doctor to doctor depending on their experience level and competency. To be truly called LANAP, this is considered a full mouth protocol which can be done in 1 or 2 visits. If only a selective area in the mouth is done, this is not called LANAP. This is considered localized laser therapy and results can vary.29 Apr, 2014 8:31 PM
If have full upper dental plate why is my gum shrinking or receding? Could it be stopped with vitamins or treatments?It is normal for the gums to shrink under a denture. The bone and gums recede over time. When were the extractions done?22 Apr, 2014 11:02 AM
I have a failing bridge because of deep pockets on the right side. The three teeth on the left are fine. A periodontist told me I have to get rid of all my teeth. My question is, can I do implants on the right side and use my three good teeth on the left side to support a new bridge? He is telling me no.This is very difficult to diagnose on this forum. We would need to examine you and review your x rays. Maybe you could ask your Periodontist to explain all your options, including whether you could save the remaining teeth on the left side. You should get a complete list of options for your treatment.17 Apr, 2014 3:13 PM
If I donate gum tissue for a connective-tissue graft, will my subepithelial connective tissue regrow? Will there be a hole in the roof of my mouth? If it does regrow, how long will it take? Can subepithelial connective tissue be harvested more than once?Yes, this tissue grows back. There will not be a hole in the roof of your mouth if it is sutured correctly. The healing is fast with proper suturing and perhaps a laser for quicker healing. Subepithelial connective tissue can be harvested more than once.13 Apr, 2014 2:18 PM
I have been looking at your website and info and was hoping you would give me some advice. I have attached a photo. A few weeks ago, my crown came off. I went to the dentist hoping they could re-attach it. They told me that it couldn't be re-attached and the only solution was extraction and then a partial for that side of my mouth. During the extraction, they couldn't get it to loosen and it took them about an hour to get it out. They cut my gums all up, my lips and so on. With it being in front, I was hoping for a temporary but they said they can't make the impression until my gum heals in a week or so. Gave me a round of antibiotics and I left with a swollen face, blood stained shirt and no front eye tooth. Since then, I've seen no improvement in the healing. I'm worried that it won't grow back and I'll have no tooth there and a missing gum. It's really been a nightmare. I finished antibiotics, I couldn't take the pain meds from being so sick. I still can't eat and so much discomfort. Can you tell me from looking at the photo if this part of the gum and bone can be healed? I thought with your expertise. I have an appointment to go back but am scared they'll butcher me more. I would deeply appreciate any help or advice. I feel lost.I would locate an experienced periodontist in your area as soon as possible and request a consultation appointment. The periodontist should be able to evaluate your healing and the present the options you have for a new restoration.9 Apr, 2014 7:12 PM
I just had gum graft surgery from another Dr. I was under the assumption that the grafts would bring my gums back up higher on my teeth. I just had the sutures removed and what I'm noticing is that there are still several areas where the root part of my teeth are showing and it looks like I still have significant recession in some areas. My periodontist said that is because the anatomy of my teeth didn't allow the graft to cover that area and the important thing is that I now have healthy gum tissue. It seems like the tissue was just sewn on top of my old gums and it's not covering up much of the recession on some of my teeth. Is this normal?? It was an awfully painful procedure and recovery to not actually be able to "see" the results. We used donor tissue versus using my own tissue from my palate. I don't know if that makes a difference. Isn't gum grafting supposed to fix the appearance of recession? I'm very frustrated. Any advice you can provide me is appreciated. Thank you! I would suggest you speak to your Periodontist and review the goals of the procedure you had done. Sometimes, root coverage is not possible. There are situations where increasing the zone of attached tissue is the primary goal. Sometimes multiple procedures are needed.29 Mar, 2014 1:29 PM
I know it is never good to use smokeless tobacco. My question is when is it okay to start using smokeless tobacco again after a gum graft? It has been a little over a week and I wouldn't be chewing on the same side as the graft but don't want it to fail.Hi Downing. I think you’ve answered your own question. There is never a good time to start using it again. If you do so, it will decrease your healing capacity, increase the chance of infection, and in general, make a favorable outcome from your surgery less certain. Numerous studies have shown a direct correlation between tobacco use and periodontal disease. Chewing tobacco is even worse. Your habit probably contributed to your need for a gum graft. If you continue, more serious consequences await you; namely, cancer. If you can’t quit, maybe you can use a nicotine patch for a while. At least that wouldn’t compromise your oral health. I am sorry to be blunt, but I have to tell it like it is.25 Mar, 2014 5:54 PM
Dear Dr. Linden,

I have gum recession from tooth grinding at night. It was recognized late, and I do finally have a mouth guard, but already have had gum grafts on 5 teeth. The gum recession is still notable on most of my teeth and I don't feel the gum grafts were especially helpful. Would composites to cover the roots be an effective alternative for protection in the long run?

Thank you,
Cathy Weber
This is a difficult question to answer without examining you. If the existing gum tissue is "stable" and there is an adequate band of keratinized (solid pink gum) tissue, then maybe the bonding would be useful. If you have severe abrasion with areas of food traps or exposed surfaces open to root decay, then bonding might be wise. Sometimes the composite is not helpful. Each case is different and has to be evaluated in person for a definitive diagnosis.
19 Mar, 2014 2:57 PM
I have lost all my teeth due to gum disease and bone lost. My dentist told me that in order to get implants I would need treatment that will take about a year. Do you do laser (LANAP) for someone with my nightmare of a problem? Thank you for your time. Please answer ASAP.Yes, we do LANAP for people with your problem, and dental implants are one of our specialties (see Of course, you would need a proper examination with digital x-rays to determine the precise course of treatment. We also use a related procedure called LAPIP (Laser Assisted Peri-Implantitis Protocol), an FDA-cleared procedure to save failing implants, regenerate lost bone, and reverse implant disease to prevent loss of the fixtures. We were one of the first practices, starting in 2007, to use this procedure, and currently help train other dental professionals in its use. In most instances, the older, traditional procedures of gum flaps, bone grafts, and sutures are now obsolete.24 Feb, 2014 7:10 AM
I need periodontal work. I live in Staten Island, New York. Where are you located and do you accept Medicaid?We treat quite a number of people from Staten Island. We are located in Lincoln Towers, 170 West End Ave in Manhattan. Detailed directions on We also have an office in Northern New Jersey. Details on I’m afraid we don’t accept Medicaid but we do work with SpringStone and CareCredit. Please see for details.18 Feb, 2014 8:40 PM
I had a metal-on-metal total hip replacement. Due to malpositioning of a component, I developed metallosis, and high cobalt and chromium blood levels. I also acquired a T-cell mediated Type-IV autoimmune disorder (metal hypersensitivity reaction to Nickel). Within 1 year of my surgery, my fillings fell out, and my teeth began to crack apart. Then my teeth began to fall out one-by-one. I developed severe periodontal disease and must now undergo "gum flap" surgery to remove the embedded roots. Have you ever run across this condition? Does the literature reflect a link between chronic high levels of serum heavy metals leading to periodontal disease? Does Nickel reactivity (confirmed via a Metal-LTT test) contribute to my condition?There is not much in the literature regarding Nickel reactivity and severe periodontal disease. However, I did come across an article that addresses the inflammatory component. It would not surprise me if the high levels of C-Reactive protein (CRP) can affect the severity or presence of periodontal disease.15 Feb, 2014 5:20 PM
Given the fact that I am a bit anxious sitting in a dentist's chair for well over an hour, which would be the best surgical technique for gum surgery, less invasive the better. Would that be laser surgery? Thanks! We would recommend the laser approach if possible. We use and teach lasers of many different wavelengths and we would choose the most effective laser approach depending on your situation.

In order to determine this you would need a thorough diagnosis and clinical exam with a full mouth series of quality digital x rays.

The post-operative experience with lasers is remarkable and the patient experience is much improved comparing to “traditional” surgery. It is virtually pain-free and involves no cutting or stitching.
6 Feb, 2014 2:04 PM
I’m undergoing orthodontic treatment and have missed two of my appointments, so it’s been 3 months since I last visited my orthodontist. Yesterday all of a sudden I observed spontaneous bleeding from the lingual side of my lower first molar. There had been no trauma or pain. It was just spontaneous and I had almost a mouthful of blood. It stopped in around 6-7 minutes after cold application. What could be the possible cause?As much as I would like to help you, I can't do so responsibly in this forum. You need to be examined professionally. So I recommend that you see your orthodontist, dentist or periodontist as soon as possible.29 Jan, 2014 3:55 AM
Is there a natural alternative treatment or substance which can accomplish what LANAP does, which may not be painful, have negative side effects, and not be as costly? Thank you kindly for your response.If one has an acute situation such as an abscess or infection (swelling), a regimen of antibiotics MIGHT help temporarily. This will not stop the progression of moderate to severe periodontal disease and should not be considered a treatment. There are no known natural substances or prescribed medications that I am aware of that can control periodontal disease and stop its progression.22 Jan, 2014 5:46 PM
Should our patients be using a CHX rinse or Listerine product following SRP's with the use of a laser diode treatment?We use a diode laser in addition to many other wavelength lasers. We use YAG, Erbium, and CO2 lasers for our perio cases. The diode laser is used for very specific situations but not for the definitive treatment of periodontal disease. It has a very shallow penetration depth, and burns tissue away, which is not the goal of periodontal therapy.

There are no specific requirements for a rinse. You could use warm salt rinses. I don’t particularly care for the alcohol based rinses.
3 Jan, 2014 9:45 PM
Dear Dr. Linden,

I am 53 years old and have had gum disease since I was a child. My dentist just recently "learned" how to do laser surgery. I believe that I am his third or fourth patient. I had the surgery in Sept. 2013. Since then, I have had problems with my mouth. I have no taste and can't eat certain foods. My mouth is swollen and I have dry mouth. I have used the biotene products, but they help just for the moment. My tongue is usually numb. I was told by my dentist that it takes about a year for the process. But I didn't realize that I would have such a problem with my mouth. Can you help me?

Thank You,

In order to help you, I first need to ask a few questions. What type of "laser surgery" did you have? Was it with the Periolase and LANAP? Was it with an Erbium, CO2 or YAP laser? You probably don’t know the answers to these questions, but you’re certainly entitled to ask your dentist. Please let me know what he says. Thanks.

The following email correspondence with Darlene then ensued:
31 Dec, 2013 10:18 AM
If I have LANAP done do I need to do perio scaling and root planing?No. It is absolutely not necessary. In fact, scaling and root planing can actually negate the results of the LANAP protocol.27 Dec, 2013 8:26 PM
When is it too late to save teeth? I have had the CT scan, several teeth are loose, and some pockets are 6 mm. Went to Periodontist who recommends total extractions because of my history. I have chronic Periodontitis. I am in my late 60's. Surgery plus orthodonture can be done but no guarantees against future gum disease. I am going to get a second and third opinion. Should the opinions be from other Periodontists or oral surgeons? My peri did not mention laser.It’s impossible to give a general response as to when it is “too late to save teeth”, but I can say that with LANAP, many teeth which would have been lost with conventional gum surgery are now being saved. No one can offer guarantees against future gum disease, but with LANAP treatment and conscientious ongoing preventative care, you stand your best chance.

Regarding second and third opinions, I would recommend a consultation with an experienced periodontist who does LANAP. The doctor can you give you your options including the laser approach if you quality for the treatment.
6 Dec, 2013 11:17 AM
1) What do numbers on periodontal probings mean, such as 2, 3, 4... ?
2) Can impressions for a permanent crown be taken on the same day of crown lengthening surgery?
Thank you very much in advance.
The numbers on periodontal probings, such as 2, 3, 4, etc., are pocket depth measurements that indicate gum disease. In general, the deeper the pocket, the more serious the problem.
We do not recommend taking impressions for a permanent crown on the same day as crown lengthening surgery. We recommend waiting 4-6 weeks for healing to take place.
4 Dec, 2013 8:02 AM
I am 53 and have had braces put back on my teeth after 40 years to stop the strained biting in the back (I have several crowns in the back and to stop from having to replace all of them this was suggested). I have had them now for 7 months - 5 more to go. I had a metal crown placed on one tooth on a back molar temporarily (was afraid to spend money on a porcelain and have it damaged - will wait until braces come off to put it on).
This week I have developed the most incredible pain in the gum above that crown! My ear actually is hurting. I went to my dentist last Monday and she took an x-ray and said it did not look like anything was going on under the crown...all was good, but that the gum did look inflamed. Now it is 5 days later and I am in excruciating pain. I have some amoxicillin (425 mg) that I have been taking along with 600 mg Motrin every 4-6 hours, both courtesy of my daughter who did not proceed with surgery for an implant that has been postponed.
My orthodontist can't imagine what it could be. I have been off school (I teach) all week for holiday break. I will need to take off on Monday to have this all checked out (due to holiday no one could see me after Tuesday. Both doctors say that they haven't a clue what it could be...would not even tell me who I should come to first on Monday.
At first I thought it was due to "the chains" on my upper bracket that were placed for the first time a couple of weeks ago, but this gum thing, that even if I put my finger on it up there, is so awfully painful, I want to shoot myself! I truly have always had a high tolerance for pain...I am making my husband nervous. He wants to take me to ER when I have break-through pain. What in God's name could it be?
Thank you for any insight you can offer me.
Hi Joan,
Where do you live?
I would suggest a visit to the Periodontist ASAP for an evaluation of the area that is causing you discomfort.
It is impossible to diagnose you on this forum.

Followup Q&A's:

Q: If you could just tell me if this is a possible explanation given to me today by my dentist. She explained that the metal crowned tooth in the back was too long and hitting the bottom tooth and that is why the ortho had a wire (I went in and saw him the other day and he took the band off the crown and cut the wire) which its purpose was to shorten that tooth pushing it up into the gum. The wire was bent to push the tooth up, that is why I probably had immediate relief when the wire was cut. She went on to say that the direction the tooth is being pushed is different than when the other teeth had been moved in the past. That my other teeth have only been moved side to side....that this tooth has been affected on both sides. Also, that having the tooth be pushed up, the nerves are on the end of the tooth, and that is probably why it also hurt so much. She also said that on Monday she removed a bit of debris in between the band and gum that could have caused some of the swelling. She went on and said that it might be best to let the tooth take a break for a few days and possibly see if the wire that will be replaced not be at such an angle? Are these logical explanations?

A: I am not clear regarding the goal of your treatment. Was the orthodontist trying to “intrude” the tooth (that is, to force it back up into the bone)? It sounds like you experienced irritation (from debris) and from the force of pushing the tooth upwards.

Usually, we would extrude teeth, not intrude. However, since I am not an orthodontist, I would defer to the specialist in this case.

However, I can see why you experienced pain. Perhaps a periodontal consultation would be appropriate in your situation.

Q: Since I am so fortunate to have you respond if I could bother you about one more thing. We have a daughter that was born without her lateral incisors. She is 15 yrs. old and about 3 years ago prior to putting her in braces we spoke to the insurance co. and they would cover implants if we left the space avail....last summer she was scheduled and the receptionist called and told us they will no longer be covered! I have been around and around. We finally resolved to bite the bullet, and went to another dentist for a second opinion and price check. She took x-rays and it turns out her roots have grown too close, she couldn't put a peg/pin up there if she wanted to/ that her roots moved. She said the only options are that she is put back in ortho and then implants (which she could not tell if she has enough bone for it either) or put in a, the tricky part,....our regular family dentist said she would recommend a Maryland bridge (all porcelain), not a regular bridge, because she will not lose that much of the teeth. My question is: What is your experience with both and what do you think would be best. She is a red-head and her teeth have that tinge of yellow which she was hoping to have her teeth bleached after the process. I can't thank you enough for just reading this whatever you have to offer is greatly appreciated.

A: Each case is different. It appears from your description of your daughter’s case that there is not enough room for the implants in the lateral incisor position.

Your options:
1- Orthodontics again to open the space for two lateral incisor implants…viable and a good choice.
2- Maryland bridge (if the bite and tooth structure allow)

We have patients in both situations doing very well after many years. The Periodontist and Restorative dentist should discuss these options and present to you the pros and cons of each.
If you do choose the Maryland bridge route, the technique utilized, the esthetics, and materials used by the lab will be critical for a great esthetic result and longevity. Perhaps you could ask the restorative dentist for photos of cases they have done so you can make your decision easier.

Best of luck

Dr. Eric Linden

30 Nov, 2013 5:44 PM
How is LANAP covered by most medical insurance? My dental Insurance only covers up to $2000 per year. Or is this still considered cosmetic surgery?LANAP is not covered by medical insurance, unless it includes dental coverage. If it does, check to see if your policy includes periodontal care. Most do. If it does, then LANAP should be covered up to the limit of your policy, although if your limit is $2,000 per year, the cost of LANAP will likely exceed that. You need to check with your insurance provider because as you know, health insurance is a complicated issue and every policy is different.22 Nov, 2013 1:21 PM
Dear Dr. Linden,

After an unsatsifactory crown lengthening procedure, is it possible to do a dental implant?

Is it possible to make a bone grafting to restore the original gum and bone tissue removed in the crown lengthening procedure???

In other words, I need to do get rid of this crown lengthening?

I look forward to answering my questions in the very near future... Please.

Thank you very much

Q. After an unsatsifactory crown lengthening procedure, is it possible to do a dental implant?

A. Yes...of course the tooth has to be extracted and you might need a bone graft at the site of the implant placement.

Q. Is it possible to make a bone grafting to restore the original gum and bone tissue removed in the crown lengthening procedure???

A. Yes and might not be clinically necessary for a successful and cosmetic implant. Each case is different and needs to be evaluated.

Q. In other words, I need to do get rid of this crown lengthening.

A. Not really. We would need to see the area to make this final determination.
16 Nov, 2013 11:07 AM
I was involved in a car accident last October, in which I lost two of my top teeth and the bone above them. I have undergone bone grafting and that healed up perfectly. But there wasn't enough bone and it was not thick enough to be able to hold implants. So I had to go two weeks ago to have the screws from the first surgery removed and to have some type of "liquid bone" injections to make the area and bone thicker. I went back for a follow up today, where they removed the stitches. When I got back home, I looked at my gums in the mirror to see how it looked and there is a section where the gums aren't even connected in the front. And there is a small hole at the very top, where the gums meet my top lip, and where you can actually see bone because it is not covered with gum. They told me that it would take a few months for it to heal completely and to go on with the implants, but I didn't get to ask about the hole, gums, etc. because I did not know about it at that time. Will the gum start to grow back and cover the area where it looks rough, and the hole? Is there anything that I need to do to help this process? I don't want to get the implants with no gum above them, because then they wouldn't even look like real teeth; you would be able to tell the difference. And the way my gums are looking right now around the affected area, it will not look normal at all.Appropriately, your injury has been treated by a maxillofacial surgeon who deals with trauma cases, not a periodontist. I recommend that you first go back to that surgeon, and then if you still have any concerns, seek a second opinion from another experienced maxillofacial surgeon. At a certain stage in your reconstruction and healing, it may be appropriate to see a periodontist such as myself for dental implants or gum work, but judging from your description, you have not yet reached that stage.15 Nov, 2013 4:07 PM
I recently had a frenulectomy on #24 and #25 and connective tissue graft surgery on #24. I came back to the periodontist’s office after 10 days. She stated the graft went well and the gums look healthy, but she noted the frenulectomy didn't take, so she stitched that area again and I saw her about a week later. She wasn't satisfied with the results and felt that the muscle was still pulling on my teeth. She wants to do another frenulectomy in 3 weeks. My questions:

1. What is the rate of failure on this procedure?
2. Why isn't she doing the frenulectomy sooner if it is still pulling on my teeth?

Thank you for addressing my concerns.
There is a very high success rate for frenum removal. We use a laser which eliminates the need for stitches. The procedure is extremely predictable in over 95% of the cases. We usually do the frenum removal before the grafting. Sometimes this can be done in one visit. I am not sure why it is recurring in your case. Would have to examine you myself to better understand your situation.
8 Nov, 2013 5:35 AM
Will having teeth pulled cure my gum disease? I’m in severe pain. Why keep putting money into teeth that will have to be pulled anyway?I strongly suggest that you see an experienced LANAP Periodontist before you extract any of your teeth.

The doctor can determine if any teeth are worth saving.
5 Nov, 2013 1:27 AM
I'm having a LANAP procedure over the next 2 weeks, and am resistant to taking the antibiotics prescribed. I don't do well with medication, and have had adverse reactions to certain antibiotics in the past. Are they ABSOLUTELY critical for this procedure? Or is it ok to not take them, and just follow the other hygiene guidelines (rinses, etc). Also, I will be traveling overseas 2 weeks after the second and final LANAP... Will this be an issue? Thank you.The LANAP protocol should include taking systemic antibiotics. We often suggest to our patients to take Probiotics with the prescribed antibiotics. Are there any antibiotics that you can take? Travel two weeks after your final treatment shouldn’t be a problem as long as you have the proper post op instructions and follow up for occlusal adjustments, light cleaning, no flossing instructions, and the recommended diet limitations. Your experienced Laser LANAP Periodontist should know about all of these issues.1 Nov, 2013 4:41 PM
October 22nd will be 2 months after my Pocket Reduction (Osseous) Surgery performed with the LANAP procedure. At my post op appointment, (2 weeks after procedure) my doctor was pleased with the results. I received a very soft toothbrush. It is now time to replace it. Can I now use a stiffer brush? What about using my Philips Sonicare electric toothbrush? Would that be acceptable? Thank you.
I would stay with a soft brush until the 3-month period expires. We usually have our patients back on electric brushes after 6 months. Please follow up with the Periodontist who performed the LANAP.
17 Oct, 2013 11:51 PM
I had scaling done on my teeth, leading to a reduction in tooth size. Can teeth be made to look longer by any means, such as crowning and capping? If so, is lengthening of about 5mm possible?Each clinical case is different and sometimes with the proper periodontal treatment and coordination with an excellent restorative dentist or Prosthodontist, the esthetics can be improved. Obviously, a clinical and radiographic exam is necessary to make any recommendations.14 Oct, 2013 6:11 PM
My son is getting his braces off and at the same time the orthodontist wants to laser his gums that are covering his teeth. Is that ok for an orthodontist to do? He said he is going to numb his gums first. It’s only the top 6 teeth.I would suggest an experienced Laser Periodontist who does this all the time. It is routine in our office to do this procedure.11 Oct, 2013 4:07 PM
It was recommended from my dentist and hygienist to use hydrogen peroxide in an irrigator for my gums, why are you not recommending it?There was a professor named Dr. Keyes, a microbiologist in the late sixties, early seventies, who came up with a mixture of sodium peroxide and baking soda that patients brushed on their gums. In the lab, it kills bacteria. But then researchers found that peroxide causes cancerous or pre-cancerous changes in the gingival gum tissue. So we stopped using peroxide. I used to put peroxide on after gum surgery with a Q-Tip. No more. Never rinse with hydrogen peroxide.6 Oct, 2013 1:14 AM
Dear Doctor
I just had braces removed one month ago and now have two teeth with gum recession. # 24 on the lingual, I lost 4-5mm of gum tissue and #25 facial I lost 2mm of gum tissue.
In #24- I was told I could have gum flap surgery using gum tissue from my hard palate. How much in mm's can I realistically gain from the surgery?
On #25- I was told by a periodontist I could also do gum flap surgery there and also use my hard palate tissue or possibly get a frenectomy and seeing if the gum tissue bounces back. Does that really happen?
Thank you!
It is hard to predict over the internet how many mm's of tissue you would gain on the lingual of tooth #24. There are many clinical factors involved that need to be evaluated. However, a graft can usually be done and using a laser during the procedure is strongly advised. The issue with the tissue on the facial of tooth #25 presents a similar clinical picture. Some examples of the clinical things we look for are the amount of attached tissue, the position of the teeth in the arch, the depth of the vestibule, the pull of the frenum, the amount of adjacent tissue, occlusion, and other factors that need to be seen by a qualified laser periodontist in person.

If all the guidelines are followed, then your periodontal treatment should be successful.
30 Sep, 2013 5:16 PM
I have tooth loss in all of my teeth. My dentist is going to perform flap surgery tomorrow. My question is if I take real good care of my teeth will the bone loss will be recovered? Some of my teeth are also loose. I'm just 26 years old I don't want to lose my teeth.Hi Sandra. I’m sorry I didn’t respond to your question immediately. My web guy didn’t send it to me until today. I hope your flap surgery went well. I would have recommended seeking out a Laser Periodontist before doing the flap surgery. Preferably someone trained in LANAP. It’s always wise to take good care of one’s teeth, both for their own sake, and because good oral health is conducive to good overall health. I’m sure you’ll be motivated to follow all the usual advice – brushing, flossing, getting regular check-ups, avoiding sugary, acidic sodas, etc. This will afford you the greatest chance of reversing bone loss and retaining your teeth.20 Sep, 2013 8:08 AM
After having laser gum surgery I was told that a bridge needs to be considered for the left side of my mouth, both top and bottom, where teeth are missing. Otherwise the surgery will not be successful in long run. Is this correct?I would need to examine you to determine what you would need and the prognosis of the laser surgery. What type of laser surgery did you have? LANAP?9 Sep, 2013 1:08 AM
I have advanced tooth decay. Am I still eligible to wear braces?If you have advanced tooth decay, the decay needs to be taken care of prior to any orthodontic treatment.8 Sep, 2013 8:53 AM
One month ago I got dental implants. I had a 9mm pocket next to one of my implants, but in x-ray, my implant looked fine. What can be causing the pocket and how do I cure it?I am not sure why you have a 9 mm pocket next to your implant. We would treat that pocket as soon as possible. An exam and x rays are mandatory to diagnose and formulate a treatment plan.7 Sep, 2013 11:11 PM
Dear Sir, I am having gum surgery on my bottom tooth and the 2x I believe next to it in a couple of months. My question is, what is the success rate of the gum graft? And how soon after surgery will I know if it has been successful? Many thanks.There are different types of gum grafts. Your Periodontist should be able to explain the options to you as part of your informed consent.
The prognosis depends on a number of factors that may involve the tissue type, thickness, position of the teeth in the arch, amount of bone loss, amount of gum recession, mobility and stabilization of the occlusion (your bite), clenching or bruxing, any existing gum disease in your mouth, your general health, medications being taken, bleeding issues, diabetic?, smoker?, and a host of other technical parameters.
I would expect that your Periodontist can address these factors with you in advance of your planned surgery.
4 Sep, 2013 11:27 AM
Is it OK to resume cleaning in between the lower teeth in the region of a mandibular frenectomy 3 days post op? Our daughter has a permanent retainer on the back of her lower teeth and uses a mini brush type pick and red rubber-tipped instrument. Thank you.We usually recommend using a Q Tip since this tends to be a sensitive area post-surgery. If the Frenectomy was done with a laser, then the healing would be much faster and the toothbrush could be used much earlier during the post-operative period. Always check with your Periodontist if you have any questions.30 Aug, 2013 5:30 PM
My periodontist is prescribing "laser periodontal therapy" to address jaw bone loss and gum disease. The periodontist states that this will eliminate the gum disease and will rebuild the jaw bone. This is supposed to be a new procedure, but I have always heard that bone transplant/replacement of some kind is required. What is your opinion of this laser surgery to achieve the desired results?If your Periodontist diagnosed gum disease and explained all your options with the proper Informed consent, then laser therapy is a viable option. You might want to verify that the Periodontist is using an ND/YAG 1064 wavelength MP-7 Periolase and performing the LANAP protocol as approved by the FDA. If the diagnosis and treatment plan is carried out correctly, then the LANAP protocol has the ability to achieve bone regeneration without using a bone graft.

We typically review a current series of digital x rays in great detail to describe the prognosis of every tooth and the likelihood of bone regeneration based on our experience doing this form of laser surgery for the last 7+ years. In many of our patients, most of the areas do not require bone grafts and the laser protocol can achieve the desired results. Of course, some areas might require bone grafting, depending on the goals and the individual situation. Each patient presents a different clinical situation and the treatment plans can vary.

I should emphasize that the protocol as we teach it must be followed very closely for success. The occlusion and night guard therapy must also be followed as per protocol.


Dr Linden
30 Aug, 2013 12:02 AM
Roughly how much should it cost to remove a pyogenic granuloma (pregnancy caused tumor on the gum) if it is already grown to almost 2 cm? And should I get it removed or just keep waiting until after the baby comes?The size is rather large so I would suggest getting a medical clearance from your medical doctor and have the pyogenic granuloma reduced in size with an ND/YAG-1064 Periolase MP-7 Laser. There is no need to do respective therapy.26 Aug, 2013 4:34 PM
I had LANAP surgery. There is gel formation around my teeth. What is that? Should I brush them and take it off? The gel formation is most likely fibrin after the LANAP surgery. Your post-op instructions should have included not brushing your teeth and disrupting this normal healing process. Please call your Laser Periodontist and verify what you are seeing in your mouth.24 Aug, 2013 5:03 PM
Hi. You'll get a kick out of this one. I recently read that radio frequency can be used to treat gingivitis. I'm wondering if my Dermawand, which is a radio frequency device that I use for my skin, might help with my receeded gums from years of periodontal disease.I have no idea about this therapy. Please send me the scientific information or link so I can evaluate this type of approach.24 Aug, 2013 12:58 PM
Is it reasonable to pay $4000.00 for deep cleaning with a bone graft?I have never heard of deep cleaning with a bone graft. Do you mean traditional flap surgery with a bone graft? It is very difficult to comment on fees without knowing your case type, prognosis, and treatment plan.21 Aug, 2013 4:49 PM
What type of anesthetics are used for laser gum removal, small scale?We use local anesthetics for laser gum removal. I am not sure what you mean by “small scale".
21 Aug, 2013 6:15 AM
I have a tooth in the back upper right of my mouth that's fractured right under the gum line. They told me that it needs to be extracted. How is the surgeon going to get the remaining tooth out?Did you have a consultation with the surgeon yet? Each person's clinical presentation is different. The Periodontist/Oral Surgeon should explain your situation in detail to you so you can understand what he or she intends to do. I'm not able to offer specific advice, since I haven't examined you or seen x-rays, but rest assured that it is possible to remove a fractured tooth even if the fracture is below the gum line. Periodontists deal with this sort of issue routinely.15 Aug, 2013 10:02 AM
Are you able to direct me to any studies or articles that discuss the safety of osseous surgery during the second trimester of pregnancy and whether it makes sense to have the procedure done while pregnant or to wait until after delivery? Also, can you direct me to any studies or articles that discuss the pros and cons of laser versus traditional osseous surgery? Thank you.I would generally avoid periodontal surgery during pregnancy unless cleared by your physician, and even then would probably wait unless there is an active infection. If you must have surgery, I would suggest the Laser approach if possible and avoid aggressive surgery. and the links it contains will tell you a lot about LANAP. There’s also a lot on – the website of the company that makes the LANAP machine we use. If you want to learn still more, please Google LANAP and Laser Periodontal Surgery.
14 Aug, 2013 7:41 PM
I had laser LANAP 2 1/2 years ago. Now, another perio doctor is saying that he can feel roughness on the roots of my teeth and since I still have some bleeding (although I've followed the hygiene recommendations to a T) he is suggesting to do a manual (no laser) 'deep cleaning'. Could this really be a good thing to do?It is not clear from your description what the diagnosis is. We would need to see your current update x-rays and compare those with the pre op x-rays. Is there any reason you cannot go back to your original Laser Periodontist and follow up with that office?12 Aug, 2013 4:28 PM
I am having laser gum surgery. I have no teeth in the upper back and lower back left side. They want me to buy and wear a mouthpiece at night. Is this necessary?I am not sure what you mean by "mouthpiece". Are you referring to a night guard? If so, we usually have patients wear the night guard appliance until we are done with all the occlusal adjustments, which is usually several weeks after the procedure has been completed.9 Aug, 2013 2:35 AM
My son had minor orthodontic issues and had braces. Now he has to have gum grafting, due to thin gum tissue and having had braces. Should he stop wearing his retainer and let his teeth move some to relieve pressure on the bones? He is a good flosser and brusher so I don't think minor misalignment would contribute to gum disease in his case. I just don't want to have to think about a lifetime of problems for him at age 16. I wish the orthodontist had told us about his thin gum tissue and that this might happen. I suggest a Laser Periodontist consultation to assess your son's situation so things don't get progressively worse. At this point you don't want to lose any more gum tissue.27 Jul, 2013 9:15 PM
I was administered Arestin on Thursday, and I want to know if I can go swimming by Saturday. Being that the Arestin is a powder like substance, using microsphere technology in the infected pockets, would it be possible to go swimming?Although we do not administer Arestin anymore in our practice, unless you are swallowing or rinsing with the swimming water, you should not have any issues.26 Jul, 2013 11:55 PM
I notice that my gums are receding fast and I cannot afford a trip to the dentist. Is there a natural way to reverse my condition or slow it down, or is going to the dentist the only way to stop the infection? I read up on oil pulling they say this will work but I’m not sure.I’m not qualified to comment on alternative therapies such as oil pulling, but I am professionally qualified to recommend and administer LANAP – an FDA-approved procedure using the laser. Although technologically sophisticated, LANAP is natural in the sense that it utilizes the body's own ability to heal itself. It is also non-invasive, compared with conventional methods, since it does not involve cutting, stitching, or pain. So my recommendation would be to see a qualified Laser Periodontist as soon as possible, and until then, use a soft tooth brush and floss daily. You may qualify for Springstone or CareCredit patient financing. See for details.19 Jul, 2013 5:19 PM
I had dental implants put in on 14 and 15. The oral surgeon used dissolvable stitches and the surgeon told me that everyone's mouth/saliva is different and they could start coming out the next day. But on the same day, one of them is hanging down. Is that okay?If your stitches are coming out or hanging down in your mouth, you should contact your Periodontist. They will probably want to follow up with you. Our dissolvable sutures last anywhere from 7- 14 days.15 Jul, 2013 8:20 PM
I had scaling and planing done 6 years ago by my dental hygienist and 2 years later only had to visit the dentist every 6 months. Initially, there was a little recession after the procedure, but in the last two years my gums, especially on four teeth, have started receding rapidly (one tooth went from 2 mm to 4 mm between my two last visits). My hygienist doesn't seem worried and my dentist fitted me for a night guard. A few questions:
1. Do I have periodontal disease? Can I still spread it to others?
2. If my gums are receding, what precautions should I be taking?
3. Is it too late to get LANAP because I already had scaling and planing?
4. If I get LANAP now, could I still receive the benefits of possible bone and gum regeneration?
It is not too late to have LANAP. It is impossible to diagnose you precisely online, but if you are losing attachment (recession) there is a periodontal problem that needs to be addressed. You would need a comprehensive examination, a full series of x rays, and a precise and thorough exam to determine the best course of treatment to correct the attachment loss and prevent other areas from developing.
11 Jul, 2013 7:44 AM
I have a gum recession on one of my teeth in the lower front jaw. I had two gum grafting surgeries and both failed. The first one was done through taking tissue from my palate the second was done laterally. I recently changed doctors. The new doctor told me that this procedure would never work because my tooth protrudes more than the teeth next to it. Would love to hear your opinion about it.I'm not sure why the grafts failed. Often, we can save failing implants with an FDA-approved laser protocol. But of course, I can’t determine the best course of treatment without examining you and taking digital x-rays. Then I might recommend another grafting attempt, but hopefully, would advise laser treatment which would be much less invasive than conventional surgery.10 Jul, 2013 4:08 PM
I had a front tooth implant 2 years ago. Now the gum is receding and there is some discomfort and pain. What can I do or what needs to be done to save the implant?We would like to see you as soon as possible to determine if we can fix and save the implant.4 Jul, 2013 7:39 PM
After removing teeth, socket preservation was done and osteotome fixed in order to do implants. Since I am afraid to go for implants because of some heaviness in my face, can I go for partial dentures at this stage instead of implants for my premolar tooth, left side, or should I leave it as it is to avoid complications? Please advise.In most cases, a partial denture can be placed instead of an implant. However, there are many factors that need to be considered when making that decision. It is too bad, after going through the socket preservation and osteotome technique, that you now have decided against the final placement of the implant. I am not clear what you mean by "heaviness of the face". Perhaps a second opinion and more healing time might be indicated before making this important decision.15 Jun, 2013 1:20 AM
May I brush teeth after laser gum surgery?You should check with the Laser Periodontist who performed or will perform the LANAP surgery. Generally speaking, it’s very important not to brush your teeth for several days following LANAP. You should be given verbal and written informed consent prior to the LANAP surgery and extensive and detailed post-operative instructions. To achieve the optimal success of this FDA-clear protocol, the recommended procedures and instructions have to be followed very carefully and precisely.13 Jun, 2013 5:07 PM
Can you receive bone grafts at the same time as LANAP treatment is performed?If you are having LANAP treatment as the only modality, then bone grafting is not utilized in the protocol.

If you are having another procedure such as an extraction, sinus lift, or an implant, then it might be needed in addition to the LANAP treatment.
11 Jun, 2013 7:32 PM
I am a dental assistant and I have just found out I'm pregnant. The specialist I work for is thinking about purchasing a L.A.N.A.P and I was wondering how safe it will be for me and my baby to be in the room whilst he is using the laser, considering he will probably use it every day.This is an excellent question that many patients and healthcare workers are curious about. This laser device is a ND/YAG laser at 1064 nm wavelength in the invisible (non-ionizing) near-infrared spectrum. Bottom line, yes it is safe for you and the baby. You are not even in range of any laser energy reaching your body. LANAP does not use ionizing radiation (x rays). We have treated pregnant patients with lasers safely for many years without any issues. To make the point perfectly clear, we administer the laser treatment without any lead shielding, as there is no harmful radiation whatsoever. However, as you probably know, x-rays are ionizing and during pregnancy you would not want to be in range of x-ray devices.6 Jun, 2013 2:28 AM
In the last month I have been diagnosed by two periodontists and my dentist as having moderate periodontal disease. One perio has suggested laser treatment, the other has STRONGLY recommended against the laser, saying it has no clinical track record for success. Obviously, if I can avoid the traditional surgical procedure, I would. However, if its effectiveness is not known I would go with the surgery. Could you give me your opinion? Thank you.Thank you for your question. The information you were given by the “anti-laser” periodontist is not accurate. The LANAP protocol utilizing the ND/YAG laser is the treatment of choice. There are other lasers in the dental field that we also teach our residents at Columbia University School of Dental Medicine and Columbia Presbyterian Medical Centerand in California. However, for purposes of treating gum disease and regenerating bone, the LANAP protocol is effective and proven. The clinical efficacy has been shown in numerous studies and clinical trials. We have been performing and teaching this procedure to Periodontists from all over the world for the past seven years with results that exceed our traditional surgery results.30 May, 2013 2:16 PM
Hello, I've been to see a Dentist about LANAP and he referred me to his dental hygienist to commence deep cleaning and mapping of my bone. I have very serious bone loss in places and gum disease is advanced. They told me I would need to work very, very hard. They told me I would be keeping a food diary, brush and floss three times a day, and at the end of this process I will have LANAP - does this preparation sound appropriate and do you need to reach a certain point with hygiene to qualify to have the treatment? Kind thanks.If you are having or thinking about LANAP, DO NOT have scaling and root planing done before the full mouth laser protocol is performed. We tell our patients not to brush 2-3 days before the LANAP appointment. The results are best with inflamed tissue. Are you having a LANAP trained/certified Periodontist perform this laser surgery?22 May, 2013 6:46 AM
I was recommended to do this surgery to get space to get better hold and grip for my crown, as I don’t have any space to hold the crown. Please let me know how much time it will take after LANAP to get my crown done. Thank you!The procedure is known as a crown lengthening. Your question depends upon the extensive nature of the surgery. We strongly recommend that you contact and set up and consultation visit with our office. If this is a crown lengthening procedure, we don't do LANAP for this type of problem. We utilize a flap procedure to perform osseous surgery.20 May, 2013 8:29 PM
Hello Dr. Linden
I was diagnosed with advanced aggressive periodontitis and found doctor in Canada for LANAP surgery.
I would appreciate if you let me know what I have to concern about surgery and what to ask doctor before surgery?
Thanks. Paul.
Hi Paul. Presumably you'll be having an initial consultation with the doctor you have found. If you have any concerns or questions, you'll be able to ask him directly at that time. That’s what initial consultations are for.
9 May, 2013 7:15 PM
I have had bone graft done on tooth # 9 and extract # 9. What is my next step? What are the results if I had tooth # 9 removed and put an implant to replace it? What is the approximate time frame for this procedure and what should the approximate charges be?It’s difficult to tell from the question you submitted what your situation is. A consultation/examination along with digital x-rays would be necessary to get a clear picture. This would also enable us to determine time frame and cost.4 May, 2013 3:40 PM
Does LANAP require a course of antibiotics?We use antibiotics for 7-14 days depending on the patient and sequence of treatment per protocol.2 May, 2013 3:37 PM
What to do if I have an abscess in my gums by my bottom tooth?I would suggest seeing a Laser trained LANAP Periodontist for an immediate evaluation.29 Apr, 2013 11:37 AM
Do you have to be referred by a dentist to have LANAP? I have MetLife dental insurance. Do they pay any on this? About how much does LANAP cost per quadrant?No, you do not need a referral to the practice. We are out of network with MetLife dental. However, the patient may have out of network benefits with an annual maximum per calendar year. It's impossible to quote a patient over the internet. We would need to determine with a patient history, examination, and a good set of digital x-rays whether or not the patient qualifies for the LANAP Laser treatment and what the cost estimate might be.22 Apr, 2013 6:30 PM
Hi Dr. Linden,

I had gum recession on my upper two canines. So I consulted a periodontist and he performed coronal advanced flap to cover the root.

It has already been two weeks and the tissue is healing. But I have a small hole between the donor site and the recipient site which is not covered by the gum and I could see the underlying white tooth surface. The size of the hole is 3- 4 mm.

It is acting as a plaque-building food trap and I am unable to brush on the hole, because the tissue is still healing and I am afraid that I could damage the healing tissue if I brush on it.

I asked the periodontist about this and he said it is normal. But the hole is completely compromising my oral health and the healing tissue.

The hole doesn't have any signs of infection or pus. I apply Chlorhexidine every night on the hole to prevent infection.

Is there anything could you suggest in order to close the hole and is it ok if I apply gum astringent (Stolin) on the hole to constrict the gum hole?

Thank you for your time.


Since you are already under the care of a Periodontist, I can only advise you to continue follow up treatment with him or her. It is difficult for us to know over the internet what the actual treatment might have been, and should be going forward. To deal with your case responsibly and professionally, I would have to examine you, including taking a set of digital x-rays.
18 Apr, 2013 8:38 AM
I go for semi regular cleanings and have always had pockets from 2 to 8. Recently, after an exam, I was told that my back teeth top and bottom on both sides have pockets from 10 - 8. My front teeth are about a 2. Can I get LANAP just on the back teeth and not the front teeth, since they are in pretty good shape, or must the whole mouth be treated with the LANAP? The idea would be to not have to spend so much money. Thank you.It’s very rare that we only treat part of the mouth, but in any case, a full mouth examination/consultation, including a current full mouth serious of digital x-rays, would be needed first, to determine the course of treatment. Each situation is different. Everybody has a customized treatment plan. 13 Apr, 2013 4:19 AM
Can this laser treatment treat a tooth with furcation? Also, how many treatments are required for gums that have receded, what is the waiting period for a second treatment if needed, and how many follow-up visits are required?Yes, we can treat a furcation depending on the location and extent of the bone loss. Gum recession is a different issue and needs to be addressed at your consultation visit after photos and x rays are taken. The interval between treatments depends on the case type and the patient. Follow up visits can be customized for each patient. Many of our patients travel from a long distance to have their treatment done, and we take that into consideration when scheduling them.8 Apr, 2013 5:33 PM
Hi Dr. Linden. I’m having gum problems. Up to 50% of my gums are infected. Shall I prefer laser surgery for solving this problem? What is the cost of this surgery? Please help me out.It is difficult to diagnose you on the internet, however I would seek the services of an experienced LANAP-trained Periodontist. Each patient is different and the costs vary depending on the extent and specific case type.3 Apr, 2013 10:41 AM
I'm 27 years old. My last dentist visit was in a foreign country over 12 years ago. While I have tried to take good care of my teeth, my oral health has declined recently. I've developed extreme sensitivity to either hot or cold food or beverages. Four of my bottom teeth have built up tar (never smoked a day in my life), one of which recently started to turn black. Also, my bottom gum is receding. I can't floss any longer as my gums start to bleed when I do. Please help, as I'm afraid and embarrassed. What should I do? Should I go to a regular dentist? I would seek the services of a qualified and experienced LANAP trained Periodontist in your area. They should be able to give you a diagnosis and treatment plan.3 Apr, 2013 3:04 AM
I had a cone beam scan which showed infections on an implant bridge at neck #3 and 5 4 is a dummy graft. I have permanent cemented caps. My periodontist suggested flap surgery, hoping to find an opening through which to reach and clean out the infection. If he can’t reach it, he will only clean what is showing and close it up again.
First, is it not better to get some deep cleaning with the laser around the infected area before flap surgery? Second, is this the only or best way to try to stop the infection which is spreading in my bone at the bridge of two implants? What treatment plan would you suggest?
This is a very complex issue that cannot be answered by e mail. A patient exam with the necessary digital films is absolutely necessary.

However, I can say this:

• We treat peri-implantitis routinely using the ND/YAG laser.
• We don't flap nor do we scale before the laser treatment.
• Each case is different and the treatment can vary.
2 Apr, 2013 7:17 PM
Can I get LANAP surgery done during my first month of pregnancy? I am a gum disease patient and have been advised to go for a LANAP surgery. Will it cause any problem or birth defect to my child?I would consult your physician and obtain a medical clearance. However, if it is not an emergency, we generally wait until the pregnancy is over.26 Mar, 2013 11:23 PM
I am a 59 year old that decided to get braces over 3 years ago :-( I should be getting them off in about 8 weeks....hopefully! But I now have spaces between my teeth where the gums are missing because of the unraveling. What are my options after the braces come off for these holes in my teeth?? Thank you! PamHi Pam, I’m sorry to have to give you such a general response, but this is a very difficult question to answer without seeing you or photos of your teeth and gums. There could be a number of things to consider after having braces.14 Mar, 2013 2:47 AM
Sir, after periodontal flap surgery, how much time is needed for recovery of gum and bone (because I want to take braces treatment after this). So please tell me how much time needed for braces treatment.It varies from case to case. Check with your Periodontist who did the surgery. He or she should know the timing.12 Mar, 2013 5:43 AM
Within four months after having used LANAP to treat three teeth, all three teeth subsequently died, became loose, and required extraction. After extraction, it was observed that the roots of each tooth treated with LANAP had several pin point scorch marks. Is it possible, and is there research to tell, if heat from the LANAP laser could be transmitted into the pulp or nerve of each tooth, causing them to die? Any research referral would be helpful.There are no negative thermal effects on the roots of teeth if the LANAP protocol is followed according to the guidelines.
The temperatures we use with LANAP are well below the temperatures to which root surfaces are exposed, for example, in root canals. Yet even in the root canal studies, the roots and pulp were not affected by heat.
Here’s a reference for you: SPIE Vol. 188/229 16-18 JAN 1993
We have been utilizing the LANAP protocol for many years and have yet to see any of the damage you are describing.
7 Mar, 2013 12:36 AM
Do you use laser for gum grafting?We use it in conjunction with the graft procedure. 6 Mar, 2013 11:39 PM
Hello Doctor, I had my four front teeth replaced with crowns (2 of the teeth had existing crowns). It's been a year now and the gum above teeth numbers 7 and 8 is still puffy and deep red. I also feel there's been gum recession. What can I do? Is this reversible? Thank you.To answer this question responsibly, I would need to conduct a comprehensive examination, and review a quality set of digital x-rays. When possible we utilize the laser approach (including LANAP), but it is important to note that we often combine different modalities of treatment customized for each patient. 5 Mar, 2013 7:46 PM
I had a gum graft 19 days ago on an implant site (implant done in October). The same day as the gum graft, they put on a provisional crown. I did not look at the site until last night and when I did the entire area appears white. Does this mean the graft did not take well? When should the tissue start to appear like it is rejuvenating?If you had the graft 19 days ago on the implant site and the entire graft looks white, I would suggest that your Periodontist examine you and see if this graft area is healing normally. Color changes are not uncommon, but have it checked out to be safe.28 Feb, 2013 7:57 AM
I had tissue grafting a couple of times, with tissue taken from my palate. If needed a third time, can tissue be taken from the same area of my palate if it has been a couple of years?Yes, that would not be a problem.27 Feb, 2013 2:26 AM
Good Day, I just recently had my first LANAP procedure (right side). No problems and completely pain free! I almost have to remind myself that I actually had this done only a few days ago. I have followed all my instructions (fluids first three days, no brushing, etc.). My concern is, I have noticed more today that I have a very thick, white-yellowish film around and on each tooth. Is this normal? I am so pleased with my results so far and can't wait to do the rest of my mouth. Thank You.It sounds like everything went well. How many days post-operative are you? It is normal in the first few days to have color changes around the neck of the teeth. This is the fibrin. Please confirm this with your treating Periodontist.25 Feb, 2013 8:50 PM
Hello, Doctor. I have a query for you to address. I am 27 years old. I inherited tooth decay problems.I had root canal treatments done to 5 or 6 teeth. I am worried about the bad effects. I am a bride to be, so I want to know whether, with post root canal treatment, there is any way to control and avoid bad odor during kissing. Please advise. I have been taking regular care of hygiene, but am in need of extra guidance to prevent a bad odor.Your breath might be an indication of periodontal disease, which may be spread to your spouse. You should be seen and examined by a LANAP trained laser periodontist as soon as possible.16 Feb, 2013 8:26 AM
I'm really scared. I am petrified of dentists and I've just been told I have periodontal disease. I've got to have root planning and I'm worried about the procedure. Will it hurt?Are you seeing a laser trained Periodontist? This mode of treatment is easier and less invasive. However, it needs to be the FDA-cleared protocol with the ND/YAG laser. Did you have a full series of x-rays with a diagnosis?29 Jan, 2013 9:09 PM
It's been 30 days since I had LANAP surgery. May I eat normally now?You should be able to eat everything but I would check with your Periodontist just to be sure.27 Jan, 2013 4:01 AM
My 21 year old son came back from the dentist and found out he has gum disease - around 6 on some teeth on the probe. We have no dental insurance and he is unemployed - we were quoted $1,700 - it might as well be a million. Anyway, how long can he wait before something must be done and what can he do in the meantime?It would be irresponsible for me to comment on his case specifically, without examining him. There could be issues that require prompt attention, but again, without examining him, I can’t say. Ideally, he should see a laser trained periodontist ASAP. There may be one in your area who offers Care Credit or Springstone, as we do. That might make it possible for your son to get the necessary professional attention despite your financial situation.25 Jan, 2013 2:26 AM
How much does it usually cost to have laser gum surgery done for all 32 teeth? Give an estimate to have 32 teeth done - starting price and end price. We need to do a complete clinical examination with a full set of quality digital x-rays to make a diagnosis and treatment plan. It is only then we can give an estimate of costs. Each case and patient is different and the requirements to achieve periodontal health vary.

The best solution for the treatment of gum disease is based on an accurate diagnosis, comprehensive examination, and review of a quality set of digital x-rays. The course of treatment can only be determined by examining the patient. The cost of treatment varies from patient to patient and according to the severity of disease. When possible we utilize the laser approach (including LANAP), but it is important to note that we often combine different modalities of treatment customized for each patient. Treatment fees would be discussed at the consultation visit.
22 Jan, 2013 5:08 PM
My son has been a mouth breather all his life and it has caused significant problems with his teeth and gums, especially when he had his braces on. He is 21 now and still with deep pockets and also a bar across his bottom teeth. He brushes and flosses every day and rinses with Listerine. Unfortunately he has no dental insurance so the cleanings are few and far between. For Christmas we gave him the Sonicare platinum series toothbrush to help him, but with all this his breath is still bad. How long does Listerine last in his type of mouth to where the effects are still good and unfortunately the alcohol content stays in effect with his condition of deep pockets of 5 and 6mm?Listerine or any other mouthwash is just a minor help with pocket depths that you are describing. The penetration of any mouth rinse is limited just to the surfaces of the gums and not into the pockets of 5+ mm. Do all you can to get your 21 year old son to a Laser Periodontist that does LANAP. It sounds like he has an aggressive form of bone loss for his age.18 Jan, 2013 9:04 PM
I had a crown lengthening procedure done 10 days ago. I had my stitches removed already. Am I still vulnerable to infections? May I share drinks with other people or kiss without risk (of blood transmitted diseases like HIV). Thanks so much!This surgical area is considered an open and healing wound. Yes…it is possible to transmit diseases, and until the wound heals, it is vulnerable to infection. Please follow the oral hygiene instructions that your Periodontist provided. If you have any complications or questions, please contact your Periodontist.17 Jan, 2013 10:23 AM
I just recently had LANAP surgery. Am I allowed to take a few puffs of a cigarette?I always recommend to my patients who smoke to try to avoid it if possible.

Maybe the fact that you’ve recently had LANAP surgery could motivate you to quit, since cigarette smoking is a known contributor to periodontal disease. Many of our patients have quit smoking after LANAP surgery, with positive results.

Best of luck,
Dr Eric Linden
30 Dec, 2012 11:24 PM
My teeth are yellow. The doctor says they cannot be whitened. They need a crown, but I don't think it's what I should do. I want to know if teeth whitening will work.I couldn't answer this question about whitening without examining you. Did you see a restorative dentist who does cosmetic dentistry? They would know right away how to get the result you want.30 Dec, 2012 9:34 AM
How do you fix a really gummy smile? How much does it cost?A gummy smile can be corrected with either traditional surgery or with the LANAP Laser treatment. We have had excellent results! An examination and patient history are in order to determine what has caused the problem to begin with. The fee would be determined after the examination and consultation appointment.28 Dec, 2012 4:38 AM
What is latest bonding technique for severe recession of four front bottom teeth? I have already had gum surgery but these teeth hurt all day long even though I use sensitive toothpaste and brush very lightly. Can bonding be done on the inside as well as the outside of these teeth? Thank you for your answer.You should see a good restorative dentist to see what they can do to bond the front teeth that are bothering you. Are these teeth loose? Are they splinted? Has the bite been adjusted on these teeth? What is the prognosis? Did a Periodontist do your gum surgery?20 Dec, 2012 10:37 PM
I had LANAP four days ago and some of the white stuff (I'm guessing the clot or scab) came off. How long does the clot usually stay intact? Is it okay if it falls off? There was no bleeding when this happened.
Every patient responds differently. Since I don't know your history, I would need to examine you personally in order to answer these questions. In light of the fact that you were treated just four days ago by a LANAP-trained Periodontist, I recommend that you report the situation to him or her and ask whether you need to be seen.
11 Dec, 2012 10:18 PM
Can 22 x-rays be taken in one visit?A traditional full mouth series does involve 22 x-rays, which can be done in one visit. Digital is the preferred method.11 Dec, 2012 4:25 PM
Should you do the LANAP procedure in one visit or two? Can the whole mouth be done at once instead of going to the dentist twice? Thank you.We do full mouth LANAP cases routinely.7 Dec, 2012 8:16 PM
Hi Dr. Linden,
I have pain in all my left side teeth, top & bottom. I took doxycycline and was ok for a few months, but now it started again. I am using Sensodyne. It helps for a while but after a few hours it starts again.
Dear Usha:

You really need to come in for a consultation to see what is going on in your mouth. Antibiotics and Sensodyne are not a cure for underlying dental problems.

Please follow up a.s.a.p.
6 Dec, 2012 8:29 PM
When I awaken in the mornings and wash out my mouth, my saliva is red. What is the problem and how can it be corrected without operations? What if one does not have insurance? How much does it cost?The first step is to schedule an appointment with a qualified laser trained periodontist for a thorough examination and full mouth series of digital x rays. An appropriate treatment plan will be suggested to you that will address your symptoms. It is impossible to tell you here on this forum what needs to be done and what the costs might be. If it makes you feel any better, most offices offer financing. We are out of network with most dental insurance. A recent set of dental radiographs is required for the consultation. We recommend that you call the office to schedule an appointment for a full Periodontal examination and evaluation. The phone number for NJ is 201-307-0339, NYC is 212-595-5559.28 Nov, 2012 7:49 PM
What pills should I avoid when I get periodontal work?This is a very difficult question to answer without knowing your entire medical history and individual situation. What kind of periodontal work is planned? Allergies? Medical conditions? Sensitivities? Too many issues to mention here on this forum.28 Nov, 2012 12:02 PM
I've gone through the Invisalign treatment and now I wear a full Invisalign retainer on my upper teeth every night. Will I be able to continue wearing this if I have the LANAP treatment? I wouldn't want to stop wearing it as I've invested a lot in straightening my teeth.You have to be careful after having the LANAP procedure protocol. We don't want anything to disturb the clot around the neck of the teeth. This could affect the healing and results. I would suggest not wearing the appliance for several days after the procedure. Please check with your Periodontist before having this procedure done.24 Nov, 2012 2:56 PM
Hello sir, I have a gum recession (exposed root) on my central incisor and it has become a little mobile. There is no bone loss yet according to my periodontist. According to him, it's because of the higher attachment of the frenum. I underwent a frenectomy yesterday. I would like to know whether my gum will grow back. I am 20 years old and this problem is like a nightmare for me.It is hard to diagnose based on the information you have provided. However, I would suggest a consultation to get a 2nd opinion. Did the periodontist ever suggest a gum graft?23 Nov, 2012 6:21 AM
The gum of one of my upper molars did not re-attach on the buccal side after 4 months following LANAP, at a different periodontist's office. He did not give me a prognosis after examination. I did have a deep cleaning and was asked to return for my next cleaning in 3 months. I have researched to see whether that re-treatment could be an option. If yes, would you again charge the patient to treat that area if only re-treatment was performed? It depends on the case, circumstances and the individual patient. Did you have full mouth LANAP?14 Nov, 2012 12:21 PM
I went to the periodontist and was told that I need gum grafts in all of my mouth. I went for a second opinion and the Periodontist advised bone grafting, tissue regeneration, and cut/flap surgery. I have 6 mm pockets in the front of my teeth. The back of my teeth gums is ok. I'm wondering if I could get LANAP for 6 mm pockets. It might be possible to do a laser procedure. You would need to be seen for a consult and x ray examination.13 Nov, 2012 12:31 AM
I have a gummy smile. I want to have the LANAP surgery. Are veneers or crowns required after surgery, or can other methods like tooth bonding or Lumineers be used?Do you have existing crowns on your teeth now? If not, you might not need anything if the aesthetics look good after the laser surgery. If you either have existing crowns or anticipate new ones, then I would suggest a consultation with an experienced Prosthodontist. They can give you all your options. We always work with the restorative dentist (Prosthodontist-specialist) before we do any "gummy" smile laser/traditional cases. 11 Nov, 2012 3:44 AM
Can you fly two days after getting gum skin graft surgery?Yes, but we don't usually recommend it for our patients.6 Nov, 2012 4:52 AM
What problems still require conventional surgery?A great question that is extremely difficult to answer in this forum.

I think you would need to attend one of my 2-hour lectures at Columbia University School of Dental Medicine and Columbia Presbyterian Medical Center devoted to this topic alone.

I will list a few examples:

1- implant surgery
2- gingival grafting
3- extractions
4- ridge augmentation

However, we use the laser in all the above procedures, but we have to use conventional therapy as well. This minimizes any post-operative swelling and discomfort experienced by the patient. The healing is also 60 times faster according to our clinical findings.

I hope this helps.

Questioner's response:

Thank you so much for your rapid response. I am having surgery Wednesday Nov. 7th. My periodontist told me that I would be having the laser surgery but my paper work said I was having the conventional surgery; therefore, I wanted to know the possible reasons for the change. I went to the office last Friday and was told by the person at the desk (the dentist was in surgery at the time) that the laser surgery would be done on the front teeth and conventional surgery on the back teeth. She did not know why. The surgical assistant called me today Monday Nov. 5 and said that was an error on the paperwork (one of several) and the surgery would be laser and not conventional.
I very much appreciate your answer. I would love to attend your lecture but I live in Lakeland TN, a suburb of Memphis,TN. I am very grateful that you have this website and you are willing to answer questions.

Thank you
4 Nov, 2012 5:18 PM
Dr. Linden,
For someone who is young (early 20's), with a tooth slightly mobile (very slight) and a pocket of 7-8mm - what are the available treatment options and chances of treating it non-surgically? Is the best option to go to a professional periodontist straight away or have a full dental clean, practice good oral care, and wait for results? Thank you.
I would suggest you go ASAP to an experienced and qualified laser trained Periodontist for a consultation. You should be able to get a diagnosis and treatment plan that would be appropriate for your condition.
3 Nov, 2012 4:56 AM
I'm missing my two superior lateral teeth. Should I get a dental bridge or something else? What do you suggest?You really need to be seen for x-rays and a full evaluation to really give you a fair diagnosis. However, the options usually are implants, bridges, or removable partial dentures.1 Nov, 2012 6:26 AM
What are the side effects of LANAP?None have been reported. It is completely safe when performed by a certified periodontist.30 Oct, 2012 5:11 PM
My gums have receded a little after extraction followed by gum grafting (eye tooth). Is this normal? Now I have spacing between the temporary tooth and gums.It is not uncommon after extractions to have the gum shrink. We routinely bone graft, laser, and soft tissue augment to avoid this result. You can speak to your dentist about relining the temporary tooth to make it look more natural.30 Oct, 2012 4:27 AM
I have a #7 on my lower back teeth. My dentist wants to do a perio tray. Would laser be a better place to start? A perio tray is an upper and lower mouth guard containing antibiotic gel that you wear twice a day.We discontinued that treatment many years ago. We did not see any benefit beyond a few weeks. In addition, the periodontal literature and studies did not show significant clinical gains. If you have gum disease with pocketing, the laser approach is considered the most thorough way to kill the bacteria that causes gum disease.

Have you seen a Periodontist yet? If not...I would strongly suggest it.
26 Oct, 2012 6:56 PM
My dentist recommended me to a periodontist. I had the exam and he told me I would need osseous surgery on all four quadrants. He said that my regular dentist would need to do a debridement and caries control before returning for the surgery. I'm at a 5+ for advanced periodontal disease. I'm not sure what 5+ means. My question is: How soon would I need this surgery?I would have the dentist do the caries control and then I would get to the Periodontist (preferably a laser trained LANAP Periodontist) for a complete evaluation.

You have advanced periodontitis according to the number system. However, the Periodontist can give you all the information you need.
23 Oct, 2012 9:20 PM
My family dentist has just referred me to a periodontist to evaluate pocket distal briccal #3, probing depth of 6+mm. I have no pain but fistula is present. What is this and what is the treatment? A fistula is the sign of infection. You would need to be seen for a consultation to diagnose where the fistula is coming from. The treatment plan can be determined after the x-rays and clinical exam. A good diagnostician should be able to figure it out.22 Oct, 2012 8:49 PM
Do you happen to know what a cold laser is? I have a patient who says he uses it at home to help with his periodontal health. If he is using it, it is NOT working. Seems hokey???I know nothing about this. Sorry.18 Oct, 2012 10:47 PM
Sir, I am 57 years old &and I have been chewing tobacco since 25 years. Suddenly, I have managed to stop the tobacco since 35 days with great difficulty. At present, I am without nicotine. Presently, when I feel to chew, I either chew tea powder (black) or chewing gum. Kindly please tell me any side effects of tea chewing.Honestly, not a lot of research has been done on tea chewing. You will get a lot of staining of your teeth. Can you use chewing gum instead (sugarless)? Why take a chance with tea?16 Oct, 2012 1:48 PM
Last month I had LANAP surgery, but because I was having a problem with a tooth that my dentist thought may need a root canal I went to see another dentist about this. I told her I had just had LANAP surgery, but she probed all the pockets in my gums. I am now really, really anxious that she has destroyed the work that was done and would like your feedback on the effect this may have on my recovery. I really thank you for taking the time to look at this question and hopefully give me an answer back. Thank you.The probing around the tooth in question might not necessarily have a negative impact on healing. I would follow up with the root canal specialist and let things heal up. However, I would follow up with your Periodontist and have this area monitored closely. The x-ray from the root canal will also show how the bone is healing.10 Oct, 2012 11:40 PM
I had LANAP treatment about six months ago. For the past several months I've had phlegm in my mouth which causes me to keep rubbing my teeth and the roof of my mouth until sore. Could this slime be caused by something I eat or a combination of what I eat/drink, the kind of toothpaste I use, or what? Any helpful suggestions would be much appreciated. Thanks. MWThis phlegm as you describe it can be caused by an upper respiratory infection or perhaps a post nasal drip. Other causes can be mouth rinses, food, medications, mouth breathing and allergies.

Try eliminating one thing at a time and see if anything changes. Have you been checked by your MD regarding a post nasal drip or sinus issue? Allergies?

See what happens if you follow up with the suggestions listed above.
6 Oct, 2012 3:48 PM
I have a long bridge on the lower left side, attached to a wisdom tooth. I bit on something hard six weeks ago. I have had a toothache for a month now and there's a bad odor at the tooth site. An x-ray showed no problems, but there's a deep pocket. What can be done?There could be a number of things going wrong. There is clearly an infection and you really need to be seen as soon as possible for an accurate diagnosis. You really need a very experienced Periodontist to examine you to figure this out.4 Oct, 2012 11:44 PM
Is it better to have laser surgery before pregnancy or after baby's birth? Would pregnancy reverse the condition of gum if laser surgery is done before pregnancy?Ideally it would be desirable to do your laser surgery before the pregnancy so your condition does not get worse.1 Oct, 2012 8:32 AM
I am planning on getting implants. My doctor is contracted with Medicare and the procedure will cost me $11,000. My father will be my co-signer, since I went into bankruptcy and I have my discharge papers as well. Can you recommend any finance companies that will help me? Thank you, Marci.Hi Marci. We work with a company called CareCredit, which is a dental and medical credit card that offers a variety of convenient payment options with no-interest, 3, 6, 12, & 18 month financing. Longer period 24, 36, & 48 month financing is also available. Applying for CareCredit is quick and simple. Patients can apply online at, or by calling CareCredit directly at 866.893.7864. Since CareCredit is a credit card, it can be used over and over again to finance other medical procedures.30 Sep, 2012 11:02 PM
Hello Dr. Linden, I am Kevin Trujillo and I'm 16 years old. My gums on my lower lip are reddish and one of the corners of my tooth is red. I feel my teeth are kind of loose and I don't know if it's because of that. I don't know if I can get it at such an early age I'm just really scared. Hopefully you have the time to respond to my email Dr. Linden. That would be great! Thank you.Hi Kevin. My suggestion is that you see a Laser Trained Periodontist and have a full mouth series of digital x-rays taken. Then you should have a periodontal examination. A diagnosis can then be determined and the appropriate treatment will be suggested. Is there any family history of gum disease? Early tooth loss? However, the good news is we have some really advanced laser treatments that are virtually painless. You might want to discuss this with your family. You will be fine. Don't worry.30 Sep, 2012 1:49 AM
I went to my dentist today for a cleaning and the hygienist told me that I have periodontal disease because she can insert the instrument in my upper left gum and lower left gum. She wanted to treat me with Arestin. I have no pain or any other indication of gum disease. As an option I asked for a prescription for medication but was told that was my only option. I get the impression they are trying to push this medication on me and I don't really need it.I would strongly suggest a consultation with an experienced, laser-trained periodontist before you do anything. They should be able to an evaluate you with a full mouth series of quality digital x rays. A diagnosis can then be made and the appropriate treatment plan can be given to you with all your options.26 Sep, 2012 10:37 PM
I had an apicoectomy above tooth no. 7. Then 6 months later, I had new crowns placed on teeth 7, 8, 9, and 10. Immediately afterwards, my gums flared up, especially above tooth no. 7. The gum there is very puffy and bleeds very easily. Another general dentist told me the new crown was placed too close to the bone - biologic width and whatnot. He said he would either change the crowns (which I cannot do because they're new and cost a lot) or he would fix it for me, which will most likely recess my gums. I'm very upset. Are there other options? Thank you.I'm so sorry that you are having this issue. If the crown violated the biologic width, then you might have to consider periodontal work and most likely new crowns. I would strongly suggest a consultation with a very experienced Periodontist to see what can be done. Unless you are willing to live with a very unaesthetic result – and most people are not - I would not risk gum recession as a side effect. Maybe you could speak to the dentist that did the original work and see what they suggest?25 Sep, 2012 5:27 PM
Can I have a deep cleaning and regenerative surgery at the same time?What specific treatment plan were you given? What case type are you? Please provide the type of regenerative procedure suggested. Conventional? Laser? It is very difficult to answer your question without this information.9 Sep, 2012 9:35 PM
Do we need laser gum surgery every year like we do deep cleaning?It is extremely rare that we have to do either procedure every year. Is this what your Periodontist suggested? In our practice, our goal is to have our patients on a regular cleaning schedule and not have to require much more than a simple cleaning. You should be on a regular maintenance schedule with regular cleanings 3-4 times a year.7 Sep, 2012 11:55 AM
I have been newly diagnosed with periodontal disease. My pockets range from 2 to 4. I am currently in orthodontics; my orthodontist is now very conservative with moving my teeth. I have a severe overjet that causes daily headaches. I need my teeth aligned, is there reason to halt orthodontics… to limit moving teeth? My periodontist did not place restrictions. What to do?If you have confirmed with your Periodontist that there are no restrictions then we can assume your gum disease is under control. Who diagnosed you with periodontal disease, the orthodontist or the periodontist? If you are confused, why don't you speak to your periodontist to get clarification or seek a second opinion?6 Sep, 2012 2:46 AM
Dear Dr. Linden,
My dentist told me I have advanced periodontal disease. After looking at several x-ray shots she recommended that my left canine tooth be extracted and the other next to it given a root canal procedure. She then wants to do root/scale cleaning and then gum surgery to complete the treatment. In the meantime, she prescribed Clindamycin Cap/ 150mg to treat the infection with a fistula but it kept coming back. Much worse, my gum above the two teeth has begun to bleed persistently. I am taking medicines for Type 2 Diabetes (Januvia/100mg), Hypothyroid (Levothyroxine/0.05mg)High Cholesterol (Lipitor/40mg) and Coronary Heart Disease (Plavix/75mg & Aspirin/81mg; Isosorbide Mononitrate ER/60mg; Atenolol/25mg; and Losartan Potassium/50mg). I would like to come in as your patient and be evaluated for the proper procedure and due to my persistent bleeding, I really need to do this right away. Also, Would you please accept payment via credit card after my Metlife PPDO coverage runs out?
Hi Cynthia. Since this is a very individualized question, we need to speak with you directly. Since you expressed interest in working with us, we emailed you at the address you provided, but the email bounced. Please call our office so that we may proceed. Thanks, Dr. Linden
30 Aug, 2012 10:21 AM
I have run out of money and need treatment. My teeth are falling out and my gums throb. What can I do? Many thanks.I am sorry to hear that you having difficulty. Do you live near a major metropolitan area with a dental school? Although it could take a lot longer to get your treatment completed, it might be worth investigating this option. Best of luck.27 Aug, 2012 10:37 PM
I was told that having deep cleaning done with a laser will help regenerate soft tissue or bone growth. Is this true?I am not sure what you understand "deep cleaning with a laser" to mean. If you are referring to LANAP, approved by the FDA if performed by a qualified Periodontist, the answer would be yes. The Periodontist should be able to verify that he or she is licensed to perform LANAP, having undergone a year of specialized training. If this is not what you are considering, I would get a second opinion before you consent to any laser periodontal treatment. Your periodontist should give you a comprehensive informed consent so you understand completely what procedure you are having done. Unfortunately, a lot of misleading claims confuse some patients.27 Aug, 2012 6:19 PM
Yesterday I had two quadrants (osseous surgery) done using LANAP procedure. How long should I wait before having the other side done?In our office, we generally do full mouth LANAP cases in one visit. A small number of our patients have half mouth done no more than 7-10 days apart. Did you have a qualified laser periodontist perform your LANAP surgery? I suggest you speak to the treating doctor to get the information you need to understand how the LANAP protocol should be performed. A full description of LANAP is always discussed at our consultation visits and is part of the informed consent process for our patients.24 Aug, 2012 10:12 PM
I had two implants nine months ago. Can I now undergo scaling and root planing? Also, I had my denture. How much does scaling and root planing cost? Thanks.We need to do a complete clinical examination with a full set of quality digital x-rays to make a diagnosis and treatment plan. It is only then we can give an estimate of costs. Each case and patient is different and the requirements to achieve periodontal health vary.24 Aug, 2012 5:06 AM
I have had upper dentures for years. Would I still be able to get implants even though my gums have receded?Most people can have dental implants after wearing a denture. However, you would need special x-rays and scans to determine in which areas the implants can safely be placed. In addition, a thorough oral examination and review of your medical history would need to be done prior to treatment.

Many patients are able to discard their dentures after all the dental work is complete. The esthetic and patient comfort results are amazing.
16 Aug, 2012 1:18 AM
I've already been told I'm a good candidate for gum grafting due to the recession I'm experiencing. However, on a recent trip to the general dentist for a standard filling, he seems to have nicked the gum tissue in between two teeth - the papilla I've learn it's called - and now my tongue continues to go right there to notice the tiny gap. It's such a minute space yet very uncomfortable and nerve-wracking! If I go forward with gum grafting, which was talking about around the same tooth, can something possibly be done about this as well?Over time, the papilla may grow back on its own, depending on the severity of the injury. If you are having the area grafted, ask the Periodontist if there is anything they can do to repair the damaged papilla. It might be possible, but it's not always predictable.14 Aug, 2012 7:43 PM
When is it too late to do the procedure?Which procedure are you referring to? If you mean laser surgery or any other gum treatment, then you need to have a periodontal exam and a full set of quality digital x-rays for a diagnosis and treatment plan. Then we can determine what teeth can be saved and treated.10 Aug, 2012 7:48 PM
Do I need to have deep cleaning before laser surgery?If you are having LANAP, then you don't have to go through any scaling before the laser surgery. If it is not LANAP, then you should consider getting a second opinion from a qualified laser periodontist that offers the FDA cleared protocol known as LANAP.8 Aug, 2012 2:24 AM
I just had LANAP done four days ago and had my four front lower teeth extracted due to bone loss. I noticed a yucky white coating on my top teeth that makes the teeth look dirty. Is this normal healing? I think it looks gross and the rinse I was given does nothing to take it away. Will it go away?The coating on your top front teeth could be fibrin. This is usually white in color and is normal in many instances following LANAP. It eventually turns into normal pink gingival gum tissue. However, this could also be dead epithelial tissue or white plaque buildup. Either way, I would follow up with your Laser Periodontist just to verify you do not have any infection in your mouth.4 Aug, 2012 8:16 PM
Is it possible for an eleven year old girl to have gum disease?It is possible for an 11 year old to have gum disease. The dentition is mixed with permanent and deciduous teeth. There are conditions that affect younger teenagers that range from gingivitis (gum inflammation) to a condition that used to be called "Juvenile Periodontitis". This latter condition can affect the bone and has to be treated aggressively to prevent permanent tooth loss.

I highly recommend a qualified, experienced Periodontist preferably with laser training to evaluate the 11 year old.
1 Aug, 2012 2:49 AM
I had the LANAP procedure done in November and am completely happy with the results. My doctor did some grinding to correct the way my teeth "fit" together, not just the bite, but the width of the six front upper teeth. I have been wearing the retainer as instructed and was told that I could just wear it at night now. My problem is that after a couple of hours there is a noticeable gap between my two front teeth, so I wear the retainer almost all the time. Will this problem resolve itself or is there something else that needs to be done?You might want to have some of your teeth evaluated for bonding/splinting to retain the teeth twenty four hours a day in the correct position. I would suggest discussing this with your periodontist in more detail.27 Jul, 2012 12:48 AM
I had all my gums grafted 6 weeks ago and just started have a bad taste in my mouth. I had 6 weeks of antibiotics.You had all your gums grafted 6 weeks ago? Did you have bone grafts? Soft tissue grafts? Why were you on 6 weeks of antibiotics? Did you have any oral infections during this time? Do you have a periodontal packing in your mouth? Are you under the care of a qualified periodontist? Did you have any post-operative visits? The taste could be related to an infection in your mouth, or medications that you are taking. I strongly suggest you follow up with your periodontist as soon as possible to find out the source of your "bad taste".25 Jul, 2012 6:27 PM
Hi Dr. Linden,

I know one needs to wait 6 months after LANAP laser surgery before probing, but how long do patients have to wait after LANAP before they can get routine cleanings done on their teeth? Thank you!
We wait 12 months to probe. We are always cleaning our patients supra-gingivally (above the gum line) throughout the post-operative period. As needed, we will instrument sub- gingivally after 3 months.
24 Jul, 2012 4:16 AM
How do you handle severely fearful or phobic patients? Is it possible for the first visit to be just to meet the Dr. and discuss the issue up front rather than having an examination? Yes. We can discuss your situation if you like and perform the examination another day or even that day IF you feel comfortable. There is no pressure. We will be in a relaxed and non-threatening environment.
Don't worry.

Please speak to my staff when you call and mention this response.


Dr. Eric Linden
15 Jul, 2012 10:51 PM
Gum Attachment: Healing of the gum may occur within a few days. Does this mean that there also will be complete attachment of the gum to the tooth root in this period of time? In addition, where there was a 7mm pocket depth, when could ligament formation be expected to be completed, in most cases?If you are referring to epithelial attachment in the absence of a long junctional epithelium, then this could take weeks, months, and in some cases years. We also might get incremental attachment (connective tissue) over time as well. This is based on human histological studies already completed and our clinical cases over the last 7 years.

Our clinical cases have shown radiographic regeneration with an intact lamina dura in as little as 3 months, and we also have cases that, over a period of several years, continue to show bone changes ultimately leading to an intact lamina dura with bone fill. We know we have reached our limit when we see an intact lamina dura.

It is impossible to know the exact histological changes that occur without taking block sections on our patients, but the current evidence shows changes histologically as early as several weeks.

Are you a periodontist or doctor?
15 Jul, 2012 11:56 AM
LANAP: The regeneration and healing time, of course, differ among patients. In your experience, what is the time range for complete healing around tooth/teeth?From the patient's perspective, the healing from laser periodontal surgery is rapid, virtually painless, and takes only a few days. From a bone regenerative perspective, bone growth continues for several years after the laser procedures are performed and followed up with close maintenance and occlusal adjustments as needed.12 Jul, 2012 2:08 PM
I am having a bridge replaced and having LANAP done. Should I have the bridge replaced before or after LANAP? Thank you so much!I would suggest you consult your Periodontist regarding the bridge situation. This should have been discussed at your consultation visit. However, most of the time we have the teeth temporized before we have the restorative dentist place the final bridge. Also, please check to see if you need crown lengthening. This is not part of the LANAP procedure.10 Jul, 2012 8:54 PM
I was told I need conventional gum surgery for 6mm pockets. I had double hip replacements a year ago and am concerned about the potential effects of the gum surgery. Amoxicillin will be prescribed for before and after, but he won't use the laser, as he said the disease is down to the bone. Wouldn't laser be better with my hip replacements?We try to utilize laser periodontal surgery whenever possible. ( would be a more desirable method to treat your gum disease.) We routinely use the laser to treat patients who have prosthetic hips, knees, and other prosthetic body parts. Additionally, we follow the antibiotic guidelines to cover our patients to avoid any post-operative infection. We treat the bone with the laser so we are not concerned about any of the issues you have discussed.9 Jul, 2012 6:35 PM
How much does lanap surgery cost and is that the best solution for gum disease?The best solution for the treatment of gum disease is based on an accurate diagnosis, comprehensive examination, and review of a quality set of digital x-rays. The course of treatment can only be determined by examining the patient. The cost of treatment varies from patient to patient and according to the severity of disease. When possible, we utilize the laser approach (including LANAP), but it is important to note that we often combine different modalities of treatment customized for each patient. Treatment fees would be discussed at the consultation visit.7 Jul, 2012 6:12 AM
I have a gum fistula which I'm told results from a root canal inflammation. This fistula goes flat and fills up periodically. I have no pain whatsoever on the tooth or gum. Can I just live with this? I've heard different treatments and both do not appeal to me - one, have the tooth extracted, secondly, drill through the bone to clean out the canal. Again, my question: can I just live with this? Thanks so much.From your description of this dental infection, I would strongly suggest you don't leave this alone. I would seek the opinion of an Endodontist (a specialist in root canals) and discuss your options.25 Jun, 2012 4:42 PM
I recently had a full series of x-rays that showed high bone loss. I do not have recession or bleeding gums and the doctor said there was no tartar buildup under my gums either. Is there medication that can fight these bacteria that are attacking my bone? If my mouth is clean and gums are in good shape, what else can I do to ward off further bone loss?You need a qualified Laser periodontist (specialist) to do an examination and recommend the necessary treatment to stop your bone loss. This might include an FDA cleared laser protocol to target the potent bacteria. Antibiotics alone will not cure this problem. The exam should include an occlusal analysis, a thorough review of your medical and dental history, and a detailed discussion of the results of the full series of digital x rays. Is there a family history of gum disease or early tooth loss and dentures?13 Jun, 2012 7:56 PM
Dr. Linden - I have been advised for years that I have bone loss in my jaw. I have a clenching/grinding problem at night that I suspect is contributing to the problem. I had orthodontics 3 years ago to correct my bite as the theory was that my bone loss could be a result of my bite being so bad. The orthodontics corrected my bite. However, I did get some root resorption on one of my front teeth. While I was in braces I think I stopped clenching at night because it was too painful. However, the clenching has started again.
My general dentist referred me to a periodontist who is recommending LANAP.
I have 4-6 mm pockets scattered throughout my mouth and my front top and lower teeth are slightly loose (I was not aware of it, but the periodontist pointed it out to me). I do not have any obvious signs of gum disease (bleeding, redness, odor, etc.). My periodontist is recommending LANAP on all 4 quadrants. I also just got a new, better night guard made by my orthodontist to try to help with the clenching/grinding issue. I am 40 years old and very concerned about losing my teeth. In your experience, is LANAP an effective treatment for periodontal disease caused by clenching/grinding?
Is LANAP safe on a tooth with very little root left due to resorption?
LANAP is safe on short roots, resorbed roots, and long roots as long as the periodontist follows the protocol carefully and according to the strict guidelines. Having a new and improved night guard is a smart move. This should take the secondary occlusal trauma out of the picture.
I would also discuss with your laser periodontist the possible need for splinting your mobile teeth together. There are various ways to accomplish this. The laser periodontist can explain this to you in detail. Additionally, as part of the LANAP protocol, an occlusal adjustment is also performed at the time of surgery and at your follow up visits. Finally, LANAP is very effective in treating bone loss (periodontal disease) and when done in conjunction with occlusal therapy, can ultimately save your teeth.
12 Jun, 2012 1:34 PM
My dentist wanted me to be evaluated by a periodontist for possible bone loss. I went for an evaluation and he said I had bone loss and recommended osseous surgery 4+ per quad. I have no pain, no bleeding while brushing, but chronic bad breath. I thought periodontal scaling and root planing would be done first before osseous surgery. Also, I was advised that I needed crown lengthening to prep a tooth for a crown. I am hesitant to have the surgery without trying the scaling and root planing. What are your thoughts? Thank You.This question seems to come up quite often from patients, doctors, students and residents, so I will try to explain how things have changed over the last 29 years in our approach to treating gum disease.
First, an accurate diagnosis is necessary. Once we review the clinical information and full set of quality digital radiographs, we can determine how to treat the disease in the least invasive but most effective way possible with the best long term results.
We utilize laser therapy, which eliminates the need for separate scaling and root planing appointments and aggressive surgery (see our web site for more detailed information). We try to eliminate the need for conventional osseous surgery, when possible, and treat the entire mouth with the FDA-cleared laser approach (LANAP).
The advantages of this are to:
• Eliminate scaling and root planing as a separate procedure and eliminate the need for multiple appointments involving local anesthesia.
• Utilize the laser surgery instead of the conventional osseous surgery, where possible.
• If crown lengthening is needed, the area of conventional surgery is limited to the area in question.
We find that we can treat about 85% of our patients with the laser approach and in many cases, eliminate the need for cutting, suturing, scaling and root planing. In a worst case scenario, we can just do the conventional osseous surgery in very limited areas for crown lengthening. This comprehensive approach in treating periodontal disease makes for a pleasant post-operative experience for the patient with excellent results.

I would suggest a second opinion with a Periodontist trained in LANAP surgery.

Best of luck,

Dr. Eric Linden
10 Jun, 2012 2:54 AM
Can I fly two days after bone augmentation and sinus lift treatment?When we do sinus augmentation and bone grafting in our office we use the osteotome technique, which is much less invasive and puts very few restrictions on the patient's post-operative activities. However, If you have had a "traditional" "window technique" for your sinus grafting, you might want to check with your Periodontist regarding flying. The altitude changes can affect your sinuses and the variations in pressure could affect the seal or closure of the extensive wound from the traditional procedure.5 Jun, 2012 5:18 PM
I have bleeding from my gums, especially in the mornings when I get up, and sometime during the day. Can you help and advise me? Thank you.You really should have a thorough periodontal exam and full mouth digital x-ray review with a qualified laser periodontist for an accurate diagnosis and treatment plan. 4 Jun, 2012 8:31 PM
Is it normal to still be bleeding a little bit a week after I had LANAP done when I brush/floss (carefully)?You shouldn't be flossing one week after LANAP surgery. The bleeding issue needs to be evaluated with the treating Periodontist as soon as possible.31 May, 2012 8:22 AM
I am a 42 year old man with gum recession and bad breath (the latter for 20+ years). I have a 6 unit Cercon bridge, on the right upper portion. I recently met a periodontist who said I have some bone recession near the bridge and suggested deep cleaning (not very urgent as there is no bleeding). To take a second opinion, I met a second periodontist (who practices Laser therapy). The information he gave me is as below.

1. I have metal fillings on 2 of my lower teeth. Will it be impacted by laser treatment?
2. He said the bridge will not be affected in any way.

Can you verify this information? Also are there any aspects I have to consider before going for this?


Fillings should not be impacted by laser treatment unless there is decay or other unknown tooth issues. The bridgework should also not be affected, with the possible exception of an occlusal adjustment (bite adjustment that might be necessary following the strict LANAP protocol). Please review all the issues with your Laser Periodontist if you have any concerns. Usually, this would be discussed in your consultation visit.
26 May, 2012 2:10 PM
My daughter has a lot of gum that shows when she smiles. I was told that she can have her gums cut around her teeth. Can this be done with your laser tech?Yes, it is possible to perform this surgery with the laser. It is one of the most common procedures we do in our office. It is much less invasive than traditional surgery. We would need to do a comprehensive examination, and evaluate a recent set of quality digital x rays to evaluate your daughter's periodontal condition and confirm that the laser approach can be done.22 May, 2012 10:13 PM
Can a periodontal pocket be caused by trauma or something other than a disease process? Yes...a good question.....a periodontal pocket can be caused by the inflammatory process (disease process) and also from trauma. This means your bite, the way your teeth meet and touch, or any trauma might cause a periodontal pocket. Other possible causes include root or tooth fracture, failing root canal, dental decay below the gum line, iatrogenic dentistry, a foreign object embedded below the gum, systemic disease, pregnancy, hormonal changes, and traumatic impact to the face.
Of course there are many other causes too numerous to mention here that can cause a periodontal pocket, but I think we have discussed the major factors.
17 May, 2012 3:09 AM
What gum is best to chew if you have dental implants?If the implants are finished and restored with properly fitted permanent crowns, then chewing gum of any kind should be fine. We usually recommend sugarless gum.17 May, 2012 1:31 AM
I have a 7mm pocket with bone loss. I am getting surgery in #30 tooth. What is the recovery time? Do I have to change my diet?What kind of surgery? Laser surgery? The recovery is quicker and virtually painless if you have the FDA-cleared LANAP procedure. You would need to get an opinion from a certified laser periodontist who offers both the traditional and the FDA-cleared laser approach to treating bone loss and gum disease. In our practice, we utilize the laser approach whenever possible. The healing is rapid and the procedure is much less invasive. The results are equally impressive. Your diet would be adjusted according to the type of surgery and how many areas are treated.16 May, 2012 11:04 PM
I live in Naples, I am looking for a better deal and estimate for the following:


Extraction-surgery - D7210 (Tooth 1; 16; 32 )

Hello. How are you? Are you from Naples, Florida or Naples, Italy? I would be happy to answer your question, but I need a lot more information. For starters, here are some examples of information I would gather from a new patient. I need to know what type periodontal classification you are. Do you have pocketing around all the line angles of your dentition? How many teeth have signs of disease? Do you have any recession? Do you have furcation involvement? If so ...what class? Do you have posterior bite collapse? What is the prognosis of each tooth involved? Do you have a limited opening? Have you been given the option of a FDA cleared laser procedure (LANAP)? Are you referring to traditional gum surgery? Do you need or have you been offered bone grafting? If not...why?

Do you take any medications? Is there a family history of gum disease? Any mobility of teeth requiring splinting? Do you have a night guard? What is your general health? Are your wisdom teeth impacted? If so what is the angulation? Any teeth close to the mandibular nerve? Any history of bleeding problems? Evaluation of digital x-rays...I could go on and on, but I just want you to understand the reasons why it is unprofessional to give a quote over the internet or phone without evaluating a patient.

Each patient presents differently and fees can vary depending on many factors too numerous to list in its entirety.

By all means, I recommend getting a second opinion if you have any concerns. Concentrate on getting the best diagnosis, and a presentation of all your options that would be appropriate for your situation. In our office, we will often spend 1-1.5 hours on the consultation, examination and treatment plan. We don't encourage or recommend that anyone get a quote for treatment over the phone or the internet unless they have been examined by a qualified, laser periodontist specialist.

Best regards,

Dr. Eric Linden
15 May, 2012 9:31 PM
I had gum grafting done Wednesday and today some of my packing on the teeth are loose should I be scared? Thanks.Generally this is not a problem. However, I would check with your periodontist in the morning and see if they want to re pack the area or leave it alone.13 May, 2012 9:08 PM
I recently had a tooth removed. I have gum recession where the tooth was removed. Can a periodontist build that back up so I can get an implant?Typically, when we extract teeth we do an immediate bone graft and laser procedure (socket preservation) around the extraction socket. If a patient has not had a socket preservation done, then an evaluation for a secondary procedure or possibly more would be necessary to build up the area for a future implant.13 May, 2012 5:46 PM
Would you recommend a full mouth debridement before LANAP?No, we do not recommend a full mouth debridement before LANAP.7 May, 2012 6:25 PM
My husband is going through the lengthy process of getting two implants which as you know is quite costly. We are getting lots of denials from the insurance company, but pursuing. Do you know what the rationale would be for our dentist to have done four gum treatments on the same day for two teeth? Does that make any sense? Thank you. It is very difficult to know what type of gum treatment was done on the two teeth you are referring to. Was it soft tissue grafting? Did he have a bone graft? Ridge augmentation? In our practice, it is not uncommon to perform multiple procedures on the same day depending on the needs of the patient.
7 May, 2012 2:16 PM
Is deep cleaning safe for kids with gingivitis from orthodontic braces? Starting what age is it safe to do? What is an alternative treatment? Thank you.How old is the child? If there is gingivitis, frequent cleanings are highly desirable to keep the inflammation down to a minimum. We try to avoid the use of local anesthetics if possible. We also would consider (in addition to better oral hygiene) some mouth rinses safe for children. Once the braces are removed, it will be easier for the child to brush effectively.7 May, 2012 3:57 AM
I just had a second bone graft surgery done 10 days ago. The stitches in my mouth taste really gross and there’s a smell that’s nasty too. My mom said it’s from the blood or because they’re getting ready to come out, since doctor said they'll be starting to fall out. But I don’t know if that's right. Can you tell me why I have that nasty taste and smell?The foul taste and smell can be from food debris, plaque, blood products, or an infection. If a periodontal dressing was used, then it can be from bacteria under that area. We usually place our patients on a Chlorhexadine rinse or warm salt rinses for this reason. Ten days is approaching the time for the sutures to be removed or start to dissolve away. Be sure to have your periodontist check this area soon.5 May, 2012 8:56 PM
Dear Dr. Eric,

I had a bone graft performed on tooth #18 back in April 2011. An implant was performed in January of this year. Within 3 weeks, the implant loosened and came out. It was replaced in March with a larger diameter implant (same length). Is this common? What would cause this? This was done by a well-known Periodontist here in the Boston area. Regards, Doug. BTW, impressive website.
Implants can fail for no reason at all even though the success rate is over 90%. There are many factors that can possibly cause the loss of an implant. Risk factors include smoking, diabetes, poor bone quality, poor occlusion (bite), a compromised medical condition, trauma and a number of other more rare events.

The placement of the wider diameter implant is the correct approach and hopefully will lead to an improved outcome.
2 May, 2012 3:57 PM
I've had a bone graft to accommodate an implant. All the work completed in approximately two years. Shortly after this I had sore spots on my gums and am told by my hygienist that I have chronic Lichen Planus. Can this be the result of the bone graft surgery?Lichen Planus can be brought on by stress or trauma. The bone graft procedure is not the cause of this but merely an event that might have triggered your outbreak. You might want to consider seeking an opinion from an oral pathologist or a specialist in oral medicine if these lesions persist and become a concern.2 May, 2012 12:49 AM
I had bone graft surgery on my upper and lower gums in Sept of 2011. Everything has healed well it appears, except from time to time I get a weird cold sensation on one part of my gum. It happens when I am not eating or drinking. Any thoughts?I am not sure from your description what type of procedure you had done other than "bone graft surgery." However, a cold sensation usually would come from a tooth. It would be advisable to have a periodontist look at this area and take a digital film if necessary and see what is going on around this area. 25 Apr, 2012 6:25 PM
What is the price range of this procedure?The case fee varies from patient to patient. There are so many factors that we have to evaluate, too numerous to list here. We need to do a comprehensive examination and evaluation of a recent set of quality digital films to give an accurate diagnosis and case fee. This appointment typically lasts more than an hour.20 Apr, 2012 2:07 AM
Is there a clinic in Australia, Malaysia or Indonesia that can do the LANAP procedure?Unfortunately, it is not offered in the countries you have listed. However, as you may have noticed (if you read through our web site), we have had patients fly in for their treatment from all over the world - one of them from Thailand. Are you planning a trip to New York anytime soon?19 Apr, 2012 1:34 AM
Good Afternoon,
I just came back from the dentist and was told I have advanced periodontal disease. The doctor I went to wants me to have one tooth pulled w/bone grafting. She then wants to do root/scale cleaning and then gum surgery to further clean I guess. I truly hate the dentist, hence the reason I'm where I'm at. Would laser surgery be something I could consider?
I would get an opinion from a well-qualified, experienced, Laser Periodontist (specialist) that is trained in the LANAP procedure before you do anything. You should be presented with all your options.
18 Apr, 2012 6:49 PM
I'm getting laser gum removal tomorrow and two days after that I want to go out with my boyfriend. Will I be able to French kiss (without pain)?I would suggest you speak to your periodontist and see what they recommend. Each case is different.18 Apr, 2012 6:19 PM
I had deep pocket laser surgery three days ago. I still have pain that worsens when talking or eating! A Vicodin plus 2 Advil don't get rid of all the pain. It wakes me up 2-3 times a night. I have no idea why this is happening because everywhere it says that this procedure is "painless", including my periodontist and my dentist. Do you know any reason why I am having this much pain?I don't know what type of laser therapy you had. Was it LANAP? This is a very unusual post-operative experience. Best to call your periodontist and find out what protocol was used and how to deal with this issue.13 Apr, 2012 9:31 AM
I'm having a scaling and DDS says I need six laser treatments. Is this necessary?It may or may not be necessary. It's hard to say without a proper examination. I would recommend that you get a second opinion, preferably from a periodontist trained and approved in the use of LANAP (the FDA-approved laser technology revolutionizing the treatment of gum disease).12 Apr, 2012 10:56 PM
How long do you have to wait after getting a receding gum surgery to get braces?Depending on the goals of the surgical procedure, the wait time can vary from 4 weeks to 3 months. If a secondary procedure needs to be done, then the wait can be longer.

I hope this helps.


Dr. Eric Linden
5 Apr, 2012 12:37 AM
During consult for LANAP, I was told it was part of the normal procedure to grind molars to adjust for occlusion. Is this true? I have gold crowns on my molars and do not wish to have them replaced due to grinding.It is part of the FDA-cleared protocol in the LANAP procedure to adjust the occlusion (your bite). I would suggest asking your periodontal specialist whether they feel you will have to replace any crowns. We very rarely have to do that in our practice.
Best of Luck
Dr. Eric Linden
3 Apr, 2012 5:17 PM
Which criteria should be followed for to decide whether a tooth should go for endodontic treatment, in which only bone loss is present?The criteria for performing a root canal are clearly stated by the American Academy of Endodontists. Generally speaking, if a tooth has decay into the nerve or is necrotic (dead) or has symptoms of severe pain which could include cold or hot sensitivity, and/or shows a radiographic periapical lesion (PAP), then root canal therapy is indicated. Teeth can be tested as well to see if they are vital (alive) or necrotic (dead). This is called pulp testing. Just having bone loss alone is not an indication for endodontic treatment. However, having bone loss would justify a consult with a highly trained Periodontal Laser Specialist certified by the American Academy of Periodontology and having additional certification in performing laser surgery with FDA clearance.29 Mar, 2012 6:44 AM
I had LANAP two weeks ago on one side. The procedure went well until the end when the Dr. said he was doing the cleaning. I felt bad nerve pain with only the teeth that had fillings. Next was the drilling to adjust the bite. The pain was so, so bad. When people get LANAP, do the Dr's have to do this INTENSE cleaning and use a drill to adjust the bite? I am still in pain with severe sensitivity. Is this normal? My dentist has never heard of this. I am petrified to do the other side.The cleaning part of the procedure is not done at the end so I am a little confused about the sequence of events. If you have profound anesthesia, then you should not feel anything during the procedure. If you are still in pain, then something else is going on with your fillings, or possibly decay or root canal issues? It is very hard to diagnose without examining you.
24 Mar, 2012 9:16 PM
What does it mean when gums are trying to separate from teeth and how can it be fixed?This is indicative of gum disease. You should seek an opinion from a Periodontist that has the additional laser training in the FDA cleared laser protocol. After you have a thorough exam with a quality set of digital x rays, a treatment plan with all your options can be presented to you. Please read more on our web site to see what the options are to treat gum disease. 23 Mar, 2012 3:29 AM
Hi. I had LANAP last June. It was ok. Now I've been told that I need a gum graft. One of my front lower teeth is loose. Can it be still saved? The reason I did all this was to save my teeth. Please tell me, does LANAP help the gums to reattach to the tooth and also for new bone to grow? I had high hopes but now I do not know what to do next. I already spent a lot of money that I don’t have. Thank you. I do appreciate your time in regards to this matter.It is very difficult to assess your situation without seeing the pre and post-operative x rays and photos. It is possible to get some "coronal” migration of the gum tissue. However, this has not been studied enough to draw conclusions. We do see this occurring in our periodontal practice after several years of follow up with our patients. We always are looking for new bone growth from our LANAP procedures. In your specific situation, your treating Periodontist (I am assuming you had the LANAP done by a specialist?) should be able to provide you with a prognosis of the tooth in question. Did you have any of your teeth splinted together? Have you had any occlusal adjustments? Do you wear a night guard? As you can see there are a number of factors that are important for success of your treatment.
Best of luck,
Dr. Eric Linden
21 Mar, 2012 12:06 AM
My name is Toni-Ann and I’m 16. I have juvenile periodontitis but I need braces. Can I still receive the braces even though I have periodontitis?I highly recommend a qualified laser periodontist (specialist) to evaluate your condition before starting your orthodontic case.

We have treated a large number of "Juvenile Periodontitis" cases with a specific laser protocol and they manage very well. Without any treatment, you are a high risk for tooth loss.


Dr. Eric Linden
20 Mar, 2012 12:42 AM
I have had 3 gum grafting surgeries (3 different areas) and now my periodontist is recommending an additional surgery for one of the areas. I am hesitant because the previous one obviously did not do well. Should another type of gum surgery be performed?Sometimes a secondary procedure is necessary to achieve the best result with grafting procedures. We inform all of our patients in our practice that multiple procedures might be necessary.
Best of luck,
Dr. Eric Linden
16 Mar, 2012 9:16 PM
In spite of my twice-a-day perio gel trays, an exemplary home regimen of brushing and flossing, my hygienist tells me my gums are in great shape when I visit her every 3-4 months for teeth cleaning. BUT I STILL HAVE A FOUL ODOR. The pockets have decreased in size considerably, but the smell won't go away. What can I do to get rid of the odor completely or lessen it somehow? Please help.A couple of questions:
1- Are you certain that you have no gum pockets deeper than 4 mm? That should be verified by a qualified periodontist to eliminate this as a cause of your symptoms of a foul odor.
2- Have you been brushing your tongue or using a tongue scraper? This is an area where sulfur containing bacteria build up and cause the foul odors.
3- Do you have any digestive issues? Acid reflux and upper gastrointestinal problems can also be a possible cause.
4- Are you taking any medications? This can also be a contributing factor.
Have the above suggestions thoroughly examined and hopefully you will find your answer.
Good Luck,
Dr. Eric Linden
16 Mar, 2012 1:42 AM
Can in office teeth bleaching cause guns to burn off requiring a gum graft? I lost gum on white, burned area above my tooth caused by the bleaching.Yes, I'm afraid bleaching can have this effect. Needless to say, we don't practice it in our office, but we can perform gum grafts if needed.12 Mar, 2012 5:52 PM
I am 65 years old, and on medication for panic attacks high blood pressure. I also have a heart murmur. I am suffering with gum disease and loose teeth. I also am a bleeder who has hemorraghed on having prior dental work. I need help that would not be surgically invasive, due to all my problems. I am hoping you can help me.Please give us a call for a consultation appointment and we can review the least invasive treatment plan possible to help you with your periodontal situation.


Dr. Eric Linden
6 Mar, 2012 5:58 PM
I currently take Enbrel and methotrexate for RA which is well controlled. I have permanent upper and lower retainers after having braces at age 36. Now, I am 51 and about 3 months ago I developed pain in the bone area under the teeth, especially affecting the teeth with the retainers. In the morning I have zero pain. The pain begins gradually after eating and progressively worsens as the day goes on as I eat lunch and dinner. After dinner my mouth is throbbing. My dentist could find nothing wrong and said my gums were healthy and my teeth were fine. I have regular checkups with my rheumatologists and she has never heard of bone pain in the mouth from the meds. I take. I am not sure who to see at this point. Hopefully you may have a suggestion. Thank you.This is a difficult case to diagnose without examining you. However, a few questions:

• Do you grind or clench your teeth?
• Have you had a TMJ (Temporal Mandibular Joint) evaluation?
• Rheumatoid Arthritis can affect the joints around the lower jaw.

I would suggest seeing an expert in TMJ and get the necessary CAT scans and x-rays to make a diagnosis. Where are you located? I can help make a referral for you.


Dr. Eric Linden
2 Mar, 2012 7:55 PM
I have to go for gum grafting. I was thinking about AlloDerm. My periodontist told me he uses Muco-graft. What is the difference? Which is better?I think your Periodontist would be the best person to ask about this. This information should have been part of your consultation appointment. It is important that all your options are discussed with the treating periodontist prior to any procedures commencing so that you have full informed consent.28 Feb, 2012 7:36 PM
I have a couple of deep pockets (7-9mm) and I had the laser treatment which didn't work at all. In fact, six months later they had gotten a little worse. My dentist suggested the surgery in which the gum is cut back and deep cleaned. I can't afford this and was wondering if there could possibly be another alternative. There is a product called Vitapick which has a very small syringe that you fill with peroxide and salt water and then squirt the solution into the deep pockets. Would that be something I should try before going into surgery? Thanks, Kim.Did you see a Periodontist? Were they laser trained? Did they utilize the FDA cleared protocol LANAP? This is a very unusual course of events. Something else could be going on. However, it is difficult to diagnose you without an examination and x ray evaluation. We tend to avoid syringes and peroxide regimens. I cannot recall having to do a traditional cutting procedure after having treated a patient with the FDA cleared laser protocol. Please let me know how you make out.


Dr. Eric Linden
28 Feb, 2012 6:07 PM
I am 52 and recently had gum surgery on all the upper and lower teeth of the right side of my mouth. My periodontist explained that I have bone loss but did not mention anything about how deep my pockets are. I have these gaps now between my teeth that catch so much food, and I am very unhappy about it. I have to clean these areas with piksters interdental brushes at least 2 times a day. Before I have this invasive surgical procedure done to all the teeth on the left side of my mouth, I would like to know if this is truly necessary. My periodontist strongly advises that it be done, but will the results be lasting and worth the sacrifice? Thank you for your reply. (I would not be a candidate for laser surgery, since my insurance would not cover it).I don't understand why your insurance won't cover laser periodontal surgery. Is it the LANAP protocol that was not covered? Our patients are generally covered for these FDA-cleared procedures. We have not encountered any major issues regarding coverage. I would suggest discussing your diagnosis and treatment plan with your periodontist. He or she should be able to provide you with the answers to your questions about your pocket depths. One of the major benefits of laser periodontal surgery (among many things) is that we don't end up with the spaces and gaps you have described.28 Feb, 2012 2:55 AM
I am 56 years old and have pain in my last left upper molar. My dentist says a root canal will not help. Instead he said LANAP surgery might help. I have deep pockets in my mouth. Why are they saying that root canal will not help and LANAP will?Did you dentist pulp test the tooth? (A test to determine if the tooth's nerve is dying.) Did you see a specialist (Endodontist) to confirm this diagnosis? Is there any decay in the tooth? Root exposure? Root fracture?

As you can see a thorough diagnosis is needed to give you an accurate treatment plan.
26 Feb, 2012 2:17 PM
How much does pocket reduction for the gums cost?We need to do a complete clinical examination with a full set of quality digital x-rays to make a diagnosis and treatment plan. It is only then we can give an estimate of costs. Each case and patient is different and the requirements vary to achieve periodontal health.21 Feb, 2012 11:23 AM
Dear Dr. Linden,

First of all I want to thank you for taking the time to answer so many people's questions! I have found your site to be very informative. I am 32 years old and at my most recent cleaning visit the hygienist informed me that I have several 4mm pockets and one 5mm with some bone loss around the tooth with the 5mm pocket. I also had some cavities that needed to be filled. Needless to say I am a little scared about my dental health, so I started doing some research on periodontal disease and came across the LANAP procedure as well as other procedures for treating periodontal pockets. When I went back for my fillings I expressed my concerns to my dentist and asked if he would suggest that I seek further treatment. I was a little surprised when he told me I just needed to floss more often and that we should re-evaluate my condition at my next six month cleaning appointment. I have also noticed that after having my teeth cleaned I have a space between two of my lower incisors that was not there before. I know that you cannot possibly provide a diagnosis without doing an exam on a patient, but I just want to know if I should get another opinion on my situation. I have been seeing this dentist for a number of years and do trust him, but I just am very concerned with my oral health. I am afraid of the possibility of losing my teeth at an early age and want to be as proactive as I possibly can be. I have found a few dentists in my area that offer the LANAP procedure, and was wondering if this procedure could possibly be beneficial for treating/reversing early gum disease.
Thank you very much for your time,

Dear Emily:

I would recommend seeing an experienced periodontal specialist in your area to evaluate your condition. It is always better to be safe rather than sorry later on.

It would be desirable if the periodontist has been trained in the LANAP procedure and has had experience using the ND/YAG laser for a few years.

Best of Luck,

Best of Luck

Dr. Linden
28 Jan, 2012 2:51 AM
I am about to go in for osseous surgery for severe perio disease, but everything I can pull up about this treatment, will not guarantee the removal of the disease, only to say that of course, maintenance is the key. But my question is, I am 50 and the possibility of more surgeries in the future to obtain the look I want, would I be better off, physically and financially just to have teeth pulled and get full dentures? I am so confused. I think my doctors are great, but maybe a little bias with the truth! Please help me decide. Thanks so much,,,, Carol Dear Carol,

I would suggest that you get a second opinion about your plan for osseous surgery as soon as possible. I have done these procedures for over 25 years. I used to use a conventional surgical approach, but for the past six years I have used the laser approach for most cases. Both I and my patients love the alternative! The laser procedure is much less invasive, which means much less pain and faster recovery time. Again, get a second opinion before subjecting yourself to the scalpel.
25 Jan, 2012 3:23 PM
Dear Dr. Linden,

I had a bone graft and three implants placed on my right lower Jaw in 2007. Soon afterwards I started losing bone around them and had to have another bone graft. I continued to have bone loss and have now 6-7 mm pockets. The gum around one of the implants is often sensitive and often bleeds. My periodontist has tried several things such as cutting some muscle in the mouth that he thinks was pulling on the gums (it grew back), using Avastin, a mouth guard, Peridex, etc., but the problem continues. He has not referred me to another periodontist that is trained in LANAP. Do you do LANAP around implants? Is it effective? I was told it will just need to be done in the quadrant of my mouth with the problem because my natural teeth are OK.
Yes, we treat natural teeth and dental implants with the laser protocol. We would need to see you for a consultation first to review a treatment plan. If interested, give us a call.

I look forward to helping you.

Best Regards,

Dr. Eric Linden
11 Jan, 2012 3:45 PM
I woke up about a week ago with a toothache and now my gums are slightly swollen with little pockets between some of them. I haven't eaten anything since last week because I'm afraid to get something in between my teeth and make this worse. I have no dental insurance and currently am out of work. I was wondering about your personal opinion on getting oraMD. I've read good things about this product and would like your professional opinion on what I should do about this because the pain is getting worse. I rinse with Listerine and salt water every day and have been brushing 3 to 4 times a day hoping to halt this pain before something extreme happens. Thank you for your time.I would recommend you see a dentist as soon as possible. It is extremely difficult to know what is happening without examining you, getting an accurate medical and dental history and taking the necessary x- rays to diagnose your condition. Most rinses alleviate some of the symptoms of various dental conditions, and some oral rinses can actually make conditions worse. Many dentists take credit cards and offer payment plans if that would be helpful to you in your situation.2 Jan, 2012 10:01 PM
Please HELP! I am 35!!!! I just went to the dentist yesterday after not going for about 6 yrs. No cavities. Good, but not so good. Dentist said I have gum disease. Severe at the bottom, where she said that my bottom teeth are loose. I hadn't noticed. She sent me to a periodontist.... Can my teeth be saved????????????Sounds like you need a diagnosis and treatment plan immediately. Hopefully, you will be a candidate for the FDA-cleared Laser Protocol. It is very difficult to diagnose without examing you and doing a comprehensive exam with a quality set of digital x rays. Please feel free to contact us at one of our 2 offices.
26 Nov, 2011 2:11 PM
Hello Dr. Linden:
I was in my dentist earlier today and he suggested I needed Lanap to fix my gums/bones. He had an estimate of $8500 on the paper and tried real hard for me to agree to do the procedure. I am wondering is this normal amount that this procedure costs?
Did you speak with a Periodontist (specialist) in gum surgery, or a regular dentist? How long has he been doing this procedure? Does he do advanced cases and have the ability and experience to do traditional work if needed? What case type are you? What geographic area of the country do you live in? The case fee varies depending on these factors and the extent of the disease. It might be wise to get a second opinion.
22 Nov, 2011 9:36 PM
Do you offer some type of payment plan for LANAP? I would like to save the few teeth I have left, mostly the front ones. I lost a lot of bone. Four of my teeth are loose. My dentist wanted to pull them, but recommended that I see a periodontist. Please help.We offer a payment program called Care Credit which is endorsed by the ADA. Please call our office for more information.
15 Nov, 2011 10:16 PM
Dear Dr. Linden ~
I had laser surgery to reduce pocket depth on several teeth a couple years ago and I have since been on a 3-month cleaning schedule. I'm told that I am doing good with respect to my periodontal disease, but I was left with a smile that I am unhappy with. Two of my front upper teeth (i.e., central and lateral incisors) have receding gums and appeared to have dropped lower than the rest of my other teeth due to bone loss, as I understand it. It was suggested that my only option to improve my smile would be to get dental veneers, which I really do not want to do.
My question is: Are bone and gum grafting a possible alternative based on what I described?
Thank you.
Yes, it might be possible to achieve a better smile without the veneers. You really need to be seen clinically to see what your options would be.
3 Nov, 2011 10:37 PM
If I have an abscess at the bottom of a molar where I had a previous root canal done, can LANAP be used to kill the bacteria in the abscess to prevent a tooth from extraction?What kind of abscess are we referring to? Endodontic or periodontal? Or both? Generally speaking, if this abscess has an endodontic component to it, then the root canal infection has to be resolved first by conventional accepted endodontic treatment. After the endodontic therapy is completed, this area can evaluated, and based on radiographs and clinical presentation, it can be determined whether a periodontal laser procedure would be necessary.3 Nov, 2011 1:48 AM
How much does this treatment cost for whole mouth?It’s difficult to offer a specific answer to such a general question. The cost of laser treatment could vary greatly depending on an individual’s condition and medical history. Please call our office, and if you choose to have a personal examination, with x-rays, etc., we would then be able to give you a fairly accurate estimate of the final cost of treatment.2 Nov, 2011 2:07 PM
Hi. I had LANAP done about 2 years ago. I have followed up with regular maintenance appts every 3-4 months since then. They use a laser in the cleaning sessions. My question: Do I have to continue going to the same dentist for my cleanings? Would a dentist that does laser cleanings suffice? Or do I need to continue going to the office that did my LANAP?

I would continue with the dentist (Periodontist?) who did your LANAP. They should know your periodontal situation the best, and be best qualified to maintain you, since the original work was done by them.
27 Oct, 2011 3:10 PM
Hallo, is there possibility for LANAP treatment in Europe? I am Slovakian. Thank U.I don't think it is available in Europe at this time.23 Oct, 2011 8:20 PM
I realize that everyone heals at a different rate, and can have markedly different outcomes, from a given procedure -- all dependendant on things like genetics, current state of overall heath, etc. But I am very curious about the pace, and extent, of post-operative results -- be it Localized Laser Periodontal Surgery, or LANAP.

In other words, is it reasonable to expect a 9 mm pocket to "heal" into a 3 mm (or less) pocket ?

And, would it (the destined level of healing) happen in a week, a month, a year...? Will healing time be linear (e.g. slow in the first 5 days, faster in the next 10)...?
There are many factors that determine the rate of healing that we don't fully understand. We have many cases that have healed in a matter of months and some cases took up to 2-3 years to see significant healing and bone fill. In our periodontal laser practice, we have treated diseased pockets that have exceeded 10mm+ and have seen reductions down to 3-6 mm with radiographic bone fill. However, whenever we have teeth with extremely deep pockets (like 9mm), we always explain to the patient that the prognosis is guarded but we can possibly have success if the laser protocol is followed carefully and we don't encounter issues in healing.
18 Oct, 2011 9:15 PM
I had laser surgery July 27th for a 9 mm gum pocket (with abscess). I went for periodontal maintenance cleaning yesterday- Oct. 13th. The hygienist found drainage at the site. I was told to gently swab the area with antibiotic rinse several times a day. Is this drainage unusual after this period of time? I had not noticed any drainage or anything unusual prior to cleaning. Today the area is sore. Would like a reply on this drainage and I thank you.From your description, it sounds like the area is draining again and perhaps the periodontal defect might require additional treatment. I would recommend an updated digital x ray to see what is happening around the tooth and bone. It is difficult to diagnose in this forum without actually seeing your situation. However, I would follow up closely with the treating doctor so he or she can make the appropriate decision.15 Oct, 2011 2:20 AM
First, a big "thank you" for hosting a forum like this to answer all our questions...

Can LANAP be done on a "site specific" basis, vs. doing it in "quadrants" or "full mouth"?

And, are the results permanent? That is, if one maintains a proper home cleaning regimen, will the bacteria re-populate? (I ask this because I've repeatedly read that there is "no cure" for gum disease.)
>First, a big "thank you" for hosting a forum like this to answer all our questions...

It is my pleasure

>Can LANAP be done on a "site specific" basis, vs. doing it in "quadrants" or "full mouth"?

Excellent question. If the full mouth protocol is followed precisely, then it is considered LANAP. Full mouth is usually indicated when there are several areas around the mouth that show disease. We do our full mouth LANAP cases in 1-2 visits maximum. They are usually completed within 7 days. Most of our patients have the LANAP done in one visit and that seems to work very well.

If we are treating an isolated periodontal area of breakdown and the rest of the mouth looks perfect, then we would call the procedure "Localized Laser Periodontal Surgery".

>And, are the results permanent? That is, if one maintains a proper home cleaning regimen, will the bacteria re-populate? (I ask this because I've repeatedly read that there is "no cure" for gum disease.)

As with any periodontal procedure we have done over the last 26 years, our goal is to stabilize the disease. If home care and professional maintenance are followed, then the odds are very high of retaining your teeth and periodontal health. We have been maintaining our patients for over 26 years and the people who followed our maintenance schedule have fared very well. The same has been true for our laser cases. In fact, the laser cases seem to do better than our traditional surgery patients. We even see this improvement 3-5 years post op. Bacteria are always present in healthy gingival crevices in normal or healthy gum tissue. If the tissue becomes diseased, the bacteria shift over to the destructive type which can cause the disease to become active again. The concept is to eradicate the disease and prevent it from another burst of activity.

The laser has been shown to be our best preventative tool to date to get rid of the disease and keep it away.
14 Oct, 2011 5:48 PM
Generally speaking, is there a pocket depth beyond which LANAP would not be of clinical value? For instance, if I had an 11 mm pocket, would LANAP be able to reduce it?

Also, does your office provide any form of sedation for the anxious patient, or would one have to get that from their primary care physician?
LANAP and our customized laser surgeries cover a wide range of periodontal issues. We have treated teeth with 3-15 mm pocket depths. There are a number of factors that are considered when suggesting a procedure (too numerous to explain here). Each patient is evaluated and given all their options. We always attempt to treat in the least invasive way possible.

We use oral sedation in our office. You would have to be escorted by someone to and from the office.
11 Oct, 2011 4:08 AM
I recently had lanap procedure. Now they want me to get a fitted teeth guard or tray. I am 70 years old and have never had a problem with grinding my teeth. My question is, do I really have to have the guard. I have trouble sleeping now and this will probably be flung across the bedroom at some point.Since I am not the treating Periodontist in your case, I cannot make this professional judgment. However, I can say that night guard therapy is very common following the LANAP procedure. Please check with the doctor who did the LANAP procedure.26 Sep, 2011 2:05 PM
I am told I have Periodontal disease, but I do not nor have I ever had any of the symptoms I've read about. I am very interested in laser surgery if needed. My question is: Why don't I have any symptoms?Sometimes patients do not realize they have periodontal disease because they might not have the classic symptoms that you have read about. However, usually after a comprehensive periodontal exam and review of the digital full mouth series in our office, we ultimately do find that some of the signs of the disease were apparent but not considered significant from the patient's perspective. A small percentage of my patients over the last 26 years did not realize they had gum disease until they were told about it from a prior dental professional or ultimately from me.
The customized laser surgery we perform and teach is very effective, non-invasive, patient friendly, and predictable in stabilizing the disease.
21 Sep, 2011 10:23 PM
I am 63 years young and had to have all of my teeth pulled in 2009 due to gum disease which caused my teeth to separate from the bone. The teeth were held in place by the gums. I had them removed and in May of this year, after a C scan, was told that I have infection in my gums. This was no surprise because they ache. I have dentures that I can't wear for very long. (only a couple of hours per day) What would the procedure be for getting rid of the infection in my gums?What kind of CAT scan did you have? What did the radiologist see on your films? Do your dentures fit correctly? Do you have any systemic diseases? Is the mandibular or mental nerve close to your ridge with the dentures possibly causing irritation to the nerve? There are a number of reasons you could be having problems. I would have to examine you and evaluate the x rays to determine the correct diagnosis.17 Sep, 2011 11:06 PM
I need periodontal treatment badly and live in NYC. I have had 2 uncomfortable, nerve racking experiences in the past, and DO NOT want to be awake for future procedures. Is sedation an option for me at your Manhattan office? Thank you.We can give you oral sedation (by mouth) which would make you quite comfortable. You would have to be escorted home after the appointment. We haven't put any of our patients to sleep in over 26 years. We don't need to take that risk when we can manage well with oral sedation. If we are able to utilize the laser therapy option, then the periodontal procedure would be very patient-friendly. Obviously, we need to see you first for a consultation and evaluation of a full mouth series of digital x-rays to determine what the most appropriate treatment plan would be for your situation.24 Aug, 2011 5:19 AM
I am fifteen years old going on sixteen, and during a recent check up at my dentist they mentioned I have periodontal disease. I really don't know anything else of it, and the more I research it the more afraid I become. So far they have only talked about sealants and composites and cavities. I've been brushing regularly and flossing once a day but my teeth are becoming more yellow and the receding gums are noticeable. I'm really afraid and sad and I'm afraid to ever smile again. What should I do?I highly recommend seeing an experienced Periodontist that offers all types of therapies including laser treatment. In addition, a full mouth series of digital x rays should be taken as well. Do you have any family members that have a history of gum disease? You really want to get this disease under control as early as possible.16 Aug, 2011 8:11 PM
I have been told (by an oral surgeon) that I have erosive oral lichen planus and that short of systemic steroids, there is not much that can be done, as this is a chronic condition. Do you have experience with this type of autoimmune disease and do you treat it?When we diagnose this condition in our office, we refer our patients to a specialist in Oral Medicine. This is their area of specialty and we will let them recommend the appropriate course of treatment and discuss the treatment plan with our patients.16 Aug, 2011 1:46 AM
I have periodontitis. My dentist found two teeth with cavities. He wants to extract the two teeth and eventually all of my teeth. I would like to keep my teeth as long as I can and raise the bar on care (cleaning twice a year instead of once a year and better care at home, etc.) I would like to have the cavities filled. Please advise.It is difficult to diagnose your case without a complete oral examination and evaluation of a quality set of digital x rays. It would then be possible to give you all your options.1 Aug, 2011 8:28 PM
After having laser gum surgery to correct deep pockets due to bone loss, how long will it be before results are seen? Will bone actually regrow and strengthen the tooth and will the gums grow, because at this point they are receding in that area. Thanks.It would probably be best to consult the doctor that treated you with the laser gum surgery. The prognosis depends on the technique employed and the skills of the treating doctor.26 Jul, 2011 7:37 PM
My periodontist in Delaware is recommending conventional skin grafting to correct an area of receding gum. Needless to say I am wary of the procedure and curious to know more about laser surgery as an alternative. Would you say the cost for laser surgery is considerably higher or about the same? Is anyone in Delaware certified in this procedure?

Thanks for your comments. Dave
Dear Dave: Without knowing the details of your situation, a conventional gum graft might be the correct treatment. However, I have done many cases with the laser either in combination with the conventional procedure or as a standalone procedure. The cost in our office is the same. If you contact Millennium Dental Technologies in Cerritos, California, they can refer you to someone certified in Delaware. If you’d like to see me, it’s a quick train ride from Delaware to New York, and there are many trains a day. My office in Manhattan is a short cab ride from Pennsylvania Station. Good luck. Best Regards, Dr. Eric Linden
21 Jul, 2011 7:06 PM
I have been diagnosed with gum disease and need to have surgery asap on all 4 quadrants. I am terrified of going through this procedure and saw your website and if I can do anything to avoid being cut open (my upper left side needs to be done from behind my teeth so the gumline would not be too high after the procedure). Is everyone a candidate for LANAP? I live in Connecticut, but would come to NYC. I am very anxious about this.Give our Manhattan office a call (212-595-5559) and speak to Patti. She will explain everything you need to know to start the process. Most of our patients qualify for the laser procedure. However, you would need to do a consultation appointment first using a quality set of digital x-rays. (If you have had these taken recently, they can be emailed to our office.) We will be open all this week, but will be closed from July 25th - August 8th. If you would like an appointment the week of August 8th, please call before Friday. Don't worry, we will figure it out. Best Regards, Dr. Eric Linden20 Jul, 2011 4:00 PM
Can dry mouth result from osseous surgery or from aggravated TMJ problems due to osseous surgery ?There have been no documented cases that I am aware of in the periodontal literature of dry mouth from osseous surgery. The same is true of TMJ. However, dry mouth can occur if a patient has certain systemic diseases, or has been taking specific medications.27 Jun, 2011 6:44 PM
Can I receive gum laser surgery without the removal of metal braces?Yes, it is possible to perform laser gum surgery with metal braces if we are presented with that clinical situation. However, it might be helpful if the wires were removed. We have done laser surgery successfully on our orthodontic cases with and without the wires.15 Jun, 2011 10:37 PM
I had lanap done in the entire mouth. I need to know when can I start braces. I have an overbite. Lanap was done 4 days ago on my left side. The right side was 3 weeks ago. What kind of braces do you recommend? I'm 48 years old, in good health, but I need my teeth to be pushed back, and also not to cost an arm and a leg...for how long do I need the braces? I do not care if is the old fashioned ones as long as it does the job.It is best that you consult the doctor that performed your full mouth LANAP. They should be able to explain to you what the protocol is following the LANAP procedure and the necessary clearances and time to wait before starting any orthodontic treatment.31 May, 2011 2:07 AM
Do you do replacement of a lost low front tooth, and if so what's the procedure? Also, do you do the procedure in your Manhattan office? My front lower tooth fell out after being loose for some time. Yes, we do replacement of teeth. Some patients are eligible for dental implants. We place dental implants in both our Manhattan and New Jersey offices. A comprehensive exam, a review of your medical and dental history with the appropriate x-rays are required to determine if you are a candidate.26 May, 2011 5:50 AM
I would like to know what is the warranty on dental implants and what has been the success rate on them. I would also like to know what has been the success and side effects of having the laser treatment done.Laser Periodontal Surgery is a safe therapeutic modality and very successful in gum disease treatment. It has essentially replaced over 75% of our conventional surgeries. We are currently preparing our cases for publication. There are no side effects of the laser. Implants are over 90% successful. If an implant fails before the one year anniversary, we replace it at no charge to the patient. This rarely occurs.11 May, 2011 7:24 PM
Is it normal to have LANAP done before trying planing and scaling? Can dentists do scaling/planing or only periodontists?The best qualified professional to do any periodontal therapy is a Periodontist. The LANAP protocol includes scaling and root planing. In our laser periodontal practice, if a patient has a diagnosed periodontal condition, we recommend the most effective treatment to stabilize the disease. There is little research and clinical data to support scaling and root planing as a definitive treatment.28 Apr, 2011 2:14 AM
What is the treatment for gum disease? I recently found out that my friend has gum disease. Is kissing her open mouth dangerous as far as the gum disease? What is the eventual outcome?Dental studies prove that the bacteria that cause gum disease is contagious and transferable. Your friend should be evaluated and treated as soon as possible. The laser might be a good option.23 Apr, 2011 1:08 AM
I have been having issues with my gums. Please help me. I don't want to lose my teeth. As much as I would like to help with a written answer, that cannot be a substitute for professional periodontal examination and treatment. The sooner you have that done, the better will be your chances of not losing your teeth. Gum disease often becomes progressively more severe if left untreated, so time is of the essence. If you don't live in our area, or don't want to travel, find a good periodontist in your area who is proficient in the use of LANAP. 15 Apr, 2011 3:06 PM
I have recently been diagnosed with severe periodontal disease. I would like to know if removal of your teeth is the only solution. Are there any other methods out there that can help?Removal of teeth is a last resort, but in most cases, even severe periodontal disease can be arrested with professional treatment. With proper follow up care and adoption of a prescribed daily regimen, your teeth can probably be saved. But don't allow your condition to worsen. Schedule an appointment with your periodontist as soon as possible.13 Apr, 2011 5:08 PM
My current dentist has me on a 3 month cleaning schedule. My gums are receding. One tooth, he says, is "hanging by a thread". How long is he going to wait before treating me for gum disease? I don't want to lose my teeth. I have a fear of dentists.It sounds like you need to see a periodontist as soon as possible to evaluate your condition. If you are fortunate at this late stage, you might be a candidate for laser periodontal surgery. Scroll down a bit on our home page and watch the video in the center column. As you'll see, this form of "surgery" is nothing to fear. It is a gentle, painless procedure which does not involve cutting or sutures, and it has been shown to be very effective in remedying the root cause of receding gums.
8 Apr, 2011 4:51 PM
At 84 years old and with periodontal disease for the last God knows how long now, spent $4,000 in the eighties to resolve it, but it came back. Now I'm afraid I might have to leave my right arm at the D.M.D. M.S.D. And at this point of my life, when most of my money, it seems, is tied up in China, what should a Vet. do? Wait until my teeth start falling out, and make a necklace? And not only that, you're in NJ & I'm in PA. Just my luck. HeshDear Hesh: Before you make a necklace, let me try to save some of your teeth. We treat people from all over the world. PA is right next door to us. Don't give up hope.
23 Mar, 2011 6:21 PM
I noticed a slight receding of some of my gums. I went for a check-up and the dentist said it is due to wrong brushing. She told me to floss and brush the proper way. Two of my lower teeth need a bonding material to fill the gap; others that are a little receded do not need anything as of right now. I will be 35 in two months and I am very scared of losing my teeth. Is there anything I could do to reverse in any way my recession of gums. I have to mention my teeth were clean and no cavities. There is no bleeding of gums ; they are not sensitive to cold or hot foods. I feel very frustrated and scared that it might keep on going worse. There are no issues of gum problems in my family. I do not want to let my teeth go so bad that I need a surgery. It is very expensive even with insurance. Having 2 kids is a financial challenge enough.
I hope there are things I could do to stop recession or hopefully reverse it.

Thank you
Gum recession can be progressive and if not treated, can lead to tooth loss. There are periodontal procedures (if necessary) that can stop and possibly regain the lost attachment. We often use the laser with these procedures. I would recommend seeing a qualified periodontist and having a thorough evaluation. There are many factors that can lead to the gum recession which you are describing. I would certainly use a very soft toothbrush using the correct brushing technique (this should be shown to you at your periodontal visit). Don't neglect this situation. See a Periodontist.
22 Mar, 2011 9:56 PM
I have been diagnosed with periodontal disease. My dentist hasn't explained to me the severity of my disease. All he said was that I need to have 9 teeth removed. I need a second opinion. I would like to know whether there is another alternative and whether maybe some of my teeth can be saved. Please answer my question as soon as you can, Thanks.I'm afraid it's hard to answer a question like that without conducting a comprehensive periodontal exam, including a quality set of digital x-rays. Then we could determine what we can save and the approach that would most appropriate.9 Mar, 2011 12:33 PM
I'm not a smoker. I do not drink coffee and have less than five cups of tea per month, yet my teeth stain at a rapid pace a month after professional cleaning. My dentist does not know why this happens. Have you seen this condition with any of your patients? Can you advise on a possible cause? I have good oral hygiene.This is a rare finding in our practice. But I would ask you the following questions: Do you use any chlorhexidine rinses? Does your diet include spices? Exotic foods?
6 Mar, 2011 4:45 AM
I have a crown on a molar that was put on 20 years ago. It was a tooth with a very large filling and when the dentist was drilling out the filling it came apart and the smell was terrible! Obviously some awful bacteria living below the filling. He had to take so much of the tooth away that he had to put a pin in the middle of the tooth to help support the crown along with adding some silver filling around the pin to mount the crown on. I now have pain around this tooth and down in the jaw. I feel that the bacteria infection stayed and is now down in the jaw. Is this likely and is the only way to fix the problem to remove the tooth?It sounds like the old crown was removed, decay excavated, and a pin placed as a core for a new crown. If you are still having symptoms, an x-ray should be taken to see if there are any root canal issues or if the tooth needs a gum procedure or possibly an extraction. It is very hard to diagnose this condition without a clinical and radiographic exam. I would go back to the dentist who did the work and get his/her opinion or seek the services of a specialist.28 Feb, 2011 1:06 AM
My daughter has braces and for the past 6 months her gums are swollen. The specialist told me that he has to cut her gums. Does this happen often with braces? Will it happen again? Is cutting and sealing her gums the only remedy?It is not uncommon to have "swollen" gums during orthodontic treatment. Usually, proper oral hygiene can control this condition. However, if the gums become so inflamed that removal of inflamed gum tissue is necessary, we will use the laser and not cut the tissue. The healing is significantly faster and the post-operative experience is much easier for the patient.23 Feb, 2011 11:45 PM
Is tetracycline gel a good treatment for gum disease and what are the side effects?Tetracycline is an adjunctive medication useful with definitive periodontal treatment. This is an antibiotic that is specific for killing off bacteria that cause periodontal disease. However, it doesn't kill all of them. Warnings: Long term use could create resistance. Use with caution when taking birth control pills, excessive sun exposure, ingesting dairy products and cross reactivity with many other medications. Always read the warning labels when taking any medications. In summary, tetracycline alone is not an adequate treatment for gum disease.22 Feb, 2011 4:51 PM
I was just told that I have moderate to advance periodontal disease. I started the deep cleaning and scaling, I am being referred to a periodontal specialist by my dentist. I wanted to know if laser surgery would be a better option instead. To get rid of the bad breath and to replace any bone loss and to safe my teeth and to prevent the chronic presence of the gum disease. I realize there isn’t a cure but with the right preventions can. These symptoms go away and prevent any further health problems. When you say control the gum disease does that mean you will now have healthy gums fresh breath and good oral hygiene after laser surgery or periodontal surgery? How often will I have to see the dentist after surgery? Every 3 months or every 6 months? I am totally horrified I wish that deep cleaning or surgery would fix the problem that my gums would just be healthy again...will they be healthy after this procedure? Please let me know. What is the best option for me? Thank you and waiting for your response.All of your questions are excellent. In our Laser Periodontal practice, as a first step we do a thorough clinical exam and review of a full mouth series of digital radiographs. If we determine that your gum disease requires further treatment, our first choice would be the use of an FDA cleared protocol with the laser. Assuming no other unusual factors, we would prefer to treat the disease without cutting or flapping of the gum tissue, as is done in traditional surgery. We can stabilize the disease in most cases and the use of the laser is the most effective method. In certain cases, we are forced to do traditional surgery. I would need to see you to determine the prognosis and the least invasive way to get your gums healthy again so you can maintain your oral health for many years. At the conclusion of your treatment, we would then recommend the appropriate interval for your cleanings and checkups. I hope this helps.13 Feb, 2011 12:31 AM
I had three teeth removed because of bad taste. I still have the bad taste. Help.I would advise going back to the dentist who extracted the teeth to make sure there isn't any infection.11 Feb, 2011 9:52 PM
I had laser gum surgery 9 days ago to remove some gum tissue that was growing over my implant posts (while we are waiting for the lab to re-do a mistake on my permanent crowns for implants). I have a horrible taste in my mouth and have really bad breath since the laser. My periodontist says he has no answer to why I have this. I need to know if this is normal after laser surgery, and how long it will take to go away. Thank you for your help. TrinaDear Trina:

We really have not seen what you are describing after our laser procedures. We usually don't have any "bad breath complaints". Did your Periodontist look in your mouth and examine the tissues when you started having the bad breath? Was there any infection? Was there food and plaque build up all over your teeth, gums and cheeks? Do you have any other teeth which might have infection and drainage? Have you been brushing any areas of your mouth, or tongue? You could get bacteria buildup on the tongue which could contribute to bad breath. Are you taking any medications? Using any rinses? Any change in diet? Do you have any digestive problems? All these are possible explanations. Be sure to check with your Periodontist to rule out any of these possibilities.

Best of luck,

Dr. Eric Linden
11 Dec, 2010 5:54 PM
I am 44 years old and have advanced gum disease and now one of my lower front teeth is loose. Is it possible to save a loose tooth or must I have it extracted as I have been told?Yes, it is possible to save a loose tooth. However, this can only be determined after evaluating the clinical findings, quality x-rays, and a full dental and medical history. Sometimes we are able to use laser surgery (which is less invasive than traditional surgery) and splint the loose tooth to the adjacent teeth to strengthen it.
30 Nov, 2010 6:15 PM
I had an apico performed on #10 about a year ago. I am unhappy with the incision that was left. Can this incision be modified to be smoother with the aid of a laser? Also do lasers do deep cleaning of the teeth?It is possible that using the ND/YAG laser at the correct setting and power can affect or "soften" the incision. How much resolution is not predictable. Lasers alone cannot do a deep cleaning. The cleaning portion needs to be combined with hand instruments or ultrasonics. This is part of the LANAP protocol sequence.28 Nov, 2010 5:07 AM
I recently swallowed over 90% of a molar, and didn't realize it until I brushed my teeth a couple of hours later. I'm assuming that I swallowed it while eating. It wasn't loose, nor had I had any problems with it previously. I was just told that I had osteopenia, and am wondering if that could contribute to bone loss to the effect of having teeth fall out.I am not really clear what "90% of a molar" swallowed means, but from what you describe the options might include:

Option #1 - a fractured portion of the tooth breaking off (90% as you describe), which can be caused by either tooth decay or other dental trauma unknown to the patient without any pain or symptoms. I am assuming that the remaining portion of the tooth has been extracted by a dentist since then. Usually an x-ray of the area would reveal the situation that lead to the loss of the 90% of the tooth in question.

Option #2 - bone loss leading to a loose tooth exfoliating on its own. This is unusual if you have seen a dentist within the last 6 months or so and had a thorough periodontal dental exam. You mentioned the tooth was not loose. Sometimes a patient doesn't realize how loose a tooth can be depending on the individual situation and whether dental x-rays were taken prior to the spontaneous tooth loss. Although osteopenia can affect the bone support in the mouth, it is extremely rare that teeth just "fall out" if you have been under the care of a dentist. There are rare systemic diseases where we see spontaneous tooth loss, but the odds are extremely remote. A complete work up with your family doctor is also advisable to rule out any other conditions.

My suggestion is to visit your dentist or periodontist and have a full set of digital x-rays and clinical exam and see what is going on in your mouth. Hopefully, you will avoid this situation from happening again.

Good luck!

Dr. Eric Linden
5 Nov, 2010 6:34 PM
During my recent cleaning my teeth were probed by the hygienist and apparently there were 7mm pockets towards the back of the two molars adjacent to where my wisdom teeth are partially erupted. These are the only pockets I have and would have had my wisdom's removed earlier if I knew there was such activity but my previous dentist missed it. I have read that is extremely common to have pockets due to wisdom tooth eruption, especially if they are impacted and are pulling the tissue away from the tooth. So my multi part question is : 1. Does a 7mm pocket next to an erupting wisdom tooth necessarily mean bone loss or is there a chance bone loss has not occurred yet? Trying to figure out whether 5mm+ automatically equals bone loss. 2. There is currently inflammation due to the impaction plus whatever else terrible is going on. Is it common for a pocket to appear 7mm in depth due to tissue inflammation. 3. What usually comes first? The wisdom tooth extraction or the adjacent pocket treatment?

As you can see I did a little research but I know my limits and am acknowledge I need best-in-class professionals on my side. Thanks in advance for your response.
It is common to have periodontal pocketing and inflammation between the wisdom teeth and the adjacent 2nd molars. Most of the time, there is bone loss present. Depending on the individual clinical situation and evaluation of x-rays, our first step is to decide if removal of the wisdom teeth is necessary. If it is, then we would extract the wisdom teeth first and then treat any remaining periodontal pocket issues with the laser.
27 Oct, 2010 9:31 PM
I am 43 yrs old and was told I have periodontal gum disease. I was told that I would have to have all my back teeth pulled and have the denture things done. I was told that I lost a lot of bone. I am not ready to give up my back teeth. What can I do?The only way to make a diagnosis and treatment plan for you is to see your full mouth series of digital x rays and perform a clinical exam. We can determine at that point what teeth we can save and if any need to be extracted. We do everything reasonable to save teeth. With the use of laser treatment, we are saving more teeth than we did 10-25 years ago. We are able to perform dental implants and perhaps save a few teeth as an alternative to full dentures.8 Oct, 2010 6:41 PM
I am 25 and have found out I have juvenile periodonitis. I'm presently in Montreal Canada and you seem to be the nearest dentist to me who does the LANAP procedure. I'd like to get some more information on lanap and also would like to know what a consultation entails before I make the drive to your facility.

I welcome hearing back from you

We have shifted our approach to treating juvenile periodontitis away from aggressive traditional surgery (which we performed for over 20 years with reasonable success) to the laser approach. The laser surgery results in our office have been extremely successful and the procedure is certainly more patient-"friendly" than older procedures which involved cutting and sutures. Please see our web site for more information on laser surgery. We usually perform laser surgery in one appointment.

We would need to do a clinical examination, review your medical and dental history, take a set of quality digital x-rays, and put together a custom treatment plan for your situation. If you are traveling a long distance to our office, as many patients do, and we determine that you need laser treatment, we will try to schedule it the same day or early the next day for your convenience. If you have a current digital full mouth series done in Montreal and have them emailed as JPEG attachments, then we would review them in preparation for your visit. This may shorten your initial consultation and help us properly schedule your actual treatment.

For more information, please call our office and we can help you and answer all your questions.
24 Sep, 2010 2:46 AM
What is a dental laser?A dental laser should be a laser that’s FDA-approved for dental use. There are different types of lasers. Some can take your tonsils out. But very few lasers are FDA-approved for treating gum disease, and the number one protocol to do that is LANAP. I often combine LANAP with conventional procedures. Let’s say someone needs a crown on one tooth and I can’t do it with a laser. I’ll do that one tooth traditionally and treat five other teeth with the laser, so I don’t have to cut all the teeth. I can take teeth out, which I do all the time, laser the socket, bone graft it, and get it ready for an implant or a bridge. That will enhance the result and there will be less post-operative discomfort. So we not only do LANAP, we expand the use of laser surgery with conventional work, and minimize the amount of aggressive surgery. 16 Sep, 2010 5:39 PM
What are the side effects or after effects of gum surgery?It depends on which gum surgery. If it’s traditional surgery, you might have stitches and periodontal packing and might need to take it easy that day. If it’s laser surgery, I often have patients from out of town who hop on a plane to go home the same day, or drive three hours. The recovery from laser surgery is relatively easy. In general, laser procedures are much more easy and patient-friendly than traditional surgery.16 Sep, 2010 5:38 PM
Is periodontal surgery safe for children?Absolutely, if they need it. We do laser procedures on kids before braces. We also do what we call frenectomies (removal of excess gums attachments) and some gum removal if the teeth need to be exposed.16 Sep, 2010 5:38 PM
Is it OK to go swimming after periodontal surgery?I wouldn’t recommend it. If I use the laser, I would prefer that you wait a couple of hours before being under water, or getting water in your mouth.16 Sep, 2010 5:38 PM
I just had osseous surgery for gum disease. Do I need to have scale planing too?If someone has osseous surgery, they should not need scaling and root planing in the same location. 16 Sep, 2010 5:38 PM
How long do I have to rest after periodontal surgery? What is the recovery time?I just had a patient who had full mouth laser periodontal surgery who went to play golf right afterwards. Most patients go back to their normal routine in a few hours after the laser procedure.16 Sep, 2010 5:37 PM
Does periodontal surgery affect your equilibrium?I have never seen either traditional periodontal surgery or laser effect equilibrium. Perhaps that might come up with a patient who’s had some local anesthesia, who has low blood sugar and might tend to get dizzy after having any procedure done, or it might be caused from lying back, and sitting up too quickly. That’s called postural hypotension. 16 Sep, 2010 5:37 PM
Can you cure a periodontal fistula?A fistula is a hole in the gum with an infection (pus) in it. . Sometimes we gently place a “gutta percha” point in the fistula – a rubbery material that’s used for root canal filling. It’s radio-opaque, so you can see it on an x-ray. This enables us to see where the fistula is going. If it’s going to the root of the tooth, it’s probably a root canal problem. If it’s going to the side of the root, it could be a cracked root (which the laser usually can’t treat), or gum disease. I had a recent patient with a fistula present. The front tooth had a deep pocket. I treated it with LANAP and I also went into the fistula with the laser at a reduce power setting. Periodontal fistulas respond very well to the laser. We have treated many of these types of infections with great success.16 Sep, 2010 5:37 PM
Can LANAP surgery remove calculus?The LANAP protocol includes the removal of calculus. The laser itself does not remove calculus. Calculus is removed with ultrasonic and various instruments. 16 Sep, 2010 5:37 PM
Can I have laser dental surgery during pregnancy?Ideally, elective work should be done before the patient becomes pregnant if possible. Otherwise, we wait until after the pregnancy. But if there is an infection in the mouth, we have to take care of it, no matter what, with clearance from the patient’s physician. There is something called “pregnancy gingivitis”. If someone has preexisting gum disease and they get pregnant, it gets very much out of control. If treatment is essential, we prefer to treat during the first two trimesters, not the third. Cleanings from a trained Periodontist are recommended during pregnancy to avoid problems and infections. Laser treatment can be done as well.16 Sep, 2010 5:36 PM
Are all periodontists qualified to perform laser gum surgery?No. Periodontists have to undergo special training which takes up to a year. This involves attending FDA-approved laser accreditation courses in which you learn the FDA-cleared protocols for laser therapy.16 Sep, 2010 5:36 PM
After periodontal surgery my mouth had a terrible odor from the band they put around the gum.You’re referring to the packing or “perio-pack” that is used after traditional surgery. That does develop a stench after about a week (usually bacteria buildup under the packing causes this smell). Because we use the laser, we do not need to use a pack anymore.16 Sep, 2010 5:36 PM
Can you kiss someone with periodontitis?You can, and I’m sure it happens all the time, but you risk giving it to your partner, so you might want to have it treated before you do that.16 Sep, 2010 5:35 PM
Do you ever provide emergency services on the weekend?I would if necessary, but in Periodontics, emergency care is rarely needed if the disease is controlled correctly.16 Sep, 2010 5:35 PM
What percentage of Periodontists now uses the laser, as opposed to more antiquated methods? A majority of Periodontists still use traditional surgery for pocket reduction or gum disease, but laser use is growing rapidly.16 Sep, 2010 5:35 PM
How effective is ARESTIN® in treating gum disease?ARESTIN® is a powder like antibiotic that we used to place underneath the gum tissue. For many years our office used almost every injectable antibiotic product that seemed reputable and available, but we had to repeat their use every two or three months. We don’t need to do that anymore because of the laser protocol. The laser takes care of the infection and regenerates the bone. 16 Sep, 2010 5:35 PM
How painful is pocket depth reduction?Traditional pocket depth reduction surgery is more invasive than the laser approach, which is much more patient-friendly. Traditional pocket reduction surgery, which we performed most commonly for 20 years, is more aggressive and can be much more discomforting to the patient.16 Sep, 2010 5:34 PM
Are there oral rinses for gum disease that do not stain the teeth?Chlorhexidine antibacterial rinse is very effective for gum disease. It does stain some people’s teeth, but not all. Smokers and heavy coffee and tea drinkers have a greater tendency to stain. It is available by prescription only. We have some patients on it long-term. Each case is different. There are many other rinses on the market that don’t stain. We have no preference.16 Sep, 2010 5:34 PM
Is there a particular brand or kind of toothpaste that you recommend for people who have or are prone to having periodontal disease?There’s a wide variety. I don’t advocate a particular brand. I like the natural products, because they contain fewer preservatives and also contain fewer artificial sweeteners and chemicals.16 Sep, 2010 5:34 PM
Is there a medicine, whether prescription or over-the-counter, which effectively treats gum disease?There’s no magic bullet. We rarely use low-dose antibiotics which can be taken long-term, such as Doxycycline. However, I am not a big advocate of long-term antibiotic usage. A short-term regimen is indicated for some patients. Laser treatment has replaced the use of long term antibiotics. Long term antibiotics can allow resistant strains of the bacteria to develop which will render antibiotics ineffective if needed for other future medical uses in your lifetime.16 Sep, 2010 5:33 PM
How can I treat periodontal disease at home?Good home care, a balanced diet, professional check-ups. Also, try to reduce stress. Periodontal health is compromised when people are under a lot of stress.16 Sep, 2010 5:33 PM
Do you recommend any sort of natural or alternative treatment for gum disease, such as homeopathy?If a patient is using something I don’t know about, I always ask them to bring it in and show me the ingredients. As long as it doesn’t do anything detrimental, I don’t have a problem with it. Laser therapy could be considered a natural treatment in that we don’t use any external bone grafting and we use the body’s own cells to regenerate bone. We do have to anesthetize the patient, but the laser protocol is an effective and innovative procedure which can often obviate the use of traditional invasive surgery.16 Sep, 2010 5:33 PM
Can vitamins or minerals help prevent or reverse gum disease?About 15 years ago I had a patient who had severe periodontal disease and needed a lot of treatment. She declined treatment and instead started on a regimen of about 25 vitamin supplements recommended by her dentist. A year later she lost eight teeth and needed surgery. I wholeheartedly endorse a good balanced diet with vitamin supplementation (not megavitamins) but we still do not have proof that supplements prevent or stabilize gum disease. 16 Sep, 2010 5:32 PM
Can peroxide help fight gum disease?There was a professor name Dr. Keyes, a microbiologist in the late sixties, early seventies, who came up with a mixture of sodium peroxide and baking soda that patients brushed on their gums. In the lab, it kills bacteria. But then researchers found that peroxide causes cancerous or pre-cancerous changes in the gingival gum tissue. So we stopped using peroxide. I used to put peroxide on after gum surgery with a Q-Tip. No more. Never rinse with hydrogen peroxide. 16 Sep, 2010 5:32 PM
Are there any home remedies to get rid of periodontal disease?If there were, I’d be out of business. Other than mechanical removal, there are a variety of natural, organic, anti-plaque agents on the market. I don’t advocate anything in particular, but I do avoid alcohol-containing mouthwashes like Listerine. If someone wants to use that to freshen their mouth, I recommend they dilute it – not use it full-strength. Tom’s of Maine makes some interesting products. Each person gets different results from different products. One product might work for one patient but not be the best for another.16 Sep, 2010 5:32 PM
Can I wear braces after LANAP?Yes. We do LANAP around braces; we just have the wires taken out in certain cases. We leave the brackets on but we work around them. Braces can also be initiated after LANAP treatment once clearance is given by the Periodontist.16 Sep, 2010 5:32 PM
Does the quality of crowns and implants vary?Yes. A few Periodontists and general dentists have tried to save a few hundred dollars by using implants from China and other questionable sources that were contaminated with lead and other impurities that are not biologically acceptable and safe. But most use high-quality FDA-approved products. Always ask your specialist what manufacturer the implants and crowns are procured from.16 Sep, 2010 5:31 PM
What can you eat with temporary implant teeth?It depends on the case and the individual situation. You can eat most things. You just want to be careful with very sticky foods such as gum, or hard things, so as not to break them. 16 Sep, 2010 5:31 PM
Does the dental implant come through the gum after surgery?You can see the tip of the implant after gum surgery in some cases, but once you put a tooth on it, you won’t see it.16 Sep, 2010 5:31 PM
What is the effect of periodontitis on the lungs?Recent studies have indicated that there might be some connection between lung disease and periodontitis, because both involve some of the same bacteria. Laser treatment can eliminate these potential bacteria from the oral cavity, which have the potential to spread to the lungs and other sites in the body.16 Sep, 2010 5:30 PM
What can be done about receding gum line grafts?If the graft is receding, you have to have that looked at and perhaps retreated, or maybe the tooth or the area treated weren’t very good candidates for a gum graft to begin with. If the person is a diabetic and doesn’t heal well, it’s difficult. A big plus for the laser is that we can avoid cutting and surgery.16 Sep, 2010 5:30 PM
Does periodontal cleaning involve cutting the gums?No. Periodontal cleaning is not surgery or laser surgery. It is merely using some sort of hand or ultrasonic instrument to clean the teeth.16 Sep, 2010 5:30 PM
What causes gum recession?Some habits can cause gum recession, such as excessive brushing with a hard toothbrush. Genetics can also cause it, and gum disease itself can cause the gums to recede.16 Sep, 2010 5:30 PM
What are the side effects of periodontal disease?It can cause you to lose your teeth and suffer other illnesses, the bacteria accumulating in your mouth is uncomfortable and causes bad breath and a bad taste, you can transmit it to your partner or companion, you can’t chew your food correctly, which can cause digestive issues, and of course there are aesthetic concerns if you lose your teeth or they start spacing.16 Sep, 2010 5:29 PM
My teeth are loose because of gum disease. If my gum disease is cured, will they become “tight” again?We would have to study models of the mouth and the bite. It may be possible to stabilize them through the appropriate periodontal treatment, in conjunction with occlusal therapy (analyzing and stabilizing the bite). In many cases that’s done with crowns or occlusal guards. It’s like stabilizing the loose posts in a picket fence by connecting them. Laser treatment is mandatory in these cases to treat the gum disease.16 Sep, 2010 5:29 PM
Is there anything a tobacco user can do, other than quitting smoking, to prevent gum disease?Quit, quit, quit! We recognize human nature, but nothing can replace quitting smoking. If you can’t quit, cutting back is helpful. Numerous studies have shown a direct correlation between tobacco use and periodontal disease. Clinically, we see it all the time. Chewing tobacco is even worse. There are documented reports of baseball players who chew tobacco and have pre- cancerous or oral cancer lesions removed. 16 Sep, 2010 5:29 PM
Is there a periodontal treatment for severe dry mouth?Usually, dry mouth is a side-effect of medications. There are medications to enhance salivary flow. In some rare cases a disease causes this condition. It can be diagnosed through a blood test. We do see an increase in periodontal disease in these patients.16 Sep, 2010 5:28 PM
Is there a connection between joint disease and gum disease?Ongoing studies are looking at the associations or potential associations between gum disease and joint and bone problems such as arthritis and osteoporosis. It’s not clear at this point whether there’s a direct association, but studies are ongoing.16 Sep, 2010 5:28 PM
Is periodontal disease contagious?Yes. Studies have indicated that it is transmissible between partners and companions, through kissing and intimate contact.16 Sep, 2010 5:28 PM
In what age group is periodontal disease most prevalent?After the age of 25-30 it starts to go up exponentially, but we have seen cases of what we call juvenile periodontitis, which is a genetic form of gum disease that shows up in the late teens.16 Sep, 2010 5:27 PM
If my gum disease is advanced, will I lose my teeth?You may, if you are not treated. We treat gum disease all the time - early, moderate, and advanced - and we save the majority of teeth. You’re not doomed, but if you don’t seek treatment you will end up with dentures or expensive implants. We are able to save teeth now that we were extracting 10-15 years ago.16 Sep, 2010 5:27 PM
How to stop bleeding gums?It’s also called gingivitis. If x-rays and a clinical exam confirm that the cause is soft tissue only, it can be reversed with good home care – flossing, brushing, and a good professional cleaning. If the cause is periodontitis – bone loss underneath the gum tissue – that has to be treated with the laser or other modalities. Depending on the severity, laser treatment might be able to reverse or at least stabilize the situation and regenerate new bone. We can also use the laser at an earlier stage to prevent the disease from going into an advanced stage. 16 Sep, 2010 5:27 PM
How long does it take for a periodontal infection to show up on a dental x-ray?That’s a hard question to answer. Some bone defects could show up clearly on an x-ray. Others not. But if it were an acute abscess – an emergency – it would usually show up.16 Sep, 2010 5:26 PM
How does a mouth tray help in dealing with periodontal disease?If you mean a mouth guard, that’s a piece of plastic that fits over the teeth which prevents you from grinding and clenching them. Grinding and clenching results in what is called occlusal trauma. If you have preexisting gum disease, it makes it more destructive. 16 Sep, 2010 5:26 PM
Do you recommend the use of a perio tray for gum disease?We don’t use that as a routine procedure in our office because the therapeutic model that we follow makes it unnecessary. We use laser treatment and certain rinses. We’re not big on the perio tray.16 Sep, 2010 5:26 PM
Can receding gums grow back, or is it irreversible?Generally irreversible without professional treatment. This might include gingival grafting or “lateral pedical grafting” which is moving tissue around to protect teeth, like moving a curtain around to cover windows. We now usually use laser in conjunction with all these procedures to minimize the post-operative discomfort associated with these procedures.16 Sep, 2010 5:25 PM
Can periodontal disease make you sick?That’s a big question these days, because a number of studies in the last couple of years have indicated strong associations between periodontal disease and cardiovascular disease, heart attacks, and liver cancer. Now studies are looking into brain and kidney issues. The bacteria in the mouth that cause periodontal disease include, among other things, gram negative bacteria and spirochetes, and they’re very virulent; very powerful. If they circulate around the body in the blood stream, it can lead to a number of systemic illnesses.16 Sep, 2010 5:25 PM
Can I tell if I have gum disease, or do I need a professional examination?The main things that people may notice themselves include bleeding gums, a bad taste in the mouth, bad breath; teeth that feel loose or have moved, and gum discomfort. If you have one or more of these symptoms, visit a professional (periodontist) who can determine whether you have gum disease; whether it’s moderate, advanced, or severe; and what can be done to treat it.16 Sep, 2010 5:25 PM
Can gum disease be controlled?Absolutely. Between professional periodontal care and good home care, it can be controlled.16 Sep, 2010 5:24 PM
Can advanced periodontitis damage the alveolar process?Yes. In this case, “alveolar process” refers either to the "tooth socket" or bone that holds the roots of teeth, or to the alveolar ridge, the jaw structure that contains the dental alveoli. Periodontitis is destruction of both of these supporting structures of the teeth.16 Sep, 2010 5:24 PM
Are some people genetically predisposed for gum disease? Yes, and we have actually seen patterns in entire families. We can’t necessarily test for this and predict it, but we have seen it clinically. 16 Sep, 2010 5:24 PM
Are HIV patients especially susceptible to periodontal disease?Absolutely. Very severe. Their resistance is compromised, so their ability to fight off the bacteria in the mouth is greatly reduced and they suffer the consequences of that. 16 Sep, 2010 5:23 PM
When you have a soft tissue graft, where does the donor tissue come from?One of two different sources. The patient’s own mouth in a different location, usually the palate, or AlloDerm® from a tissue bank, which is obtained from a cadaver. Tissue banks are very heavily regulated, so donor tissue is safe. There have been no documented cases in the last 25 years of anyone getting a disease from a tissue donation like this.16 Sep, 2010 5:23 PM
When a gingival graft is done and stitches dissolve does that mean that it is healing?If they are dissolvable stitches, they will dissolve whether it’s healing or not. The success of a gingival graft doesn’t necessarily hinge upon the sutures dissolving.16 Sep, 2010 5:23 PM
What is the success rate for gum grafting?It’s in the 90%’s. With very severe gum defects, the percentages come down a little bit. In each case, we conduct a clinical examination and photograph the gums to see where we’re starting. Based upon the result we think is achievable, we can predict an outcome. 16 Sep, 2010 5:22 PM
Is there gum surgery for bone loss?There is, traditional bone surgery is seldom used, but we choose the laser whenever possible. It’s less invasive and gets the same result, if not better. No cutting or sutures.16 Sep, 2010 5:22 PM
Is a gingival graft painful?It can be, but with laser, we can laser the donor site to eliminate a lot of post-operative discomfort.16 Sep, 2010 5:22 PM
How long does it take for microcirculation to develop after a gum tissue graft?You have to have blood supply within hours, or the graft will fail. The graft will continue to develop a more elaborate blood supply within days. 16 Sep, 2010 5:21 PM
How long does it take a gingival graft to heal?Everybody is different. A diabetic or a smoker will heal much more slowly. Some people have a genetic predisposition to heal extremely quickly. Typically, grafts can take several weeks to fully heal. Not that you’re feeling pain all that time, but it can take that long to feel completely normal again.16 Sep, 2010 5:21 PM
How do you treat bone loss due to gum disease?The laser protocol enables us to regenerate bone lost due to gum disease. Traditional surgery will also give us bone regeneration in cases where the laser isn’t appropriate.16 Sep, 2010 5:21 PM
Are there any alternatives to gum grafting?In certain instances, the laser might be able to enhance gingival (gum) augmentation, but sometimes a gingival graft might also be necessary. Using donor gingival tissue such as AlloDerm® prevents having to take tissue from the roof of the mouth. Such donor tissue isn’t rejected, so anti-rejection drugs are unnecessary. Donor tissue is very well screened, so there’s no risk of contracting hepatitis, HIV, etc. Other than gingival grafting, it is also sometimes possible to move existing gum around, thus avoiding having to take a tissue donation from the roof of the mouth. This would depend on clinical factors such as how much gum is left, and the anatomy of the mouth. The patient must be examined to determine the best treatment plan.16 Sep, 2010 5:20 PM
I had a crown lengthening procedure done seven months ago, but my front teeth still hurt. Is that normal?It’s not uncommon to have some root sensitivity. But it has to be determined whether it’s root sensitivity or the nerve of the tooth is aggravated, etc. A number of factors could contribute to your discomfort, and it’s hard to determine without examining the patient. Generally, crown lengthening procedures increase the amount of exposed tooth surface. They’re done for a number of different reasons – aesthetic (for placing new crowns on the teeth), or for restorative reasons. Teeth can become sensitive after crown lengthening, but crowns which reduce sensitivity are usually placed on the teeth. 16 Sep, 2010 5:20 PM
How much does gum reduction surgery cost?Gum reduction surgery is a very general term which could represent a number of different procedures. We would need to examine the patient, collecting their clinical and radiographic data, to determine what procedure is appropriate. Then we could provide a cost estimate. All of the procedures we do are coded and standardized, and are covered under the average dental insurance plan. Even though we’re an out-of-network provider, our patients generally get reimbursed according to their plan. We help with filling out forms. We accept MasterCard, Visa, American Express, and something called Care Credit, which is an American Dental Association accredited financing program. We need to complete a consultation to quote a fee.16 Sep, 2010 5:20 PM
What is the cost of periodontal osseous surgery?Periodontal osseous surgery is a form of traditional surgery. It’s difficult to answer that because each case is evaluated on an individual basis, based on the severity of disease, medical history, and the whole collection of clinical and radiographic data. Please call the office to discuss individual situations. We need to see the patient for a consultation before we can give a treatment estimate.16 Sep, 2010 5:19 PM
Do you offer a free initial consultation?We do not. However, senior citizens get a courtesy discount, based on the individual case and situation. 16 Sep, 2010 5:18 PM
If you have a bridge can you still have this treatment? And how to get rid of that smell it has?The "smell" you describe can be originating from bacteria buildup in the gums or leakage from the bridge. We routinely do periodontal treatment around bridges safely and effectively to treat gum disease.9 Sep, 2010 2:31 PM
I am living in Philadelphia, PA. Do you have any location near or in South NJ. And I need the cost information of the treament please.We see patients from New England down the coast to Florida. Our office is located in Northern New Jersey close to all major highways. If you live in the Philadelphia area, we are approximately 1.5 hours away. Please keep in mind, laser treatments can be done in one visit. Please see other recent answers regarding cost.
26 Aug, 2010 3:20 PM
Dr. Linden,
I had LANAP treatment and misunderstood the instructions. I brushed and flossed two days after treatment removing all of the clotting around my teeth. Will this diminish the effictiveness of the treatment? Also, is it possible to have the LANAP treatment a second time?

It is possible that there was a "disruption" of the healing process because of the premature brushing and flossing at day #2. is also possible to have LANAP a second time. Please call us if you feel you would like to be seen and evaluated.
26 Aug, 2010 12:48 AM
Do you have a cure for chronic halitosis?Halitosis (bad breath) can be caused by a number of factors, most often by "gum" or periodontal disease. There are also a number of medical conditions that on a rare occasions can cause halitosis. If we determine that gum disease is the cause of a patient's halitosis, we can treat it with the laser or other periodontal techniques if necessary, and provide instruction on proper oral hygiene techniques. We also want to rule out any systemic illnesses that can contribute to this problem. If necessary, we work with other medical specialists to cure this problem.19 Aug, 2010 1:11 AM
WHAT IS THE COST FOR LASER GUM TREATMENTThe cost for laser gum surgery can vary for each patient. After a thorough clinical exam, medical history, and review of a quality (digital) full mouth series of x rays, a final cost estimate can be discussed with the individual patient. Generally speaking, the costs of laser surgery are comparable to "traditional" flap surgery in our office.16 Aug, 2010 1:34 AM
I am missing two teeth lower teeth and am considering replacing a bridge with implants. I have been told that I will need to have bone harvested from the back of my mouth and inserted into my jaw to prepare it for implants. I will be under general anesthesia but am very nervous about this whole procedure. How painful will it be when I wake up? How difficult is recovery from this procedure?There are many different treatment options to consider when treating this area of the mouth. The anterior region of the lower (mandibular) jaw tends to have thinner bone. In many cases the ridge of bone is deficient for the placement of implants. In our office, we use local anesthesia and use either freeze dried bone (cadaver bone that is safe) or synthetic bone. We graft the sites as needed before implant placement. We would usually wait at least 3 months before the placement of the implants. We do not use general anesthesia. We do not have to harvest the bone from the back of your mouth. We try to keep the procedure as simple and conservative as possible. However, in very extreme and rare circumstances such as automobile accident cases or severe trauma, it might be necessary to refer you to a hospital trauma team. Many of those cases do require general anesthesia. 22 Jun, 2010 6:20 PM
My orthodontist referred me to a periodontist. I had gum issues before. Can I get laser surgery or treatment even though I have braces?
Yes it is possible to have laser treatment with braces. We would recommend a thorough clinical exam and radiographs to confirm this mode of treatment. Having periodontal issues during orthodontic treatment is a concern, but intervention is usually successful and oftentimes done with the laser.
17 Jun, 2010 8:55 PM
Is it ever possible to treat and heal gum pockets as serious as #6 without surgery? Thanks.If you are referring to a 6 mm pocket then the answer is yes. We can treat pockets of varying degrees depending on the clinical presentation and radiographs. We always recommend a complete oral exam and treatment plan.14 Jun, 2010 4:18 PM
How far are you located from NYC?Our New Jersey office is about half an hour away, depending on where in the city you're coming from. We'll be opening a Manhattan office soon, in addition to our NJ office.9 Jun, 2010 5:02 PM
Do dental insurance policies cover your services?Most dental insurance plans cover periodontal therapy. We are an out-of-network provider. However, we will fill out all necessary forms and submit them to your insurance company for reimbursement directly to you. Please check your policy for further details. We would be happy to help you better understand what your out-of-network dental benefits may be.21 May, 2010 1:12 AM
Is there a link between periodontal (gum) disease and heart disease?The link between periodontal disease and heart problems is well-established. Please see the Heart Disease and Stroke page of our site ( and the Periodontal Disease and Your Heart section of our blog ( May, 2010 10:47 PM
I understand that it is hard to determine price without seeing a patient, but if you were to compare laser to conventional surgery as an average, is it higher in cost or lower in cost, and by what percent?LANAP is not more expensive than conventional surgery. The two cost about the same, but in most cases, LANAP is preferable for the reasons discussed on May, 2010 11:50 PM
How much is this treatment?Each patient is different and the fee depends on the severity and extent of the disease. 9 Mar, 2010 4:40 AM
I see that there are connections between heart attacks, cardiovascular disease, premature births and numerous other medical conditions with "unstable" periodontal disease. Does this laser surgery help? How about preventing infections if someone has an operation?Yes. The FDA approved Laser protocol we follow targets only the diseased tissue and specific bacteria that cause gum disease. These are the same bacteria that have been correlated with a number serious medical conditions. We also utilize the laser protocol before patients undergo hip replacement, knee replacement, chemotherapy, and other major surgeries to prevent any infection from traveling from the areas of gum disease around the teeth to other parts of the body.9 Mar, 2010 4:38 AM
Do I have to follow a special regimen after the laser surgery is completed?Dr. Linden will review with you at the consultation appointment the suggested regimen of cleaning, follow-up and necessary home care.9 Mar, 2010 4:36 AM
Will I have gum recession after the laser surgery?Laser surgery does not cause any recession of the gums around the natural teeth or crowned teeth.9 Mar, 2010 4:33 AM
I am on blood thinners. Do I have to get off these medications before the laser surgery?One of the advantages of laser surgery is that patients don't have to stop their medications as with conventional gum surgery. This eliminates the risk to you of discontinuing the medications.9 Mar, 2010 4:31 AM
Are you available to give lectures on laser periodontal surgery?Yes, as one of the first Periodontists on the east coast of the US doing this FDA approved technique, I am often invited to present Laser gum surgery to dentists, doctors, and health care workers. Check our web site under "Lectures".9 Mar, 2010 4:28 AM
Can a patient make payments for the periodontal services such as laser surgery, implants or conventional surgery?Yes. We offer financing through the American Dental Association's approved financing programs. Please call our office for details.9 Mar, 2010 4:26 AM
Does insurance cover laser gum surgery?We do not participate with any insurance plans, but typical dental insurance that covers "gum surgery" should cover you for laser surgery as well. Please check with your dental insurance carrier. We will also help you with the insurance "red tape" when you finish your consultation appointment.9 Mar, 2010 4:23 AM
Will this treatment hurt?No. You will not feel anything. We use local anesthesia and will be extremely gentle. Patient comfort is our primary consideration.9 Mar, 2010 4:19 AM
How long does Laser gum surgery take to perform?In many cases, we can do the treatment in one long session (2-3 hours). Sometimes, it can be split up into two sessions, usually one week apart.9 Mar, 2010 4:09 AM
How soon after Laser periodontal surgery can I go back to work and family responsibilities?Laser surgery enables people to get on with their lives with minimal disruption. You might leave the office a bit "numb" but this wears off after a short period of time and you should feel little or no discomfort. Recent patients come to mind who, shortly after surgery, have traveled, made public or TV appearances or business deals, taken care of children, worked with heavy equipment, or performed as professional musicians.9 Mar, 2010 4:02 AM
Do some problems still require conventional gum surgery?Yes. We still use conventional procedures in some circumstances, but even during these procedures, we utilize the laser as much as possible. This reduces post operative discomfort for our patients.9 Mar, 2010 3:56 AM
What is the advantage of laser surgery over "conventional" gum surgery? Are the results better than conventional surgery?With laser surgery, there is no cutting or stitching of the gums, and therefore, minimal post operative discomfort. In our office, we are finding the results have been superior to the conventional therapy.9 Mar, 2010 3:52 AM
How would a periodontist determine whether I might be a candidate for laser gum surgery?By conducting a thorough clinical exam and reviewing a quality full mouth series of low exposure digital x-rays.5 Mar, 2010 3:43 PM