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Dentist2Dentist
Join Dr. Mike Miyasaki as he talks dentist to dentist about the trends, products, and clinical applications in dentistry today.
Dentist2Dentist
Beyond Gums: Linking Oral Health to Overall Wellness with Tanya Dunlap, PhD
Discover the innovative world of periodontal care with Tanya Dunlap, PhD, Vice President of Perio Protect, as she shares the compelling journey behind the Perio Protect trays. Inspired by her father's quest for a less invasive treatment for his mother, these trays have revolutionized the delivery of medication into periodontal pockets. Our conversation unveils the surprising role hydrogen peroxide gel played in this breakthrough, offering a new perspective on periodontal therapy.
We spotlight the Perio Protect custom form tray, an essential tool for dental professionals. Designed to minimize medication leaks and ensure patient safety, this tray promises ease of use without extensive training. We also touch on the concerning trend of antibiotic over-prescription, encouraging responsible practices amid the stressors of modern dental care. A bit of humor peeks through as we share light-hearted anecdotes about pets and the quirks of remote work life.
Beyond trays and treatments, we explore the profound link between oral health and systemic conditions like diabetes and cardiovascular disease. With insights from practitioners like Garrett and Tanya, we champion the integration of Perio Protect into dental practices for enhanced patient care and boosted practice revenue. Patient testimonials underscore its impact, highlighting improved health outcomes and satisfaction. Join us for an engaging discussion on how these innovative tools can transform dental practice and patient experiences.
Hi, I'm Dr Michael Miyazaki and I'm really excited to be here today. I've got Eric Caldwell, again CEO of Core Dental Laboratory and the Pacific Aesthetic Continuum, or we call it the PAC, and our guest today is Tanya Dunlap, phd, and Tanya knows a great amount and so I'm kind of really eager to pick her brain, but she is the VP, vice president of ParaProtect. Paraprotect, just in case you haven't used them I know it's hard to see because I got it blurred, but they're these little trays that you put some hydroperoxide in Garrett. You need some of these. You'll wake up, won't have morning breath, you'll have better gum health and you'll have wider teeth.
Garrett:Well, I sleep with my dog, mike, your dog will appreciate you.
Dr. Mike Miyasaki:My dog will appreciate me.
Garrett:That's right.
Dr. Mike Miyasaki:But don't leave them out, because the dog will love these as a chew toy, I believe. So just kind of be careful.
Tanya Dunlap, PhD:Completely yeah.
Dr. Mike Miyasaki:But Tanya has been the vice president of Parapetect. She started there back in 2005.
Tanya Dunlap, PhD:Not as the vice president, but yeah, I've been working there for 20 years almost now 20 years.
Dr. Mike Miyasaki:So see, this is tried and true. And she served as a research liaison, working with microbiologists, principal investigators, statisticians and consultants. So this is a home treatment that is well steeped in research. And she also, and I had the pleasure of working with Tanya at a couple of programs where she actually teaches and trains KOLs. So those are the key opinion leaders of how to teach others of our colleagues about the power of the prayer protect trays. And she teaches courses to other clinicians and both to dentists, hygienists. We've had assistants there, really front desk. The whole team needs to understand the importance of this. We've had assistance there, really front desk. The whole team needs to understand the importance of this. And she shows us the clinical and the financial implications and the research data, and so I thought it'd be really cool to have Tanya on for today. So, tanya welcome, garrett welcome, thank you. Thanks, mike, welcome Tanya.
Tanya Dunlap, PhD:Thank you, I'm so happy to be here with you both.
Dr. Mike Miyasaki:So the part that I told Tanya that I really like is the story Like how did the Prayer Protect Trace come about?
Tanya Dunlap, PhD:It is a great story. It's personal because my family is involved, but also there's a lot of accidents that happen along the way and sometimes really good science results from accidents things you don't expect. So my father was a dentist. He trained in perio. He ended up doing general dentistry and focusing on a lot of patients in chronic pain for TMJ dysfunction. But one of those patients was his mother and she ended up, as many Americans do, right Like by the time we're over 65, 70% of us have lost bone already. So she was at that age and she had lost some bone and she needed perio surgery. So she went out and got a quad of surgery and came back and he said you look great, we're ready to do the next one. She said oh no, we're not ready, I'm not doing it. Find another way. I would rather lose my teeth than do this again. Now. This is back in the day, when it was, you know, there weren't a lot of options as we have now, but that began the quest. She said I'll try anything you recommend and I'll let you know how it goes, but we have to find a different way to do this. And, to be clear, you can't always avoid surgery, so I'll put that out there.
Tanya Dunlap, PhD:But in his case he was trying all kinds of things. So you know we're classically trained biofilm-based infection. Biofilm wasn't even a thing at the time, so we'll call it a bacterial based infection. You, you work with antibiotics. So he took syringes and he pushed the antibiotics deep in the pocket. It all flowed back out, and so he came up with a variety of delivery vehicles, and the one that worked for some of his patients really well was tufted floss. So every two or three inches on the floss there'd be this big tufted thing and he soaked it in tetracycline and he had patients who used it and it was pretty effective for them. It was super messy, right. You can imagine you're flossing and there's tetracycline going all over the, all over the, wherever you are. And it went to controlled clinical trials and it totally fell flat. And so he thought, okay, I got to come up with a way that is not technique sensitive, that is super easy and that is comfortable for patients. And so he ended up playing around with tray designs. Now, your regular vacuum form tray leaks really badly, and so that wasn't working. Like you know, mouth guards are really bulky and the whitening trays didn't have enough. So he ended up finally designing a tray that has an internal peripheral seal so that tray reliably delivers the medication really deep. So let's focus on the medication for a moment.
Tanya Dunlap, PhD:He was still using antibiotics in the tray, but he was also recommending a hydrogen peroxide gel, primarily as a propulsion agent to get that medication, the antibiotic, deep in the periodontal pocket. He was getting great results and so one day this patient comes in and he was about to. He was submitting things to FDA for the delivery of the tray and everything else, cause you got to get FDA clearance to take things to market. And one day a patient walks in and she says, after he had told her, you know, you look terrific, keep it up. She said do I need that liquid medication anymore? And he's like well, the liquid was the antibiotic. How long have you not had it? She said probably six months and he's like huh, well, we'll put you back on it.
Tanya Dunlap, PhD:But he started to think it wasn't the antibiotic that was doing it, it was the hydrogen peroxide that was doing it. So that led him back to a literature review and that lit review took him to bill costerton. Bill costerton was a microbiologist out of canada and he was working at montana at the time and bill says well, I got some office hours. You want to come and see me? So dwayne flies out the next week and they sit down and he starts to figure out it is the hydrogen peroxide that is doing all the work. So, to make it long story short, we started working more with hydrogen peroxide and less with antibiotics, and there are times when we still recommend an antibiotic, but not for its antibacterial properties. We recommend it because it actually stabilizes bone for its antibacterial properties.
Tanya Dunlap, PhD:We recommend it because it actually stabilizes bone In the tetracycline class of drugs. The drug will inhibit osteoclasts and boost osteoblasts. So we do value all of this science basis and we do have detailed versions for people who want more education. But our basic program focuses on the peroxide and the advanced program now focuses on the antibiotic.
Dr. Mike Miyasaki:I love that story. It's always the post-it notes, right.
Tanya Dunlap, PhD:That's right yeah.
Dr. Mike Miyasaki:It's like the post-it note story. So, garrett, now you know why you need your trays. You got to grow more bone.
Garrett:Actually like you need to tell me.
Tanya Dunlap, PhD:I don't know, Our number one reason that we actually prescribe it is just to get rid of all the bleeding and inflammation, right, that chronic inflammation. So when you have bleeding sites and we, so we have a gum score, the gum score your best gum scores is zero, right, zero bleeding points, but you want to score that's under 10. If it's over 10, over 100, you know you're really concerned, especially if you have type two diabetes or a high blood pressure or something like that. And our goal there is to say look, you have a high gum score and we're concerned. Let's say they have type two diabetes, because if you let this chronic infection go, it's much harder to manage your blood sugar, or you increase your risk for heart attack or stroke, or there's research that actually shows that the bacteria leaving your gums can lodge in an artery and cause arterial inflammation. These are things that we're very concerned about for you.
Dr. Mike Miyasaki:If I had a practice of, let's say, 1,000 patients, how many of those patients in a typical practice are going to be candidates for using the Peritrate?
Tanya Dunlap, PhD:Yeah, clearly 80% 80%.
Tanya Dunlap, PhD:Yeah, so you're talking about everybody with gingivitis right Over 10 bleeding points, for example. Anyone with restorative work is a great candidate, because you get those chronic infections around your crown margins or your implant crown margins and it threatens the life of your restorative work. If you want optimal restorations, you definitely want perioprotect. Anyone who's got bone loss right so by the time we're 65, that's 70% of us and by the time we're 30, even young adults half of us have bone loss. So there's a huge patient population there. And then anyone who's even let's say you're an orthodontist. You finish an ortho case. What happens typically after that? You've got fours and fives in the posterior of your molars. You've got some gingival infection around the rims right. Clean it up, put it in after every case and you will have gorgeous gums but also white teeth that you've newly aligned, which everyone will appreciate, and the whitening is super soft and gentle because it's a low concentration of peroxide 1.7%.
Garrett:I was going to ask you Tanya is this a tray and a product combination? It is. It's a tray and a product.
Tanya Dunlap, PhD:So there are other drugs you put in the tray which you know the whole antibiotic story, but also remineralizing agents go in the product. So there are other drugs you put in the tray which you know the whole antibiotic story, but also remineralizing agents go on the tray. If you have lichen planus you can put in some analgesics as well as some topical steroids. That's a whole protocol that a periodontist at University of Oklahoma created. But the primary antimicrobial is this, what we call periogel, 1.7% hydrogen peroxide. So your lowest whitening agent is 10% carbon monoxide. This equates to half of that 5% carbon monoxide. The white teeth are awesome, unless you have like one veneer on number eight right. That's going to cause a problem for most people. They love the white teeth.
Dr. Mike Miyasaki:And they are really comfortable. You know, you, just you with the trays just put a little bit of the hydrogen peroxide gel on there, you pop the tray on for 10-15 minutes and you're done. And you know when you put it in and you get used to how much you actually have to put in. You kind of forget that they're there, and so the like. The other day I was getting ready for bed, put my gel in there, I don't know making the bed, getting it all ready, and almost jumped into bed instead of my trays in. So then I remember I'm now going to get out of bed, rinse them out, let them dry, and then I mean they're really comfortable. So no, it's nice to have that.
Tanya Dunlap, PhD:It is nice. We want them to fit like a glove. We were just I was just in a meeting and our return rate is less than 1%. It's actually like a half of 1%, so we're very proud of that, and it helps with people scanning, as you can imagine.
Dr. Mike Miyasaki:Yeah, so two things. I want to go into the antibiotic story a little bit more, because a lot of us think, oh, there's an infection, antibiotics are the thing to use. But really quick, you mentioned something in the introduction. You mentioned the tray and the way that it fits so tightly around the tissue, because some doctors will look at this and think, well, I can just make a suck down, right, what's the difference between a bleach tray versus a peri tray? So can you just clarify that one more time? I know it's.
Tanya Dunlap, PhD:So, yeah, I went over it really fast in the new event. So just a regular vacuum form tray. Especially if it's a bleach tray, it's designed to prevent the medication from getting any contact to the gingiva. This tray has an extension that's going to go past your gingival margin by several millimeters and on the internal peripheral side of that there is a seal. And where we place that seal and how we make it that's what really matters the seal and the extension. It works like a gasket and it prevents the medication from leaking out.
Tanya Dunlap, PhD:So if you're going to take any kind of a product, especially one that delivers a drug to market, you have to have clearance from the FDA before you can make claims, and those claims are often also based in your research. So this is what makes ParaProtect such a great product for any dentist. All the work has been done for you already and it's a pretty easy process to get started. You just take a quick course less an hour and we will show you all the patient candidates who can benefit. We'll explain to your team, my friend, why the peroxide works well and who it's good for. There really are no contraindications, except for that case when you have a veneer or a child right that has too many changes in their dentition, but otherwise it's super easy. We have lots of done-for-you programs to get started as well.
Garrett:So, Mike, you mentioned, Mike, one thing you mentioned, you know whitening at night. Can this tray be used with other manufacturers' products?
Tanya Dunlap, PhD:I wouldn't use anything else. That's a high concentration of peroxide, because it burns the tissue.
Garrett:Okay.
Tanya Dunlap, PhD:Yeah it causes. It would be super uncomfortable. The tray itself fits really precisely. You should not be able to easily dislodge this with your tongue and it does have almost a suction effect to it. But, as Mike said, it's super comfortable. It is really, really comfortable. I also often forget I have them in. I, you know, sometimes watch TV and when I watch really comfortable, I also often forget I have them in. I, you know, sometimes watch TV and when I watch I binge. I don't like just casually watch. So and I'm lazy, I don't get up in the after. You only need to wear them 15 minutes max, 10 is good, 15 is ideal. If you go longer, it doesn't help you. The hydrogen peroxide is broken down to oxygen and water right at 10 minutes, 17 minutes. So it doesn't help you, it doesn't hurt you, it's just it's convenient.
Dr. Mike Miyasaki:I don't know if it's politically correct to say but are you a cat lady? No, it just happened to be working from home and this cat is insistent on being here First the cat was on your right and the cat's on your left. Is it just one cat?
Tanya Dunlap, PhD:I'm pushing her down like this out of the screen and she decided she's going to come up another way. I should have closed the door yeah, no, it's, it's good.
Dr. Mike Miyasaki:We like to have pets. Everyone's welcome to these interviews.
Tanya Dunlap, PhD:We get more dogs barking or cats jumping.
Garrett:It's one of the others right mike, we should add cats to our podcast, because we have more views?
Dr. Mike Miyasaki:yeah, we should. There's millions of them around that probably are interested in what we have to say Exactly, you know, and Garrett, going back to the manufacturer and then we'll jump back into the science part of this. But you know, before the paratrays, like we've been using them for years and you used to take your impressions and send it to lab and it would take you weeks to get these back. So that was kind of a, you know, drawback Dentists, patients, we just hate waiting for the crown or whatever to be back in the office. But, tanya, how fast do you turn these around today?
Tanya Dunlap, PhD:We're turning them fast within two days, and then we set them FedEx in two days, so you'll have them within a week. See Garrett If you send it with a scan, right. If you mail it in, then it's a totally different thing. You got to have the front end mail time.
Dr. Mike Miyasaki:Let's go back into the science, because I know one of the best parts of your presentation. Everything's really good, but one of the best parts is always that antibiotic story. So we sit there and I know you've got all the details, but we as dentists, oh, you've got an acre of pain, here's maybe a pain med and here's some antibiotics, and we just give those antibiotics that kind of out like candy. But you know that we shouldn't be doing that. So what's the story behind the antibiotics?
Tanya Dunlap, PhD:So let's have some fun. Dentists write a lot of scripts. You guys are the number three prescribers. Outpatient in the country. The first most common scripts are the most numerous scripts come from your primary care physicians, then from nurse practitioners and then dentists are the number three prescribers. You want to guess how many scripts dentists write a year? Go really high, it's over 10 million. There's what I don't know. Can we say there's 200,000 dentists in the US?
Garrett:Yeah, what do?
Tanya Dunlap, PhD:you think yeah, okay, dentists write 25 million scripts a year according to the ADA and the CDC. 25 scripts a year according to the ADA and the CDC. 25 million that's only 10% of all the scripts that are written. So we're writing. This was pre-COVID. We wrote 250 million scripts a year. After, not after. In the middle of COVID, we were down to 211 million scripts a year, but dentists were still high. Your offices were closed. You had to still write scripts. This is difficult.
Garrett:Mike, are you writing 90 scripts per year? Pardon me per month?
Tanya Dunlap, PhD:Yeah, that's some fast math, right yeah 90.
Garrett:That's about what it is. It's like a thousand a year, that's a lot.
Tanya Dunlap, PhD:It's a lot, yeah, so some patients know that they're supposed to have it right. You're those with prosthetic joints. They were told nine years ago that they always need to be pre-medicated, but even though those guidelines have changed, um, they know it. So there's a lot of pressure. But the the fact of the matter is it's really hard to treat a biofilm-based infection with an antibiotic. It and I'll just make this premise if, if antibiotics were going to work well for periodontal disease, we would have seen it already.
Tanya Dunlap, PhD:We have been using them for decades and we have super high rates of disease, and there's a lot of reasons why antibiotics don't work well against a biofilm-based disease. So a biofilm is that community of bacteria that's covered and enclosed in a matrix which is basically a gooey layer of slime. It's really hard for an antibiotic to penetrate through the slime and even if it did, then a lot of the cells that are within the actual community are not actively dividing. They're dormant, they're alive, but they're not actively dividing, and so traditional antibiotics are going to work only as those cells actively divide.
Tanya Dunlap, PhD:And then you got to find the right drug for the right combination of bacteria, which, in the human mouth, you got a lot of variety of bugs, so it's hard to find the right antibiotic in any event. Plus, you get a cell that develops a resistance to an antibiotic and it can teach that resistance to other cells. So now there are whole classes of well. I should say there's at least 18 different species that I've identified in casual research that are completely resistant to all antibiotics. Now this is scary stuff, and so having a non-antibiotic option is very important. Besides that it's a heck of a lot more effective is very important. Besides that it's a heck of a lot more effective.
Garrett:So what about patients that are gargling regularly with 3% hydrogen peroxide?
Tanya Dunlap, PhD:Yeah, they may end up with black hairy tongue. So when you gargle a rinse, your toothbrush floss, whatever it is, it doesn't get deep enough and this is why you need the tray to deliver that medication deep and hold it there long enough to work. So with peroxide you need time. So those folks who are gargling I don't know how long they're gargling, but if they're really doing it for the right amount of time, they're going to have an overkill of healthy bacteria in their mouth too and they may end up with a fungus that looks like black hair growing on their tongue. It's not dangerous, it's just unsightly. You can use a nice statin rinse there's solutions for it but you don't need all of that antimicrobial action. And for gum disease we really want to target it deep into the pockets where the bacteria have this safe harbor.
Dr. Mike Miyasaki:Yeah, that's really cool. So antibiotics don't work. The trays work better. The trays are easy to get. The trays are comfortable. What are some of the other benefits to the patients?
Tanya Dunlap, PhD:It is so important to look at patients' health histories. So in general, what you can expect with PeriProtect is a huge reduction in bleeding and probing and inflammation. So we say, in the first two weeks, at least 50, 5-0%. So if you're bleeding at 168 sites, we should get you well below 80 even, but we want to get you down to zero. If we can't get you to zero, we should be able to get you to single digits. So huge reduction in bleeding and inflammation. And this is in combination always with what you do in the office. So I want to be clear this is prescription home care. Whatever you're doing in the office, it doesn't really change that. You add this in order to help your patients maintain the gains you got and actually improve on them between office visits. So the huge reductions in bleeding and probing and inflammation, an additional significant reduction in pocket probing depth scores. Optimal restorative results. Whiter teeth, which most people really love. It takes about four weeks to see that because it's a low concentration, but the fresh breath is very fast. Those people you can smell before you can see even them first. We wipe it out. Huge quality of life improvement right there.
Tanya Dunlap, PhD:In terms of the office workflow, there are also benefits because when patients are healthier, between office visit, your maintenance appointments, or even if they're prophy, they're so fast and easy. They're comfortable for the patient because what's uncomfortable is the swollen tissue right, so super comfortable. I think anybody who's doing implants. It's like a no-brainer just throw a set of perio trays in there, right. It's a low cost way to make sure the tissue around the implant stays healthy, cause once that starts to get infected, it's it's a harder, harder treatment plan.
Tanya Dunlap, PhD:And then productivity. So think about all the patients in your practice who can benefit from this, from gingivitis to perio, to perio maintenance to your to your restorative cases. Implants are the fees actually quite reasonable to dental practices and most offices are making at least $500 a case. So if you go through there and you think about what you can do, we we have practices that add single practices, you know somewhere between five and 10,000 a month just, and I'm talking profit, not revenue, with this. So there's so many benefits and on the financial side it's just because you can help so many patients. It really it really is great work for your patients.
Garrett:So, tanya you just, you just were reading my mind. So we're jumped from the, from the chemistry, to the business side, because Mike and I are trying to always. You know, we talk about um implants and we talk about ortho, we talk about doing, uh, resin bonded dentistry and some of the, some of the tech, uh, some of the techniques that are a little more difficult to just deliver immediately versus versus something like this where a doctor can incorporate it into their hygiene program and see initial revenue returns. So my question was what is the average cost for the dental business to deliver this to the patient? What is the average return per patient?
Tanya Dunlap, PhD:So we recommend people charge around three times their lab fee simply because it really doesn't require much doctor time. It's almost all team driven, right. The doc needs to know and the doc needs to confirm that that's the right choice for the patient. Moving forward, that's kind of a no brainer when you see chronic infection, especially. I didn't go back. Let me go back to this because you asked it earlier, dr Mike. What if your patient has type two diabetes? Right, it seems pretty far removed from your mouth. What if your patient has type 2 diabetes? Right, it seems pretty far removed from your mouth.
Tanya Dunlap, PhD:But we teach all of these talking points and they don't have to be complicated, but they're true. If you have chronic periodontal inflammation, it's much harder for you to maintain proper blood sugar. Right, it just it is. If you have high blood pressure and you have gum disease, that gum disease is a chronic low-grade burden on your immune system, right? And if your immune system is like a battery, there's only so many things challenges it can handle. But we can get your gums healthier. Let's unplug that from your immune system.
Tanya Dunlap, PhD:We put this into the context If you already have cardiovascular disease, you're at a higher risk for stroke or heart attack if you have chronic periodontal infection. The numbers are clear. So putting that in there, this just means that it is important for so many patients number one to know they have disease Like. The most important thing you can do on the dental team is diagnose disease. So doctor's roles come into there. Doctor needs to help you know, diagnose and confirm that diagnosis. But beyond that doc does very little. Three times your lab fee, it's somewhere around $750. And that includes three tubes of gel, the shipping, all of it. And some offices are higher, like I know perio offices that are charging $1,200 for a set. Some are lower, but that's where we recommend it.
Garrett:And the cost for the doctor? I'm sorry, tanya so the delivery costs are $700 to $1,200 for the patient side on the retail side.
Tanya Dunlap, PhD:Your cost is we start at $250,. But the more trays you do, the more volume you do, the better your price gets.
Garrett:Okay.
Tanya Dunlap, PhD:And if you're in a small group, everybody's grouped together. The more you do, the better your pricing gets.
Garrett:So the hygiene department can do the equivalent of the doctor delivering one aesthetic case per month, right, yes, that's right, yeah, yeah it is a great way to boost your production, out of hygiene for sure so, like gary, what we're talking about is if you have a patient comes in and they want, let's say, veneers.
Dr. Mike Miyasaki:But they haven't been to the desk for a while or their hygiene is not very good, so they've got the bloody gums. Well, we don't want to prep into bloody gums. So what you do is you'd start them on the peritrace first, get the gums all healthy, and then that'd make the case management much easier from that point on. And then, once you did your aesthetic case like veneers, you can have another set of trays made if you needed to, so the patient can maintain the health of the tissue around that aesthetic work plus keep the teeth whiter. So it's kind of a win, win, win for everyone.
Garrett:Yeah, no, I can see that we deal with. You know, at the seat of an anterior aesthetic case you're always dealing with the concern of bleeding, that's right. Corrupting the margin and getting those little black spots on the margins, and that anytime we can have healthy tissue healthier tissue when we're bonding, it's always better.
Tanya Dunlap, PhD:And if you use those trays before you place the veneers, you'll have a very clear understanding of where your margin is and it's not going to move around on you. And then if you need a set of trays afterwards for whatever reason, it's cheap. It's like 150 bucks total for a second set. And whenever that happens, trays typically last a really long time. I say five to eight years, but I know patients who've been in trays for 10.
Garrett:So maybe, if you have micro leakage, mike, maybe there won't be me If you do these trays post-op. If you have a little bit of micro leakage, you won't see any black. That's right. That's the idea, Honestly.
Dr. Mike Miyasaki:Absolutely.
Dr. Mike Miyasaki:And you know, and these are, they're a delivery device. So, like Tanya was mentioning before you could. You could put a remineralization type of product in there so that you don't have to worry about recurrent decay around your margins as much cut down sensitivity. So there's a lot of different uses for these trays and because it can be so cost-effective, if you're placing implants in your patients, you might give them a set of trays just to keep the implants healthy. Because we know that's kind of the weak point, that perimucositis, andi-implantitis and if we can keep that tissue healthier then you kind of ward all that away, which is something that's really good. Or if you get a patient you know that tough case they're starting to get some inflammation around an implant then I like to move into peritrays just to kind of see if we can reverse that before we get into the peri-implantitis stages. So it's got a lot of great uses and so easy to use. Maybe we could talk about that. You know the great thing about it is integration wise. It doesn't really disrupt your workflow, garrett, it's just patient comes in, like Tanya has mentioned.
Dr. Mike Miyasaki:You know, a lot of times the hygienist will say so-and-so. You know, mrs Jones has inflammation of the gums and it could be gingivitis or periodontitis. And you know, a lot of times in our office what we'll do is we'll say you know, mrs Jones, what we would like to do is we'd like to get this inflammation down because you have too much bleeding. That's not a good thing, not only for your mouth but for your entire body, and we've got an adjunct to treatment and that would be the parotrace. But a lot of times, like, let's say, they have gingivitis and it's just a lot of bleeding but not a lot of bone loss, we'll tell the patient hey, you know, our, our hygienist, bobby, spent some time with you, went through your, your home hygiene regimen. Do you think you can brush and floss? And of course they say, yeah, I'll do that. Well, they come back six months later and nothing's gotten any better. So at that point now it's like well, mrs Jones, you know, we gave it a shot, it's just not working. And we really want to control that inflammation because it's having a bad effect on the rest of your body too, not just your mouth and teeth. And so you know, that's a it's a good time to just get them in the pair of trays. And so if that's something that our hygienist has seen. You know we've tried to do better home care. That's not working. Then I'll come in and say I'll confirm that yeah, it hasn't gotten better and I'll reconfirm the recommendation to go into a paratray treatment. And what we'll do is our hygienist isn't really good at scanning, but my assistants are. My assistant will bring the scanner over, one of my assistants will scan the mouth. That just goes to peritray and, like Tanya's saying, in a week we get the trays back.
Dr. Mike Miyasaki:When the trays come back, the patient's usually scheduled for the delivery. We give them the instructions on how to use a tray, what not to do. Don't leave them in heat, you know, we don't want them to warp or anything like that. We show them a video of how to use the trays and we go through that with the patient. They try the trays in and I usually don't even have to see the patient.
Dr. Mike Miyasaki:My assistant will go through everything, answer all the questions and then we let the patient go and the patient will come back, usually at the next hygiene visit, and they'll bring the trays just so we can be sure that everything's, you know, good with them. Everything's working, it's comfortable, they don't have any questions, and so it is really easy minimal amount of doctor time but, I think, maximum amount of effect. Because if the patient just uses the trays and their home care doesn't really improve, they're going to have healthier gums. And so I think that's the important part is we, you know, we're looking at trying to keep the cost reasonable to the patient, but it's almost invaluable, right, if they come and they spend, you know, a thousand dollars, let's say, for these trays, and they're healthier and their blood pressure is better and their blood sugar is better, I mean that's kind of priceless. So, and I think the significant other waking up and there's no morning breath, that's priceless too. So, so, Tanya.
Garrett:I have a question to jump in before I forget, two questions actually. First question is what if the doctor doesn't have a scanner? And is it impression-based? No problem?
Tanya Dunlap, PhD:You can take an impression. Don't make sure you use plastic, because we throw it into CT scanner and we digitize everything You're going to digitize it, so you're going to scan it.
Garrett:Insurance-supported doctor-prescribed yes or no?
Tanya Dunlap, PhD:Yes, there are two insurance codes, one for the upper arch, one for the lower arch. Those four numbers are 5995 and 5996. However, they're not well covered.
Garrett:Okay, delta Dental, for example. Can you talk a little bit about that?
Tanya Dunlap, PhD:Delta Dental, delta PPO to my knowledge has never covered this. Delta Premier covers pretty well. If you are still grandfathered into Delta Premier like I mean we're here in $450 a tray in California. Unitedhealthcare in California has done well more recently and we're you know we work with the VA. So there are Blue Cross. Blue Shield has a couple of plans out east that they do business as other names. They cover sometimes at $350 a tray, but usually patients' benefits are exhausted pretty quickly.
Garrett:So we so like you're an independent of insurance. So now if you have a patient that wants this pair of tray, you can prescribe that and they can get up to $450 of that $750 to $1,200 covered back, which I think is fantastic. And it's not always the case, especially with something that's a product like this, that's potentially not recognized industry-wide at this point. But do you see that expanding? Because we have a large percentage of our doctors, obviously in this country, still driven by I say unfortunately, but still hopefully not much longer insurance-based, driven by insurance based recapitation, and so the patients are expecting everything's for free once I have a dental insurance.
Dr. Mike Miyasaki:So yeah, you know, I think. Well, I think it goes back to the value statement that I think you know. I think the costs relative. So these trays are going to last five years and let's say, let's say you do get some benefits from insurance and the trays 750 and and you get 450 of it covered.
Dr. Mike Miyasaki:That's 300 and for the last five years, yeah, 60 a year, right for the pain from the patient side, so, um, but you know it could mean that they live longer, so they might have to save more, um, but that they could have, you know, able to get closer to the ones you love.
Tanya Dunlap, PhD:Right like you're, you're those people who offend you by their smell. Right, you know them.
Garrett:This is a huge quality of life improvement yeah, I kind of have a rule, at least in my world anything under 1200 that can deliver this kind of benefit and the profitability for the practice when you're doing something great for the patient and you have great revenue for the practice should be incorporated right away. We're always looking for how do we get new patients and how do I improve my marketing and how do I do all these things to create new business rather than working on the clients or the patients that we have now and doing a better job with those patients and creating those revenue opportunities and a great opportunity for the patient to be healthier and get better services from the practice. This fits right into that niche.
Tanya Dunlap, PhD:You know it's hard to understand how excited offices get when they see their first couple of patients come back, because we show you in our training programs before and afters and what you can expect. But when it's your patient and this person's been coming in for years and they're struggling and they always have 40 to 50 bleeding points or whatever it is, and now we're down to like one or two, you know, sometimes I mean the stories are people jumping out of chairs giving each other high fives and it's just. It's such a good experience and it builds a lot of trust with your patient base also. You can help so many people.
Garrett:Great, great. So we need to get Tanya to come over to one of our study groups next year. If she's in town, tanya, where are you located?
Tanya Dunlap, PhD:I'm in St Louis. That's where home is.
Garrett:St Louis, near Dr Jack Griffin.
Tanya Dunlap, PhD:Yes, actually yeah, not far about 25 minutes from him.
Garrett:Do you know, jack?
Tanya Dunlap, PhD:I do, I know him, great guy, great guy.
Garrett:He was just out teaching a program with us here, but great. Well, we'll definitely have to have Mike include this in the lectures for the hands, on course, to talk about this a little bit more next year.
Tanya Dunlap, PhD:Yeah, hands on. If you've got scanners, you should incorporate all that, or send your scans early and we can send trays. You guys can deliver them there and check them out. That would be fun.
Garrett:I love it, you're sold. Huh, I'm sold, I'm going to get. I guess, when I come by hygiene, my hygiene is going to be now a little bit more expensive at Dr Mieslacki's office, cause I'm going to get a. Say, I think I only had three bleeding points last time, though.
Tanya Dunlap, PhD:Oh well, that's pretty good.
Garrett:Unless she's lying to.
Dr. Mike Miyasaki:they might just be making me feel good, though, so yeah everything is all good, but you know, everything can always be better. Like Tanya is saying, we strive for zero.
Garrett:Yeah, for sure. I love the whitening benefits and I love the whole concept of something that's, you know, perio're going to scale again and again. If this can help with that, I think it's right away. Right there, patients are going to jump in on this.
Tanya Dunlap, PhD:Yeah, you know what patients are like, though. They get that first scaling appointment and they think they're done forever.
Tanya Dunlap, PhD:So, it is important to tell them. We prescribe PerioProtect and it is prescription home care right. It's cleared by FDA as a prescription medical device, so we prescribe PerioProtect and it is prescription home care right. It's cleared by FDA as a prescription medical device. So we prescribe PerioProtect so that you won't have to do this and repeat it in the next two to three years. You don't want to promise them they're never going to have to do it, but honestly, a lot of people can't. They keep up with their maintenance. They don't need nearly as much repetitive scaling, if any sometimes.
Garrett:Well, the first time you get a chest pain, you say I wonder if I should go jogging right now. So the first time you get scaling, you're pretty much open to anything.
Dr. Mike Miyasaki:That means you have to come back again so I'm glad I've had a great time, uh, talking with both of you today and the cats the cats were cute there, the um. Now I just want to say thank you very much for your time and to go through the benefits of the PriorProtect protocols with the Paratrays, and I think they are. They're you know, they're minimally invasive. It's just a great way to keep our patients healthier and so it's good for the patient. And on the practice side, you know we do get some revenue from the hygiene side of our practices, which is a good thing in today's economy. So it really is win-win and very affordable as, as Garrett mentioned, everybody should be implemented into their practices.
Dr. Mike Miyasaki:And just think if you, if you had an average practice today is what about 1400 active patients?
Dr. Mike Miyasaki:And if 80% of those need to get get into these trays and you were making $500 a tray, you're adding almost three quarters of a million dollars of revenue to your practice just by scanning and delivering the trays. And I think it. You know that's the important side from the business perspective and Garrett and I have been trying to get the doctors to think about the business side of the practice. But as a clinician, you know we don't do it necessarily for the money. We do it for our patients' health and what's better for them. So I think you're both right. At today's fees, a set of trays is what like maybe half a mouth of SRPs, and this is a lot more comfortable than that and it's something that will keep your whole body healthier, because you know, face it, those patients that get the SRPs usually don't have the best hygiene even after they've gone through that pleasant experience. So this is just an easy way to help them avoid that again and to keep them healthy.
Tanya Dunlap, PhD:So we try to tell the patients right, or teach the teams to tell the patients, like we know you're trying at home your toothbrush can't get deep enough. It's not your fault, it really isn't their fault. They might not be flossing, but even if they had great technique, it's not going to go deeper than three millimeters.
Garrett:Yeah. So this, it's a way to like empathize with them and be there with them as they make these tough choices, because it is emotionally charged, tanya, where's the best place for doctors to go first to look?
Tanya Dunlap, PhD:into this. So paraprotectcom slash for you has just a ton of information. But you can also, once you get there, ask for somebody to reach out directly to you and you'll get full information.
Dr. Mike Miyasaki:Okay great and Tanya brought up a good point, that. So the depth, you know when cause. You're absolutely right. When I'm talking to patients and they've got gum disease, I tell them are you brushing and flossing? And they go yeah, I'm brushing and flossing, I go. Okay, you know, even if you have the best technique, you're probably getting down two or three millimeters, but you know you've got this five or six millimeter pocket and that's why these peritrays are so important, because a peritray will get the hydrogen gel. How deep.
Tanya Dunlap, PhD:Nine millimeters.
Dr. Mike Miyasaki:Wow, nine Wow.
Tanya Dunlap, PhD:But I mean, if you've got nine millimeter pockets, you might have granulominous tissue that still would require some surgery, right? So I, we it's home care, but it is great home care.
Dr. Mike Miyasaki:Yeah, so the potential's there. I mean, if we can get the hydroperoxide nine millimeters. Hopefully we're catching this earlier, before we get that heat, Exactly yeah.
Dr. Mike Miyasaki:But I mean, I think that's the benefit. You know, we've got that patient just even with the four millimeter pocket, and a lot of our patients have those and they brush and floss and they're not getting down to that bottom of that four so that bacteria is just colonizing down there, becoming that biofilm that we can't disrupt, and things just kind of start going south from that and especially with the dental implant down there now it gets even more difficult. So what's the answer? Paratrays, it helps a lot of people. Just want to say thank you again to garrett. It's always good to have garrett andanya, it's been great having you on this interview.
Tanya Dunlap, PhD:Thank you both yeah.
Dr. Mike Miyasaki:Love the information and I hope everybody looks into the ParaProtect protocols and implementing the Paratrays We've been doing in our office and, as Tanya is saying, our patients love it and our team. They all have their Paratrays and they all love it, so it makes it an easier way to serve our patients.
Garrett:All right, thank you, thank you, tanya Great information. Thank you so much for taking the time today.
Tanya Dunlap, PhD:Thank you for your interest. I really appreciate it.
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