Ep 164: The Power of PerioStōm

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Dr. John Meis (00:01.364)
Hey everybody, welcome to this episode of The Double Your Production Podcast. I'm Dr. John Meis here with my partner, Wendy Briggs. Hey, Wendy.

Wendy Briggs (00:09.186)
Hey, Dr. John, how's everything?

Everything is fantastic and getting better.

Good, good.

So we're so excited to be talking about the topic today. Our topic today is really the most modern advances in periodontal care. with the, we can all feel that progress is getting faster and faster as the technologies of today are building the technologies of tomorrow faster and faster products. It's really amazing. It's really hard to keep up with everything. And that's one of the things that we love to do on this podcast is, you know, kind of go to the forefront of what's out there, not what maybe so much about what's coming, but what's out there and real and working in practices.

Yes. And so today I'm super excited that we have an amazing guest with us, Ellen Myers, and we're going to be talking about one of those innovative technologies that's making a difference in dental practices all across America. And I was just asked to speak on this topic actually at Thrive Live that just happened. It's a big event in Las Vegas sponsored by Henry Schein every year. And the topic they asked me to talk about was navigating the next generation of both preventive and periodontal therapies. And one of the products that I featured very heavily in that content is who Ellen is here to talk about with us today. So we're super excited to have you here on the podcast, Ellen. Welcome.

Ellen Myers (01:29.28)
Thank you. Thanks for having me. I'm excited to be here.

Yeah, so I'll dig in just a little bit and talk about my, I guess, discovery of what we're going to be talking about here today. Really began about a year ago when I was doing research for an advanced periodontal course that we offer to our members. And on this course, the whole idea was to talk about four innovations in periodontal therapy. And one of them that I came across was really compelling research about the use of Chitosan in periodontal therapy.

And this was something that was new to me. It wasn't on my radar. And so when I started to dig into the research about Chitosan, I got really excited about it, learned from a few friends and colleagues about forward science and the fact that they had taken Chitosan and created a product that was being used and as FDA approved and all of those things for use in periodontal therapy. So that's what we're here to talk about. That product is called PerioStom.

So Ellen, can you just give our listeners maybe a quick overview of why Chitosan is such an exciting thing to use in periodontal therapy, maybe some of the research things, and then we'll get into like how they use it.

Sure. so Chitosan is the second most common naturally derived polymer, and it's produced through the de-isolation of chitin. So it's a biocompatible polymer, and that allows us to use it in many different applications. So it's been used in medicine since the 1950s. We've kind of taken this technology and innovated it to use it in this application in dentistry.

So, what's unique about Chitosan is it's almost like the Swiss army knife. It has all these inherent properties. So most notably when we're talking about periodontal care, the things that we like to highlight about Chitosan is that it's naturally antimicrobial. So we're not contributing to antibacterial resistance through antibiotics, which is something really, really important now as patients are considering more and more what they're putting in their bodies. It is naturally anti-biofilm, which we know like, hey, step one, if we can prevent that biofilm formation, that's a great first step to gum health.

And then it's naturally anti-inflammatory. So being able to independently affect inflammation, which we all know is another buzzword, something we're hearing a lot about, know, oral systemic health, how much inflammation plays a role in that, is what makes it this really unique product to have and use in PerioStom.

Yeah, super fascinating. And you know, for a long time, we thought that periodontal disease was caused by the presence of calculus, right? So for many of us, they've been in the trenches any number of times. That's what we were taught, that it was caused by the presence of calculus. Well, now we know that's not necessarily true. We know that periodontal disease is classified and peri-implantitis as a biofilm infection, a chronic biofilm disease. And what that means is our approach has to shift in how we actually treat it.

You know, too many practices are still just relying heavily on scaling and root planing without any ancillary or auxiliary services to help us treat this disease. And so an analogy that I'll often use in these courses is unless we're doing something to minimize biofilm growth, reduce bacterial load as part of our scaling and root planning, scaling and root planning is just not enough with everything that we now know about the disease.

It's almost like taking a lawn that's infested with weeds and mowing it, only mowing it, and expecting it to get better. That's not gonna make progress for very long, right? Dr. John, I mean, I'm sure you've probably had a lawn that you've mowed once and then what happens a few years later?

Mm-hmm.

That was my first job with mowing lawns. I've mowed a lot of lawns in my day. And that's a great analogy, Wendy, because the more we know, the more we can adjust our therapies to be more effective.

Right? Yeah, so we've got to treat the infestation. We've got to address the bacteria, we've got to address the biofilm. We've got to help the body fight that inflammation, right? And so that's what some of these ancillary products can do. We teach lasers in conductive scaling and root planing. We teach other things to decontaminate the pocket, address biofilm, influence the biofilm, treat the smear layer with any type of infection in the body.

We remove the source of the infection, but then we actually treat it with something. And as you mentioned, Ellen, over the years, the best thing we've had up till now is antibiotics. But there's a lot of research telling us we need to be more aware and a little bit more cautious with overuse of those antibiotics because we're seeing the emergence of these strains of bacteria that are tolerant and resistant and really become a challenge in treating our patients that have this chronic biofilm disease.

So, that's what I love about the emergence of this research and the ability to use PerioStom because it helps us do more than just mow the lawn, right? We're able to use products and services that can really help our patients improve their health.

Yeah, for sure. Yeah. You bring up a good point too, you know, with the antibiotics and mentioning, you know, scaling and root planing alone is not enough. And, you know, looking at the patients comprehensively and what's going on with them. And I know we've all experienced this in our clinical careers. You have a patient that comes in, you do the scaling and root planing, they come back, they're doing their home care, they look great. And you may do the same thing for another patient. They come back, they're doing their home care and they don't. So there's that biologic variability that each patient is different.

And so just getting rid of that biofilm, getting rid of the calculus isn't enough. And then sometimes applying just an antibiotic isn't enough, right? So sometimes it's not necessarily even just the bacteria and getting rid of that, it's that host response, so that inflammatory response.

So having a product that can address three different things in one is not only a value to the patient, but also to the clinician, right? From a workflow perspective, applying one product that can address multiple different things, because this is a multifactorial disease, right?

You know, I think the other thing that is important to note here with this product that's unique also is it's FDA cleared as a wound dressing. So I also love the education that that allows us to surround with this of getting away from the fact that we know it's not just a number on a probe that tells us if gums are healthy or not, right? We know we're looking for other things. We've got inflammation, we've got bleeding, those things are yelling at us, something is going on. So it allows clinicians to really remember, let's take a step back, let's look at that whole picture and what all we need to address to get these patients stabilized.

Also being that it's FTA cleared as a wound dressing opens it up for broader applications for use. So it's not limited for use by any minimum or maximum probing depth. And that allows us to now have an opportunity to treat patients more proactively and preventatively. So again, we talked about when we've got a wound, our clinical indications are bleeding, inflammation. Why can I have bleeding and inflammation on a patient that doesn't necessarily have a four or five, a six millimeter probing depth, right? And it doesn't mean that it's okay. So why are we still waiting and watching for that to deteriorate when, you know, now we have innovations in technology that allow us, let's get on top of that earlier.

Very similar, you know, to other things we've got on the market, like one that I love, you know, Curadont, that allows us to decay more proactively. Let's not wait until it goes all the way through to the dentin and we need to do a filling. So, know, leaning into that is something that's really exciting that I'm seeing in our industry that I love and I think we all, you know, need to lean into.

Yeah, that's awesome. So I'm excited. I got the why. That sounds good. But sometimes it's the how where people get kind of stuck. So do you want to walk us through the typical use of PerioStom?

Sure. So PerioStom is administered by, it's a blunt stainless steel cannula. It is the same diameter as a curette. So we made it definitively the most narrow applicator on the market for a locally applied product. So it is intended to be site specific. We want to get right to the site that is of concern. So you apply it below the gum line in a pocket in the sulcus and it comes out as a powder. When it comes in contact with saliva, it turns into a bio adhesive gel. So very, very important when we're putting something in a wet slippery environment, we want it to stay where we put it.

So now we've got this wound and we've applied, think of it like a liquid band-aid after we've cleaned it up. So no different than like if I've got a splinter, I'm going to remove the splinter. I'm going to apply something that is going to clean that area. Maybe I'm going to irrigate it. You mentioned we are using lasers. It works beautifully with lasers. You can get that immediate bacterial reduction in the soft tissue. Then coat it with this liquid band-aid where then we are going to have those sustained benefits because it's bio-adhesive. It will slowly dissolve away with the saliva. Again, it's site-specific, so it's a lock-lure system. You twist the cartridge on, it's preloaded, remove the silicone tip, place it down in the sulcus, you depress the thumb ring. The dispenser itself is stainless steel. It's auto-clavable and reusable. The cartridges you dispose of, and you can apply more cartridges as needed to treat however many sites you need in the patient. And then like the patient doesn't have to come back to have it removed.

We try to say, don't manipulate those areas. We want it to stay there and the biggest thing with the manipulation is not so much inter proximal cleaning, especially if it's a deeper pocket where the floss can't get anyways, it's oral irrigation. If it's someone who uses a water pick, we want to say avoid that for about 10 days. We don't want to dilute that. We want the product to stay there as long as possible to reap those additional benefits.

I would add to that too, Ellen, you mentioned before this is not just for scaling and root planing. So the other locally administered products that have antibiotics, for example, you have to have a five millimeter pocket to be able to use this effectively in those sites. This is different. So if we have even a profy patient that has a hot spot around a crown or a localized area of inflammation, we can apply that very quickly and easily during their regular profy visit.

We can use it if we're doing a 4346 or a gingivitis cleaning, we can hit a few of the most troublesome sites with that. And another thing that I think is important for us to illustrate, the coding is the same. It's that localized delivery of a chemotherapeutic agent. That code is the same. So a 4381 type code. But the cost of the material is about half of what people are used to paying out of pocket for a similar product, right? And I think that's something that we need to highlight as well, simply because so many practices are feeling that squeeze to cash flow and profitability.

So it's nice to be able to say, we actually advise practices to charge the same fee that they already have established for other localized delivery products. But that reduced fee, the reduced cost for procuring PerioStom just helps with overall profitability, which so many are desperately in need of.

The patient still receives a powerful benefit, and the research, by the way, is really awesome. I've seen some amazing before-and-after cases of how they look so much better when they come back and the inflammation is controlled. Like you said, it disrupts the inflammatory pathways in the body. There's a lot of really amazing reasons why we're excited about PerioStom. But that answers your question too, Dr. John. We don't have to wait and only use it with scaling and root planing. It can be used seamlessly and frankly, almost invisibly from a time standpoint, you know, the time required is just to grab the product, set the cannula, insert it and go. Like that's it. It's super quick and easy to add to the workflow, which we love because if it's not in the workflow, it really doesn't exist.

Yeah.

Wendy, I really appreciate you bringing up the codes and the cost because I know those are things that are on everybody's mind. And, you know, it's so we know that with any code, some insurance companies are going to pay for it. Some aren't going to pay for it. But we also know that when patients understand the value, they choose to do things. So, Ellen, how do you recommend practices communicate with patients about the benefits?

Yeah, so a lot of times, you know... We're huge on education. I think the most important thing is educating the patients on what is going on. So I'm big on tell, show, do, right? So I'm going to tell you what I'm doing. I'm measuring your gums. I always tell my patients beforehand, hey, if you hear anything above a three, we'll talk about it at the end. But something else to highlight to them is, also, I'm going to call out areas that are bleeding. Bleeding indicates that there's infection present, that there's something going on here.

We'll also talk about that. So that's part of, know, kind of setting yourself up for, hey, I'm gonna let them know what to be listening for when I'm doing this. But then that opens up the door for the conversation afterwards to say, hey, so I told you to listen for these things and you heard me say a few of those things. Now we can walk into, well, what are we gonna do about it? And I think the wonderful thing with this is to Wendy's point that we don't have to wait until, you know, they've got bone loss to treat these areas.

And I think it's important for us to let our patients know if we wait, this can and will progress. It's not reversible. It's going to get worse, but we can if we intervene earlier. And this is something we now have available to us that allows us to do that. So I think a lot of us as clinicians get hung up on, my gosh, I've got a patient who I've been seeing for 10 years and I've never told them they needed anything. And now how do I address that?

What's wonderful with this is, "Hey, use the opportunity that now we've got technology that allows us to address this sooner," and lean into that. And that takes the onus off. Not that you're doing anything wrong as a clinician. We didn't have tools available to us before. So I think that's one piece.

I think the other thing is really presenting the value to the patient. So I've now got one product that addresses the three main causes of this disease of what's going on in your gums and that gives us a better chance of stabilizing and getting your gums healthy. So presenting, there's a lot of value in this one thing that I'm recommending and it's not just addressing one specific piece of that and that's another great way to lean into and get that case acceptance.

One of things that we've seen practices used pretty effectively is to just have a case fee for the periodontal care. And the case fee includes all the whatever codes. And so you're just saying to the patient, this is what you need. This is what it's going to cost. This is what insurance is likely to pay. And just leaving it at that without going into the detail, what would your thoughts be on that?

I love that. I'm all about like, let's automate, let's standardize, then let's raise the bar on our standard of care. I think as these new technologies come out, we've got to be taking advantage of that and leaning into it or we're behind, right? Like, you know, the whole premise of our profession is let's be proactive, let's be preventive. And when we have these things available to us to do that, we've got to incorporate them and take advantage because also that's part of that oath that we took to do right by our patients and including that is, you know, making them aware that we have all these things available to them. So I love that idea.

Yeah, and to your point, Ellen, one thing that I think is also important for us to understand, and we're trying to build value, all of the science and research about the oral systemic link, right? Having infection, bleeding, redness in the mouth is not simply putting the teeth at risk, right? We know that the bacteria can enter the bloodstream, ends the circulation, settles elsewhere in the body, on the heart valve, on organs. It can cause some serious harm, you know? And we don't have time to get into all of that today, but certainly that's one of things that we often talk about in our perio courses is all the science linking periodontal disease to other serious systemic health risks in the body.

And isn't it amazing? Like you said, that we now have resources that we can be proactive. When we first see the bleeding sites, when we first see the reticent inflammation, we can take action rather than waiting until there's more serious consequences and more serious challenges. And I think that's to your point too, Dr. John, the whole idea of having a case fee or this is the total investment for the first three months of care simplifies that for the patient.

Rather than having them get hung up on, well, if the insurance doesn't cover the debridement, then I don't want to do that part of it. That just creates a measure of complexity that nobody wants to deal with. And so I think part of the understanding of the value of PerioStom is it enables us, we always look for strategies that are a win for the patient, a win for the provider, and a win for the practice. And of course, proven by science, all those things are also important.

But when we find something like that, usually we end up talking about it, which is why we're having this podcast today, because I personally have seen in practices that we've worked with that are implementing PerioStom that it does satisfy those three things. It's the right thing to do for the patient. It's absolutely great for the provider because it doesn't disrupt the workflow. We know we're being proactive and providing solutions that matter. And the practice benefits too, as we mentioned, it helps us with that profitability threshold. more care, the more care we provide a patient, that's usually represented in our productivity.

This is one of the reasons why when I first discovered it over a year ago, I reached out to Forward Science and we started having these conversations and we've added it to our advanced courses and we teach it in perio because we believe it does fill a gap for a lot of practices out there. So we're super excited about the technology.

The one thing I will say is this is the most common question I get when I'm teaching about it, because it is derived from crab shells, there is a shellfish allergy contraindication. That's the only one that we know of at this point. And it's such a small fraction of your patient base that it really is a non-issue, but people do ask about it, right? So just be mindful if you have a patient with a shellfish allergy, you will not want to use PerioStom, but that's the only contraindication I know. Do you have any others, Ellen, that we should share with our listeners today?

No, we don't. And we often also get asked, can I use it in pregnant patients? Because we know with a lot of the other locally applied products, it's contraindicated because it's a tetracycline.

What I think is great about this is, we can ask those OB-GYNs. We know there are negative pregnancy outcomes for uncontrolled periodontal disease in pregnancy. So it's certainly worth asking. Pregnant nursing patients aren't eagerly signing up to be guinea pigs, but it's worth them asking and looking up. It's actually because it's naturally derived, it's considered a supplement. So the benefits may well outweigh the risk and it's worth having that conversation and that can potentially for those patients be another option for us.

Very, very good point. That's part of that oral systemic link we talk about. The thinking of we have to wait until the second trimester to treat anybody in pregnancy, that's old, outdated thinking. All oral care in every stage of pregnancy is recommended, especially if there's gingivitis inflammation, pregnancy gingivitis. We know that can actually lead to stillborn babies. So we want to be super mindful of that. Love that.

Yeah.

That is awesome. Ellen, I want to thank you so much for being with us today and bringing the latest and greatest. I can see so many advantages to this product. Easy to place, using skills you already have. It doesn't lead to bacterial resistance. Great for the patient. Fantastic. Thanks so much for being with us.

Thank you, thanks for having me.

Thanks again, Ellen.

That's it for this episode of The Double Your Production Podcast. We'll see you next time.

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Ep 164: The Power of PerioStōm

Ep 164: The Power of PerioStōm

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