QUESTION: Hi Dr. Burdett,
I have been diagnosed with periodontal disease, I am 33 years old. I have read other questions about this subject and have found it helpful. The first dentist I went was Aspen dental, they said I had 4 to 5mm pockets, some bone loss, and loss tooth. There recommendation was pull all teeth and get dentures. This type of reaction was horrifying and put me in a depression. Fortunately, I went to another dentist to get a 2nd opinion, they were very helpful. This time they did a cleaning first, Aspen dental did not. The dentist was nice, said I had some 5 to 6mm pockets, and bone loss only. I have an appointment with their perio next week to do further testing and to see what types of procedures. My question is should I have root and scaling done first, then see if my pockets come back up? Also when does bone grafting come into play as a treatment as well as gum regeneration? And does laser surgery help with the disease? I am try to find all options to prolong my bone jaw, the dentist says I have very healthy teeth and upper gums, which is a surprise to them about the bone loss. Any information you give would be helpful. Thanks for your time.
ANSWER: Dear Kim,
I can't give you treatment advice because I can't exam you to see how advanced your periodontal disease is. But I will give you some advice which is intended to save your teeth and your money.
As you now know, dental over treatment is one of the dangers you must beware of. Not only from where you have been but also where you are about to go.
Periodontal disease is simply a bacterial infection. The object of treatment is to get the bacteria down to low enough numbers to where the bone holding in your teeth stops disappearing. Scaling, along with various ant-bacterial treatment, is the process whereby bacteria and all other contributing factors are removed from the root surfaces and pockets.
Pockets are not the disease. Pockets are just the damage caused by the disease. Your treatment should and will cause some shrinkage of the pockets to lower numbers. But pockets don't have to disappear for treatment to be successful. The aim of periodontal treatment is not to remove pockets. The aim of periodontal treatment is to stop the loss of bone which is holding your teeth in.
I wouldn't even think about periodontal surgery at least until conservative no-surgical treatment stops the progress of the disease as shown by comparison of x rays before and after treatment.
My advice to you would be to ask your present hygienist if he or she knows of a hygienist who does a lot of non-surgical periodontal treatment and have that hygienist treat you, at least initially.
Another choice is the periodontist you are about to see will probably suggest treatment in two stages. Stage one, deep thorough scaling with possible antibiotic treatment. Stage two will be surgery. This may consist of things you mentioned like gum regeneration, bone grafting, and many more possibilities of expensive, painful, and in my opinion medically unnecessary. None of this surgical treatment is likely to add to your retention and health of teeth after successful non-surgical treatment.
I would tell the specialist you will undergo stage one treatment, see if the disease has been halted, and then decide after at least a year if you want to go ahead with the surgical treatments.
My first choice would be to find a competent hygienist to diagnose and treat your condition. if it is too far advanced for her, she will refer you to a specialist who is in line with her conservative treatment philosophy.
I would really like to hear how you progress. Right now I think your fear will tempt you to undergo any treatment proposed. Statistically speaking, your condition is probably less serious than you think it is.
Please keep me posted on your progress.
Larry Burnett DDS
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QUESTION: Thank you so much for your reply, it has helped eased my fears a bit. I will to my best to keep you up with my progress. Instead, of going to a periodontitis the dental office has working for them, I have decided to find my own that I am comfortable with. I have found a Board Certified periodontitis, who teaches, and lectures throughout the country. I have done research on the periodontitis and am comfortable in seeing him, but extremely terrified at the same time. I shall keep you posted.
ANSWER: Most periodontists will be biased toward surgery. If the new one insists on surgery I would suggest trying to get a second opinion from a hygienist who is confident in treating you without surgery.
The competent periodontist will offer a plan which treats you in 2 stages. Stage 1, non surgical debridement(scaling and root planing followed by stage 2, surgery. A really good periodontist will offer stage one followed by evaluation over time. Then the decision will be made to add the surgery component of not. The problem is, even the best and well meaning periodontists can be influenced in the decision to procede with surgery or not. It has to do with financial incentives and often effect the judgement to to surgery or not. You can always refuse or delay stage 2 even though it is offered.
I repeat, a competent hygienist, especially one who is somewhat independent would be very helpful for you, even if you are under the care of a periodontist. Please keep me posted as you progress. I am interested in your outcome.
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QUESTION: The result is I have severe aggression periodontal disease. Almost every pocket in my teeth are 6mm and 7mm. I have one molar that is stage III for looseness. He might be able to save this one, because the pockets around it are not as deep. He gave me three options, option 1 scaling and rooting but with some pockets being so deep it might not help, option 2 was surgery with bone grafting, but the cost would go up higher with each bone graft, option 3 was LANAP surgery, he said was least cost effective compared to surgery with bone grafting. I have done research on LANAP surgery and it seems the best option in my case. Now the perio did not push me in any way, he said the option was mine. I still have more research to do on LANAP and on aggressive periodontal disease, but it have been confirmed that it is a hereditary case. It is not good news, but it is also not bad news. Again, thank you for your help and time.
The extent of the damage sounds worse than the 2 previous dentists. But it doesn't change my original advice.
This periodontist sounds quite reasonable and fair. However, if it were me or a family member I would choose to omit any surgery. There is no evidence to be found that surgery beyond thorough scaling and root planing (anti-infective) procedures would in anyway add to the lifetime retention of your teeth.
This latest description of your pocket depths and especially the looseness of that 1 molar, suggest this case is more advanced than what I discerned from your original messages. that is why I'm trying send you an informative article. Although it was written for dentists and dental hygienists, I think it will benefit you personally
The non-surgical aspect of your treatment should include cleaning with an ultrasonic instrument and in your case systemic antibiotics. I will attempt to attach a link to an article I wrote about about ultrasonics for advanced periodontal diseases.
It is for you to read and learn about treatment. Then you might approach the periodontist to discuss points in the article that should affect your treatment. If he asks, give him a copy of the article. I would be glad to discuss it with him if he would like.
I want you to know that in the end, I will consider his advice superior to mine because he can see and examine you individually and I can't. Furthermore everything he has said and done for you thus far sounds as though you are in a good office. He is a specialist with advanced training and I am not.
If you can't access the article, let me know and I will find a way to get it to you.
And please keep me posted of your progress.
Larry Burnett DDS