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Dentistry/gum disease


QUESTION: Thank you for allowing me to ask you a question. I have gum disease and was diagnosed approx 10 yrs a go. I have managed to keep on top of my strict cleaning routine and have no tooth loss since my diagnosis. I have regular check ups and cleaning, i no longer see a periodontist which i did initially as it became to expensive. I see a private dentist who has done a lot of cosmetic work on my upper teeth of which I am pleased, my upper teeth are all bridged and crowned. My lower gums are well looked after by myself if anything I am quite obsessive with my cleaning routine. As i mentioned i have 6monthly check ups and cleaning by a hygienist. I have had a small swelling very low down on my lower gum (2 yrs ago) dentist gave me antibiotics and said if it goes away but returns it would need rct. It returned about 3months ago so I went to see dentist had xrays exam but as the teeth were not paining in any way I was told it was best to monitor it as it seemed to be more of a gum problem not a abscess. this was same dental practice (different dentist). I went for my 6monthly check up yesterday (3months since the last visit with the gum problem) but this time with my regular dentist. My dentist looked at the area and said it was more of a hard bone swelling and not an abscess he did not mention anything about rct (which he had suggested 2yrs previous)??? if this swelling returned??? i was just relieved that it was not a abscess. Then my dentist followed out my routine check up and said that the tooth directly above the swelling which had now been checked twice in 3months by 2 dentists has a 5mm pocket.   I asked if this was what was causing the swelling? and I also asked why it was now noticed on the last 2 examinations, but did not really get an answer. My dentist suggested that I go straight to the hygienist for a deep clean on that particular tooth. I had this done apparently with Chlorexadine?? I was made another check up appointment for November so does this mean that the 5mm pocket will now reduce or close or is there something i should be doing to help, or is this the end of this tooths life??? just feel left without knowing what to expect, your opinion would be immensely appreciated, kind regards genny x

ANSWER: Hi Genny and thanks for your question.

Knowing that you have periodontal disease, in my opinion, warrants a full perio probe charting of all your teeth at each recall appointment in order to identify and treat any suspicious areas as early as possible.  a pocket of 5mm is not the end of the world and easily treated if the pathology is only local, but if left unmanaged, could escalate to greater problems for you.  The prognosis of proper root planing and irrigation of the pocket is good, but should be monitored every 3 months to evaluate the success of the treatment executed.

For this reason, I feel it is crucial for you consider being regularly managed under the care of a reputable periodontist - I know it is expensive but the benefits far out-weigh the financial inconvenience.  Think of it as an investment into your health and well being, especially knowing that there is link between periodontal disease and the development of heart disease.  I mention this not to scare you but to emphasize the importance of oral health and the value of having the peace of mind that you are doing the best you can in order to keep your perio under complete control.

Also, the lower tooth which presented with swelling concerns me because if it was a bony swelling, how did the course of antibiotics cause it to reduce in size, only to recur some time later?  There definitively sounds like some infection is present there - either from a non-vital or dead tooth or as a result of your perio disease, possibly an endo-perio lesion or a perio-endo lesion.  This needs to be fully evaluated and all the surrounding teeth tested for vitality - ie. cold, hot and thermal testing to cold, hot and thermal reactivity.  The fact that there was no pain is not of much use in diagnosis, especially if the tooth is already non-vital and has been for some time - you mention 2 years - or if the pus is finding a route to drain from the area, which prevents excessive pressure build up and hence pain.  And a perio pocket would definitely facilitate the ease of pus drainage.  Get this problem proper diagnosed and treated effectively.

I hope this helps and wish you all the very best in resolving your dilemma and for the future in general, take care.

Kind regards
Dr Craig Peck

---------- FOLLOW-UP ----------

QUESTION: thank you for very much valued advice. I am in a awkward situation there are NO periodontists within easy reach of me. The last one I had was when I lived down South. I now live in a very extended rural area, lucky to have a dentist really. I will bring my appointment forward to get this pocket checked out again ASAP. Could i ask you what i can do on a daily basis to keep my teeth and gums as healthy as possible, I already eat a healthy diet and exercise, if its down to my cleaning regime I can't do any more. Do you think the pocket will reduce from the deep clean? and should I ask for deep cleaning sessions for all my pockets on a regular basis?as most of the time all they clean deeply is my 2 bottom front teeth which seem to get badly stained,my teeth are so sensitive I need to be numbed for every little thing as my roots are very exposed due to gum recession. Could I ask in your opinion if the new laser treatment advertised on the web is actually true to work?? thank you once again genny x

Hi Genny

A very beneficial tool especially for perio disease, is called a water-pick, which most pharmacies stock.  Use this in addition to flossing as the water jet enables good rinsing and flushing of the perio sulcus and pocket areas.  For extra benefit, you could dilute some antibacterial mouthwash such as Corsodyl or Eludril into the water of the pick and use as described.  

It is impossible for me to tell you what the prognosis of any proposed treatment is going to be because every situation is unique but a deep cleaning, or root planing, of the area is a good place to start and the prognosis then evaluated for success and monitored regularly for improvement or deterioration.

There are various laser treatments available, but most of these are quite pricey, although very effective - if done properly and for the right reasons.  If you do consider this approach, first locate a periodontist and then discuss which option works best in his or her hands.

I hope this helps you, take care.

Kind regards
Dr Craig Peck


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Dr Craig W Peck ( B.Med.Sc., B.Ch.D., Clin. Botox, Cosmet. Derm.)


I am a General Dental Practitioner, with special interests in Cosmetic Dentistry & facial aesthetics and Periodontology, placing a strong emphasis on the establishment and maintenance of a healthy periodontium (the support structure of the tooth) before cosmetic options are considered. I uphold all principles of prevention above interventional treatment and try as far as possible, to remain conservative in my approach. I believe in detailed, open and honest patient discussion, establishing what the patients expectations are and what the reality is of achieving this and involving the patient at every level of the treatment. I have strong principles on ethical treatment and appropriate patient management. I have chosen to treat and rehabilitate many nervous and phobic patients, who, for whatever reason, find it impossible to take part in the very important task of even a routine check-up. I will accept questions relating to general and cosmetic dentistry (in conjunction with the use of facial cosmetic procedures) and dental fears/phobias. I will be more than willing to answer any academic questions in dentistry, biology, physiology, psychology and health sciences in general. As most dentists will tell you, there is often not only one way of dealing with a dental issue - so very often, there is no precise right and wrong way of approaching the problem. All clinicians vary when it comes to treatments and what works best in their hands is often the treatment that is advised. Be understanding of this and bear in mind that nothing lasts forever! Patients are happy to accept only a one-years warrantee when buying a new car, but seem to expect that dental work is going to last them their lifetime.


I have worked for many years in the UK and RSA as a general dental practitioner - within the NHS, private practice and the government dental health services. I am certificated for the administration of Botox and Dermal Fillers for facial lines and wrinkles as I have attended further courses in minimally invasive facial cosmetic procedures. I started seeing an increasing number of patients who presented with severe to moderate dental fears, even with full-blown phobias, so I started with the slow and patient task of tackling this problem and have successfully rehabilitated many patients. The key is good, effective, concise and understandable communication, shifting control from the dentist to the patient in order to slowly, but confidently, regain their trust back in dentistry, thereby giving them the feeling of achievement and this self-empowerment which drives them to the next level of treatment.

Academy of General Dentistry. American Dental Education Association. IAPAM (International Association for Physicians in Aesthetic Medicine). Professional Speakers, Writers and Managements Consultants in Dentistry. The British Dental Association. UK Aesthetics Group. ARC - Aesthetic Professionals. Botox. Aesthetics & Beauty. American Association for Dental Research. FDI - World Dental Federation. SOURCE1uk. World Dental Hygiene Forum. ProDentalCPD. Public Health Dentistry. Dentist Network. LinkedIn. Who's Who of South Africa.

B.Med.Sc. Degree (Medical Physiology and Medical Virology; Physiology Cum Laude; Stell 1994). B.Ch.D. Degree (Bachelor of Dental Surgery; Clinical Dentistry Cum Laude; Stell 1997). CPR and CPR-Advanced Courses (2000/2001; UK). Clinical Botox (UK, 2001). Cosmetic Dermatology (Botox and Dermal Fillers; RSA 2011).

Awards and Honors
Placed on the Dean's List at University for academic achievement (1994). Highest achievement in the subject Dental Materials. Medal from 3M and the Radiology Association of South Africa for highest achievement in the subject Dental Radiology and Imaging. Medal from The Periodontal Association of South Africa for highest achievement in the subject Periodontology. Highest achievement for Oral Medicine. Highest achievement in Oral Pathology. Received the DASA (Dental Ass. of South Africa) Gold Medal for highest achieving dental student across the 5 1/2 years of the Degree. Passed the subject, Clinical Dentistry with distinction in final year.

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