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Question
This is in regard to a 82 F patient in overall good health but complaining of tooth/gum pain. However, she has not taken care of her teeth and gums. Amount of plaque built up since last cleaning (10 years prior) was unimaginable. A debridement was performed expecting to follow that with a deep cleaning. But when xrays were taken again after the debridement, numerous cavities were found. Could these have been hidden by the tartar and plaque? Now a wisdom tooth is loose. Could the debridement and xrays be the cause of the loose wisdom tooth? Fillings are expected to be done on the cavities. Sent to a periodontist for the deep cleaning but instead recommended gum surgery to clean the below the gum area by creating a flap. Patient is 82 and not desirous of surgery. Is gum surgery a good idea? Wouldn't the deep cleaning by general dentist be enough?

Answer
Dear Chris,

Without examining the patient it is hard to be certain on the answers to  all your questions, but it should be pointed out that many octegenarians can have a lapse in their oral hygiene and also have "dry mouth". This situation can lead to both periodontal disease and rampant root decay. That being said, your treatment  plan should take into consideration their medical conditions and overall health. If they are in good health( both physically and mentally) they may benefit from periosurgery, but most would benefit from a  simpler course of treatmen. Certainly, deep cleanings , using new or sharp curettes seems like a sensible plan.f I would follow up with some home care instruction and frequent cleanings (every three months). Considering that the patients last cleaning was 10 years prior, cleaning her teeth regularly and fixing her cavities, may be the way to go.

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Lawrence Spindel DDS, www.lspindeldds.com

Expertise

Cosmetic Dentistry, Endodontics, General Dentistry, Preventive Dentistry, Comprehensive Dental Care

Experience

Former Clinical Instructor of Comprehensive Dentistry, and Prosthodontic Department New York University School of Dentistry. Also former instructor of Preventive Dentistry Columbia University School of Dentistry.

Publications
Ask Dr Spindel Dental Blog also numerous articles on http://www.lspindeldds.com (over 100 pages of original content)

Education/Credentials
1980 DDS New York University College of Dentistry 1981 GPR Manhattan VA Hospital

Awards and Honors
OKU 1980 Honor Society 1980 Long Island Academy of Odontology award for highest combined Academic and Clinical Achievement.
In 1997 he was elected to Fellowship into the International Academy for Dental Facial Esthetics

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