Expert: Mark Bornfeld DDS - 1/31/2005

Question
If someone had root planning and scaling and after two months one quadrant is still redish and somewhat swollen (like before the procedure) how can surgury cure it? Is it red because of plaque, bacteria or someting else inside the gums that the procedure could not remove? Are there any other ways to rid it besides surgery? What about laser? Thanks

Answer
Dear Greg,

Inflammatory periodontal (gum) disease is indeed believed to result from the body's response to bacterial plaque. While there is significant variability from person to person in just how the gums will react to plaque, the way in which the tissue responds to plaque cannot be easily modulated. Because of this, almost all periodontal therapy has the aim of removing plaque and facilitating its removal by the patient.

The effectiveness of a patient's oral hygiene is paramount. There is very little benefit to root planing itself unless the patient implements an effective oral hygiene protocol: properly executed brushing, flossing, and any other techniques that the dentist deems appropriate to the specific conditions in a patient's mouth.

In the real world, however, many patients cannot or will not expend the effort that is required to effectively control their plaque on a daily basis. When the obstacle is failure to comply with a program, often the only appropriate treatment is to properly motivate the patient to do what is necessary. However, there are some anatomical features of the gums that often present an insurmountable obstacle to effective oral hygiene-- deep pockets. If the crevice between the gum and the root of a tooth is over 4 millimeters deep, it becomes increasingly difficult for even the well-intentioned patient to clean the root to the depth of this pocket. That is where surgery comes in.

Most periodontal surgery is intended to reduce the depth of the pockets between the root and the gum. By re-positioning the margin of the gum tissue further down the root, the pockets can be rendered sufficiently shallow so that they may be more readily cleaned by conventional oral hygiene methods. Most important is the fact that periodontal surgery merely facilitates oral hygiene and little else; this fact is often lost in all the commotion. Proper oral hygiene is the cornerstone of periodontal therapy, and all else will fail if this is not emphasized.

Of course, treatment must be customized to the specific needs of a patient. For example, periodontal surgery is of little use if the periodontal pockets are not deep. It may well be that better oral hygiene alone, or management of an underlying problem such as diabetes, may suffice to eradicate or control gum disease.

As for laser-- unfortunately, laser therapy is more flash than substance. There is nothing that a laser can do in dentistry that cannot be accomplished as well or better by more conventional methods, and at a significantly lower cost. Laser therapy is little more than a curiosity or a practice promotional device, and confers no additional benefit for the patient.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY