Periodontal Treatment: Addressing Pain and Confusion After Dental Procedures

Periodontal disease treatment

Hello, Dr.
Tseng.
I had an inlay/onlay/overlay placed a week ago, and during my follow-up visit today, I mentioned that the gums around my lower right first molar hurt when touched by my fingertip (accidentally while using dental floss).
However, there is no pain when I touch it with the pad of my finger or my pinky nail, and I don't experience any pain during normal chewing or eating.
When brushing, the bristles do cause a slight irritation, but it’s not painful, and there is no bleeding or swelling.
The dentist examined it and used instruments to probe, stating that everything seems fine and that it might just be static electricity from my finger.
They advised me not to touch the gums unnecessarily, but I still feel quite confused.
Does pain not indicate a problem?
Furthermore, the dentist initially mentioned that I could finish my treatment after one more cleaning today.
However, just a few weeks ago, they recommended a bone graft procedure for my lower left second premolar and first molar due to gum recession and a gap between the teeth.
Today, they said I could conclude my treatment.
I asked again about the treatment options, and the dentist suggested that I first undergo deep cleaning and then monitor the healing process.
If the recovery is not satisfactory, they would need to surgically open the gums to clean beneath and then suture it.
I later realized that the topic of the bone graft had seemingly disappeared.
Additionally, the lower left second molar, which was filled with silver amalgam, was previously said to possibly have secondary decay, but the dentist did not want to remove the amalgam to check.
I considered that if they did, it would require a new filling.
So, during my follow-up a week later, I asked if the X-rays taken during my initial visit two months ago could reveal any decay beneath the amalgam.
The dentist confirmed that it could and later stated that there was no decay in the lower left second molar.
I inquired about the slight black extension beyond the amalgam filling, which looked like decay (though I am not a professional), and the dentist explained that it was just staining from the amalgam.
This back-and-forth information has been inconsistent (for example, possibly having decay → no decay; needing treatment but initially saying the treatment was complete), which has caused me anxiety.
Therefore, I would like to seek a second opinion from another dental professional.
Is this normal? Additionally, what should the treatment for periodontal disease entail? Should the gums be incised to remove the calculus below, and then after healing, proceed with the bone graft? Or should it be one or the other, depending on the healing progress to decide if a bone graft is necessary? I understand that without seeing the actual teeth, it’s challenging to explain.
I have X-ray images, but I cannot upload files.
I apologize for the lengthy description and appreciate your time in reading this.
Thank you.

Lyn Chan, 30~39 year old female. Ask Date: 2021/03/12

Dr. Zeng Guanghui reply Dentistry

The initial treatment for periodontal disease begins with X-ray examinations to assess the condition of the alveolar bone around the teeth.
If periodontal disease or gingivitis is diagnosed, the first step is to perform scaling and provide oral hygiene education.
After a period of observation, it will be determined whether subgingival curettage is necessary.
In cases of severe bone loss, bone grafting procedures may be required.
It is advisable to discuss a detailed treatment plan with your dentist.
Dr.
Tseng Guang-Hui, Department of Dentistry, Nantou Hospital.

Reply Date: 2021/03/12

More Info

Hello! Thank you for sharing your detailed concerns regarding your recent dental treatments and the confusion surrounding your periodontal care. It’s understandable to feel anxious when receiving inconsistent information from dental professionals, especially when it involves pain and potential treatments. Let’s break down your situation and address your questions.

Firstly, regarding the pain you experience when your gums are touched by your finger, it’s important to note that some sensitivity can be normal after dental procedures, especially if there has been recent work done on the teeth or gums. The fact that you do not experience pain during regular chewing or brushing, and that there is no bleeding or swelling, suggests that there may not be a significant issue. However, if you continue to feel discomfort, it’s worth discussing further with your dentist to rule out any underlying problems, such as inflammation or infection.

As for the conflicting information regarding your treatment plan, this can sometimes happen in dental care due to the complexity of individual cases. Dentists often reassess the situation based on the healing progress and any new findings during follow-up visits. It’s not uncommon for a dentist to suggest a treatment plan that evolves over time as they gather more information about your dental health.
In your case, the recommendation for a deep cleaning followed by observation is a common approach in periodontal treatment. Deep cleaning (scaling and root planing) is intended to remove plaque and tartar buildup below the gum line, which can help reduce inflammation and promote healing. If the gums do not respond positively after this procedure, further interventions, such as flap surgery (where the gums are lifted to clean below the surface), may be necessary.

Regarding the potential need for bone grafting, this is typically considered when there is significant bone loss around the teeth, which can be assessed through clinical examination and X-rays. If your dentist has suggested this in the past, it may still be a consideration depending on how your gums heal after the deep cleaning. It’s essential to have a clear understanding of the timeline and the rationale behind each step of your treatment plan.
If you feel uncertain about the diagnosis or treatment plan, seeking a second opinion from another dental professional can provide clarity and reassurance. It’s crucial that you feel comfortable and confident in your treatment decisions.
In summary, your periodontal treatment should ideally follow a structured approach:
1. Initial Assessment: Evaluate the condition of your gums and teeth.

2. Deep Cleaning: Remove plaque and tartar to promote healing.

3. Observation: Monitor the healing process and assess the need for further treatment.

4. Further Interventions: If necessary, consider surgical options like flap surgery or bone grafting based on the healing response.

Remember, communication with your dental provider is key. Don’t hesitate to ask questions or express your concerns about your treatment plan. Your comfort and understanding are paramount in achieving the best outcomes for your dental health. Thank you for your patience, and I hope this information helps clarify your situation!

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