Periodontal Disease Treatment: Expert Insights and Options

Questions related to periodontal disease treatment?

Five to six years ago, I underwent orthodontic treatment and had bone screws placed.
This year, I was diagnosed with moderate to severe periodontal disease throughout my mouth, and there is a family history of periodontal disease.
An X-ray of my lower right molar shows that the alveolar bone has eroded down to the root of the tooth.
The inflammation is severe, and the tooth is very loose.
I consulted two doctors: Doctor A recommended that I first undergo periodontal therapy, combined with medication and laser treatment, and extract the molar.
Depending on the situation, I would then enter the second phase of periodontal treatment and proceed with dental implants, as the alveolar bone erosion is close to the nerve, and further deterioration could lead to cellulitis or affect other parts of the body, posing a risk.
Doctor B, on the other hand, determined that the cause of my condition was improper orthodontics combined with genetics, and he advised against any treatment, even scaling below the gum line.
He expressed concerns that this would remove the protective layer above the root, and the accompanying laser treatment could harm the gums.
Post-operative tooth sensitivity and loss of protection could lead to acute recurrence, and I might regret spending money on this in a few years.
He only administered a type of ointment (which seemed to be an antibiotic gel, priced at about $1,000 per tooth), prescribed antibiotics, and advised me to minimize inflammatory responses (such as avoiding staying up late and not eating spicy, fried, or sweet foods), enhance oral hygiene, and have dental cleanings every three months.
He suggested waiting for the teeth to loosen and fall out before considering implants, estimating that I could manage for another five to ten years.
The recommendations from the two doctors are completely different.
My personal stance is to preserve my natural teeth for as long as possible and to ensure that any future implants are successful and long-lasting (as I have learned that I will eventually need implants).
Therefore, my questions are: (1) In the long term, if periodontal treatment successfully reduces the depth of the pockets in cases of severe periodontal disease, how much longer can the lifespan of the teeth be extended? (2) What is the medical perspective on Doctor B's claims that these treatment methods could harm the gums and have severe side effects? (3) Considering the future need for implants and overall health, it seems necessary to reduce inflammatory responses and eliminate bacteria deep in the gums.
What is the effectiveness of these treatments? Is it really possible to improve inflammatory responses and control the condition solely through the lifestyle changes recommended by Doctor B? (I have been following Doctor B's advice for three months, and he mentioned that the looseness of the lower right molar and other teeth has significantly improved.) Thank you, Doctor, for taking the time to answer my questions, and I wish you all the best.

Miss Hsu, 20~29 year old female. Ask Date: 2022/11/02

Dr. Zeng Guanghui reply Dentistry

1.
The treatment for periodontal disease primarily involves the thorough removal of dental plaque and calculus from the tooth roots and the surrounding periodontal pockets, with the aim of reducing the depth of these pockets.
Traditionally, in addition to regular dental cleanings, patients are advised to follow the dentist's instructions for proper oral hygiene and may require root planing to thoroughly clean the root surfaces.
If the treatment is effective, the depth of the periodontal pockets will naturally decrease.
2.
Root planing, when performed in a sterile oral environment, does not typically result in serious side effects such as infections.
Removing the granulation tissue within the gums aids in reducing the depth of the periodontal pockets.
3.
As long as proper oral hygiene is maintained and root planing is performed on deep periodontal pockets, most adverse reactions should be reduced, leading to improved periodontal health.
Dr.
Tseng Kwang-Hui, Department of Dentistry, Nantou Hospital.

Reply Date: 2022/11/02

More Info

Understanding periodontal disease treatment is crucial for maintaining oral health, especially for individuals with a history of dental issues or genetic predispositions. Your situation, characterized by moderate to severe periodontal disease and significant bone loss around your teeth, requires careful consideration of treatment options.
1. Longevity of Teeth with Periodontal Treatment:
When it comes to the longevity of teeth after periodontal treatment, studies suggest that effective management of periodontal disease can significantly extend the lifespan of affected teeth. The primary goal of periodontal therapy is to reduce the depth of periodontal pockets, which are spaces that form between the teeth and gums due to inflammation and infection. Successful treatment can lead to a reduction in pocket depth, improved attachment levels, and overall stabilization of the teeth.
In cases of moderate to severe periodontal disease, if treatment is initiated promptly and followed by regular maintenance, patients can expect to retain their natural teeth for several years, often extending beyond a decade. However, the exact duration varies based on individual factors such as oral hygiene practices, the extent of bone loss, and the presence of systemic conditions (like diabetes) that may affect healing and inflammation.

2. Concerns About Treatment Side Effects:
Regarding the concerns raised by Dr. B about potential harm to the gums from treatments like scaling and root planing, it is essential to understand that while there can be temporary sensitivity and discomfort post-treatment, these procedures are designed to remove plaque and calculus that contribute to periodontal disease. The risk of damaging the protective layer of the tooth root is minimal when performed by a skilled practitioner.
Laser therapy, when used appropriately, can enhance the effectiveness of traditional treatments by targeting bacteria and promoting healing with less discomfort. However, the choice of treatment should be tailored to the individual’s specific condition and needs. It is advisable to discuss these concerns with your dental professional to ensure that you are comfortable with the proposed treatment plan.

3. Importance of Comprehensive Treatment:
Your inclination to maintain your natural teeth as long as possible is commendable. While lifestyle changes, such as improving oral hygiene and dietary adjustments, can help manage inflammation and support overall health, they are often not sufficient on their own to control advanced periodontal disease.
The combination of professional treatment and personal care is crucial. Periodontal therapy not only addresses existing infections but also helps to create an environment that is less conducive to future disease. Regular cleanings and follow-up appointments are essential components of this strategy.
In summary, while Dr. B's approach emphasizes conservative management, it is important to balance this with the need for active treatment to address the current state of your periodontal health. If you are experiencing improvement under Dr. B’s guidance, it may be beneficial to continue monitoring your condition closely. However, if the situation does not stabilize or worsens, seeking a second opinion or considering Dr. A’s more aggressive treatment plan may be warranted.

Ultimately, the decision should be made collaboratively with your dental care team, taking into account your preferences, the severity of your condition, and the potential risks and benefits of each treatment option. Regular communication with your healthcare providers and adherence to their recommendations will be key to achieving the best possible outcome for your dental health.

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