Periodontal Disease: When Is Surgery Necessary?

Q: Periodontal Disease: When Is Surgery Necessary?

Hello： Generally, a dentist will perform root planing only when there are deeper periodontal pockets present. <br>The purpose of root planing is to assist patients in cleaning the roots of their teeth, so the primary focus of periodontal disease treatment remains on cleaning. <br

Please inquire about the severity of periodontal disease!

Dear Dr.
Chuang,
Recently, I discussed dental issues with friends, and one of them mentioned undergoing long-term treatment for periodontal disease, which involved anesthesia and a procedure called root planing.
I was previously informed by my dentist that I showed symptoms of periodontal disease, but I was only advised to have regular cleanings, use dental floss, and brush after meals, without any further treatment recommendations.

I would like to ask at what stage or what symptoms (such as tooth mobility) indicate that surgical intervention with scaling is necessary for periodontal disease? In my case, does this suggest that I am only experiencing early symptoms of periodontal disease, such as calculus and gingivitis, and not yet periodontitis? I would appreciate your explanation and advice.
Thank you.

A-Hong, 30~39 year old female. Ask Date: 2013/04/27

Dr. Zhuang Suhui reply Dentistry

Hello: Generally, a dentist will perform root planing only when there are deeper periodontal pockets present.
The purpose of root planing is to assist patients in cleaning the roots of their teeth, so the primary focus of periodontal disease treatment remains on cleaning.
Perhaps your periodontal condition is not too severe, and the dentist believes that simply removing the calculus is sufficient, allowing you to maintain your own oral hygiene.
Therefore, no further treatment was provided.
If you still have concerns, you may consider consulting a periodontist for their opinion.

Reply Date: 2013/04/27

More Info

Understanding periodontal disease and when surgery becomes necessary is crucial for maintaining oral health. Periodontal disease, which includes gingivitis and periodontitis, is an inflammatory condition affecting the supporting structures of the teeth, including the gums and bone. The progression of this disease can lead to tooth mobility and eventual tooth loss if not properly managed.

When is Surgery Necessary?
Surgery is generally considered when non-surgical treatments, such as scaling and root planing (the procedure your friend mentioned), are insufficient to control the disease. Here are some indicators that may necessitate surgical intervention:
1. Deep Periodontal Pockets: If the depth of the pockets around your teeth exceeds 5mm, it may indicate that there is significant attachment loss and bacterial accumulation that cannot be effectively cleaned through regular dental cleanings.

2. Tooth Mobility: If you notice that your teeth are becoming loose, this is a sign that the supporting bone and gum tissue have been compromised. This often requires surgical intervention to stabilize the teeth and restore periodontal health.

3. Persistent Inflammation: If you experience chronic inflammation, bleeding, or pus around the gums despite regular dental care, this may indicate that the disease has progressed to a point where surgery is necessary to remove infected tissue and promote healing.

4. Bone Loss: Radiographic evidence of bone loss around the teeth is a critical factor. If significant bone loss is detected, surgical procedures such as flap surgery or bone grafting may be required to restore the periodontal architecture.

Symptoms Indicating Advanced Periodontal Disease
- Gum Recession: If you notice that your gums are pulling away from your teeth, exposing more of the tooth or the root, this is a sign of advanced periodontal disease.

- Bad Breath: Persistent bad breath or a bad taste in the mouth can be a sign of infection.

- Changes in Bite: If your bite feels different or if teeth are shifting, this could indicate underlying periodontal issues.

Your Situation
Based on your description, it sounds like you may be experiencing early signs of periodontal disease, such as gingivitis, which is characterized by inflammation of the gums without significant attachment loss. Regular dental cleanings, good oral hygiene practices, and the use of dental floss are essential in managing this condition at this stage.

However, if your symptoms progress to include any of the indicators mentioned above, it would be advisable to consult with your dentist or a periodontist for a thorough evaluation. They may recommend further diagnostic procedures, such as periodontal probing or radiographs, to assess the extent of the disease.

Conclusion
In summary, surgery for periodontal disease is typically reserved for cases where non-surgical treatments have failed or when the disease has progressed significantly. Early intervention is key, so maintaining regular dental visits and adhering to your dentist's recommendations is crucial. If you have concerns about your periodontal health, do not hesitate to seek a professional evaluation. Early detection and treatment can prevent the progression of periodontal disease and help maintain your dental health for years to come.

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