Periodontal Disease in Molars: Symptoms, Risks, and Treatment Options

Molar periodontal disease

Hello Doctor,
Symptoms: I have a loose upper molar that is not painful and shows no signs of inflammation.
The dentist said it is due to periodontal disease, and one of the two roots has experienced bone loss, which is causing the looseness.
The dentist mentioned that the molar is well cleaned and still functional, and we should try to preserve it, but also indicated that it might affect the adjacent tooth.

I have a few questions:
1.
Should I consider preventive extraction to avoid affecting the adjacent tooth?
2.
Since the dentist did not mention any treatment, does this mean that the tooth with bone loss is just going to fall out eventually, or are there other ways to stabilize it?
3.
If it cannot be salvaged, how often should I have follow-up X-rays to monitor any changes?
Thank you for your help!

Allen, 50~59 year old female. Ask Date: 2015/09/27

Dr. Zeng Guanghui reply Dentistry

1.
The above condition may be chronic periodontal disease, which leads to the gradual resorption or loss of the alveolar bone surrounding the teeth.
If oral hygiene is maintained and it does not progress to acute inflammation, and there is no discomfort when biting, the tooth may be temporarily preserved.

2.
If the bone resorption is more severe, traditional bone grafting materials and periodontal surgeries may not be effective; the focus should be on thorough cleaning to prevent bacterial infection.

3.
It is recommended to take X-rays every 3 to 6 months to monitor changes in the alveolar bone.

Reply Date: 2015/09/27

More Info

Understanding periodontal disease, especially in molars, is crucial for maintaining oral health. Periodontal disease, or gum disease, is an infection of the tissues that surround and support the teeth. It can lead to tooth loss if not treated properly. In your case, the symptoms you describe, such as a loose upper molar without pain or inflammation, indicate that there may be underlying issues related to periodontal disease.

Symptoms and Risks
The primary symptoms of periodontal disease include:
1. Gum Inflammation: Red, swollen gums that may bleed during brushing or flossing.

2. Tooth Mobility: As you mentioned, a loose tooth can be a sign of bone loss around the tooth roots.

3. Bad Breath: Persistent bad breath can be a symptom of gum disease.

4. Receding Gums: Gums that pull away from the teeth, exposing more of the tooth or its root.

5. Pockets Between Teeth and Gums: These can form as the disease progresses, leading to further infection.

The risks associated with untreated periodontal disease include:
- Tooth Loss: The most significant risk is losing teeth due to the loss of supporting bone and tissue.

- Spread of Infection: Periodontal disease can lead to infections that may affect adjacent teeth, as your dentist mentioned.

- Systemic Health Issues: There is evidence linking periodontal disease to other health problems, such as heart disease and diabetes.

Treatment Options
1. Preventive Measures: Before considering extraction, it is essential to explore all treatment options. Regular dental cleanings and improved oral hygiene practices can help manage periodontal disease. This includes brushing twice a day, flossing daily, and possibly using an antibacterial mouthwash.

2. Scaling and Root Planing: This deep cleaning procedure removes plaque and tartar from below the gum line and smooths the tooth roots to help gums reattach to the teeth.

3. Bone Grafting: If bone loss is significant, a dentist may recommend bone grafting to help regenerate lost bone and provide a stable foundation for the tooth.

4. Periodontal Surgery: In advanced cases, surgical procedures may be necessary to restore supportive tissues.

5. Regular Monitoring: If your dentist has not recommended immediate treatment, it may be wise to schedule regular check-ups, including X-rays, to monitor the condition of the tooth and surrounding bone. Typically, follow-up X-rays may be taken every 6 to 12 months, depending on the severity of the disease and the dentist's recommendations.

Questions Addressed
1. Should you have the tooth extracted preventively?: Extraction should be a last resort. If the tooth is still functional and well-maintained, it may be worth trying to preserve it with proper care and treatment. However, if your dentist believes there is a high risk of infection spreading to adjacent teeth, they may recommend extraction.

2. Is there a way to treat the bone loss?: While bone loss can be serious, there are treatments available, such as bone grafting, that can help restore some of the lost bone. Your dentist can provide options based on the extent of the bone loss.

3. How often should you have X-rays?: Regular monitoring is essential. If your condition is stable, X-rays every 6 to 12 months may suffice. However, if there are signs of progression, more frequent monitoring may be necessary.

In conclusion, it is essential to maintain open communication with your dentist about your concerns and treatment options. Periodontal disease can be managed effectively with the right approach, and preserving your teeth should always be the primary goal. If you feel uncertain about your current treatment plan, seeking a second opinion from a periodontist may also be beneficial.

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