Periodontal disease: Treatment can save teeth


Wobbly teeth, bleeding and inflamed gums. The hallmarks of periodontal disease conjure u thoughts of expensive treatment, painful recovery, and the ultimate question: Will my teeth be saved? Treatments include deep scaling and planing the root surface of the tooth below the gumline, with or without antibiotics, and surgery. Crucial to the success of any treatment is the flossing/brushing home routine, as well as periodic maintenance care with professional scaling of the teeth The overwhelming majority of teeth were saved in a new study of 114 people who had moderate to advanced periodontitis diagnosed before 1987 (Journal of the American Dental Association, March 1997). Investigators reviewed the records of a single dental practitioner whose patients were treated over a 29-year period at The University of Iowa College of Dentistry. The 114 patients had received maintenance therapy for an average of 12 1/2 years. Of the combined total of 2,899 teeth present after treatment, 152 were lost to periodontal disease and another 68 were lost to other causes.

The new review was conducted by Dwight E. McLeod, D.D.S., assistant professor, Southern Illinois University School of Dental Medicine, and colleagues at other dental colleges. In a telephone interview, Dr. McLeod said his results confirm those of earlier studies. He explained that in the last decade or so research has provided a much greater understanding of periodontitis. It is, for example, not just one bacterial disease, but several distinct (though related) diseases. The new review showed that there is a small subgroup of people for whom surgery did not prevent tooth loss. "About 10-15% of people with very severe periodontitis do not respond to conventional therapy--that is, routine scaling, o deep scaling and root planing, and/or surgery--for environmental, genetic, or other reasons." The people who fall into this category usually show signs of rapidly advancing periodontal disease such as bone loss, before the age of 35. They may have uncontrolled diabetes, lupus, or immunological problems. "We must monitor them more closely with bacteria culture and sensitivity testing to see which kind of bacteria is involved during different stages of the treatment," said Dr. McLeod. "A 2-3 week antibiotics regimen would be recommended. Then we would reevaluate the patient to see if the gums look better." If so, there would be a higher chance that surgery could successfully save teeth.

The majority of people with moderate to severe periodontitis, however, would be treated first with the deep scaling and planing of the root surfaces. "If the patient responds well to this treatment, and the follow-up dental visit shows that there's shrinkage of [gum] pockets, then some will not need surgery." If there's no improvement, surgery would be indicated. In some people, the gum pockets are deep, but the dentist simply can't get down far enough to remove the tartar below the gumline. The various surgical treatments range from gingiva flap surgery (tiny incisions are made in the gums around the "neck" of the tooth; the gums are pulled away from the tooth so the dentist can clean the root surfaces) to bone graft and bone regeneration procedures. "Long-term studies show that treatment may not be successful in people who don't comply with the flossing and toothbrushing home care regimen and don't receive scaling every three months," said Dr. McCleod. "Such people may show progression of disease and the loss of attachments surrounding the teeth, which means they will lose the teeth over time."

Whatever happened to the Keyes Technique, a much-touted alternative to gum surgery that received lots of media attention over a decade ago? Paul Keyes, D.D.S., formerly of the National Institute of Dental Research, taught dentists around the country his method, which combined regular professional cleaning with a home care regimen involving a baking soda and hydrogen peroxide. "A lot of studies show that the conventional therapy--routine flossing and brushing--is just as effective or more effective than the Keyes technique," answered Dr. McLeod. "You can traumatize the gingiva with abrasive substances like baking soda and hydrogen peroxide. The American Dental Association warns against long-term use of hydrogen peroxide at full strength."

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