Thursday, December 14, 2017 22:38

The Best And Worst Tooth Loss Treatments

Posted by on Friday, February 5, 2010, 16:49
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Research into the causes and treatment of periodontal disease is going at a rapid pace. The most currently accepted theory is that susceptible adults who neglect (or whose dentist neglects) to remove all the food that the ever present mouth bacteria digest suffer from both the end products of that digestion and from the body’s attempt to control the bacterial toxins.

This immune response can be too intense, leading to resorption of the bone around the tooth and further inflammation. It has also been determined that adolescents and children sometimes suffer from a distinct and rapidly advancing type of periodontal disease called juvenile periodontosis.

Advanced adult or juvenile periodontal disease are often beyond the competence of the general practitioner and requires the expertise of the specialist. Effective treatment must begin with an accurate diagnosis, and this requires that the dentist carefully assess the presence and depth of any periodontal defects around the teeth.

He is looking specifically for gum that has receded or that has separated from the tooth. This is best accomplished with X rays, and a periodontal probe. The perio probe is calibrated in millimeters. The dentist places it carefully between the tooth and the gum and measures how far it penetrates and if the gums bleed when it is removed.

Charting of the pockets is useful to track the progress of the disease. Dr. Badwork rarely does a probing or charting. If your dentist has never probed your gums, ask why. The most important and easiest factor to control in periodontal disease is oral hygiene. If there are no food residues in the mouth to feast on, or plaque and tartar to live on, the bacteria responsible for causing perio disease cannot multiply insufficient numbers to do any harm.

Therefore, periodontal therapy is geared toward cleaning the mouth, removing all food residues, plaque, and tartar, and making it easier for the patient to keep the mouth clean. This involves teaching the patient proper oral hygiene methods, and also correcting defective and ill fitting dental restorations that catch and trap food debris.

Periodontal Disease Treatment begins with thorough scalings (scraping away plaque and tartar) after which, if there has been much bone loss, periodontal surgery may be necessary. After periodontal disease treatment, any missing teeth can be replaced. And finally the patient will be required to visit both the dentist and penodontist two to six times a year, to appraise the health of the mouth and to do regular cleanings.

Periodontal surgery is sometimes needed to stop the progress of gum disease. Modern surgical approaches vary, but they all share certain steps. The gums are anesthetized and carefully flapped back from the underlying bone, diseased tissue is removed, and the tooth roots are scraped and cleaned. The gum tissue is shortened and then sutured back in place. A dressing, called a periodontal pack, is put over the gums to protect them.

Sutures and dressings are removed in about a week. The surgical procedures, usually done with local anesthetics, are painless. Some discomfort after the surgery is common, and the teeth may be sensitive to hot and cold for a while, but any pain is easily controlled by medication. The idea of periodontal surgery is frightening to many people and can be quite expensive, but it is now a routine part of dentistry and gives excellent results when performed properly.

Periodontal surgery is an area much abused by Badwork, frauds, and quacks. It is too easy and tempting to muck about the gums a bit and report “surgery” on the insurance form; this is sadly true of some Badwork periodontists we know. Cleanings are an area where Dr. Badwork cuts corners almost every time. A proper cleaning always requires careful scaling of the teeth using metal instruments.

These thin sharp scalers are inserted under the gums and pushed and pulled against the tooth, removing the tartar and smoothing the tooth so that it is more difficult for new tartar to attach itself. For cleanings, some Badwork only use an ultrasonic cleaning device, or an apparatus that blasts a high-pressure stream of mild abrasive. Then some simply polish the teeth without any scaling at all.

The ultrasonic device is excellent for removing heavy tartar, but it is still essential that the dentist or hygienist use hand instruments to meticulously remove any remaining particles of tartar and, most important, smooth and polish the tooth where the tartar was attached. This is painstaking, tedious work; like other dental procedures, it takes time. The abrasive device is useful only for removing stains and has no effect on tartar under the gums.

It is therefore useless in treating or preventing periodontal disease since its effect is only cosmetic. Badwork also like to use mouthwashes, and many are advocates of the discredited baking soda and peroxide method of cleaning teeth. This method, also called the Keyes technique,  but it is important to note that the baking soda and peroxide method has not been shown to offer any advantages over regular toothpaste in cleaning the teeth or controlling gum disease.

This technique does lessen the superficial symptoms, but the disease continues to advance until the patient’s teeth are beyond salvation. We call this “supervised neglect.” But since Dr. Badwork is interested in creating more work for himself, such neglect is an added incentive. The bulk of Dr. Badwork dental work is always limited to what his patients will readily accept and pay for at rates that return a healthy profit for the limited amount of time Badwork invests.

Periodontal treatment makes Badwork unhappy because it takes too much time, time for which his patients are not accustomed to paying. Badwork is capable of diagnosing periodontal disease and knows that it leads to pain and tooth loss. But his patients are used to a “cleaning”: a polishing that takes just a few minutes and a perfunctory scaling called a “gum treatment.” Masking the symptoms with peroxide mouthwashes, applications of gentian violet, and, in some cases, even antibiotic prescriptions is far quicker and easier and more in line with the fees Badwork patients accept without question.

Unfortunately, many patients have never had a thorough cleaning so don’t know that they are being shortchanged. Peroxide can work superficially to reduce inflammation, often convincing the patient that his gum problems are “cured,” and all the while the bacteria are continuing to destroy the tooth’s support system under the gums. Gentian violet is left over from the days when a dentist would get paid only if he “did something,” and the patient was happy only if the doctor “put something on it.”

This dye has absolutely no effect other than turning the gums purple. But many patients are convinced (and happy to pay for) the purple gum treatment of Dr. Badwork. You might ask, “Why isn’t Dr. Badwork sued when his patients lose their teeth?” The answer is that Badwork’s patients have been taught that pyorrhea is incurable and that tooth loss is inevitable, and they quietly accept their fate.

There are excellent, honest, reputable periodontists who diagnose accurately and treat properly with superb results. But there are others whose fraudulent diagnoses and treatment plans are matched only by their incompetence. We’ve seen full mouth surgery (a major and expensive procedure) performed on patients who had not a trace of periodontal disease. We’ve seen collusion between general dentists and specialists to defraud patients.

In one case the general dentist recommended his patient to the specialist for extensive periodontal treatment; the specialist in turn recommended that the general dentist do extensive crown and bridgework for this patient following completion of the periodontal treatment. Both dentists knew that the patient’s teeth could not be saved, yet they took thousands of dollars from her, putting her through annoying treatments that in a short while failed completely.

Finding a good periodontist can be hazardous. Some dentists recommend only their friends and golf partners, which is not a good way to get a recommendation. Checking the local dental school faculty may be worthwhile, but since there are many bad periodontits (as well as good ones) on dental school faculties or associated with teaching hospital clinics, there is still no guarantee.

The best recommendation will probably come from a good general dentist, but it never hurts to get a few opinions when major dentistry is needed.

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