Doctor Kulaga

“I just want my regular 6-month cleaning”

It’s a phrase we hear from time to time when we tell a patient that a routine cleaning won’t be enough. It’s understandable that these folks may not want to spend extra time in the chair, make a necessary follow-up visit, or spend the money for the cleaning procedure they really need. But the truth is, sometimes a routine cleaning simply isn’t enough to stave off periodontal disease.

80% of Americans have some form of gum disease and this is why we have a Periodontist on staff. Even I, your dentist, have periodontal disease. Ask my hygienist, Melissa, at your next visit and she will tell you from time to time I will develop some 5 millimeter pockets. How do I, a dentist, have gum issues? I floss 4 times a day, I brush 3 times a day and yet I am still getting pocketing. More than likely my cause is genetics, the type of bacteria I have in my mouth, and the fact I am a clencher. My father’s side of the family does have a history of tooth loss from periodontitis and the type of bacteria I have in my mouth is more aggressive. We have tools to check your bacterial levels when needed and a wide range of treatment options from scaling and root planing to LANAP to help control the bacteria. LANAP is a very technologically advanced procedure that it has even been granted approval by the FDA to state that the procedure can regenerate some amounts of lost bone. Never in dentistry has this been possible until now.

Periodontal disease is very serious as it slowly leads to tooth loss. It can be difficult for the patient to understand a recommendation we make when the disease is present as many times the symptoms are not. This is why every once in a while we will have a patient leave our practice due to us not performing a regular cleaning because periodontal disease has been diagnosed. This can be a frustrating moment as many of these patients do not feel pain, do not see any issues, have been coming every 6 months for cleanings, and usually have good home care. So how did this problem all of a sudden show up? Well the answer is it has always been there in some form, but unfortunately many dental practitioners ignore it until its too late. Here at White Wolf we will always inform our patients of their oral health in an honest manner.

Now it is time to share a story. About once a month we will have a patient return that left our practice due to us not performing regular cleanings on them due to being diagnosed with periodontal disease. They usually will find another dentist that will perform regular cleanings. After 3 or 4 years pass by they start to develop symptoms such as sensitive teeth due to receding gums, teeth looking longer in appearance, or teeth beginning to move. Here is an xray of a patient that left our office about 4 years ago. The black arrows on the first image is where the bone was in 2012. The second image has black arrows showing the height of the bone in 2012 and the red arrows showing the current level in 2016.

Periodontal Disease

Notice how much bone loss has occurred; all the way around the root tip! Believe it or not this patient did not have any pain on this tooth even though there was no bone around it. The main complaint was that her partial denture did not fit anymore. This inability to be put the partial denture back into the mouth was due from to the teeth moving from due to the lack of bone support. Many patients will even state to me “Well isn’t doing 6 -month cleaning (prophylaxis) better than nothing?” Unfortunately, as you can see in the example above, doing the incorrect treatment can have very negative effects.

I do not like seeing this situation as to and recovering from it is very difficult. We now have to discuss extractions and tooth replacement options such as implants and partials. All of this adds further frustration, cost, and possible decreased function than if we would have done periodontal therapy to control the disease from the start.

Please notice how I said ‘control the disease’ not eliminate it. Periodontal disease is like high blood pressure, once you have it there is no way to cure it, but you can control it. With high blood pressure you take a daily medicine and your blood pressure stays in a normal range. With periodontal disease, after the initial therapy you will be on a 3-month periodontal maintenance program to keep bacterial levels lower. Also, the periodontal maintenance cleaning at each recall appointment is more thorough than a regular cleaning as the hygienists do go under the gums more aggressively to wipe out the bad bacteria.

So the next time we recommend a cleaning other than your regular cleaning, we are not trying to up-sell you, but rather we are trying to help by preventing bone loss, eventual tooth loss and the future heart ache and expense of replacing lost teeth. Periodontal disease is a very slow process and I do not want to see another patient return and say “Doc you were right 4 years ago and now I need help!”

Dr. K