Advanced Periodontal Disease - Extractions

Lebear

This is a question for the dentists on here. Can you please tell me who decides when its time for a patient with Advanced Periodontal disease to have extractions, is it the dentist or the patient?

If the patient is suffering with recurring infection, sore gums, bad breath, headaches, jaw pain etc., and is tired fighting a disease that they will never overcome should they not get to decide their treatment plan?

Can a patient with this severe stage of the disease opt for full extractions and dentures?

Big_G

Ethical principlism dictates that it is the patient who must ultimately decide their treatment (autonomy). This is never more important than in the treatment of periodontal disease where 90% of the success is due to the patient both in terms of the motivation to change their lifestyle and work they put in to maintaining good oral hygiene practices and also their own physiological/genetic/immune response.

So to answer your question, it is up to the patient to opt to transition to dentures. This is not a decision to be taken lightly however, as full dentures are at best a poor replacement for natural teeth in most cases. Even in advanced periodontal disease cases where the bone loss is severe, the teeth can be maintained for many years with the use of frequent hygiene visits and splinting.

I was looking at your previous post about laser surgery, there is one dentist that I know of in Dublin that does this procedure.

Lebear

Thank you Big_G I have lived with this disease and discomfort for many years, initially I wanted to save my teeth and have tried by maintaining a good oral health routine at home and having 3 monthly cleanings, however the infection keeps recurring and I don't think I will ever get it under control. This disease has affected my overall health also and I am terrified of the risks associated to heart attacks and strokes etc.

I know dentures are a last resort and it is not a decision I have taken lightly, however when I suggested it to my dentist recently she said it would be unethical to extract all of my teeth. I am very confused by this statement as I feel it is unethical not to. It is my life so therefore should be my decision. I have already lost 3 teeth that were abscessed and had to be extracted, I would rather have all teeth extracted together than to lose them individually and suffer ongoing pain and infection.

I have been looking into the option of laser gum surgery but have decided against it as after doing some research it seems that it is not always a success.

I am also considering mini implants and implants as replacements to my natural teeth. I intend to get a second opinion as I cannot accept what my current dentist says. Can you give me any advice as to how to to speak to the dentist about it and make him/her understand my situation

btkm8unsl0w5r4

I understand where you are coming from OP. However sometimes I do have to refuse to do treatment I am unhappy thats its the correct thing to do in my mind. I suppose you as the patient must be happy but the dentist must also be happy.

Personally I am reluctant to extract savable teeth unless a good restorative treatment plan is agreed ( implants, bridges dentures etc). Dentures might seems like a good and simple solution but believe me please, dentures are a total nightmare for some people so if you can avoid....avoid.

Have you seen a gum specialist or a restorative specialist ???

Lebear

I have just been to the Hygienist for my 3 monthly clean and she has reassured me that my disease is not as advanced as I assumed, I have mostly 3 mm gum pockets on my front teeth with a couple of 6's at the back molars, one of which now needs a Root Canal and this is the cause of the pain. I have a lot of gum recession but she said this is from brushing too hard and that is also what makes my gums sore. I have been classified as having Moderate Periodontal disease which although I am aware is serious is not as bad as I assumed.

I think I will continue with my home care and 3 monthly cleanings for now and put the extractions on hold. I will however look into laser gum surgery and/or treatment with Emdogain as I found a clinic in Blackrock that offers this treatment.

I still however have the problem with the taste in my mouth which the Hygienist said could be diet related as there is no active infection in the gum

Big_G can you let me know the name of the Dentist offering Laser Gum Surgery by posting here or by pm.

Thanks for your replies

ballsymchugh

a periodontal definition of successful treatment is removal of disease. that applies even if the teeth left are able to fall flat in the wind, because since there is no disease, there should be little or no pain. the little that there should be would mainly be sensitivity.
i've had a few cases where some people have managed to turn around their perio health to a state of maintenance as opposed to fighting the disease. it takes hard work and commitment, but as the previous guys have said, it's better to have your own teeth than not. added to that, recession occurs naturally when the disease resolves, so you can add that it's better to have long teeth instead of no teeth.