Interesting case: Missing teeth, periodontal disease


A patient whom I have not see for 10 years recently showed up in my office. The 6 unit bridge I did on her earlier is still structurally good but she will need root canal therapy on one of the canines. missing teeth.

The remainder of the mouth is much more interesting to look at. She recently had 1 of her lower incisors fall out due to periodontal disease. Unfortunately, her 3 remaining lower incisors are in bad shape and will need to be removed as part of her treatment.

Other observations include bone loss around an upper molar and premolar that have super-erupted into a space where the occluding teeth are missing. She will most likely lose these teeth, but she would like to try and save these. She sees an alternative medicine doctor who thinks that they could possibly get bone to grow in there; if she doesn’t try, she will never know for sure. These are 9 mm. pockets, and those are pretty substantial.

The patient inquired about implants to help restore At this point, I have counseled against this, for many reasons. The patient is very scared of the dentist, a fact which must be taken into consideration. Also, there is a lot of periodontal damage to supporting bone, so investing into implants on the short term where the treatment plan may change is just not a good idea. So the guiding principles for this patient include addressing her periodontal disease with deep cleanings, extracting the hopeless teeth, and making a treatment partial denture for her to wear while she is healing. I can then attack any minor restorative work plus the endodontic treatment for her upper bridge abutment tooth.

These are interesting cases that we run into when patients are too nervous to confront going to the dentist. If you are concerned about dental treatment, you are much better off getting everything treated early, and then going in for maintenance visits. If something comes up, it is usually minor and easy to fix. When you wait, the damage can extend exponentially and require a lot more time and money to get to a desired result. Although complete dentures are an option, this is usually a sign that all dental efforts to save the teeth have ultimately failed.