Q: I have a gum fistula which I’m told results from a root canal inflammation. This fistula goes flat and fills up periodically. I have no pain whatsoever on the tooth or gum. Can I just live with this? I’ve heard different treatments and both do not appeal to me – one, have the tooth extracted, secondly, drill through the bone to clean out the canal. Again, my question: can I just live with this? Thanks so much.

A: From your description of this dental infection, I would strongly suggest you don’t leave this alone. I would seek the opinion of an Endodontist (a specialist in root canals) and discuss your options.

Q: I recently had a full series of x-rays that showed high bone loss.  I do not have recession or bleeding gums and the doctor said there was no tartar buildup under my gums either. Is there medication that can fight these bacteria that are attacking my bone?  If my mouth is clean and gums are in good shape, what else can I do to ward off further bone loss?

A: You need a qualified Laser periodontist (specialist) to do an examination and recommend the necessary treatment to stop your bone loss.  This might include an FDA cleared laser protocol to target the potent bacteria.  Antibiotics alone will not cure this problem.  The exam should include an occlusal analysis, a thorough review of your medical and dental history, and a detailed discussion of the results of the full series of digital x rays.  Is there a family history of gum disease or early tooth loss and dentures?

Q: I have been advised for years that I have bone loss in my jaw. I have a clenching/grinding problem at night that I suspect is contributing to the problem.  I had orthodontics 3 years ago to correct my bite as the theory was that my bone loss could be a result of my bite being so bad.  The orthodontics corrected my bite. However, I did get some root resorption on one of my front teeth.  While I was in braces I think I stopped clenching at night because it was too painful.  However, the clenching has started again.

My general dentist referred me to a periodontist who is recommending LANAP.

I have 4-6 mm pockets scattered throughout my mouth and my front top and lower teeth are slightly loose (I was not aware of it, but the periodontist pointed it out to me).  I do not have any obvious signs of gum disease (bleeding, redness, odor, etc.).  My periodontist is recommending LANAP on all 4 quadrants.  I also just got a new, better night guard made by my orthodontist to try to help with the clenching/grinding issue.  I am 40 years old and very concerned about losing my teeth.  In your experience, is LANAP an effective treatment for periodontal disease caused by clenching/grinding?

Is LANAP safe on a tooth with very little root left due to resorption?

A: LANAP is safe on short roots, resorbed roots, and long roots as long as the periodontist follows the protocol carefully and according to the strict guidelines.   Having a new and improved night guard is a smart move. This should take the secondary occlusal trauma out of the picture.

I would also discuss with your laser periodontist the possible need for splinting your mobile teeth together. There are various ways to accomplish this. The laser periodontist can explain this to you in detail.   Additionally, as part of the LANAP protocol, an occlusal adjustment is also performed at the time of surgery and at your follow up visits.  Finally, LANAP is very effective in treating bone loss (periodontal disease) and when done in conjunction with occlusal therapy, can ultimately save your teeth.

Q: My dentist wanted me to be evaluated by a periodontist for possible bone loss. I went for an evaluation and he said I had bone loss and recommended osseous surgery 4+ per quad. I have no pain, no bleeding while brushing, but chronic bad breath.  I thought periodontal scaling and root planing would be done first before osseous surgery. Also, I was advised that I needed crown lengthening to prep a tooth for a crown. I am hesitant to have the surgery without trying the scaling and root planing. What are your thoughts?  Thank You.

A: This question seems to come up quite often from patients, doctors, students and residents, so I will try to explain how things have changed over the last 29 years in our approach to treating gum disease.

First, an accurate diagnosis is necessary.   Once we review the clinical information and full set of quality digital radiographs, we can determine how to treat the disease in the least invasive but most effective way possible with the best long term results.

We utilize laser therapy, which eliminates the need for separate scaling and root planing appointments and aggressive surgery (see our web site for more detailed information). We try to eliminate the need for conventional osseous surgery, when possible, and treat the entire mouth with the FDA-cleared laser approach (LANAP).

The advantages of this are to:

• Eliminate scaling and root planing as a separate procedure and eliminate the need for multiple appointments involving local anesthesia.
• Utilize the laser surgery instead of the conventional osseous surgery, where possible.
• If crown lengthening is needed, the area of conventional surgery is limited to the area in question.

We find that we can treat about 85% of our patients with the laser approach and in many cases, eliminate the need for cutting, suturing, scaling and root planing. In a worst case scenario, we can just do the conventional osseous surgery in very limited areas for crown lengthening. This comprehensive approach in treating periodontal disease makes for a pleasant post-operative experience for the patient with excellent results.

I would suggest a second opinion with a Periodontist trained in LANAP surgery.

Best of luck,+

Dr. Eric Linden

Q: Can I fly two days after bone augmentation and sinus lift treatment?

A: When we do sinus augmentation and bone grafting in our office we use the osteotome technique, which is much less invasive and puts very few restrictions on the patient’s post-operative activities. However, If you have had a “traditional” “window technique” for your sinus grafting, you might want to check with your Periodontist regarding flying.  The altitude changes can affect your sinuses and the variations in pressure could affect the seal or closure of the extensive wound from the traditional procedure.

Q: I am a 42 year old man with gum recession and bad breath (the latter for 20+ years). I have a 6 unit Cercon bridge, on the right upper portion. I recently met a periodontist who said I have some bone recession near the bridge and suggested deep cleaning (not very urgent as there is no bleeding). To take a second opinion, I met a second periodontist (who practices Laser therapy). The information he gave me is as below.

1. I have metal fillings on 2 of my lower teeth. Will it be impacted by laser treatment?
2. He said the bridge will not be affected in any way.

Can you verify this information? Also are there any aspects I have to consider before going for this?

Regards,

Ashok

A: Fillings should not be impacted by laser treatment unless there is decay or other unknown tooth issues.   The bridgework should also not be affected, with the possible exception of an occlusal adjustment (bite adjustment that might be necessary following the strict LANAP protocol). Please review all the issues with your Laser Periodontist if you have any concerns.  Usually, this would be discussed in your consultation visit.

Q: Is it normal to still be bleeding a little bit a week after I had LANAP done when I brush/floss (carefully)?

A: You shouldn’t be flossing one week after LANAP surgery. The bleeding issue needs to be evaluated with the treating Periodontist as soon as possible.

Q: I have bleeding from my gums, especially in the mornings when I get up, and sometime during the day. Can you help and advise me? Thank you.

A: You really should have a thorough periodontal exam and full mouth digital x-ray review with a qualified laser periodontist for an accurate diagnosis and treatment plan.