Healthy Smile: Hey Doc, Can We Save Some Teeth?

by Jeffrey Gross, DDS, FAGD of The Healthy Smile

Normally, it occurs during our initial consultation when a patient asks me that question. We discuss trying to keep teeth and, if necessary, strategically remove some teeth and plan their replacement. Together, my patient and I develop a plan to fit their needs and desires. We discuss details, timing, cosmetics, and a host of other considerations. When I first met her, we had all of those discussions. She showed me her mouth, which had rampant gum disease and multiple loose teeth. How loose is loose? Some of her teeth fell out without any help as they had no gum or bone support due to gum, or periodontal disease, which is the proper term for that condition. In this case, the question about retaining teeth did not appear until our second appointment.

At that visit, we planned to remove all of her lower teeth and give her a denture. When I deliver a full denture on the day of extractions, we use the term “immediate denture.” One of the biggest reasons for using an immediate denture is cosmetics. This approach ensures that there will not be any time without teeth. Since her gums were in such bad condition, I felt that if I removed some plaque and build-up before the surgical date, her healing would be more predictable as gum disease affects how well and quickly tissues heal. Last week, she saw Sarah, one of my hygienists, who cleaned her up in anticipation of the upcoming teeth removal.

This week, she told me that she felt so good she was committed to more gum work in hopes that we could keep more teeth. Her statement threw me for a loop as her full denture was sitting on the counter in front of me. I gathered my thoughts and looked at the improvement in her gums after one short session. Frankly, I did not expect that type of result in such a short time. Her body responded above and beyond what we typically see.

Last week, I mentioned that February is American Heart Month. I spoke with a friend and colleague, Dr. Ian Neeland, a cardiologist in town, about this subject. Dr. Neeland is the Director of the UH Center for Cardiovascular Prevention and an Associate Professor of Medicine at Case Western Reserve University School of Medicine, among many other titles. He told me, “The risk for heart disease may be as high as 2-fold in men with periodontal disease and bone loss.” He also said, “intensive (periodontal) therapy was associated with a significant improvement in blood vessel function at six months. However, it is not known if intensive therapy would have this effect in the long term or whether such interventions prevent the progression of cardiovascular disease or improve cardiovascular outcomes.”

Can modern medicine promise that developing or current heart problems will disappear with oral health? I believe that a statement such as that would be a stretch. However, many, if not all, diseases in the body result from more than one factor. Improving gum and bone health appears to impact general body inflammation, which has been suggested in recent years as a component in heart and other disease processes.

My patient and I decided not to remove all of her teeth and follow our first plan of making a full denture. Her excitement and motivation to improve her home care, coupled with more visits from my hygiene department, became our new direction. I will replace the teeth she already lost due to advanced disease to restore esthetics and function in her mouth. If you think or have been told that your oral condition is hopeless, let’s take a second look. Please call 440-892-1810, and we can talk about it. As always, I look forward to meeting you.

Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.

The Healthy Smile • 27239 Wolf Road, Bay Village, OH 44140 • 440-892-1810 •

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