New gum surgery option available, but is it preferred by dentists?

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New gum surgery option available, but is it preferred by dentists?
September 17, 2007
By Paul Swiech
Pantagraph.com

NORMAL -- Dr. Jeffrey Jones picked up a dental instrument with a red light at the tip and began vaporizing inflamed and infected tissue around Gregg Watson's three back teeth on the lower right side.

"We're killing all the bad guys," Jones said, referring to infection and inflammation around Watson's two molars and one bicuspid.

Jones was using a laser.

Dental lasers have been used for several years for dental procedures, including numbing teeth, removing decay and cutting soft tissue. A recent trend is using a dental laser to treat chronic periodontitis, sometimes called gum disease, which often involves bone and other tissues that support the teeth.

Jones has been using the laser-assisted new attachment procedure for periodontitis for two years. He said 42 patients have had the procedure "and we have had no failures that I'm aware of."

Since he began offering the laser procedure for gum disease, none of his patients who needed treatment have opted for the traditional treatments, which include scaling and root planing and various surgical options.

"The laser is the new paradigm," said Jones, who has practiced general dentistry in Bloomington-Normal for 29 years.

"Old school gum surgery is still predominant and it works well. It saves teeth. But why not advance? Why not progress?"

Three Bloomington-Normal periodontists who specialize in treating gum disease -- Drs. Thomas Johnson, Kirk Noraian and Anthony Pecora -- don't use the laser and continue to use traditional treatment for gum disease.

"I can't think of a periodontist who uses a laser because it's not evidence-based," Pecora said. "It (the laser) sounds more appealing, but the research isn't there. I don't think that it's been proven to be beneficial as a replacement to surgery. As an alternative to scaling and root planing, it has no significant extra value."

An April 2006 article in the Journal of Periodontology, a publication of the American Academy of Periodontology, concluded that "there is a great need to develop an evidence-based approach to the use of lasers for the treatment of chronic periodontitis. Simply put, there is insufficient evidence to suggest that any specific wavelength of laser is superior to the traditional modalities of therapy."

But Jones points to U.S. Food and Drug Administration approval of the laser to treat gum disease; 2004 research at Louisiana State University that concluded that laser assisted new attachment procedure had resulted in periodontal regeneration; and a 2004 article in "General Dentistry" that concluded that laser-assisted new attachment procedure should be included as a choice for patients with gum disease.

"My whole career, I've been looking for something to replace cut-and-stitch for gum disease. It's time has arrived," Jones said.

Teeth are held in place by surrounding gums, bone and other tissue, according to the publication, Understanding and Treating Periodontal Disease. Dental plaque, the bacteria that forms on teeth and at the gum line, is a threat to teeth and supporting tissues because it can harden into tartar.

When tartar and bacteria under the gum line lead to infection, the gums become inflamed and pockets form between the tooth and gum, making plaque harder to remove. As the disease advances, bone damage may occur.

Gingivitis is the mildest form of periodontal disease. Gingivitis may be reversed with dental cleanings and regular brushing and flossing.

If untreated, gingivitis may lead to periodontitus, which means gums are receding and infection and inflammation has spread to the bone supporting the teeth.

Scaling and root planing, sometimes called deep cleaning, involves using a special device to reach just below the gum line to remove tartar deposits that can't be removed in ordinary dental cleaning. Root planing involves smoothing rough spots on the root of the teeth where bacteria collect.

When that doesn't work, periodontists have several surgical options. One involves rolling back the gum from the tooth, removing the tartar and diseased gum tissue, reshaping the bone and returning the gum and sewing it shut.

Another surgery is rolling back the gum, packing graft material into the area where bone was lost, and sewing the gum closed. A third surgery involves opening the gum, placing a membrane over the damaged bone to allow the bone to heal, then sewing the gum closed.

Which treatment is offered to patients depends on their degree of disease.

Jones said he likes the laser treatment because it involves no cutting or stitching, involves less pain and bleeding and has a quicker recovery time than traditional gum surgery. He said the cost is comparable to traditional gum surgery -- about $1,200 per quadrant of teeth. Dentists divide the teeth into four quadrants.

Watson, 56, of Bloomington, said Jones told him a couple of years ago that he detected problems at his gum lines and Watson needed to get more aggressive with flossing and using his Water Pik to clean between the teeth and at the gum lines.

Watson did so. At a recent appointment, Jones told Watson that his increased maintenance work had helped. However, pockets of bacteria beside three teeth on the lower right side -- two molars and a bicuspid -- had progressed to the point that something needed to be done.

"When he described the gum surgery, I thought 'If you have to, you have to.' But I really didn't want to have anything to do with it.

"The laser sounded as if it involved less pain, bleeding and swelling and less down time from work and the rest of your life," Watson said.

Jones performed the laser procedure on Watson in Jones' Normal office Sept. 5.

Jones numbed the lower right side of Watson's mouth. He used the laser to vaporize the inflamed and infected tissue, cleaned the area, then used the laser to help seal the remaining healthy tissue. The procedure took about 15 minutes.

"The firing tip (of the laser) goes into the pocket and fries all the bad guys and then we seal it closed," Jones explained.

"I feel fine," Watson said immediately after the procedure. "I didn't feel anything, I just heard some popping (of the laser)."

Jones told Watson to avoid brushing in that area of his mouth for 10 days, to avoid flossing in that area of his mouth for 21 days and to avoid using the Water Pik and drinking carbonated beverages for awhile to allow the gum to heal. He was given one Motrin and prescribed an antibiotic to reduce the risk of infection.

Watson said the next day that he felt fine.

"If I put my tongue down there, I can feel a scab (where the gums were sealing)," Watson said. "But I have no swelling gums."

While Jones' patients appear to have had positive results, the periodontists remain skeptical about lasers to treat advanced gum disease. But they were careful to not make patients who have had the laser procedure feel uncomfortable.

"Each treatment modality is based on the decision of the doctor to try to provide the best results they can provide to each patient," said Noraian, who also is president of the McLean County Dental Society. "If the doctor can offer good results, he or she will do it.

"But I find use of the laser limited," Noraian said. "I think more research needs to be done to compare the different modalities."

Noraian, Pecora and Johnson said their patients have had good experience with traditional gum treatment. Pecora said some patients have told him they are surprised at the lack of discomfort.

"The laser adds interest to dentistry and dental care and that's good," Noraian said. "Lasers are an exciting part of what we're doing today but we're just not ready to give up the tried and true yet."

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Gum disease

Ô Periodontal disease, sometimes called gum disease, forms when tartar and bacteria under the gum line lead to infection, causing gums to become inflamed and sometimes damaging the bone that supports the teeth.

Ô Periodontal disease can lead to tooth loss. In addition, bacteria that cause the disease are linked to heart disease, stroke, diabetes and pregnancy complications.

Ô People are at increased risk of periodontal disease if they smoke, don't brush and floss their teeth adequately, have diabetes, grind their teeth or have bite problems, experience hormonal changes including those that happen during pregnancy, have a weakened immune system, or have a close family member with the disease.

Ô In addition to recommending increased flossing and brushing, dentists may recommend additional aids -- such as rubber tip gum stimulators -- to treat gums before medical procedures are recommended.

SOURCES: "Understanding and Treating Periodontal Disease," Dr. Jeffrey Jones, Dr. Kirk Noraian, Dr. Anthony Pecora, Dr. Thomas Johnson

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