hey it's dr amanda with straight smile solutions street smile solutions.com and
today we're going to talk a little bit more about having existing periodontal disease
and getting braces or invisalign or clear aligners and i have a really a more detailed blog
that's written more towards the dentists that are out there you can access the blog by going
to my website straightsmilesolutions.com and click on about us then click on blog
and in there we're going to go over the points more in detail this is written again more for
doctors and i'm going to be talking about this today um at a high level um for patients that
often have this question um it's best that you talk to your particular dentist your general
dentist or your periodontist to ask this question as well as your orthodontist your dentist might be
the same as your orthodontist not all dentists are orthodontists but all orthodontists are dentists
but you need to get all the people that are involved in the care of your teeth
involved in the care of making this decision it's not a decision that i can make for you
um okay so my answer basically high level is yes some periodontal patients can indeed get
orthodontic treatment but it isn't without risk my preference is for these patients always to
be in a the slowest a lowest type of movement system which for the most part out there is
invisalign although there are some other aligner systems that can be tweaked
to be slow and low forces that would not be clear correct that is the last aligner system
i recommend because their trim level is too high so it needs to be an aligner system that has a
scalloped trim line now and that also has slow and low forces so now you can take any liner
company or any liner system and you can slow down the forces but that's not how the default
comes so the doctor needs to know how to drive the bus on this and for the doctors that are out
there if you don't know how to do that that's something we'll be glad to help you do um also
and why okay so let's go back to braces absolutely periodontal patients i don't think should get
braces hands down that's a no um you know 20 years ago there really was no choice so we used to say
no to most patients who had periodontal disease severe moderate you know now we can take more
patients because with braces and i've gotten more content made on this you can just put in on google
not google but go to my youtube put in periodontal disease within my streetsville solutions youtube
and more videos will come up we talk more about periodontal disease but and the difference between
braces and aligners and how that works braces you're gonna come in you're gonna be using heavier
forces just as a default because it's wires and you're gonna have your tightening quote-unquote
every six to ten weeks so it's a high force tightening patients feel that after they get
their braces tightened it's like ouch for two or three days and then the forces slowly dissipate
over time until you get the new tightening again so it's a bit of a sinus curve in terms of forces
we don't want that that's actually the and that's fine for kids but that's not fine for periodontal
patients so the thing i like about invisalign or supple liner companies like i said not clear
correct those that have the scalloped full scallop trend this is where full scalp trim
comes into effect is that the forces normally these are made to change we want ones that have
seven day changes or four day changes or three day changes not two week changes because we want the
forces to be as slow and as low as possible so it's literally just a slow low consistent force
the less undulation we can have in the forces the better for the periodontal patient so um
that leads to less tissue breakdown over time during treatment
and less inflammation also we need to put our periodontal hat on and differentiate between
active periodontal disease and past or historical periodontal disease people can have periodontal
disease that happens previously in their life but it's been totally resolved it doesn't mean
the tissue breakdown might still be there they might have still have some recession
um but there's no active disease going on no inflammation no bacteria anything like
that that's okay as long as it's not so much breakdown that the teeth are not supported
okay so hey even i probably i don't know if i had periodontal disease or it's just getting old but i
have a few millimeters of recession and a little bit of bone loss as far as i know my hygiene has
always been perfect but i'm hey i'm old so you know these things happen who knows you know maybe
i don't know but i definitely if you diagnosed me it will say i had mild periodontal disease had
you know but i can have ortho that's totally fine because it's not active and it's only mild
a little bit right now look at this patient here this patient here has severe periodontal breakdown
on many of the teeth i don't know if this is active or passive you know they might go
in in probe and there might be two to three millimeters pockets everywhere and no bops
well but this patient if we try to put aligners on them these teeth are probably gonna fall out
you have to think about just like a tree in some soil if you don't have enough soil for the tree
it's going to flop over if you try to you know if there's a wind storm it's going to fall over right
so same thing with moving teeth you need to have enough support so that might mean the patient
needs to go to the periodontist and have some surgeries get some more bone things like that
but i always recommend that unless you are a periodontist you shouldn't be making this decision
if you have that kind of gut feeling that i don't know if this is enough bone i don't know if this
is too much recession attachment loss you need to send your patient to the periodontist always
let the periodontist make the call on that you are not a periodontist you're a general dentist
okay so you know something about peridot and you can do periodontal treatment
but now you are mixing three things you are mixing two specialties that you're not orthodontist and
periodontics and you're trying to make a decision and in my experience and i've seen this happen
i've had patients come to me for second opinions um i've had you know people consult with me
if you're not sure let the periodontist make the decision that is their specialty
and i'm gonna always recommend that in writing and if the patient doesn't want to go to the
periodontist to make that decision then it's not the right patient for you refer that patient to
ortho and let them deal with it because you can get yourself as a dentist in a bunch of trouble
by taking a period on a patient who is not cleared for treatment okay so that's what i do that's what
i recommend you do get it in writing let them quote unquote babysit your patient
it's not babysitting but let them manage your patient during orthodontic treatment they come
in for their pmts i know you're afraid that their gut your patients are going to get stolen
later for their hygiene visits and ultimately that's up to your patient because they might
like going to the periodontist for their hygiene business you can't force them to come back to you
you know obviously a classy periodontist will recommend the patient goes back to you if
that's what you're requesting but you can't force that right so in any case that's how i recommend
managing perio patients with their liner treatment and if you want help on a case or a periodontal
case um you're welcome to schedule an appointment with us by going to streetsmilesolutions.com
services we have one-time appointments where we can help you with your patient
but again if your patient just had srps that's not solving periodontal disease necessarily you have
to do that one month evaluation and show that the inflammation and the state of disease is
improved you have to document it because what's gonna happen if you started that that case and
something went south okay and you didn't do that one month eval to show that you're managing it and
your pmt's to show that you're managing it just doing an srp is not solving the problem of course
you're not proving that it's been solved okay so make sure you're putting your dental school
hat back on and doing things properly during orthodontic treatment all right thanks so much