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Dear Mervelee,
I hope you are well.
Please find attached your periodontal assessment letter created by Dr Rajvi Patel.
Should you have any questions, please let me know.
We look forward to seeing you next in March of 2024!
Kind regards,
Zana Golaj
Treatment Coordinator and Practice Administrator
ZG
Wytes | Elephant & Castle
94-96 Walworth Road, London SE1 6SW
t: 020 7703 2524
WYTES | wytes.co.uk | @wytesdental
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CONFIDENTIAL
9th October 2023
Wytes
94-96 Walworth Road
Elephant & Castle
London
SE1 6SW
Ms Mervelee Myers
16 Alma Grove
Bermondsey
London
SE1 5PY
Dear Ms Mervelee Myers,
Thank you for attending your assessment appointment on14 September at Wytes Dental. Further to your visit to the surgery I have had an opportunity to study your clinical presentation and x-rays (full mouth x-rays were taken in May 2023). The following is the summary of the report and proposed treatment plan. Please find a description of terminology at the end of this letter.
On presentation you had no major complaints and have noticed an improvement in your gum health.
Medically you suffer from high blood pressure and are diabetic. You are not taking your medications for your blood pressure and are under review with your GP. You have had some recent tests carried out including an ECG for which you are waiting results. For your diabetes you were previously not taking prescribed medication as advised by your GP, however, recently you have started taking Metformin and you have had a blood test to review your blood sugar levels.
A clinical examination at your assessment revealed:
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Clinically sound soft tissues.
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The majority of the gum pockets are 4-5mm.
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There are some localised pockets of 7mm and 9mm affecting LR5.
There is increased mobility of the following:
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Grade 2 (moderate mobility) – UR2
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Grade 3 (severe mobility) – LR5
We had an extensive discussion regarding your periodontal condition and I explained that since seeing you in 2021 you have had a vast improvement in the periodontal pockets. You are aware of some teeth with a poor prognosis including UR6, UL7, LR6 and you are aware that these teeth will likely need extraction in the future. For now, you would like to maintain these for as long as possible and you are aware of the risk of further pain, infection and bone loss around the adjacent teeth. The LR5 has a hopeless prognosis due to severe bone loss and increased mobility, again, you would like to keep this tooth for as long as possible and the risks are as above.
Your oral hygiene is good, however, you mentioned that you are using the electric toothbrush 1-3 times daily and interdental TePes most days, but not every day.
Even though there has been a great improvement in your oral hygiene since you first came to see me, I explained that since you are genetically susceptible to gum disease, with other predisposing factors such as diabetes, we need to improve your oral hygiene even further if possible. This will include the regular use of an electric toothbrush and interdental TePes as discussed. You have shown good technique with the use of interdental TePes. I also explained the bidirectional relationship between diabetes and gum disease which is why blood sugar levels are so important. I would like you to provide a report of your most recent blood tests and send them in if possible.
I have recommended periodontal surgeries, however, since there needs to be an improvement with your blood sugar levels and oral hygiene, I would recommend this to be carried out first and then a reassessment in 8 months’ time.
I would recommend 4 monthly maintenance with the hygienist and I will reassess you in 8 months’ time.
Alternatively, you may decide:
Not having any treatment, in which case periodontal disease will continue causing bone and gum breakdown which may complicate periodontal treatment and also lead to potential tooth loss. Loss of more bone may also make any potential dental implant placement more complex. There is also some evidence that periodontal diseases may be associated with systemic diseases such as diabetes and cardiovascular diseases.
Thank you for attending your appointment. I look forward to seeing you soon but if you have any questions or queries in the meantime, please do not hesitate to contact me.
Kind regards,
Dr Rajvi Patel
Specialist Periodontist
BDS MPerio RCS (Ed) DClinDent Perio
Treatment Cost Estimate
At the reassessment any residual gum disease may need to be treated by further non-surgical periodontal therapy or periodontal surgeries, the cost of which will be discussed at the re-assessment. Periodontal surgeries are from £650 each (depending on the type of surgery and number of teeth involved)
Cost estimates are valid for 6 months from receipt of this letter
Procedure
Cost
Non-surgical periodontal therapy
4 monthly sessions required with hygienist
£180 for each session
Periodontal reassessment 12 weeks after treatment with specialist
£130
What is periodontal disease? Periodontal disease is an inflammation of the gums, which if left untreated, can lead to bone loss around teeth. The main cause of periodontal disease is bacterial infection, however the severity and extent of the disease depends on patient susceptibility and on various systemic (e.g. genetics, smoking, poor oral hygiene, diabetes etc.) or local (e.g. teeth position, presence of plaque retaining restorations etc.) risk factors. Periodontal diseases progress at different rates in different individuals according to their susceptibility and their exposure to these local and systemic risk factors.
What is a periodontal pocket? You may hear the term ‘periodontal pocket’ being used when discussing your treatment. This describes the gap between the gum and underlying bone. In healthy gums there is a small gap between the gum and bone, and this is termed a ‘closed pocket’. Since the gap is small, fewer bacteria are able to enter and cause gum disease.
In areas of active gum disease where there has been some bone loss, the gap between the bone and gum increases and this is called an open pocket. More bacteria are able to enter this gap which leads to a higher risk of further bone loss. The numbers that you hear during your assessments describes measurements of periodontal pockets.
The aim of gum disease treatment is to reduce open pockets to closed pockets. Although we are unable re- establish the original bone level, by closing periodontal pockets we reduce the risk of more bacteria entering the pocket. This reduces the risk of further bone loss around a tooth and therefore reduces the risk of future tooth loss.
How do we close periodontal pockets? Initial therapy describes the first stage of treatment of gum disease. This will include oral hygiene instruction in order to improve brushing and reduce the level of bacterial infection. This will also include debriding or removing bacteria within the open periodontal pockets which you will be unable to reach with normal toothbrushing. This will be carried out under a local anaesthetic.
What is a periodontal surgery?
Gum disease surgery is treatment for residual open periodontal pockets that have remained after a round of initial deep cleaning. Not everyone will require gum surgeries and this will depend on the response to the initial cleaning, which in turn is affected by factors such as the initial severity of gum disease. The need for periodontal surgeries will be discussed with you at your periodontal reassessment
Plaque score- the percentage of tooth sites with plaque present. Ideally we would like this <20%
Bleeding score – the percentage of gum sites which bleed.
Tooth prognosis: This describes the long-term survival of a tooth and aids in assessing whether a tooth will benefit from treatment.
Mobility: How ‘mobile’ or loose a tooth is. This may occur after losing bone support around a tooth.
Furcations: The portion of a tooth where it divides into its roots
REPLACEMENT OF MISSING TEETH:
Denture: A denture is an appliance which can replace one or more missing teeth and which can be removed from the mouth.
Bridge: A dental bridge is a false tooth suspended by an adjacent tooth/teeth (abutment tooth/teeth). There are two types of bridges; a sticky bridge which may be ‘stuck’ using dental adhesive to the inside of neighbouring tooth or a conventional bridge where a false tooth is suspended off a crown which is then cemented onto the neighbouring tooth. The use of an adjacent tooth as an abutment requires a restorative assessment, as both the tooth itself needs to be sound (eg no cavities/decay) as well as its foundations (bone levels)
Dental implant: A dental implant is a ‘screw’ which is placed into the jaw bone on top of which a crown is placed. The placement of dental implants depends on the bone levels. In gum disease patients, bone has been lost which means that bone augmentation may need to be carried out prior to dental implant placement. In addition,
dental implants can only be placed in stable patients. If you are gum disease patient, this needs to be stabilised prior to placement of dental implants otherwise there is a higher risk of bone loss around the implant itself.
Tooth notation
In this report the teeth are described as follows:
UR = Upper Right. LR = Lower Right. UL = Upper Left. LL = Lower Left
The number indicates the tooth in each quadrant beginning from 1 for central incisors (front tooth) to 8 for wisdom teeth, e.g the upper right central incisor is UR1 and the lower left permanent first molar is LL6. 1 = Central incisor 2 = Lateral incisor
3 = Canine 4 = First Premolar 5 = Second Premolar 6 = First Molar 7 = Second Molar 8 = Third Molar (wisdom tooth)
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