Perio increases cavities at gumline

[HadEnuff]

Looking for some perspective from the esteem members of the Forum.
We moved about a year ago and so had to start all over with docs and dentists.
Lo and behold, new dentist identifies a number of cavities at gum line attributes them to my previous perio treatment. Currently, all my gums are healthy with acceptable to good 'pocket" measurements--none over 5, mostly 3's.
According to him, no matter how good the perio treatment, tooth surfaces previously covered by gum are newly exposed. These surfaces supposedly have softer surface.
Two questions:
1. Has anyone else received or heard of my new dentist's assessment of perio impacting cavity risk at gum line?
2. New dentist also says the gum line cavities restorations are high risk for failure and root canals are better long term repairs.

Thanks for any help

I am a retired dentist. to answer your two questions:
1. If you have any periodontal recession where the root surface of the tooth is now exposed to the oral environment then you are at greater risk of decay. the root surface does not have any enamel covering it and decay will occur easier and faster than the crown of the tooth
2. restorations on the root surface of the tooth are not as well bonded to the tooth as restorations on enamel. this being said ,restorations can nevertheless be successful long-term with good oral hygiene. if the decay gets too deep into the tooth and encroaches on the pulp then you are looking at a root canal. decay on the root surface will penetrate the tooth much faster because the root surface is softer than enamel plus it is closer to the pulp to begin with. therefore any decay on the root surface must be treated promptly.

I hope i have answered your questions.

Another retired dentist here:
I would like to clarify what mn54 said. Or maybe we disagree, but I doubt it. Untreated period disease is more likely to encourage root decay than a good periodontal treatment result. This is because one major objective of good periodontal treatment is to provide access to the root surface for more effective plaque removal. Untreated periodontal disease leaves areas of root surface accessible to bacteria that cause decay, but inaccessible to good brushing and flossing.

Root decay is the bane of geriatric dentistry. Mouths that survived decades without decay can be very vulnerable to root decay, for the above mentioned reasons: Root surfaces are less mineralized than enamel, and hence, "softer" or more prone to decay. Furthermore, root decay tends to be broad across the surface, and the walls of solid tooth one needs to surround and support the restorative effort can be hard or impossible to find. In other words, root decay can be an absolute bitch to get a good reliable restoration to treat long term. Tooth colored restoration will bond, but not nearly as well. Also, it can be really hard to isolate the restorative effort from blood and saliva along , or under the gum line when placing the restoration, and good isolation is an absolute MUST for a good bonded restoration.

To make matters even more fun, the location of the nerve and blood supply of the tooth is much, much, MUCH closer to the surface of the root than it is to the surface of the crown of the tooth, so you don't have far to go before you are encroaching on it.

So why is it so abundant? We are living longer, so the natural tendency, even in healthy mouths of the gum and bone line to migrate towards the root tips, goes on longer. Also there is a tendency for our salivary flow to reduce as we age. This is exacerbated mightily by many medications, especially blood pressure meds. The most common side effect of almost every drug out there is "xerostomia", which is "DRY MOUTH"...
Now, just to throw a little gasoline on the fire, self treat your dry mouth by sucking on hard candies with sugar, or juice with sugar, and literally, in 6 months between cleanings, I've seen mouths devastated. Absolutely devastated.

Moral of story: keep 'em clean, and do NOT suck on hard candies with sugar, or treat dry mouth with any liquid with sugar in it. Absolutely, do not.

As far as your treatment plan, if you have any questions, get another opinion. Never hurts to get another opinion.

Best of luck!

 

[HtownRose]

Parents especially need to be careful when taking their children to a dentist to check reputations & references first. I have heard horror stories of dentists calling CPS when a parent wants a 2nd opinion.

 

[nwsteve]

OP here. Thanks for all the comments and a special thanks to the former practitioners. It was reassuring I am not the only one with "suspect" experiences with the dental profession.
My adventure in perio appears to have started with a dentist who took gum readings that were consistently 5 and under and never uttered a word about going to a periodontist for an assessment. In fact, actual readings were much higher especially in the molar areas. He probably did not want to give up the revenue from the regular maintenance visits.
In contrast my "new" dentist recognized he might be giving up some cleaning revenue but also that we needed a more comprehensive current assessment of perio status.
My recent perio visit did identify some gum recession and decay at gum line that abruptly erupted in the last year. (no real change in diet (no sugar or soft drinks) but different water supply from location with hard water (lots of minerals) to a much softer water supply).
The new digital xrays are simply amazing and at least make it a bit easier for even a patient to see where there is change and intervention is required/recommended. Also could easily see how old crowns are in the way of restorations between teeth at gum ;-<

 

[Brat]

My cleaning was scheduled just as Covid19 started, postponed. The dental office has now opened and I got a cleaning last week. The personal protective practices were impressive. The root of a molar has broken, it had a root canal and filling, needs to go. The dentist is only doing critical work and they would call to schedule. Going in next week.

The dental group is a Kaiser group. They do not 'sell' services. I respect their recommendations.

I once had a dentist who tried to impress me with his ability to make my teeth beautiful. The guy purchased the practice after the family dentist retired. I moved on.

 

[Nick12]

That happened to me. New in town. Saw a nationally advertised brand of dental office. All of a sudden I have cavities. And she was frantic telling me how important it was to fill them immediately.

In 55 years I had had a grand total of ONE cavity and my previous dentist said everything was groovy. So, I hit a dentist shop that had just opened closer to my house. Like every dentist I have ever had he said my teeth were remarkable. Don't see a set of teeth like that every day. Still waiting for a cavity.

Those advertised brand of dentists attract dentists of low quality. Those dentists get rotated out every year or two. I see that dentists that are in private practice for a long time in one location is a better bet. Google is your friend to see the dentist reviews.