Failure in periodontal therapy

My next two articles will focus on treatment failures in the fields of periodontal care and dental implant therapy. Failure in treatment can either be relative or absolute.

An implant may not integrate. That’s absolute. A patient may not like the appearance of an implant supra-structure despite it meeting all the normal aesthetic criteria. The latter being somewhat relative, the former may be easier to manage.

In both periodontal and implant care, patient expectations have a huge influence on what may be determined successful or otherwise, and it is crucial at the outset to determine treatment prognosis and patient expectations for any given care.

A huge stumbling block has been, and in many practices continues to be, the amount of time available to assess and discuss options and the various potential outcomes of any care. Despite being qualified health care professionals, we are still human and things can, on occasion, go wrong or in a different direction to what we expect. So we need to fully consent the patient, preferably verbally and in writing, and build in contingencies.

So what potential failures do we face in periodontics? I suppose the ultimate is tooth loss, but let’s look at the bigger picture. What are the effects of tooth loss on the overall status of the mouth and patients’ self-esteem? The loss of an upper second molar in an otherwise intact mouth may not be a problem functionally.

It may, however, make the patient feel as though they are ageing. If the patient has been made aware of the potential long-term prognosis for this tooth then the psychological impact may be less.

On the other hand, the loss of a whole dentition will involve major functional and psychological aspects, and so failure to save the teeth becomes a much bigger issue.

Failures in periodontal care can present in a number of ways:

• Loss of a tooth or teeth

• Repeated infections

• Discomfort and pain

• A deterioration in appearance through tooth loss or ongoing gingival recession

• A diminution in the self-esteem held by patients

• Failure to meet a patient’s expectations. Occasionally it may be the failure to meet the expectations of somebody close to the patient. Beware of outside influences.

Success often follows sound periodontal treatment but can never be absolutely guaranteed. In the modern world of private dental care where patients pay more than they used to, then success becomes more of an expectation.

A good rule of thumb is to under-promise and over-deliver. In periodontal care, if you are in doubt over the prognosis tell the patient early on without frightening them. Patients must understand that sometimes teeth are lost and on occasions the best we can do is keep the teeth going for a bit longer. As long as we are honest and do our best that may be enough.

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