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White Papers & Research
Is Periodontal Disease Curable?
By Richard H. Nagelberg, DDS
June 2011

When a patient has perio disease and is treated successfully such that the clinical parameters of health are achieved, that patient is healed or in remission, not cured. When the same causative factors line up again, the same disease will recur. The recurrence is not a new disease; it is the exact same disease rearing its ugly head again. When a patient has appendicitis, they go to the hospital and have their appendix removed. That patient is cured. They never have to worry about having appendicitis again, ever. With perio disease we are managing the patient’s disease ups and downs over their lifetime. When the patient comes out of remission and gum disease recurs it is not a new disease, it is a repetition of the previous occurrence of the same disease. The same tissues are involved; the same immunological, genetic and bacterial factors are causing the recurrent disease; the exact same factors and events, causing a recurrence of the same disease.

When we arrive at the endpoint of our periodontal treatment we cannot say to the patient that they never have to worry about having gum disease again, as is the case with the appendix removal. What we can tell the patient is that they have achieved disease remission. The patient should be informed that the only true cure for perio disease is full mouth extractions. Only then can we say to the patient, “You will definitely never again have gum disease, period. You are cured”. No appendix, no appendicitis. No teeth, no periodontitis. This is not to say that people with teeth won't be able to be cured, just not yet. What will a cure look like? It has to do with the tissue destructive immune-inflammatory response. There are local immunological triggers for different organ systems including the heart, kidneys, liver, periodontium and so on, in addition to the global immuno-inflammatory system. There are on and off triggers for each system. When we can modify the local perio triggers, such that the triggers for the periodontium are turned off, without shutting the whole system down, then we will have a cure. At that point, you can have biofilm coming out your ears without causing disease, because the tissue degrading immune response trigger has been turned off. At that point we can then say, "You never have to worry about getting gum disease again, period". That day is coming.

If my doctor cannot look me in the eye after treating me for something and say, “Now go home and relax. You are cured and you will never have this disease again”, then I am not cured. If he suggests recalls checking for signs of disease every three months, then I am not cured. I am being managed in and out of recurrent disease and what presently passes for health, because the root cause has not been fully addressed, just managed.

Since periodontal disease must be managed we must help our patients do so with frequent periodontal maintenance and monitoring of risk factors as well as the subjective and objective signs of disease. Until the day we can cure periodontal disease, careful disease management will allow us to identify recurrence and retreat immediately.