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    I have a 54 year old patient with generalized severe adult chronic periodontitis. Probing depths range from 4-6mm with 7mm probing depths at the molars. No mobility, no furcations. Horizontal bone loss with moderate to heavy calculus deposits, some of which are visible on the x-rays.

    The patient is a smoker, currently has acceptable home care. This gentleman has no plans to quit smoking.

    I think this is a treatable situation, but what concerns me is pain control. He is allergic to NSAID, and as you all know, smokers seem to always have more pain than non smokers.

    I plan to perform root planning, and will likely perform surgery for the posterior teeth.

    My thoughts on minimizing post operative pain include the use of systemic steroids, pre op use of chlorhexadine, possible use of Emdogain ( even though I do not anticipate regeneration). I also plan to apply a desensitizer at the root planning appointment to attempt to minimize that source of pain. We have already placed the patient on Sensodyne.

    Other thoughts on what will aid healing and therefore reduce pain?



    How good a candidate is a smoker for periodontal surgery?

    I have found that endoscopic debridement as a primary treatment works well for smokers as they are not good candidates for surgery. Simple OTC pain meds (acetominophen in this case) suffice for this procedure.

    Good luck to you and your patient!

    All the best,



    I agree with John.
    We would attain measurably effective plaque control. 80% or better effective using disclosant for instruction. No Chlorhexidine since I feel masks ability to teach plaque control.
    Then S&RP either half or FM . followed by the perioscope at the same visit. Will remove more Sub G calculus than I can surgically.
    Minimal PO discomfort,no pain. 1-2 doses of Tylenol. less recession and less sensitivity and better outcomes relative to surgery. My hygienists perform this treatment.

    In response to Rob’s post re LANAP. Hard to believe that LANAP which is a closed procedure makes as much sense as the best debridement possible at 48 magnification. I am hearing from the marketing that the Laser’s wavelength targets pigmented organisms. Does that destroy the remaining bugs in the red family? What if not a red family caused perio? Maybe it is sensitive to this and automatically changes wavelenth. Dr Spock is using a phaser.



    My pharmacology background beckons, Fioricet tablets for the pain , not an NSAID,
    acts centrally without the CNS depressant side effects combined with acetaminophen
    Patients are comfortable, relaxed, sometimes given pre-op x 2 tablets for anxious patients as well.


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