The “No Calculus” Periodontitis

Dr. Lee Sheldon

“That’s funny. You have no plaque and no calculus, but you’ve suddenly lost a lot of bone support,” your dentist says. “I wonder what’s going on.”

I’ve seen lots of patients like this. The first thing they often say is, “How did my dentist miss it?” The answer is that you likely have what used to be called Aggressive Periodontitis. In current terminology, it is called “Stage 4, Grade C Periodontitis.” And it moves very fast.

Not all plaque shows up as a jelly-like mass. Some aggressive plaque can’t be seen by the naked eye. You may see it as a highly mobile group of bacteria under the microscope however. What else do we find in Aggressive Periodontitis? No calculus.

The bad news is that bone destruction occurs rather quickly. The good news is that if it is treated correctly, these patients can regrow some of that lost bone.

What are the clinical symptoms? The gums are often sore when doing the periodontal probing examination. The probe itself drops right into the pocket with almost no resistance. Pockets of 7 to 10 mm and even more are quite common. Often, there is a mouth odor.

In aggressive periodontitis, the bacteria has overwhelmed the immune system. Connective tissue destruction can be rapid. The key is to identify which bacteria are causing the problem. Often, I will place these patients on antibiotics that are identified in the testing to be the most appropriate for the bacteria that’s been identified in the lab. I’ll then reevaluate the patient after two weeks and see what the effect of the antibiotics has been. If successful, we move on to decontaminating the roots so that they are in perfect condition for the bone and gum tissue to grow back.