Initial extractions and tooth loss during supportive care in a periodontal population seeking comprehensive care

Background/aims: This retrospective survey was aimed at determining the prevalence of tooth extractions and the dental pathologies associated with them during both the active and maintenance phase of periodontal therapy in a periodontal population seeking comprehensive dental care. Methods: A total of 273 randomly selected subjects from the oral prophylaxis clinic of the University of Berne were included. All subjects had received comprehensive care consisting of periodontal and restorative treatment and participated in a supervised maintenance program for an average of 67+/-46 months (range 5 to 278 months). The population consisted of 39.6% current smokers and 27.8% previous smokers. 6.2% of the patients had gingivitis, 20.5% mild periodontitis, 48.4% moderate and 24.9% severe periodontitis. The average frequency of the recall visits was 4.4+/-1.5 appointments/year (range 1.7-12 appointments/year). Results: Results indicated that 574 out of a total of 6503 teeth were extracted; 311 teeth were extracted during active therapy and 263 during the supportive periodontal care (SPC) phase of therapy. 46% of patients received tooth extractions as part of their active treatment and 41% during their participation in the secondary prevention program. In the subgroup whose treatment plan included extractions the average number was 2.5+/-1.6 teeth per patient. Likewise, the patients who received extractions during recall lost an average of 2.35+/-1.9 teeth per subject with an incidence of 0.4+/-0.37 teeth per patient per year. These data reinforce the concept that a minority of the population is responsible for the majority of tooth extractions, both during active therapy and SPC. Periodontal disease was the only pathology observed at 57% of the extracted teeth; while caries, endodontic pathology and technical problems in the absence of periodontitis were observed in 29% of cases. Conclusions: These observations indicate that the rendered treatment was effective in the long-term maintenance of the dentition of these subjects and suggest that advanced periodontal disease represented the major cause of tooth loss in this population.