{"id":28588,"date":"2026-01-23T12:00:16","date_gmt":"2026-01-23T18:00:16","guid":{"rendered":"https:\/\/www.oraldna.com\/trends-in-salivary-testing\/?p=28588"},"modified":"2026-01-21T12:09:01","modified_gmt":"2026-01-21T18:09:01","slug":"when-a-hopeless-tooth-isnt-hopeless","status":"publish","type":"post","link":"https:\/\/www.oraldna.com\/trends-in-salivary-testing\/index.php\/2026\/01\/23\/when-a-hopeless-tooth-isnt-hopeless\/","title":{"rendered":"When a \u201cHopeless\u201d Tooth Isn\u2019t Hopeless"},"content":{"rendered":"

\"\"<\/a><\/p>\n

A 45-year-old woman arrived in our office in significant pain. The day before, she had seen a dentist for a painful lower left central incisor. The recommendation was straightforward: extract the tooth and then see a periodontist.<\/span><\/p>\n

She refused. <\/span>Instead, she searched for another option and drove nearly 50 miles to our office.<\/span><\/p>\n

The Clinical Picture<\/b><\/h3>\n

\"\"<\/p>\n

She was hitting tooth #24 every time she closed her mouth\u2014and it hurt badly. The gingival tissue was visibly swollen, and the tooth had Class III mobility.<\/span><\/p>\n

\"\"
Periapical X-ray of #24<\/figcaption><\/figure>\n
\"\"
CBCT slice of #24<\/figcaption><\/figure>\n

Radiographs showed severe bone loss. At first glance, this looked like a tooth destined for extraction.<\/span><\/p>\n

But something didn\u2019t fit.<\/span><\/p>\n

What Didn\u2019t Add Up<\/b><\/h3>\n

When we probed the rest of the mouth, we found deep pockets elsewhere\u2014like a 9 mm pocket on the distal of tooth #4\u2014with surprisingly little calculus.<\/span><\/p>\n

This wasn\u2019t typical chronic periodontitis.<\/span><\/p>\n

This was <\/span>aggressive periodontal disease<\/b>, where the probe drops apically with almost no resistance and minimal calculus is present.<\/span><\/p>\n

That distinction matters.<\/span><\/p>\n

First Visit: Stabilize, Don\u2019t Extract<\/b><\/h3>\n

\"\"<\/span><\/p>\n

The patient was anxious and in pain. Probing around #24 wasn\u2019t possible.<\/span><\/p>\n

So we did three simple things:<\/span><\/p>\n

    \n
  1. Careful local anesthesia<\/b>\u2014inject a drop of local in the vestibule. Wait for a minute. Then inject through the numb spot. Patients love it.<\/span><\/li>\n
  2. Occlusal adjustment<\/b>\u2014we reduced the incisal edge so she stopped traumatizing the tooth.<\/li>\n
  3. Diagnostic testing<\/strong><\/li>\n<\/ol>\n

    The relief was immediate once the tooth was taken out of traumatic occlusion.<\/span><\/p>\n

    Diagnostic Testing<\/b><\/h3>\n

    \"\"<\/p>\n

    We collected a microbial sample and ran a MyPerioPath test from OralDNA Labs.<\/span><\/p>\n

    \"\"<\/p>\n

    Testing matters because dentistry should work more like medicine: <\/span>identify the pathogens first, then treat.<\/b><\/p>\n

    OralDNA doesn\u2019t just identify periodontal pathogens\u2014it also helps guide <\/span>antibiotic selection<\/b>, rather than relying on guesswork.<\/span><\/p>\n

    Because this patient had a severe active infection, we started empiric antibiotics (amoxicillin and metronidazole) immediately while awaiting results.<\/span><\/p>\n

    Five Days Later<\/b><\/h3>\n

    \"\"<\/p>\n

    The tissue had already settled down.<\/span><\/p>\n

    My son, Dr. Matt Sheldon, splinted tooth #24 (to #23 and #25), but she was feeling better even before the splint was placed. Infection control\u2014not extraction\u2014was already changing the outcome.<\/span><\/p>\n

     <\/p>\n

     <\/p>\n

     <\/p>\n

    Definitive Treatment<\/b><\/h3>\n

    \"\"Next came periodontal endoscopy, allowing us to go beneath the gumline and ensure the root surfaces were truly clean.<\/span><\/p>\n

    Weeks later, pocket depths had dramatically improved\u2014nearly all were resolved.<\/span><\/p>\n

     <\/p>\n

     <\/p>\n

    The Proof Is in the Bone<\/b><\/h3>\n

    \"\" \"\"<\/p>\n

    Look at tooth #24. <\/span>Bone regenerated.<\/span><\/p>\n

    This wasn\u2019t magic. It was the result of:<\/span><\/p>\n