Dr. Dandu Siva Sai Prasad is a Periodontist and a laser specialist. He completed his BDS in 2013 from Adhiparasakthi Dental College and Hospital, Melmaruvathur, Chennai, Tamil Nadu, India, where he developed an interest in the field of Periodontics based on his observations during patient follow-ups in his internship. Later, he completed his MDS at Mamatha Dental College, Khammam, Telangana, India. He has eight and a half years of experience as an Associate Professor at CKS Theja Institute of Dental Sciences, Tirupati, Andhra Pradesh, India.
In this interview with Dr. Lakshmisahithi Tanneru of MedBound Times, Dr. Dandu Siva Sai Prasad discuss the importance of his specialty and his clinical experiences.
Part 1 of the conversation includes his journey as a periodontist, the importance of the specialty in clinical practice, patient management in terms of communication, surgical management, different treatments in periodontics, and differences between laser and conventional practices.
Dr. Lakshmisahithi Tanneru: Can you please introduce yourself to our readers?
Dr. Siva Sai Prasad: I am Dr. Siva Sai Prasad. I graduated with a bachelor's degree from Adhiparasakthi Dental College, Chennai, and a postgraduate degree from Mamata Dental College in Khammam.
At CKS Theja Institute of Dental Sciences, Tirupati, I currently hold the position of Associate Professor. As an experienced periodontist, I have worked for eight and a half years. Additionally, for the past six years, I have been practicing general dentistry in my clinic.
Dr. Lakshmisahithi Tanneru: Could you tell me about your journey toward Periodontology and what made you choose this field?
Dr. Siva Sai Prasad: My path to periodontics began during my internship when I developed an interest in the field after starting my first assignment. Since periodontology is a broad specialty, it is crucial to understand immunological, microbiological, and patient behavioral elements. In periodontics, it is even more essential to understand how we treat or advise patients. During my internship, I saw many periodontal cases and spent a lot of time counseling patients, teaching them proper brushing techniques, addressing behavioral factors, and identifying harmful habits that needed to be corrected. Considering all of these factors, I observed the changes that occurred during follow-up intervals. Thus, all of these experiences combined to lead me to specialize in periodontics.
Dr. Lakshmisahithi Tanneru: Why is periodontology an essential part of dental care?
Dr. Siva Sai Prasad: Periodontology is a subfield of dentistry that focuses on the long-term diagnosis, treatment, and prevention of diseases affecting tooth-supporting structures. Every dental treatment requires strong tooth-supporting structures for long-term stability. To preserve good oral health and maintain the stability of teeth, it is important to visit a dentist or periodontist regularly. This makes periodontics a crucial part of dentistry.
Dr. Lakshmisahithi Tanneru: How do periodontists contribute to society, and what role do they play in dental disease management?
Dr. Siva Sai Prasad: As experts in gum disease and dental health, periodontists possess extensive knowledge of oral health. Their role is to evaluate and treat various gum-related conditions, determine their severity and progression, and provide treatment to restore lost tooth-supporting structures. Only a periodontist can assess whether a treatment is effective and predict the prognosis before initiating treatment.
Dr. Lakshmisahithi Tanneru: How do you communicate with patients in your daily clinical practice regarding treatment protocols?
Dr. Siva Sai Prasad: My approach to patient care involves speaking to them in their native language, carefully listening to their history and symptoms, and then explaining the diagnosis or possible diagnosis. I strive to comfort them by discussing different treatment options. Every patient expects a guarantee, but in dentistry, outcomes depend on various factors. Before treatment, I clearly explain the treatment plans, advantages, and disadvantages. In cases of poor prognosis, I inform patients that tooth extraction may be necessary if satisfactory care or guarantees for a particular procedure cannot be provided. Patients then decide whether to proceed with treatment or reconsider and return later.
Dr. Lakshmisahithi Tanneru: How do you manage patients, especially for surgical procedures?
Dr. Siva Sai Prasad: First and foremost, we must obtain appropriate preoperative blood investigations before performing any surgery. If everything is in order, we proceed with the surgery. However, we must first obtain the patient's consent and conduct a comprehensive assessment of their overall health. Systemic health conditions must also be considered when planning treatment strategies.
For example, if a patient has diabetes, we prefer scheduling a morning appointment. If the patient is on anticoagulants, we advise prior blood tests, such as clotting and bleeding time assessments, and check the INR value. The patient must maintain stable blood glucose levels before treatment. If the patient has respiratory issues, precautions must be taken, as aerosols generated during procedures like ultrasonic scaling may trigger respiratory problems. Therefore, different techniques and treatment options must be adapted based on each patient's systemic health.
Dr. Lakshmisahithi Tanneru: How many different treatment approaches exist in periodontics for surgical protocols?
Dr. Siva Sai Prasad: Different periodontal problems require different surgical procedures or therapy strategies. Pocket elimination techniques are among the most common surgical modalities. When a patient has deep, widespread periodontal pockets, we plan periodontal flap surgeries. To address gingival recession, we perform periodontal plastic surgery, which involves covering the exposed root surface with gingival tissue.
Pre-prosthetic surgeries include vertical ridge and horizontal ridge augmentation, as well as crown lengthening procedures. Additionally, implant placement is becoming increasingly popular in periodontics, requiring a variety of surgical techniques and therapy strategies.
Dr. Lakshmisahithi Tanneru: How do you determine whether to use laser or conventional approaches for treatment? Which do you prefer?
Dr. Siva Sai Prasad: When choosing between laser and conventional surgery, I prefer lasers because they are less invasive and suitable for mild to moderate disease progression. However, we must also consider the patient's financial situation, and in such cases, I opt for conventional procedures. Both laser and conventional approaches have their advantages and disadvantages.
The extent of tissue destruction is the main factor influencing the choice of treatment. To determine whether a patient has a deep or severe periodontal lesion, we must first assess the extent of periodontal progression.
For example, in cases of deep periodontal pockets, a laser beam or fiber cannot reach the affected area effectively. In such cases, I typically prefer the open flap technique combined with laser treatment. For mild to moderate cases, I prefer LANAP (Laser-Assisted New Attachment Procedure). If the condition has progressed further, I opt for LBR (Laser Bacterial Reduction), which is also beneficial for patients experiencing gingival bleeding.
Stay tuned for Part - 2 of the interview for different treatment approaches of lasers, most commonly used procedures in periodontics, reasons of patient preference for laser over conventional and much more!