I don't want to be 25 and toothless!

July 24, 2012 8:24 AM

How worried should I be about my teeth?

I went in for a routine cleaning with a new dentist 2-3 months ago, where my gums were measured and I was told I had periodontal disease and needed "laser curettage" and "planing and root scaling" procedures on the four quadrants of my mouth. I have dental insurance, but they only cover a few hundred dollars off the cost, leaving me to pay a little over $800.

I spoke to my parents about this, who seemed extremely skeptical, having never had the procedure pushed on them. They have all their teeth and what I would consider to be standard oral hygiene. My last cleaning (in my home state, with my long-time dentist) was in October of 2011, where nothing was amiss, and when I asked about the diagnoses and mentioned that the dentist had said I had some 4-5 and I think one 6mm pocket, he also seemed skeptical given my records.

While I planned to get a second opinion, I decided to oral hygiene the hell out of my teeth in the meantime. Before the appointment I'd been brushing regularly, but I'd lost my Sonicare toothbrush, been skipping out on regular flossing and been doing it only occasionally (a sin I have been guilty of in the past, although to no adverse effect).

After the appointment, I got a "gum care" Sonicare toothbrush with which I brushed twice a day, started flossing 1-2 times a day strictly, and used mouthwash 1-2 times a day (and occasionally peroxide). The inflammation seemed to go down and I got a little sidetracked with life in my quest for a second opinion.

Last week, however, I noticed that my back three molars on the upper sides of my teeth were again red and inflamed, particularly the gum area between where the teeth meet. There's quite a bit of tartar/plaque build-up on these teeth as well, and I can't tell if there's been any recession but I suppose it is possible. They definitely aren't loose or anywhere near that. My gums do not bleed when I floss. The rest of my teeth -- the front ones on the top and all the bottom teeth -- look quite healthy and the gums look pretty normal, I think. When I smile, my teeth still look normal, but in pulling back my lips I can see the inflammation around the top back teeth.

I bit the bullet and agreed to the "deep cleaning" procedure, mostly out of panic. The soonest I could get the appointment is next Monday, but I can't stop panicking. Because one of the pockets was 6mm and apparently in the "severe" range, and I put it off, I'm terrified they're going to tell me I need full-on gum surgery or I'm going to lose my teeth. I am, in fact, so panicked that I couldn't really sleep much last night. But somehow I have to pull it together and make it until Monday the 30th.

Other relevant information: I am an otherwise healthy, 24-year-old female, and I haven't had any serious problems with my teeth before this (I had some cavities as a kid, and had my wisdom teeth removed around four years ago). I don't smoke or have diabetes. I do drink coffee regularly. I switched recently to plastic flossing pick things, which I fear I might have gotten too enthusiastic with, which is ultimately how I noticed the inflammation.

I'm looking for information on what to expect, given what I've shared here. Is it likely I will need gum surgery, or would a routine deep cleaning procedure probably take care of it? I really need my nerves calmed as I'm already prone to anxiety, having an incredibly stressful summer, and tooth loss would just push me over the edge. Google is unfortunately doing very little to help me understand the situation, as there is no consensus and opinions range from "Planing and root scaling is a scam!" to "If you have 6mm pockets you will probably get cancer and die."

I know you are not my dentist, but... help?

posted by aintthattheway to health & fitness (29 answers total)

(Erm, I should note that in paragraph three I meant I flossed only occasionally, not brushed only occasionally--I brushed every day.)
posted by aintthattheway at 8:26 AM on July 24, 2012

Can you get a second opinion?
posted by discopolo at 8:29 AM on July 24, 2012 [3 favorites]

Are you seeing a periodontist? That's the person who's really up on gums. Inflamation of your gums can be anything, I had it when I was taking a lot of aspirin based pain relievers.

I'd get a second opinion before going in for an invasive and expensive, non-reimbursable cleaning.

Husbunny has horrible teeth/gums and he had implants of antibiotics. No surgery yet. Also we have 20 some-odd years on you.

For sure, take it seriously, but don't lose your shit.
posted by Ruthless Bunny at 8:29 AM on July 24, 2012 [1 favorite]

And frankly, I had root scaling done and it was a good thing. Make sure you find a reputable dentist.
posted by discopolo at 8:30 AM on July 24, 2012 [1 favorite]

Second opinion, see an actual periodontist. Every dentist I have ever seen has referred me to a periodontist for this kind of thing.
posted by elizardbits at 8:32 AM on July 24, 2012 [2 favorites]

Second opinion. I used to manage a dental office, and like I tell everyone, if you're feeling swindled before you even sit in the chair, don't do it. You want to trust your dentist.

But first, if you're comfortable with the following plan, ask the dentist if you can beef up your home care regimen (for some reason, I suspect that like most patients you may have said that you've been flossing every day and diligently brushing. If that were true the inflammation would be a big concern. But you have not been flossing every day.) and come back for another standard cleaning and exam in 3 months instead of 6. If the dentist still thinks then that you need root planing and scaling, I would suggest you get a new dentist at that time unless your pocket depths have increased.

Bear in mind, I am not a dentist and never will be one.
posted by bilabial at 8:39 AM on July 24, 2012 [3 favorites]

In the meantime, don't get too aggressive with your mouth. Gums are soft and ... um, gummy. You can do some damage if you attack them too hard and too often with floss, brushes, etc. My dentist has wagged a finger at me for doing that.
posted by Longtime Listener at 8:41 AM on July 24, 2012 [3 favorites]

This isn't an Aspen Dental, is it? They seem to push expensive procedures a lot...

In any case, definitely get a second opinion.
posted by Kriesa at 8:44 AM on July 24, 2012 [1 favorite]

On the matter of the toothbrush, you can pick up an Oral-B electric toothbrush for $30 or so that will clean your teeth and gums very well. I brush with one of those two minutes, twice a day, and floss at night.
posted by Currer Belfry at 8:46 AM on July 24, 2012

I've had root scaling/planing done a few times, but my dentist showed me, on x-rays, why it needed to be done. My periodontal disease is causing bone loss, and though I've never had a cavity in my life, it is possible I may lose all of my teeth if I don't do this ridiculously expensive procedure every few years. Doing it sucks, but after it's done my mouth feels awesome and my teeth don't wiggle anymore.

So get a second opinion.
posted by xyzzy at 8:48 AM on July 24, 2012

Also, general dentists, even if they are totally honest, aren't always the best at diagnosing specialty stuff. My dentist thought I needed a root canal. She doesn't do them, so she sent me to the specialist. On my evaluation meeting with the specialist, he decided I probably didn't need a root canal, and even if I did, I could wait until the tooth started to bother me again. (By the time I got to the specialist, the pain was gone).

That was a year ago.

So n'thing get a second opinion.
posted by COD at 8:49 AM on July 24, 2012

My dentist swears that any kind of powered toothbrush -- the $7 spin brush to the $150 Sonicare -- is a good step, and it doesn't matter which one. I've had a fancier one, but I like my $30 one I got at Target just fine.
posted by Madamina at 8:49 AM on July 24, 2012

I spent a month at a Dental insurance company once, so I'm relatively informed about this. Periodontal disease is a serious concern if untreated. "Deep cleanings" (which can be painful) are usually just one step above surgery. If the worst happens and you end up losing your teeth, replacing them individually generally costs a couple of thousand dollars per tooth, and you will spend several months with missing teeth, since they need to sink titanium posts into your jaw, give the bone time to heal around the posts, and then attach the prosthetic tooth replacements.

In other words, tooth care is serious business and you are right to be concerned. However, if the only thing they are talking about right now is a deep cleaning, then it looks like your issues were probably caught in the nick of time.

Whether or not you can trust your dentist (it sounds like you are skeptical) is a separate issue, and one that I'm not qualified to comment on. It's important that you feel confident about your medical professional - spending a little more money on a second opinion may end up saving you a lot of money in the long run, since medical bills have the potential to become a major expense and they are one of the things I never skimp on.
posted by wolfdreams01 at 8:50 AM on July 24, 2012

Get a second opinion, but if they confirm periodontal disease, do not delay treatment. I was skeptical about the need for aggressive treatment and put it off. My treatment has cost magnitudes more than it would have had I started earlier, and some of my molars could not be saved.
posted by Wordwoman at 8:54 AM on July 24, 2012

Oh, and my story is a bit similar to yours in that my longtime family dentist said nothing about periodontal disease, so I thought that the new dentist must be scamming me. It turns out that the old dentist had never done routine periodontal probings.
posted by Wordwoman at 9:00 AM on July 24, 2012 [1 favorite]

I had deep cleaning years back in response to such a diagnosis by a dentist. It is a standard procedure, as far as I know (and I don't think you need a periodontist to diagnosis/prescribe, but I could be wrong). Since then I have adopted daily flossing, mouthwash rinse, and Sonicare toothbrush. Gums have been good since. Don't freak out, just hop on the oral hygiene bandwagon. (And don't go wild -- gums are sensitive (as you know).)
posted by ClaudiaCenter at 9:04 AM on July 24, 2012

Also, dental care and research has really improved since your parents' day. Don't rely on their understanding of what dentists do. Poor gum health can cause a lot of problems in the rest of the body.
posted by discopolo at 9:10 AM on July 24, 2012

IANAD, but I also was diagnosed with periodontal disease in my early 20's. My understanding is that periodontal disease is relatively slow-moving. I don't think much is going to change if you have to wait a few weeks (or even a few months) before you get the procedure. Obviously, you need to be flossing everyday. But, I have been told that you'll never actually be able to reach a 6mm pocket on your own with floss. Maybe try a water pik.
posted by shannonigans at 9:36 AM on July 24, 2012

I have moderate gum disease, but I am not a dentist, so this is my experience:

I have always had bad gums. Teeth are fine, gums have bled after brushing and flossing my entire life. It can be genetic. I routinely have 4mm-6mm pockets at every dental visit, and typically have a root planing and scaling done once every two years. It is not a scam, and it makes a huge difference. I still have all my teeth. Most people only need it once if they do not have actual gum disease; it sort of gives you a blank slate in your mouth and if you keep up with mouth care after you will be okay and not likely to have gum surgery.

Your deep cleaning will be fine. It might even help you avoid the root planing and scaling, or if not, make it less traumatic. If it's scheduled for Monday, though, call the office today and ask them if the dentist can please prescribe you ONE valium because your appointment isn't for another week and you are really freaking out and are likely to panic in the chair on Monday. Provide the phone and fax number of your local pharmacy.

Do what you can, compliance-wise, to get your teeth and gums in shape now so you can avoid gum surgery. I've had a gum resecting and gum transplant, and it puts you out of commission for a while and can be really effing expensive because a lot of dental insurance doesn't cover periodontal care.
posted by juniperesque at 9:40 AM on July 24, 2012 [1 favorite]

I can't comment on whether you need this procedure since I'm not a dental expert and I don't know your particular situation, but get a second opinion. I have genetically weak teeth, I had a serious accident that knocked out a tooth and damaged a bunch of others, and I have moved around a bit, so I have some experience shopping for dental services. Some dentists will definitely ring you up for unnecessary services. Health insurance makes it expensive up front to shop around, but shop around-you'll save money and peace of mind in the long run.
posted by Kwine at 10:03 AM on July 24, 2012

As others have said, there is nothing about the progress of periodontal disease that will worsen if you take the time to get a second opinion.
I would argue with COD's assertion that general dentists are not good at diagnosing "specialist" stuff. Diagnosing is the heart of what we do, especially the diagnosis of periodontal disease (or at least it should be), because it's the true reason we see patients periodically to 'clean' their teeth.
A 25 y.o. pt. with a good history of regular check ups, uses a sonicare, and no bleeding would not seem to be at risk for the type of attachment loss (recession) that would need surgical intervention (laser or otherwise), but without records I can't make that call.
Settle down, keep up with your hygiene and get that second opinion. you won't lose your teeth.
posted by OHenryPacey at 10:20 AM on July 24, 2012

Definitely get a second opinion. I have been told that one potential contributing factor to gum problems is birth control pills. If you have recently started using a (new to you) birth control pill, you might ask about that as well.
posted by freezer cake at 10:42 AM on July 24, 2012

Get a second opinion.

I went from 2-3mm deep pockets to 4-5mm deep pockets 6 months after years of being at 2-3mm. They immediately pushed the "deep cleaning," and went to my insurance company to get pre-approval.

When they couldn't get pre-approval they dropped the matter entirely.

So clearly it wasn't important enough of a procedure to suggest I pay out of pocket for it.
posted by MonsieurBon at 11:25 AM on July 24, 2012

I'm not a dentist. I am a dental patient, however. If your parents have good teeth, and you are in your twenties, I wouldn't rush into anything. I would use the Sonicare and floss regularly and check again in 4 months (maybe with some other dentist) to see if the pockets have receded. Chances are, they will. I have horrible teeth and had the expensive scaling twice but ultimately, it is regular care that makes the difference.
posted by Obscure Reference at 11:46 AM on July 24, 2012

Nthing getting a second opinion, preferably from a periodontist. My gums were incredibly inflamed and I had deep pockets too. After having it recommended by my dentist and a periodontist, I finally had root planing and scaling this spring (after putting it off for quite a while) and I can't believe what a difference it made. (So much that I will not need gum surgery like I was afraid I would!) I asked for sedation during the treatment and got it...they also used novocaine so I didn't feel much of anything. I was able to eat normally and didn't have a lot of pain once the novocaine wore off. I had to do it in two appointments - one for each side of my mouth. (after the first appointment my mouth looked like a before and after ad!) I had to pay $500 out of pocket - my insurance took care of the rest.
posted by SisterHavana at 5:12 PM on July 24, 2012

Thank you all for your feedback! I am still pretty anxious (but chalk that up to being extremely anxiety-prone) but your answers have calmed me down somewhat, particularly from those who are involved in dentistry or have had the procedure. I took the advice here and am getting a second opinion from the family dentist I've had for several years -- just for the sake of feeling more comfortable. I managed to schedule that for Monday, and assuming he gives me the same answer as the first place, I've been able to reschedule the procedure with the original dental place for Wednesday, so it's not put too far off. I'm glad to know I can look forward to my mouth feeling nice and clean, even if it's painful at the time.

I will check back in after my appointments so future freaker-outers who happen upon this question will know what happened...
posted by aintthattheway at 5:59 PM on July 24, 2012

Second opinion, just because I don't trust dentists! The last guy I had said I needed like 3k worth of work (crowns, replacing fillings, etc). I agreed to one filling (the only one I actually needed) and while he was filling that tooth he took it upon himself to drill it's neighbor - replacing a perfectly good amalgam filling with a white filling, after I specifically said I wanted just the one messed up tooth taken care of. He was snide too. While he was drilling I asked him what he was doing and he told me to 'just be quiet and let him do dentistry.' What a bastard. Paid for just the one filling, and left some awesome reviews for him.

Got a new dentist, and the guy is awesome. He confirmed that all the "necessary" stuff the first guy suggested was major, major overkill, and that I didn't need anything done at all. I really like my new dentist. First guy sucked.

Also, you can brush your gums away - don't be overzealous, use the softest bristle brush you can find, and always floss. You can brush your teeth away too (I did this several years ago to two of my molars - brushed the enamel right off of the sides close to the gumline)! Use a non-abrasive toothpaste - most major brands use what is basically sandpaper grit to scour away plaque - use something like Sensodyne or Toms - I think both of these are harsh-abrasive-free.

It sounds like you have the same feeling about your current dentist that I had about my last one. Get a second opinion!
posted by amcm at 6:59 PM on July 24, 2012

Get a second opinion. I was off dental insurance for a couple of years, moved to a new town, and went to a dentist a co-worker told me they had seen. -- I got the exact same bad news as you. I could not afford it at the time, then the dental plan changed, and could not make it in to a new (different) dentist for another year. I went in fearing the worst, got a thorough cleaning and a good scolding for my flossing habits, and then was told that they would see me in 12 (preferably 6) months. I asked about the root scraping and they gave me a look, asked me who had told me about needing the procedure, and then the dentist and the technician had a good laugh because "Dr Bob" always tells people that is what they need, apparently the margins on the insurance are better than for just normal cleaning.

I know nothing about your mouth and the recommendation might be appropriate, but I am also against needless medical procedures and your story sounded so much like the Exact same thing that happened to me I thought I would suggest a second opinion.
posted by cgk at 8:06 AM on July 25, 2012

Update! I went today to see my family dentist for a second opinion. The hygienist started out with periodontal probings and found that since my visit to the last dental office, after a few months of stringent twice-a-day-for-two-minutes brushing with a Sonicare, flossing, and mouthwash use, my gums are measuring overwhelmingly in the 1-3mm range, which is healthy. On one side of my top teeth, on the back and inside, there are a few 4mm. On the bottom on both sides of the back teeth on the inside, a few measure 5mm. The hygienist thought this was fine and gave me a regular cleaning, saying the dentist would look it over too just in case. When the dentist came in afterward, he too measured the back problem areas, but said that while it wasn't ideal, it wasn't something to be overly concerned about. He said I should concentrate on those areas more when brushing, aiming the bristles toward where the gum line meets the teeth. He put up my x-rays and pointed out that my bones looked very healthy and there was no indication of bone loss. Both the dentist and the hygienest agreed that my gums looked overall very healthy and gum disease was not likely. The dentist said I should keep up my regimen and we'll keep an eye on the pockets in the back, but not to worry.

In short: all that panic for nothing! I feel $800 richer!

My personal take-away lesson here is that periodontal disease is an easy thing to diagnose, given the ease of gum inflammation and the development of "pockets." As my dentist noted, they aren't always necessarily indication of gum disease, but if 4-5-6mm etc. pockets are more widely disbursed in the mouth, if the gums bleed, if bone loss is indicated on the x-ray -- these are things to be more concerned about. But a deep cleaning won't hurt you, it'll just cost 4-5 times the cost of a regular cleaning, which is why some dentists can be pretty liberal with insisting upon it. For all future people in my shoes: get a second opinion with a doctor you trust, and keep an eye on your gums. Don't get quickly hustled into a deep cleaning you can do yourself with a brush, floss, and mouthwash.
posted by aintthattheway at 2:51 PM on July 30, 2012