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Does periodontitis require scaling treatment?
May 8, 2013 11:02 AM   Subscribe

Does periodontitis require scaling treatment? I just saw a dentist who said I have bone loss in my teeth but didn't clean them or refer me to a hygienist or periodontist--does that seem normal?

I just went to a new dentist to get a tooth fixed; I don't trust my old dentist for various reasons and after this check-up, it seems my mistrust was well-placed.

One of the issues he found is that I apparently have bone loss of 4-5mm in my teeth. He said I have juvenile periodontitis (I'm 30) and told me to make sure to floss, brush twice a day for 3 minutes, and use anti-bacterial mouthwash. I already do (and have done) all of these things. If the bone loss continues my teeth will fall out and I'll need dentures but he said I might have 10-20 years before that happens (god).

The bone loss was apparent on the x-ray but he said you couldn't tell just by looking at my teeth. I have been trying to figure out what to do about this (since I'm already doing everything the dentist told me to do) and nearly everything I come across says that dentists will generally recommend scaling/cleaning to remove plaque to stop the bacteria from causing bone loss. This dentist didn't recommend that or clean my teeth. I'm in the UK, on NHS, and no dentist has cleaned my teeth in 4 years (I go to the dentist every 6 months for a check-up). My last dentist would always tell me that my teeth were already so clean, that there was nothing for her to clean.

I have been googling this for the past few hours since getting back from the dentist and am exhausted and freaked out. Obviously I couldn't question the dentist about all this at the time as I didn't know then what I know now. Do I need to keep trying new dentists? Does this sound right, that I could have that much bone loss and not need scaling/cleaning? Any help is really appreciated. I don't want dentures when I'm 40.
posted by Polychrome to Health & Fitness (8 answers total) 2 users marked this as a favorite
 
I have periodontal disease, YMMV. You might gain some insight from this thread:
http://ask.metafilter.com/220694/I-dont-want-to-be-25-and-toothless

While I can't say what is possible in the UK in terms of your health care situation, I can say that if you have periodontal disease, root planing and scaling is one of the only ways to arrest the progression. Note that you do not just skip straight from bad gums and bone loss straight to teeth falling out. There are middle steps to take, including gum transplants, which I've had done, bonding, and dental implants tooth-by-tooth. But whatever you can do now, including finding a new dentist who can refer you to a periodontist, would be a good first step if possible.
posted by juniperesque at 11:14 AM on May 8, 2013


no dentist has cleaned my teeth in 4 years (I go to the dentist every 6 months for a check-up). My last dentist would always tell me that my teeth were already so clean, that there was nothing for her to clean.

I have never been to the dentist for a 6 month checkup without the dental hygenist doing a cleaning and polishing, nor have I ever heard of this happening to anyone else I know. Is it typically different in the UK? I'd call back and ask your questions of the new dentist, and if you don't get helpful answers, maybe dentist #3 is a good choice?
posted by leahwrenn at 11:58 AM on May 8, 2013


In my experience (US), a hygienist cleans your teeth for every dental visit (so, every 6 months or even more frequently) and they always find something to do -- scrape off some plaque, polish up the teeth, give you extra fluoride treatments, and so on. So I find it extraordinary that they've refused to clean your teeth for 4 years, even setting aside the bone loss issue.
posted by Houstonian at 12:00 PM on May 8, 2013


Yeah, in the UK cleaning is at the discretion of the dentist. It does not necessarily happen every 6 months like it does in the US. That's the NHS. NHS also only recommends having a dental check-up every 2 years. Dental care, especially preventative dental care, is much, much, much better in the US.
posted by Polychrome at 12:01 PM on May 8, 2013


It depends on the dentist.

But as someone with now massive boneloss due to ignorance and oversight, I urge you strongly to get thee directly to a periodontist for a gingivitis checkup. Its entirely due to gum disease that there is such bone loss in x ray. Dentists somehow pretend that it doesn't exist. Don't be me, save your molars.
posted by infini at 12:35 PM on May 8, 2013


This might not have any connection to your problems but I wanted to bring it up in case it could help you or someone else.
Bone loss can be connected to osteoporosis. My mom had horrible problems in her 30's with abcesses and boneless. The dentist said her teeth were in perfect shape but the bone was deteriorating so much, they had nothing to hold on to. Now in her 70's, she had some broken bones from osteo. Supplements like calcium/magnesium/vitamin D combo have slowed things down, along with prescription meds for osteo but I can't help wondering if knowing earlier would have made a difference. I'd ask your doctor to check for osteo just to be safe.

http://www.niams.nih.gov/Health_Info/Bone/Bone_Health/Oral_Health/default.asp
posted by stray thoughts at 4:58 PM on May 8, 2013


Dental student here. If you have periodontitis it is imperative that you get regular cleanings. Brushing, flossing and mouthrinse take care of the environment above the gum margin, but it's the pockets down inside the gums that harbour the worst bacteria - the places where brushing can't reach. The longer the bacteria sit in there, the more tissue and bone destruction they cause. You need professional scaling and root cleaning to keep that environment clean, ideally every 3 or 6 months depending on how severe your case is.

I'm trying to think why your dentist wouldn't recommend cleaning or refer you to a periodontist, and can only think of two scenarios:
1) The pocket depths of your gums are in the healthy range (1-3mm), in which case root cleaning can sometimes harm more than help (did your dentist do any periodontal probing?)
2) He thinks that juvenile/aggressive periodontitis will go away on its own - which yes, it can sometimes do, but not without supportive periodontal therapy and strict oral hygiene.

It seems unlikely to me that you would have 4-5mm bone loss with healthy pockets and not need periodontal therapy. Even if your gums are relatively stable now, once you've had periodontal disease you'll always be at risk of re-infection without treatment and monitoring. Bear in mind that I'm a student, so more experienced practitioners may want to step in - but I'd definitely advise you to seek the advice of a good periodontist.

Lastly, do you smoke? Smoking masks the visual signs of periodontitis, which might be why your dentist(s) didn't pick up on it until you had an x-ray.
posted by cucumber patch at 9:22 PM on May 8, 2013


Just in case anyone comes across this later looking for info--I got a second opinion from another dentist who said my gums and teeth were healthy, very clean, and I didn't really even have any plaque. She did not diagnose me with periodontitis. Said I had some bone loss but it was minimal and recommended I see a hygienist for regular cleanings just to make sure everything is removed that I can't get with a toothbrush and floss.
posted by Polychrome at 9:06 AM on May 13, 2013


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