Too old for the tooth fairy
January 11, 2009 11:46 AM   Subscribe

My periodontist is telling me I need to have an osseous graft procedure. Questions inside.

A little background: I have great teeth, but apparently craptacular gums. I have had a planing and scaling once before and had a really bad experience with it and the periodontist who did it (he was very rough and I was in a lot of pain). I finally found a new periodontist that I am comfortable with, but I've only seen him for two visits. On my last visit on Friday he told me that he wants to do osseous grafts on all four quads. I met with his office manager and she went over prices with me. I do have dental insurance, but it's as bad as my gums and won't cover much. She's quoted me $980 per quad and then an additional $1350 for bone replacement grafts, bringing the whole total to $5270. !!!!!!!!

That's a pretty big number for me to wrap my head around and will put me into debt to pay for it but I don't want to lose any teeth. I'm really not experiencing any problems with my teeth (I'm a smoker, so they don't bleed like I'm told they should) I have a little bit of sensitivity, but all in all, I'm not in any pain or feel any loosening in my teeth, so I'm torn about what I should do here.

I have two areas of questions

1. If you have had this procedure done, do you feel it really helped your gum issues? or If you declined having this procedure, do you regret not having it done?

2. Is that price about right? I live in the Philadelphia suburbs if that makes any difference.

Thanks in advance
posted by NoraCharles to Health & Fitness (3 answers total)
Best answer: I live in Texas - had a gum graft on just four front/bottom teeth only, no bone graft, and it was around 2K, so yeah, that price sounds about right for the extensiveness of your procedure. I just had it 6 or 7 mos ago, so not enough time has lapsed to speak on whether or not it was worth it. It looks much better though, and my teeth feel more "anchored". I some pretty severe recession.
posted by delladlux at 1:15 PM on January 11, 2009

Best answer: I am not a medical professional of any kind.

Short answer: go to yet another periodontist and get a second opinion. Anyone considering a major medical procedure should think about seeking a second professional opinion. You should also get information on gum disease and periodontal treatments [American Academy of Periodontists].

Long answer: Do you feel like you've been given adequate information on why you need osseous surgery with bone grafts?

People with periodontitis have pockets in the gums where the gums have come away from the supporting tooth and bone. The pockets are prime growing grounds for bacteria that destroy bone and tissue.

People with advanced periodontitis sometimes need osseous surgery where the gum is pulled back from the bone, the bacteria are removed, and the bone is resurfaced or restructured to encourage the gum to readhere to it firmly.

If you have already lost a lot of bone, you may also need osseous (bone) grafts in order to fill in the structural holes and cause the body to generate good bone and tissue.

If you continue to grow bacteria, lose bone and soft tissue, and don't replace the missing bone, you will lose your teeth. Even if they feel pretty good right now. In other words, your periodontist is telling you that your good teeth are meaningless because he thinks you're in danger of progressing to tooth loss soon.

Whether or not he is right is another matter. That is why you need to seek a second professional opinion.

Additionally, bone grafts are not the only regenerative procedure performed on people with periodontitis, so you need to know whether you do need them and what your other options are.

Now forgive me for this lecture portion, as I'm sure you've heard it a thousand times, but the information has to be provided. Smoking is a huge contributor to gum disease. Smoking will also decrease your chances of successful healing if you have a surgical procedure done. If you continue to smoke, you may sink thousands of dollars into this and lose both the money and your teeth.

Smoking is not a reason to give up on treating gum disease, because gum disease causes a lot of other problems, like heart disease, diabetes, miscarriages, and low-weight or premature babies. But smoking will make it much harder for you to heal. Some periodontists will not perform procedures on patients who do not agree to quit smoking.

People with mild gum disease who quit smoking may prevent the need for surgery. If you have already lost a lot of bone and soft tissue, quitting smoking will not prevent your need for surgery, but it will increase your chances of a successful recovery.

Again, seek out a second opinion, and read information on gum disease and periodontal treatments [American Academy of Periodontists].
posted by jeeves at 1:42 PM on January 11, 2009 [1 favorite]

Best answer: Jeeves may not be a professional, but he has given you as good an answer as any professional would, and i would know, because i am a dentist, trained at Penn, which, in the day, produced better periodontists than any place in the world. In fact, you might want to go there for your second opinion (Penn, that is) and quit smoking.
posted by OHenryPacey at 9:42 PM on January 11, 2009

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