27 with 4mm pockets that I can’t get to shrink! Please advise

[FearfulAlways]

Hello everyone,

I’d really appreciate some insight on my oral care routine and what I can do to improve it and attempt to get rid of these 4mm gum pockets. About six months ago, the hygienist was very kind, and she informed me that I had some gum pockets that were a little bit alarming for my age, but could be reversed. She urged me to upgrade to a WaterPik (I was using a low powered handheld one prior to this) so I did. She also said I could use a mix of water and hydrogen peroxide to help eliminate some of the bacteria, and to do this every other day or every couple of days and to use only water in the WaterPik in the meantime. Well I’ve been using it regularly, about 5 days a week but I admit I do skip a day here and there.

I do not skip any brushing or flossing. I have OCD so I am religious about it. My routine goes something like this:

Morning:
Brush (2 mins)

Afternoon:
Nothing although sometimes I may use an interdental brush for food particles

Night:
Floss
WaterPik
Brush

So I was doing that for 6 months. Today my hygienist said my pockets are still at 4mm, that the top is worse than the bottom but there is very little bleeding. She said I should focus more on my front teeth. Now I really don’t want to lose my teeth, especially not the front teeth, so I was wondering what I’m doing wrong and why these pockets are going down to 3mm. Am I screwed?

I did watch a tutorial on the WaterPik and I am now using the tip ideal for periodontal issues. I was not using this before. Could it really be as simple as that? At night I am occasionally a mouth breather as I have asthma and allergies (medicated for both) and I do smoke cannabis fairly regularly, but I’m cutting back on that.

Any advice would be greatly appreciated.

 

[Gordon]

1) Once bone is lost and pockets form, they don't go away. The important thing is stopping them from progressing. Which is where all your oral hygiene efforts should be directed. 4mm is really not a big deal, especially as measuring pocket depth isn't 100% accurate, I wouldn't obsess over a mm in this instance.

2) The really important thing is whether there is bleeding on probing or not. Bleeding equals active disease. You need to know where the bleeding is coming from and increase your efforts to clean those areas extra carefully. Are you using an electric brush or a manual one? An electric brush is more effective. Most dentists use Oral B, btw.

3) Are you using a steroid inhaler regularly? This will be an aggravating factor for gum disease, as is the smoking. Cutting back on the latter is a good idea if you can manage it, not much you can do about the former though

4) Brushing around lunchtime is quite a good idea, if you are able to. Fine to use a manual brush for that since it saves hauling an electric one around with you!

 

[FearfulAlways]

@Gordon

Thank you so much for the reply.

1) they did not mention anything about bone loss and I hope they would if I have it! It’s my front teeth mostly Wouldn’t they make me aware of a problem like that?

2) she said there was almost no blood (but implied there may be a little? I didn’t see or taste any) but when I asked where I should focus on more she said to keep up with what I’m already doing, and maybe focus on the front a bit more. She didn’t give me any specific advice. Also yes I use an oral b electric toothbrush, I recently switched the sensitivity to a more gentle motion because I read that could also be irritating my gums on the deep clean setting.

3) yes I do use a steroid inhaler with an aero chamber at night. I usually use it before my WaterPik, rinse, and then the WaterPik also rinses my mouth. Do you think I’m better off using my inhaler in the morning? I didn’t realize it could play a role; they never mentioned it to me. I already use it less than I’m supposed to because it’s so insanely expensive. I’d hate to have gum disease that’s exaggerated by my medication but I hear birth control and antihistamines can also contribute to gingivitis. :/

4) I will start brushing around lunchtime! Perhaps flossing too!

Thank you Gordon! What level of concern should I be at? I’m panicking, feeling like I’ll be toothless at 35. If hate to lose my front teeth and don’t understand why those are the worst pocket depths.

 

[Gordon]

1) I don't know, I wasn't there! To get pocketing you must have bone loss. It's pretty trivial at this stage though, so don't worry about it.

2) Do what she says then, spend a bit more time cleaning round the front teeth. Those will be the ones most affected by your inhaler so that makes sense. You could use some disclosing tablets to check you're getting all the plaque off when you brush.

3) Yes, as long as your doctor is happy with that. Contraceptive pill can contribute, but pregnancy is worse

4) Good stuff

No reason for any panic just now, 4mm is pretty minimal and now you're taking steps to work on things then it should stabilise nicely.

Bear in mind that this is a life-long commitment you're making, if you stop maintaining things then it's going to start again.

 

[FearfulAlways]

Thank you so much for the response and advice Gordon. I do not plan to ever stop maintaining my teeth and gums. Would you say that it’s possible for me to get another 25-30 years out this before I should be ready for implants or dentures?

That is my biggest fear. Thank you.

 

[Gordon]

I'd expect you to keep your teeth for life if you continue to maintain them.

 

[FearfulAlways]

Hi Gordon,

Thank you so much. I did buy plaque disclosing tablets and lo & behold my front teeth at the gumline were all bright blue. My gums are receded a bit there and I find it difficult to remove the blue stains/plaque. I’m angling my brush correctly and even trying other angles and I end up irritating my gums (I think). I also use the WaterPik and that helps as well, but it gives me a sharp little pain if I hit specific spots on those front teeth. Any ideas on what I’m doing wrong and how I can better target these areas? I believe I’m over rushing them now because I can’t seem to hit those spots! I had my cleaning 2 weeks ago, so I know it’s possible tartar has already formed. I was thinking of paying for an extra cleaning out of pocket.

Any suggestions for me would be welcome. I really want to nip this in the bud and I’m starting to feel pretty stupid that I can’t get a good technique down. No wonder I have gingivitis!

 

[Gordon]

You're not over brushing them if there's still plaque on them
I find it easiest to use 2 hands for cleaning down there, one hand to pull your lip down out of the way, the other to hold the brush. Some people have a very tight attachment between lower lip and jaw, so physically getting the brush into place can be difficult.
If you're getting sharp pain from the WaterPik then try rubbing some desensitising toothpaste into the areas at bedtime. (Rub in with a finger, leave it there and go to bed, works best that way).

It's not likely to be much tartar at this early stage.

 

[FearfulAlways]

Hi again, Gordon

I’ve actually been referring to my top front teeth this whole time, believe it or not. Those are the areas my hygienist says I have some swelling and pockets. My bottom teeth were actually really good. So really, if you have any tips for me for the top front teeth, that would be great. I use the plaque disclosing tablets and all along the gum line of my top teeth, especially the two main front teeth, it tends to really linger there and I end up brushing my gums raw it feels like. I try to angle it out at a 45° and it doesn’t seem to get deep enough. Sometimes flossing a second time will lessen the stain, but I’m worried I’m not hitting the spots that I need to. Do you have any advice?

Thank you.

 

[Gordon]

Same idea really, use your spare hand to get the lip out of the way so you can see what you're doing. Take your time and be thorough. Next time you're seeing your hygienist ask her to watch you and check your technique too.

 

[letsconnect]

Hi @FearfulAlways, another thought - which Oral-B electric toothbrush are you using? There are quite a few different models and in my personal experience, some are much better than others (and some of the brush heads are better than others).