Advanced Chronic Inflammatory Periodontal Disease?

[chzzz]

(This is reposted from the other forum area, sorry about the mix-up!)


I knocked a tooth loose last night while eating. I am very very scared.
it is the tooth on the lower jaw, directly right of the centre. It is visible when I smile or speak.
Several years of drug abuse has left me with some nasty mouth damage. An x-ray of my mouth taken on June 6th this year includes the following letter:
OPG
All third molars are missing. There is loss of alveolar bone height from both arches. Vertical bone loss is particularly obvious in the lower central incisor region. Considerable vertical bone loss is also noted in the 21/22 region. The radiographic appearances are suggestive of reasonably advanced chronic inflammatory periodontal disease. Correlation with the medical history would be of value in assessing the considerable bone loss in a patient of this age.


The dentist I saw wrote a referral to a periodontist that I could not afford, even in my wildest dreams.
Patient has advanced periodontitis affecting the anterior segments. She reports a history of perio abscesses and was mainly concerned with the mobility of the #12 (maybe #42? Illegible)
Patient is very anxious and has been medicated for this the past 7 years. She is currently not taking any medication but uses mainly tobacco through a bong.
Patient would like to be treated under sedation.

What does all that mean?! I am 23 years old, female, attractive (and vain).
I have not had any dental treatment in five years, my last was cleaning and fillings under general anaesthetic in the same theatre session as having my tonsils removed at a hospital. When I was 13 I endured a horrific treatment without anaesthetic where I was physically restrained as I howled in pain - I am now a hostile patient who 9 times out of 10 can't even sit in the chair and when I do I have it on file as being a biting, swearing monster. This is a great source of embarrassment and shame :\ Having that level of anxiety, coupled with previously being a a heavy drug addict (experiencing 'mild dissociation' for breakfast daily and nitrous oxide socially) I have zero confidence that twilight sedation or gas will stop me from assaulting the person working in my mouth.
Normally I'm a placid, friendly girl with good manners and respect for others. Exposure to dentistry turns me into a bad person. Thinking about dentistry makes me cry, I am crying now. I really need this work done so I don't lose any teeth. Besides missing bone in my jaw and having receded gums, my teeth are healthy and well cared for (now).

What sort of treatment will be given? Is there any hope of keeping my tooth? Does the bone that has been lost ever grow back? Should I expect to lose all the teeth in the front of my mouth because the periodonwhatsit never goes away and just keeps eating at the bone? If that happens, will I ever qualify for dental implants or will I end up with dentures? Dentists I speak to freak me out so much that I have panic attacks in their offices and any answers they give are either not absorbed and remembered, or not answered at all (trying not to upset me more?) so I've never had a straight answer from any of them.
Oh please help me, I'm so scared! I will have to be at the public dental clinic by 7:30 monday morning to see if I qualify for emergency treatment. I'm told I will, but then it's a first-come first-served basis for treatment. (I live in Australia).
What will happen to me?

 

[Gordon]

Re: Advanced Chronic Inflammatory Periodontal Dise

There isn't any good news really.

Bone that's been lost doesn't come back.

I haven't any idea what the criteria are for the Australian health system to pay for implants for you, you would not qualify in the UK NHS which I suspect is a bit more liberal with spending money than the Oz system.

The loose tooth will probably need to be extracted.

 

[chzzz]

Re: Advanced Chronic Inflammatory Periodontal Dise

Thank you for replying so quickly, Gordon!
Last night the tooth was wiggly and could be pushed approximately 2mm forward from the normal position. Today it has gone back to the usual <.5mm softness. I am not sure what this means.
If/when the tooth is extracted, will the other teeth around it slowly shift into the gap? I had five years of orthodontics to straighten both rows of teeth but after the metal came out of my mouth the teeth started to move a little, crowding together at the front on the bottom jaw. It was reasoned at the time that tooth extraction to prevent the overcrowding was excessive because so much improvement had been made with the orthodontics alone - pulling a few teeth for a 100% result was silly when I was already at 96% beautiful smile.
So if the tooth is wiggly now, does that mean the teeth will no longer re-arrange themselves as they would have with the orthodontist's option?
Should I expect that the bone loss will continue? I have stopped doing all the things that caused the damage in the first place, and have not done them in several months. The tooth causes no pain. Would it be an option to have my original orthdontist stabilise the tooth with a retaining wire behind the adjacent teeth until an implant can be afforded?

I'm curious - what happens if I do nothing about the situation? Do the teeth just drop out like baby teeth do, or is there terrible infection risk, lots of bleeding/pain/gore?

The free treatment will not cover implants at all. I expect that I will need several implants to correct the damage I did to myself while I was younger, and that I will be paying a fortune for the luxury of solid teeth. I wonder, though, can implants be installed with so much bone loss? If not, are there any procedures to regrow the bone or graft in new (or synthetic) bone in which to place the implants? While finances are tight at the moment, $20 000 for a new smile is possible within 12 months.

 

[Gordon]

Re: Advanced Chronic Inflammatory Periodontal Dise

If the tooth goes, the remainder of the teeth will probably move about into the space, it'll happen faster than with ortho because there is almost no bone left to be remodelled.

Bone loss is likely to continue because it has got so far on, I assume there is some depth of "pocketing" around your teeth due to previous bone loss, when that happens, there's a massive area for plaque to grow in that simply can't be cleaned properly.
Stabilising with wire may be possible, it won't need an orthodontist to do that though, almost any competent dentist can do it easily.

In time the teeth would probably fall out fairly painlessly.

Implants may or may not require grafting, don't know without seeing x-rays, grafting works fairly well and predictably.

 

[McGonicle]

Re: Advanced Chronic Inflammatory Periodontal Dise

Hi Chzzz

I'm not an expert in this area, but have you made your dentist explicitly aware of your concerns over resistance to anesthesia? The chances are that even if you haven't told them, they will be more than aware of your past drug problems just by looking at you mouth. Speaking as a non-expert, I'm guessing tolerance to opiates or a past exposure to huge amounts of cocaine will probably not make much difference to the effectiveness of most modern anesthetics, but from what Gordon says, you probably won't need them anyway.

But most importantly, I want to wish you good luck with your progress back on the straight and narrow. It sound like you've pulled yourself back from the brink, and of course, it takes some time to put yourself back together. That might mean saving up the bread for a little while to fix your teeth up a bit. But you will do it, because I just get the vibe from your message that although you are scared, you are getting your motor running and taking on the world.