Sudden Deep Periodontal Pocket and Potential Wisdom Teeth Removal

[AnxiousWretch]

It's been a hot minute since I've posted here, and I thought—for the most part—that I had managed to overcome the bulk of my dental anxiety. I've been seeing a dentist regularly for nearly three years at intervals of six months, and my dental health seemed to be relatively stable and improving. Today, however, while doing an exam for probe depth, the dental hygienist just sunk the probe into my upper right second molar by 12mm—a dramatic increase from the stable 3-4mm of previous visits.

X-rays were taken, the attending dentist called in, and he commented on slight bone loss while taking an additional, opposite probe depth on the upper left second molar to 6mm—opining that it must be something affected by my wisdom teeth, and suggesting the removal of all four, but also stating that the pocket only might recover. This was particularly shocking, since all my wisdom teeth had grown in cleanly, were healthy probing depths, and hadn't presented any significant issue in previous visits, so their complete removal for an issue not even affecting them—that might not even work—seemed like a rather excessive, preventative measure.

Suffice to day, the anxiety was bad, and I wanted to faint, curl up, and puke in my chair all at the same time to the news. He referred me to a periodontist for further evaluation and a second opinion, stating that it wasn't a decision I would have to make immediately—but that I should be 'prepared' for the inevitability of it. After that, I've been sick in bed with constant anxiety attacks all day—in grief—hoping that this is all some bad dream I'm going to wake up from.

That was a longwinded summary, and he was clear that this was not an issue that was going to go away on its own with home care—but this all seems rather speculative and extreme.

I guess I want to know if it is, in fact, that way—knowing that wisdom teeth removal is a common fact in dentistry, and that while impacted wisdom teeth are often removed as a preventative measure, that this doesn't quite align with that? That my wisdom teeth have grown in cleanly and are otherwise healthy, and their removal may not otherwise alleviate the issues affecting the upper second molars—am I being told to risk four, five, or six teeth for speculation?

Secondly—the excessively deep, 12mm pocket on the back of my upper right second molar itself. I don't even know how it rapidly formed in the course of six months from an otherwise unremarkable 3-4mm depth. I know I hadn't been particularly attentive in brushing and flossing in those months—only both about once a day, in light of some troubling family events—but that sudden increase in depth feels absurd. The dentist speculated its cause, but it also seems rather out of place for something that had been previously stable, and I am concerned that there is some other factor independent of everything else that might be causing it—that we may go through this whole process only for it to continue unimpeded?

He had no other solutions for this pocket outside of calling for wisdom teeth removal and hoping for an improved prognosis, but he was also unsure of any other solutions, and briefly stated that maybe the periodontist might have different opinions and answers for me—and I am wondering if there's any alternatives that anyone is aware of outside of tooth removal?

I'm sorry for my exceedingly long post, but it has been something I have been crying over all day—over the potential risk of losing multiple teeth for something that seems so sudden and out of the blue—and simultaneously looking for answers and comfort. I'm 29, male, non-smoker, and on no medications—and I'll try to fill in any miscellaneous detail anyone has if it leads to a better picture of the situation. Thank you for your time and consideration.

 

[Gordon]

Honestly I'd wait and see what the periodontist has to say before getting too worked up, for a single deep pocket area then some other surgical options are available.
An increase from 3mm to 12mm in a few months is remarkable to put it mildly, especially in a relatively young non-smoker.

 

[AnxiousWretch]

I'll try to hold on and hope for a better diagnosis from the periodontist, but it's rough—especially waiting for an opening with all the ambiguity and dramatic increase in pocket depth. I'm almost hoping there is some kind of error involved, but that seems like wishful—probably delusional—thinking at this point.

I still wonder what could even cause such an remarkable increase in a matter of months—but truthfully, I'm just hoping at this point that whatever options are on the table, that they will be relatively painless, or that I hopefully won't have to be conscious for them.

 

[AnxiousWretch]

Midpoint update—the periodontist is booked on March 13th, so any examination won't occur until then, but there's been some mildly concerning developments that's been adding onto my anxiety.

After the initial examination on February 11th, there was some swelling and tenderness of the gums over the upper right second molar closer to the palate. I passed it off as minor irritation from the probe, but it gradually increased over the week, culminating in an abscess by the early morning of February 20th. It eventually popped that same morning, releasing a considerable amount of pus with slight blood. I massaged out the remnant pus, rinsed between warm salt water and cold fresh water to help clean and manage whatever swelling was left—and after telling a family member while having an anxiety attack—was told that with the periodontist appointment a few weeks out, to try and wait for them to address that too.

Now—a week later—it's healed over relatively nicely, but the area is still tender and there's still a soft, mild bump over the same spot that has me concerned. It's not too large, but I can't tell if it's healing, or if it's original abscess reforming from not addressing it properly the first time. Also worrying is that it's about half an inch (12.7mm) away from the gumline, not unlike a periapical abscess, but there's no pain or history of carries—so I don't think that's the case, but the ambiguity only makes it more concerning.

Do I stay the course? Keep waiting for the periodontist since it's relatively close? Or is it one of those situations of 'looks bad, probably mild, unrelated' sort of situations? At the very least, is there anything I should be doing to manage it outside of brushing and flossing twice a day?

 

[Gordon]

It's a periodontal abscess, very common when there is a deep pocket. Try to keep it as clean as you can in the meantime and use salt mouthwashes. All you can do at this stage is wait to see the periodontist and don't panic, it doesn't mean that there's anything worse happening.

 

[AnxiousWretch]

Thank you, Gordon. I'm going back and forth between calm and panic, but knowing that it's not a sign of anything worse is some relief. I'll try to keep it clean in the meanwhile, and share any updates that come up.

 

[AnxiousWretch]

Following up on the periodontist evaluation. It's not... worst case scenario, I guess? The examination was fine, but the conclusion has had me bedridden all day with my heart ready to pound outside of my chest.

I'll preempt that I'm not a fan of the periodontist—military dentist with a businessman demeanor—and I'm pretty nervous by how he was machinegunning numbers during probing, kind of moving through everything at a marching pace, and didn't seem really involved in questions as much as dictating what's going to be done. I'm not fond of how I'm being ran through like a grunt in the service, but my usually gentle dentist referred me to him, so I don't know what to think at this point.

The good news is that the original 12mm depth by the original dentist seems to have been greatly exaggerated—I couldn't catch much from the numbers slurry, but there was no reading that severe.

The bad news is that what was once a constant and stable 3-4mm reading around the mouth about a month ago was recorded as various deeper depths by the periodontist—several 4s, 6s, and 7s. He also measured gum recession and mobility—which amounted to nothing fortunately—as well as another set of measurements that I was curious about, but he ultimately didn't pause to let me ask or comment on.

He was also insistent on the wisdom tooth situation, although that also seemed more on prophylactic speculation than any specific issue in and of themselves—better to take four teeth out in a year or so than eight out in ten to fifteen years, says he. I'm not convinced, but I was also trembling from anxiety, and didn't think to ask if it was an issue with the teeth themselves, or related more along the lines of cleaning.

I also told him about the abscess situation and the pus drainage, but he seemed convinced it was a passing burn on my palette, took some pictures, and told me to come back in two weeks to see if it was worth investigating.

All-in-all, he diagnosed my situation as Stage 2 Gum Disease, recommended a Deep Cleaning/SRP, followed by continued visits to his office for cleaning and examination for the next year. I mentioned my fear of the LA needle over actual procedure, but he dismissed it as necessary, and expressed that said fear was probably causative of my general situation in the first place. It struck me as particularly callous, and I'm wary about his care in the future, but I'm not sure if I'm overreacting.

I'm scared. I almost want a third opinion, since the diagnosis seems to be getting wilder with each examination, but I also don't know if it'd meaningfully change anything—it looks like deep cleaning in any case, and pretty much most periodontists in the city run out of his office group anyway. Working out of pocket hasn't made the situation any better, between $350 for the examination itself, $1600 for the deep cleaning, and even the mention of a nitrous option for $110 at mention of my needle anxiety has me concerned that patient care might be secondary to patient finances—everything was so fast-paced and high-stakes that it felt like a sales pitch.

I'm, uh... disassociating a bit just thinking about it. I've been told its normal procedure, and that it's better to get it addressed now than later, but between the wildly different and progressively worse diagnoses, and the periodontist's seeming lack of concern—I'm just a bundle of nerves right now. I'm not sure what to do with what seems like a flurry of issues popping up after years of stability. It feels so artificial, like a bad dream, with everything right one moment, then suddenly expensive treatments and follow-ups needed the next—the dental doom spiral. I almost feel like I'm being led around, with everything going fast-paced enough so that I won't keep up.

I'm sorry for the wall of text—I'm still kind of processing everything myself. Part of me is still trying to look for a way out, as if this is all some mistake or something I can bolt halfway across the country from. I guess I would like to hear another opinion on everything; from the varying examinations to the wisdom teeth situation to if the red flags I see are actually red flags? If I should be considering my opinions, or if I should be bracing for what's ahead?

The deep cleaning is scheduled out on August 8th and 15th, ahead of—coincidentally—an actual trip across the country, so I'll have time to think on things and maybe plan ahead, but right now, it feels like the closing highlights of my current peaceful life. It's not a good feeling.

And, erm, thanks again for obliging my many, rambling anxious thoughts. I can't nearly express the magnitude, but I appreciate it greatly.

 

[letsconnect]

I almost want a third opinion, since the diagnosis seems to be getting wilder with each examination

Well... it doesn't sound as if the periodontist you saw is someone you'll want a long-term relationship with (and I can't blame you - he doesn't sound like my cup of tea, either). So it would make sense to find a periodontist who is more in tune with your needs. I'd say listen to your intuition... there must be other periodontists who are not in the same office?

 

[AnxiousWretch]

There should be, but for the most part, I've only found one other periodontist with limited information about his practice—everything else is mixed offices with multiple specialties. I'm hoping my dentist's receptionist has some recommendations, since she's been relatively helpful through everything, and probably has a better grasp of who's who in the field than a patient, dentist shopping.

I'm not really expecting a different diagnosis at this point—it sounds like I'm looking at a deep cleaning either way—but I'm hoping for a periodontist who is more receptive to patient concerns. It's feels a little rude, especially between the dentist referral and going through examination and various bookings, but I would really like to at least see if it's a matter of common practice or just personality.

It's not that I don't have faith in the periodontist's work, but I just don't have faith in the man. I have a follow-up with him in two weeks, so that opinion might change—we all have off-days and all—but I think we might be looking around in the meantime.