Suddenly and unexpectedly diagnosed with periodontitis....!!!

[parsleycat]

Hello all. 37yo non smoking male here. Solid bi annual recipient of professional cleanings, brush 2x a day (previously with electric, now with ultra soft brush), floss 1x a day and waterpike 2-3 times a day. I find myself suffering a life shattering anxiety over a few dental appointments, my last two.

My second to last appt. By this time, I've been going very normally to get regular prophylaxis and exam. Ive been told i have a few 2-3mm pockets, but to floss etc (which i was doing). I am actually shocked when this dentist (1 of 4 ive never met in a rotation) tells me i need one of my front teeth removed and an implant put in. This just blows my mind as it comes out of the blue...my previous dentists have never said anything about this tooth and the current one makes this judgement after looking at my last xray. This sent me into a big hygiene tizzy. Even though my brushing and flossing was on point (ive never gone to bed in 3-4 years without flossing brushing), somehow I was "needing" some radical treatment.

At this point I commit to getting a water pik and supplementing my routine with irrigation. I irrigate with non alcoholic mouthwash and water mixture religiously for 5 mo ths. I write off what the dentist said about extraction as a revenue generating recommendation. By this time the office has a very established pattern of upselling, from optional fluoride constantly pushing ortho. I start to really take notice of my mouth and gums and develop a complex, fixating on my gums, concerned about the recession I do have, but which my previous dentist never mentioned.

Fast forward to today. Ive switched to a dentist I feel like I might trust better and dont say anything about the tooth the previous dentitst said needed extraction. He says that he can shave it down and crown it to look better (its buccally versioned due to trauma/surgery/braces feom childhood) but that it didnt need anything and waS healthy. However, im told at this appointment that i mow have almost a full mouth of 4-6mm pockets with some boneloss on the xray. Im absolutely crushed. I was told i needed a deep cleaning and to go on a perio maintenance rputine.

Ahhh, my heart dropped. Im still struggling to cope with this because i dont understand how im in this position. I do everything right and super consistently. But i guess I'm supposed to ask some questions...

1. Is it common for periodontitis to stabilize after an srp? I already live the proper dental hygiene routine...i feel like i really just need good hope that enduring the body horror of srp will lead to me being stable and that i have some control over the outcome.

2. I havent been to a general practicioner for a very long time. Decades! Should I be super concerned that I have something else systemic like diabetes? Im in decent shape and exercise quite a bit but my mom is prediabetic. I'm just a little confused how i can have such bad gum disease and bone loss with my commitment to my hygiene.

3. My dad had crappy gums/teeth. I think he even had a graft done. I dont think he ever flossed but If its genetic...is there any point? It just makes me feel so hopeless...

4. My dentist didnt seem to ask for previous xrays or probe readings to see what the progress of my mouth was since last time. Should i be concerned? (As if i could be more concerned than i am right now)

Im emotionally exhausted...this has already ruined me for my best friends wedding tomorrow and I have nothing but incredible anxiety up until my srp on monday. Any help or success stories would be super great

 

[Gordon]

1. Is it common for periodontitis to stabilize after an srp? I already live the proper dental hygiene routine...i feel like i really just need good hope that enduring the body horror of srp will lead to me being stable and that i have some control over the outcome.

I'm curious as to why you're using an ultra soft brush? They don't normally do a great job of cleaning.
A good electric brush with a standard head (most dentists use Oral B) but they're pretty much all OK is as good as it gets for cleaning.

Scale and root plane is necessary to give a solid clean base for the patient to maintain. The frustrating thing about perio for a dentist is that all dental treatment is really only done to make it easier for the patient to maintain things. if they don't then there is no treatment that will work.

2. I havent been to a general practicioner for a very long time. Decades! Should I be super concerned that I have something else systemic like diabetes? Im in decent shape and exercise quite a bit but my mom is prediabetic. I'm just a little confused how i can have such bad gum disease and bone loss with my commitment to my hygiene.

No. It's not usually related to general medical issues.

3. My dad had crappy gums/teeth. I think he even had a graft done. I dont think he ever flossed but If its genetic...is there any point? It just makes me feel so hopeless...

It's definitely got a genetic component, but it can be arrested and maintained by good plaque control. Which is what all the treatment is aimed to make possible.

4. My dentist didnt seem to ask for previous xrays or probe readings to see what the progress of my mouth was since last time. Should i be concerned? (As if i could be more concerned than i am right now)

Not really, it wouldn't give much useful information, what counts is what is there now.

4-6 mm pocketing is not too bad, some of it may well be "false pocketing" if there's a bit of inflammation present, so you're probably looking at a true depth of a bit less. Not great for somebody relatively young but not that bad either.

 

[parsleycat]

Hey Gordon, thankd for the reply!

As for why I'm using an ultra soft, its because i was panicking over the state of my gums after the dental visit before last. My hygienist then had made some random comments about recession due to maybe over brushing and I read a lot of comments about people brushing their gums away. I also remember my dad having brushed over aggressively and having gum problems as a result. I dunno, I'm pretty thorough and gentle with it...brushing takes me a deal longer.

Yea, Im worried that Ive had some sort of systemic inflammation for a while now as Ive had other symptoms that the interwebz points to diabetes.

I think the thing that really scares me, outside of the periodontitis not being caused by actual subgingival microbes (crowding due to my wisdom teeth, possible diabetes) is that SRP won't work for me. As I'm furiously reading all the articles, i see a 2019 study showing only 39% efficacy of SRP and that was really horrible to see. I'm not a lucky guy, lol. I feel like its taking all the emotional strength I have to go into the office tomorrow and do this deep cleaning, which to be fair is *just* a cleaning...but the idea of it being less than a coin flips chance of success is demoralizing.

 

[Gordon]

As for why I'm using an ultra soft, its because i was panicking over the state of my gums after the dental visit before last. My hygienist then had made some random comments about recession due to maybe over brushing and I read a lot of comments about people brushing their gums away. I also remember my dad having brushed over aggressively and having gum problems as a result. I dunno, I'm pretty thorough and gentle with it...brushing takes me a deal longer.

It's not possible to brush "too aggressively" with an electric brush... an ultra soft brush may well not be removing the plaque adequately and plaque is the root cause (sorry!) of all gum issues, have you heard of disclosing tablets? Might be worth trying some after you get the cleaning done to make sure you're getting all the plaque off.
Also, I assume you're having a hygienist do this cleaning? In which case get them to show you if you're missing anywhere.

As I'm furiously reading all the articles, i see a 2019 study showing only 39% efficacy of SRP and that was really horrible to see.

You've lost me there, (not hard!), what do you mean efficacy? Referring to my post above, all treatment is aimed at allowing the patient to maintain things themselves... if they don't, then it won't make any difference.

 

[parsleycat]

I'll get some disclosing tablets then and see what I can see I seem to remember using those as a little kid...so back to basics.

I think I was referring to this article here. Not super confidence building.

@Gordon how do you feel about post SRP care? I was told not to floss or waterpik the Arestin treated areas for 10 days...but I assume I am good to floss/waterpik/brush the rest of my mouth with no problem? The thing that really concerns me is that SRP is supposed to "allow my gums to reattach to my teeth", but I am concerned that oral hygiene techniques like flossing will interfere with that healing process. But at the same time, also allow the area to get dirty

Add on to that, apparently my dad had a history of periodontitis, so now I am just freaking out that the bone loss (my hygienist guessed 15-33%) will just continue unabated and there's nothing I can do. Of course this won't stop me from my routine, but it just feels super hopeless.

Am I just thinking too much?

 

[Gordon]

I'll get some disclosing tablets then and see what I can see I seem to remember using those as a little kid...so back to basics.

As a dental student we used to add some to people's drinks at parties... worked best on dark drinks. Predictable results for the easily amused (like a bunch of dental students!).
They do the job though, made from vegetable dyes if you're worried about chemicals in your mouth

I think I was referring to this article here. Not super confidence building.

TBH their criteria for success were more academic than practical. They were aiming to reduce pocket depth to less than 5mm, without surgical intervention. Getting that many cases to reduce to that level without surgery is pretty good actually. And they were looking at cases with pocket depth of up to 9mm, which is pretty terminal for most teeth.

Active disease shows up through bleeding on probing, which they managed to get down to 14%, again this is pretty good going without surgery.
Overall I'd say that the results were fairly encouraging in your particular case actually

I was told not to floss or waterpik the Arestin treated areas for 10 days...but I assume I am good to floss/waterpik/brush the rest of my mouth with no problem?

Yep. You don't want to wash out the Arestin before it's finished working.

The thing that really concerns me is that SRP is supposed to "allow my gums to reattach to my teeth", but I am concerned that oral hygiene techniques like flossing will interfere with that healing process. But at the same time, also allow the area to get dirty

No it won't interfere with the process unless you're using the floss like a cheese cutter!

Add on to that, apparently my dad had a history of periodontitis, so now I am just freaking out that the bone loss (my hygienist guessed 15-33%) will just continue unabated and there's nothing I can do. Of course this won't stop me from my routine, but it just feels super hopeless.

We don't know how much of a role genetics play in periodontal disease (actually we know very little about periodontal disease, it's quite depressing!) We do know that for most patients, plaque bacteria is the primary trigger for the disease. Other patients can have loads of plaque and smoke like chimneys but don't get the disease (I'm really glad I wasn't a periodontal specialist!).
If your plaque control is good, then you stop plaque triggering the disease and so you don't lose your teeth...

 

[parsleycat]

Thanks for the reply @Gordon . Really appreciate you taking the time.

I don't know why I can't stop researching...maybe I'm developing an OCD...but some periodontist on youtube said that 6mm+ pockets almost always require surgery to correct. Is this true?

You also mentioned the pseudopocketing phenomenon that might have slightly elevated my numbers 4-5 with 2x 6mms. Is it outside the realm of possibility that I didn't have 6mm readings and it was just due to inflammation?

The YT perio also said that at 4mm you should get a deep cleaning. If my dentist from 6 months ago did perio probes and saw 4mm readings, did they do me a disservice by not telling me that I had a 4mm pocket or more? They seemed more concerned with whether i was going to do ortho or get an elective implant for my front tooth...

 

[Gordon]

I don't know why I can't stop researching...maybe I'm developing an OCD...but some periodontist on youtube said that 6mm+ pockets almost always require surgery to correct. Is this true?

I'd say that it's a bit of a broad generalisation, your article quoted a success rate of 39% without surgery
The surgery/non-surgery thing in Periodontal therapy seems to be a big debate, the fashion (if I can call it that) seems to switch from cutting everything to cutting nothing about every 5 years or so...

You also mentioned the pseudopocketing phenomenon that might have slightly elevated my numbers 4-5 with 2x 6mms. Is it outside the realm of possibility that I didn't have 6mm readings and it was just due to inflammation?

It's within tolerance for operator error, if you think about it, trying to measure a difference of a mm or so down the side of somebody's molar is pretty tricky. The bigger question is "Is there bleeding on probing?" which means that there is active disease, rather than "is that 4mm or 6mm?"

The YT perio also said that at 4mm you should get a deep cleaning. If my dentist from 6 months ago did perio probes and saw 4mm readings, did they do me a disservice by not telling me that I had a 4mm pocket or more? They seemed more concerned with whether i was going to do ortho or get an elective implant for my front tooth...

I think this is a US centric thing in response to your crazy (from my perspective) insurance system. In the rest of the world, there's no such thing as a "deep cleaning", you get into the pocket and clean it out as thoroughly as you can...

 

[Lioness]

The bigger question is "Is there bleeding on probing?" which means that there is active disease, rather than "is that 4mm or 6mm?"

@Gordon what is "probing"?

 

[Gordon]

Sticking one of these things (GENTLY!) into the gap between tooth and gum, to measure how deep any pockets are and to see if there's bleeding, which is a sign of active disease.

Periodontal probe - Wikipedia

en.wikipedia.org

 

[Lioness]

Ah, @Gordon maybe I'm silly now, but isn't it so that after sticking one of these things everyone's gums will be bleeding? The instruments look quite sharp...

 

[Kml1998]

@Lioness no it isn't stuck into the gum, it is stuck between the gum and teeth

 

[Gordon]

Ah, @Gordon maybe I'm silly now, but isn't it so that after sticking one of these things everyone's gums will be bleeding? The instruments look quite sharp...

No, they are deliberately made with a ball on the business end, so they aren't sharp at all.