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Medical Forum / General / Dentistry / November 2004

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Tissue graft to gum questions

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Camilla Cracchiolo - 15 Nov 2004 07:59 GMT
I've been told by a peridontologist that, despite being a fanatic
about oral hygiene,  I have about 25% bone loss under the gum line and
I need a tissue graft to my lower 4 front teeth if I want to keep
them.  He also wants to reposition the attachment from my lower lip to
my gums since he says pressure from the lip pulling on the gum line is
part of the problem.  This will cost $3000.  

My questions:  

1.  How effective is this procedure?  Is it controversial in any way
or still experimental?  

2.  Is there an effective alternative that doesn't require surgery but
is effective in supporting the teeth (such as wiring them in place,
perhaps?)

3.  He told me that the latest thinking is that bone loss and gum
inflammation may not only be due to poor oral hygiene but in some
people is autoimmune.   Is this backed up by evidence, and if so, are
anti inflammatories such as naproxyn at all useful?  Are there other
medications of value?   I do have what appears to be some mild
unidentified autoimmune problem. I do have what appears to be some
mild unidentified autoimmune illness so it wouldn't surprise me too
much.

4.   And is $3000 a reasonable price for this procedure?  (I live in
Los Angeles, I realize prices can vary from community to community.)

I can see that one gum is considerably lower than the rest and the
front 4 teeth are slightly loose.  They have been slightly loose for
years, since prior to about 6 years ago I was not a good dental
citizen and did not floss.  That changed with my discovery of floss
holders and I now not only brush several times a day, but floss EVERY
time I brush.  The bone loss and the looseness of the front teeth have
stayed steady since I started this practice and otherwise my gums are
in good shape with no bleeding or pockets.  

Obviously, if it's good standard dental practice and is effective,
then I want to do it. My mama and both my aunts lost all their teeth
after menopause and  I do not want to wind up like them.   Want to
keep those teeth.  But I don't want to get ripped off either.

Thank you.
___________________________________________________              

             Camilla Cracchiolo
              Registered Nurse
            Los Angeles, California

camilla4@mindspring.com     webpage temporarily down
Joel M. Eichen - 15 Nov 2004 12:40 GMT
REPLY

On November 15, 2004 at 5:24:42 AM '????????????' posted....

Where did you find this Joel? Without seeing the patient is sounds
like she has a lack of attached gingival tissue and has had some
recession. I assume the proceedure planned is a SECTG. A very
predictable proceedure. 3K sounds very high even for LA. Would like to
hear what others think. Ed

>I've been told by a peridontologist that, despite being a fanatic
>about oral hygiene,  I have about 25% bone loss under the gum line and
[quoted text clipped - 46 lines]
>
>camilla4@mindspring.com     webpage temporarily down
Steven Bornfeld - 15 Nov 2004 14:17 GMT
> REPLY
>
[quoted text clipped - 5 lines]
> predictable proceedure. 3K sounds very high even for LA. Would like to
> hear what others think. Ed

Joel--

    Who is Ed?
    We should clarify that Ed is abbreviating a subepithelial connective
tissue graft.  It is no longer considered experimental, that's for sure.
 I would guess that the actual attachment gain would vary depending
upon the particular situation, but it is quite predictable.  Yes, $3K
sounds pretty high, but there could well be other parts of the treatment
plan (bone grafting? splinting?) that we are not hearing about.

Steve

>>I've been told by a peridontologist that, despite being a fanatic
>>about oral hygiene,  I have about 25% bone loss under the gum line and
[quoted text clipped - 46 lines]
>>
>>camilla4@mindspring.com     webpage temporarily down
Joel M. Eichen - 15 Nov 2004 14:52 GMT
>> REPLY
>>
[quoted text clipped - 9 lines]
>
>    Who is Ed?

Ed is from "The Other White Meat" dental site, that I rarely refer to
by name ......

>    We should clarify that Ed is abbreviating a subepithelial connective
>tissue graft.  It is no longer considered experimental, that's for sure.
[quoted text clipped - 55 lines]
>>>
>>>camilla4@mindspring.com     webpage temporarily down
Camilla Cracchiolo - 17 Nov 2004 06:11 GMT
>> REPLY
>>
[quoted text clipped - 17 lines]
>
>Steve

Thank you for your replies.  To clarify: nothing was mentioned about
bone grafting.  I don't know what splinting would entail.  He said
that the tissue graft would be taken from some other part of my mouth
and that the attachment of the lower lip to the gum would be
repositioned.  It would all be done in the office under mild oral
sedation (ativan) and a lot of novacaine, if that provides any help.

It seems to me now from your replies that I should get a second
opinion.  What is the best way to find a peridontologist in Los
Angeles?  I want someone competent.  The one I saw was referred to me
by my dental plan.

Thank you.

>>>I've been told by a peridontologist that, despite being a fanatic
>>>about oral hygiene,  I have about 25% bone loss under the gum line and
[quoted text clipped - 46 lines]
>>>
>>>camilla4@mindspring.com     webpage temporarily down

___________________________________________________              

             Camilla Cracchiolo
              Registered Nurse
            Los Angeles, California

camilla4@mindspring.com     webpage temporarily down
Joel M. Eichen - 17 Nov 2004 12:38 GMT
>It seems to me now from your replies that I should get a second
>opinion.  What is the best way to find a peridontologist in Los
>Angeles?  I want someone competent.  The one I saw was referred to me
>by my dental plan.
>
>Thank you.

What plan was that?

Joel
Steven Bornfeld - 17 Nov 2004 14:33 GMT
> Thank you for your replies.  To clarify: nothing was mentioned about
> bone grafting.  I don't know what splinting would entail.  He said
> that the tissue graft would be taken from some other part of my mouth
> and that the attachment of the lower lip to the gum would be
> repositioned.  It would all be done in the office under mild oral
> sedation (ativan) and a lot of novacaine, if that provides any help.

    This sounds more like what we call a free gingival graft.  They work
well, but the disadvantage when compared to the subepithelial connective
tissue graft is that the tissue is usually obtained from the roof of the
mouth, so you have 2 surgical sites instead of one.  Postop, the donor
area is usually more uncomfortable than the graft site.

Steve

> It seems to me now from your replies that I should get a second
> opinion.  What is the best way to find a peridontologist in Los
[quoted text clipped - 61 lines]
>
> camilla4@mindspring.com     webpage temporarily down
Joel M. Eichen - 17 Nov 2004 15:38 GMT
>> Thank you for your replies.  To clarify: nothing was mentioned about
>> bone grafting.  I don't know what splinting would entail.  He said
[quoted text clipped - 4 lines]
>
>    This sounds more like what we call a free gingival graft.

However, do not be confused by the term, "FREE." Besides the "free"
there is a surcharge that will certainly WoW! you ......

Joel

> They work
>well, but the disadvantage when compared to the subepithelial connective
[quoted text clipped - 69 lines]
>>
>> camilla4@mindspring.com     webpage temporarily down
 
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