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Medical Forum / General / Dentistry / November 2004

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Gingivitis and bone loss questions.

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Royler - 25 Nov 2004 17:41 GMT
Hi,

Posted here before. Briefly: in my 20s and have largely neglected
dental care since 14 or so. Saw a dentist in February who diagnosed me
with gingivitis. Improved home care and got a cleaning done in June.

Went to a different dentist this past week (now have insurance and
wanted to start fresh - didn't like the old one) and had another
cleaning. The hygienist also confirmed a "little" bone loss but seemed
really unconcerned. Just told me to improve home care and get some
fillings taken care of.

Once gingivitis progresses to bone loss, isn't that now irreversible?
The dentist told me my teeth look great for not having any work done
in over a decade, though my gums are red in spots.

Is it possible to have bone loss but not periodontal disease? I guess
I'm just surprised by their lack of real concern, though everyone is
very nice.

Does "bone loss" in the jaw actually change the shape of your face, or
is it not that radical a problem? What am I missing here?
Joel M. Eichen - 25 Nov 2004 18:21 GMT
>Hi,
>
[quoted text clipped - 18 lines]
>Does "bone loss" in the jaw actually change the shape of your face, or
>is it not that radical a problem? What am I missing here?

X-rays would tell more of a story ....... bone loss is part of life in
much of the population. Maybe it needs treatment maybe not.

No way to tell from here.

Joel M. Eichen DDS
W_B - 25 Nov 2004 22:02 GMT
>Once gingivitis progresses to bone loss, isn't that now irreversible?

Yes, in some respects. Once bone loss occurs the disease is
called periodontitis. The progress of the disease can be halted,
and sometimes (rarely) somewhat reversed.

>The dentist told me my teeth look great for not having any work done
>in over a decade, though my gums are red in spots.

Keep getting those regular professional cleanings.

>Is it possible to have bone loss but not periodontal disease?

Yes, once the disease process is halted.
Meticulous home care and regular professional care is
of the utmost importance if you wish to keep your teeth.

> I guess
>I'm just surprised by their lack of real concern, though everyone is
>very nice.

Everyone ? ;-)

--
W_B

wubbabubbazG@RBAGEyahoo.com
Take out the G'RBAGE
StovePipe - 26 Nov 2004 04:57 GMT
> Keep getting those regular professional cleanings.
> >
> >Is it possible to have bone loss but not periodontal disease?

Perio disease is a bit like other CHRONIC DISEASES: there are
exacerbations and remissions. Generally, bone loss is not reversible,
but can be halted like W_B says. I would seriously consider having
cleanings at AT LEAST six month intervals and if the gums are still
inflammed at those, reduce the interval to every four months, and if
needs be every three months. You want to prevent the osseous
inflammation.

JMO, HTH, YMMV, not responsible for lost or stolen items, one cross to a
prisoner, etc....
Cheese
SP
Signature

Not a real Addy, yet

Dr. Steve - 27 Nov 2004 02:11 GMT
>> Keep getting those regular professional cleanings.
>> >
[quoted text clipped - 12 lines]
>Cheese
>SP
Perhaps the " bone loss" is abfraction.
..
Stephen Mancuso, D.D.S.
Troy, Michigan, USA

Writing on a tablet PC,so forgive me if the PC misreads my poor handwriting.
StovePipe - 27 Nov 2004 03:42 GMT
> >JMO, HTH, YMMV, not responsible for lost or stolen items, one cross to a
> >prisoner, etc....
[quoted text clipped - 4 lines]
> Stephen Mancuso, D.D.S.
> Troy, Michigan, USA

true... I hadn't thought of that.
SP
Signature

Not a real Addy, yet

Winston - 27 Nov 2004 03:12 GMT
> Hi,
>
> Posted here before. Briefly: in my 20s and have largely neglected
> dental care since 14 or so.

(...)

> I guess I'm just surprised by their lack of real concern, though
> everyone is very nice.

They are very nice now. They figure you are *not* going to improve your
homecare and are looking forward to many many boat payments directly
from your account to theirs.  They like that a lot.

As your homecare improves, they will get increasingly nastier.

Welcome back!

Time to get your teeth clean and your gums back in shape.

If I had been told this at your age, I could have saved enough
money to buy a couple cars. I am quite serious.

Supplies:

 Sonicare toothbrush.  You can use any toothbrush, of course.
  The Sonicare just 'feels' more effective to me.
  If it feels too 'violent', try the Braun.
  Electric brushes are more fun than the manual type.

 Toothpaste (Plain white stuff, not gel).  Most gel pastes don't
  have fluoride.  Fluoride is good.

 Floss
  (Johnson & Johnson waxed. Flat, measures about 0.005" thick)
  (Not the store brand, because that cheap stuff shreds and sticks
  between your teeth, driving you crazy.)

 Hydrogen Peroxide Solution, 3% concentration.
  Found hidden on bottom shelf, near the first aid supplies.
  Often in a dark brown plastic bottle.
  The label will say "For treatment of minor cuts and abrasions."
  And "For use as an antiseptic gargle or rinse."
  Get a couple of the smaller 16 oz bottles.  It becomes ineffective
  over time and / or if it is heated much beyond 86 F.
  Try not to shake the bottle.  Leave tightly capped.

  The bottle may say "dilute with an equal amount of water."
  I rinse with the stuff full strength. No problems.

 Forget mouthwash. Stuff is completely ineffective for longer than a few minutes.
 Forget breath mints.  Most contain sugar, which grows oral bugs like crazy.
 Forget chewing gum like 'Dentyne'. Lots of sugar.
 Read the label first.  You will be surprised at times.

First thing in the morning and after every meal and snack,
 rinse out with an ounce of Hydrogen Peroxide.  The stuff is very safe to rinse in
 your mouth and will not cause discomfort if it comes into contact with
 oral bugs.  Swish a few times and spit. The oral bugs will konk out and be rinsed
 down the drain. Peroxide foams a little when in contact with bacteria.
 The stuff has a delicate 'mediciny' taste.

After rinsing, floss.  Yank about 24" out of the container and wrap the end
 around either index finger.  Saw the floss between each tooth to get the bad
 stuff out.  There will be blood.  There may be pus. This is normal, until your
 gums are back in shape.  After each tooth, wrap the used floss on your finger and
 use clean floss for the next tooth. When you are done with both upper and lower
 jaws, rinse with another ounce of Peroxide.
 The stuff is very inexpensive. You are giving the antiseptic better access to
 the bacteria in the gaps between your teeth. Swish and spit.

*"Brushing teeth" is just a figure of speech.*
 Brush only those surfaces that you want to be clean. So in addition to all
 surfaces of every tooth, you will want to also brush the bacteria off of all
 other mouth surfaces, to slow the bugs as much as possible.
 Feel free to rinse the bristles under hot water and reload the brush with
 a little paste to clean another area.  Toothpaste is cheap.

 Brush all surfaces, including but not limited to:
 * Gums, (tongue - side and outside surfaces. Use side-to-side cleaning motion.)
 * Tongue. Top and bottom.
 * Roof of your mouth.
 * Inside surface of your lips.

 Take your time. This is a lot more pleasant than a root canal.
 Ask me how I know that. Go ahead. Ask. :)

 The first few dozen times that you attempt to clean the rear part of your tongue
 and perhaps the rear part of the roof of your mouth, you will gag.
 Don't worry, everyone reacts the same way to pressure in these areas.

 You aren't gonna lose your lunch. But stay near the sink anyway.
 After a while, you will react with much less enthusiasm.

 Soon, you may not gag at all.

Want to know what your breath smells like to others?
 1) Sniff one wrist to get a baseline.
 2) Lick that wrist and allow it to dry.
 3) Sniff that wrist again.  This is pretty much what you are radiating.

That is about it.
When you have kids, please show them the dental litany every day, follow up
with them as they grow up because they are not going to think to do this
themselves.

They will grow up to be much happier people.

Best to you.

--Winston
Royler - 27 Nov 2004 16:33 GMT


> Supplies:
>
>   Sonicare toothbrush.  You can use any toothbrush, of course.
>    The Sonicare just 'feels' more effective to me.
>    If it feels too 'violent', try the Braun.
>    Electric brushes are more fun than the manual type.

I've heard nothing but good things about the Sonicare. It's on my XMas
list.

>   Toothpaste (Plain white stuff, not gel).  Most gel pastes don't
>    have fluoride.  Fluoride is good.

I bought into the hype and bought some Colgate Total.

> First thing in the morning and after every meal and snack,
>   rinse out with an ounce of Hydrogen Peroxide.  The stuff is very safe to rinse in
>   your mouth and will not cause discomfort if it comes into contact with
>   oral bugs.  Swish a few times and spit. The oral bugs will konk out and be rinsed
>   down the drain. Peroxide foams a little when in contact with bacteria.
>   The stuff has a delicate 'mediciny' taste.

Here's where you lose me. It's fairly impractical to rinse and floss
after every meal. I brush 2x a day, floss once, and rinse once with
Fluoridex, supplied by the dentist.

Yank about 24" out of the container and wrap the end
>   around either index finger.  Saw the floss between each tooth to get the bad
>   stuff out.  There will be blood.  There may be pus. This is normal, until your
>   gums are back in shape.  After each tooth, wrap the used floss on your finger and
>   use clean floss for the next tooth.  

My gums never bleed, except for when I picked up flossing several
months back. (Never bothered with it before.) I guess that's not a bad
thing. I'm not certain I'm getting way down into the gumline with the
floss, though. And what really bothers me is that every time I floss,
both my fingers and the floss really stink after coming out of my
mouth, unless I've just had a professional cleaning.



> That is about it.
> When you have kids, please show them the dental litany every day, follow up
> with them as they grow up because they are not going to think to do this
> themselves.


Believe me, I will be a taskmaster when it comes to this stuff.

Thanks for all the advice...but what's "abfraction"?
Joel M. Eichen - 27 Nov 2004 16:59 GMT
>> Supplies:
>>
[quoted text clipped - 5 lines]
>I've heard nothing but good things about the Sonicare. It's on my XMas
>list.

What do you believe it can do?

Its a toothbrush you know.

A toothbrush.

Joel

>>   Toothpaste (Plain white stuff, not gel).  Most gel pastes don't
>>    have fluoride.  Fluoride is good.
[quoted text clipped - 33 lines]
>
>Thanks for all the advice...but what's "abfraction"?
Winston - 28 Nov 2004 10:19 GMT
(Snip)

>>I've heard nothing but good things about the Sonicare. It's on my XMas
>>list.
[quoted text clipped - 4 lines]
>
> A toothbrush.

I believe the Sonicare is the most effective toothbrush I ever purchased.
That may be entirely subjective, just because it feels like it is scrubbing
really well.  I like how clean my teeth feel after using it.  I really liked
the comments my hygenist had for me as a result of using the Sonicare.

Never having seen an independently produced, peer-reviewed, double-blind test
of tooth brushes, I can't say that it is the best for everyone.
I just like the heck out of mine.  It is way more fun to use than a manual
toothbrush.  I'm much more likely to use something I consider 'fun' than not.

Believe it or don't, I have no financial or familial connection with the
manufacturers of this product.  I'm just astonished that Philips could make
a product this good.

Thassall.

--Winston
Joel M. Eichen - 28 Nov 2004 10:29 GMT
>I believe the Sonicare is the most effective toothbrush I ever purchased.
>That may be entirely subjective, just because it feels like it is scrubbing
>really well.  I like how clean my teeth feel after using it.  I really liked
>the comments my hygenist had for me as a result of using the Sonicare

Good to hear ... THANKS.

Joel
StovePipe - 28 Nov 2004 18:07 GMT
> tirely subjective, just because it feels like it is scrubbing
> really well.  I like how clean my teeth feel after using it.  I really liked
> the comments my hygenist had for me as a result of using the Sonicare.
>
> Never having seen an independently produced, peer-reviewed, double-blind test
> of tooth brushes,

the hygienists have done this... I remember one of mine showing me the
study, because I wanted to know where OUR brush fit in (RotaDent by
ProDentec). Perhaps try Googling for studies on mechanical toothbrushes
by hygienists.

>I can't say that it is the best for everyone.
> I just like the heck out of mine.  It is way more fun to use than a manual
> toothbrush.  I'm much more likely to use something I consider 'fun' than not.

then this is the brush for you... just remember to PAY ATTENTION when
you use it... don't be looking over your shoulder at the TeeVee or
whatnot... Listen for the motor; it should not start forcing and you
should not hear the revs drop off, or you are applying too much
pressure, and your gum line will be in danger.
Cheers
SP
Signature

Not a real Addy, yet

Winston - 28 Nov 2004 20:00 GMT
>>tirely subjective, just because it feels like it is scrubbing
>>really well.  I like how clean my teeth feel after using it.  I really liked
[quoted text clipped - 20 lines]
> Cheers
> SP

Roger that.

We will need a different metric for the Sonicare, though.  The oscillator
that drives the brushhead will remain at the same frequency from full
unload to full stall.  I tried it just now, 'strue.

I will worry about brushing too thoroughly right after I have resolved
all the issues I have about being underweight and too wealthy.

(Grin)

--Winston
W_B - 28 Nov 2004 20:27 GMT
>Roger that.
>
[quoted text clipped - 8 lines]
>
>--Winston

Ahem,

When you are Rogering yourself what is the frequency of ocillation ?

--
W_B

wubbabubbazG@RBAGEyahoo.com
Take out the G'RBAGE
Winston - 29 Nov 2004 01:34 GMT
>>Roger that.
>>
[quoted text clipped - 12 lines]
>
> When you are Rogering yourself what is the frequency of ocillation ?

http://www.googlism.com/who_is/o/ocillation/

Oh, did you mean 'oscillation'?  Thanks for asking, you little rascal.

My girlfriend and I roger about halfway between Wilco and 10-4.
Takes about 30 minutes to get to over-and-out.
Two, three times a week. Still, not too bad for an old guy.

What's the frequency, Wubba Ruth?

73's, :)

--Winston
Winston - 28 Nov 2004 08:00 GMT
>>Supplies:
>>
[quoted text clipped - 5 lines]
> I've heard nothing but good things about the Sonicare. It's on my XMas
> list.

Good!  I like mine a lot.  I bought one on the advise of my dentist and
decided I didn't like the aggressive-feeling action.  Tossed it and
went back to the Braun.  Really missed the effectiveness of the Sonicare
so I bought another.  Never looked back.  It works great.

>>  Toothpaste (Plain white stuff, not gel).  Most gel pastes don't
>>   have fluoride.  Fluoride is good.
>
> I bought into the hype and bought some Colgate Total.

Even most inexpensive commodity pastes have everything you need.
Check the label.  Crest is just fine.

>>First thing in the morning and after every meal and snack,
>>  rinse out with an ounce of Hydrogen Peroxide.  The stuff is very safe to rinse in
[quoted text clipped - 6 lines]
> after every meal. I brush 2x a day, floss once, and rinse once with
> Fluoridex, supplied by the dentist.

You have several dental emergencies in the making.  It is time to head off
as many of them as possible.  A healthy tooth way less expensive than a post -
and - crown.

Make time to do your dental care after every snack and meal and you will get a
similar report to the one I got from my hygenist. 2 mm pockets all around. One
'trouble spot' it was *4 mm*. Not too bad.  She called me a 'hygenist's dream'.
No kidding.

>  
>  Yank about 24" out of the container and wrap the end
[quoted text clipped - 10 lines]
> both my fingers and the floss really stink after coming out of my
> mouth, unless I've just had a professional cleaning.

This is good.  Get that plaque out from between every tooth and below
the gumline. Those bugs are eating you and you need to lose them.

Make a choice: Gross for you or gross for the people around you.

>  
> Believe me, I will be a taskmaster when it comes to this stuff.

Good.  You will feel better and have more money in your pockets.

> Thanks for all the advice...but what's "abfraction"?

One each bogeyman.  Have a look at http://www.atlantadentist.com/abfraction.html
In the bad old days dentists believed in the existance of real witches and in the
possibility that brushing one's teeth too hard could actually damage them.
Turns out that neither of these things is true.

When you discuss healthy homecare, dentists like to raise the spectre of
some horrible fate likely to befall the hapless patient.
You won't have to listen very hard.  They will scream 'Cancer!' and 'Abfraction!'
Hey if my paycheck depended so much on an uneducated patient base, I might also
do my best to keep them frightened and uninformed, too....

Nah, forget it.  That would be wrong.

--Winston
StovePipe - 28 Nov 2004 18:07 GMT
> One each bogeyman.  Have a look at
> http://www.atlantadentist.com/abfraction.html In the bad old days dentists
> believed in the existance of real witches and in the possibility that
> brushing one's teeth too hard could actually damage them. Turns out that
> neither of these things is true.

I aggree re: abfraction, BUT... aggressive brushing will ruin your GUMS.
It is a fine art to brush thuroughly were it counts (at the gumline)
without traumatizing it.
JMO
SP
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Not a real Addy, yet

Winston - 28 Nov 2004 19:50 GMT
>>One each bogeyman.  Have a look at
>>http://www.atlantadentist.com/abfraction.html In the bad old days dentists
[quoted text clipped - 7 lines]
> JMO
> SP

Thanks for that, 'Pipe.

Short of autism or severe mental illness though, I am hard pressed to imagine
that someone could be so reality-impared as to actually damage their gums
with a toothbrush.  'Course some folks choose to hang from hooks, so it is
*possible* I guess.  :)

--Winston
Bill Combs - 27 Nov 2004 23:12 GMT
Mostly good advice, but a couple of items need correction and
clarification. Hydrogen peroxide is not a panacea. If periodontal
prevention came in a bottle, then nobody would have had periodontitis
since the 1970's. Back then, there was a fad in gum care which
utilized hydrogen peroxide.

It didn't work.

No rinse or mouthwash is a substitute for preventive oral hygiene
using a brush and floss. Short-term use of chlorhexidine gluconate or
even Listerine can be an adjunct to a planned episode of treatment.

>  > I guess I'm just surprised by their lack of real concern, though
>  > everyone is very nice.
>
> They are very nice now. They figure you are *not* going to improve your
> homecare and are looking forward to many many boat payments directly
> from your account to theirs.  They like that a lot.

Highly speculative on your part. If it is true, based upon your own
experience, you ought to consider switching dentists. Most dentists
are not like that. Why stay with one whose motives you suspect??

> As your homecare improves, they will get increasingly nastier.

You REALLY need to switch dentists. The vast majority of dentists will
applaud any improvement in home hygiene effectiveness! Or are you
making this up?

>   Toothpaste (Plain white stuff, not gel).  Most gel pastes don't
>    have fluoride.  Fluoride is good.

Fluoride is indeed good, but most gel pastes DO INDEED have fluoride!
I can't recall any that don't, though some may exist.  As a matter of
fact, the only NON-fluoride toothpastes I remember in local stores
were the white kind.

The vast majority of major-brand toothpastes have fluoride. Aim,
Aqua-Fresh, Colgate, Crest, MentaDent, and so on -- they all have
fluoride. To be sure, just check the label, where it will be listed as
the "active ingredient."

>   Floss
>    (Johnson & Johnson waxed. Flat, measures about 0.005" thick)
>    (Not the store brand, because that cheap stuff shreds and sticks
>    between your teeth, driving you crazy.)

I've seen "store brands" that were just as good as the major brands.
Dump the brands that shred, and use the ones that work well.

>   Hydrogen Peroxide Solution, 3% concentration.

Unnecessary in the treatment and prevention of periodontitis. Simple
rinsing with hydrogen peroxide will NOT get it down into the gingival
sulcus where all the periodontal action takes place.

Some dentists may use it as a part of a short-term treatment plan, but
its value in long-term prevention is dubious, to say the least.

Are there any LONG-term studies which show safety in regular daily
oral use of hydrogen peroxide, which is a powerful oxidant?

Most of the rest of the advice is good. Careful brushing and flossing
to remove all plaque is the key. Because calculus cannot be removed
with home care, and because periodontal destruction can occur without
outward symptoms, it is also necessary to have a thorough exam and
cleaning at least once every six months.

Best regards,

- dentaldoc
Winston - 28 Nov 2004 08:41 GMT
> Mostly good advice, but a couple of items need correction and
> clarification. Hydrogen peroxide is not a panacea. If periodontal
[quoted text clipped - 7 lines]
> using a brush and floss. Short-term use of chlorhexidine gluconate or
> even Listerine can be an adjunct to a planned episode of treatment.

No argument from me about the synergy of brushing, flossing and rinsing
with an antibacterial.  Nowhere and at no time did I ever hint that
dental homecare could be done with just one technique. That would be silly.
Hydrogen peroxide continues to work better for me than any other mouth rinse
because I use it in conjuction with brushing and flossing.

Listerine is an alcohol based (26.9%!) oral rinse.
I found it totally useless for more than about a minute after rinsing.
Despite the television commercial graphics, I feel the stuff is no better
than any other brand of snake oil.

>> > I guess I'm just surprised by their lack of real concern, though
>> > everyone is very nice.
[quoted text clipped - 4 lines]
>
> Highly speculative on your part.

Well, ok. Perhaps they are buying investment property rather than a boat.
That is not the point.

> If it is true, based upon your own experience, you ought to consider
> switching dentists. Most dentists
> are not like that. Why stay with one whose motives you suspect??

I switch dentists like most people switch socks.
The Reader's Digest report was a love letter to the profession in
comparison to my experiences.

>>As your homecare improves, they will get increasingly nastier.
>
> You REALLY need to switch dentists. The vast majority of dentists will
> applaud any improvement in home hygiene effectiveness! Or are you
> making this up?

No, I am not making anything up.
Feel free to use Google Groups and search for the subject
'Controlled Substances?' from July 27 of 2004.
That is the most serious example, but my experience follows the same
trend.

>>  Toothpaste (Plain white stuff, not gel).  Most gel pastes don't
>>   have fluoride.  Fluoride is good.
[quoted text clipped - 8 lines]
> fluoride. To be sure, just check the label, where it will be listed as
> the "active ingredient."

We are in 'violent agreement'.  Like I said, check the label.

>>  Floss
>>   (Johnson & Johnson waxed. Flat, measures about 0.005" thick)
[quoted text clipped - 3 lines]
> I've seen "store brands" that were just as good as the major brands.
> Dump the brands that shred, and use the ones that work well.

I recently stumbled across a brand that is every bit as good as the
flat waxed stuff from J&J at half the price of the 'brand' product.

You are right; they are out there.  It does take some research.

Until an emergency patient gains confidence in the use of floss, he
or she should use a good quality brand.  That patient simply cannot
risk getting turned off to good homecare for any reason.

The risk to their health, happiness and wallet is just too high.

After the patient is in the 'safe zone' they can experiment with
cheap floss all they want.  They just need to go back to a quality
floss rather than drop the whole regimen out of frustration with
an awful product.  Many cheap and not so cheap flosses are awful.

>>  Hydrogen Peroxide Solution, 3% concentration.
>
> Unnecessary in the treatment and prevention of periodontitis. Simple
> rinsing with hydrogen peroxide will NOT get it down into the gingival
> sulcus where all the periodontal action takes place.

Like I said, Rinse, brush, floss, rinse. The peroxide must find its way
into the sulcus under those circumstances.  My hygenist affirmed that
during my most recent checkup. The effect is too real and too pronounced.

> Some dentists may use it as a part of a short-term treatment plan, but
> its value in long-term prevention is dubious, to say the least.

I respectfully disagree.

> Are there any LONG-term studies which show safety in regular daily
> oral use of hydrogen peroxide, which is a powerful oxidant?

I am unaware of any.

> Most of the rest of the advice is good. Careful brushing and flossing
> to remove all plaque is the key. Because calculus cannot be removed
> with home care, and because periodontal destruction can occur without
> outward symptoms, it is also necessary to have a thorough exam and
> cleaning at least once every six months.

If you can manage to find an honorable, competent dentist*, I could not
agree more with the above sentence.

* Check between Santa Claus and the Unicorns.

--Winston
 
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