Periodontal Disease and Bone Loss: These Walls Are Paper-Thin

Periodontal (Gum) Disease is a bacterial disease which wreaks its havoc by setting up a small but highly destructive zone of damage in the gum tissue around our teeth.  As it progresses, it's like a neighborhood that goes downhill after, say, the loss of a few key businesses.  As it gets worse, it does so faster and faster.  In the later stages, the jawbone (New York dentists say "joorbone") that supports our teeth is lost as well.  The patterns of bone loss can be rather horizontal, like a water level dropping:

 

 

(That bone level should be a lot higher on the teeth!)

 Or they can be vertical, like a crevasse:

 

Bone loss from periodontal disease also doesn't happen all over the mouth all at once.  It's very episodic, it happens here and there and once it reaches a critical point, it goes a lot faster.  So we might see one tooth ready to fly across the room if the patient sneezes, it's so loose already, and yet the one next door is anchored like one of Sir Edmund Hilary's Everest-climbing pitons.

Periodontal disease isn't just a local problem, either.  The damaging germs themselves, and the various toxins that they produce, periodically break out into the bloodstream.  There is a growing body of rersearch that shows that all this nasty stuff flying around in our arteries can lodge on the atherosclerotic plaque on our artery walls, triggering an immune response.  If a clot forms, or forms and breaks free, a heart attack, stroke, thrombus or embolism can result.  This is all a strong set of reasons for maintaining a healthy mouth, especially considering that daily maintenance and preventive dental visits are not costly in terms of time and money.  It's the treating and repairing that gets out of hand...

Back to the local neighborhood in the mouth, though.  When bone loss gets severe, there is a big question of how many teeth are affected.  Here, from the same patient, are two quite different situations.

In the first, one tooth has almost no bone.  Dark is "air" or gum tissue, light gray is where the bone is.  Note on the tooth to the right of the one with the severe bone loss, there is just a little sliver of bone left on the side, valiantly fighting off its seriously disturbed neighbor.  Remarkably, if we extract the loose tooth, the one next door will heal beautifully, particularly if bone grafting materials are used in the socket.

 

In the next X-ray, though, the failing tooth has, regrettably, caused terrible problems for its neighbor.  There's no bone left on the side, next to that big dark space.  This is very, very difficult to induce to heal, even with modern techniques.  That tooth next door should probably sue.

 

The bottom line is, preventing bone loss in the first place is essential- and far less expensive than complex periodontal treatment or tooth replacement.  What's even better is that for 85% of the world's population, preventing periodontal disease is very effective and not too difficult.  Only 15% of people are highly susceptible for genetic reasons and must take even greater precautions than most due to how rapidly this serious condition may progress in their mouths.

When I was in dental school, my classmate Dave, once a semester or so, so as not to burn out the joke, would page on the school-wide intercom system for "Dr. Perry O'Donnell".

Perry O'Donnell, and no one in admin ever caught on to the pun...

Comments

[Dorothy Shapland]

"and yet the one next door is anchored like one of Sir Edmund Hilary's Everest-climbing pitons"

Your colorful flourishes make reading about dental issues much less like studying something I'd rather not know, and more like a treat.... though the vaudeville act has got to go!! :)

[Rick Wilson DMD]

Thanks, Dorothy- yah I guess there's a reason that we have reality TV rather than Vaudeville on the airwaves...

Hey, wait a minute- have we really made any progress, then, after all?

[generic]

This disease really scary me out...

[Rick Wilson DMD]

Yes, periodontal disease is rather scary in a way, and yet it can be completely prevented. It's more difficult if a person is in that 15%, but prevention is still possible with diligence and frequent professional recalls. So my advice is, only worry to the extent that it motivates you to take action!

[dental implants Chattanooga]

Periodontal disease is truly scary! Anyone can have this disease. So if you see such symptoms, better visit a professional periodontist for some check-ups.

[Fosamax Lawsuit]

Thanks Dorothy,I really found your article interesting. Just like other suggest, If the symptoms persist, Consult a doctor before it will become worst.

[Los angeles dentist]

Periodontal procedures are available to stop further dental problems and gum recession. But they are very delicate and need so much of care.

[DePuy Pinnacle Lawsuit]

Nice blog you have here about periodontal disease. This is very informative. Thank you for sharing.