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Periodontics

Paul (21 Jun 2012 17:19): At my dentist visit, I was diagnosed with "first stage gum disease" and recommended to have "scaling and root planing". It was noted that I have been brushing and flossing twice daily for the past 2 years, so it's not "my fault" that I have this problem.

It seems there are two factors in my symptoms: gingival pocket size and periodontal bone loss. Gingival pocket size seems to vary widely from one visit to another, from 2mm (good) to 4mm (bad) and now 5mm (bad enough to warrant scaling and root planing).

The periodontal bone loss is quite evident in my xrays over the past 6 years: 6 years ago my periodontal crests were present, and now they're gone. Moreover, it has continued to get worse year by year, and seems likely to create severe complications over the next 5-20 years if not arrested.

Here are my questions:
* Why don't they use any standard measurement (eg, standard points to measure between) to quantify the level of periodontal bone loss? Is there such a standard and my dentist just isn't using it?
* What is causing the periodontal bone loss?

The dentist seems to assume the periodontal bone loss is caused by gingival pockets over 3mm. However, I am not convinced that the speed of bone loss correlates with the pocket size, let alone that there is a causal relationship in my case.

Here are my various ideas of what might be causing periodontal bone loss:
* infection in gingival pockets (as the dentist seems to assume)
* flossing "too hard" (either pulling the gum away from the tooth or crushing the periodontal bone directly)
*@ brushing with a sonic toothbrush (maybe the sonic vibrations, which are good for loosening plaque, also damage the periodontal bone underneath the gum)
* flossing with the wrong kind of floss (currently I'm using J&J woven floss with fluoride; I'm also suspicious of Oral B Satin Floss which I used to use)
*@ using too much fluoride (I use high fluoride prescription toothpaste (Prevident) once daily), which may calcify plaque more easily and increase gingival infection, or may otherwise damage the periodontal bone structure
* not enough calcium in my diet
* not enough exercise in general
*@ silver fillings change my mouth chemistry, killing good bacteria and letting bad periodontal bacteria thrive

The items marked with @ are items that changed around 2006, when my periodontal bone loss began and also when it happened most rapidly (based on xray history).
Paul (22 Jun 2012 4:58): ok, it seems I had some alveolar bone loss before 2006. I have xray copies from 2004, 2005 and 2006. I will request all xray copies since then.

Journal articles like this answer my question about how to measure alveolar bone height: "ABH (alveolar bone height) is defined as the distance between the cementoenamel junction (CEJ) and the alveolar bone crest. In normal conditions, the level of the crest is 1 to 2 mm apical to the CEJ."

Using this definition, I'm measuring distances on my own xrays. It also seems the ABH may vary throughout the mouth; as a clear baseline, I'm measuring mine between teeth 18-19 and 19-20. These teeth are chosen because they show clearly on all bitewing xrays and also because they have never had any fillings or other dental work other than routine cleanings:
2004: ABH = 2mm basal to the CEJ (ie, 3mm of bone lost already compared with normal)
2005: ABH = 2mm, same
2006: ABH = 2.5mm, a tad worse
m (22 Jun 2012 8:06): paul, you thinking of becoming a dentist?
Paul (23 Jun 2012 4:59): No. I just think I better learn about it since it seems the dentists I've seen don't understand what I have. (They pretend to understand it, but their advice is inconsistent with my symptoms.)

So I had misunderstood the direction of "apical" (I thought it was this, but it actually meant this). Meaning my earlier alveolar bone height measurements are 2mm apical to CEJ (in the range of "normal", although the crest bone structure is a bit blurry, so there might have been 1mm of loss already) and 2.5mm apical (a tad worse).
Paul (26 Jun 2012 12:06): Link to kinds of procedures that exist. I think I want them to do "Perio Maintenance" but skip the "Scaling and Root Planing" step. We'll see if they'll agree to do so.