Caring for the gums haven\’t been this easy and effortless, and it can be done at home….

Stephanie, you like many patients, have had an incredible amount of information presented to you and it can be confusing. To make matters worse, the information has been either interpreted incorrectly or presented to you incorrectly. I will respond to just what you have posted here and try to clarify the best I can for you and what I think you are trying to convey.

First, You asked. Is there a cure?
What needs clarification here is for what. Periodontal Disease or Periodontitis.
Periodontal Disease is a loss of:
1. Alveolar bone (the bone surrounding your teeth),
2. The Periodontal Ligament (your teeth have a ligament that surrounds them, holds them in the bone socket and provides absorption to biting forces. In other words the teeth are not “fused” to the bone in normal situations.
3. Gingival fibers and attachment apparatus: These are all the fibers that attach the gum tissue to the bone and circumfrentially the gum tissue surrounding the teeth.

Any anatomical body structure that has the suffix “itis” means inflammation of that structure. (example tonsilitis, appendicitis etc..)
Thus Periodontitis is an inflammation (infection) in part or all those periodontal structures (mentioned above) caused from a bacterial origin (plaque). If part of those structures are inflammed, it can be a less serious state of gingivitis. If all those structures are inflamed/infected resulting in loss of bone at any site around a tooth or teeth, it is periodontitis.
Now, Periodonatal disease generally is more the FACT that there is bone loss. Understanding then that it is not a matter of “curing” the condition of bone that is lost and may I add that in some cases the type of bone loss (how the bone has degraded) can and should be considered for bone grafting by a periodontist. There are some instances that the bone can be grafted and reversed. Generally if the condition has happened over time, the type of boney architecture that results is not usually graftable.

What is curable?
PERIODONTITIS is curable in nearly all cases by eliminating the inflammation of infectious bacteria at all depths of the gum pocket and tooth surfaces involved and this is where you can find yourself confused and mislead by what David is explaining in his case. You can cure inflammation and thus prevent any more bone loss in most all situations. That is in essence the curable part of periodontitis.
There are many times, that I see patient(s) that have a 4-5mm pockets and spend a great deal of time cleaning those pockets out for them at their routine cleaning appointment with the understanding that they are going to have to follow all my instructions and demonstrations for homecare and come back and see me in 3 months. A 5mm pocket is in most all circumstances slight-mod loss of bone and I inform them that this is most likely the case. The question is whether it is SL or Sl-Mod. The reason why I give the condition a chance to resolve is because, if there is a combination of inflammation (pseudopocketing) or (false pocketing due to swollen gums and not loss of bone), we should see improvement in 3 months if they do what I recommend. I use this rationale because if they do get scaling and root planing (SRP- Deep Cleanings), I would have them on a 3mo (Supportive Periodontal Therapy recall anyway). This is to prevent areas from getting re-infected because of a lapse in home care or to determine the thoroughness of the treatment (SRP) itself. So, it usually makes sense to my patients that if the routine cleaning was thorough enough and their homecare is thorough enough and 3 months would be a short enough period of time to prevent re-infection, the pocket should resolve. In other words, I do my best (given the limitations of a routine cleaning appoint (Pophy), the patient does their best and we will both see the results. If the pockets depths are still present and there is bleeding upon probing from bacteria still attached to the deeper structures (usually the sides of the tooth root surface), then we discuss treatment such as scaling and root planing. In some cases, I have had a 5 mm pocket depth resolve to a 4mm with no signs of inflammation or bleeding on probing. In some cases, I will watch those areas and monitor them and KEEP THE PATIENT ON A 3-4 month recall for awhile so they don’t fall off the wagon with their homecare. In other cases, there is no resolve and continued inflammation (infection) and we discuss what I previously explained to them as DEEP CLEANING or SRP treatment.
But don’t misunderstand me, SRP treatment is absolutely the first line of treatment even referred to as Phase I therapy and if you do go to a periodontist it is almost certain that they will have a hygienist do SRP as the first course of treatment.
See what I think is missing here and to be fair to David is what are the pocket depths? Are we talking 4-5mm sl-mod or 6 mm (millimeters) or greater, which are not going to resolve with any guru device or self-therapy. I have treated patients for more than 10 years and do periodontal treatment (SRP’s) routinely, a 6mm pocket is not going to resolve without treatment

Another question:
Did your dentist or hygienist do your Deep Cleaning? I am just curious about that. Usually, most dentist’s forte is not in periodontal treatment. They aren’t usually trained as extensively as their hygienists in scaling techniques and periodontal knowledge. They usually refer them to their hygienists for treatment.

Now, in your case and what you should do.
Yes, I do agree with David, ask your dentist for a referral to a periodontist. If he beats around the bush, just set yourself up an appointment with one. If he acts hesitant about giving you one (after he has already carried out phase I treatment or SRP’s) then I would suspect something’s up. Many times they won’t refer right away and they want to carry out Phase I because if they let the periodontist’s hygienists do it, it is money out of their own pocket. They get cranky about that. However, many of them do not realize when they are in over their heads either. So, get the referral. What you have had done thus far is not working and that is OK to find that out at this point. No harm done. if anything, the process of bone loss has been slowed way down with the treatment made thus far and your homecare efforts..
Additionally,
-Being as young as you are, let’s consider the following:
Slight to Moderate bone loss at your age with inconsistent or nonexistent inbetween the teeth care (flossing), is conceivable.
-Moderate to advanced would make me pause and question your health history information and take a hard look at the condition of your restorations. If there are overhanging margins on crowns or fillings that are deep into the gums, it is not good and can explain the persistent puffiness in your gum tissues. Grossly overcontoured restorations can most certainly protect bacteria from even the most meticulous home care efforts (brushing, flossing etc..) and harbor more long term forms of plaque bacteria that put more pressure on the bone integrity.

David,
As far as having a relative that received SRP treatment and the pocketing had been perceived to have worsened, that would be a perception and not a reality. If the condition worsened, it would have to be due to other factors and as far as your success David in preventing further bone loss—congratulations. However, remember that you do have periodontal disease. Maybe not periodontitis, but stable periodontal disease. I certainly would be asking my hygienist, what my pocket depths are every time I got my cleaning.

Well I hope this helped a bit. I know it is long, but like David, I felt compelled to respond and take as much time as needed.
A. Thomas Bozung RDH