Expert: Steven C. Scherr, D.D.S. - 9/22/2005

Question
I am 41 yrs old. For at least the past 8 yrs, I have gone to the dentist for a checkup and cleaning 2x/year.  Before that I went often, but more sporadically.  No major problems, just a few cavities until now.

During my routine cleaning today, I was informed that I have some gum problems.  Apparently, some gum pockets are 4 mm and the bite-wing x-rays show some bone loss over the past 5 yr period.
The dentist did not seem overly concerned.  He said that I have no infection, swelling, etc, and that my hygiene is "impeccable." He stated there was nothing else I could be doing.  The internet indicates that 4mm pockets and bone loss constitutes serious gum disease.  

My questions:
1. how could I have developed this when I brush with an oral-b power toothbrush 3x/day, and floss religiously each night.  Also use listerine.
2. the internet describes periodontitis as having red, swollen, bleeding gums.  My gums never bleed.
3. From what I have read about bone loss and 4mm pockets, it seems I am steps away from tooth loss.  True?
4. Is there ANY treatment that will reverse this process?  Should I consult with a periodontist?

I can't believe this has happened to me, I thought my teeth were in great shape.  Any information you can provide will be of great assistance.  I am going to try to speak with my dentist about this again next week, ARE THERE ANY QUESTIONS I SHOULD ASK HIM?

Thanks so much - Karen

Answer
Karen,

First, take a deep breath.  Your teeth are unlikely to be going anywhere anytime soon.  It isn't the depth of the pocket that is important, it is how effective one is able to clean to the base of the pocket that counts.  Deeper pockets are simply more difficult to clean thoroughly.

Bone loss is a concern because it indicates irreversible damage has taken place.  If the loss of bone is mild, it is best looked at as a warning sign.  We can all withstand the loss of a little bone without any real harm.  The trouble is that ongoing bone loss will ultimately undermine the support for the teeth.  Bone loss is most often the direct result of bacterial infection.  In some cases, the loss of bone is thought to be accelerated by problems related to the bite.

I'll answer your specific questions one at a time:

1. Bacteria form on the teeth and in the gum pockets every day in everyone's mouth.  No one is 100% effective at removing the germs.  This is because teeth and gum pockets, when viewed up close, are irregular in shape.  It just isn't possible to traverse every little nook and cranny with any cleaning aid.  Studies have shown that mouthrinses only make it 1-2 mm into gum pockets.  Most people are only effective cleaning up to 3 mm into gum pockets with toothbrush and dental floss.  Each of us has a different natural resistance to fight off the bacteria that remain.  There is probably a hereditary influence here, though diet, habits, and the bite likely play a role as well.  In short, life isn't fair.  Some of us have a higher susceptibility to gum disease than others.  However, the things we do can influence the progression and expression of gum disease.

2. The gum areas that are cleaned effectively every day will be healthy and will not bleed.  Most people are very consistent.  The gum areas they can reach are cleaned well each time.  However, the areas that are inadvertantly missed tend to be missed every time as well.  Bleeding will only be noticed if brush or floss happens to make it into an area that had routinely been missed in the past.  Your dentist can use a special instrument, called a periodontal probe, to check the gum pockets for bleeding.  The probe explores to the base of the gum pockets.  It not only measures the depth of the pocket, but also tests to see if bleeding is stimulated.  Health areas do not bleed.

3. False!!!  Unless bone loss is already in an advanced state, 4 mm pockets are an early warning sign.  They are not an indicator of imminent danger.

4. It is beyond the scope of this format to determine whether or not treatment is required.  If you would feel more comfortable with a periodontist's evaluation, I see no harm in it.

Karen, I wish you well.

Steve