Periodontics/bone loss


QUESTION: Hi Dr Hormia

I have a lot of 4mm dental pockets and a few 5mm pockets which is strange since the last dental cleaning 6 months ago at another dental clinic I had 3mm pockets.

I asked hygienist if a deep cleaning was needed? She said no since my periodontitis is inactive. I didn't have any bleeding and not much plaque on my teeth.

Conclusion: My teeth are stable, 4mm and 5mm pockets, periodontitis is mild and inactive, will lose my teeth.
Oddly, she scheduled me out for another 6 months visit.

Apparently I had periodontitis some point in my life but now its inactive.
How does someone continue to have bone loss and deep pockets and not have infection? This baffles me.

ANSWER: The question you ask me appears to be whether you can (continue to) have bone loss and deep pockets in the absence of infection. The answer to this question is: Yes, you can.

Sometimes (for instance if you smoke), you may have chronic infection and continuing bone loss without having any signs of infection (no bleeding, no swelling, no redness). This happens because smoking paralyses the cells that normally fight the bacteria and cause the infection. Sometimes a very similar situation may occur even if you do not smoke.

There are also so called pseudo-pockets (false pockets), pockets that are deeper than 3 mm but are not due to infection but rather occur because the gum tissue is locally very thick and hard. If this is the case, bone loss does not usually happen. Whether your pockets are pseudo-pockets can only be judged by an experienced periodontist and by comparing the pocket depths over a period of time.

Sometimes a deepening of pockets and gradual bone loss may occur due to excessive biting forces. This may happen in the absence of visible infection.

Without knowing your case it is impossible to guess whether bone loss and thus periodontal disease is progressing or not. I would need to know your age, medical status, previous dental history and so on. A very important piece of information would be whether you smoke or have smoked. Also, without looking at good-quality x-rays it is impossible to judge your periodontal situation. Thus, whether your periodontitis is active or inactive can only be judged by taking into consideration all the above-mentioned aspects. If you want to be certain that your situation is stable, you should make an appointment with a periodontist.

---------- FOLLOW-UP ----------

QUESTION: Hi Dr Hormia,

I am not a smoker nor do I drink. I am health conscious. However, I do have an auto-immune disease called sarcoidosis. I do take steroids such as prednisone and advair. Does this disease and steroids contribute to bone loss?

The hygienist said I was going to lose my teeth. How could she make an diagnosis like that if my pockets are only 4mm and a few 5mm?
Yes, it needs attention. But to say Im going to lose my teeth is crazy unless they were 7mm or more.

Sarcoidosis by itself does not contribute to bone loss. Steroids do weaken immune reactions and therefore depress or prevent the signs of infection. Thus this medication, if you have taken it for years, may have something to do with your periodontal situation.

About the millimeters... Iíll give you some examples:
If some of your teeth (or some surfaces of the teeth) only have 4 or 5 mm of surrounding bone left (pocket depth is used as a means to evaluate the amount of bone), then loosing that bone means that the tooth is lost. Also, if a tooth has 7 mm bone left and then looses 5 mm, the tooth is most probably lost unless it is splinted to its neighbors to prevent biting forces to weaken the 2 mm that are left. Periodontics is not a simple science. Everything depends on so many things that you can not predict the future just by pocket depths or even bone level.

The hygienistís words were not a diagnosis. She expressed her view about your situation. Only periodontists a qualified to make a diagnosis.

The future depends on your dental history and on your present situation. A judgment about the future can only be made by an experienced periodontist who has all this information and also good quality x-rays (past and present) upon which to base the judgment.

I really recommend that you see a periodontist. The periodontist can give you a precise evaluation of the situation and can also give you treatment to prevent tooth loss.


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Marketta Hormia, DDS, PhD


I am a periodontist living and working in Helsinki, the capital of Finland, where I have my private dental practice. I am an international member of the American Academy of Periodontology. I have a Ph.D degree and a long background in research and teaching at the University of Helsinki and at the University of Turku, Finland. I function as an adjunct Professor at these Universities. I have also worked as a visiting scientist at the Scripps Clinic and research Foundation, la Jolla, CA. I can answer any question in the fields of dentistry and periodontics.


Private practitioner in Helsinki, Finland over 20 years. Former researcher and teacher at two Finnish Universities.

The Finnish Society of Dentists, Division of Periodontology, American academy of Periodontology

Over 30 scientific research articles published in peer-reviewed international scientific journals (can be found on PubMed)

D.D.S., Ph.D, Specialist in Periodontology. Adjunct Professor.

Awards and Honors
Visiting Scientist at the Scripps Research Foundation, San Diego, California, 1992-1994. NIH grant

Past/Present Clients
Dental patients, national and international. All kinds of dental, oral and temporomandibular joint problems

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