Periodontics/Bone loss


QUESTION: Hi Dr Siegla,

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: Dear Todd,

I understand your confusion.  Periodontal disease is an infection that causes damage to the gums and surrounding bone  It sounds like there was a period of time when you had some active disease and you lost some bone.  This left spaces between your gum tissues and teeth called pockets. If the bacteria is removed from the root surfaces and the infection resolves you will not have any ongoing inflammation, but you may still have a space between the teeth that measures 5mm, but does not harbor any bacteria that is causing ongoing bone loss.  The bone loss you had in most cases is not , so by definition your bone loss is always present, but your disease may be inactive.  I am in disagreement with the hygienists plan to see you in 6 months.  You need to be seen every 3 months or your disease could come back.  It takes 90 days for bacteria to grow into a complex biofilm that will then cause disease. While you don't have active disease you are at risk for it to come back, ergo, you need to be seen every 3 months.

Good Luck
Dr. Siegelman

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

QUESTION: Hi Dr Siegelman

That makes more sense.

Since I have stable deep pockets my goal is to keep my teeth to at least I am at retirement age. If I could keep my teeth intact for life that would be optimal, however in my case, it seems unlikely since I have a tooth death sentence called periodontitis.

1.)I floss, brush, use water irrigator, and use Listerine twice a day. I also use dental sticks after each meal. Maybe brush and floss after every meal too?
2.) Can I add drops of iodine or bleach to my water irrigator regime to halt the bacteria from destroying my bone loss?
3.) Any ideas to keep my periodontitis inactive for life? I prefer not to get dentures at my age of 46.


Todd, I do not agree that you have a tooth death sentence.  I think if you brush twice a day and floss at least every other day you should be fine.  Using Listerine and bleach in your irrigator will help.  The key is to have a periodontal maintenance appointment every 3 months and you should be able to stay out of dentures.  You need to be doing this regardless of whether or not your insurance pays for it.  I see thousands of patients who have worse conditions than you do and they do not end up in dentures.

Dr. S


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Bryan M. Siegelman, DDS


I can answer any question relating to the diagnosis and treatment of periodontal disease. I can also answer questions relating to the placement and restoration of dental implants.


I have been practicing Perioodontics for the past 20 years. I limit my practice to periodontics and implant dentistry. I am a diplomate of the American Academy of Periodontology. I am in private practice in Pennsylvania and am on staff at the local hospital in my home town. My practice website is

American Academy of Periodontology, Academy of Osseointegration, American Dental Association, American College of Dentists, Pennsylvania Dental Association

I have a BS from Muhlenberg College, I did a general practice residency at St. Joeseph's Hospital and Medical Center in Paterson, NJ. I received my DDS degree and specialty certificate from the University of Maryland Dental School.

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