Periodontics/Bone loss


QUESTION: Hi Dr. Hormia,

I don't have any active inflammation in my mouth.
However, I have rapid bone loss on my lower and upper part of my mouth region(incissors). Bone is normal on my molars. I lost about 3mm of bone in 6 months.

Each dentist I see is puzzled. Not sure what it is causing it. I have no bleeding, no inflammation, no pockets deeper than 3mm, some 4mm pockets. No plaque, don't need a deep cleaning I am told.

I was on Advair for a year. Off it now. I don't take in much calcium since I don't eat dairy--not sure if that's it since I do eat fruits, veggies and whole grain to get calcium. I do wear a night guard.
I have the xrays if you want to see them. I an appt. scheduled next week with a periodontist.

Any suggestions on what's causing this bone loss?

ANSWER: It is not possible for me to judge or explain your situation without seeing X-rays and a clinical picture.

It would also be important to know your age and your medical and dental history.

I can make some guesses, though.

You have a night guard. Therefore I can guess that you are grinding your teeth and/or have unfavorably high biting forces.

You have been on Advair, which is a corticosteroid. This kind of medicine can make gums thinner and more vulnerable to mechanical, bacterial, or chemical trauma. It also dampens the inflammatory process and may therefore weaken the attachment of gum tissue to the tooth surface. Moreover, corticosteroids may directly cause bone loss and osteoporosis.

Additionally, your vegan diet may increase the risk of bone loss.

It is also possible that you have a so-called “thin biotype” to begin with. This means that your gums and tooth-supporting bones might be naturally thin and therefore particularly vulnerable. Furthermore, the shape of teeth varies and sometimes teeth have short and tapered roots that do not give stable support against the forces caused by biting.

Bone loss is often not only caused by bacterial infection but might in addition be due to a number of other factors. It is good that you have an appointment with a periodontist. I am sure that you will get a good evaluation of your situation and then receive a proper treatment.

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

QUESTION: Good Evening Dr Hornia,

I went to a Periodontist yesterday. He examined my mouth. He probed and checked my bite. He told me I have a lot inflammation in my gums especially my upper right canine. He said I have a 7mm pocket there and I have bad bacteria in my mouth. I have many pockets of 2,3,4's.
He recommended a deep cleaning and take an antibiotic called Metronidazole to kill the bacteria. I also need an occlusal adjustment because my upper teeth are hitting lower teeth which is causing the bone loss on the bottom. He also mentioned a better night guard--one that which is not flimsy because they biting forces need to be evenly distributed throughout the mouth. Advair he didn't mention and thin gums he was not sure. Genetics possibly.
I don't have insurance. I may have all this done at a perio-dental college. I could pay $1,000 for all the work or pay minimum through a dental school. Not sure if dental school will do a good job.

Thanks for your information.

Good to hear that you received understanding and explanation of your problem.

The treatment plan is adequate and proper.

I believe that you will receive good treatment at the perio-dental college if it is done by a postgraduate student. The treatment might take longer than at a private clinic, but the result will be good.  


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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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