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Periodontics/RE: 50% bone loss


Hi Dr. Hormia,

I want to ask for your opinion.

I am 47 years old, non-smoker, non-drinker, exercise and eat very healthy.
My teeth were strong and healthy up until 2012.
However, in 2014 my x-rays revealed 15% bone loss on my lower 4 front teeth. My dentist said I have perio-maintenance.
I used to have mild periodontitis but it stopped a few years ago with my excellent oral hygiene.
I get my teeth cleaned every 3 months and my gums are always pink and teeth are healthy. I have always brushed and flossed twice a day.

Yesterday, I went in for another x-ray and cleaning.
I now have 50% bone loss on my lower 4 front teeth. Its getting worse.
My dentist is concerned and does not recommend a deep cleaning because there is no tartar or plaque around my teeth.
The bone loss is centralized. My entire mouth has full bone density except for a specific area.

What else could be causing this bone loss? We have talked about a bone graft and gum graft, but he does not recommend it because the bone loss in that area would not anchor the teeth properly and the bones loss will progress again.
He says possibly getting a bridge if my lower front teeth fall out.

I am not sure how to stop bone loss if I am doing everything right. Should I take extra calcium and Vit D?
I eliminated dairy from my diet years ago. I wonder if this could be causing it. I also take Advair steroid and used prednisone for asthma. Could this cause bone loss?


I cannot judge the situation of you lower front teeth without seeing X-rays and the clinical situation in your mouth. Therefore, it is also not possible for me to suggest a specific treatment for you.
From what you write, however, it seems to me that your dentist is confused about your situation.

If the bone loss around your lower front teeth is not caused by periodontal disease and inflammation, then, most probably, there are traumatizing forces that cause the gradual loss of bone. It is also likely that the bone and gums that support these teeth have been very thin to begin with.

Also, a prolonged use of corticosteroids (Advair and prednisone) may weaken oral soft tissues and tooth-supporting bone. Since these medicines suppress the immune system, they may also make the gums and periodontal tissues more susceptible to infection.

My advice for you is to seek the treatment of a periodontist. It is helpful if you can get copies of your dental x-rays to take with you. A periodontist is a specialist in problems of the kind that you describe, and there are ways to treat the situation. When the reasons for bone loss are understood, then the right kind of treatment can be chosen.


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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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