Bone Loss???

[321Marie]

I just got home from the dentist and am totally stressed. I knew I definitely needed some serious work done on 2 teeth, but was shocked when he told me that I had bone loss, and a cavity in almost every tooth.
I still can't believe it! Although I do have a few sensitive spots in my mouth, I am not getting tooth aches, so was surprised to hear about the cavities. But what really bothered me was hearing him say I have bone loss.

He also said my gums were in bad shape and that they bled a bit when he probed them. Yikes! I can honestly say that when I brush (twice a day), my gums do not bleed. And I do floss, but probably not often enough.

He took many xrays (approx. 15) and he said that after studying the films, he would call me in for a consult to discuss 'my options'. ??? I didn't even ask him what he meant; I was just so darn shocked by the time I left the office. I'm afraid that he might think I should consider getting dentures.

So please ------- can anyone explain this bone loss thing to me, and what scenarios might cause this problem.

Thank you!!! (p.s. I am 45.)

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[UBTom]

Hi,

Severe bone loss is usually the result of periodontitis, which is the inflammation and destruction of bone and gums, the tissues that support your teeth.

Periodontitis can be caused by many things. Poor oral hygiene can be one common cause, when heavy plaque and tartar accumulate on teeth and increase the amount of destructive bacteria in the mouth, which precipitates the destruction of gums and bone through their toxins.

Other causes include systemic disease such as diabetes, AIDS, leukemia, etc., which destroy the immune system and the body's ability to fight off normally-harmless bacteria in one's mouth and allow these germs to start destroying the tissues. Then there are circumstances which contribute to these conditions ("risk factors") such as smoking.

Other risk factors include some medications such as birth control pills, hormone replacement for menopausal women, calcium channel blockers for high blood pressure, etc., which have side effects that affect the gums. People with dry mouth (not enough saliva to wash away the germs) are also predisposed to periodontitis and cavities.

Consequences of periodontitis: Not only does it cause your teeth to come loose and fall out and all the discomfort that goes with it, it also puts a burden on your immune system if it is still functional. It might be premature, but current research are finding evidence that periodontitis may increase risk for conditions like cardiovascular disease.

To diagnose periodontitis, a dentist usually takes a very thorough medical history (to rule out those systemic diseases I mentioned), X-rays to check how much bone is supporting your teeth, then a soft tissue exam to check the conditions of the gums and other parts of your mouth, periodontal exam to see how deep the pockets around the teeth are, if the teeth move when pushed, how much plaque and tarter are on the teeth, etc.

As far as the other problem you mentioned, cavities are checked for with an explorer (the sharp pick-like instrument) and by x-rays.

If you are not comfortable with this dentist's diagnosis, you can always go for a second opinion. You might want to consider going to a dental school if you live near one. Dental students and their supervising professors do very good diagnostic work because dental students (like me!) are more concerned with getting things right than making money.

Good luck!

 

[321Marie]

Tom - Thank you so much for taking the time to reply! Much appreciated.

I will hopefully hear back from the office tomorrow with a scheduled time for my consult with the dentist. So tonight I'm busy gathering info. off the internet so that I will some idea (albeit rather limited) of what the dear dentist will be talking about.

I should start off by saying that I am a smoker. I know......stupid stupid stupid. I still can't believe that I continue such a disgusting, harmful, expensive habit year after year.

Re medications that can be a contributing factor, have you ever heard of this being the case with either sulfasalazine or celebrex? (I know, I know, of course I should be directing this to my doctor or dentist......but in the interim....)

I notice you mention systemic diseases causing this. I have come across a couple blurbs that specifically mention diseases contributing to periodontitis (such as diabetes). And I do have rheumatoid arthritis, but haven't read anywhere that r.a. (specifically) can cause or predispose someone to peridontitis. Do you know if it one of the auto-immune diseases that can cause this?

You also mention dry mouth. I believe I produce a normal amount of saliva, but I was once sent to an opthomologist for the Schirmers test which came back saying that I did not have Sjogrens (sp?), but that I tested at a 10, with normal being 15.

hmmmm I know that, of course, you can't really give specific information over the internet, but I really would appreciate your take on this.

Thanks again. Your reply was much appreciated.

Marie

 

[UBTom]

Hi there,

If you were one of my patients here at my dental school, I would usually get one of the professors at the Oral Diagnostics Sciences department to take a look, check my findings and make sure I got things right, but since I'm going on limited data here and can't get an ODS consult, you might want to take what I wrote here with a grain of salt.

As far as I know, sulfasalazine and celecoxib should not have significant periodontal side effects.

We can probably rule out Sjogren's Syndrome. It was suspected because Sjogren's usually presents with another autoimmune disease such as rheumatoid arthritis. That's probably the reason why you were sent to an opthalamologist for the Schirmer's test in order to rule that out.

Just a case of straightforward rheumatoid arthritis should not have significant direct periodontal manifestations. Oral symptoms as a direct consequence of RA tends to be temporomandibular joint pain and dysfunction.

However, if RA affects your manual dexterity, it would be understandable if you cannot brush your teeth or floss correctly, which may indeed lead to periodontitis over time.

Meanwhile, smoking and oral hygiene are main suspects.

Don't be afraid to get a second opinion from a dental school or another dentist, and good luck!

 

[gryffindor]

You are looking for some pretty remote causes for bone loss. Just focus on the main one - you are a smoker, and smoking has a HUGE correlation with bone loss and periodontal disease. Smoking and diabetes are the two risk factors that have plenty of research out there to correlate them to periodontal disease.

Have your dentists show you where the cavities are on your x-rays and while you look in a mirror and he shows you in your mouth if you have doubts about 15 cavities. Have him show you what "normal" bone levels look like on an x-ray in comparison to your bone levels for the periodontitis.

Or get a second opinion or go to a dental school, like Tom suggested.

 

[321Marie]

Thank you both for your replies. I am not questioning what the dentist has told me. I believe he is very competent. I suppose I am just trying to understand and come to grips with how I suddenly have bone loss, as I would have expected that something such as this would have been apparent when I had a check-up and cleaning last year.

I suppose I hate to admit that it appears the condition of my mouth is probably the result of many years of smoking.

Anyhow, thanks again. I think it is great that you took the time to reply to a complete stranger in such detail. Much appreciated.

Marie