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Endo tips    Better Endo    Endo abstracts    Endo discussions

Interdental molar bone
The opinions within this web page are not ours. Authors have been credited
for the individual posts where they are

To: Periotherapist group
Sent: Friday, March 12, 2009 2:48 AM

I am a periodontal patient. Following the Periotherapist Group to better
understand the disease.

Wondering ... on say the interdental space between the two lower molars...
there is not much room. Even if the teeth are healthy.

So, if the space between the molars is largely filled with calculus and
placque would whatever bone there might be between the two teeth tend to
collapse? Leaving a crater to heal? Or would a high quality SRP be able to
remove the calculus and leave behind a sliver or more of bone that would
be able to maintain and possibly grow back to the prior apparent bone
height? Or something close. If there was any actual bone height.

My general thinking is that any superficial appearances of prior bone
height is really just an illusion. And that what will naturally happen if
the gap is severely infiltrated is that the bone height will collapse.
And that a crater is the natural result.

Also whether any X-rays suggesting bone height could be confused with
calculus. Perhaps even if it just gives the outer bone a suggestion of
greater density. Thanks for any thoughts - a patient

Hi there periodontal patient, This group is for dental professionals
who chat about periodontal disease but we occasionally chat with
patients. It's not a problem. Let me see if I can explain the
etiology of periodontal disease to you in terms that you can
understand. There are over 400 types of bacteria that live in the
mouth and they live in a sticky matrix called a biofilm. It's like a
cocoon that protects bacteria from being destroyed by the body's
immune system. Typically, when patients don't clean in-between their
teeth, the bacteria in biofilm matures to the point where it's no
longer compatible with the body and the body's immune system tries to
get rid of it. In trying to get rid of the bad bugs in the biofilm,
the body destroys the tissue and bone around the biofilm and that's
why patients with periodontal disease lose bone around the teeth. The
tooth is like a splinter and the body is trying to shed it. There are
also risk factors for periodontal disease like smoking which makes
things worse and the disease is sometimes more severe. Patients who
have poorly controlled diabetes are at increased risk for severe bone
loss and these poorly controlled individuals sometimes have other
risk factors like smoking/heavy drinking/ poor homecare. As a
registered dental hygienist, I spend a tremendous amount of time
teaching patients how to thoroughly remove biofilm and I customize
homecare for every patient. I use a special dye to show patients
biofilm that is visible on their teeth and I like to teach patients
how to "brush" in-between their teeth. There are very thin brushes
that can be used to brush in-between the teeth. The spaces in-between
the teeth vary in size so it's important to figure out which diameter
brush will be a correct fit. Many of my patients irrigate, too, and I
find that it's best for them to use a variety of tools on a daily
basis like a power toothbrush, an in-between the teeth toothbrush and
the Water Pik. I also like patients to trace along the gumline with a
rubber tip, especially in places where it's not easy to place the
toothbrush bristles. Remember that the bacteria love to live where
it's warm and moist and the perfect breeding ground is along the
gumline. Sometimes, patients also take medication to reduce the
inflammation. There are some individuals who have what is referred to
as an inappropriate inflammatory response to the biofilm.
- Lynne H. Slim, RDH, MS

Re Lynne's comments. Let's start with the obvious. Typically the cause
of an isolated periodontal lesion is not just what's below, esp. on a max.
2nd PM. Endo-perio etiology is common. Restorative overhang, food
impaction, occult root fracture are also common etiologies. Did anyone
rule out necrotic teeth here? I forget, did one of the teeth have endo?
if so, that's the likely cause of the problem. Solutions? Re-treat the
endo, watch and wait, and hope. Fix any perforation if it's not already
communicating with the periodontal pocket. If it is, it's not fixable.
It's impossible to cover all of the potential etiologies but when it's
an isolated problem, the key cause is probably right in front of you
somewhere. Sometimes leaving it alone is okay. Other times extraction
makes good sense. Impossible to generalize - Michael P Rethman
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