4mm and 5mm pockets... very scared and unsure of realistic outcome

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Jim in Ottawa, Ontario

29 months ago

Hi everyone,

I'm 33 and went in for a cleaning 2 weeks ago. I haven't been so strict with my homecare and though I was brushing twice a day, I wasn't flossing very much like I should have been. I had my last cleaning 6 months prior and was told that I had a few 2/3mm, many 4mm pockets and two 5mm pockets upon probing.

I noticed a very small space (black hole) between two of my front upper teeth and got scared that this may be gum recession related so I immediately booked a cleaning appointment and started flossing rigorously. During the cleaning, my pocket depths were read at a few 2-3mm, mostly 4mm, and two 5mm pockets. I'm not sure if starting aggressive flossing the week before may have artificially increased some of these numbers due to swelling, but the numbers really have me worried. The dentist and hygienist did mention the possibility of pseudopockets.

I had scaling done on all my teeth and laser cleaning on some of the 4mm and 5mm pockets (looking back, I'm not sure if this was being pushed on me as an upsell, but I agreed as it was covered by insurance and I was hopeful that it might help). I didn't have any root planing, nor was it offered.

1.5 weeks have passed and since then, I've been extremely worried and having trouble sleeping..

I've been flossing twice a day (morning and night), brushing 3 times a day, and using a mouth rinse 3 times a day (Gengigel). My gums no longer bleed when flossing (occasionally I'll get a bit of blood if the floss snaps through tight teeth into the gums). Some areas are still a bit puffy, but look like they're settling down a bit.

I have a follow-up with my hygienist in 5 weeks from now. What can I expect as a realistic outcome for the 4mm and two 5mm pockets if I continue diligent homecare and regular cleanings?

cheers and thanks in advance!

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RDH in Toronto, Ontario

29 months ago

You have to remember that nothing happens overnight. 4-5 mm pockets, if they are in the back of your mouth (around your molars) isn't too much concern. If you have recession on top of those numbers than there is cause for concern. When you mention laser cleaning, I'm not sure what you're referring to. It may be a new system of cleaning but I have a feeling it was a Cavitron that they used. Did it vibrate with a high-pitched sound and spit out water? If it did than it was just an ultrasonic cleaner.

As far as root planing is concerned, if you have roots exposed, then root planing is done. We just may not charge for it as not all insurance companies cover it if a periodontist doesn't work at the office.

One great thing about our mouths is that they heal relatively quickly, compared to the rest of our bodies. You noticed that after flossing regularly for 1.5 weeks, bleeding stopped, so keep doing that.

I would have to say, if you have pseudopockets, they should be down by the next time you see your hygienist. If they are true periopockets, it may take longer because there may be bone loss also. Did you have x-rays done? If so, ask the hygienist to show you if you have bone loss. Remember that what's gone is gone, so if you have bone loss and recession, the only way to combat that is with bone grafting and gingival grafting. Both are usually only used in advanced cases.

Your office may not tell you this, but sometimes a gingival graft can look unsightly after it has completely healed. If the graft is in the back of your mouth, there's not much to worry about but if it's around your front teeth, I'd really think about it (if you don't have an advanced case). If you have teeth that are really loose and grafting is the only way to keep them, then do it, but it doesn't sound like you're that advanced.

Hope this helps!

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Jim in Ottawa, Ontario

29 months ago

Thank you for the reply, it's very much appreciated!

I didn't have xrays done this time, but I will be having them done upon returning so we can assess any bone loss. The dentist had mentioned that she didn't think there was bone loss, but we'll know with the xrays.

As for the laser, it definitely was a laser cleaning system they used (I had to wear glasses to protect from the certain wavelength). It probably was an upsell as this hygienist did try to push a few different products on me that their office offered.

I had a lot of 4mm pockets up front, and a 5mm pocket 2 teeth over from the my top front tooth. The other 5mm pocket was in the back.

Thanks for the info on the grafting. I have a feeling that's still a ways off and I will do my best not to let it get to that point.

Out of curiosity, have you ever seen a 5mm pocket reduce to 3mm?

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RDH in Toronto, Ontario

29 months ago

I have seen that, but I am concerned that you have a 5mm pocket so close to the front of your mouth. When you started flossing, did you bleed a lot?

It's great that you're having x-rays done, do you know if it's a full mouth series (~20 x-rays of your whole mouth), or just bite-wings (2 or 4 of just the back teeth)?

I guess the laser thing is a new system. The only laser I ever used was an experimental one in school called periowave, but I'd probe each pocket and inject it was methylene blue with dyed the bad bacteria then I'd go in with the laser that killed the dyed bacteria. My patient's pockets went from 8's and 9's to 4-5mm pockets in a matter of 3 months!!

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Jim in Ottawa, Ontario

29 months ago

I'm not sure about the xrays, I'll ask when I go in next. I can ask for the 20 if it's more comprehensive.

I did have bleeding throughout my mouth when I started flossing, but it stopped after flossing for 2-3 days. The probing did cause bleeding, though.

Wow, that's a great improvement!

Would it be worth going in again before the 6 week mark to have some of the spots that were 5 checked again to ease my mind?

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Jim in Ottawa, Ontario

29 months ago

Thanks again for the reply.

It turns out I do have some recession on four of the lower molars (3 have 1mm and one has 2mm of recession). This scares me as I know it adds to the amount of attachment loss.

I also have class 1 furcations on these 4 teeth. My dentist mentioned that he doesn't think there's bone loss and that my last bite wing xrays from June 2011 showed bone loss at the proper level for my age. He believed a lot of the probe readings are due to inflammation, though I'm confused as to why I'd have furcations if there was no bone loss.

I've kept up flossing 2-3 times a day + brushing after every meal.

I had started clenching my teeth at night 2 years ago and I'm wondering if this contributed to it. I was waking up with jaw pain, my jaw muscles felt tired, and actually had some ear buzzing.

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Jim in Ottawa, Ontario

29 months ago

Oops, I meant bone levels at the appropriate level for my age on the June 2011 xrays

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Jim in Ottawa, Ontario

29 months ago

Oops! I meant bone level at the appropriate level for my age in the June 2011 xray.

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granolagirl in Airdrie, Alberta

29 months ago

Before you mentioned the clenching I was going to ask you about it. Clenching and grinding strain the periodontal ligament and supporting bone. Also, do you smoke cigarattes? Another factor is your occlusion(bite)-are there any problems there?
Regardless of contributing factors you are doing the right thing with the daily flossing. Ask your hygienist to show you how to clean the furcations. You may want to have your teeth scaled every 3 months so that you can better control the inflammation. Have your hygienist demonstrate the correct brushing technique to you as well. I have seen periodontal pockets go back to normal depths but they are fragile and likely to return to previous depths if you and your hygienist are not dilligent. Good luck!

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Bluetea in Texas

29 months ago

Jim in Ottawa, Ontario said: Thanks again for the reply.

It turns out I do have some recession on four of the lower molars (3 have 1mm and one has 2mm of recession). This scares me as I know it adds to the amount of attachment loss.

I also have class 1 furcations on these 4 teeth. My dentist mentioned that he doesn't think there's bone loss and that my last bite wing xrays from June 2011 showed bone loss at the proper level for my age. He believed a lot of the probe readings are due to inflammation, though I'm confused as to why I'd have furcations if there was no bone loss.

I've kept up flossing 2-3 times a day + brushing after every meal.

I had started clenching my teeth at night 2 years ago and I'm wondering if this contributed to it. I was waking up with jaw pain, my jaw muscles felt tired, and actually had some ear buzzing.

What has 50 legs, no teeth and an IQ of 60?
>
>
>
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The whole first row of a Willie Nelson concert. Ha!

My dentist loves that joke.

Your case isn't really bad. Its those 9's and 10's that are troublesome. A lot of this can be reversed with scheduled periodontal care. Even, in the worse situation, there is gum surgery. I have been through it all. Heh!

Understand that if you see an old person with great teeth - they bought them. Lol1

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JuleAlain in Madagascar

3 months ago

I came accross a very interesting website with more info on this product: www.medicalexpo.com/medical-manufacturer/dental-probe-6883.html

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