Why do I keep losing bone and gums around my teeth, when I am doing everything “right”?
I had lunch with a dental colleague of mine last week, a specialist called a periodontist. She has limited her dental practice to treatment of conditions specifically related to improving the condition of the gum and bones surrounding your teeth. Also, she is specially trained in the placement of dental implants to replace one or more missing teeth, and she really enjoys perfecting the skill of growing bone and gum tissue to help people improve the chewing function which may have been lost years before. She is skilled at using dental lasers in her office (as I also do in mine) to combat bacteria growing around teeth in hard-to-reach places, and she has had great success in the past few years using this technique.
Much of the conversation we had related to the topic of those patients for whom, despite our best efforts and skill, unexplained bone loss around their teeth continues to be a problem. We call it unexplained because these are often patients with excellent oral hygiene habits at home, they have gum tissue treatments in her office or mine every three to four months, and there doesn’t seem to be a definitive reason why these patients aren’t either remaining stable or getting healthier.
What can be causing continued bone loss in these patients?
The best way to describe the problem is with an analogy. Think of building a fence in your backyard, and picture the large fence posts sunk deep into the ground which hold the different sections of fence, and the dirt needs to be packed very tightly around each post. A certain length of the post needs to be placed deep enough in the ground to withstand any forces from the wind or your dog against your fence to prevent it from coming out. This is just like the roots of your teeth; the section of root under the gum needs to be longer than the section of tooth above the gum to withstand the forces of chewing.
Now imagine you have a friend who is a weightlifter. He drinks too much at your backyard party, grabs hold of one of your fence posts, and rocks it back and forth, around and around. What happens to that fence post? The dirt around it will loosen from the pressure, and the fence post will loosen as well. The more he pulls on it, the easier it becomes to loosen it. Because it is connected by the fence sections to other fence posts, they too may loosen…and now other fence posts may be threatened. This is just like what can happen to teeth. When you clench and grind your teeth, all of that extra stress and pressure loosens the gum and bone around your teeth, and they melt away. The pressure occurs on many teeth, as you are touching all of the teeth when grinding them…and now you have multiple areas of bone loss. The more bone lost, the easier it is to lose even more bone. In fact, losing the first millimeter or two of bone around a tooth may happen fairly slowly, but once that area is weakened, the next two millimeters of bone lost can happen twice as fast! This problem has similarities to a snowball rolling down a hill; carried by momentum, it rolls faster near the bottom of the hill than the top, and has collected more snow on its way down to become a much bigger ball (problem) than it was at the start.
Why do I grind my teeth, if it is so bad for my teeth?
Maybe you remember a time when you got a new filling or a dental crown while you were frozen. You couldn’t really tell while you were at the dentist that something wasn’t quite right about the fit of your teeth…until the freezing wore off a few hours later. That’s when you started to grind on that little “high spot”, over and over, until your tooth hurt. You called your dentist, he smoothed down the area a little…ahhh, that felt so much better. If your nervous system senses the slightest shift in the way your teeth touch, your body will try to remove the interfering area by grinding it out of the way. It’s not your fault, your body is just trying its best to accommodate to an imperfect system. If your teeth don’t fit together properly in general, the grinding continues until the teeth are worn flat and/or getting loose through loss of bone support.
What can be done to stop this process?
This is why I have so much respect for the periodonist with whom I spent time last week. She wasn’t satisfied with some of the treatment outcomes she was having, and was looking to work together to create a better solution for our patients which includes reduced bone loss, and therefore reduced tooth loss! We talked about ways to work together as a team to help our patients keep the bacterial level low in their mouths (her part of the job), better balance the bite (my part of the job), and have a more stable outcome in the end (have a happy and stable patient). In fact, carefully evaluating your BITE before treating your gums can lead to a smoother treatment with a greater chance of success in the long run. Please feel free to contact our office for more information.