35 year old woman with bone loss

[SunnyDayzWI]

I am writing in desperation, as I have seen over 7 specialists in the past 3 months trying to address my condition. I have (what I've been told is significant) bone loss for a woman in her mid 30s. I have seen orthodontists, perios, my general, implant specialists, and more recently a TMJ expert to help me. I have notoriously had impeccable hygiene since a young age, but no matter, I have experienced bone loss and recession. I have pain along the gum lines and a slight cross bite and open bite. I grind heavily at night and wear a nightguard. As I approach my 40s, this pain has increased. I'm being pulled in so many directions. Do I have enough bone to warrant orthodontic work or would that be risky? Should I consider bone and soft tissue grafting? Should I consider a full mouth extraction with all on 4s for both arches? I am at a loss. Please, any advice would be much appreciated. The pics are a little old, but the condition is relatively the same.

 

[MattKW]

It appears to be significant bone loss for your age. I wonder what the periodontist thinks about it and the possible cause? You will achieve nothing with orthodontics, and it would be a brave orthodontist who would even want to touch your teeth - and to what end goal? Bone and soft tissue grafting is neither indicated nor wise, and I wonder who would suggest that to you. You should continue to maintain your teeth as best you can under regular review with a periodontist, and you'll be fine for years. You don't appear to have active periodontitis. Avoid implants for as long as possible - if you have bone loss with normal teeth, you're liable to get the same problem with implants.

 

[SunnyDayzWI]

Thank you for that feedback. I guess the whole intent with orthodontics is to get me out of malocclusion in hopes that my bite will improve to reduce forces on some of the teeth. After seeing numerous specialists, no one has been able to explain the bone loss to me. It appears to be a mystery that no one wants to touch : (

 

[honestdoc]

Your lower anterior teeth appear very compromised. How is your health history? Do you have diabetes or any immune compromised conditions? One possibility is to obtain a bacterial culture & sensitivity to determine the species and proper antibiotic. It is still possible to maintain the lower anteriors as long as there are no bleeding upon probing. Any bleeding indicates active periodontitis.

I see toothbrush damage. Make sure you are using a soft bristled brush and the brush head is not getting destroyed. Your brush head should look like new when you throw it out after 3-4 months. Orthodontics will worsen your bone loss. Any torquing and pressure will cause further damage. Make sure your night guard is custom made and wear it as much as you can even during the day if you are by yourself. You may have an anterior open bite in which your lower anterior teeth may be hyper-erupting. This may be minimized with a custom guard.

 

[SunnyDayzWI]

Thank you both kindly for the feedback. I have another appointment with a different perio in about two weeks down in Chicago in hopes he can provide some solutions. My biggest fear is that since it's horizontal bone loss, that there may be nothing they can do in terms of bone grafting.

 

[honestdoc]

Bone graft will not work for horizontal bone loss. The periodontist may want to splint the lower anteriors to minimize torquing. The unfortunate situations with periodontists are they do not make money by "maintaining" your lower anterior teeth. They make more money pulling your teeth and sticking implants in. I saw a trust worthy older periodontist present cases where teeth just like yours lasting over 10 years. The key is frequent 2-3 months recall visits and no bleeding upon probing.

Usually younger periodontists wants to put implants in you mouth. They have a lot of student loans to pay. Find a teaching periodontist at a dental school near you.

 

[SunnyDayzWI]

Thank you again for the counsel. This is why I sometimes turn to anonymous forums. After meeting with all these specialists, I'm being pulled in so many directions, it's just difficult sometimes to see who has my best interests in mind. Thanks for the tip about dental schools. We do have the Marquette School of Dentistry here in Milwaukee, so I'm going to look into that : )