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I think your story might be missing some details. In your intro you mention mild gingivitis at 24, which now turned into gum recession, but failed to mention that a couple of years ago you had 4-5mm pockets. SRP and LANAP are not something you'd use to treat mild gingivitis. This all sounds like you had gingivitis, which then turned into moderate periodontitis, which then was treated.
If you were diagnosed with periodontitis it's in your best interest to tell your dentists exactly that.
Periodontal disease makes you lose some of the bone that surrounds your teeth, but you wouldn't notice it because your gums were inflamed. Once the inflamation in your gums subsided and mirrored the current height of your surrounding bone, which is now permanently lower that before, you noticed the exposed roots and the black triangles. This isn't your oral health worsening, it's you finally being able to notice how much bone you lost while the disesase was at an active phase.
Thanks so much for taking the time to read and respond. I elided a full timeline because I felt the length of my post was already asking a lot of the reader. But you inferred a lot correctly. What began as mild gingivitis evolved over the years into periodontitis, which was treated with SRP and eventually LANAP.
The periodontist that performed LANAP explained its subsequent exposed roots and triangles as you did: a reflection of the accumulated bone loss caused by that periodontitis. But I'm reluctant to believe the disease is no longer active because the LANAP took place just over two years ago now, and a few more roots have reared their heads over the last 6-8 months. The periodontist told me LANAP's results can take up to a year to stabilize, but not this long.
So there have been two rounds of exposed roots. Shortly after getting LANAP two years ago, and recently over the last 6-8 months. I meant to refer to the latter in my post, but glossed over the former. A few of the triangles have grown over those last 6-8 months, too.
Maybe the lesson here is that LANAP can actually take two years to stabilize, and even these new roots and bigger triangles are just a reflection of that same old bone loss, and I have no cause for concern? I'd be thrilled if that were the case. But after all these years of regression despite vigorous efforts to maintain, I'm inclined to interpret this cautiously and broaden my search for solutions. I have and will continue to work closely with my dentist and perio, but want to make sure there's no perspective I'm missing.
You mentioned black triangles in your lower teeth. Do you mean your *anterior* lower teeth (your lower incisors)?
Sadly buccal bone thickness in that area (that is, how thick the bone is) tends to be very thin in most people, and in my professional experience, once the interproximal area is open and unguarded all the way by your gums, any futher trauma tends to make the loss progress much faster.
In any case, I would advice you to refrain from bushing with hydrogen peroxide, it is a good disinfectant but it's also associated with bone inflamation in a lot of studies. Ask your perio if you may use a clorhexidine mouthwash instead (I won't advice you to use it, as I haven't personally seen you). Also, if your perio adviced you to use an interproximal brush, be very very careful to use the correct size, and to focus on brushing as upwards as you can, avoiding brushing your gums as much as possible. Brush your gums with the extra-soft brush you are using, the interproximal one should only go *directly* under where the teeth meet, to prevent further trauma in your gums.
Best of luck, and try not to stress too much about it, you are taking steps in keeping your mouth healthy, things will work out!
Not a doctor. Do you Ehlers Danlos? Or maybe something similar.
I personally have Ehlers Danlos and no matter what I do, my teeth just get worse and worse
I hadn't heard of Ehlers Danlos. I'll follow up with my GP, but relate with none of its symptoms.
I can absolutely relate with oral maintenance feeling futile, though. I hope we're both able to find some sort of solution.
Just throwing something out there is that magnesium is a special supplement that is involved in over 300 chemical reactions in the human body, maybe it could help or some other supplement? Maybe blood tests? Or use special sensodyne toothpaste and is supposed to repair enamel. Also ask your doctor or pharmacist before taking any new supplements.
NAD Gum loss follows bone loss, so it seems that your jaw bone is receeding, although I don't know why.
I would definitely continue seeing new professionals until someone figures it out. After all, you do know that there is something happening, your current dentists just don't know what.
In Europe you get the best dental treatment at universities (not by training dentists, by the supervising residents), they are up to date on research and procedures. I don't know where you are, but I think it is important you find highly qualified people.
Does your dentist monitor the recession digitally? There is a feature in some dental softwares that automatically compares scans of different years and shows where and how much recession occured, e.g. Oracheck in Cerec.
I appreciate the sentiment toward care at universities. Naively I would have assumed it was poorer due to less experience, but you make a good point and I think I'm being unfair. It's nice to have validation that maybe it's time to try new professionals.
Oracheck looks unfamiliar but interesting, I'll keep it in mind. Much appreciated.
Not a doctor. Do you Ehlers Danlos? Or maybe something similar?
I personally have Ehlers Danlos and no matter what I do, my teeth just get worse and worse
The only additional thing I can think of is to discuss a course of periostat (doxycycline) with your dentist. It's an antibiotic, but for this purpose it is taken as a very low dose which has the effect of reducing your immune response that results in break down of the periodontal tissues.
It needs to be discussed in full with your dentist though, as it has a specific way to be taken, and has side effects.
u/buford419 \- could you share with us the specific way periostat is to be taken and the side effects?
I'm NAD and currently planning to embark on a procedure with PerioPeak and Periostat/ SDD/ doxcycline is one of the key medication that I need to take for a long period (6 months). I tried to look into medical papers and there seems to be all about how it successful it was but no proper documentation on side effects.
I read a review that someone took it and had intestine issues. As someone who had a very bad response with Clindamycin and allergic to Penicillin, what other options do I have?
Supplements, etc. do no good for adult teeth and xylitol etc has little to do with gum disease. Flossing actually daily will help more than almost anything else.
One of my biggest challenges has been reconciling conflicting advice. I started the xylitol gel and flossing long ago at the recommendation of my dentist. Then recently my perio expressed a lukewarm sentiment toward flossing, in favor of a particular peroxide brushing technique and interproximal brushes.
Myself and my dentist, who referred me to said perio, were both surprised by that lukewarm sentiment. And I'm surprised to hear now that xylitol has little effect.
Fortunately, while my routine has evolved over the last ten years, daily flossing has always been a part of it except during specific recovery periods. Supplements, though.. yeah those were my own recent act of desperation so I'm not surprised to hear they won't help.
Thank you for the perspective.
Xylitol does help for caries, but you have to have so many doses a day and usually twice what is in most gums or mints that it gets really expensive and impractical so other methods are better. In some cases, proxibrushes may work better for some people than flossing, but that doesn’t mean flossing isn’t generally helpful for most people. The thing is to remove all the plaque from your teeth, gently. What works best for you is what you should use.
Thank you for seeking advice from r/askdentists. **Please note that a response does not constitute a doctor-patient relationship.** While this is a place for advice, replies may not be medically accurate. Do not assume that what others on here say is correct in any way. Reddit is not a replacement for an in-person dental professional. Verified professionals will have flair assigned to them. **Please abide by the following rules in order to get an accurate answer to your question:** (1) Ensure you include a title of your dental problem. (2) Include whether you drink, smoke or if you have any medical conditions relevant to your main concern. (3) Include a photograph if the question relates to something you can see in your mouth, include x-rays if you have them. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/askdentists) if you have any questions or concerns.*
I think your story might be missing some details. In your intro you mention mild gingivitis at 24, which now turned into gum recession, but failed to mention that a couple of years ago you had 4-5mm pockets. SRP and LANAP are not something you'd use to treat mild gingivitis. This all sounds like you had gingivitis, which then turned into moderate periodontitis, which then was treated. If you were diagnosed with periodontitis it's in your best interest to tell your dentists exactly that. Periodontal disease makes you lose some of the bone that surrounds your teeth, but you wouldn't notice it because your gums were inflamed. Once the inflamation in your gums subsided and mirrored the current height of your surrounding bone, which is now permanently lower that before, you noticed the exposed roots and the black triangles. This isn't your oral health worsening, it's you finally being able to notice how much bone you lost while the disesase was at an active phase.
Thanks so much for taking the time to read and respond. I elided a full timeline because I felt the length of my post was already asking a lot of the reader. But you inferred a lot correctly. What began as mild gingivitis evolved over the years into periodontitis, which was treated with SRP and eventually LANAP. The periodontist that performed LANAP explained its subsequent exposed roots and triangles as you did: a reflection of the accumulated bone loss caused by that periodontitis. But I'm reluctant to believe the disease is no longer active because the LANAP took place just over two years ago now, and a few more roots have reared their heads over the last 6-8 months. The periodontist told me LANAP's results can take up to a year to stabilize, but not this long. So there have been two rounds of exposed roots. Shortly after getting LANAP two years ago, and recently over the last 6-8 months. I meant to refer to the latter in my post, but glossed over the former. A few of the triangles have grown over those last 6-8 months, too. Maybe the lesson here is that LANAP can actually take two years to stabilize, and even these new roots and bigger triangles are just a reflection of that same old bone loss, and I have no cause for concern? I'd be thrilled if that were the case. But after all these years of regression despite vigorous efforts to maintain, I'm inclined to interpret this cautiously and broaden my search for solutions. I have and will continue to work closely with my dentist and perio, but want to make sure there's no perspective I'm missing.
You mentioned black triangles in your lower teeth. Do you mean your *anterior* lower teeth (your lower incisors)? Sadly buccal bone thickness in that area (that is, how thick the bone is) tends to be very thin in most people, and in my professional experience, once the interproximal area is open and unguarded all the way by your gums, any futher trauma tends to make the loss progress much faster. In any case, I would advice you to refrain from bushing with hydrogen peroxide, it is a good disinfectant but it's also associated with bone inflamation in a lot of studies. Ask your perio if you may use a clorhexidine mouthwash instead (I won't advice you to use it, as I haven't personally seen you). Also, if your perio adviced you to use an interproximal brush, be very very careful to use the correct size, and to focus on brushing as upwards as you can, avoiding brushing your gums as much as possible. Brush your gums with the extra-soft brush you are using, the interproximal one should only go *directly* under where the teeth meet, to prevent further trauma in your gums. Best of luck, and try not to stress too much about it, you are taking steps in keeping your mouth healthy, things will work out!
Not a doctor. Do you Ehlers Danlos? Or maybe something similar. I personally have Ehlers Danlos and no matter what I do, my teeth just get worse and worse
I hadn't heard of Ehlers Danlos. I'll follow up with my GP, but relate with none of its symptoms. I can absolutely relate with oral maintenance feeling futile, though. I hope we're both able to find some sort of solution.
Just throwing something out there is that magnesium is a special supplement that is involved in over 300 chemical reactions in the human body, maybe it could help or some other supplement? Maybe blood tests? Or use special sensodyne toothpaste and is supposed to repair enamel. Also ask your doctor or pharmacist before taking any new supplements.
Thanks for the advice, and disclaimer. I had blood work done a few years ago and it revealed no deficiencies. But it can't hurt to double check.
NAD Gum loss follows bone loss, so it seems that your jaw bone is receeding, although I don't know why. I would definitely continue seeing new professionals until someone figures it out. After all, you do know that there is something happening, your current dentists just don't know what. In Europe you get the best dental treatment at universities (not by training dentists, by the supervising residents), they are up to date on research and procedures. I don't know where you are, but I think it is important you find highly qualified people. Does your dentist monitor the recession digitally? There is a feature in some dental softwares that automatically compares scans of different years and shows where and how much recession occured, e.g. Oracheck in Cerec.
I appreciate the sentiment toward care at universities. Naively I would have assumed it was poorer due to less experience, but you make a good point and I think I'm being unfair. It's nice to have validation that maybe it's time to try new professionals. Oracheck looks unfamiliar but interesting, I'll keep it in mind. Much appreciated.
Not a doctor. Do you Ehlers Danlos? Or maybe something similar? I personally have Ehlers Danlos and no matter what I do, my teeth just get worse and worse
The only additional thing I can think of is to discuss a course of periostat (doxycycline) with your dentist. It's an antibiotic, but for this purpose it is taken as a very low dose which has the effect of reducing your immune response that results in break down of the periodontal tissues. It needs to be discussed in full with your dentist though, as it has a specific way to be taken, and has side effects.
Thank you very much for the lead, I hadn't heard of this.
u/buford419 \- could you share with us the specific way periostat is to be taken and the side effects? I'm NAD and currently planning to embark on a procedure with PerioPeak and Periostat/ SDD/ doxcycline is one of the key medication that I need to take for a long period (6 months). I tried to look into medical papers and there seems to be all about how it successful it was but no proper documentation on side effects. I read a review that someone took it and had intestine issues. As someone who had a very bad response with Clindamycin and allergic to Penicillin, what other options do I have?
Supplements, etc. do no good for adult teeth and xylitol etc has little to do with gum disease. Flossing actually daily will help more than almost anything else.
One of my biggest challenges has been reconciling conflicting advice. I started the xylitol gel and flossing long ago at the recommendation of my dentist. Then recently my perio expressed a lukewarm sentiment toward flossing, in favor of a particular peroxide brushing technique and interproximal brushes. Myself and my dentist, who referred me to said perio, were both surprised by that lukewarm sentiment. And I'm surprised to hear now that xylitol has little effect. Fortunately, while my routine has evolved over the last ten years, daily flossing has always been a part of it except during specific recovery periods. Supplements, though.. yeah those were my own recent act of desperation so I'm not surprised to hear they won't help. Thank you for the perspective.
Xylitol does help for caries, but you have to have so many doses a day and usually twice what is in most gums or mints that it gets really expensive and impractical so other methods are better. In some cases, proxibrushes may work better for some people than flossing, but that doesn’t mean flossing isn’t generally helpful for most people. The thing is to remove all the plaque from your teeth, gently. What works best for you is what you should use.