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The dentist wants to extract all my teeth

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I’m a 41-year-old female with periodontitis and severe bone loss. I went years without dental insurance and checkups. I recently started seeing a dentist who performed two scaling and root planing appointments. The hygienist saw improvement, with pink gums and my deepest pocket was 9mm. She recommended I see a periodontist for follow-up and maintenance cleanings, which I did three weeks later.

However, the periodontist made me feel terrible about myself. She measured pocket depths up to 12mm and noted blood and pus between my gums and teeth on nearly all my teeth. How could the pocket depths change so drastically in just three weeks? She said my teeth wouldn’t withstand laser treatment and recommended extracting all of them, stating that even with implants, I could still get gum disease.

I feel that as a dentist, her role is to help save as many teeth as possible. Shouldn’t I have been prescribed antibiotics for the pus and blood? Shouldn’t she have offered treatments like perio trays to address the pockets? I feel defeated and devastated at the thought of losing my smile, which has always been my best attribute.

I’m desperate for advice and would appreciate any guidance. Thank you.

– Jessica from Colorado Springs

(See Dr. Hall’s answer below.)


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Jessica,
I doubt that your pocket increased from 9 mm to 12 mm in three weeks. There are a couple of reasons for discrepancies in the measurement of pockets. When you have periodontal disease, there will be deposits of tartar on the roots of the teeth, and a dentist or hygienist can hit one of those with the periodontal probe and think they have reached the bottom of the pocket. Also, when the tissue is badly inflamed, it can be easy to poke through it and think that the pocket is deeper than it actually is.

While I’m not going to be able to tell you who is more accurate in assessing your condition, there are a couple of things about your experience with the periodontist that bother me.

First is the blanket recommendation that all your teeth should be extracted. Advanced periodontitis is serious, but to go from having all your teeth to saying all of them are hopeless is a diagnosis that I find hard to believe. A tooth that is hopeless is going to be loose. It doesn’t sound to me like all your teeth are loose.

Second is the eagerness to give up without giving your teeth time to respond to therapy. If you had been faithful and regular with dental care and still had advanced periodontal disease, I would be more receptive to a hopeless diagnosis. But you admit that you went years without professional care. It’s not all that surprising that the condition of your gums is poor. Why not give you the best care we can, see how you do with your home care, and see what we can save?

Dentists vary a lot in their commitment to saving teeth. Some will do everything they can to save a tooth. For others, extracting a tooth is the easy way out. A periodontist is supposed to be a specialist in saving teeth, so it is surprising to me that your periodontist is so willing to give up on all of them. The way your periodontist made you feel telegraphs to me a lack of caring.

Now, maybe your periodontist is right and the condition of your teeth is that bad. But I would recommend getting another opinion. You’re in Colorado Springs where there are a number of periodontists. I would look them up and read some of their online reviews, and see if you can find one who cares deeply about their patients and seems to be committed to helping them save their teeth. You seem to be very willing to do what you can to save your teeth and I would think an excellent periodontist would very much enjoy working with you to try to accomplish that.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

I have throbbing pain in my gum in one spot

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Dear Doctor Hall,

I am intrigued but also worried by a persistent sore point between by last molar top right and the next molar. The gum, not the tooth, is incredibly sensitive and always hurts after eating with a throbbing pain. The pain goes away completely after about 30 minutes-1 hour (better after tooth brushing) after eating and doesn’t return until I eat something again. This has been going on for over a year with a very slight improvement (pain not as bad as 12 months ago) No problem with hot and cold. My dentist has examined it twice and x rayed and can find nothing. There was a root canal treatment on one of the teeth which may well have triggered something but seems to be nothing visibly wrong and the pain is not under or in the tooth but next to it. It is exactly the gum between the teeth which hurts, not the teeth themselves. The dentist advises removing the tooth if the pain doesn’t heal. Seems a pity as I don’t think it is the tooth itself causing the pain, but I might be wrong. Any idea what could be going on? All my other gums are fine. No sign of an abscess no bad breath just very painful on the gum specifically in the space between the two teeth. Comments much appreciated.

Michael W from Germany

(See Dr. Hall’s answer below.)


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Michael,
You need a second opinion. Is there a periodontist (gum specialist) you can go to?

It really bothers me that your dentist wants to take out the tooth simply because he or she can’t figure out what is wrong. I suspect this wouldn’t be all that complicated for a dentist that knew a little more.

This is a gum problem. I’m pretty confident that the root canal in the one tooth has nothing to do with this. An x-ray of the tooth probably isn’t going to tell you much about the gums. I don’t know much about the status of dental practice in Germany, but even here in the U.S. where we have fairly high educational standards for dentists, some dentists pay very little attention to gum health.

Of course I can’t tell you for sure what is wrong without a personal examination. But the first thing I would check would be for pockets between these two teeth. This could be a periodontal abscess which would mean that there is a particularly deep pocket between these teeth. Food particles could end up here after you eat and when they disintegrate the pain goes away. It’s possible that a quality deep cleaning could solve your problem.

Do you floss? If you don’t, that could be a contributing factor here, because you would be much more likely to develop gum disease if you don’t floss. If you do floss, I’d be curious to know if flossing between these teeth, with a technique that gets the floss down into this pocket, has any effect on the pain.

Anyway, please don’t let this dentist take out your tooth, and see if you can find a dentist who knows what is wrong.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

The deep cleaning is so painful, I don’t know what to do

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Hi Doc.
I did a deep cleaning 2 years ago but my problem is that I have deep gaps pockets that it never heals no matter how much I go and have my teeth cleaned. Now my teeth are so sensitive that is so painful. I try to go back to the doc and have my teeth cleaned but I can’t do it because of the pain. Please I what can I do. I am 53 years old. I never have problems with my teeth but sense I did the deep cleaning now I have this problem. I feel like it was a mistake to have the deep cleaning done. I am desperate and in too much pain. 😢 Please help—tell me what to do.
– Lisandra

(See Dr. Hall’s answer below.)


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Lisandra,
You clearly have serious gum disease and need to get that taken care of or you will lose all your teeth.

As to why you have this pain when you have your deep cleaning, I’m not clear about that. Deep cleaning, when it is done correctly, can be painful, so it should be done under local anesthetic. The gums are usually infected and inflamed, and the teeth have to be cleaned clear down to the attachment of the tooth to the gums. That’s why it is called “deep cleaning.” But I’m guessing that’s not the type of pain you are experiencing.

Because of the infection of the gums, there is a potential for post-operative pain. That doesn’t always happen, but if the infection is particularly active, the deep cleaning can provoke it. It’s sounding to me like this is what you are experiencing. The way to handle that would be with antibacterial agents. One possible way would be to have you on a course of antibiotics for the duration of the deep cleaning appointments. So, for example, your deep cleaning could take four appointments. They could be done over a two-week period with you taking the antibiotics for the duration.

My recommendation to you would be to find another dentist. Given the difficulties you’ve had, I would go to a periodontist (gum specialist) and when you make the appointment, I would explain your experiences so far and ask them what they would plan to do to make this tolerable for you. A periodontist should have a lot of experience with your type of case.

The bottom line—your gum infection is clearly serious and needs to be solved or your teeth will end up falling out.
– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

Bone grafting for my dental implant didn’t work

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Dear Dr. Hall,

I chose to use my regular dentist to do a dental implant as he has done hundreds of them over the years. When first attempting to place the implant, he informed me that I would need to have a bone graft first. He did the bone graft, then, after healing, I went back for the implant. He again attempted to place the implant but had to remove it as he said the bone was still too thin and he couldn’t do an implant after all. So now after three surgeries, I am left with no implant and the suggestion to get a bridge instead. Is it possible this could have also happened with a specialist?

Thank you,
Linda Cohn

Linda,
The short answer to your question is that no, I doubt this mishap would have happened with a dental implant specialist. Although dental implantology is not a recognized specialty in dentistry—there are just some dentists with more advanced training and oral surgeons and periodontists who specialize in surgery.

However, I don’t want to be too hard on your dentist. It sounds like he is really trying to do the right thing and may have a lot of experience with implants, but bone grafting is a tricky procedure, and I think he may be a little short on experience with that aspect of implant dentistry. He may be just starting to get into the grafting. Any dentist who tries to explore new skills is going to have things like that happen.

A dentist of lesser integrity would have just plowed ahead and placed the implant. It would probably have done just fine for a while and then failed at some point down the road. So I think he has done the right thing.

Let me share a story of the first set of porcelain veneers that I placed. As time went on, I became accredited in cosmetic dentistry and felt that I produced truly beautiful work. But, as with any dentist expanding their knowledge, I had a first case. The patient would come back for regular checkups, and as my skills improved, I became more and more dissatisfied with how her smile looked, since it was very mediocre. Finally, I think it was after three or four years, I shared my feelings with her and offered to re-do her case for free, and she accepted.

It sounds to me like your dentist is leveling with you, and feels like you will end up with a fine result. For a single tooth, a dental bridge or a dental implant are two acceptable ways to treat the case, each with their pros and cons. If you really want to go with the dental implant, you could ask your dentist to refer you to a periodontist or oral surgeon with extensive experience in dental implant surgery.

– Dr. Hall

Do you have a comment or a question or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

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