I am a Dentist in Kitchener, ON, and each week I like to explore a question that I commonly get at my Kitchener Family Dental office. This week, I'd like to discuss gum disease and bone loss around teeth, and whether this condition is reversible or not.
"Can dental bone loss be reversed?".
Many patients ask me this because they are concerned about the longevity of their teeth. Dental bone loss can reduce support for teeth. It can also result in gum recession. Progressively, teeth with bone loss can become loose and it can even become painful to eat.
So, "can dental bone loss be reversed?". First let's look at the different types of bone loss because it will help us to understand which kinds of bone loss we can reverse and why.
When patients ask me if we can reverse the bone loss around their teeth, my answer is that it depends. Most commonly, dental bone loss occurs as a result of Periodontitis or "Gum Disease". Gum Disease results in slow bone loss over time. The cause is usually long-term accumulation of plaque, tartar and bacteria around and under the gums. If you don't floss much, brush your teeth regularly, or seek regular dental cleanings you will be at a higher risk of developing Periodontitis.
More rarely, bone loss results from local infection. This most commonly occurs in the case of abscessed or infected teeth (this is called Apical Periodontitis). Bacteria that cause infection leak out the tooth root tip and cause destruction of bone. In the image below, you can see the dark oval-like area under the tooth at far right. This is how a dental abscess and the resulting bone loss appear on a dental x-ray.
Most importantly, this area of bone loss is surrounded by healthy dense bone. In the next section, I will discuss why this is important!
To heal infection and to regenerate and replace lost bone, we need to be able to supply the area with nutrients in the blood. So, if the bone loss is surrounded by healthy bone (as in the image above), we can eliminate infection (i.e. with root canal treatment) and then healthy bone will be able to provide a blood and nutrient supply to rebuild the area.
Now, when we talk about healing bone loss that occurs in Periodontitis, we have a much more difficult challenge. If you think of the jawbone encasing your teeth as a body of water, it will help. What I want you to focus on is that, for the most part, bone levels are flat like the surface of a body of water. Now, think of good bone levels as being similar to "high tide". When you lose bone to Periodontitis, you are moving toward "low tide" and, therefore, lower bone levels. Your teeth are in the same spot, but they are now submerged in less bone. Again, the key to this analogy is that the surface of the bone stays relatively flat through bone loss.
Now, the area of bone loss is not surrounded or contained in Periodontitis. Therefore, the only blood and nutrient supply to fuel new bone growth would come from a flat bone surface below. But, this nutrient supply doesn't tend to move upward and so bone regeneration never occurs. The best you can hope for is to control Periodontitis, stop its progression and stabilize bone levels. So, to answer our question "can dental bone loss be reversed?" in the context of Periodontitis, no it cannot be reversed but it can be stopped.
In most cases, dental bone loss around teeth occurs as a result of Periodontitis or gum disease. This process most commonly results when plaque, bacteria and other pro-inflammatory irritants remain on gum tissue and within gum pockets. If flossing and other cleaning efforts are irregular, the mouth will be in a constant pro-inflammatory state, fueling bone loss.
In other cases, patients who have pristine teeth and gums will have an overactive immune system that mounts an excessive attack on what is a normal, minimal level of pathogenic bacteria in the mouth. When the immune system mounts this attack, it produces lots of destructive substances and enzymes that also wear down and dissolve jaw bone. Bone loss occurs as a result.
Generally, your best efforts at preventing dental bone loss will involve the 2-3 by 2-3 approach. This means brushing 2-3 times a day for 2-3 minute each time. Then, try to floss at lunchtime and again in the evening. This is consistent with keeping plaque and pathogenic oral bacteria in a range consistent with stability of gums and teeth.
How do you stop active bone loss around teeth? This can be done but it's more challenging than simply preventing bone loss from the start. The additional challenge comes from trying to keep your teeth clean when you have already lost bone and gum tissue. This is because bone and gum loss makes for larger spaces between teeth and deeper gum pockets. Both defects allow for more trapping of plaque, food fibrils (think meats and vegetable strands) and ultimately, harmful bacteria.
Additionally, teeth with bone loss tend to be looser and more mobile. That means that, as you chew, plaque, food particles and bacteria can slide into gum pockets around loose teeth that wiggle as you chew.
In most cases, if you want to stop active bone loss, you'll need to brush more, floss more and incorporate additional cleaning tools. If you can brush and floss after every meal, it will have a major impact. Also, consider using a waterpik or rinsing/irrigating syringe to free up and remove larger food particles that flossing may not eliminate.
Teeth with dental bone loss become less and less stable over time. This can cause loosening of teeth, gum recession and pain with chewing over time. Dental bone loss can be stopped in most scenarios. However, it is only in a limited set of circumstances that we can actually regenerate bone and reverse bone loss. Unfortunately, Periodontitis is the most common cause of dental bone loss and this condition cannot be reversed. If you have experienced dental bone loss, ask your Kitchener Dentist if their is a possibility to regenerate bone or, at the very least, arrest the bone loss that is actively occurring.
Thanks for reading today!
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This article is meant to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Accordingly, always seek the advice of your Kitchener Dentist or other healthcare provider regarding a dental condition or treatment.