Alright Roshell, let me sit you up and discuss your findings.
Just want to ask you if you have any concerns for me at all right now?
Any questions regarding treatment?
Yes, actually I do.
Or your assessment?
My doctor referred me here because I recently found out that I had diabetes
and so he referred me to see you because I have, like, a weird taste in my mouth
and I'm not so fresh smell.
Not so fresh smell, okay.
Well, my findings show that you have what is called periodontitis.
It is a progression from gingivitis.
It kind of progresses and now it's called periodontitis
and what that is is you actually have bone loss occurring in your mouth.
I found that you had generalized pocketing between six and seven millimeters.
And the gum tissue is no longer pointed like it was and healthy
It kind of progressed. So let me show you. I want to show you the progression of your mouth.
Okay, when you first came to us you started off with normal, healthy gum tissue,
which is nice and pink and pointed and its firm.
And then it progressed to gingivitis. When you came in and you were pregnant
and you had pregnancy gingivitis due to hormonal changes
and what that did is kind of created false pocketing.
Upon probing you had a lot of bleeding
and you had inflammation so these nice pointed tissue was kind of inflamed
and puffy and red and kind of boggy to touch.
And now, you haven't been in to see us for approximately 10 years.
and you have progressed to periodontitis.
Can't I get rid of it? You said that when i had the gingivitis it goes away, so.
No, you can not get rid of this unfortunately, but it is maintainable.
So, with regular visits and I recommend that you see a periodontist.
They may recommend that you seek treatment every three to four months
instead of every 6 months that is normal for a healthy person
to maintain oral health.
So, I would recommend that.
Periodontitis is kind of a blunting of the tissue
you have lost attachment, you have actually lost all of this pointy gum tissue.
It has now receded or kind of gone upward.
You are seeing root surfaces.
Oh, is that what that yellow is?
Yes, that color change is actually where the root is
and the problem with exposed roots is that it puts you at higher risk of developing cavities,
as well as, it actually creates a rough surface for plague and bacteria
to kind of multiple on to.
So that is two things that we showed you there and again your bone levels have
kind of decreased so your tooth is not structurally as sound
as it was when you had healthy tissue or even gingivitis
because with gingivitis we could reverse that with brushing and flossing
and regular visits. Okay, I also have some other photos for you.
This might give you a better understanding of where you are right now.
So, I just want to show you your normal attachment.
This is someone who is in good health. They have a little bit of bacteria,
plague that is it surrounds the tooth, but it is not much and they usually remove that brushing.
So, you will see some of these orange circle areas are the bacteria attachment.
And then, if you let that go, you are not brushing, you are not flossing,
more bacteria multiplies and it kind of grows around
and its irritating the lining of your gum tissue.
Where that sulcus is, which is the space between your tooth.
You have a microscopic space between the tooth and the gum tissue
that is where the floss reaches. So, when you are not flossing,
you get more bacteria and plagues to attach.
So, you want to remove that. If it is not removed, you will get to a point where it is actually
kind of multiplying even more and it is traveling down
through the gum tissue and it's actually pulling the tissue away from the tooth
and you'll get that. And it is releasing endotoxins and basically that is
more dangerous than the actual plague bacteria itself. So, it is more harmful,
it does more damage, it grows at a much rapid pace, much faster pace.
So then it is going down and as you see it this little line around the roots of your tooth,
is called the periodontal ligament and that holds the tooth in place.
So, once it starts to go down into here it is essentially eating away that periodontal ligament.
Once that has increased, it grows and it can actually decrease bone levels.
It attacks bone so that it how serious it is. You can actually lose teeth at this way here.
So this is something that you want to definitely take care of before hand,
but, unfortunately you are already at this stage, so we want to maintain it.
So, we want to reduce this bacteria here to as minimal as possible.
Okay.
Alright, so let's discuss your risk factors. Now you said you were referred here for diabetes.
So what a diabetic patient is concerned with is poor healing.
So, what you would normally have in a healthy patient the ability to kind of fight off that bacterial infection
that you have going on in your mouth. Because your immune system is kind of suppressed,
your body's ability is kind of reduced. So, you have to be more vigilant in your home care,
as well as seeking regular medical and dental check-ups.
Also, I know that you are a smoker so
Only on the weekends. I only smoke when I drink.
That is still a risk factor for developing periodontal disease by seven times
and that as well suppresses your immune system.
So, you kind of have both factors involved, smoking suppressing the immune system as well as the diabetes.
In your body's response, what we call a host response, naturally will also depend on how the periodontal disease,
how the bacteria progresses. So if your body is suppressed with the diabetes and the smoking,
or normally suppressed, stress can do it as well. So even if your diabetes is controlled
and you are on medication for it and you quite your smoking, there's other factors
in your body's ability to fight the bacteria, so stress is one of those.
Also, I noticed that you had some over hanging restorations
which is due to when the dentist packs the filling in.
The contour of the tooth has changed so it is no longer the same anatomy of the tooth that you had.
It is not anything that you have evoked.
Oh, so it's not.
No. It is something that should be fixed by the dentist that filled the tooth.
But that kind of creates a pocket for the bacteria, food impaction as well,
and I noticed when I probed into that area you had an eight millimeter pocket.
So, it is definitely taking its effect on your mouth already.
So, you want to get that taken care of as soon as possible.
So, our goal is to try and reduce your risk factors, reduce your body's response to
stress and diabetes and smoking. So by quitting smoking and being controlled
and seeking regular medical visits this will help, as well as dental visits, so.
Okay, we're going to go over current brushing and flossing habits.
Alright, I just want you to grab hold of
I really don't like brushing because it hurts.
It hurts?
Yes, it bleeds
Okay, that's normal for where you are now.
It is going to be uncomfortable because you have essentially a bacterial infection in your mouth.
But, you have to take care of it so.
I mean we're going to take care of removing, you need a deep scaling.
So, we're going to remove plague and calculus as best we can.
So, but it will start to heal up, the tissue will start to it and it will feel better for you,
but you have to still brush and floss.
Okay, show me how you are currently brushing.
Okay, so that is missing quite a few areas of your mouth.
So, I want you to kind of come up with a routine so you are kind of going to do the same thing
everytime that you brush. If it is easier, a lot of right handed people
sometime, I know myself, I start on the left and move over to the right. 0:09:34.166,0:08:38.966 So, if it is easier for you to start on the right and make your way to the left
or the bottom, but kind of keep up with the same routine.
Now, what you are going to want to do is put the brush,
this is called the bass method of brushing, at about a 45 degree angle
toward your gum tissue and you are actually going to feel it go underneath a little bit.
And it is going to take care of two teeth at a time
So, you are going to jiggle the brush and you can kind of do the sweeping
How long does it usually take?
It is going to take two minutes total.
That is a long time
I know it is a long time to brush, but you have to get in the habit
and once you keep doing it over a period of time,
two minutes is not going to seem so long any more.
So, the problem is because of the pocketing you are not going to get in.
In a healthy patient, this one millimeter may be enough to really reduce all that plague
and bacteria under the gum line. For you in your case its not going really get underneath there like
you need to. So, it is reducing the amounts on the crowns and a little bit under the gum line,
but you're not going to get what you really need to get off.
so that is why you may have to come in every four months
depending on what the periodontist recommends you do.
Just to kind of keep you more at a healthier level, maintain what you have
and not progress to more bone loss.
Okay?
So what do you think about, like, those power brushes?
I actually recommend the power brushes.
Studies have shown that they actually work really well
and especially for patients that have a difficult time angling the brush, this way
they have a nice job, they remove plague very well.
The manual brush works just as well, but for some people the power brush works better for them.
You kind of do it in the same manner.
You are not going to scrub with this it is going to rotate for you.
So I still got to do it for two minutes?
You still have to do it for two minutes.
It still is a long time.
Yes. I also have what is called a proxy brush
and this gets in those areas, you know you have the spaces in between your teeth.
They are called embrasures and they will actually get in those areas very well for you.
and it will remove plague and food.
And we also have what is called super floss. So this is for areas that are kind of
in between, not as open for the proxy brush,
but a little bit more open than certain areas in your mouth
for regular floss. Where this area would work a little better
for you because you have a little tighter contact there.
Oh, so I can use just this one piece?
Yes, you can use this just one piece.
This area is thinner so for areas that may be easier for you to get into
with this thinner floss is good and then you have this
thicker area that is kind of fuzzier and
you're going to use that part for areas that are a little bit
more open and you feel like you are getting the food trapped in there.
I'm going to have you, you're going to do this with the floss,
middle finger, wrap it around, and you are going to
wrap it around your index finger, your pointer finger there.
And you are going to grip it, there's going to be a tight, close grip
because you have more control over it when the grip is closer.
And, I'm going to have you hold the mirror up so that you can see.
And you are going to see saw it in and wrap it around like a "C"
and you have to get both ends. So you are going to do that.
I'm going to have you demonstrate for me.
You can demonstrate actually the back of your mouth where your molars are.
That would be better because that way I know you can actually reach those areas.
Like this?
Yes.
That must be where that overhang is.
You can feel it?
Uh-hu.
Uh-mm. So you are going to have to do as best you can to get in there
because that is where your overhang is.
Ok. Will it stop bleeding soon though?
it should stop bleeding, yes. The more work you do to increase your health,
brushing at least two times a day, flossing once a day and I also recommend Listerine
and it is ADA approved for reducing bacterial levels in your mouth and it works really, really well.
So, we are going to start off with this and I recommend using this two times a day,
maybe in the morning and then at night to reduce that bacterial level.
And we could also use something called chlorhexidine,
which is by prescription it something we usually do in office
and we kind of irrigate below the gum tissue with that,
which also works really, really well for reducing bacteria.
But we are going to start off with Listerine and see
how that is going along with your brushing and flossing.
So, use your super floss, as well as the proxy brush daily as well.
Both of those items need to be used.
Colgate Total is really well.
It contains an ingredient called Triclosan that works for up to 12 hours.
Isn't that a hand soap or something, Triclosan?
Triclosan?
I heard that before, yeah.
I don't believe this is in hand soap.
It reduces bacteria up to 12 hours so, even more than your brushing and flossing can do.
And you really need this so I recommend this. This is also ADA approved.
Oh, so after I brush it still is working on my teeth?
Yes, it still is working.
That is pretty cool stuff.
Yes, very good.
You have any other questions for me?
No. You really helped me out a lot today.
Okay. Good. I just want you to take this home and read through it.
This is just a pamphlet on periodontal disease.
And once I see you back, if you have any questions
regarding your findings in there, the reading,
you can let me know, but it's a good informational.
Thank you.