The two biggest issues we deal with as dentists are tooth decay and gum disease. Gum disease is the most prevalent disease globally and in simple terms involves the early reversible phase, known as gingivitis, and the later irreversible phase known as periodontitis.
Gingivitis means a superficial inflammation of the gums, not involving the underlying bone. It occurs primarily due to plaque left at the gum-line and causes the gums to appears red and to bleed easily. It left untreated, gingivitis will often progress to periodontitis. Periodontitis also involves the underlying bone and unfortunately causes bone loss around the teeth. This is most often seen as a gradual recession of the bone around the teeth. In severe cases the bone around the teeth recedes so much that the teeth become loose and are lost.
We monitor bone levels at your check-up primarily in two ways. One is by probing around the gums with a gum probe. The gum probe should tuck under the gum a little. However, if it goes down much deeper this suggests that the bone is receding under the gum. Bone levels are also monitored on routine x-rays. These are usually taken every two years and can be compared over time.
Some degree of bone recession is likely to occur over time and a small degree of bone loss may be considered consistent with age. I often tell patients that you don’t get to be 80 and have the bone levels of a 20 year old. (The occasional older patient can surprise me with excellent bone levels and research shows around 10% of the population are genetically quite resistant to gum disease). However, anything beyond fairly minimal bone recession needs further investigation.
The dentist should tell you about your bone levels if you have any bone loss. This may be expressed as, for example “you have lost 50% of the bone height around your teeth” or “you have lost around half the bone height around your teeth”, or “you have lost around 6mm of bone height around your teeth”. If given a figure in millimetres you might want to know what percentage of root length this is as root length will vary from person to person and from tooth to tooth.
Knowledge is power, as they say. If you know your bone levels are receding, you can take action to prevent further bone loss. This may include more frequent visits to a dental hygienist and stepping up your home oral hygiene routine. So if you have any concerns about your gum health, ask your dentist to talk you through your bone levels. Then you, the dentist, and the hygienist can work together to stabilise any gum disease, prevent further bone loss, and avoid the risk of losing your teeth in the future.