Bone loss around teeth, medically known as alveolar bone loss, occurs when the bone supporting the teeth diminishes. This condition primarily arises from untreated periodontal disease, which is an infection and inflammation of the soft tissues and bone surrounding the teeth. When the supporting bone is lost, teeth can become unstable, potentially leading to their loss. However, various dental interventions can help manage and often reverse the effects of bone loss, aiming to preserve natural teeth.
Initial Steps to Address Bone Loss
Initial treatment for bone loss focuses on controlling the underlying periodontal disease. A primary non-surgical intervention is scaling and root planing, often referred to as “deep cleaning.” This procedure involves removing plaque and calculus (tartar) from above and below the gum line, extending to the root surfaces. Smoothing the root surfaces after cleaning helps remove toxins and microorganisms, creating an environment where gums can reattach.
Antibiotics may be used with scaling and root planing to reduce bacterial load. Systemic antibiotics, like amoxicillin and metronidazole, can reduce pocket depth and improve clinical attachment. Local antibiotics are also beneficial in recurrent or deeper periodontal pockets. These initial steps establish a healthier oral environment, a necessary foundation for subsequent advanced treatments.
Restoring Bone and Supporting Structures
When non-surgical treatments are insufficient, advanced interventions focus on regenerating lost bone and stabilizing teeth. Surgical procedures like Guided Tissue Regeneration (GTR) and Guided Bone Regeneration (GBR) encourage the growth of new bone and gum tissue. During GTR, the dentist folds back gum tissue, cleans the root surface, and places a barrier membrane over the bone defect. This membrane prevents faster-growing soft tissue from occupying the space, allowing slower-growing bone cells to regenerate.
Bone grafting often accompanies GTR or GBR to fill bone voids. Graft materials can be combined with tissue-stimulating proteins to promote bone regeneration. GBR specifically aims to regenerate bone tissue and is commonly used to prepare the jaw for dental implants or address bone loss from periodontal disease. These regenerative therapies improve the prognosis for teeth affected by periodontal disease.
Another surgical approach is pocket reduction surgery, also known as flap surgery. This procedure involves pulling back gum tissue to remove bacteria, plaque, and tartar from tooth roots. Its purpose is to reduce gum pocket depth, which harbors bacteria and causes further bone destruction. Sometimes, uneven bone surfaces are reshaped to prevent bacterial re-accumulation. These specialized procedures are performed by a periodontist or an oral surgeon.
Long-Term Maintenance and Prevention
Maintaining oral health after initial and advanced treatments for bone loss requires consistent care. Regular professional dental check-ups and periodontal maintenance appointments monitor bone levels and prevent disease recurrence. These specialized cleanings are more thorough than routine cleanings, removing plaque and tartar above and below the gum line, and are often recommended every three to four months.
Meticulous home oral hygiene is essential for long-term success. This includes brushing teeth twice daily with a soft-bristled toothbrush, focusing on the gum line. Daily flossing or using interdental brushes is crucial for removing plaque and food particles from between teeth, areas a toothbrush cannot reach. Using an antimicrobial mouthwash can further reduce harmful bacteria.
Managing systemic health also prevents further bone loss. Poorly controlled diabetes can worsen gum disease, and severe gum disease can make blood sugar control more difficult. Smoking cessation is important, as smoking is a major risk factor for periodontal disease and hinders healing.
When Teeth Cannot Be Saved: Alternative Solutions
Despite best efforts, some teeth may be unsalvageable due to severe or irreversible bone loss, mobility, or persistent infection. In such cases, extraction might be the only option to prevent further complications. After extraction, various tooth replacement options are available to restore oral function and aesthetics.
Dental implants are a common solution, involving a titanium post placed into the jawbone as an artificial tooth root. The post fuses with bone, providing a stable foundation for a crown or bridge. While immediate implant placement after extraction is sometimes possible, a waiting period of typically 10 weeks or more may be necessary for healing, or longer if bone grafting is required.
Fixed bridges replace missing teeth by joining an artificial tooth to adjacent natural teeth or implants. These bridges are cemented into place and are not removable. Removable partial or full dentures consist of a plate with artificial teeth that can be removed for cleaning. The choice of replacement depends on individual circumstances, including the number of missing teeth and overall oral health.