We often associate cavities with losing teeth but bone loss in teeth is also another major contributing cause. That is correct, you can still lose teeth that have no tooth decay in it but simply for the reason that it lost bone around it. Our long island city dentists will explain what causes it, how to prevent it, and what the treatment options are. We don't want you to lose any teeth due to bone loss.
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What causes bone loss in teeth
The most common reason for bone loss around your teeth and jaw is due to gum disease but there can be other causes as well.
The most well known cause of bone loss in your mouth is from periodontal disease but it only happens during the advanced stage of gum disease, called periodontitis. It all starts with leaving untreated plaque on your teeth.
Plaque formation. Bacteria in your mouth come together to form a biofilm called plaque, which sticks onto the surfaces of your teeth. Fortunately, it is very soft and can be easily removed by light brushing pressure or by flossing your teeth. Unfortunately, plaque rebuilds after every meal, which is why you should ideally brush after every meal. It is a constant process of building up and removing it on a daily basis.
Plaque hardens into tartar. If you do not remove the plaque before going to bed, it will harden and become a calcified substance called tartar or calculus. Once this happens you can no longer remove it by brushing and floss. Only a dental professional can get rid of it with a teeth cleaning.
Gum inflammation. Plaque and tartar that are left untreated from your teeth will cause irritation and inflammation to your gums. Once they start bleeding easily from just brushing, you've probably reached the first stage of gum disease called gingivitis.
Bone inflammation. When gingivitis is left untreated, the inflammation can spread from your gums to the bone around your teeth. Eventually you start losing the bone that surrounds your teeth from the inflammation. Once the bone is loss, it will not grow back, which makes this an irreversible process with permanent damage to your jaw. That is what periodontitis is, irreversible bone loss from gum disease.
Missing teeth that don't get replaced can cause bone loss in the area that has no teeth. This in turn can affect the bone near the adjacent teeth. The reason this happens is because bone is maintained by mechanical pressure or stimulation from using the teeth. Once the tooth is gone, there will be no further stimulation going to the spot where the tooth once was. This sends a signal to the body that the bone in that area is not being used so it should be resorbed and transferred to another place that needs the calcium more.
As you know, most people are calcium deficient and do not get enough Vitamin D.
Poor fitting dental restorations
Dentures or dental bridges that don't adapt well to the soft tissues may not provide enough stimulation for the body to keep the bone around. This is the same situation as missing teeth because bone that is not being used will get taken back by the body to be reused in other parts that need it. You need to let your body know that the bone there is being used by providing it with mechanical stimulation.
If you sustain a heavy impact to your mouth and jaw, you may knock out a tooth and sometimes what comes out along with it is some bone. This is an unconventional way to get bone loss in teeth but it does happen. The most common examples would be either sports injuries or rough behavior at bars and night clubs.
Wearing a sports guard for your mouth can help prevent this from happening if you happen to be an athlete playing a sport with physical contact.
Bone remodeling is a natural part of the healing process after having a tooth removed. What happens is that you will experience very mild bone loss in the areas adjacent to where the tooth got extracted. You can't really prevent it from happening but you can minimize the amount of bone deterioration if you get a bone graft, which is also known as socket preservation. It helps to preserve the bone in the area if you get a graft.
Other contributing factors
The above 5 are the main causes for loss of bone but there are other factors that can contribute to it or exacerbate the condition.
Smoking. Cigarette smokers are known to have an increased prevalence and more severe extent of periodontal disease. This means that they're more likely to get the disease and also when they do get it, it is more severe. Therefore, smokers don't fare well with bone loss for teeth.
Nutritional deficiency. Not only is calcium important for physical functions such as muscle control and blood circulation but it is also required for building strong bones and teeth. If you're not getting enough calcium or vitamin D in your diet, you will have an increased risk of bone problems. Therefore it would be prudent for you to consume a sufficient quantity of this important mineral called calcium.
Osteoporosis. This is a condition that causes your bones to become weak and brittle. Unfortunately, the bones that surround and support the teeth are no exception to this disease. If you have osteoporosis, you will be at an increased risk for tooth loss due to loss of bone.
Signs and symptoms
There are a multitude of signs that you may have bone loss in teeth. Some of the symptoms are more mild while others are more severe but you may have a combination of them as well.
Loose teeth. You can move the teeth with your fingers or you feel them moving when you chew. Basically they aren't very stable.
Gaps between your teeth. Your bone holds the teeth in and once you start losing it, the teeth can start drifting causing gaps to open up. If you notice a gap that wasn't there before, you may want to go get a dental check up.
Black triangles between your gums. Typically if you lose bone in between your teeth, the gums will shrink as a consequence of it. It results in an unpleasant looking condition called black triangles between your teeth. It literally looks like a triangle that is black.
Longer looking tooth. When you lose bone, more of the tooth will become exposed and that results in longer looking teeth.
Receding gums. Soft tissue follows hard tissue so if you experience bone loss, the gums will shrink.
Bad breath. The most common reason for loss of bone around teeth is periodontitis and that is often accompanied by bad breath. The reason is because the bacteria which cause the disease produce a lot of volatile sulfurs and that contributes to bad breath.
Red swollen gums is a sign of active gum disease.
Gums that bleed easily is also another sign of periodontal disease.
Pictures of bone loss in teeth
Here is a picture of what bone loss in your mouth looks like. Notice how the tooth looks significantly longer than the adjacent tooth? You can also see how the gums have receded, exposing more of the root which looks yellow.
Here is a picture of severe bone loss in teeth that affects the entire mouth. All of the teeth are longer looking and there are gaps between a lot of the teeth. Black triangles are also present throughout the mouth. This individual has advanced staged periodontitis.
Here is a picture of a dental x-ray that shows what bone loss in teeth looks like radiographically. The teeth look like they are barely embedded in the bone and the teeth also look like they are drifting out of place.
The only way to treat bone loss in your mouth is by a combination of getting periodontal treatment by your dentist and improving your at home oral hygiene. Doing just one of them is not enough to stop the disease because it will come back. You must do both in order to stop the bone loss.
How to stop bone loss in teeth
Your dentist can stop your teeth from losing bone by a deep teeth cleaning for the mild to moderate cases in severity. The more severe cases would require gum surgery. The reason is because the bone loss is due to unremoved tartar that is stuck on your teeth and also below the gumline. Until you get rid of it, you will continue to lose bone.
Deep teeth cleaning. A regular cleaning only removes plaque and tartar from above the gumline, which is insufficient for this condition. You will need to clean below the gums and that procedure is called a deep cleaning. It is also known by another name called scaling and root planing because you have to clean the roots of the teeth, that are underneath the gums.
Gum surgery. For very severe cases of bone loss, a deep teeth cleaning may not be enough. The next treatment would be gum surgery or osseous surgery, which is when the gum specialist opens up the gums so that they can visualize the tartar and get rid of it. This is much more invasive and you will require stitches afterwards.
Once treatment is completed your dentist has completed their part but you still have to continue the treatment at home. In order to stop the plaque and tartar from building back up again, you need to maintain impeccable oral hygiene.
Brush twice a day for at least 2 minutes each session with either a fluoridated toothpaste or a nano hydroxyapatite toothpaste.
Floss your teeth at night before you go to bed.
Use a mouthwash such as Listerine twice a day. If you prefer a more natural mouth rinse, you may use salt water or coconut oil for oil pulling.
What is stated above is the recommendation but if you want to go above and beyond what your dentist expects of you, you can do it after every meal!
How to reverse bone loss in teeth
Once you lose bone in your teeth, the only way to reverse it is by seeing a gum specialist called a periodontist. There is a technique called bone grafting where your dentist will try to regrow some of the lost bone by adding new bone to the area.
Due to the fact that periodontitis causes irreversible bone loss, prompts us to refer to it as permanent damage. On the other hand gingivitis, which is the first stage of gum disease is reversible and it does not cause permanent damage. That is why it is important to get gingivitis treated as soon as possible so that it does not progress to periodontitis.
Can you reverse it naturally?
Unfortunately, the bone will not reverse naturally once it has been lost because the bone that supports your teeth are different than your regular bone. It is also the reason why your teeth are not considered bones because they don't regenerate. If you broke your leg, your body can repair the leg bone but if you broke your tooth, it won't repair itself. The bone that embeds your teeth are no different, it does not regenerate to the same extent as a broken leg bone.
Even though you can't reverse it bone loss in teeth naturally, what you can do is at least prevent it from happening or it slow down. The way to do this is by getting your dental cleaning on a routine basis and also practicing good oral hygiene at home.
How to slow down bone loss in teeth
The most important way to slow down bone loss in teeth is by seeing your dentist every 6 months to have the tartar removed. It is the most important part of the process because once plaque hardens into tartar, you cannot remove it at home by brushing nor flossing. Only a dental professional such as a hygienist can remove it once it calcifies into calculus.
It is the untreated tartar that remains on your teeth, which causes gum and bone inflammation that leads to bone loss. As long as you get rid of it, there will be no chance for the bone to be inflamed.
At home care
With that said, it is still not enough to just see your dentist every 6 months because plaque will rebuild on a daily basis. Fortunately for you, plaque is soft enough to be removed by gentle brushing and flossing. This means it is incredibly important for you to brush and floss twice a day so that the plaque does not turn into tartar. You need to fend off gum disease for the next 6 months until you are due to see your dentist again for another teeth cleaning.
For those who simply aren't able to prevent the tartar from forming within that 6 month period, you may need to see a dentist more often. Patients with severe bone loss are often required to get a teeth cleaning every 3-4 months instead of the usual 6. When you go in to get cleanings more frequently, the procedure is referred to as periodontal maintenance.
If you're getting bone loss from trauma because you play sports, it would be prudent for you to ask your dentist to make you a sports mouth guard. These are customized mouth guards that protect your teeth. You wear it whenever you play sports so that if you get hit in the face, the guard will take the brunt of the force and not our front teeth.
Bone loss in teeth can be caused by a variety of conditions and factors but the most common would be gum disease. There are treatment for it and it involves a combination of visiting your dentist along with improving at home oral hygiene.
Unfortunately once you lose bone, it will not regrow naturally so the best treatment would actually be prevention! So, don't skip out on your dental check ups just because you're not feeling any pain because the early stages of gum disease are often painless.
This article is written by Dr David Chen, a long island city dentist that is focused on restorative and family dentistry.