Bone Loss on Incisor: any thoughts?

Last Updated: Dec 30, 2015

I am posting as a patient seeking some insight into my situation.

My recent dental visit showed significant bone loss (2mm-3mm) on a lateral incisor, gum pocket depth of about 6mm. This bone loss seemed to appear within the past year, which was rather odd. The dentist did not believe this was entirely caused by tartar build-up as all my other teeth are within normal limits. He noted that the lingual surface of the tooth is abnormally shaped, which may be causing bacteria to enter beneath the gum where regular brushing/flossing cannot access (however, he is still unsure).

The only other reasons I can think of:
– I had an abscess on the mesial surface of the gum in the same biscupid area nearly 3 years ago. It was drained and has not happened again. However, I did notice it caused slight recession on that bicuspid.
– If this was due to trauma, the only instance I can think of was falling on my face when I was a kid nearly 16-17 years ago. I did not have any serious issues at that time except for a cut/swollen lip & bruising, but could this bone loss have started here and slowly progressed?

I recently had SRP completed, so I’m hoping that this will stop the progressing bone loss. However, this puts me in a very uncomfortable position as I’m only in my mid-20s and I fear I might need an implant or even lose my tooth. I will see a periodontist soon for a consultation, but I was hoping I could get some insight from anyone here. Since I’m not a dentist, I’m not familiar with advanced dental terminology – if you could explain in simpler terms that would be great. Thank you so much!

8 Comments on Bone Loss on Incisor: any thoughts?

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Shelly

12/30/2015

CORRECTION FROM OP: tooth is a lateral incisor, not bicuspid.

David Levitt

01/05/2016

This is a difficult case to diagnose without examination of the occlusion (bite), habits (biting on a pencil, smoking a pipe), and of course a visual examination. IT is extremely important to know the cause since without treatment of the etiology the treatment is doomed. I would say trauma. Either a bite that is off, a habit that traumatizes the tooth, or an accident that occurred at some point. When one hears hoofbeats one thinks horses not zebras. But in the zebra category, if you are a popcorn eater (even occasionally) your incident three years ago could have been caused by a wayward popcorn kernel that got caught under your gums and damaged the bone. That damage is progressive unless treated with cleaning out of the area (debridement) followed by grafting. It doesn't have to be popcorn there are other culprits as well. Popcorn is just the most common and the worse. I am glad you are seeing a periodontist. If your tooth is to survive it will need a bone graft and that is the dentist to do it. The good news is bone grafting (regenerative therapy) is highly successful these days. There are many good options for grafting materials. Also the periodontist can examine your bite and the shape of your tooth. Both can be altered if necessary.

Shelly

01/05/2016

David, thank you so much for your response. I am almost 100% sure that popcorn was in fact the culprit for the abscess that I had 3-4 years ago - I don't smoke, but I did eat popcorn maybe a week or so before I noticed the abscess. When I went to see an emergency dentist for that issue, all I can recall the dentist doing was draining the abscess. I was under the impression that after the abscess was drained, I had nothing else to worry about (although unfortunately....that doesn't seem to be the case). If only my dentist had warned me about potential bone loss... I am scheduled to see the periodontist in two weeks, so hopefully I can have my options laid out for me. It may also be worth mentioning that I grind my teeth at night, however I was not informed if this would lead to significant bone loss. In case you're curious, here's a link to my FMX taken 11/2014 with updated BWX/PAs taken 11/2015: http://oi65.tinypic.com/2d5ag9.jpg - in the FMX you can clearly see that #7 is the only tooth suffering major bone loss. In your professional opinion, is it possible for this specific bone loss to migrate towards other teeth? Again, thank you so much for taking your time to review my case and addressing nearly all of my concerns. I greatly appreciate it! Hope you have a great new year.

DrT

01/05/2016

Based on the x-ray it appears that you have lost more than half of the supporting bone around the upper lateral incisor. This is quite a significant amount especially in view of your young age. First of all I would want to take a full series of x-rays of your entire mouth to be certain there are not any other periodontal issues that are going on in other parts of your mouth. I am not quite sure I understand what your dentist means when he says that the lingual surface of this tooth is abnormally shaped. I also am concerned that this is the second periodontal abscess that you have had in this same area within a few years while the other teeth in your mouth are allegedly healthy. So these couple of issues/questions need further clarification, which a periodontist should address when you see him. As for the tooth in question, again based on the x-ray that you show, and please understand that a thorough clinical examination of this area is definitely needed, I would say that the periodontal prognosis is questionable. I also have some significant concerns, based on the x-ray, about some bone loss on both of the adjacent teeth, which would also need to be carefully evaluated. There will be several treatment options for you, but these should only be offered for your consideration after the full set of x-rays have been taken and your entire mouth has been thoroughly evaluated periodontally.

Shelly

01/05/2016

Hi DrT, thank you for your response and taking the time to review my case. When my dentist mentioned that the lingual surface of #7 is abnormally shaped, he described it as having some sort of ridge that sticks out. I wish I have intraoral photos to show you as I'm sure that description tells you nothing. Here is a link to my FMX taken 11/2014 with updated BWX/PAs taken 11/2015: http://oi65.tinypic.com/2d5ag9.jpg â€“ in the FMX you can clearly see that #7 is the only tooth suffering major bone loss. In your professional opinion, is it possible for this specific bone loss to migrate towards other teeth? Also, tooth #7 only had an abscess once and that happened 3 years ago. It was only noticed recently through x-rays that there was significant bone loss. Again, thank you so much for taking your time to review my case and addressing nearly all of my concerns. I greatly appreciate it! Hope you have a great new year.

DrT

01/06/2016

The bone loss can and has affected the teeth on either side of the tooth in question. Since it would seem that there was some specific/local causative factor on this tooth, and the rest of your mouth appears to be healthy, at least on the old FMX, I would not anticipate that the bone loss in this one area would migrate to other teeth. Regarding the past abscess, I think it would have been wise to re-evaluate this tooth several months after the abscess occurred, with an x-ray, to determine if there was any residual problem that required further treatment.

DR JD

01/18/2016

There are maxillary lateral incisors that have a very deep groove extending from the cingulum apically. The effect is rather like an invagination. These are tough situations to treat. Sometimes the lingual tissue can be flapped and the root smoothed flat. Sometimes the root can be somewhat smoothed and a bone graft placed. Sometimes it is impossible to successfully treat this condition.. I am a periodontist and I have seen several of these teeth over my career and have treated them with mixed results. You are on the right track to see a periodontist. Good luck.

Shelly

01/18/2016

DR JD, thanks so much for your comment and giving me a better idea of what exactly is going on with my tooth. In the case where it cannot be treated successfully, how did you advise your patients to deal with the situation and to halt the bone loss, if possible? Since regular brushing & flossing won't do the trick, do you think a mouth rinse (like Periogard) will help? Even after the scaling/root planing, the lateral gum on that incisor is still tender/puffy after 3weeks. I'm just worried that I don't have many options and will inevitably lose my tooth :( I'm seeing a periodontist tomorrow but would like to prepare myself if I'm given bad news...

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