Horizontal Bone Loss - scared of losing teeth

[OhioGirl123]

I think I have horizontal bone loss in my lower front teeth and I am terrified of losing my teeth.  I used to not take good care of my teeth until my orthodontist in high school told me that I will have serious problems if I don't change my habits.  I started brushing regularly and flossing after that.  After I had my braces removed, they put a fixed retainer behind my front teeth which I was supposed to have removed several years ago.  I was also thrusting my tongue against my teeth after braces were removed which caused them to shift forward.  I quit going to the dentist for 4 years due to insurance and then anxiety.  I had plaque buildup on bar and when I went to get my wisdom teeth removed, the surgeon said I had some bone loss in that area.  My gums receded some but then came back almost normal.  I took good care of them on and off and noticed on another xray the there is less bone.  I think there is 60% bone loss on the canine and lateral incisor and 80% bone loss on the central insicor - this is my guess.  When I went to the periodontist, he looked at my xray and said there was no bone loss, but I think this was the wrong xray because you couldn't see my bar on it.  I didn't say anything since he checked for pockets and didn't find any.  I haven't had any infections since and I have been taking good care.  There is some pressure when the dentist polishes the central incisors.  Will my teeth keep moving if I leave the splint in place and don't get more infections?  I'm so mad at myself for not taking better care.  I'm in my 30s so getting dentures seems terrifying.  Do you know what procedures would need to be taken.  I want to go back to the periodontist but I'm scared to find out what they will say?  Should I go to the same one?  A different one?  Is there any diet changes I could make or anything at home I can do to keep things from getting worse?  Everything is fine if I brush and floss and go to the dentist so far.

[mimikk]

A related discussion, Bone loss to canine discovered after 5 years of braces was started.

[OhioGirl123]

The teeth with the retainer on them did not rotate from side to side, but they have all tipped forward.  The gums do not go up as far as they used to, as the same with the gums between my teeth.  From what I can remember the triangles between my teeth were long, especially in the middle, but shorter near the canines.  I'm considering going back to the periodontist like you suggested.  I just don't know how much bone is needed for an implant if there really is bone loss.  I think the bone loss is only in the front where my retainer is between both canines.  Thanks for your help.

[Jerome Tsang, DDS]

The teeth, in theory, shouldn't be moving too much at all with a retainer.  That's the purpose of the retainer.  There is normally a black triangle in the space between teeth.  We interpret bone loss by looking at the level of the bone along the tooth and it should be near where the enamel meets the cementum (root surface).  If its half down the root, then that's 50% bone loss.  Sorry I can't draw on this website but I'll see if I can find a link for a photo or something.

[OhioGirl123]

Is it possible to have both gum recession and bone loss at the same time.  My teeth look like they have moved forward, maybe from tongue thrusting. I know the tongue thrusting problem started after my braces were removed since my teeth were pulled back, but I've stopped doing that.  From what I can remember it looked like there were large black triangles on the xray that the dentist took  You couldn't see this at the periodontist.  If I do have bone loss, can I have a bridge put in place or will I need dentures on the bottom?  My teeth don't feel loose because of the retainer.

[Jerome Tsang, DDS]

I would recommend going to back to the periodontist just in case.  Sounds odd that there wasn't a bar on there when there should've been.  If he probed the area and found nothing, then there probably isn't an issue this time.  I don't think any dentist could miss 60-80% bone loss.  That's pretty severe and usually extractions are recommended.  

The most important and best thing to do is to maintain your oral hygiene and see your dentist regularly for cleanings to maintain the gums.  

You may want to consider removing the bar so you can have an easier time to clean the area but the drawback is that the teeth may shift, especially if you don't wear the removable retainer that would be used instead of that one that's glued to your teeth.