- Start -
MANIFESTO - The basic DIYPERIO positions are
1) "WE DEMAND AN 8H SRP!" - More
closed curettage, in general. This includes
prophylaxis, SRP and periodontal abscess
curettage. Actual debridement time per
prophylaxis should be at least a half-hour and
maybe even a full hour. SRPs should last a
good two or more hours per quad. Or a good 8 hours of
actual debridement time in total. Especially if the
periodontium is obviously severely infected. And if
the situation is even more severe then perhaps a
second full SRP before declaring surgery to be the
next step. Or likewise to make a second full SRP part
of the normal protocol. And not be so quick to switch
into so-called "maintenance mode." Which is really
more of a death watch for a lot of people's teeth.
Plus no mysterious musings about what it could be down
there giving the trouble. Bottom line it is calculus.
Plus dead stuff. Plus granulation tissue. NO MYSTERY.
GET TO IT
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CHANNEL - - www.youtube.com/user/diyperio
- PROGRESSIVE DEBRIDEMENT - REVERSE DOUBLING - MAXIMUM EXTENSION - FOLLOW HEALING CYCLE - REPEAT - Eventually the area will get clean if you can eventually manage to loosen every last bit of calculus and infection. Whereupon the area will heal. As described by general surgeon Abu'l-Qasim from Cordoba roughly a thousand years ago: "Scrape throughout... until the calculus is gone. It is possible that one scaling will suffice. If not begin a second, third or fourth time, until your purpose is completely attained."
- PERIODONTAL ABSCESS THEORY - GASKET THEORY - OUT-FLANKING CURRETAGE - Believes abscess is blocked-in by a fortress of calculus that functions as a gasket, thereby trapping abscess. Tooth is visualized as a castle, surrounded by walls of calculus. Three rings are envisioned. Shallow, Medium and Deep. Calculus fortresses thereby develop at the corners. Can otherwise be viewed as towers or pyramids. In addition the deepest reaches of calculus can form a gasket directly against the bone. But with less ability than the corners to "lock themselves in." Hence corner abscesses would tend to be more primary, while tooth face abscesses would tend to be more secondary. Object is to start far away and gain depth. Then to undermine the calculus fortress that is trapping the abscess. Through artful curettage, including brute force with a Sickle Blade. Or other artful application of curette, possibly completely through undermining. Though in a practical way think brute force may indeed be necessary. Or otherwise so practical as to insist on its practice.
- CALCULUS & BIOFILM -
subterranean cities of unfriendly infrastructure of
calculus and biofilm and
detritus. Also seen as xenomorph
colony. Which is easy enough to imagine and visualize
realistically. Hence providing an accurate enough
visualization of the subterranean environment. Which
also includes energy transport mechanisms to enable
the colony to infiltrate down the side of the tooth
all the way to the tooth nerve. Causing apical periodontitis.
- CURETTES - Which curettes
are my favorites? It varies according to mission -
Mainstays - LANGER
EXTENDED MINI FAT HANDLE - 1/2 mandible + 3/4
maxillary. Plus the PDT Montana Jack and
McCall-13-14s, angular scimitar-like sickles. Plus
don't forget the Graceys! Especially the Hu-Friedy
Micro-Minis for deep-access fine debridement finishing
work. Also getting big on the PDT O'Herirs, scoops.
Plus the Furcator, a twisted scoop. Plus like the PDT
Queen of Hearts for finishing work, a long twisted
scimitar. Also for debriding deep nectrotic
periodontal membrane-ligament getting big on the EXD
11/12AF Explorer. Which is kind of twisty with a
pointy end so it rips off the dead membrane at least a
little bit, which is otherwise fairly impossible to do
even just a little bit.
= = =
DIARY - Includes a reckoning
of debridement sessions since 2006. Eight years of DIY
periodontal debridement. Plus original essays mostly
from 2006-2007 attempting to figure out the nature of
periodontal disease. Plus my own particular problems.
X-RAYS - Includes panaramic
x-ray from March 2007 and individual x-rays from
October 2012. Will include commentary soon.
= = =
- REGENERATION - You Gotta Believe or Magical
Wishful Thinking? - It's a little bit of both. But
largely what it means is it is a long road and if you
think you are close you are most likely totally
confused. Bottom line is it centers around a concept
known as De-Trenching the Bone. Basically every last
speck of calculus has be debrided.
Then the cementum and
deal periodontal membrane have to be removed too. Then
the teeth have to be properly conditioned.
Accomplishing all of this is close to impossible. Then
if you did all of this successfully and not just in
your imagination then the gums can work their way back
up the tooth and the bone will fill in the space left
behind. Will you be successful? Probably not.
Highly unlikely. Unless you have a very good
progressive plan and then execute it faithfully over a
period of a long long
time. Then maybe you will get some regeneration. But
if you can get everything real clean then you can
expect roughly 1mm of bone to grow back, plus the
teeth can and will tighten up. So good enough!
- CARIES - CAVITIES - General alternative to "drill & fill." Basic idea is to stop the progression of the caries, help the tooth heal, maintain the hole and wait for the hole to seal itself off and partially regenerate. Especially useful if you have a compromised tooth or a secondary cavity around a pre-existing filling. Presumably only works with living teeth. Idea is to put off getting the cavity filled until... later.
= = =
- 3MIX-LSTR-TAP -
Lesion Sterilization Tissue Repair - Triple
Antiobiotic Paste - Idea has been around for a long
time with various formulas and applications. Most
common applications are for children. Plus to avoid
root canals in Japan. But the stuff will also leak in
through the dental tubules. Plus it is similar to
various drug therapies used by dentists now. Just
throwing the stuff in all together. And using Tylose
as a thickener. Plus a combination of different drug
carriers (mules) and surfactants.
- IRRIGATION - - Also
includes disinfection, flushing, fracking,
tooth conditining -
Includes hyaluronic acid
(HA) as a flusher - plus wannabee
fracker - plus HONEY! (I
BELIEVE!) - plus urea-papain
chemical debridement -
plus DuoDerm autolyctic debridement - Also see - SUBSTANCES
NOTE - I used to be a big believer in aspiration. To
suck out exhudate, along
with some detritus. But no more. Now I largely believe
in irrigation alone. Believing aspiration to largely
be an illusion. Where you may suck out small amounts
of crud. But the main bulk is still there. So a lot of
time is wasted with little accomplishment. Plus also
consider that the aspiration can suck stuff down into
the hole. BUT... for some serious lake of crud
aspiration is still a good choice. Especially if the
hole is narrow.
- NEEDLES - For
irrigation and aspiration - Originally used 23 guage standard half-moon
Kendall endodontic needle
as aspiration-irrigation tool. Now more into 20 guage for hyaluronic acid gel. Plus 16 guage for hydrocolloid gel,
per chronic wound theory ... ALSO... Starting to like
HONEY!! ... ALSO... DUO-DERM! ... plus UREA PAPAIN -
SUMMARY - IRRIGATION HAS ITS PLACE BUT IT IS NOT THE
= = =
- SINUS ISSUES - Thar she blows! supposedly not
common except for maxillary extractions - but I have
had a bunch of them. What happens here is the
infection eats right into the maxillary sinuses. YIKES
is right. But if you can debride
the teeth and clean the hole it can and will
eventually heal and seal itself over. You gotta believe! (or kiss your
offending tooth/teeth goodbye.) Bulls-Eye theory is
the general strategy.
FACIAL NERVE ISSUES - YIKES
IS RIGHT! - General discusion. The three main nerves:
1) The Infra-Orbital nerve, which is part of the
Tri-Geminal nerve, which runs along the sinus floor
and then branches off to somewhere around the first
molar and second bicuspid. Any trouble here can be
highly serious and dangerous. 2) The Inferior Alveolar
Nerve. Which runs along the lingual side then crosses
over to the buccal side. This one is trouble along its
entire length. But the trouble is less severe, mostly
sensory. 3) The Buccal Nerve, which is located on the
outside front corner of the wisdom tooth, fairly deep.
It controls the jaw muscles. So any trouble can be
ISSUES - DEEP SPACE INFECTION - Periodontally there
are two main sources that I am aware of and have
experience with. One is from the back of the first
mandible bicuspid where the periodontium and salivary
gland are in close proximity. I had this problem and
largely massaged the salivary gland free of infection,
at least for the time being. Second source is there is
an anatomical/developmental hole between the mandible
wisdom tooth and the second molar to provide a channel
there for the buccal nerve and whatnot. So especially
when the mandible bone gets rotted away then the
infection can slip past into the sub-lingual and neck
region. It's pretty hairy. General advice is to go see
an oral surgeon. Who may want to pull some "offending
teeth" and stick some drains into your neck. But you
could get lucky too, with some open debridement and
irrigation. Or possibly some aspiration and
NOTE - On my wisdom tooth submandibular issue I have
been dealing with it myself for 9 months so far
(07-14). But really I should just go see a surgeon.
However I am pretty sure the surgeon will want to pull
some teeth and I want to avoid that fate. But if it
blows up will see the surgeon pdq. Check out -
TOOTHPICK BLOBBAGE - TOOTHPICK CLOSEUP - But whether
or not I can resolve it still plan to go see the
surgeon. Either for the surgery to just to check it
= = =
GLOSSARY - Largely consists
of both real and make-believe words I use to describe
the various activities and processes I use to treat my
periodontal disease. Largely the words are used to
give some substance to both the concepts and the
ideologies. Many of them are pretty much the same
thing. Or are supposed to be funny.
STRUCTURE - This is an imaginative essay dealing with physical properties of teeth versus their apparent textural reality via self-perception via dental tools. Idea is to try to correspond the perceptions with reality. Plus develop general ideas so that the interpretation of the perception turns into a reasonablyh accurate portrayal of the reality. Also to keep it simple. Such as how to articulate the difference between tooth and bone. Or how to tell if something is a nerve. Or general rules to help avoid doing really really dumb things.
= = =
VIDEO - RAW FOOTAGE - QUAD
KILLER ABSCESS COMPLEX - www.diyperio.com/video.html
- Here are two debridements of the lower right 2nd
molar #31 from the lingual side. This tooth ended up
wobbly and hopeless. Part of a giant abscess complex
encompassing all of my lower molars, including my
extracted 1st molar and even infiltrating the eye
tooth and 2nd lower incisor. It even infiltrated the
salivary gland and got into the submandibular. It's a
true mess. I have been trying to fix it up for roughly
the past two years.
= = =
GOLD - Cavity on t31d - lower
right 2nd molar distal - PLAN IS ON HOLD - TOOTH IS
TOO LOOSE - Plan was to fill cavity with gold.
Acceptably. Maybe even just as well as the Egyptians
or Babylonians or Civil War dentists or yore. Problem
is the tooth is too destroyed to be able to take a new
filling very well. So I cleaned it out and have been
maintaining it by brushing it out and keeping it
disinfected with iodine and hydrogen peroxide. Also
keeping it mineralized with flouride
and Arm & Hammer Whitening Booster... <>
> - Also using both hyaluronic acid to clean it on
a micro level and encourage fibroblasts... Also
periodically using the antibiotic - 3MIX-LSTR - all
around the tooth to disinfect and penetrate the
dentin. Same idea as Arrestin (minocycline-based
putty) and doxycycline-based gels. Part of the idea is
also to stave off irreversible pulpitis (infection of
the dental pulp cavity) and root resorption (infection
of the dentin leading to wasting away of tooth
structure, from either external or internal source of
OPINION - - GENERAL OPINION
- "It is impossible for non-professionald
to debride their own
teeth safely and properly - Anybody foolish enough to
try will definitely screw up and slice themselves up
badly. And maybe even cause nerve damage. Or maybe
even cause a brain infection or a sinus infection and
die. Just to try to save a few bucks."
DIARY - - This is a catch all
for either ongoing issues or past random stuff. Will
probably do a blog too. Bottom line on most of my
stuff is it is highly repetitive around a few main
themes. Do also plan to do a simplification of my main
= = =
DEBRIDEMENT - There is a fairly modern But the most
serious guru seems to be Abu'l-Qasim from Cordoba
roughly a thousand years ago. He described progressive
debridement. "Scrape throughout... until the calculus
is gone. It is possible that one scaling will suffice.
If not begin a second, third or fourth time, until
your purpose is completely attained."
is more or less the same strategy as both DIYPERIO and
Winston Churchill. "When you are going through hell
THE CAN DOWN THE ROAD - IS IS
REALLY WORTH IT? - 11-01-12 - Example is I am under
recent attack by periodontal abscesses. In three
separate areas. In all the cases these are the same
areas where I either had or thought I was having peridontal abscesses roughly
five years ago. So what did I accomplish five years
ago with my so-called -aggressive- attack against
these problems. Five years. Why couldn't I resolve
these problems five years ago? Or likewise had I had
these teeth pulled or seriously gotten done over five
years ago would I be better off today? Hard to say.
But remember this - The thing you missed or the
dentist missed in the past is now burrows itself
deeper than it was before. If you couldn't get it then
why is it supposed to be any easier to get it now?
This leads to the maxim - You cannot kill the monster. So whatever you do certainly don't feed it. - What does this mean? Floss Floss - remember biofilm has it's own electro-chemical food delivery service to the lower layers. Plus STOP EATING SUGAR!! FORGET ABOUT RINSING IT OUT - JUST STOP EATING IT - Plus watch out and eliminate high blood pressure. And possibly eliminate any food binges. You can just imagine a binge of sugar being pressure driven through the blood stream to feed the lower level bacteria. While meanwhile a lack of flossing gives the upper layers of biofilm enough extra food that they can pass along to their lower brethren.
= = =
will be blood. Plus lots of strange detritus, crud,
blobs, strange stringy stuff and xenomorphs,
from monstrous mothers down to baby size, both young
and old, shallow and deep. For lack of a better word
blood is good. Better infection down the drain than
living among your teeth, as colonists in their
Self-dentristy periodontal-curettage & irrigation-aspiration-needle & tooth-brush-pick hygiene - is a lot like detailing your car except it's your teeth and you can't see and it's hard to figure out where you are and to get to the right place - plus its dangerous - don't want to whack any bone, nerve or tooth or sinus etc etc all bad - and you may need to pull hard on something and hope it isn't your bone (great! lets yank out bone) or your tooth, ie the cemanto-enamel-junction or your infantile developmental ridges (both tooth and NOT calculus and easily mistakable to any fool with possible negative injurious damaging consequences) and better not slip or else get sliced up (Chinatown style) - because you are pulling a knife on your teeth - and you should full well know what happens to teethy people.
Plus the bad
stuff (calculus, biofilm
and crud and detritus) is real hard to get to come
loose - but indeed it will eventually liberate
itself or be liberated - also thanks to the
Liberating Blood, freely dispatched by the gums to
help you flush out the infection and detritus. Your
body wants to liberate itself of its infection and
detritus and will rise up and help you with the
Liberating Blood. Which is not to be confused with
the Healing Blood, which is a separate category.
Then... the teeth will become more free of infection
and become more able to reduce the trauma, start
recovery, relieve themselves of their horrible
burden oppressor and soul destroyer and hopefully
tack down some epithelium (the empire of skin and
its lessor tributes) -
and then hopefully be able to achieve some
regeneration of self. Except damaged to the degree
and level of the infection and missing bone.
There is also the danger of the abscess, which lurks behind and escapes the liberation and then like time-bombs or baby xenomorphs feed off of blood and assorted sugars and daisy-chains to sustain themselves and build up their mini-empires. Through Doubling - patiently waiting for their opportunities to destroy peoples periodontals and then emerge. Like chest-bursters. Taking down the tooth with them. Or maybe even the entire quad. Travelling subterranean from tooth to tooth. Plus the palate, sinuses, upper and lower nerves and spit glands. Free to travel the body including soft tissues to higher and higher levels of destruction.
= = =
PERIODONTAL DEBRIDEMENT THEORY AND PRACTICE
on baby, finish what you started
= = =
= = =
there ain't goin' to be no hangman
= = =
= = =
IS THE XENOMORPH ANALOGY FAIR? YES PERFECTLY SO. WHY? - If you imagine somebody who was caught completely by surprise by periodontal disease. For some strange reason his dentist claims to have known nothing about it. But certainly right now it is revealed as a serious condition. Indeed about to claim the person's dentition for its abode with the only reasonable final solution being to send the dentition to the scrap heap. And hopefully to save the sinuses and lower jaw. Plus intermittant teeth. With no way around this. Since the "disease" has infiltrated so deep. And can have its will unless stopped by surgery (for awhile). Indeed so deep as to create abscesses. (Let's keep an eye on this one and see what happens?) Which are presented as poor bacteria who only want to escape but restrained by the body. But what if instead creating tunnels & abscesses was the goal. Leading to tunelling and new empires. Indeed it forwards a mission to capture the entire dentition. And take the sinuses, palette and jawbone too as additional abodes and trophies. ENOUGH ALREADY!
But realistically you can imagine the entire colony of infection working toward a singular goal. Which then becomes the metaphor for the counter-attack. Then likewise the biofilm, blobs, calculus, detritus etc can also be viewed as having lifecycles within the xenomorph. Who is a powerful enemy. And think a military metaphor is also reasonable but more using logistical metaphors rather than aggressive. Though obviously aggressiveness then clearly becomes the attack of choice. But to be done in a precise manner and not at all slipshod at all, but rather to be both afraid and determined.
OK OK - But also remember that a lot of abscesses are caused by regular cleaning or SRP up top, leading to healthy tissue, while stuff bubbles underneath, lounging on blood and twinkies. Anyway, I stand behind the xenomorph analogy. But also to remember that the entire process of going from infested to not very infested at all really does need as many decent analogies and metaphors as possible. So when have to go extreme do what you have to do. But otherwise something more resembling a spa may also be a good metaphor.
= = =
PERIODONTISTS LIKE TO SCRAPE? OR WOULD THEY RATHER DO
SURGERY AND IMPLANTS? - Here is an interesting quote
from the Northeastern Society of Periodontists
bulletin from Spring 2006:
the changing dynamics of a periodontal practice from
scaling, osseous surgical treatment and maintenance,
to a more implant-oriented or single area focused
treatment ... Today, periodontal students spend much
less time scaling and far more time doing surgery and
implants, so the prospect of spending time scaling
seems unappealing and economically unrewarding.
= = =
DENTISTS WANT TO BE HEROES AND SAVE YOUR TEETH? - Or
is it preferable (to them) to extract them and replace
them with implants or dentures? Meanwhile if they
don't want to save the teeth but you do then who is
left to do the job? The answer is you.
= = =
= = =
you donít want to use the army, I should like to
borrow it for a while. Yours respectfully, A. Lincoln.
best thing about the future is that it comes only one
day at a time.
= = =
--Dilligence and perserverence can turn the
tide against the infection. Balanced off by the phenomona of sliding down
the dinosaur, which means to lose all your bone. Was
it worth it? Really? Who caused the loss of bone?
Was it you or the disease? Did you make any
mistakes? Gashes? Broad loss of bloody and meaty
along with cruddy body material in one foul swoop?
With resulting "Sam Peckinpah"
- LOTS OF BLOODY CRUD - Did you perhaps dig a little
too deeply? Or think falsely? Or can you justify
everything you did honestly and tell the truth about
your mistakes, at least to yourself. Including
damage caused and why you made the mistake and what
you were thinking at the time.
OR DID THE BLOODY CRUD DESERVE TO GO? YOUR CALL. With the miserable refrains - why did you go in so deep? - did you have to? YES GENERAL OPINION IS THAT THE DEBRIDEMENT HAS TO EVENTUALLY GO ALL THE WAY TO THE BOTTOM NO MATTER WHAT MIGHT APPEAR TO GET DESTROYED IN THE MEANTIME. LOGIC IS THERE WAS NO WAY THIS WOULD NOT HAVE HAPPENED ANYWAY.
Dude! I got a crater where my gumbone
used to be. How can you say I didn't just dig out
bone that could have survived? ANSWER: The fact you
lost all that bone is because of the disease. The
puffed up gums were an illusion based on swelling
and bone that had pretty much already been
destroyed. Granted if you had perfect abilities to
slip past the cruddy-bone down to the deepest layers
of infection and not even jostle the cruddy-bone
that would be better if you had the skill.
Otherwise to kill and starve out as much of the infection as possible, then hope the cruddy-bone becomes at least a little stronger and then attack. That also makes sense. Strangely enough the cruddy-bone may technically have the theoretical ability to come back to life. But which I still doubt. Otherwise, bottom line don't think there is any way for cruddy-bone to survive. Unless surgeons can put it back. Which also sounds doubtful. So just have to accept the bone as lost.
= = =
final countdown is with HYALURONIC ACID - eventually
as a displacer around otherwise incurable and
dastardly issues - FRACKING-FLUFFING-DISPLACEMENT
DEBRIDEMENT W HYALURONIC ACID - www.diyperio.com/hyaluronic.html
-- THIS IS A CONCEPT PIECE - I AM VERY BULLISH - Idea
to use HYALURONIC ACID (HA) - as FLUFFER or FRACKER or
FLUSHER or DISPLACER or PLAQUE-MIME
INFILTRATER-CONQUERER - (concept) -
But HA idea could be dangerous and cause people's heads to explode. (not literally but pretty close if used improperly, like in periodontal tunnels) - Since HA is water loving - hydrophillic - and will tend to cause infections to swell up. So have to be real careful not to screw the pooch. (but may be okay for relatively clean areas, just not for any totally filthy and enclosed areas, like tunnels (!) don't know) - I tried it on a dirty tunnel - enclosed dirty space with scary and painful swelling and on clean space with good results. But also, in spite of the painful swelling the infection then came to a head and largely seemed to expel itself. So overall I am happy I did it and happy there was no permanent damage.
Currently heading towards idea of HA blobs transported on brush picks. In addition to weaker mixtures transported via irrigation needle. Idea is that the blobs should achieve longer survival time than a more fluid mix. Ideal result is for the HA to cause calculus to frack and give itself up. Plus to cause other infection to blob itself up. Thereby making it more vulnerable to debridement. Or ooze out of it's spiderhole like whack-a-mole.
Also to use HA as a mimic and infiltrater. of a biofilm. Since HA also has biofilm properties. Idea here is the HA infiltrates the biofilm and takes on biofilm properties. On the side of good rather than on the side of evil. So hard to say how this battle pans out. To start idea is to use the brush-picks to reduce the available biofilm. Here biofilm is not that indistinguishable from spit. Being slightly more sticky is the giveaway - bladerunner. Incidently crud seems to always supply itself in abundant supply. Then put the HA to war and hope it wins.
= = =
GUMS ARE TOUGHER THAN YOU THINK - SO ARE TEETH - What this means is that to a large degree that a person can manhandle their teeth and gums in various ways so indeed both the teeth and gums do suffer trauma but that over a period of three days to two weeks or so or sometimes up to a month they will pretty close to fully recover, even though the damage and pain seem fairly severe.
RECOVERY FROM TRAUMA - IBUPROFIN & COLD WATER - The most critical thing about teeth is the nerve travels through a narrow channel. So if it swells it can damage itself. To counteract this problem the standard treatment for this type of trauma is ibuprofin and cold water. The ibuprofin counteracts the swelling. The cold water temporarily slows down metabolic activity and helps the swelling to drain.
SO TO COUNTERACT TRAUMA SWIRL COLD WATER AROUND IN MOUTH AROUND PAINFUL TOOTH FOR A GOOD THREE MINUTES OR SO - BUT NOT TOO FAST SO IT HURTS - ALSO THERE IS POSSIBLE DANGER OF CRACKING TOOTH OF COOL DOWN TOOTH TOO FAST - SO COOL DOWN TOOTH SLOWLY AND TRY TO KEEP IT COOL FOR AT LEAST A FEW MINUTES AT A TIME.
IBUPROFIN TO TRY TO SAVE THE NERVE FROM DEATH FROM
TRAUMA? - Also have to be careful with the Ibuprofin. It can mess up your
kidneys and could even end up killing you or otherwise
ruining and destroying your life. This apparently
happens to professional athletes quite a lot. Though
not as dangerous as acetomyphin.
Still not to be messed with.
DIYPERIO seems to ignorantly think, bottom line is
that if anything goes seriously wrong with the tooth
and the nerve becomes inflamed and is not hopeless
that Ibuprofin and cold
water is virtually the only thing that can actually
save the nerve. HOW CAN THIS HAPPEN? - This is because
a tooth nerve will tend to die within roughly 36 hours
of active trauma. SO RUNNING AGAINST A 36 HOUR CLOCK -
What this means is that if you can slow down the clock
and give the tooth some rest, even short term, then
the body might get enough time to figure out how to
get the nerve to quiet down before it dies. NOTE -
This is a common general tooth problem. The nerve
starts to act up and then dies. Possibly after the
tooth gets hit. So not that the Ibuprofin
and cold water will save the tooth. But the logic is
sound. So it might. Who knows?
= = =
INFECTION AS A CHRONIC WOULD - google
- chronic wound lactoferrin
xylitol - Randall Wolcott seems
to know alot here. Even though his field is saving
feet from amputation, not periodontics. Nonetheless
the principles are the same. A lot of his stuff is
fairly complicated. I generally like to use DuoDerm,
which is a hydrocolloid bandage.
OF POSITION - The ideal would be for the patient to
work the curette in real deep and then have the
hygienist yank out the large calculus ledge all on one
foul swoop. That alone, if the ledge is large enough
is enough to send a highly troubled and vulnerable
tooth back into a position of having a future. Even
though the price that typically has to get paid is gum
recession. Since the gigantic piece was like a
fortress stacked from layers of crud where bone should
have been instead.
ON! WILL SHE REALLY BE ABLE TO YANK OUT THAT GIGANTIC
PIECE OF CALCULUS? - Probably not. But she can
certainly try. Maybe she can get a big chunk to break
off or otherwise do something amazing. Since the only
other option is to slowly break it apart, which is a
process that can take hours. Or to get the surgeon to
cut open the gums.
- MINIMAL OPEN FLAP DEBRIDEMENT - looks like a
reasonable way within the realm of dental hygienists
to get to the deep stuff. Not really sure how this
works. Whether the hygienist actually cuts the gums
open and then peels them back. Or whether the dentist
or surgeon makes the cut, and then does the peeling
back and then lets the hygienist work the elbow grease
to get the rock-like ledges and otherwise impossible
pieces of calculus to come loose.
flap debridement seems to be a lesser form of
what is known as a gingivectomy.
With differences between the level of aggressiveness,
whether bone is exposed and cut away and filed down
and other differences of seriousness. Presumably in a
minor open-flap debridement the person may reasonably
be able to return to a fairly normal life within a few
days and not break the bank quite so hard, plus not
notice much gum recession, whereas in a gingivectomy
the person would end up in serious pain for up to
several weeks, spend a lot more money and end up
losing a lot more bone, resulting in greater gum
= = =
But in the meantime.... Pizza Parlor Owner: "Hey!... What about my pizza?" - Tony Montana: "Screw your pizza!"
means is that the only other solutions besides
appeasement, which will eventually fail even with
great hygiene, or surgery is diy
perio. Or other exotic
expensive solution like bone grafts or the perio-laser.
FORGET MY STUFF - DON'T EVEN BOTHER - READ THIS STUFF INSTEAD
MICROBIOLOGY - SUMMARY OF MAIN POINTS - from a
Russian dental journal - www.med-stud.narod.ru/med/dentistry/oxf_periodont.html
- STRONG POINTS
DENTAL ABSCESSES - One primary cause is that the
higher level infection gets removed and the lower
level infection is allowed to prosper. The upper
layers heal and tighten. The lower levels then have
limited ways to release by-products, thereby leading
to an abscess. What this means is the infection has a
totality. And the deeper layers can get a life of
their own. It also suggests finishing what started and
using the needle or explorer to visit the deepest
available layers no matter how deep the instrument
goes. Can also practice with brush-picks and tooth
picks, which can also help release any abscesses. Or
other material or bloody crud or fluid that could
eventually turn into an abscess.
DOES DIYPERIO THINK? - DIYPERIO does agree at least in
part that SRP of the upper layers combined with
healing that tightens up the gums does help promote
periodontal abscesses... HOWEVER.... DIYPERIO's main
position is that periodontal abscesses are not caused
by some ubiquitious undefined infection that much to
its dismay gets trapped, but rather by walls of
calculus. Always? Yes always. Plus maybe also by
nectrotic periodontal membrane that gets covered in
some type of granulation tissue or biofilm. Just to be
a weasel to cover one more possible other
explanations. That is DIYPERIO's position.
WHAT DOES THIS MEAN? - It means that DIYPERIO says
that it is walls of calculus down below that hold in
the abscess. Pure and simple. TEAR DOWN THE WALLS and
the abscess will release. Don't tear down the walls
and the abscess will continue to fester. Pure and
IS HARD TO TEAR DOWN THE WALLS, REAL HARD - So what if
it is hard? Nobody said life is supposed to be easy.
Do what you have to do to tear down those walls. And
don't come back and say "It's impossible" because it
isn't.... Think about it. The enemy is a series of
small ridges of calculus clinging to the teeth. Be
real. How hard can it possibly be? Impossible? Surely
not. But maybe harder than you would like it to be,
yes. Maybe it takes longer than you would like to
spend, yes. Maybe you can't get it all at once and
have to come back, yes. But these are not issues of
impossibility. These are issues of will and
determination. Try harder and you might be successful.
Maybe. Or if not this time, then maybe next time.
= = =
= = =
MEANWHILE... A person's level of aggressiveness will tend to go up too. This especially includes the toothpick and the brush-pick, both of which are serious tools. Perfectly capable of both dramatic cleaning and damage. But also including the brushes. From this it may become clear that what is presently visible is really just the tip of the iceberg and that no matter how much crud is removed one way or the other there is always going to be more left behind.
ADDITIONALLY ... is the COST. Price a few things out. If the tooth fails and is left in place root canal plus cap for $2000. Then if it needs to get pulled add in another $3000 for a replacement. Meanwhile the periodontist is charging at least $150 for cleanings... but there is STILL MORE CRUD LEFT - HOW TO GET TO IT? - Classic approach is surgery - which has been getting less ghastly over the generations - now thankfully including focusing more away from drama and more on more minimalist procedures - like open flap debridement - which actually sounds great (but is it really?) - Where all they claim to do is cut a little while pulling back gums hard. Which means less surgical trauma and less internal scarring too. Which can be bad.
SURGERY + SURGERY - Even surgery or even LASIK does not eliminate everything. So what is the answer? Get your gums cut open on a regular basis to clean them? OR whack down the gumline so the teeth are on stilts? RESEARCH - What are your options? Do any sound appealing? That make you happy? ANSWER - The only happy answer to serious periodontal infection and even less severe by some reckonings is eventually implants. OR this is the threat as the only answer. But is this all there is? Really? - ANYWAY... The logic is that the "disease", which I prefer to call "infection" is just too difficult and tenacious. And you should have flossed before! This sucker has us all in its grasp, 80% of the American public, and there is nothing we can do about it. Except listen to our dentists and periodontists and accept their explanations and solutions and work and floss 2x a day while waiting for guidance - LET'S SEE WHAT HAPPENS - and cutting checks. And losing teeth at high rate and cost. THIS IS WHAT I CALL THE APPEASEMENT STRATEGY. Net net at the end of the day is to accept the loss of the teeth.
APPEASEMENT STRATEGY - Is to accept that the infection has won and to give the infection free housing and free food under our gumlines and into our bones. Or we promise not to feed the infection - ie flossing - plus deeper - which is also important - especially because of the biofilm and calculus energy transport mechanisms down to the lower levels of the creeping infection. But nonetheless, flossing and even normal SRP does not eliminate the infection deep down. So what is the real answer? Clearly it is do-it-yourself. Or get double or triple full mouth debridements - or better get progressive debridement chronic wound strategy - But doubt if it exists at the present time. See no other solutions.
UP THE COSTS - Imagine you had full reign to map and
locate all of the bad areas and could work hand in
hand with your hygienist to go in there really deep
and then have the hygienist yank out the deep calculus
and crud. Then imagine going back a few months later.
Clearly you might imagine that a particularly tough
area might take an hour to clean out. And that it
would take say three trips to progressively debride it enough that it
could heal. Also figure that the other basic
alternative for any calculus this deep would be
surgery. So, if you paid $100 per visit then cleaning
out the one bad area would be $300. Likewise you can
imagine four problem areas for a total cleanup cost of
$1200. Or roughly what the original Scaling and Root Planing cost. NOTE - THINK
DOUBLE SRP IS THE WAY TO GO FOR THE PROFESSIONAL WORLD
= = =
WHAT IS THE
DIY PROPOSAL - First is that the issue of
having the hygienist go in deep one way or the other
is the real deal. As example some high-end periodontists specialize in
just this. For price is no limit type of people. Who
instead of having the surgeon cut the gums to see in
better just has the hygienist work a little longer
and deeper and not worry so much about the clock
since the client is rich and is happy to pay more
for good work.
KILL FOR PEACE DILEMMA - So what is the point? - This leads to a dilema. Which is this: Not removing the crud leads to sooner or eventual disaster. Removing the crud and allowing the rest to flourish likely leads to disaster, sooner or eventually." So what is the answer? Answer - RIGHT OR WRONG - is basically - BE BOLD & CONQUER - But the crud is in so deep that it is almost impossible to even reach. What do do? Well, first how about trying to get your periodontist to do it? Give it a try. Then if you have to and think you have the stomach to do it, then DIY.
baby, finish what you started
So what does that mean? In common sense terms it is referred to as "Getting to the bottom of a problem." It is the same idea as a large mud puddle. Where you do not know how deep the mud puddle is. In periodontal, once you enter the mud puddle, if you ever want the problem to more or less go away, you have to go all the way to the bottom. No matter how deep that is. Otherwise the deep levels of infection will eventually regroup. But.. if you can get to the complete bottom, in reality as well as in imagination, then the chronic wound can heal, from the bottom up. Possibly almost by magic. If that eventuality can be achieved.
GET TO THE BOTTOM - But what if you don't "Go all the way to the bottom?" What then? Here the actual downside sounds grim. That what will happen is the infection will just keep on working it's way down. But is there another way to look at this? Namely yes. That however deep the infection was it reached where it reached. So how can somebody reasonably say that to get the upper layers is bad?
But what if you do "Go all the way to the bottom?" What then? In the worst case scenario what happens is cratering. Meaning the area between the teeth collapses. But the sides are still there. So the damage doesn't look as bad as it really is. Essentially there is no bone between the teeth. But after awhile gum will grow back. And if you get close enough to the bottom can get some bone too. I have had one cratering wound I have been nursing along for six months. I am convinced that by the year mark I will get to the bottom and that bone will grow back.
QUE SERA SERA - What this leads to is a philosophy which may or may not be correct. Which is that the areas that were not so bad managed to heal. But that the eventual dire result of the worst places has to be viewed as inevitable. But... did I make it worse? Real good question. But on the other side, if SRP is deemed to be the gold standard and got the SRP then shouldn't a little extra SRP even if done in a fairly amateurish way, shouldn't that be beneficial too? (As long as no lasting damage was caused. Like gouging the teeth for example.)
DIY Perio's basic position here is the same as the dental profession, in theory. Which is that a half-ass SRP only allows the infection to continue without even reducing it much. You can even think of it as pruning, where the xenomorph grows back stronger than ever. Ultimately what this means is that if you are going to go after the crud and really mean it then going at it half-ass, whether by professional or DIY is a poor way to go about it. Instead have to concentrate on the bad areas until they are perfectly clean, no matter how deep it ends up going.
= = =
WHAT DO BIG LEDGES OF DEEP CALCULUS FEEL LIKE? - They feel FURRY. Just like bone. So make sure you are tugging on the one and not on the other. Especially since the teeth do not have a self-referential system. And you may have no way to have a perfect reckoning about where the curette is. Don't want to go tugging on bone do we? WHAT DO I DO? As a fail-safe I typically try to remember to test every calculus patch. Once the scraping starts to release blood and debris and you are not screaming in pain (unless you have an atypical low pain response) then that means it is calculus. OR work around the edges. BUT I am quite sure that there are many calculus ledges that I dismantled one piece at a time or even in layers that I could have dispatched more readily by not being so timid. Since what else is it supposed to be sitting on the tooth? Doesn't take a rocket scientist to figure that one out. But also is the extreme pain of attempting to peel off a large piece of an especially deep calculus ledge. Indeed impending screaming pain. So rather than go for that my usual response is to try to dismantle the calculus ledge from the edges. And avoid the pain as much as possible.
= = =
WEB STORY ABOUT A WOMAN WHO HAD A BAD TOOTH AND USED A
SCALER TO CLEAN THE TOOTH - AND IT WORKED - THE TOOTH
GOT BETTER - LIKE A MIRACLE
= = =
WEB - LARRY BURNETT DDS - RENOUNED AUTHORITY - EXPLAINING REALITY-LAND TO A FRUSTRATED DENTAL HYGIENIST
- But permit me to address the fact that I believe you
may be a little hard on yourself because of things you
may have learned in hygiene school.
NOTE - THIS EXPLAINS THE JUSTIFICATION FOR PROGRESSIVE DEBRIDEMENT - LET IT RECOVER AND THEN GO BACK LATER AND GET SOME MORE - PER DOUBLING THEORY - 2-4-8-16-32-64-128-256 etc
= = =
F YOU HAVE SERIOUS PERIODONTAL infection YOU CAN LIKELY FIGURE ON 150 HOURS OVER THE COURSE OF THE FIRST YEAR - Also if you don't have the stomach to go in deep then you should hope and pray that you readh the bottom without going in too deep. Otherwise for anything less than most severe a few hours here and there might suffice - You can work on one area at a time as a hobby and then move on to the next area afterf the first area has healed. Turning it all into a long term do-it-yourself-project. With lots of time in between to ponder - plus time to heal from any dumb moves you might make that might screw the pooch - ie kill the tooth or damage the trigeminal nerve - which is a major nerve - or bust a hole into the sinus. Which is also pretty bad. But in cases of sinus communication it still might be fair to blame the infection and not yourself. And then use the generally accepted hygiene-method to recover from the hole. Which will hopefully seal itself off on its own.
Believe it or not the amount of labor it might take to get your teeth up to snuff might be in the hundreds of hours. Especially if you have zero clue and don't get better. I will confess, I still do not know how to remove calculus except for slowly. Why so slow? Largely it is because I am afraid. I think. I can always improve my technique or get more aggressive. But what do I do? Do I get more aggressive? No. Why? Because I am afraid. Now I will tell you something, lately I have started to become more adept at really being sure that something is calculus that I am ripping down and not my own bone. But even here I always check to see if the blood is coming out the right way. Why? Because I think it is important to go 100% sure and that fear is a teacher. Someone else could chose to be more aggressive and knock out chunks of calculus like you wouldn't believe. But who knows. I will tell you that I don't understand this at all. But the blood just keeps on running and keeps on running and my mission is to keep going until it stops. And if you are spending 3 hours at a time at one site. Which might only be one of four sites on a tooth you will see that you have just spent 12 hours on a single gap. And if you have 4 major gaps that adds up to 50 hours for one debridement. Then if you do three major debridements on the four gaps you are now up to 150 hours. That is the reality. And you could be better. But unfortunately you are not. And you have to accept what is. And if you are a superstar then great. That is wonderful for you. But if you are not that is okay too. You just have to be more dilligent and spend more time and be more methodical and take a long time to figure things out. And know only what you know.
SEARCH - CHRONIC WOUND PERIODONTAL infection - In simple terms a chronic wound is an infected wound. Healing cannot take place in the presence of infection. So the wound lasts forever and can even kill the host. If the infection reaches a serious enough level the only reasonable solution is amputation. Whether it be a leg or a tooth. What is the alternative? Let us say prior to the point of no return ie amputation. It is a dilemma. The answer is debridement. Removal of dead and infected tissue by any means necessary.The more aggressive the infection the more aggressive the debridement must be. Though still delicate. Even at high risk to the infected area. Or putting the person at risk or danger in order to save part of the person, such as a leg or tooth. Hence debridement is also a value judgement. Plus an economic judgement too. What are the risks and dangers to the person relative to the wished-for benefits, such as saving a hopeless tooth. But if the person gets bacteremia (blood infection poisoning) from debriding the teeth and dies then it is not a good trade-off is it?
DENTAL ECONOMICS - Likewise the DDS may declare the tooth to be (economically) hopeless at his normal hourly rate. Why keep a money pit when brand new teeth are so convenient? What is the alternative? Spend thousands on a hopeless tooth? Open wide. Alternately what if things aren't so good and you got the SRP and regular maintence and then spent some extra time going in deep as necessary. And say for example it took 30 hours over six months of debridement and healing to get a tooth back on track? And you got four real problem teeth and like maybe ten others that aren't terrible. An one that is right on the edge. Should you have it pulled since it is so hopeless?
WILL WORK FOR FREE - JACK OF ALL TRADES MASTER OF NONE - But people do things for themselves for free and will oftentimes work for hours and hours at a time in horrendous conditions and don't complain. So in large part DIY perio is really just off-shoring or farming in for free. To the poor person of the self who is forced to do things for the self for free. So spend the money where it counts. On the maintenance. And don't be so quick to go for surgery, including the magic lasers, or to throw away the tooth because it has so much negative economic value and is a health hazard to boot. Cheaper to buy a brand new tooth? Yes if you have to pay for a hygienist to put hours and hours into a periodontically hopeless tooth. Some high-end periodontists charge up to hundreds of dollars per hour for the actual cleaning time.
ALTERNATELY - JUST HELP OUT - WITH TOOTHPICKS - After the hygienist does as good a job as she can then can help out and go looking for crud that got left behind. Then get the easy stuff. Then when it gets hard again make a note about the specific area and see if your hygienist can clean out just the bad areas. As example, if it is $300 for an 8-tooth quad then that is $40 per tooth. So $120 to clean out say 3 medium pockets or one real bad pocket might be reasonable. Best to try to nip the problems in the bud. Before you know it a bad problem area can turn into the entire rack. But what if the damage is so severe it is scary? Then just do the easy parts and get your DDS to come up with good ideas and good plans and positive results at reasonable prices for the bad areas. One possibility is open debridement. Where they do cut. But it is not as severe and costly as some of the more exotic surgical solutions. Simpler less surgical solutions may be better. Learn and use good judgement and don't just let yourself get sucked in to somebody else's plan for your dentition. In my own case I was recommended to get several teeth pulled that six years later are still functional and likely to continue to survive though still technically hopeless.
DON'T SCREW THE POOCH! - Because once you jump in a pit it can turn out to be very deep. But maybe not. Whacha gonna do then? Are you going to dig all the way to the bottom of the pit? Are you going to dig all the way into your jawbone or into your sinuses? And crawl around the nerve with sharp curettes? And think: "Trust me. I will not screw the pooch. I know what I am doing." Or being a fool. Because you really don't know. And are messing deep with an infection. Which sounds like a dangerous combination. Ask around. What do others think? Think you know the likely answer already. Maybe they know something you don't. Or alternately if you go ahead try to avoid foolishness. Which are likely to lead to injury and potential bad results. Understand hygiene and the healing cycle, tooth and bone plus exactly what hygienists do. Review videos and start small. And don't try to create too many new worlds without giving any open pit-mines time to heal.
- In reality, though a lot of bad things can
potentially happen from aggressive periodontal hygiene
and people certainly need to properly warn themselves
and work through the scenarios in their minds, realityland is that gums heal.
So unless you trash a nerve or break a tooth or punch
through to the sinuses etc most of the damage is
likely to heal within two weeks. And what you might
think is damage is not really damage anyway, just
trauma. Other issue, of opening up underworlds by debriding away the upperworlds is just a fact of
nature. Yes, if you debride
you create the opportunity for the deepest layers to
thrive. Which means what?? Yes, it means that you
could be setting the stage for the end-game. You did
it yourself. So does that mean it is better to live
with the deep calculus?
No, what it means is that it is important to accept the reality of the dilemma and make up your mind what your battle plan is going to be. And what you can live with. What it means is that the battle is real. The enemy is not just going to lay down and die. So if you pick up the curette you also pick up the consequences too. Which I am saying is mostly just sore gums that will heal soon enough. Plus the risk of committing a serious error leading to injury. But if you are super-super careful that is unlikely too. Unless you screw up. So have to line up your scenarios properly and do double-secure logic to avoid errors. Plus also use various ways of thinking that guide good technique too.
LOSING TEETH IS NOT FUNNY - : Doctor I would like to keep my teeth? DENTIST:Where? In a jar or would you like something that fits in your mouth just like your own. Except better. -- Summary is serious periodontal infection is a serious infection. Losing teeth is not funny. Would you laugh at other diseases?Why is it socially acceptable to laugh at periodontal disease? Three Stooges? Why should losing teeth be so funny. It is not funny. It is serious business. With serious problems. And if a person is up to the challenge then positive results are possible. But even if they only get a few things and let the DDS take care of the rest, even if it means extraction, then still ahead. Since what was supposed to save the tooth? Hope and Change? Then that means it was a loss either way. Wishful realities are not real. Similarly people can justify DIY by thinking if the tooth is hopeless anyway then what is the harm in DIY? Win a few. Lose a few. Still ahead.
DOMINO EFFECT ON TOOTH DESTRUCTION AND LOSS - In particular the uppers (maxillaries) are particularly prone to domino effects that take out multiple teeth. Because of the proximity to the sinuses and thin bone. Also because the roots of the teeth converge in close proximity in an arch. Plus there are built in developmental channels through the roof of the palate that are prone to communication tunneling. (Apparently so.) So an infection that gets into the root area of one maxillary tooth, such as a bicuspid can "tunnel" to reach the roots of adjacent or non-adjacent teeth. Which is what happened to me. Which then threatens to take down the entire rack. Where the solutions become costly and dicey at the same time. Where you don't really own your own teeth anymore. But are renting them instead. And the landlord is threatening to raise the rent. DIY Perio is an alternative to this. Help out the DDS or hygienist. Let them do their jobs. And then you do yours with "toothpicks." And let the proof be the pudding.
= = =
WHAT SHOULD YOU DO IF YOU END UP DEEP INSIDE A POCKET THAT IS MUCH DEEPER AND SCARY THAN YOU COULD HAVE EVER IMAGINED - LIKE "HOPELESS" SO DEEP YOU SHUDDER EVEN THINKING ABOUT IT - AND TO TOP IT OFF THE POCKET IS FILLED WITH CRUD? IT FEELS LIKE IT IS SURROUNDING THE NERVE OR GOES ALL THE WAY INTO YOUR SINUS OR JAW. PLUS IT HURTS. ARE YOU COMPLETELY SCREWED? NOT COMPLETELY. BUT THE CHALLENGE TO SAVE THE TOOTH BECOMES VERY SCARY, SLOW AND DIFFICULT. AND REQUIRES GOOD JUDGEMENT, DILLIGENCE, RESOLVE AND CONFIDENCE. OR YOU LOSE THE TOOTH. PLUS YOU MIGHT LOSE THE TOOTH ANYWAY. IN SPITE OF DOING EVERYTHING YOU COULD. BUT MORE LIKELY YOU WILL EVENTUALLY EXPERIENCE A MIRACLE. FOR AT LEAST A WHILE LONGER.
If the pockets are deeper than 12mm ie 1/2 inch SOP is often to
declare the teeth FUBAR.
= = =
HEALING MIRACLE - Healing is the second half of chronic wound management. If we imagine 100% hygiene (which is impossible) then healing will take place. Somehow someway. It's a law of nature. The healing won't replace the destruction. But it will create a perimeter. And hopefully a clean and intact perimeter. Essentially a perimeter between the interior border-line of the person and what may be viewed as a colonizing alien life form and its complementary infrastructure. ie not part of the person.
DOUBLE-WAVE OF HEALING IS THREE PLUS THREE EQUALS SIX DAYS LONG - Healing and also recovery from trauma may be viewed at as a series of waves roughly 3 days long. First 3 days gathers the materials into the Extra-Cellular-Matrix (ECM). And virtually no actual healing takes place. Second 3 days organizes the materials into a completed healing matrix. Wounds that are too big or complicated to heal in one 6 day healing cycle will improve as much as they can in one healing phase. Which can round out to a week. These wounds may be viewed in terms of how many healing cycles they are away from closing a perimeter. For example a cut finger may heal in 6 days. Or it may heal in 12 days. Including allowance for perspective. Or if it is a broken bone that takes six weeks to heal then this can be visualized as a series of six healing cycles. Similarly for other long-sustaining wounds. Including pinched nerves, muscle tears, etc etc. Where a certain number of healing cycles where the healing effects are ahead of the destructive effects.
ASSEMBLING THE ECM - Likewise people may want to account for the ECM separately. But this complicates the math. And it's not rocket science anyway. Just think of healing as a series of waves. Likewise can imagine that after the first three days the material is still being gathered and is healing in 3 day cycles. Or whatever. Then figure recovery times of 7 or 14 or 21 days etc. Or just give it time to recovery. Or to just go after the blobs after the area got worked over. Since infection causes trauma too. Everything in balance. Yin and yang. If its banged up let it heal. If it is largely healed and it is still dirty then it should be able to take some aggressiveness. Or if it is still filthy and is highly traumatized then switch to the brush-picks and proxy brushes and figure the trauma to take a long time. Largely don't have to think this out too much. Just allow adequate healing time before going back to some area. Or alternately if you want to speed things up then you will need to figure on healing times. And most of the time you can speed things up for bad areas. Because otherwise the progress can be too slow.
RECOVERY FROM TRAUMA - This is how I look at it. Light trauma can return to semi-normal in 1 to 2 days. The trauma from light injury or manhandling takes roughly 3 days to recover. But certainly even the worst trauma will largely stop hurting by the 11th day. Ibuprofin is good medicine to reduce swelling. And even to save the tooth from dying from any swelling. Forget about Tylenol. And also if the area is still highly infected it can take longer to recover from the trauma and there won't really be a healing phase. Instead the body will "blue tarp" the leftover infection in an attempt to save itself. In which case the infection can be cleaned up on an ongoing basis and things will eventually revert to some type of remission. Though the infection is still bubbling.
COMPETITION AND NET CONSEQUENCES BETWEEN HEALING AND DESTRUCTIVE CYCLES - Part of the issue is whether healing is actually taking place or not. Here the model looks at things like infection or overuse as a repeated injury. For example, if a periodontal pocket that is still infected manages to get a week's worth of healing then maybe it is also getting a week's worth of ongoing destruction from being situated right next to an infection. So the net might be zero. Likewise a partially infected area might be healing faster than the infection can destroy it.
GETTING HEALING AHEAD OF DESTRUCTION THROUGH REAL ESTATE MANAGEMENT - So it is like 2 steps forward and 1 step back. Then attempt to leapfrog off the progress. And cut off the real estate available to the infection. Isolate it into a corner. Then develop a strategy whereby the infection can in-effect "surrender" and "give itself up." Which is especially important where the infection is in close proximity to vital parts of the body. Like nerves or major blood vessels. Infection is similar to cancer in that it is an invader. But where cancer apparently tries to operate independently from the body infection "becomes one" with the body and turns nearby tissue into something resembling the "living dead."
NOTE - Periodontal infection can also be looked at as a real estate issue. The more the infection the more the real estate. Once the person fights back some areas will heal. And the infection will have fewer places to flourish. What is left thereafter becomes the problem areas. Similarly each of the problem areas can be resolved too. If they heal and are not just maintained. And can even return to quasi-normal. Like bombed out buildings with a maintenance man. Who carts out the rubble as he can and tries to keep the place tidy. And is happy he has a place to live. Still a tooth, just a high maintenance tooth. Not a bad position. And implants are not necessarily all there is to be believed either. They do not mean the end of infection. Plus they are expensive and can have expensive complications too. Especially if they are cantilevered.
And once the original hygiene is done or well on its
way keeping it up does not necessarily take a long
time. Can think of it like golf. It's a hobby, a very
practical hobby. So it is not all effort. Part of it
becomes learning a new skill. One that can keep your
teeth inside your mouth and not in the trash where all
reasonable thought says they should be. Or should end
up soon enough. Perhaps just an abscess away from
being a goner. "My teeth should not be in my
mouth... but they are." -
Or as Peter the Great said to one of his advisors, speaking to his head, of which Peter personally knocked off lots - "Oh Head! Head! How could thou be so smart as to still live so comfortably upon thine shoulders?" - That is the reality. The teeth will either sink or swim. Hope and wishful thinking are not the answer. And how deep does floss go anyway? Can you really expect to save your teeth by flossing twice a day like your dentist said would work? I would be skeptical. I would suspect bad surprises may be in order. Also with teeth once the bad surprise gets out of the bag it is oftentimes too late. So if you have strategies to cut off the bad surprises at the pass then that is not necessarily so bad. Even if it means digging. If you know what you are doing, learn from mistakes, are lucky and don't screw the pooch.
SELF-DENTISTRY - Periodontal - The general subject starts with brushing & flossing & irrigation and cleanliness and general hygiene and works its way up from there. Next step is brush-picks and proxy brushes. After that comes the Explorer, with it's shepards hook and straight probe with the bent point on the end. After that comes the periodontal curettes. Which is where it starts to get very scary and potentially dangerous. But there is no reasonable practical way to remove the thick layers of calculus, tarter and biofilm without periodontal curettes or expensive gum surgery. Which still does not solve the problem. Also most important is the issue of depth.
OF DEPTH - What this means is that the periodontal
infection and calculus works its way and infiltrates
down the side of the tooth, while compromising and
destroying the bone and connective tissue. What is
left is literally a train wreck. What to do? Go get
your teeth cleaned!! Obviously. But the hygienist can
only do a good job down to 5mm or so. Which is only an
eighth of an inch or so. Not much. Deeper than that
gets very very dicey.
Plus delicate. Can the hygienist clean this? Not
really. As example you can imagine a curette in so
deep that it jostles the nerve or where the area is a
total mess. In this situation a person's ability to
feel their own body enables them to move the curette
around in these deep areas. Realistically a hygienist
cannot do this. Only a surgeon can reasonable access
these areas. At hundreds of dollars per hour. But a
DIY can work cheap. For Free. Except for the cost of
So a person can spend hours upon hours upon endless hours meticulously removing pieces of crud and allowing the biofilm to liberate itself. Then let it heal and go back. And eventually turn a chronic wound into an acute wound. And get the upper hand over the infection. Instead of losing teeth. Where the teeth are defined as "hopeless."
GANGLAND THEORY - Gangland theory visualizes the long-term periodontal infection and layers of calculus as an interconnected metropolis of squatters who have created their own infrastructure right on the surface of the tooth. Including survival networks and life-cycle support. Starting off as a newly minted bacterium, joining a biofilm colony, fulfilling responsibilities and then dying and turning into calculus. Attached to the tooth or not. Etc. Ultimately leading to either loss of the tooth or destruction of the biofilm colony. Accordingly, once a major portion of the infection has gotten whacked the calculus and biofilm that is left behind will quickly fill in to fulfill the roles left behind by the previous gangland leaders. So ultimately the goal becomes to whack the new leaders as they emerge from the bacterium.
BASIC PREMISE - Under conditions of severe periodontal infection the basic integrity of the tooth and bone have been compromised. What this means is that biofilm, debris and calculus can go deep down the side of the tooth and drink blood. At this point the question arises about whether the tooth is "hopeless." Flossing doesn't reach deep enough but is still good, especially since biofilm can relay nutrients to deeper levels. Plus drink blood. Proxy brushes, brush picks and tooth picks w holder can largely be viewed as close to a complete system to combat deep biofilm and minor floating calculus-biofilm bloody blobs, which can form fairly massive parts of the infection.
But in the end, even if the toothpick has miraculously managed to knock loose all available blobs there is still the calculus left behind on the tooth. Which functions as housing for biofilm "tenants." It can also be said that the course of the infection is not going to be stopped until all of the calculus layers have been removed too. Which we assume can be accomplished. Based on calculus reanimating itself. Plus possibly fluffing up the calculus with hyaluronic acid. To prep it for the knife. Or needle.
Calculus can be imagined like a pile of dried-out wet newspapers. It is easy to peel off the layers almost indefinitely without getting to the bottom of the pile. This phenomona of what is left behind or remains untouched is what perpetuates periodontal infection.
Severe periodontal infection may be thought of as end-game for the tooth. The natural next step would either be to get surgery, get deep deep cleaning or start to consider getting the tooth pulled. Meanwhile the tooth becomes highly suseptible to abscesses, since the calculus-biofilm can feed off of blood. Plus the infection can compromise and kill the tooth nerve, leading to an abscess or expensive root-canal and cap. Which costs $2000. For a hopeless tooth. Making an implant the more attractive option.
The surgical option also sounds like good sense for most people of good sense. But expensive and likely not covered. Here the surgeon peels away the gums to see better and get down deep. Then scrapes away! To get everything as clean as he can. What happens here though is that there is always something left behind and that will regrow. But it can basically buy 5-10 years. After which the surgery would need to get redone.
Realistically here idea of a less expensive open-flap debridement also makes good sense. If not too expensive. Here people would try to get every thing as cleaned and healed as they can on their own. This could be a two-year process. Then whichever areas are still bad and hopeless looking get the debridement. So maybe it would only be a few teeth instead of larger expanses. Which would seem to cause more permanent trauma and greater scarring. Take your pick.
INFECTION VS TOOTH - WHO WINS? - Once the infection has reached the point where the infection can rule unmolested at the deeper layers then the infection will eventually win and the tooth will eventuall lose. So, how much "time" is left in the tooth can be imagined as similar to a mechanical device. But rather than change the time, keep the time the same, since the tooth will remain permanently damaged and forever vulnerable. So think of it as if the tooth only had to minutes left. If the infection is still severe those two minutes are going to get used up very quickly. If the infection is completely eliminated 100%, which is unatainable, then those two minutes are likely to last a long time. Maybe even until the person dies. In between there are lots of time-bombs or war-lords, ready to take over all the empty real estate left behind. So lifetime commitment becomes finding and removing these time-bombs.
So who is there besides the surgeon, hygienist and the person who has the infection to do anything about it? Nobody. So question becomes what to do. This naturally leads to the toothpick etc. Next step would be the needle or explorer. With the two points, straight and curved, to check things out. Next step becomes the curettes. Which are available on eBay or otherwise on the web.
Is this smart or dumb? Bottom line is that if the tooth is already lost then what is the harm? Plenty - Could cut the nerve of the tooth and cause the tooth to die. Could punch a hole right into the sinus or jawbone. Could die from blood infection, ie bacteremia. Could also worsen the infection by helping the biofilm lower down to thrive. Leading to possible bone-infection and abscesses. Because of foolish "self-surgery" - (which it is really not) - Could cut right through the gum - (OUCH!) - but it will almost always eventually heal, even if it hurts something fierce for a few weeks. Could latch the curette right onto weakened bone and pull it right out. When if you treated it more nicely it could eventually survive.
So... all in all the entire enterprise looks very foolish. Especially if somebody falls into deep deep pits. That go right down to the nerve or into the jawbone or sinus and won't give up. Like bad news. And the only other reasonable response if somebody decides to go ahead or wants to is to know what they are doing. But they have to figure it out for themselves. Through books and practice and building up slowly and learning from mistakes. All of which is justifiable. If the only other reasonable alternative is to lose the tooth. Or all of them. Or critical ones. Or even an entire "rack" where all the teeth fall down like dominoes. Because the terrorists won.
Alternately a person can map out their bad areas on a tooth diagram and bring that to their hygienist to do extra work on their bad areas.
Alternately is to look at severe periodontal infection as a huge outlay of money eventually leading to not only losing the teeth, but being subjected to ongoing problems one leading into another. And is somebody figures they can do some of the work by themselves for free instead of paying somebody else $200 an hour. Plus if the infection is severe enough people will discover they go in so deep they can hardly wonder how a hygienist could possibly find the place. Meaning that in fact doing at least a small portion of the work, ie. real deep - is something that only the person themself or a surgeon can reasonably reach. Then eliminate. Somehow.
WARNING - One big issue is developmental ridges on the tooth. Which create edges. The main one is the Cemenanto-Enamel-Junction - CEJ - between the root portion of the tooth and the crown portion. It runs horizontally. There are also various developmental ridges running both horizontally and vertically. So how do you know if an edge is calculus or part of the tooth? Don't want to break off part of the tooth. That would be bad. Answer is to never be too sure about anything. Investigate. Know for sure it's calculus and not tooth or bone. General rule is if you scrape it and it breaks off reasonably easy and results in blood and debris then it is calculus. Also large calculus ledges are too hard to break off all at once. So have to work from the sides.
BASIC PREMISE - General industry description is that pockets deeper than 5mm are difficult to clean. And that pockets deeper than 10mm are too deep for any type of closed debridement at all. And that only surgical debridement will work. But... closed debridement can be expected to leave behind 17-64% of the calculus. While even open surgical debridement will leave behind 7-24% of the calculus.
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Calculus and biofilm are very effective at making good lives for themselves. They infiltrate down the side of the tooth. Then open up territories to build grand thickly layered infrastructures that are almost like cities unto themselves. They live off of blood and sugar.
They also live off the biofilm plaque at the gumline. This fact is most important. What happens is that the gumline plaque becomes the most vibrant and plump. It then transports energy resources down some type of electro-chemical chain to the biofilm and calculus deeper down the side of the tooth.
In addition the deep biofilm and calculus can fend for itself too. What it does is trigger an inflamatory response. Which causes the body to issue blood to fight the infection. This kills some of the bacteria. But after that the surviving biofilm and calculus get to suck out the nutrition from the dead biofilm and blood. Meanwhile the corpses of the dead bacteria pile up into highly multi-layered mass.
So... the deep calculus and biofilm is difficult to reach by any means, including surgery. And the survivors will regroup and perpetuate the infection.
But if progressive debridement is used then the 25% or so that is left behind can be further reduced by say half. And then again by half, etc. So progressively you can imagine the calculus reduced to 12%, then 6%, then 3% and even down to 1% or less of it's original amount. But this can only happen with an aggressive policy towards the calculus plus the means to carry it out.
= = =
For anything less than severe periodontal infection there is no reason to think that mainstream methods won't work. Flossing. Plus perhaps some toothpicks. Along with making sure that the hygienist does a great job. There is no excuse for accepting anything less than a great cleaning. Where the actual cleaning or "curettage" should last at least 30 minutes.
AND even if the infection got to be reasonably advanced as long as there is a deep perimeter that is still intact then there is no reason to go beyond toothpicks. And what you can do when you find blood is to keep on going after the spot with the toothpick, giving it a few days to rest between treatments. Until the spot gives up and accepts staying clean. Likewise you can ask the hygienist to clean out the particularly troublesome areas with extra dilligence, either during regular cleanings or ideally as a stand-alone "touch up" job. In this manner you can get progressive debridement and ultimately gain mastery over the infected pockets.
But if you have severe periodontal infection, the maxim is that the treatment must get more aggressive. And by this to mean that ultimately the instruments have to reach and clean out the bottoms of periodontal pockets. No matter how deep those pockets might go. Even if those pockets have formed into abscesses. Or reached the nerve at the apex of the tooth. Or destroyed the bone between the furcations of the teeth. Or even destroyed the bone between the teeth and the sinuses so there is risk or reality of a hole into the sinus.
General strategy of progressive debridement for extreme areas is to clean out the area as much as you can without causing or risking additional damage. But to stop once the area starts to feel traumatized. Then to let it heal, with perhaps some light cleaning in the interim with the brush-picks or proxy brushes or toothpicks. Then once the area heals the healthy area will be larger and tougher and the infectiond area will be smaller. Then repeat.
Common sense treatment in these extreme cases would be to pull the infectiond teeth. Why? Because the infection has infiltrated well past where dental professionals with instruments can conveniently reach and dislodge the calculus in a reasonable amount of time. Because even a high-quality debridement will leave enough calculus behind for the infection to reflourish. And because the infection is unstoppable. Also to consider is whether losing the depth of the gumline over the rest of the life of the tooth is worth it.
Anyway, idea is that when the tooth is pulled then the infection can be stopped where the tooth used to be. The other options, such as implants, can be implemented. Essentially, when the tooth becomes "totalled" there is not much hope for it. Which is why they call them "hopeless teeth."
The premise of DIY Perio is for people to more or less adopt their "hopeless teeth," as well as all their other teeth and up the level of aggression themselves. After the dental professionals have done all they could. Except perhaps surgery. Where people may choose to take a wait and see approach. While in the meantime getting more aggressive and then deciding whether they are comfortable with it.
Proxy brushes and brush picks are the most elementary level of aggressiveness. Then come tooth picks. Since they can be jammed in deep and aggressive. Then comes the irrigation and aspiration needle. Which is deemed aggressive because it can go in very deep and also dispense irrigation fluid. Plus also seems pseudo-medical. Then comes the explorer. Which doesn't really have a blade. Then comes the curettes. But they cross the line. Since it means that people are doing what is judged to be a professional skill and not something people should be doing themselves. So people have to make the choice.
My general thinking here is not to rush into the curettes. But rather to become more and more skilled with using the toothpick in its toothpick holder. Then perhaps to practice with the explorer and become comfortable moving the instrument around under the gumline. Then go from there. Whatever you are comfortable with. And also to remember the big dilemma. The big dilemma. And not to move forward until you resolve it.
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Aspiration Irrigation Strategy - Use aspiration needle - ie a 22 guage half-moon endodontic needle as an irrigation-aspiration needle - to suck out the nasties OR to wash them out to kingdom come. Flakes, flecks, chunks,blobs & stringy stuff all are subject to the needle. If the needle is right on top of them they get sucked right up. Bye. But... if most of what is there is established layers of calculus then the needle won't break it loose and certainly will not suck it up. For that the only answer is the curette. Ideally from the hygienist. Plus, in certain instances the toothpick could work at least a little bit too.
Write down or diagram the location where it is
bleeding. Then ask your hygeinist
to clean out the bloody area. Can also get more
aggressive with the toothpick and work it with the
proxy brushes and brush-picks too. Which is the
current mainstream general advice.
= = =
But be aware that dental professionals will oftentimes talk about calculus growing back, as if from nowhere. They commonly like to blame mouth-breathing. But in real life most if not all of the calculus that "grows back" is really just old calculus that becomes more active because after the initial SRP debridement it has less competition. This is what I call Gangland Theory and the progressive debridement strategy.
You should be able to ask your dentist or periodontist to clean out a specific area. They should charge you a reasonable percentage of a quad. For example a quad of 8 teeth has 7 gaps. At $300 a quad each gap technically would be worth $45 wholesale. But otherwise a reasonable price is $65 per gap or no more than $75. Unless it is a gusher.
So if you have three areas that you want to tell your hygienist to clean again then you should expect to pay around $200. And they should take at least 20 minutes per gap. And if they don't then tell them to work on it some more to use up the 20 minutes.
But if they pull some 5 minute gig and then try to tell you it's clean then don't believe them. And figure you just got stiffed. And you are still stuck with your problem. And possibly you are at an impasse too. Since you might not reasonably expect a more fervent effort from a different hygienist.
Plus dentists always ask who your "old" dentist is and how come you aren't happy. Then they talk to each other to find out how compliant you are. And are quick to blame the patient. Especially if the patient has a head filled with silly ideas.
So, general advice is that if your dentist is not interested in cleaning out your recurringly bloody pockets to get some extra cleaning on the side, from another dentist, and then don't tell your regular dentist about it. Plus -
MAKE SURE YOU GET A COPY OF YOUR X-RAYS! And if you
get some extra cleaning on the side from another
dentist don't let them forget to give you your x-rays
back! As many people have surely noticed many dentists
are perfectly happy for you not to have your own
X-rays. Think about that. The concept that anybody
wouldn't automatically give you your x-rays back is
completely silly. Of course you should have your
x-rays! Or let them make a copy and only charge you a
few dollars for the copy. Since that is all it costs
Likwise you can tell them you will make sure to bring them in with you whenever you get anything done. REMEMBER - NEVER NEVER GIVE UP YOUR X-RAYS. What are you going to do if you ever want to see anybody else? Get your head zapped again? Nooo. Or maybe diagnose you without x-rays? Nooo again. Both dumb ideas. Of course you are going to keep your x-rays. It isn't a matter of liking somebody that means you have to give up your x-rays. No. You loved every word. It's just that... that... you want to keep your x-rays. That is all. In fact it is really nothing at all, isn't it? So it shouldn't matter one way or another for me to keep my x-rays, should it? I promise I'll bring them with me. I promise.
= = =
CHRONIC WOUND THEORY - Who rules the roost? The nasties or not? Object is to reduce the nasties and tip the balance away from debris and infection and towards healing and life. Through debridement, release of toxins and discouragement rather than poisoning. Per xylitol & lactoferrin. Plus following the spiral upwards of the healing cycle. Basic idea is that if the infection can be eventually reduced to say 1% of its previous levels then the body just might win the fight.
Regeneration - General logic is that it is possible. But wounds tend to recover with various levels of scar tissue and gaps. In particular it is generally believed in the medical community that "dead space" will always to continue to be dead space. But within these limits there can be natural regeneration.
Infection Healing Maxim - Also - maxim of the medical community - healing cannot take place in the presence of infection - also leads to a symetrical conclusion. Which is that healing can take place without the presence of infection. Which argues for 100% hygiene.
Healing Cycle - Infected tissue is typically sickly, poisoned by endotoxins, and traumatized on an ongoing basis by the calculus and biofilm. This means the curette clearing out the crud is also contacting living tissue that is weak and vulnerable to injury. As a general feeling it feels like the curette is floating around in the middle of jello or against various bodily things that seems shredded and highly sensitive and prone to tearing and injury.
RECOVERY - So this tends to limit the attack with the curette on the calculus and crud. But later, after 3 days it is not so tender. After 7 days it may start to heal. Then after roughly 14 days or so, depending on the original trauma from the debridement and the ongoing trauma from the infection what happens is that the tissue gets stronger, healthier and more resiliant to manipulation.
DEBRIDE AGAIN - Finally leading to possibilities after a month or so of so-called "free manipulation" using the Furcator or equivilent instrument like a spaceship throughout the real estate of the formerly infected areas. As a liberator, opening up Furcator communications to help the infection to flee the body and/or get flushed to the outside world.
CALCULUS IS PERSISTENT
- According to
Dimensions of Dental Hygiene in "Using
Files in Periodontal Therapy" (11/2004):
= = =
SEVERE PERIO MEANS LOSE TOOTH & REPLACE WITH IMPLANT
Per article in Dental Economics - "Periodontal Treatment - Extraction or Implant Insertion"
A less than 5-year prognosis for a natural tooth despite restorative or periodontal therapy, warrants extraction of the tooth, with grafting and planning for implant abutment support as part of the initial treatment plan. This treatment scenario may often be faster, easier, less traumatic, and less expensive compared with maintaining a questionable tooth.
When probing depths are above 7 to 8 mm with bleeding upon probing, the teeth are usually placed in a 0- to 5-year prognosis. Maxillary molars with Grade II or III furca are at a higher risk of complications and are often lost within 5 years. If hygiene is poor with Grade II or III furca involvement in molars, the tooth most often is considered in the 0- to 5-year category. This is especially true when other teeth in the same quadrant are missing or hopeless.
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MONSIEUR - YOUR TOOTH IS TOTALED. WAKE UP TO REALITY.
What the article really means is that the tooth has been "totaled." That the cause to maintain the tooth is more than the replacement cost. And if you are paying $200 an hour and the requirement is for hours and hours again and again then the cost will add up. And before you know it paying $3000 to replace the tooth does not seem so bad.
But if a person is willing to do some of the hygiene themselves then the total cost to keep the tooth might not be so high. For example with brush-picks and toothpicks.
Likewise, the hygienist may not be able to go in as deep as the DIY. So in this sense the DIY is doing the work that the hygienist cannot do. And that the only similar thing they can do is surgery. Which is assumed as better. But you can't realistically get your gums cut open every year or two to go back and clean it again, can you? So in this way the DIY is superior. Since you can go back successfully again and again. And if you are both persistent and lucky and just as tenacious as the calculus the area can eventually get fairly clean. Clean enough to heal.
= = =
This leads to a basic premise of DIY Perio that the only reasonable way to get rid of the calculus at the lowest levels is in fact DIY. Enough beating around the bush. Said it. Meaning that as much as you might love to have your hygienist go to the deepest lowest levels the targets are too elusive. And in various ways dental professionals will admit it.
This refers to non-surgical, just using the curettes or the irrigation to clear out the crud.
Hence, in a sense the dental profession has "left the field" for this particular task. Outside of surgery. Since the only credible way they offer to get to the lowest levels is surgery OR claims they will really really go there, but do they really? ANSWER = NOT REALLY
Anybody who does in fact send a dental instrument under the gumline really deep will after awhile start to realize that they are placing the instrument in places that under normal circumstances the dental hygienist is not really going to go. Largely these places will feel highly sensitive and vulnerable. And the debridement will cause pain if not injury to boot.
Issue then becomes: Is this bad or is this good? And reasonably arguments can go both ways, especially if somebody injures themself. But my premise is also that they won't. WHY: Largely because of pain, under normal circumstances. Plus any early nasty lessons will heal and teach what not to do again. Plus obviously, don't be a fool waving sharp objects around nerves. But also figure that nerves are generally pretty good about looking after their self-interests.
In theory, imagine tooth nerves as great blood suppliers. Which make sense. Figure they can resist the infection and wall it away into softer tissue. But otherwise if a nerve has lost bone support somehow they seem to do their best to struggle along. I have one tooth nerve that has been hanging in mid-air for the past five years and is still enervating along, knock on wood. But it has been obviously surrounded by infection. So why didn't it die?
As a practical matter though, though I am always fearful and trepidacious when I approach nerves with the curette. I typically find that the pain of approaching a nerve effectively drives me away.
So I only debride around the edges and then hope and pray that the nerve area will reject the infection soon enough when the perimeter is otherwise fairly clear. Which it will tend to do based on total bacterial "load." Which the body must overcome in order to be able to reject a bacterial intruder that otherwise feels at home.
But since the infection is also obviously up against the nerve too it would seem to make good sense to debride. So best approach seems to be to do it progressively. Wait like 2 weeks or even a month between treatments. Relying on a perimeter of more healthy tissue to enable you to punch the curette in reasonably deep without causing damage. Then repeat again until the area around the nerve starts to become clear and healed. And if so then one more problem has just been dealt with.
In "gangland theory" is this is the same as Let a Thousand Flowers Bloom. Idea being you give the periodontal infection a chance to recover at a certain place and then whack it again. Progressively. Down through the Reverse Doubling Cycle.
Also keep in mind that at least initially the pockets tend to have a convoluted formation. So can very well see some zealous person needlessly separating tooth from gum. Possibly. But realistically would think it would hurt. But otherwise an inexperienced person faced with thick calculus ledges seems outmanned by the infection.
NOTE - But even here, if somebody does injure themself, which I have, typically through overzealousness and the curette slipping within two or three weeks even a reasonably bad slip is likely to heal reasonably well. Leading to the thinking that an especially careful effort is not likely to lead to serious injury. Maybe just a few slips that will heal up just fine within a few weeks. And not to get worked up over.
But meanwhile the argument for good is that the infection will get a chance to liberate itself from each pocket, especially from the deep threatening neo-abscess pockets. And that a dilligent effort, eventually leading to the person becoming more experience ultimately has the potential to enable a person to more or less return their teeth to health. And in a manner where the dental profession has already "left the field." And can't really "be in the field" right now. Because of the structure and theoretical basis of the field. Meaning that DIY is the only way to accomplish the objective of systematically and progressively debriding the deep calculus and crud.
= = =
DIY PERIO - BASIC PREMISE - CALCULUS IS UNACCEPTABLE - CALCULUS MUST GO - CALCULUS IS BAD - NOT BENIGN - - We hate calculus, a lot. Less severe position is that we are in fact Liberating the Calculus. So it can live a free life somewhere down the Mississippi River. Or to respect it. Like the Xenomorph it is. Oftentimes even including a mother ship. And once the calculus is gone the teeth do in fact heal. And even though the calculus always comes back it can get attacked again too.
As a side point, I do not much believe in poisoning the calculus. The biofilm survives on its dead comrades. So killing the biofilm only creates more food for the survivors. The only answer is Removal. Send the calculus off to live in the sewers.
DISRUPTION CAN REMOVE CALCULUS AMONG THE CRUD - Also, significant calculus can oftentimes be removed simply by disruption. Without any blade contact. In which case huge colonies of blobs, including free floating calculus can be liberated simply by getting an instrument into the actual area of the xenomorphic colony. Upon which time the body will produce large quantities of blood to flush out the colonies, akin to flushing a toilet. Where the communication between the calculus and blobs and the outside world instantly triggers the body to reject the foreign nasty stuff.
ARGUMENT - IT'S THE BIOFILM - NOT THE CALCULUS - But why be such a hater? This is a common argument of the dental profession. It works like this - If only you would stop feeding the calculus all that junk and floss and brush more often wouldn't all that calculus become more inert and inocuous? First reaction is if the sayer is out of their mind. But... they do have a point. What the calculus largely does is provide housing for nasties. But it can survive for a long time without adequate nutrition and will slowly turn to rock. But no matter what it will always remain a noxious substance. Especially with all of it's accompanying biofilm. Adds up to an ugly combination.
CRUD MIXED IN WITH CALCULUS - My experience is that the initial contact with the infected area with instruments oftentimes releases a flood of bloody crud. This is a combination of biofilm, loose calculus, previous blood put out to defend against the infection, plus a new release of blood and plasma that "flushes" the infection out of the pocket. Typically in the middle of the blobs are large pieces of calculus and stringy crud. Functioning as a kernel. After the initial release it gets harder. Somehow there is a reservoir of ongoing infection. Existing in different ways. Calculus in a sense can function as a storehouse for infection. Fluffing itself up as upper layers are scraped off.
CALCULUS REANIMATES ITSELF - This is a basic premise of DIY Perio. The claim is that removing the more easily removable layers and blobs and chunks of crud will create a more open environment for the harder to remove areas of infection to thrive. What will happen then? The layers of calculus will fluff up with new infection and then become vulnerable to removal. In this manner over a period of time an area can progressively be cleaned out by removing the calculus as it reanimates itself. And thereby be able to "get to" the tenacious calculus that resists getting chopped away.
Also keep in mind that the floss does not go down so deep. Though the proxy brushes and toothpicks do go down fairly deep and can become a mainstay too. But anyway, bottom line is that floss is not going to stop periodontal infection below floss level.
CALCULUS vs BIOFILM - Counter-argument is again "It's not the calculus, it's the biofilm." Claiming that daily removal of the freshest biofilm will halt the disease. Here can certainly see the argument. Even though it seems to ignore the older biofilm hidden away. But as it's opposite can certainly see somebody dilligently removing old calculus and crud while ignoring the daily biofilm buildup. So here the person might be encouraged to give just as much attention to daily care as to attacking the longer term invader.
So what is the argument against boldly attacking the calculus? One is damage. But second one is more damning. That removing higher level crud will tend to expose the lower level crud to the benefits of a richer and higher lifestyle. Leading to some real or make believe phenomona that I term as "Sliding down the dinosaur."
SLIDING DOWN THE DINOSAUR - BAD - What is "Sliding down the dinosaur" ? - It has two components. Main one is that the deeper areas are now better fed. So removing the upper layers of crud potentially leads to the so-called "last stand." Where the infection now can robustly attack deeper layers of bone. And hence cause a a periodontal abscess. Which is more or less pretty close to a disaster. Since it can quickly lead to the most immediate and urgent loss of the tooth. "Pull that thar tooth right out please." Just like back in 1930s movies, but yet today.
CRATERING - WHO IS THAT SLIM BONY FELLOW? - This is the greatest mystery of all. What was bone turned to crud. Nobody saw any symptoms. But the bone is gone.... Here like to point out that peridontal infection diagrams usually only include one tooth. But any tooth is next to another tooth. And what destroys the bone for one tooth also destroys the bone for the other tooth. This leads to the reality of a thin stick of bone surrounded by crud and calculus. So what is going to happen after all the crud is removed? Naturally it would look like the area would collapse into a crater. But what about the bone?? This is a big mystery.
But what is the alternate? The natural alternate would be that the crud is somehow magically removed, but that the skinny amount of bone that is left over can contain it's form Alternately it is that there includes demineralized bone, which looks a lot like the surrounding crud, which could recover bad again into hard bone. Is this true or a fairy tale. Think it is probably a fairy tale. Unless you had some super-duper hygienist. So who knows.?
WHAT IS THE REALITY OF THE CRUDDY BONE - Simplest explanation would seem to be that the previously healthy bone gradually got more and more cartilage-like. De-boning itself so to speak by giving up its calcium tri-phosphate structure. And then becoming even weaker than cartilage. So how strong is it? Really. Can it actually survive a minimally invasive strategy? Probably not. So... when the surrounding calculus and biofilm is removed abruptly the left-over bone and cartilage superstructure just does not have the tensile strength to hold itself up and gets washed away with the calculus.
YIKES - YOU MEAN THE GOOD GETS WASHED OUT WITH THE BAD? - Can always hope for miracles, But when the good gets mixed in with the bad and also becomes sickly then what is to differentiate pseudo-living potentially viable tissue from the crud? ANSWER: As best as I can figure the traditional view of the medical community throughout history has been that "If it looks like crud then treat it as crud."
CRAZY STUNTS - PULLING DOWN BONE - This is a very difficult area to review. Since early debridement includes a lot of bulk of calculus and debris. Plus the bone and gums are traumatized and sickly. So presumably first step in a professional SRP. But after that my basic attitude is I always presume that I could very well accidently break off part of my jawbone. And largely the effect has been to make me very timid. Which I figure is reasonable enough.
DO NOT TUG ON BONE ! - AND KNOW THE DIFFERENCE BETWEEN BONE AND CALCULUS ! - OR POSSIBLY CAUSE BAD DAMAGE TO YOUR TEETH - ALSO DO NOT PULL ON ANY GROOVES OR RIDGES IN THE TEETH OR ON THE CEMANTO-ENAMEL JUNTION (CMJ) - This is the edge between the crown and root of the teeth. In general don't tug too hard on anything that puts up a good fight unless you are 100% sure of what it is. Also if it is calculus it will tend to get bloody. Then can largely go after it like a truffle-dog.
But otherwise I am very leery at tugging on ledge-like objects. Though there are a limited number of possibilities and one of the great ones in calculus. Nonetheless, bone can become recognizable. So always try to make sure you are tugging on tooth and not bone! So now he tells me! Also, don't want to break off a tooth either. So certainly try to be naturally careful. Even though you are sticking knives into your mouth.
= = =
ANOTHER PERSPECTIVE - REGARDING CRATERING - What are some of the things that are going on? Inflamation, obviously. From the large amounts of infection and crud. Next step is that it seems pretty obvious that the crud is going to have to go. But is the crud holding a hostage? YES YES - What? Who is the hostage? The leftover bone!! When you go after the crud please don't shoot the bone too! Take good aim.
MEANWHILE, BACK AT THE BONE - What is going on? Clearly the bone is hurting bad. It's demineralized. It's surrounded by infection and crud. It is definitely not happy. So, is "killing for peace" the hostage bone an absolute necessity? Don't know. What I imagine might be possible would be to debride either side of the bone and somehow have the bone survive, like a radio tower held up by guy-wires. Then as the infection is mostly removed then the surviving bone somehow manages to remineralize and survive without much loss of level.
BAD TO THE BONE - It would appear that the reality is that if the area is not to bad that the bone will still have some life left in it. Especially if there is a reasonable space between the teeth where the bone can survive. Most of the teeth should be this way. Not so horribly diseased. Once cleaned out they will tend to heal. In addition you can reasonable expect some of the somewhat demineralized bone to survive, remineralize and even fluff up, adding a millimeter or two of height. So the missing bone is mostly not missed. Or missed. But there is enough left to make you happy.
But, if the area is bad, then what that really means is that the calculus has worked its way most of the way down the tooth. And the instruments have to go right past the demineralized and dicey bone to get to the infection. Especially if the infection is on both sides of the gap, which it certainly most obviously is. So what happens now? Basically the weak demineralized bone collapses and you are left with a crater. Likely with deep layers of infection right next to the nerve too.
BAD TO THE BONE - What can be done here? Looks like here the only alternative to cratering would seem to be surgery. Or super-skilled SRP. Or maybe the cratering is inevitable and to worry about saving bone that cannot be saved is false. Don't know, but suspect the cratering is largely inevitable for severe infection.
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INFECTION RIGHT AROUND NERVE = EVENTUAL DEATH OF TOOTH - In particular, once the infection has messed with the nerve enough the tooth will typically die. So now have to get a root canal. For say $800. Plus need a cap for another $1200. Or $2000 for a tooth that will still have serious periodontal infection, including an ongoing likelihood of getting an abscess. Which could mean have to pull the tooth anyway. Or get an implant. Which I am guessing will cost around $3000. Under these circumstances the implant looks like a good idea.
SO PARTIALLY RECOVERED TISSUE IS TOUGHER THAN INFECTED TISSUE?
Yes, Leading to general idea to clean out as much as possible, but not to get too dicey. Then after that heals to gradually get more aggressive. Can also go sooner and go back as few as three days later. Figuring the trauma will subside by then. But also can figure that after a month or even two weeks that the sensitive area will have had a chance to heal somewhat from being relieved of so much active infection that it will tend to get tougher. So, if you have a concentrated but widespread area of infection then it can be partially reduced then gone back to after it has had a chance to recover and heal. Second time the most sensitive area will be significantly smaller.
So, gradually a stricken area can be reduced so much of it becomes healthy again. And then to repeat progressively until the stricken area becomes even smaller. And is surrounded by healthier tissue. This way if you accidently cause a disaster at the stricken area then the size of the disaster will be smaller too.
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ORO-ANTRAL MAXILLARY COMMUNICATION - BAD - For some people their molars go right into their maxillary sinuses. So if the infection gets close to the apex of the tooth then naturally it seems likely there should be a hole into the sinus too. But the body tries it's best to avoid these situations. So one way or another the sinus will typically get walled off. But if this situation is allowed to persist, with or without open sinus communication then it seems pretty obvious the tooth has to eventually be a goner. Since it is so easy to imagine the deep infection progressively removing the possibilities for the tooth to survive.
- SEE - www.diyperio.com/sinus.htm
CALCULUS - TO BE OR NOT - Am In some imaginary exercize, if calculus could be removed without causing additional harm there would be no question to remove all the calculus. BTW debridement is generally considered to be akin to a no-brainer in medicine. Meaning that arguments in favor of debridement are taken as obviously true. But which even so is still only partially true. Or at its simplest level, nasties are always interpreted as injurious to wounds. Plus removal of nasties is always considered to be beneficial to the prospects for wounds to heal. Unless there is some compelling reason not to.
DIY PERIO - A MORE AGGRESSIVE APPROACH - INCLUDING INSTRUMENTATION - Or, after the basic SRP from the specialized periodontal dental hygienist to consider taking a more aggressive approach towards the periodontal infection. Based on following the trauma & healing cycle for any type of aggressive activity where the gums get sore and are likely to be traumatized or even injured. Likewise to follow the cycle for the healing too. Keeping in mind that healing is highly impaired by the presence of infection. Meaning that periodontal infection is correctly termed as a chronic wound.
All of this leading to a self-education process. That potentially leads to higher and more delicate and potentially dangeous levels of aggressive activity. Which also help clear out and debride the infection. Which then becomes subject to the healing cycle. 3 days to reduce basic trauma. Up to around 11 days to calm down more highly aggressive trauma.
DIY PERIO - FOLLOW THE HEALING CYCLE - PER CHRONIC WOUND THEORY -
It takes roughly 3 days or 72 hours for the Extra-Cellular-Matrix (ECM) to lay down the various biological materials to set up the start of the actual repair cycle. 4 more days or a total of 7 days to finish the first healing cycle. Through Primary Intention. Meaning only primary surfaces will mend. For more serious trauma you can think in terms of number of healing cycles.
From these numbers you might imagine that 11 would be the end of the Second Healing Cycle. Then 15, 19, 23 etc. Since the first 3 days were consumed setting up the original ECM
But it is easier to remember that a healing cycle lasts roughly 7 days. And just imagine a series of overlapping events. Especially since it looks like the ECM can still be layed over traumatized tissue, just not as well as it would if the tissues were not traumatized. Likewise it looks like a traumatized area of tissue right next to a non-debrided area can still recover from trauma. Only not as well as if the area had been properly cleaned out.
Why is this important? Main reason is it helps plan for recovery. So, after say a particularly nasty piece of work, perhaps even with loose teeth and strange random pains, you can say to yourself that - Every day in every way the teeth can heal better and better - And after say 3 days or 2 weeks or whatever it will get better. And you can plan on that.
Likewise you can visualize the repair process. So if say you were to liberate a particularly nasty bunch of crud you can predict 3 days to stop hurting, 7 days to feel halfway normal and say 2 more healing cycles or a total of 21 days to return to a natural baseline. Then, if you want to, or maybe after 28 days or even longer you can go back and do more debriding.
All of this leads to a real estate analogy. Also called Gangland Strategy. Where the infection occupies various niches. Plus the geography and ecology is infection friendly. Object then becomes to make the area infection unfriendly, starting with getting rid of the debride-able infection. But... the infection will then return, mostly in latent quantities. Which fill up the niches again. Then strike again. This can also be termed as a Halving Process. Cut in 2 then cut in 2 then cut in 2 etc. Originally this will lead to cutting the infection in half, then into a quarter then into an 8th,16th, 32nd etc. Object then becomes to reduce the infection down to Nil. Which is impossible of course. But which nonetheless represents a remission. Though maybe not all around. But nonetheless to most.
LEVELS OF AGGRESSIVENESS - FROM FLOSS TO INSTRUMENTATION
FLOSS - First level of aggression is obviously dental floss. Which is universally approved. Next would come the proxy brushes. Next would come the brush-picks. With a spear on one end and a TV antenna on the other end. Brush-picks can be used with fairly intense results. Get lots of blood and large blobs and flecks of nasty looking stuff means Jackpot. Get rid of all of that stuff and the disease is curbed. But GFL there if you have severe periodontal disease. In which case it turns into different levels of challenge. Plus questions about the depth of the disease.
TOOTHPICKS - After the brush-picks the next level of aggression would be either the toothpicks or the aspiration needle. In the case of the toothpicks the wooden surface can polish off a lot of the biofilm. Plus the toothpick can go in fairly deep to disrupt and liberate blobs upon blobs of bloody crud. From here there is no reason why this process cannot be continued indefinitely to eventually result in fairly clean teeth. To summarize, the toothpick can knock off a lot of crud. And for people who don't want to mess with DIY instrumentation the toothpick is a relatively safe choice. Disadvantage is it does not really knock off calculus ledges very well. But the hygienist should be the one doing that anyway.
ASPIRATION NEEDLE - These can go in fairly deep. Especially into any deep cratered pockets.
EXPLORER PROBE - This can be used for trial instrumentation.
GRACEYS & UNIVERSALS - CURETTES - Once studied and applied in super-slow-motion it is possible to use these things to remove crud. But it is a complicated somewhat dangerous and potentially injurious thing to do. Since it basically involves sticking knives into your jaws and scraping away at rock-like monstrosities that want to stay right where they are and which are going to resist removal. Hence the term "tenacious calculus." They mean it.
But also remember that skill level will tend to improve over time. And maybe things won't be as nasty as imagined. But also to remember... general idea is to finish what you started... so if you end up with some nasty bad stuff you pretty much have to eventually finish it. Or get the hygienist to finish it for you. Say please please pretty please and say it some more and they might just do it for you. But otherwise, in the case of serious periodontal disease, what will happen is you will quickly end up in deep over your head and with no knowledge of how to swim. And only remembering one thing. To try to clear out as much of the crud as possible and then to stop and let it heal. Then in a few weeks to maybe go back again.
PIEZO ULTRASONIC ?? - This sounds pretty crazy to me but cheap ultrasonic scalers can be purchased on the internet. But think they could damage the teeth. Likely through heat. But I could be wrong and don't know anything about them. Plus the instruments sound pretty dangerous too and the ultrasonic might be easier. So possibly it could work.
HOW DEEP IS DEEP - Standard periodontal chat and reckoning is that reasonable and thorough cleaning can only be achieved if pockets are less than 5 millimeters deep. But pockets 5-10 millimeters deep can be fairly common. So standard logic is to clean them as best as they can. While accepting that some calculus gets left behind. Likewise you can imagine what is possible without surgery if the pockets are even deeper than 10 millimeters. Or where the pockets go almost all the way to the nerve. What then?
CONVENTIONAL WISDOM - $$$ - SURGERY OR IMPLANT ?
Conventional wisdom is surgery or just accept the fact of losing the tooth and getting an implant. And conventional wisdom also includes the admonition that even the surgery will not help forever. Classic logic would seem to be that the surgery will last for 5-10 years. Or more. Putting off the day of reckoning until as long as possible. Like Two-Minutes to Midnight.
BASIC CLAIM - DIY PERIO IS BETTER THAN SURGERY - DIY Perio offers a different approach. Which is to go after the deep stuff and get rid of them. And more or less to forget about the surgery. But based on what? Based on what? Based on the purported claim that a person can use the curettes and irrigation-aspiration needle to DIY to the same or almost the same level as the surgeon. And meanwhile save the money. Then once the crud starts to come back again, on an ongoing basis, go back and debride again.
MY STORY - 6/7 GAP - As example, I have been working on a gap between Tooth #30-31 since June 2011. Six months so far to January 2012. The entire are was deeply infested with calculus ledges. As I went in deeper there were numerous residual calculus ledges. Plus a lot of time was spent waiting for the area to heal between treatments. So what is the point? Reasonably it might seem the only other alternative would have been surgery. Or perhaps a second SRP from the hygienist. Nonetheless, through numerous treatments managed to clean the area out fairly well. But still not finished. The calculus appears largely to have gotten quite close to the nerve. So what is the point? That I may prove to ultimately be successful. And that the very nature of my approach is that it takes a long time. So would surgery have been better? My answer is shouldn't the SRP have cleaned it out already quite fully? But obviously it did not. Or I wouldn't have been digging away all these past six months.
But how is this possible? And isn't this starting to sound a lot like somebody doing surgery on himself? Well yes and no. But mostly no. I can explain. Let me explain. But starting with the premise and basic claim that the only way to reasonably get to the deep levels is DIY. Since I can take all day to do the work. And won't charge a dime. Plus what I may lack in skill I can at least partially make up for with dillegence. Plus nobody is talking about replacing the best dental hygiene and hygienist possible, short of surgery or extraction. But rather to go in deeper and recover what what already missed by them anyway. And if all this can be accomplished eventually then maybe miracles will happen. Maybe even some of the bone will grow back.
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WHACKING THE HORNETS NEST
CURRENT SITUATION - JANUARY 2012
keep in mind that if the area is cleaned up well
enough it will tend to "skin over." So even if there
is still a hole left in the bone the skin will prevent
leakage. Or, similarly, if the periodontal infection
is cleaned up well enough then the tissues around the
hole will tend to shrink tightly and mostly seal off
the hole. Plus the sinuses also have defense systems.
With thickened tissue around the hole. Plus some gooey
stuff to help seal things off. So, breaking into the
sinus is bad. But it is not the end of the world.
unfortunately the only person besides a surgeon who is
going to be able to reach into those areas is the
patient himself. And it might takes hour and hours
just to clean out one spot. But the person does not
have to pay himself. So... if say 10 hours of the
patient's effort could have theoretically been done by
a hygienist in only an hour then the patient is paying
himself the equivalent of $10 per hour. But anyone who
attempts this will quickly discover the hours add up.
And problem areas can quickly turn into big problem
areas. Where the bloody crud just keeps coming and
coming and doesn't quit.
DANGER OF BACTEREMIA AND INSTANT SLOW CRUEL PAINFUL DEATH OR OTHER HORRIBLE THINGS - Theoretically possible but not likely. Except for people with particular issues they should already know about. Namely auto-immune issues and implanted devices that could catch the bacteria. Or other hidden health problems.
keep in mind that bacteremia is present in all dental
cleanings. Nonetheless we don't hear about people
dying from dental cleanings. Under normal
circumstances can count on the immune system killing
the invaders before they can get the upper hand.
ISN'T DIYPERIO FOR HOURS AND HOURS AT A TIME?? - Good
point. Normal dental procedures don't generally go on
for hours and hours, whereas DIYPERIO does. So that
could mean that DIYPERIO is more dangerous than normal
dental procedures. Likewise DIYPERIO leaves the deep
layers of bacteria behind. So DIYPERIO could be
setting people up for a bacteria bomb down the road.
IN DEFENSE OF DIYPERIO - Some dentists will also try
to hold onto compromised teeth. But maybe DIYPERIO
holds on to compromised teeth even more so than
dentists do. So botom line is if the person feels they
are losing the battle against the bacteria, possibly
feeling sluggish, or get other indicators of poor
health then maybe it is time to pull the plug and pull
the teeth. There is no way around this bacteria issue.
Either you are successful reducing the bacteria load
or you are not.
SEARCH - BACTEREMIA PERIODONTAL BLOOD INFECTION - SEPSIS - BLOOD POISONING -
WIKIPEDIA ON BACTEREMIA - QUOTE- Common oral hygine, such as brushing teeth or flossing, can cause transient but harmless bacteremia. Some patients with prosthetic heart valves however need antibiotic prophylaxis for dental surgery because bacteremia might lead to endocarditis (infection causing inflammation of the interior lining of the heart). - ENDQUOTE
DANGER OF BACTEREMIA - And that even the worst possibly, bacteremia, which will and can lead to massive and instantaneous total bodily infection and an excruciating painful death is very very rare. In fact there are not even very many documented cases. Should check it out, but think it is rare. Though tooth cleaning, whether by DDS or DIY does cause bacteremia. Which the body thankfully has the abilities to snuff out quickly. Most of the time. But also have to figure the hours. With a dentist the bacteremia may only have to be suffered for around an hour or so. But for DIY the person is subjecting themselves to bacteria for multiple multiple hours. Like maybe even four or five hours at a time at a long session. Eventually adding up to hundreds of hours of bacteremia. So is this enough to get the body protection system to lose? If so then the DIY would obviously be a bad idea. But since the likelihood is so small then it sounds like a reasonable risk that I took and I am glad that I took the risk. Since it delivered to me my teeth, largely intact though highly damaged. Also anybody with any reduced or overactive autoimmune functions or any artificial anything inside the body, whether lenses or knees or hips or valves already knows that any DIY is a really really dumb idea.
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HERE - HERE ARE YOUR TEETH - DO-IT-YOURSELF? - PROBABLY A BAD IDEA - BUT IT IS YOUR CHOICE - PLUS DON'T WANT TO LOSE THEM - WHY NOT FLOSS MORE INSTEAD? - ALSO EVEN WITH THE BEST OF INTENTIONS THE CHANCES OF SLIPPING AND INJURING YOURSELF ARE TOO GREAT - SINCE YOU WOULD ESSENTIALLY BE TUGGING ON A KNIFE UNDER GUMS - ONE SLIP AND YOU SLICE UP YOUR GUMS - NOT GOOD - BUT GUMS DO HEAL - AND SKILLS DO IMPROVE WISENED BY ERROR - JUST DON'T SCREW THE POOCH (THE NERVE) - ALSO DON'T BELIEVE THAT STUFF ABOUT GUMS NOT GROWING BACK - SEE SPECIAL WARNINGS AT END
LINE IS DIY CAN GO IN DEEPER THAN ANYBODY BUT A
SURGEON - SO IF SURGERY IS YOUR ONLY CHOICE -
BESIDES EXTRACTION - AND YOU DON'T LIKE THE TWO
CHOICES THEN DIY IS A THIRD CHOICE - POSSIBLY A BAD
CHOICE BUT STILL A CHOICE - OR COULD GO HEAVY ON THE
TOOTHPICKS AND WATER-PICK BLASTS - WHICH IS MORE
CONVENTIONAL - BUT PROBABLY WILL NOT SAVE THE DAY
Where are your teeth going to be in ten years? In a jar next to your bed when you sleep or still in your mouth. To reiterate - periodontal infection infiltrates down the side of the teeth to depths that are inaccessible to professional technicians within the alloted time slot and pay grade. Hence the reason why periodontal infection is incurable. Even with expensive surgery. It is largely an economic dilemma. Once the infection reaches the deeper levels it is virtually impossible to completely eridicate. In addition it creates pockets that even when perfectly clean turn into what is called Dead Space. Where there is very little available public information. Except that it persists. Anyway... blah blah blah... what all of this means at the end of the day is that if a person can teach themselves the ability to reach these deepest layers where the infection is residing, and then off-shore or farm in hundreds of hours of free labor by doing the work themselves, which would otherwise cost them thousands of dollars of professional costs, even if these services could somehow magically be offered, though they are impossible to offer at this time in history, then these people will wonderfully for themselves and like magic gain the ability to get the upper hand against the infection. These people will win. Not the infection. Which is not to say that this learning process is not without dangerous risks. It does involve dangerous risks. BUT in a moment of honesty will say that these risks are overblown. Most of even the dumbest though not worst mistakes will heal in a matter of weeks or months! Plus if there is anything permanent then the mistake must have been real bonehead. Or failed in real basic stuff like keeping a disaster zone clean.
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PERIODONTAL REHAB/OVERHAUL - Also, one last thing,
which is that on my webpage I talk about the
"Eight-Hour SRP" for $1200 or $150 per hour, when the
industry standard seems to be the "Four-Hour SRP"
which works out to $300 per hour. As a goal I imagine
two eight-hour SRPs combined with GUMS OPEN UP and
more aggressive instrumentation for a total of 16
hours. 8+8=16 hours. Which at $150 per hour would work
out to a $2400 "overhaul" of the periodontium. Which
is less than the cost of just one implant.
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