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DIYPERIO MANIFESTO - The basic DIYPERIO positions are the following:

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

2) SAVE THE TEETH! - Definitive debridement is a myth. It does not exist. It is a fallacy. The proper metaphors for periodontal disease are - PROGRESSIVE DEBRIDEMENT & CHRONIC WOUND MANAGEMENT THEORY - What this means is that even the best SRP cannot truly get infected tooth roots anywhere near clean. So drop the claim. The tooth roots are still filthy and infected. So stop pretending they are not. Move more towards a double-SRP metaphor. And if it costs $1200+1200=$2400 then - SO WHAT? - It is still less money than even a single implant or a set of dentures. Or even a triple full-mouth SRP - GET AGGRESSIVE - STAY AGGRESSIVE

3) In cases of deep infection, such as with apical periodontitis, DIYPERIO believes in going around the tooth, not drilling through the tooth. Similarly in cases of root resorption to focus on external curettage and natural or enhanced hard tissue regeneration. This also includes application of 3MIX-LSTR concepts to rehab the tooth from the inside via anti-biotics absorbed through the dental tubules.

4) DIYPERIO claims that gums naturally cling to calculus. The reason is that the gums have a scalloped surface that naturally clings to the rough surface of the calculus like Velcro. This creates a false illusion of shallow pockets when the reality is that the deep calculus is slowly infiltrating toward the apex and the deep infection is just bubbling away.

5) DIYPERIO claims to have a solution to the clingy calculus. That continued curettage in a single area releases toxins from the biofilm that cause the gums to release blood and become dilated, like a balloon. This causes the gums to uncling from the calculus and creates a wonderful opportunity for closed curettage, all the way down to the bone, hence getting around the absolute need for surgery to get to the deep calculus. Which is not to say that surgery is not often the way to go. But to focus more on closed debridement and open-flap debridement rather than jumping to more radical solutions involving a lot of cutting and additional periodontal destruction.

NOTE - DIYPERIO agrees it is impractical for dental professionals to focus large amounts of time on a single tooth or a single area in order to get the area to "open up." Nonetheless DIYPERIO is pretty convinced that some sort of drug should be able to get the gums to "open up" quickly enough to make the closed debridement practical. DIYPERIO does not claim to have the actual solution. Just a promising avenue for R&D that DIYPERIO is quite convinced will be successful. It could be really simple too. Maybe even dipping the curette in hyaluronic acid would help get the process started.

6) DIYPERIO also claims that many periodontally abscessed teeth can be saved through curettage and progressive debridement, that nowadays currently get extracted, on account of being "too totaled," ie cost more to recover and rehab than to extract or replace. DIYPERIO believes that a greater focus on abscess curettage should be able to shift the economics more towards saving the originals rather than being so quick to extract the hopeless teeth and replace with dentures or implants. Likewise, since the area is so small and the degree of involvement so large, then getting the gums to "open up" should not present such a big challenge. Even if basic curettage is the primary mechanism. And no "magic bullet" drug is found. Or if the practitioner has to rely on some make-do stuff they stick in there that they hope will work.

7) DIYPERIO does not believe that present instruments are aggressive enough. In short the practioners are simply outclassed and belittled by the calculus and dead stuff. As example an "aggressive" instrument, the LANAP, wants to charge super-serious money, just based on its aggressiveness. DIYPERIO believes that more conventional instruments are needed that can also be aggressive. In particular DIYPERIO likes SLAP-HAMMERS and sharper angles. DIYPERIO believes that debriding calculus is a lot like chopping wood. Split the calculus and it will naturally surrender. Plus additional proposed solutions for Necrotic Periodontal Membrane. Which is harder. In any case DIYPERIO believes in more R&D to make the more aggressive instruments. That will in turn turn around the equation more towards hygiene and less towards surgery and extraction.

8) DIYPERIO is aware of many of the dicier more treacherous, more deadly, more dangerous problems. Including facial nerve involvement and holes into the sinuses. Plus invaded salivary glands. Plus submandibular breakout into the sub-lingual region and other ugly horrendous things. Like jaw infections, bacteremia and things that can kill you or mess you up real real bad. Otherwise known as the "DEEP INFECTION DEBATE" which has been going on for over 100 years. With two basic sides... SAVE or EXTRACT - or - HOW DEADLY? HOW REAL? -   DIYPERIO believes that ELBOW GREASE can change the equation. More towards SAVE and less towards EXTRACT.  But HOW to get the elbow grease?? Through MORE less expensive DENTAL HYGIENE and through LESS more expensive PERIODONTAL SURGERY. Which just blows the budget for a lot of people, where a more judicious application of folk's money could save the day, and not leave them up a creek.

SUMMARY - DIYPERIO wants patients to be able to make a simple request and have the dental profession heed the command.  Thereby putting the patients into the driver's seat, with a simple command - SCRAPE SCRAPE AND SCRAPE SOME MORE - Plus DIYPERIO believes that R&D will save the day and prove DIYPERIO right. Along with proving the efficacy of increased aggressiveness as a general metaphor.

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YOU-TUBE 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.

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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.

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- 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.

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- 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, chemical debridement, 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

SPECIAL 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 LEADER.

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- 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 highly severe.

SUBMANDIBULAR 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 antibiotics.
Here is a description of the problem and a description of what the surgeon does - It will curl your hair - DEEP NECK ABSCESSES

SPECIAL 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 out.

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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.

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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.

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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 infection).

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 points too.

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PROGRESSIVE 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."

This is more or less the same strategy as both DIYPERIO and Winston Churchill. "When you are going through hell keep going."

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KICK 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.

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There 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 collective colony.

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.

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Come on baby, finish what you started
I'm incomplete
That ain't no way to treat the broken hearted
Come on and finish me

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 Out of the ruins
Out from the wreckage
Can't make the same mistake this time
We are the children
the last generation
We are the ones they left behind

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Well, there ain't goin' to be no hangman
Putting no rope around my neck little child
Well, I said there ain't goin' be no hangman
 Putting no rope around me

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Islands in the stream
That is what we are
No one in-between
How can we be wrong?

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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.

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DO 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:

With 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.


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SO DO 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.

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WHAT'S A DENTIST TO DO? EXTRACT YOUR IFFY TEETH OR TRY TO SAVE THEM? -- Twenty years ago many dentists and periodontists wanted to let people keep their teeth through extensive debridement.  But nowdays since implants are such a boon maybe extraction is better...

What to do with Questionable Teeth? -

-- "Prior to the ubiquitous use of implants, many periodontally diseased teeth were retained through frequent recalls and heroic treatment efforts... Should we now be revising our traditional approach to the retention of questionable or marginal teeth and leaning more toward extraction and replacement with implants?"
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Well, there ain't goin' to be no hangman
Putting no rope around my neck little child
Well, I said there ain't goin' be no hangman
 Putting no rope around me

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-- If you donít want to use the army, I should like to borrow it for a while. Yours respectfully, A. Lincoln.
 Letter to General George B. McClellan, whose lack of activity during the US Civil War irritated Lincoln.

-- The best thing about the future is that it comes only one day at a time.
Abraham Lincoln

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--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.


Whoa 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.

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The 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.


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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.


USE 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.

But, 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?

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PERIODONTAL 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.

SUMMARY 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.

COME 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.

ALTERNATELY - 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.

NOTE - Open 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 recession.

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But in the meantime.... Pizza Parlor Owner: "Hey!... What about my pizza?" - Tony Montana: "Screw your pizza!"

What this 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.

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SO WHAT ARE YOU COMPLAINING ABOUT AGAIN? - -  DIYPERIO says definitive debridement of the periodontium is a myth. But nonetheless the dental profession clings to this myth because it makes life easier for them. But they don't have to cling to the myth if they don't want to. All they have to do is read and accept professionally acredited articles that say that even after surgery upwards of 7% of the calculus is still left. Which will then grow back. Or they have to go back again and do some more deep debridement.

Meanwhile DIYPERIO claims that progressive debridement is the only strategy that makes sense. Meaning that you agree at the start that you are going to go back as many times as you have to do, progressively debriding the calculus down to NIL. Plus if you don't cut then there is less scarring, right?

GUMS OPENING UP - Key to the DIYPERIO strategy besides putting a lot of time into the debriding is getting the gums to "open up" which is a bit of a mystery. But easy enough to imagine for anybody who has ever gotten a boil or other skin infection where the infected area opened up as the infected material was getting released, thereby providing a great opportunity to clean out the wound. Then closed up a little bit later and seems to seal itself up, so you could not go back to try to clean the wound any more.

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ORAL MICROBIOLOGY - SUMMARY OF MAIN POINTS -  from a Russian dental journal -  www.med-stud.narod.ru/med/dentistry/oxf_periodont.html - STRONG POINTS
- Calculus-tartar under the gumline takes many months to form. This means most of the calculus from before was there already.
- Periodontal infection likes low oxygen levels. This means that any type of mechanical disruption with possible release will help oxygen to enter. It also suggests the fruitfulness of irrigation with oxygenated fluid. Such as honey or highly-diluted hydrogen peroxide or very weak very weak bleach.

- 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.

WHAT 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.

SO 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 simple.

BUT IT 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.

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PERIODONTAL TUNNELS - WTF? - WHY IS THIS IMPORTANT? - YIKES!! - The issue is that once the infection has reached the point where it cuts its own tunnels through various pre-existing channels or weaknesses in your jawbone, presumably uppers or maxillary, into the interior of your upper maxillary jawbone you are deeply screwed. Like genuinely. Like real. BUT YOU CAN ESCAPE TO HYGIENE IN SPITE OF ALL THE ODDS AGAINST YOU - SO certainly infective activity within the tunnel should properly be confronted with means to de-establish them from their environment, ie the inside of your jawbone.

THINK NEEDLES. Which may indeed include HA but not before the active infection has been reduced multiple times. So there is hardly anything left except for the "spit." Which indeed it can do and surprise you with its ferociousness - so always be wary of any tunnels. But always commit to reduce them one way or another. They don't go away through ignorance. Nor inaction. What is the best way to deal with tunnels - besides the oral surgeon? - besides pulling the nearby tooth or teeth? - ASPIRATION OR TO FIND A WAY TO JUST LET IT DRIP - (this is termed as ancient-egyptian-style but has certainly been common throughout time)

NOTE - I have revised my position on needles over the past two years. Used to think of needles as a way to get into nooks and crannies that were hidden away. Now think that needles in reality are mostly just ways to get around the fact that there are walls of calculus blocking your way into the interior. Leading to observations like the existence of "lower decks" and "upper decks" and "shimmy to the right" etc.

But what is causing all the blockage?? CALCULUS! - So does that mean you need to improve your negotiation skills with the calculus or just wipe it out. The answer is to wipe it out. Don't try to negotiate with it. BUT IT'S HARD! - Too bad. If it takes 10 hours it takes 10 hours. If it takes 20 hours it takes 20 hours. TOO BAD.

SO NO MORE NEEDLES?? - This is not to say no more needles. But in the amount of time spent searching for gaps and leaking out droplets of crud the same time could be spent on actual curettage, which is much more cost-effective in terms of time. Largely I have given up on using needles for debridement purposes. Which is not to say never. I still use needles to drive "drilling mud" into pockets to make hydrocolloid bandages. But I don't use them much for detailed debridement. But will still use them for occasional "vacuum work" in areas where I just haven't gotten around to getting to all the calculus. Or to debride pockets on an ongoing basis.

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LET IT BLEED - LET IT DRIP - SHAKE IT UP - This has its good and its bad. Certainly for the good is that the body will generously give up blood for almost any infection to help the infection escape. What this means is that if the patient can create a friendly communication - that is both non-dangerous and non-injurious - then hopefully enough of the infection will escape that what is left can eventually heal - OR PER PROGRESSIVE DEBRIDEMENT - what this means is that a big nasty infection can be bled out, then be allowed to recover. Then to be attacked and bled out some more etc. Until the body gets a chance to get the upper hand.

BUT WHAT IF THE INFECTION IS TOO POWERFUL? Then can work it more like a seige. With the goal simply being to wait out the infection long enough for the trauma, both short and long term, to go away or go down. Then whack again. But there is always the chance that the infection is really too powerful. So what to do then? Treat it like a traumatic wound. Ibuprofin and cold. Likely salt water to "draw out" the infection. Keep a perfectly clean mouth. With absolutely ZERO refined carbohydrate. Followed up with immediate irrigation, flossing and brushing after any intake of any amount of food at all. Not even to wait for 10 minutes. Plus patience. And can figure that most non-remarkable trauma should subside within a week. But then have to whack again, as soon as the area feels good enough to sustain another attack. Why? Because progressive debridement rarely gets he main bulk of any infection, especially the large ones. So don't want to give a large left-behind infection a long-term opportunity to regroup. And also, even if it is a tunnel and you have already successfully whacked the main part of the infection, you should be able to successfully wait out the deeper infections for at least a few weeks for the trauma to subside. But otherwise a little leftover swelling is oftentimes considered to be a positive. Since it helps the instruments get in better. 

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INVISIBLE WALL OF HYGIENE ACTIVITY - For anyone with serious periodontal infection after awhile several things become obvious. First is that there is a lot of stuff, ie bloody stuff, ie infection right under the gums and maybe even deep inside too. Two is that the stuff is hard to remove. Third is that maybe, just maybe when all the blood remains or comes back right after the cleaning it is not so much that the calculus regrew itself over a period of days, weeks or months but because it was left behind.

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.

ADDING 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

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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.

WHAT IS THE ALTERNATIVE TO A REAL MELLOW HYGIENIST WHO GOES IN DEEP? - Indeed the only alternative is DIY. Also a person can go in so deep on themselves and for such protracted periods of time that there is no way to duplicate the experience in a professional setting. Meaning the only way to ever achieve 100% hygiene is DIY. Which people should learn to do anyway. Because otherwise they could easily spend $10,000 or more trying to save their teeth and end up losing them anyway in a losing battle. Again pointing to DIY as the only other practical alternative.

CONCLUSION - WORK FOR FREE - PAY FOR OWN EQUIPMENT & SUPPLIES - Once a person starts with the toothpicks and brush picks it is just a hop skip and a jump to the other tools. And that horror stories aside if a person is truly careful and acts as if all the horror stories could be true but to proceed anyway - damn the torpedoes - but not stupid - then the person can proceed. And their skill level will go up over the years. And they can use their successes and failures to save what they can at cheap labor cost - though will certainly want to spend on tools.

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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.

Come on baby, finish what you started
I'm incomplete
That ain't no way to treat the broken hearted
Come on and finish me

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.

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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.

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yahoo answers - SO WHAT IS HAPPENING WITH THIS TOOTH? -  http://ca.answers.yahoo.com/question/index?qid=20111213235950AAooACL 

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QUOTE - 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.
First of all, I want you to know that nobody gets all the calculus off. The research leaves no doubt about that. But the fact of the matter is that a serious attempt to remove all the calculus does remove enough of the associated bacteria to leave an environment that is compatible with periodontal health. That's why most perio patients get better despite the fact that no one, surgically or non-surgically, gets it all off. - ENDQUOTE


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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.

REALITY-LAND - 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.


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NOTE - If the pockets are deeper than 12mm ie 1/2 inch SOP is often to declare the teeth FUBAR.
NOTE - YOU CFAN STILL SAVE THE TOOTH - The answer is Bulls-eye - Big O theory - Close in from the outside then let heat and then work way down to deeper layers of the hole pit - and figure it might take six months to a year or more to get to bottom with adequate healing in between.

Hudson: Well that's great, that's just fuckin' great, man. Now what the fuck are we supposed to do? We're in some real pretty shit now man...
 Hicks: Are you finished?

Hudson: That's it man, game over man, game over! What the fuck are we gonna do now? What are we gonna do?
 Burke: Maybe we could build a fire, sing a couple of songs, huh? Why don't we try that?

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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.

NOTE - 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.

ISSUE 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 the instruments.

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.

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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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 Out of the ruins
Out from the wreckage
Can't make the same mistake this time
We are the children
the last generation
We are the ones they left behind

= = =

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.

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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.

OR... 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.

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 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 -

ALSO, 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 them.

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.

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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.

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 - According to Dimensions of Dental Hygiene  in "Using Files in Periodontal Therapy" (11/2004):

"The addition of perioscopy-the use of the dental endoscope in periodontal therapy-enhances the clinician's ability to visualize biofilm, root deposits, granulation tissue, caries, and root fractures. Perioscopy reveals that as much calculus as possible must be removed because, even after extensive ultrasonic and hand instrumentation, persistent inflammation exists adjacent to residual calculus. Research studies also conclude that, despite our best efforts, calculus remains on tooth surfaces ranging from 17% to 64% after closed scaling and root planing and 7% to 24% after surgical intervention and open instrumentation by experienced operators."

What this means is that even after Scaling & Root Planing (SRP) there is still lots of calculus left behind. Which then perpetuate the periodontal infection. And even after surgery too. So what to do then? More surgery again to clean things out some more? Or chop-down and contour the outer gums and leave the teeth standing on stilts so they clean better?...

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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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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.

= = =

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.


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.

= = =

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.

SINUS ISSUES - 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.


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.


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 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.

= = =


But also to consider is the consideration of making things worse. By "whacking the hornet's nest. Where only clearing out a portion of the crud just lets the rest of the bacterial biofilm and calculus combination thrive in a wounded area. So in no way is people cleaning their own teeth to be taken as a substitute for getting proper cleanings. Rather... some people may choose to be a little bit aggressive, ie. use instruments - on their own against their periodontal infection in between regular cleanings.


The potential for causing injury and damage is certainly there. But if an area is cleaned out reasonably well with no real damage and the area just real sore and without any real throbbing pain then there is a pretty good likelihood the area will recover in as few as three or four days or even the next day. But even fairly extreme soreness should recover within a week, with basic recovery from most of the sense of damage within two weeks. Then the cycle can be repeated to clean out the calculus and crud that has reanimated itself and repopulated the environmental niche that was occupied by the crud that got debrided and liberated.

General idea is based on a system of trauma and recovery. Where the bacterial infection is attacked. Then the teeth get a chance to recover. Then the bacterial colonists are attacked again. Akin to a warfare strategy. Where the primary godfather is Clausowitz. Secondary of course is Sun Zu. But in common terms everything can be looked at in terms of gangland strategy. Idea is to scrape out and flush out the ringleaders, ie. the largest pieces of calculus, crud and blobs. Then wait for the new ringleaders to arise. Then flush them out too. And repeat. Meanwhile letting healing processes gradually bring teeth to higher levels of recovery. While periodically attacking the remnants, both deep and shallow. And hope and pray for stability and wishful regeneration processes.


Or the bacteria can be looked at in terms of the phenomona of doubling. Where 1 turns into 2, then 4, then 8, then 16, etc. Or in reverse  where 1056 can get reduced into 512 and then back down to 2 or 1. Which is a good imaginary place for bacterial colonists to reside. Since they cannot ever be completely killed. Since they are biofilms. And have already colonized the deeper regions. Like a Xenomorph.

Here you might reasonably conservatively imagine removing say 50% of the crud in a single session. Or say that was what your hygienist managed to remove. This would mean that 50% of the crud is still there. Now imagine it growing back to 60%. And you whack it again. So now it is down to say 30%. Grows back to 40% and you whack it again down to 20% of the original amount. What this would mean is you reduced the bacteria load down to 20% of its original amount. Which you could reduce again down to 20% of its previous amount say two more times. At which point the total amount of periodontal crud under the gum line would be 1% of the original amount. At which point you might reasonably expect a good amount of healing to eventually take place. Even if much of the damage from the disease is still largely permanent. Looking like the inside of a bombed out cathedral. Or what is called cratering. Where the bone has largely collapsed and there is a big gap between the teeth. But even that can be dealt with if it is clean and healing more and more every day for the rest of your life.

= = =


Following this way of thinking trying to remove the calculus ledges by anyone other than qualified dental personnel can actually be viewed as part of the cause of destruction. As you might imagine, let us say that a dental professional were to SRP and only fully clean out the shallower areas. What you might imagine then would be fairly undisturbed remnants of deep calculus. Which might continue to provoke the infection. But mostly in localized areas.

In contrast, imagine a fairly crude attempt at DIY. Especially if the original SRP were deficient. Or, heaven forbid, that the person wanted to cheap out and thought they could tackle their original calculus ledges themselves. Now... tenacious calculus is not called tenacious for nothing. Typically even well trained professionals are only able to successfully remove 40-80% of the original calculus. Meaning that anywhere from 20-60% of the original calculus is there.

Anyway... where this is leading to the concept of "whacking the hornet's nest." Which means to crudely remove only a portion of the calculus while leaving behind large amounts of debris that can continue to advance the infection. Add onto this the actual physical damage that DIY might have caused, which may even include accidentally ripping out bone. Then what happens if the hygiene remains poor? Well, quite clearly what would seem to happen is that the periodontal infection at the lower levels would then become more prominent. Especially without as much competition from the disease at the higher levels. So you can quite easily imagine that DIY could very easily lead to speeding up the disease.

But what about the deep ledges? Well, first people should try to get their periodontist to remove them. Then if that fails to do the job completely and people really want to DIY with instruments then once excellent general hygiene is established for a period of time, so the gums are fairly healthy, then it might be reasonable to do some local cleaning while giving the gums sufficient time to heal between cleanings. Plus not messing with the most sensitive and therefore diseased living gum tissue either too much or too little. But rather to clean the right amount just right. Which takes both a lot of skill plus a lot of visualization ability.

Then to let the gums recover. Then to go back. Right now I have one particularly nasty area, a deep gap in front of the lower left first molar, I have been working on for over six months. And this is after its official SRP, plus two 3-month returns. And only in the past several weeks does it finally look like I am getting to the bottom.


Six months ago or right now the view on this tooth would be long term hopeless, if it were to stay on trajectory. It was cruising for a periodontal abscess. But I intervened. And it turned out that the SRP left a lot of calculus ledges behind. So... if I ever do get to the bottom and don't destroy the nerve in the meantime... then I am hoping the gums and even possibly some bone will regenerate. But this certainly won't happen with even a smidgeon of crud left behind. And even regeneration can be viewed at as a relative thing. Indeed, even if the nerve coming out of the tooth does become exposed and compromised the end of the tooth has still not yet necessarily arrived.

This phenomena I call "two minutes to midnight." Which means that yes, the tooth is viable. And most importantly, mostly are almost completely infection free. But even one thing that goes wrong will take down the tooth. So some lurking piece of crud will then strike down the tooth. However, melodrama aside, what this means is that a best effort basis must be made to find the lurkers and take them out. And to put off those last two minutes as long as possible. Like say 20 years. Or even 2-3 years. Which is preferable to losing the tooth sooner.

The contrary argument against this is bone level considerations. The argument is that keeping a hopeless tooth will ultimately lead to additional bone loss. So while there is still some good bone left take out the tooth and put in an implant. And can see some merit for this argument for the maxillary upper teeth. Which are the most vulnerable anyway. Since the bone is so thin. But not for the mandible lower teeth. Since jawbones look pretty thick. So how could somebody run out of bone there? Unless the tooth were well beyond hopeless.

BTW, one of my periodontists told me that one of the primary issues with DIY is that the person cannot see what they are doing. Especially since the teeth have such poor self-awareness ability. As example if I don't look sometimes I don't even know which tooth I am working on. The self-awareness is so poor. So what I do instead is work in circles and edges. And I avoid any heavy pressure or strongarm gouging unless I know exactly where I am. My strategy has always to be an opportunist. And I may fairly easily spend three or more hours on a single small area. Adding up to hundreds of hours for all my teeth over the past five years since I originally discovered that I had the infection. Which I discovered myself. Right after going to the dentist for a teeth cleaning. Who told me nothing. And perhaps might not have noticed all the blood coming out of my gums. Who knows? But one of the other hygienists did warm me a year prior. And I had a sweet tooth. So will only say that periodontal disease is one infection that it is bad news to let slide.


Good short term immediate solution besides flossing is to immediately cut out all sugar and processed carbohydrates. Possibly even including bread, rice and pasta. Logical thinking here is to institute an immediate siege to attempt to starve out the bacteria. Along with biofilm removal. And contrast this with eating a large candy bar or ice cream every day, combined with residual bread or rice. What then becomes completely clear is that sugar and carbs are a festival for periodontal infection.

Also think some people might overstate the case for floss. Sometimes even arguing for twice a day. But only as a magic bullet. And I will confess that I still don't believe as strongly in floss and biofilm as I should. But if the biofilm is indeed the culprit... then you can imagine removing the biofilm and starving the bacteria. Which also includes the deep calculus. Then eventually the inflammation would subside and one could almost imagine the remaining calculus ledges with their starving bacterial tenants as benign. Living at such a low level of ongoing activity they don't cause active additional harm.

But... more to the point... there appears to be a more important reason. Which would be to improve the general health of the gums prior to the SRP debridement. That way when the removal of the calculus reveals the underlying gum bone to being exposed to the raw infection it makes logical sense to prefer the gums to be healthier than not healthier.

Contrasting argument would be that any additional bone loss from debriding so close to unhealthy exposed bone is balanced off by the actual removal of the debris. Even if the so-called "patient," ie the exposed bone could be healthier after a month of starving out and possibly even killing the bacteria.

OK... think a conservative strategy would have to consist of immediately starving out the bacteria. Reason for this is that it looks fairly clear that unhealthy tissue at some point seems to occupy a mysterious place between life and death. So... what this would mean is that some of the debrided debris might not really be debris at all. But rather occupies a special zone where it could somehow miraculously turn back into viable tissue. So... anyway, all this means is that it makes sense to starve out the bacteria. Just in case any of the goopy spongy apparently nasty stuff down there is actually good. Now, I would also be pretty skeptical about this. But can appreciate the logic.


Other reason is that bone can actually recover from its own death. So presumably if some dead bone were left behind and all the surrounding crud could somehow be removed then the bone would somehow gain the ability to zombie itself back to life. How would this happen? Basically the extra-cellular matrix (ECM) and epithelial tissue would create a layer over the non-diseased portion of dead bone. The body would then debride the dead bone with various blood organisms. This would then create an environment for brand-new bone cells to move in. The new bone cells would then eat up all the remnants of the original dead bone and voila! The bone comes back to life.

In theory. But the practical reality is that regeneration cannot take place in the presence of infection. So scratch that idea. Unless you can come up with some way of removing the 25-50% of the calculus that gets left behind and that continues to perpetuate the infection.


Likewise people can use some of the general insights from DIY Perio in their efforts to negotiate with the dental profession for their best interests. Which is namely this: Rather than agree to expensive periodontal surgery would it be possible for the hygienist to do another SRP? (Scaling & Root Planing)

Or alternately, people might not want to use dental instruments, especially after reading about all the horrors and how close to impossible it is to break off the rock-like ledges of thick calculus. And instead decide to leave the heavy lifting for the hygienist. But to supplement the professional care with proxy brushes and toothpicks. And possibly consider aspiration and irrigation. Using a needle and a syringe to either suck out the bad stuff using a vacuum. Or to try to flush out the bad stuff with water. Plus possibly squirt in medication.Plus learning more about their problem areas.


Also... regarding aspiration and irrigation, DIY Perio strongly believes is the premise that "calculus reanimates itself." Which means this: That if you successfully remove gunky bloody biofilm from deep under the gumline with just the needle, that the more rock-like calculus will reanimate itself into a more plastic-like entity to fill in the niche you just cleaned. Then you can come back later and get rid of this too. So... after maybe a year or two (!) you might expect much of the calculus to have finally reanimated itself so there is not much rock-like calculus left behind.

This sounds great of course. But... it's like using a mop to clean up a floor with deep levels of dirt. So... though the needle might have its place something more closely resembling a shovel will tend to get the job done faster at various times. But the needle seems easier to work with and less dangerous. So take your pick.

Also... the needle can go in deeper than you can reach with the curettes. In fact I found a number of incredibly deep pockets where the needle completely liberated massive quantities of bloody crud. Which were too deep to reach with the curettes. What these were for all intents and purposes were abscesses. So any one of them could have turned into a disaster. And possibly take down a tooth. Google - diy perio buccal


Also... DIY Perio holds the position that calculus is bad! Not just the biofilm. Justification is that the calculus provides the housing for the plaque. And is alive and contributing to the infection. And must be almost completely eliminated in order to put the infection into remission.

Meanwhile the dental profession seems more focused on the biofilm as the primary aggressor. With the calculus remnants viewed as an unavoidable consequence. According to Dimensions of Dental Hygiene  in "Using Files in Periodontal Therapy" (11/2004):

"The addition of perioscopy-the use of the dental endoscope in periodontal therapy-enhances the clinician's ability to visualize biofilm, root deposits, granulation tissue, caries, and root fractures.4 Perioscopy reveals that as much calculus as possible must be removed because, even after extensive ultrasonic and hand instrumentation, persistent inflammation exists adjacent to residual calculus.1-3 Research studies also conclude that, despite our best efforts, calculus remains on tooth surfaces ranging from 17% to 64% after closed scaling and root planing and 7% to 24% after surgical intervention and open instrumentation by experienced operators.5

So... DIY Perio's position is that dentists can talk about flossing all they want. But if the nasty stuff is deeper than the floss then that is where to look. And if it is deeper then the instruments then try and try again. Remove say 75% of the calculus. And leave 25%. Then after the leftover calculus reanimates itself, like 3 months later repeat the process. The full SRP. Eventually leading to teeth that are say 99% clean. Without the surgery.


Meanwhile the dental profession continues to believe in the concept of the "definitive SRP." Saying that if the original SRP was good enough then there is no need to repeat the process a second time. And furthermore leading to the premise that continued problems are ground for surgery.

DIY Perio's position is completely different. DIY Perio claims that there is no such thing as a "definitive SRP." It does not exist. That the only way to truly clean the teeth is to more or less complete the entire SRP process a good three times. First to reduce the remaining calculus to say the 25% level. Then a few months later to reduce this to the 5% level. Then finally to reduce this to the 1% level.

But a full SRP costs $300 a quad. Or $1200 for all four quads. So triple this to $3600? ANSWER: Not necessarily.  As a practical matter what happens is that the places which weren't so bad will largely heal. Leaving behind the worst areas. Plus hidden surprises. Of which you can expect lots and lots of them. But in any case... you might be able to get the dentist to charge by the gap. The worst area here is likely to be between the first and second molars. Of which there are four. Plus between the first molar and the bicuspid. Of which there are also four. Or eight in total. But figure they won't all be bad, plus there will be additional surprises. So... at $50 per tooth (gap)... which is reasonable then might be able to expect a later equivilent of a full SRP to only cost $400. Now... all of this presumes that the perio guy truly puts out and goes in as deep as deep is.


Here is am largely skeptical. About issue of whether perio people really and truly go in as deep as possible. And here my final answer is no. They don't. And reasonably they really can't. The only person who can truly go in deep is the person himself. Since a person can manipulate the curettes through a series of strange places that ultimately quite deep under the gumline, whereas a hygienist reasonably cannot. They only go in until they get resistence. Where a person can manipulate the instrument as slowly as they want.

As example I would typically spend two or more hours in a single location in order to get it clean. Then a few days or weeks later after that I would go in again. And eventually get the area clean. In spite of impossible clusters of highly tenacious calculus, great depth and merge of everything. Where I had no idea where I was and couldn't tell the difference between tooth, bone and calculus. But still I persisted. Slowing down time as necessary. And if I had to dismantle the calculus one piece or layer at a time, instead of of big chunks, then so be it. I would still eventually get the job done. And I did. Mostly. Except for the unfinished areas. Which are still dicey.


My severe periodontal infection is now mostly in remission. Plus I have good solid plans for the three or more nasty bad areas I still have left. Plus I am devising regeneration strategies for the three real bad areas that for most intents and purposes at this moment are in remission. But I should still run search & destroy missions anyway. Including irrigation. And this in spite of one deep crater molar gap with a neo-dangling but viable nerve and a pocket from a previous abscess, with at least one definite communication to the maxilary sinus, plus the dead-space pocket.

So now, six months after six months of periodontal work, by the end of 2011, supplemented by lots of hours by me, lots of them which could be viewed as bloody and scary, but readily healing over in any case, without any real bad mistakes or serious injuries, my periodontal infection is starting to get quieter and quieter. Though the big issues still remain and presumably could crop up anytime in unexpected ways. Such as one of the molars could just die. Then leading to complications where I might have troubles with an implant. So definitely something that could be dealt with. For enough money. But meanwhile if I can keep the original that is better. 


So... DIY Perio's bad attitude is "Forget about all this talk about biofilm. We have listened enough. What needs to be gotten rid of is the calculus. And by this mean one way or another. It is either the calculus or it is the tooth. And to do what it takes, no matter what that is or how hard and scary that may seem to be to get rid of the calculus. And hopefully get the hygienist to do the job. But if they miss the mark then to step in and DIY."

But... if the infection isn't so bad then there is no need for DIY Perio. And if it is bad then what happens? Basically what happens is that you run into ledges of calculus that are almost impossible to remove. And you run into bone. Which means jawbone. As in part of your skull. So to summarize. It is sort of like stepping into a dangerous pit. And how are you supposed to tell the difference between calculus and bone? And who is to say that you are not ripping out bone instead of the calculus?

But... there are ways to be reasonable about this. Namely, I don't scrape hard against anything unless I am like real close to 100% sure it's tooth and not bone. And also, if the infection is so bad that the bone is exposed then the infection is also attacking the bone and so a light scraping is still okay. Plus much of the bone feels "stalky." Or like it has bristles. So definitely don't grab hold and pull there!


Also... FYI calculus can be looked at as a series of thin layers. Trying to peel the layers off one or two at a time leads to a lengthy and difficult effort that leads a lot of calculus behind. The ideal of the dental profession is to break off the calculus in chunks. By using very short and powerful strokes. But if the blade slips then you could cause a lot of damage. I accidently ripped open my gums at least four times. With one slip so serious it took a good three weeks to heal back to normal again.


Also... I used the Gracey curettes. Which have to be angled just right to engage. And which tend to slip. Turns out I was completely wrong. I should have used the Universal Curettes, which I alread had. I have had excellent success most recently with the Langer 3/4 w Extended Access (After Five millimeters). Should have saved the Graceys for the finer work. And used the Universal for the heavy lifting.

What happened is that the calculus layers were not completely thick. Did the best I could with the Graceys. It's just that the Graceys would take so long. Since I was only successful in pulling the calculus away in layers. But could not break away the final part stuck to the tooth. So the Langers did not have to do the full calculus ledge either. But in any case, where the Graceys would slide over the calculus in spite of my best efforts the Langers would grab hold. And from there I could do my "ape hanger" routing to slowly weaken the ledges from a variety of angles to get major pieces to break off. Then from there the remnants were small enough that I could get most of them too.

Summary is that if the tooth is otherwise a goner, especially if it has been diagnosed as "Hopeless" then there is not so much to lose by trying out some of the work yourself.  Which is a lot different than messing around with a perfectly good tooth. Or one that only has a few problems, none of them serious.


As long as there are no other complications that are even more severe. Such as having the teeth cleaning lead to a bacterial infection and possibly even getting gangrene and/or dying. This is called Bacteremia. Where bacteria get into the bloodstream and don't get killed off right away. Which does not seem too likely for normal healthy people. But is conceivably possible. Especially for people with diabetes or joint replacements. Or any other places where the periodontal bacteria is likely to find a friendly home. Normally cleaning teeth causes some bacteremia. Which is promptly killed off a healthy immunological system. But possibly not for a weakened or compromised immunological system. So for these folks too much unprotected tooth cleaning might not be such a good thing.

- HOW BAD IS BAD? - is everyone else freaking out too?
- CAN HOLE HEAL OVER? - hopefully & eventually - but have to keep it clean!!
- OR IS THIS BAD BAD NEWS? - Most of the time the dentist can get the hole to heal over within a few days or weeks.

- SEE DENTIST ASAP - But don't be so quick to agree to get teeth pulled. Think this way... "If there is already a hole there and the plan to make the hole smaller by getting rid of the tooth actually makes the hole gigantic, thanks to the now missing tooth, then does this sound like a good plan? NO." -  Instead ask for more SRP and clean out the area really well. And to try to use hygiene as the first and primary answer. GFL. Hope you have a good dentist. And not too mercenary. When you happen to be in a weak position. And pretty much have to do what they say.

Also 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.

Also if things are destroyed enough by the periodontal infection there can even be not much if any bone left between the teeth and sinuses. So breaking a hole into the sinus is also a risk. But what this also means is that the sinus is already compromised. And these holes to tend to close up by themselves is the area is clean. Plus the dental professionals don't seem to have very many good answers about what to do here either. But realistically the best answer here appears to be serious cleaning from the professional hygienist in the area around the hole. Or surgery if necessary. But most of the time there is a reasonable chance that a good cleaning by the hygienist around the sinus hole will get it clean enough to close up and heal over on its own. Eventually.

HOW DEEP IS DEEP - Furthermore, part of the premise of DIY Perio is to completely agree with the dental profession that below a certain level it becomes very difficult to remove the debris. Here the dental profession seems to skirt the line between the premise that SRP gets everything perfectly clean and the opposite premise that the only way to access the area is surgery. Instead DIY Perio makes the premise that most of the areas deemed accessible only by surgery are indeed accessible by instruments instead. But to clean out each of these spots could take the hygienist quite some time. Especial if some DIY amateur may take up to several hours or more just to clean one area. So why not have the hygienist take say 15 minutes just to clean out one particular area? Why not?


This is where the only apparent alternative to losing the teeth is expensive surgery. Or the pitch. "How about if we extract those diseased teeth and attempt to save enough bone and  gumline to get you into some nice new implants?" Which might seem like a good and expensive idea. But who says the implants are going to be so great? Plus, given enough time and enough thorough cleanings even fairly severely compromised teeth can recover much of their previous functioning.

SURGERY AND MORE SURGERY? - $$$ - Also... think about it... surgery might get the teeth fairly clean temporarily. But the gums had to get pulled away for the surgeon to gain access. Plus it leaves behind scar tissue. Plus it is expensive and certainly cannot be repeated on a regular basis. Alternately a more progressive cleaning that eventually gets to the heart of the matter will ultimately cause much less severe trauma. And any DIY teaches the patient how to do at least a portion of the progressive cleaning themselves. Whether by toothpicks. Or by something stronger. Hence it becomes that much less likely that the teeth are harboring any kind of so called "death star" type of infection that will wipe out the bone or turn into an abscess.


Any thorough DIY tooth cleaning ultimately involves SRP (Scaling & Root Planing.) The primary enemy is ledges of calculus which almost impossible to break off. Can buy used testbooks books on dental hygiene at www.half.com for around $15. Any use of the curettes without studying the textbooks first would probably be a bad idea.


 But why not just have the hygienist do more SRP? (Scaling & Root Planing) If the hygienist couldn't get the area perfectly clean the first time why not go in again? And then if that doesn't get everything perfectly clean how about having the hygienist go in a third time? How about that?

What this leads to is the premise that below a certain level it takes more time to remove the debris then is economically reasonable. Within allocated timeframes. But by whose perspective or reckoning? The doctor's or the patient's? Do the math. On a typical general cleaning, costing say $100, the hygienist may only spend 20 minutes actually cleaning the teeth. 32 teeth have 4 sides and 4 corners each. And not even counting above and below the gumline or any pockets, furcations or other complications. This multiplies out to around 256 items for the hygienist to scrape clean in around 1200 seconds. Or around 5 seconds per item. Which does not seem like very much time or even adequate time to get everything perfectly clean.


Similarly is the premise that there is often still a lot of crud left over after SRP too. Where the most acceptable norm for hygienists is 2 hours for each quad of 8 teeth. Which sounds pretty reasonable. 15 minutes per tooth. Or almost 2 minutes for each corner and side. But how many periodontists really allow a full 8 hours for a full 4 quads? Probably not many. My guess is most hygienists finish each of the quads in less than an hour. And that a lot of crud is often still left behind. And the only way to get to it is to do another SRP. But the common claim is that SRP only needs to get done once.

Hence a major premise of DIY Perio is that this particular claim about the so-called "definitive SRP" is generally false. And in more severe cases is most certainly false. Where in fact the hygienist could just keep going and going finding more and more crud. But there is not enough time. And that more reasonably priced SRP is grandly preferable to surgery in many cases. And that any claims of "definitive SRP" and that there is some strange mystery going on under the gumline that only surgery can address are simply false. So, how about pushing for another SRP and not be so quick to agree to the surgery? Especially if you have gotten good enough with the toothpicks and proxy brushes to keep the shallow areas clean.

In reality, what happens with many people is that the lower levels never really get clean. Even with a professional SRP. But especially with just normal cleanings and a little extra deep cleaning. The premise of DIY Perio is that any so-called thorough cleaning under the gumline can only happen progressively. Meaning that a second and third cleaning and even many more cleanings are needed after the first cleaning. That there is almost always significant calculus and crud that gets left behind. And that people should try to get their dentists to clean their teeth some more and more until they get everything really clean. But if they can't get their dentists to do that then then the choices are to do nothing, focus on flossing and more shallow cleaning, while ignoring the deep crud, or DIY.


To prove the point is the current thinking on chronic wounds. Which is what periodontal infection is. Now... imagine a chronic wound. Where the doctors and nurses progressively cut away the non-viable tissue. Then after weeks and weeks or months and months the wound eventually heals. Now... in this scenario can you imagine the doctors saying the wound is clean enough? Here the answer is no. Periodontal infection is no different. Until a clean edge can be created which is free of infection on an ongoing basis the infection will continue to self-manifest itself. And once the clean edge is established the periodontal infection will tend to close in some reasonable amount on the diseased area so the periodontal infection has less physical territory to manifest itself in. So, after a period of time the infection can be confined to limited areas and the bacteria biofilm can be held down to fairly reasonable limits. But none of this can happen as long as more than minimal amounts of crud are allowed to remain behind. Creating the imperative for a search and destroy insurgent attitude.


But in fact the most likely premise is that dentists will typically resist the notion of going in deeper, meaning in a sense, that they have abandoned that particular field. Meaning that in fact that beyond a particular time, when the infection gets so severe, that the only alternative besides surgery to losing the teeth is in fact DIY. Along with shallow cleaning. Based on the hours and hours of time it does in fact take to get everything clean. Suggesting that in fact even post-SRP teeth are much of the time in fact quite filthy relative to perfectly clean. And just a lot cleaner than they were. And nowhere near as clean as they can reasonably become. Even without surgery. Just DIY.. Except that nobody sees it. And instead the symptoms just show up as BOP. And the infection continues.


Or look at it this way. A full-fledged periodontist wants $500 per hour for himself and ideally $150 per hour or even more for a reasonably well trained periodontal hygienist. And though while it might be nice to think you can convince them to probe to the bottom of exactly the places you want them to, at some point this premise becomes unrealistic. First, the professionals and not the patients drive the treatment plan. Second, if there are indeed truly deep areas that are beyond the bounds of normal SRP then the teeth is indeed in trouble.

But 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.


Why is it so hard? The main reason is that the calculus forms into ledges that are very difficult to break off and that block the way to lower levels. In fact most people will find it close to impossible to break off calculus ledges. Meaning that all they can hope for is to clear out the active infection and then have to wait for the calculus to reanimate itself and thereby soften up enough to become removable. And meanwhile get lucky enough to break off pieces of the calculus.

But what are hygienists supposed to do? Hygienists are supposed to break off the ledges in big chunks. Otherwise the calculus will break off in thin layers. Leaving behind dozens or more of additional thin layers. Turning the calculus removal into a veritable endless task. So ideally the hygienist can break off the big chunks and only leave little pieces of debris for DIY.


Alternately, think my problem might have been in using the Gracey curettes. Which have a trailing blade that is offset at 70 degrees and that is difficult to engage well. Plus when the ledge was thick enough it would simply refuse to break off. Or when it finally did break off I would end up slashing open my gum. Which happened 3-4 times. But the gums healed and so did the teeth. But anyone who attempted this would know soon enough about the blood. And some people say that even if people do DIY that they are not really causing much more if any additional damage beyond what the periodontal infection has already caused. So a damage and heal cycle could possibly not really cause any lasting damage at all. If it leads to the cleaned out area eventually healing.

UNIVERSAL CURETTES ARE BETTER FOR CALCULUS LEDGES -  Then switched to the Universal Langer Curette 3/4. ALSO with the extended access, After Five. Plus the mini-blade. Which has a perpendicular blade. Which engages and gets stuck very easy. But doesn't slip on the calculus. So possibly the ledges are not so close to impossible to remove as I have experienced. But certainly even the Langer 3/4 is not a super-tool. It just makes it easier. Under any circumstances breaking off the ledges is such a hard job that even the professionals have a hard time at it. But the patient has all the time in the world. So if it takes 6 months to finally break the ledge then it takes 6 months. But realistically most ledges will give up much earlier. Within 3 or 4 cleanings spaced say a week or so apart. So can get to the bottom of most areas within a month. But if the areas are severe, then indeed it can and will take many months to finally get to the bottom.


Alternately it could be argued that all of this digging is in fact what is causing the problem. That the digging will cause the bone to recede and make everything worse. But... the actual conditions suggest that the calculus has already worked its way well down the tooth all by itself. Reason for this is that thick calculus ledges take months and years to fully develop, even if much of their competition has been eliminated. So this means the calculus was already there. And unless one wants to believe in benign calculus then one way or another the person is better off without the calculus. And that the calculus does interfere with the health of the tooth.

But what this also means is that once an area has been breached and the calculus removed then it makes a lot of sense to keep going until everything is removed. Otherwise the deep calculus will get exposure to fresh nutrition and grow. So basically once committed to a pocket the pocket has to be cleaned out completely or the deepest calculus will get a chance to prosper. Which could lead to an abscess. So, in fact, it almost looks like letting the tooth slowly rot away is somehow preferable to opening things up, doing a half-ass job and then giving the infection the chance to get the upper hand again. Which it certainly can do if it is deep enough. And an abscess typically does lead to loss of the tooth. Plus even adjacent teeth.   


Alternately the view is not to try to DIY. But instead people can use toothpicks or Brush Picks or even proxy brushes and look for BOP (Bleeding On Probing). Then convince their dental professionals to clean out that particular area to their satisfaction. Or clean everything. Then for the areas that still bleed or where there is definitely a lot of gunk to convince their dental professionals to clean it out some more. Which would be a more mainstream way to approach this entire subject. Don't try to DIY. That is foolish. Instead get the professionals to do it. And if they don't do a good job then get another dentist. Don't try to DIY. This sounds like a reasonable approach. But remember the ultimate goal is not to find a great dentist. But a great hygienist. Where the dentist is not breathing down her neck to hurry up and finish so she can move on to the next patient.

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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.

Also 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.

BUT 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.

HOWEVER 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.


WIKIPEDIA ON BACTEREMIA - QUOTE- Common oral hygine, such as brushing teeth or flossing, can cause transient but harmless bacteremia.[1] 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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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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DIY-PERIO is do-it-yourself periodontal debridement. Using cycles of progressive debridement and healing to eventually reduce the calculus and infection down to close to NIL. Which I have been doing successfully since 2006 to save my own diseased teeth. With many success stories and only one tooth lost so far. You can check out DIY-PERIO on YouTube and on the web and see for yourself. Including diary and x-rays.

DIYPERIO'S primary claim - ie GUMS OPEN UP - is the discovery that the gums cling to the calculus, like velcro, thereby thwarting debridement efforts. But that continued curettage will cause the gums to dilate and separate from the calculus, thereby granting non-surgical debridement access that otherwise can mostly only be accomplished with surgery. This phenomona can be exploited, presumably with drugs. The result will improve the economics of treating periodontal disease. In particular by elevating the role of the hygienist into being able to accomplish the results of a surgeon, but without surgery. It also avoids the downsides of surgery. Since no harm is caused. It is also repeatable, so progressive debridement can indeed eventually reach NIL. Even if it takes months or years to finally get the teeth clean.

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You can also google - progressive debridement - periodontal abscess curettage - diy periodontal scaling/debridement/curettage - to get some ideas about the subject matter. Which shows very little active interest in any serious DIY scaling besides me. But you will also notice very little interest in periodontal abscess curettage either. Which DIYPERIO thinks is an obvious protocol. So maybe some better R&D into curettage in general is a good idea too.

You can also google - diyperio video - curettage & blobbage - toothpick blobbage - t3-5 abscess - t5-6 gap - t19 abscess - for some commentary and detailed debridement videos, liberating several periodontal abscesses. With some from start to finish. I've gotten to be pretty good at curettage and have saved many teeth over the past eight years. Especially since multitudes of periodontal abscesses tend to be the death knell for teeth. Especially if they are left untreated.

You will also notice that much of the material on periodontal disease is based around reaching some type of accomodation with the infection by getting the body to modulate or "turn off" its auto-immune response and stop resorbing bone. Or by discovering particularly bad bacteria. DIYPERIO largely debunks these notions by emphasizing the boundless physical presence of the calculus and its crowding out and energy-chain infiltration abilities, the endless adaptability of the biofilm, and the sheer toxicity of the infection. In DIYPERIO's view a negative response to infection cannot really be avoided. So best to try to wipe out the infection rather than to try to get the body to modulate its response to getting infiltrated, crowded out and poisoned.

You can also use your logic, per Hippocrates, to know that prodigious progressive debridement is surely bound to be successful, if good and thorough work is done on a repeated basis, as long as the disaster is not too severe. Also that singular "definitive debridement" procedures are largely a myth. Here "chronic wound" is the model, whereby the debridement is repeated on a regular basis until the necrotic infected wound finally "gives up" and the body gets a chance to heal.

Also that "quick and dirty" "once-over" debridement is insufficient debridement and bound for relapse, due to the dead infected debris left behind on the teeth. Essentially setting up the teeth for doom. Which is not to say the task is easy. But certainly think in general that the allocated effort is too often insufficient. Especially when the call for more effort is so obvious. So sounds like DIYPERIO wants practitioners to work longer and harder for the same money or for only a few dollars more. Which is true.

Also keep in mind that if the disease is not very severe on a set of adjacent teeth then a detailed debridement can largely return them to a state of normalcy and it is likely that the teeth will never get severe periodontal disease. But if all they get are "once-overs" then you can be pretty sure the disease will get worse for both the worst teeth and their neighbors.

Likewise if an area is still not highly severe but bad enough then a primary debridement will get a majority of the stuff. Then after the teeth recover through a series of subsequent debridement sessions the teeth can recover to a largely disease-free condition. But not with cursory "once-overs."

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QUOTE - ABU'L-QASIM - "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."

QUOTE - "Research studies also conclude that, despite our best efforts, calculus remains on tooth surfaces ranging from 17% to 64% after closed scaling and root planing and 7% to 24% after surgical intervention and open instrumentation by experienced operators." - Dimensions of Dental Hygiene - "Using Files in Periodontal Therapy" (11/2004) - So obviously current protocols virtually guarantee the disease will continue unmolested. Especially if "definitive debridement" is accepted as an accepted protocol.

QUOTE - "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." - NE Society of Periodontists - Spring 2006

QUOTE - HIPPOCRATES - "What medicines do not heal, the lance will; what the lance does not heal, fire will."

QUOTE - ABRAHAM LINCOLN - "If General McClellan isn't going to use his army, I'd like to borrow it for a time."

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1) The biggest dilemma of periodontal disease is the "effort gap" between how much debridement is truly needed and how much is actually done, which is sorely not enough. So if only 4 hours of effort are applied to a 16 hour task then the job is 80% undone, which is a virtual guarantee of failure. As example if this modality were applied to a chronic wound then failure would be obviously guaranteed. Which is largely also true with the teeth.

2) In addition is the "difficulty gap" between the available instrumentation and the resistence of the infected hardened calculus and necrotic membrane. Which largely over-matches the practitioner, especially in a closed-debridement environment. This means that lots and lots of "impossible" debris is usually left behind on the teeth, thereby perpetuating the infection-disease. Note here that surgical instruments can naturally be more "brutal" than non-surgical instruments. Since the area is so open. So DIYPERIO proposes R&D and thinks that slap-hammers may have good potential for non-surgical debridement, along with other ideas so the closed-environment is not so over-matched compared with the open-environment. Perhaps vises to crush the calculus would also work. Perhaps serrated edges would make mincemeat out of the necrotic ligament.

3) Finally is the "surgical gap" which is the limited non-surgical debridement abilities that practitioners claim to have short of surgery. Standard logic being that 0-5mm is readily accessible, 5-8mm is midway between accessible and impossible and 8+mm is either borderline hopeless, close to impossible or only accessible through surgery. DIYPERIO disagrees and is more optimisic about non-surgical debridement. Even though it has to be done by feel, while "flying blind."

NOTE - Regarding closed-debridement it is worth noting that a 1st person DIY-PERIO can feel their own teeth. So they do have genuine advantages over a 3rd person practitioner, especially when going in deep. But a 3rd person practitioner can largely see what they are doing. And can largely visualize the teeth better. In any case though, when I have had to go in especially deep, and especially around nerves and other delicate things I am quite sure that I was able to do a much better job than any outside practitioner could possibly do. Especially since I put in massive amounts of time on the least little thing.

NOTE - SO... DIYPERIO imagines a combined effort. Where DIY-PERIOs scrape away on their own teeth and then the professionals come in and give it a yank when they isolate something big and treacherous. Both to optimize the effort and also to optimize the cost. As example one hygienist could conceivably manage 5 DIY-PERIOs, yank the most difficult stuff, and keep the DIY-PERIOs moving along on the light stuff. So everyone would get both a great value and great results too.

NOTE - According to DIYPERIO "Nothing is impossible. Does not matter." Which is largely just an attitude not to give up. But obviously DIYPERIO has all day to strategize and manouver and attack the intractable calculus fortresses. And obviously DIYPERIO has no problem with repeated 5-10 hour debridement sessions if that is what it takes to do the job. But unlike DIYPERIO the professionals don't have all day to accomplish their tasks. And certainly don't work for free. Hence the call for surgery. Or deeming the tooth hopeless.

NOTE - Again, this is part of the essence of what DIYPERIO is proposing. As example... if a hygienist charges $150 per hour while a surgeon charges $900 per hour then the hygienist can work for 6x longer for the same money. So even if the surgeon is 3x as fast the hygienist is still the better bargain if just as much debridement can be accomplished.

NOTE - A secondary dilemma here is how much work is reasonable. As example conservatively it took me over 30 hours to save my t29 bicuspid from virtually complete encirclement and imminent destruction from periodontal abscesses. But I work for free, so it was worth it. DIYPERIO assumes or presumes that a practitioner would certainly be a lot faster than me. But at what point should the tooth be judged as "totaled"? No easy answers here. DIYPERIO assumes that professionals can work longer than they do now without getting stuck in situations demanding unreasonable amounts of time to accomplish. Likewise that improved instrumentation can help bridge the gap.

NOTE - But maybe DIYPERIO is wrong. Maybe if an experienced practitioner actually tried to do closed debridement to the extent of DIYPERIO then the effort would add up to too many hours for the perceived value. Since say $6000 to "save" one tooth is too much money. But still... if it took a hygienist say 10 hours at $150 per hour to save that t31 bicuspid that is still only $1500 or considerably less than the cost of an implant. Likewise if SRPs in general could be more aggressive thanks to DIYPERIO claims then maybe those periodontal abscesses would have gotten liberated much earlier. Hence obviating the need to "save" the tooth since it never would have gotten into so much trouble in the first place.

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This is the main area DIYPERIO wants to address, along with more scraping. With DIYPERIO's discovery that the gums can spontaneously dilate and "open up" to accomodate non-surgical deep penetration and curettage. Leading to more complete non-surgical debridement. Which is then repeatable through progressive debridement. Essentially offering non-surgical methodologies for reasonably severe cases. To hopefully eventually be able to get the infection down to NIL. Or if the situation is better judged as "impossible" to eventually transform it to "less impossible." Thanks to progressive debridement.

So... DIYPERIO along with everybody else thinks the answer is obviously quite simple, in theory if not so easy in practice. Debride the debris. But how to get the task to match up more to the challenge? DIYPERIO proposes more involved and more detailed hygiene and not to be so quick about surgery and extraction. DIYPERIO also thinks there are strong possibilities for more aggressive non-surgical instrumentation, such as slap-hammers, vises, serrated edges or other possibilities geared towards debriding the especially thick, tenacious recalcitrant calculus and intractable necrotic periodontal ligament without the absolute need to assume that surgery is the only possible way.

In any case, DIYPERIO could be completely wrong here. Since hygienists don't have all day to go after close to impossible calculus and dead membrane with ineffective instrumentation. So perhaps indeed the only way to get the deep impossible stuff is with open surgery. But nonetheless, DIYPERIO still thinks a more aggressive non-surgical approach is worth a try. And while some claim to have the answer regarding non-surgical debridement, such as BOST or Perioscopy, DIYPERIO claims to really truly indeed have the answer. Presuming DIYPERIO is right.

But also consider that DIYPERIO is just one person too. So I shouldn't have to have all the answers. Just a promising path for R&D, which I do. And so while it has certainly worked for me and can also certainly work for any other DIY-PERIO with unlimited time and patience and ability then the issue still becomes how it can apply in a professional setting. In a greater way than to just scream and demand more scraping.

Nonetheless... DIYPERIO's main suggestion for improvement is to exploit the phenomona termed as GUMS OPEN UP, whereby the gums dilate and separate from the calculus covering the teeth, so that non-surgical debridement can accomplish what can otherwise only be accomplished with surgery. DIYPERIO knows this to happen naturally and proposes it can be also induced with drugs. And could become a part of standard protocol. Perhaps some additive to the irrigation fluid could do the trick. Who knows? Maybe even something easy like ceyanne pepper or hyaluronic acid or some surfactant.

Again, some simple R&D should provide reasonable answers. All it would really require at first would be a confirmation of the clingy calculus and GUMS OPEN UP phenomona. Which would naturally spur greater closed-debridement efforts. Especially once the researchers become clear and wise to the apparent fact that closed-debridement has traditionally been so stymied by clingy gums. Likewise, once dilated GUMS OPEN UP becomes an expected norm then naturally the more aggressive non-surgical instrumentation such as sickles can get used more aggressively and the possibilities for even more aggressive instrumenation will become more clear. So perhaps closed-debridement could then prove itself good enough to do the job. And "quick and dirty" SRPs will become a thing of the past.

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DIYPERIO's main claim is that the GUMS OPEN UP and make the deep areas accessible to the curette. The proposed reason is because the convoluted gingiva cling to the rough calculus like velcro. DIYPERIO calls this phenomona the Stockholm Syndrome. But once toxins start getting released the gingiva respond by engorging in blood, ie edema, which changes their shape and size and causes them to uncling from the calculus. Here you can imagine separate pieces of velcro attached to a balloon naturally detaching from a fixed piece of velcro as the balloon inflates. Similarly you can imagine the convoluted surface of the gingiva getting stretched flat as the gingiva engorge with blood and no longer functioning as the equivalent of velcro.

This is a temporary phenomona. Once curettage is stopped the gingiva will cling right back onto the remaining calculus, wherever it hasn't been largely smoothed or scraped off. But where the curette has largely smoothed or scraped off the calculus the curette will largely continue to penetrate. Hence expanding the available "front-line" against the remaining calculus.

In addition are various protocols for engaging the calculus, which can largely be categorized under the military strategy of "double-envelopment flanking manouvers." Logic is that once the GUMS OPEN UP then it is time to GO TO TOWN and ROLL UP THE FLANKS to wipe out the blocking ridges of calculus.

Similarly military metaphors in general can be used to describe the various phenomona and activities. Such as MOPPING UP remnants and dealing wih SECONDARY RESISTANCE, ie deep calculus that makes itself available after the hours and hours of DIY-PERIO activity. Which then typically get handled during Secondary Debridement after finishing up with the Primary Debridement. Or can get debrided right on the spot if the DIY-PERIO still has any energy left once he hits the jackpot. And has not run out of steam.

This is especially true after a periodontal abscess debridement effort that may go on for 5-10 hours at a time. When ideally somebody may want to go for 20 hours straight, based on the debris that is available and the ability to deal with it. But obviously so many hours at a stretch is not practical. But oftentimes can go back the next day. Or just wait for the area to recover and then try again. And also keep in mind that so many hours are expended in one small area. So how can so much involved labor translate into a professional environment at reasonable cost?? Well... who is to say. Presumably the professionals are faster and are not just "quick and dirty." So perhaps some accomodation is achievable in this "effort gap" between how much labor is available and how much is needed.

But none of this open warfare against the calculus covering the teeth would be possible if the gums were still clinging to the calculus. In addition is the issue of whether the gums clinging to the calculus could really be the gingiva clinging to cementum!! Which if true would mean the DIY-PERIO is ripping up his own gums!!

So obviously this is a serious issue. But once the gums release from the calculus it becomes clear what is really going on. Since healthy gums don't "release" from teeth and healthy bone does not cling to teeth either. So what is there is calculus, by logical deduction. Or dead cementum. Or necrotic membrane.

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You will notice that I repeat this "gums open up" observation, along with the "roll up the flank" talk strategy multiple times on an ongoing spontaneous basis throughout my videos. In what may be termed as "truthful utterances." Also note that once the gums do open up that I clearly get more aggressive. So my claims and talk about the gums opening up to the curette can be accepted as both truthful in declaration and true in fact. Plus I talk about the gums closing up too. So it is fairly obvious I am experiencing this phenomona in my videos in real practical ways. And that I am not just making it up or imagining it.

Also note that the GUMS OPEN UP phenomona is fairly obvious once you think about it a little bit, to the point of not even needing any proof. However DIYPERIO seems to be the first to either notice it or make such a big deal about it or say that it exists at all. And certainly seems to be the first to employ it as an actual strategy. Then go on to make such extravagant claims.

NOTE - Will say that one hygienist on one of the forums did suggest following up a "full-mouth debridement" with SRP in fairly short order. She mentioned the gums "tightening up" after debridement and appreciated the "looseness" of the gums while still in a fairly diseased state. This is similar to what I am talking about but is not quite the same thing.

NOTE - But otherwise I have not seen any description of this phenomona in any of the books or articles that I have read. Most seem to visualize the gums as laying over the calculus, not clinging to the calculus. And don't really describe the calculus resisting the curette at all. So largely think there is literally "another world" of clingy gingiva hidingt deep calculus that has largely escaped the attention of the periodontal profession. Or they just shrug it off as "too difficult."

This would largely mean that regarding closed debridement that the professionals largely live in a world of 0-5mm, with exceptions made for "deep pockets." But meanwhile there is an alternate universe of 5+mm that largely gets ignored until it is time to do expensive surgery. Hence there is no reasonable middle ground that expands the non-surgical world just a little bit further to the benefit of the patients. That is my opinion. So DIYPERIO proposes to expand the non-surgical world through the GUMS OPEN UP phenomena.

Also note that the normal way to notice this phenomona would be to scrape in the same area for perhaps a half-hour or so. But don't think that professionals have the time for this, do they? NO. So don't think there is any reason to think the phenomona is so obvious until somebody tells them it is obvious. Then yes, certainly once somebody tells them, then yes it is obvious.

Or likewise, they may notice it in passing, but presumably would typically be in too much of a hurry to get to the next tooth or to the next patient to exploit it very fully. So even if it has not fully escaped their notice think I am still the main person to make such a big deal about it and to fully recognize its potential. Especially since hour after hour in the same location makes the phenomena even more intense. And like I said, I think the potential is huge and for many folks can help to largely wipe out their periodontal disease in a non-surgical manner. With some R&D, exploitation and practical protocols.

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Likewise you can prove this phenomona to yourself quite easily, with a brush-pick or tooth pick, if you have any periodontal pockets. Just rub-a-dub-dub into the blood and you will see the pocket just "open up" to the debridement right before your eyes, until it runs out of bloody debris. So again, the observation is obvious. Or likewise the phenomona can be proved with a pimple or boil, where the infection just "opens up" to give the body a chance to rid itself of the infection. Almost like the body is a desirous entity with its own mind for its own benefit and welfare, wanting to purge itself of bad things when given the opportunity.

DIYPERIO then goes on to claim that this phenomona is the Holy Grail. Reason being that current non-surgical practice presumably never gets the gums to open up and therefore obviously just leaves the deep clingy calculus behind. Likewise surgery shouldn't be the only answer for getting the deep calculus. A repeatable non-surgical hygienist-based procedure is naturally preferable. And more economical too.

Likewise DIYPERIO goes on to claim that the calculus below is not only close to impossible to get to, due to the Stockholm Syndrome, but also largely gets interpreted as bone too! So the major source of infection gets interpreted as something positive! which is a double or even triple-whammy.

NOTE - DIYPERIO goes even further with his claims to say that traditional pocket measuring protocols get blocked by the calculus too! So a "5mm pocket" might really mean a 5mm deep hole, then 5mm of calculus ledge, then bone.  Think so? YES. So now we are left with a topsy-turvy bizarro world, where even the measuring instruments deliver wrong answers that are then taken as correct. Likewise professionals will talk about "deep pockets" getting shallower. Which DIYPERIO thinks is largely an exercise in fantasy and make-believe. Since the real issue is not the "measured depth" of the pocket but whether the tooth is caked in calculus or suffering from necrotic membrane.

NOTE - What is the answer?? DIYPERIO thinks it is 3D x-rays, a detailed inventory of the calculus and the declaration of the calculus as the enemy. Plus a lot less song and dance about how it is really the biofilm. Or about "killing" the bacteria. Or even calling it a disease instead of what it really is, an infection. So the idea is to put some light on the subject. Start simple. Keep it simple. Reach logical conclusions. Execute, one way or another, without getting confused about "efficacy" as an excuse not to do the right thing. Which is aggressive debridement to the point of 100% hygiene. Done in an efficient economical progressive manner.

So years go by and more and more destruction happens due to continued lack of debridement on the deep problem areas, with deep calculus ledges pretending to be bone, beyond the reach of the curette. Then comes the disaster. "If only we knew!" Which is why periodontal disease is often termed as a "hidden disease."

But is it really so hidden, really? DIYPERIO thinks not. DIYPERIO thinks the evidence is right there. Since even a little bit of light scraping will oftentimes deliver a whole lot of blood. But "efficacy" creates a strong motivation to ignore the problem. Since the task is so difficult and the time so short. But if the task were made easier by getting the gums to open up more readily then couldn't the problem be more easily attacked? DIYPERIO thinks YES.

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SUMMARY - DIYPERIO appears to be the only protocol that offers true "progressive debridement or a "second bite at the apple." Accordingly where the calculus is smooth the curette will be able to penetrate an additional time. Likewise wherever there is additional calculus or necrotic periodontal membrane or other crud then detailed curettage will cause the area to "open up" again for the subsequent curettage. Which will also be easier and faster if there is already less calculus.

Which is not to say that SRP cannot offer this. But DIYPERIO claims that SRP tends to leave the deep stuff behind. Largely the reason for this is the debridement session in any one spot does not last long enough to make the GUMS OPEN UP. Plus the task is difficult, as said. So the leftover calculus cannot really be considered "remnants." Since it was never really debrided in the first place.

Likewise there is a wealth of professional material claiming how difficult to impossible it is for professionals to do closed-debridement below 5mm. So why not take them at their word that what they say is impossible for them is indeed impossible for them? And also agree that the gums clinging onto the calculus is a reasonable explanation for why it is so impossible. So clearly if the gums can be induced to open up then this would open up entirely new worlds to closed debridement. DIYPERIO thinks this to be most certainly true. Who else believes this to be true?

Likewise it does not make a lot of sense that the main follow up on surgery would be more surgery. So here you can fairly easily imagine a follow up that is similar to the DIYPERIO approach to go in deep. Since the layers and ridges of calculus are presumably gone then the curette should slip in reasonably readily. But in any case, even after surgery you can figure there is still ample debris left behind. Which will then act up at some future point.

So again, deep debridement with the curette seems to be the only approach that is reasonably universal. And whether the curette slips into the deep areas on its own or gets a little help from the gums loosening up makes a world of difference. Since a little disruption goes a long way when it comes to debridement.

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DIYPERIO makes no claims about "completeness." DIYPERIO simply says to keep reducing things via progressive debridement to less and less until NIL is achieved. Which DIYPERIO presents as "reverse doubling" - What is left after each debridement? - 50% - 25% - 12% - 6% - 3% - 2% - 1% - NIL - So... in the DIYPERIO system 7 debridements can take a fairly filthy area down to NIL.

But obviously "deep is deep." So maybe those seven debridements will just get you down to a lower level of 100% filth. OK fine! So it will take 14 debridements! Or 21 debridements. Or 28. But clearly most areas will come clean after only a few debridements. And the areas that are bad are simply bad. So be thankful you still have a tooth!

And also if the debridement process is thorough perhaps the first debridement can reduce the problem to 25%. Then to 5%. Then to 1%. Then to NIL. So here 4 debridements do the job. Or 8 debridements for a deeper level of filth. Or 12 debridements if there is an even deeper level than that. In any case though the tooth will eventually run out of crud. Of that fact you can be sure. And when that time comes hopefully the tooth will still have some bone too. And most of the time it will. Or reasonably you can expect at least 1mm of bone to come back or maybe even up to 3mm. Which could do the trick to keep the tooth surviving.

At which point theoretically, miracles will happen. But even so NIL can be a pipe dream too. If everything is destroyed but there is still a lot of crud left anyway. Likewise the necrotic periodontal ligament can be close to impossible. Plus working around the apex of the tooth can be close to impossible too. So DIYPERIO does not propose to be a miracle worker.

However, if things aren't so bad then certainly the miracles can and will happen. And otherwise the situation can be compared to a real estate issue, where there is good real estate, good reclaimed real estate and infested and destroyed real estate. So even if some ultimate destruction is left that is close to impossible to resolve the situation is still moving in a positive direction and the area that is bad and destroyed gets smaller and smaller over time and can even heal over.

Now comes the question "Was it worth it?" - To a dentist the answer may be no. Heroic measures against a failed cause. But to a DIY-PERIO the answer may be yes. A lot of free work with marginal results. Tooth is still dicey and still doomed. But still alive. Which might make sense to the person who works for free. And who otherwise doesn't have a busy life. Or who thinks that another year with a living tooth is a good thing. Or what I term as "Rent-a-Tooth." Which I claim is a good thing, not a bad thing. Though do have to know when to call quits.

Likewise the DIYPERIO doesn't really cause much harm beyond soreness for a few days. Hence the DIYPERIO can be repeated. But can't really say the same about surgery. Would presume the pain lasts considerably longer. Plus the procedure is not so readily repeatable. Plus it is expensive.

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So my claim is that my unique discoveries, observations, claims and protocols, especially regarding the GUMS OPEN UP phenomona, have strong applications throughout the entire field of periodontology and have the potential to save millions or even billions of teeth. And likewise by helping to put periodontal disease into remission and avoid some very real deep infection and sepsis issues, to help save thousands or even millions of lives too.

Early on I was ready to get a bunch of teeth extracted. But then over time my motto turned into "Save them all. Let God sort them out." But even so I am still about to lose a second tooth. With at least two more ready to go after that. So really the idea is to just not be so quick to extract, do everything you can and then hope for miracles.

Which for fairly clean post-debridement environments can and do happen. Also keep in mind that the DIY reduces the economic burden. So naturally the equilibrium is going to tend towards save the tooth, don't extract it. But if the economic burden is high, via professional practitioners, then naturally the equilbrium point will more often be to extract.

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PS - 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.

Similarly at the same time let us say that any super-difficult calculus fortresses and possible periodontal abscesses should come to the attention of the practitioner for even more detailed work. So let us say to double the cost again to $5000 for a patient to get a pretty thorough going over, without the piecemeal approach done now. So now imagine it on a turnkey basis. Essentially revamping the entire treatment of periodontal disease and eliminating a good 70-90% of the disease for the folks who participate in the program. Providing them with a good value without the song and dance of incomplete SRP and waiting to see what happens next.

Also my understanding is that this type of service is largely available now. To Hollywood type folks willing to spend $400 per hour of debridement. With lots of free time. So let us say that 20 hours or $8000 gets them out of the doghouse without surgery. Still not so bad if somebody has a lot of money to spend on preventative care.

PS - Also note that a lot of tooth cleanings or "prophys" are not necessarily so extensive. And I have had my share of quick 15-20 minute "once-overs." But if the public demands better cleanings then there is a good chance the providers will provide. Likewise for SRPs.

Likewise if the American Academy of Periodontology can be convinced to publish guidelines and if the profession in general can be convinced to comply to guidelines then both the quality and the debridement times of the SRPS should go up. Which again would go a long way to improving the general periodontal health of the folks who get treated. Since "quick and dirty" would get outed for what it is and the public would demand better.

PS - Also could turn out that biofilm and progressive debridement and chronic wound metaphors as exemplified by DIYPERIO will turn into more dominant themes for the future of medicine. In particular perhaps the biofilm and chronic wound metaphors have greater applications outside the obvious. Especially if it turns out that folks are "co-habitated" by bacteria more than they might realize.

google - periodontal abscess curettage - to see what different folks think about this protocol for treating periodontal abscesses.
google - progressive debridement - to see who is promoting progressive debridement concepts.
google - toothpick blobbage - to see a bunch of submandibular granulation tissue.
google - curettage & blobbage - to see a "flame war" between myself and a bunch of dental hygienists, where I defend DIYPERIO and attack standard practice.
google - diyperio video - to see a list of my videos
google - diyperio x-ray - to see my x-rays
google - diyperio diary - to see my diary, including hours spent

google - Don't Let Them Pull Out Your Teeth - to see that the entire field is a battleground of misinformation, misrepresentation and conflict. With part of the problem coming from people not wanting to spend the money or from general distrust of dentists. But also a lot coming from high costs and unsatisfactory solutions. And the desire to kick the can down the road.

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