ongoing diary

ONGOING DIARY - starting May 2006

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GENERAL NOTE - Started with the explorer and got lots of blobs. Six weeks later I switched to cheap Gracy curettes and learned how to sharpen them with a sharpening stone. Then over the next several months I started buying better quality curettes on eBay. Then by the end of 2006 I decided to buy some expensive curettes from American Eagle. Plus more eBay curettes and scalers. For at least the next two years I was fairly enamored with Gracys. Though they tend to skip and peel the calculus off in layers. Which is very time consuming. Largely I was afraid of universals because it is difficult to gain a sense of self awareness with them. Plus they tend to dig in, so end up mano a mano against a determined calculus adversary.

I had many calculus adversaries during this time. Including cleaning out molar furcations, which was very strange and treacherous. Plus one major high volume bleed out on upper left molar 16, where I experienced "buckets and buckets" of blood for the first time. Plus the imperative to go for debridement sessions of 8-10-12 hours as necessary to take advantage of the calculus being made available by the "gums opening up."

Largely I completed this initial debridement within the first year, by early 2007, and the teeth miraculously recovered. Indeed I felt I experienced a miracle. Largely I ignored the teeth for the next three years except for regular cleanings. Plus had a few dicey areas, notably the tooth 18-19 gap, which I thought I resolved. Plus a few other areas.

Then... in October 2010, or roughly 3 1/2 years after the issues were largely resolved the chickens came home to roost in the form of periodontal abscesses. The first major abscess, on lower first molar tooth #30, ended up lifting up the tooth, which apparently caused "collision" between the first and second molar, which shortly thereafter led to root resorption and the ultimate destruction and extraction of the tooth. I tried to save the tooth with extensive debridement to no avail.

Saw a periodontist and got a scaling and root planing in February 2011. But quickly became aware there was a lot of crud left over, some fairly serious crud, in very critical places and that I was headed for deep trouble quite quickly. Especially since the periodontist recommended a series of extractions. Started upgrading my curettes too. With Hu-Friedy Gracy Micro-Minis. PDT Montana Jack & Mini-Me. O'Herir specialty scoops. Sugarman and Hirschfield files. Custom Langer 1-2 extended access mini. L&M Furcator. Plus

The second major abscess was in April 2011 between the first and second upper molar tooth 2-3 gap, which was evidenced by a horrible smell. At this point I had already purchased some Hu-Friedy Micro-Minis and ended up releasing a bloody mess that scared the pants off of me. I was ready to get one or more of the teeth pulled, but decided to stick it out with a series of ongoing progressive debridements. Including aspiration w 23 guage needles. Whereupon the teeth miraculously recovered after extensive debridement and have largely been benign ever since.

The third major abscess was in August 2012 with the tooth 29 bicuspid, which ended up surrounded by roughly five major abscesses. But again I debrided this tooth and it recovered. It took roughly 40 hours. It still has apical periodontitis and looks like it has root resorption. So I have ignored it at my peril. But it hasn't acted up much since.

The fourth major abscess was in September 2012, which was really a complex of abscesses on the upper right teeth running from tooth 2 molar all the way to tooth 7 incisor. This included apical periodontitis on tooth 7. I debrided all these abscesses in a series of progressive debridements lasting several months. The overall approach reminded me of a military campaign. Much of it was a horrifying bloody mess with large amounts of granulation tissue getting released and fear of too much blood loss. Following up with ongoing debridements, focusing on the bicuspid ever since. Roughly 20 debridements over the past two years. With more to go. Thought the teeth would fail. But they didn't.

As of August 2014 still have at least one major debridement still left to go on the bicuspid. Which I expect will be very bloody and which will likely even open up the hole into the sinus. Which I am confident I will recover from. Additionally there has been nerve involvement with the infra-orbital nerve, which has been pretty scary. But I researched nerves and am confident I can work around the nerve and that it will successfully recover. Also included are sinus issues, ie holes into the sinus. But again I am confident I will resolve these issues successfully. Or the teeth will die in the interim. Which will make the decision for me.

The fifth major abscess was in October 2012 on the molar-bicuspid 18-19 gap. Plus the 17-18 gap. Which I had been debriding on a very slow track for years. Then finally realized I had to reach the bottom and that thinking in two hour windows and debridement vs trauma was a mistake. Leading to the idea of long debridement sessions. Also expanding on the idea of the "gums opening up" after several hours to offer fresh debridement opportunities and a genuine shot at the calculus at the bone level, ie the holy grail. But also to consider that the ongoing pain was real, lasting for a month or more.

But in retrospect that there was no need to wait for the area to heal for three or more months, but the sooner the better. Hence the idea of Fast Track vs Slow Track. In addition here I pushed forward with more of a pickaxe strategy, which I had previously avoided to avoid bone issues. But think my ability to analyze bone vs calculus has improved. So use logic to determine something is calculus and cannot possibly be bone. But the logic is fairly obscure, going through a series of "what if" questions and probabilities. But in any case my understanding is almost always the same. "Everything has to go." I am confident that I have not chopped away much if any bone at all throughout all the debriding that I have done.

Starting in roughly December 2013 started revisiting this area and turns out the entire area is more severe than originally wished. Have been progressively debriding it. But have put it on the back burner and only get to it perhaps once a month or so. Hoping more serious problems don't rear up in the meantime.

The sixth major abscess complex got started in December 2012 on the gap between the second molar and the wisdom tooth tooth 31-32. Gradually this problem has evolved to where tooth 31 has been loose for roughly the past year. Likewise it became apparent at some point that the submandibular region of my neck got an escaped infection. Hence this area is extremely dangerous and dicey. Successfully drained the submandibular for the first time in October 2013. Have been progressively working the problem ever since. Finally got the 3rd bleed at the end of July 2014 and the 4th bleed in early August. So strangely I am confident I will be successful. Though may have to give up the second molar tooth 31.

In addition, since the 31-32 submandibular abscess is so severe I am trying to stay focused on a concerted irrigation program. Mostly with the 3MIX-LSTR, which I "upgraded" to 4MIX. Presumably soon leading into a special "jaw-juice" cocktail w mules. As the "closer." Plus DuoDerm for autolytic (natural) debridement. Plus Urea-Papain for more active chemical debridement. Object is to maintain the area in "critical condition" while staging both Fast Track and Slow Track debridement sessions to alleviate the underlying submandibular and jaw infection problems. Then... if the area does not go super-critical in the meantime then hopefully the healing forces will gain way. Meanwhile if I have to bail out of the situation then start with getting tooth 31 extracted and try to save the wisdom tooth.

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LIST OF PROBLEMS - February 2013

SUMMARY - My longstanding and ongoing issue of multiple periodontal abscesses started to become both obvious and imminent and critical starting in July 2012. Since then I have debrided roughly 8 primary abscesses plus multiple secondary abscesses with still more to go. So far all the teeth appear to still be alive. Teeth appear to be healing well too. With lots of secondary debridement. But the nerve involvement issues are obviously both dangerous and treacherous. Since the abscesses have definitely invaded the nerve proximities and possibly even the nerve channels themselves.

1) Tooth #1-2 gap. Deep multiple periodontal abscesses, lingual and buccal, with previous 02-11 smelly infection and multiple oral-antral communications. Now mostly appears debrided, healed and benign. Includes #1 furcation, definitely class 2, possibly class 3. Plus #2 furcation, definitely class 3.

2) *** Tooth #3(4)5 gap. Deep multiple periodontal abscesses, lingual and buccal. Dating back to roughly 2007. Mostly debrided in 09-12 & 10-12. Muscle below right nostril tends to twinge upon any deep hygiene maneuvers. Suggesting tri-geminal nerve involvement. Also includes definite multiple molar furcations class 3. Plus previous but now apparently benign oral-antral communication(s).

3) ** Tooth #5-6 gap. Deep multiple periodontal abscesses, lingual and buccal. With presumed furcation on bicuspid and a highly questionable and dicey future.

4)* Tooth #7d. Long term involvement with tooth nerve. Dating back to at least early 2011. Experienced as mild twinging or aching. Source of problem appeared to be from distal abscess crossing past back of eye tooth into what appears to be an open cavernous but small pocket around the apex of the tooth.

5) Tooth #14-15-16. Area highly damaged but largely debrided by 03-11 and apparently viable and peaceful for now. Includes long term apparently benign oral-antral communication.

6) ** Tooth #17-18 gap. Area is undebrided except for standard SRP and maintenance. Presume there is a periodontal abscess there affecting the buccal nerve. Feel warmth and occasional twinging in buccinator muscle, matching sensations on opposite side, but not as severe.

7) Tooth #18-19 gap. Periodontal abscess primary debridement 10-12. No secondary debridement yet. Debridement incomplete.

8) ** Tooth #19(20)21 gap. Long term periodontal abscesses. Dating back to roughly 2009. Revisited primary and secondary debridement in 10-12 & 11-12. Alveolar nerve involvement, with some numbness on lower lip and tongue. With reasonable some apparent recovery, but with some ongoing "acting up." Also looks like there might be some devestating resorption.

9)** Tooth #28. Multiple periodontal abscesses all around. Dating back to 2007. Mostly debrided 08-12 to 10-12. Includes definite alveolar nerve involvement on distal side and likely on buccal side too. Looks like tooth may be getting resorbed too. Plus it is loose. Also the original abscess highly swelled up the salivatory gland. Salivatory gland still appears slightly swollen but otherwise feels benign. Think primary current issue is incomplete debridement on buccal side and distal corner. Think this might be the primary cause of the alveolar nerve issue.

10) *** Tooth #30-31 gap. Deep multiple abscesses. Debrided starting 12-12 to 02-13. Ongoing buccinator muscle pain. Buccal nerve and buccinator and possibly even the neck (apparently) were highly affected for at least a month or two prior to any actual debridement. Any deep hygiene manouvers cause temporary buccinator muscle pain. In addition to ongoing buccinator muscle pain. So pocket is definitely right next to the nerve.

NOTES ON NERVE INVOLVEMENT: Most of the ongoing nerve involvement and resulting numbness is on the lower right lip and the right side of the tongue and in the right buccinator. Left side mimics the same symptoms but at a lower level,occasionally almost imperceptible, sometimes more.

The numbness comes and goes. Sometimes it seems like it has gone away almost completely, like everything is close to normal again. But talking and any general sense of emotion and stress make the numbness become very obvious. Ibuprofin tends to relieve the symptoms.

Any sort of hygiene, including using the irrigator, temporarily makes the symptoms worse. But then after awhile it will calm down.

Regarding the alveolar there is some question whether the involvement is mostly from tooth #29, likely from the buccal-distal corner or whether there could be additional involvement from tooth #31-32 lingual, either from the abscess gap or along the lingual edge of one or both teeth.

Definite tri-geminal involvement. There is some additional nerve involvement on the right upper lip and with twinges and warmth leading both up towards the nostril and up to the right side of the eye. Presume the primary source is the #3(4)5 buccal gap. But seems reasonable there could be other sources too.

SPECIAL NOTE: Close-up debridement of the actual right buccal nerve proximity at #31-32b only took place starting in early February 2013, less than a month ago. Meanwhile close-up debridement of the tri-geminal nerve proximity at #3(4)5b only took place on February 22-23 2013. Less than a week ago. So both these areas are still in immediate recovery from debridement trauma mode. And in some miracle fanciful world perhaps even definitively directly addressed both issues and they can both go on into more of a healing mode.

NOTE: Also using hyaluronic acid as "drilling mud" to wash affected areas. On semi-ongoing but intermittent basis. Also have plans for other types of so-called debridement solutions, like papain-urea and wet hydro bandages to treat affected areas as chronic wounds. To address areas that are already largely mechanically debrided.

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The DENTAL DIARY -- Saturday 5/6/06

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May 6, 2006... What do I want?

First I want to stop the disease on the one bad tooth.

Second I want a deep cleaning of all of my teeth. It looks like a good general maintenance procedure. Last time I had a deep cleaning done was in 2000.

Third I want a clear idea about the cleaning.

Idea -- dental hygienist school.

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SUMMARY OF CLEANINGS WITH EXPLORER DENTAL TOOL - STARTING JUNE 6, 2006 - W ADDENDUMS

2006 - CURETTAGE

1 --sa-05-06-06 -- Scrape tooth 14 -- hours upon hours. Approximate at 3 hours. Recall at least six major clots for tooth 14. Including serious filth in the front portion. Also recall in retrospect that cleaning the back portion was difficult. Requiring special angling. Possibly also scraped front part of tooth 15.

2-- su-05-17-06 -- Scrape tooth 14 -- Approximate at 1-hour
-- Later.... Scrape overall teeth with explorer. Approximate at 3 hours.

3 -- m-05-08-06 - Monday, May 8, 2006 -- Scrape overall teeth -- Approximate at 1 hour.

4 --tu-05-09-06 - Tuesday, May 9, 2006 -- Scrape overall teeth -- approximate at 1 hour.

SUMMARY -- 9 total hours so far. Of actual functioning scraping. With... at least 4 hours allocatable as high-end.
-- tooth 14 equals 3 plus 1 equals 4 hours. NOTE -- Reality might include 2 additional hours.
-- Overall other teeth equals 3 plus 1 plus 1 hour equals 5 hours.

5 -- m-05-15-06 - scrape upper teeth -- approximate at 1 hour.

6 -- su-05-21-06 - scrape left upper teeth -- approximate at 1 hour.

7 -- su-06-04-06 - scrape tooth 14 -- Break ledge. With serious clots released. Approximate at 1 hour.

8 -- m-06-05-06 - scrape teeth 1 through 4 -- Approximate at 1 hour. -- DID I CAUSE DAMAGE TO TOOTH 3 GUM TISSUE NOW?

9 -- f-06-09-06 - Friday, June 9, 2006 -- Midnight Madness -- scrape all upper teeth -- including tooth 14. Including tooth 3. As thorough as possible. Big blobs. Approximate at 4 hours.

-- DID I CAUSE DAMAGE TO TOOTH 3 GUM TISSUE NOW?

10 -- w-06-14-06 - tooth 14 only -- 3 hours! Several major clots. Good progress!

11 -- f-06-16-06 - tooth 14 only -- failed attempt on a shelf ledge. Estimate at 2 hours

12 -- sa-06-17-06 -   bottom molars -- good progress and general cleaning. Estimate at 2 hours. WAS THIS ONLY ACTIVITY ON BOTTOM MOLARS?

SUMMARY - END OF EXPLORER ERA -- 24 total hours. Additional total is... equals 15 additional hours -- plus 9 prior. Or 24 total hours. Versus a dental hygienist.

With Gracy Curettes -- new phase.

13 -- w-06-21-06 - Wednesday, June 21 -- tooth 14 only -- SRP with Gracy curettes. With cut gum. Estimate at over 2 hours. Serious amounts of plaque and calculus removed. PROCESS WAS PERFORMED IN A HIGHLY AGGRESSIVE MANNER. DID I CUT BREAK OFF TOOTH AND CUT OPEN GUM NOW?

14 -- tu-06-27-06 - SRP tooth 1. With Gracy. Major plaque and calculus removed. With deep pocket. Estimate at 1 hour.

15 -- w-06-28-14 - SRP outsides of teeth 1-3. Reasonable plaque and calculus removed. Estimate at 1 hour. WAS THIS A PERFUCTORY JOB?

16 -- th-06-29-06 - SRP inside of teeth 1 and 2. Medium filthy. Slow going. Estimate at 3 hours. DID I FORGET TO DO INSIDE TOOTH 3?

17 -- su-07-02-06 - SRP inside of tooth 14. Seriously filthy. Tooth is loose! With mother lode type blobs in pocket. Estimate at 2 hours.

18 -- w-07-05-06 - SRP teeth 14-16. With primary focus on outside of tooth 16. With sickle ledge breaking. With deep pocket. With furcation. With mother lode type blobs. Major Major type crud. Estimate at 5 hours. THIS WAS THE GUM POCKET. DID I BREAK IN? DID I DAMAGE GUM OF TOOTH 16 PREVIOUSLY?

19 -- th-07-06-06 - SRP t15. Area is sore. Attempt at basic coverage. For objective of comprehensiveness. Estimate at 1 hour.

20 -- m-07-10-06 - SRP t12. Tooth is loose! Along with tooth 14. Tooth is completely filthy. With mother lode type blobs. 10 blobs out of inside front pocket at once. Total filth. Estimate at 4 hours.

21 -- sa-07-1506 - SRP t14. Attempt to reckon with divot and ledge. Coming around from back to outside. Major pocket in back. With major blobs. Estimate at 5 hours.

SUMMARY - 24 total Gracy hours. 2 plus 1 plus 1 plus 3 plus 2 plus 5 plus 1 plus 4 plus 5 equals 24 hours. Amazing.

-- w-08-03-06 -   -- PERIO GUY -- One month post gum pocket.

-- m-08-07-06 - -- Get x-rays

-- w-08-16-06 -   -- Get SRP

22 -- m-08-28-06 - Floss. Check out. Light general SRP tooth 14. Plus additional SRP. With some calculus. Estimate at 3 hours.

23 -- tu-08-29-06 - SRP tooth 15. Apparently filthy. With breakaway edge. Screw up. General SRP teeth 13 -16 Estimate at 2 hours.

24 -- f-09-01-06 - Friday, September 1, 2006 -- SRP teeth 13 through 16. General all around. With comprehensiveness. Reasonable calculus.

Discover tooth 2 gum detached from bone. Requiring surgical intervention? With pocket. With likelihood of TT cutting through gum. But... could TT have caused the creation of a pocket? Debride pocket. Plan how to clean out pocket. Estimate at 3 hours.

SUMMARY - 8 additional Gracy hours. Total Gracy hours equals 24 plus 8 = 32. Total shepherds hook hours at 24. Total is 56 hours total debridement of tooth surfaces. Mostly on four teeth. With amazing surprises that calculus is still there! With realization that some of it is latent calculus that is only now attracting a following of plaque.

25 -- f-09-01-06 - SRP t16. Revisit previous ABSCESS. Second time. Idea to clean out pocket. With reasonable results. Debrided as best I could. Working curette around pocket. But... did not finish off what I had in mind. Additionally... with suspicion, gradual discovery and conclusion that my prior curetting of pocket on tooth 16 was the same thing. Summary -- Reduced bacteria load. They at 3 plus 2 equals 6 hours

26 -- tu-09-05-06 - SRP teeth 14 through 16. Irrigate pocket abscess tooth 16. Mixed results. Final scrape, brush and irrigate. Stop. Treat as surgical site. 1 hour. Teeth 29 through 32. Lower right molars. Mostly tooth 29. Clean inside surfaces. 2 hours.

27 -- w-09-06-06 - apply melaleuca to damaged gum areas. SRP teeth 29 through 32. Lower right molars. Mostly 29. Trash gum. Flops open. With destruction of gum tissue. Treat as surgical site. Entire area quite filthy. Certainly suffering from periodontal disease. But still have in between the teeth to do. 2 hours

28 -- sa-09-09-06 - SRP teeth 1 through 3. Tooth 2 filthy. Open gum abscess filthy. Estimate at 2 hours.

29 -- th-09-21-06 - non-SRP -- brush pick lower right damaged gum tooth 29 molar. Trashed gum. Clean out blobs. Estimate at 3 hours.

30 --f-09-22-06 -   non-SRP -- brush pick 14/15 pockets. Amazingly filthy. 50 pieces. Estimate at 3 hours.

-- w-09-27-06 - PERIO GUY -- interdental 14/15 traumatized.

SUMMARY - 12 additional Gracy hours. Credit 6 brush pick hours. Equals 18 additional hours. Plus 32 equals 50 hours between June 20 and September 20.

31 -- tu-10-10-06 - SRP teeth 1 through 3. Teeth 13 through 16. Light SRP. 3/4 hour.

32 -- w-10-11-06 - SRP -t14-ml - SRP filthy bacterial colony pocket. 1 1/2 hours.

33 -- m-10-16-06 - SRP - t2 abscess. Filthy. 4 hours.

34 -- tu-10-24-06 - SRP - t14-15. Gruesome looking. Stop. Stay away. 4 hours.

35 -- sa-10-28-06 - SRP- t2. Gum abscess/gum boil. 4 hours.

36 -- m-10-30-06 - t2. Clean gum boil. Irrigate. Finalize. 2 hours. With the Gracy. Later... gum 3/4 with tooth pick.

37 -- th-11-02-06 - SRP - t2-3. Filthy. 2 hours.

38 -- th-11-16-06 - SRP - t3. Furcation. SRP t2. SRP teeth 14 and 15. Plus 15 and 16. 3 hours.

39 -- f-11-17-06 - SRP - t3-4. Presumably exposing furcations? Filthy. 2 hours.

SUMMARY - 24 additional gracy hours. Roughly 6 weeks. Plus 50 equals 75 total Gracy hours.

40 -- tu-11-27-06 - Dr. K -- SRP. Later... SRP t3 furcation. 1 hour.

41 -- w-11-27-06 - SRP midnight madness. Burnished calculus. 6 hours.

42 -- th-11-30-06 - SRP. Start surgical rest. 3 hours.

18 DAYS TOTAL REST

43 -- m-12-18-06 - SRP molars. 3 hours.

44 -- th-12-29-06 - SRP molars. Minis. 2 hours.

45 -- sa-12-30-06 - SRP molars. Minis. 3 hours?

SUMMARY - 18 additional gracy hours. Total 93 gracy hours for 2006

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2007 - CURETTAGE

01-- sa-01-06-07 - SRP - molars. Minis. 2 hours?

02-- w-01-10-07 - SRP - furcation t3. Four major blobs. 1 hour.

03-- th-01-11-07 - SRP -furcation t2. Reasonable blobs. 1 hour.

04-- sa-01-21-07 - SRP - tenacious calculus. t2/3/4. 3 hours.

05- th-01-25-07 - SRP - furcations - t2,3,14 - bio-mass reduction - 2h

06-- f-01-26-07 - SRP all. Including apex. Midnight madness. 5 hours.

07-- m-01-27-07 - SRP. - Distals and mesials. Significant calculus and blobs. 3 hours.

08- m-1/29/07 -- SRP - Generalized -- post generalized SRP sweep of overall affected areas. Functioning as generalized end of hostilities and beginning of postwar phase. 3 hours

09-- w-01-31-07 - - SRP - mesial t14. SRP mesial 2 furcation. Filthy. Fistula. 5 hours.

10-- su-02-04-07 - SRP - mesial t16. Filthy/filthy/filthy. Sam Peckinpah. Hundreds of blobs. Buckets of blood. 6 hours.

11-- m-02-05-07 - SRP - t15/16 interdental. Sam Peckinpah. Buckets of blood. Plus general perio. 3 hours.

SUMMARY - 34 additional Gracy hours.

12- th-02-15-07 - SRP - Furcations 2 and 3 -- follow up on prior major debridement - fairly filthy. 3 hours

13- tu-02-20-07 - SRP - distal t4 plus buccal and lingual. Light. 1h

14- f-02-23-07 - SRP - t16m - light - 1h

15- f-03-02-07 - SRP - MLt16 - 2h - follow up on prior bloodbath. 1h

16- 03-06-07 - SRP - t2/3 gap w fistula - 1 h

17- tu-03-20-07 - SRP - D3 & ML2 - Funky. Intractable BOP. Possible apex. Apparent oral antral fistula. 1h

18- f-03-23-07 - SRP - D3 - 1h

19- f-04-20-07 - SRP - D3 mostly - BOP - 3h

20- m-07-16-07 - SRP - general - 2h

21- m-07-23-07 - SRP - t1-2 & 3-4 & 13-14 & 15-16 - furcations - 2h

22- sa-09-15-07 - SRP - 16M - 14M - 2& 3 furcations - 2h

23- th-11-08-07 - SRP - D14 - furcation - 1h

24- m-12-03-07 - SRP t14-15 - lots of blobs - 4h

SUMMARY -- tooth cleaning by hygienist on th-4/12/07 & tu-06-26-07 & 11-27-07 represents the starting of a new phase. Should try to preserve cleanliness. In addition should try to start to implement regenerative possibilities. Such as irrigation with calcium triphosphate.

NOTE - By April-May 2007 the teeth largely appear to have resolved themselves. 14/15 gap looks largely healed. 3/5 gap seems reasonably benign. 18/19 gap seems healed. General sweep gets little to no blood.

SUMMARY - 23 additional gracy hours. Plus 34 prior hours = 57 hours for 2007 & 93 hours for 2006 = 150 total hours post explorer phase.

END OF PHASE 1 - GET TEETH BASICALLY CLEAN

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2008 - CURETTAGE - START OF PHASE 2

1 - f-02-15-08 - SRP - furcations - general sweep - 1h

2 - su-04-13-08 - SRP - t2-3 gap & 31 - both filthy - 4h

3 - tu-04-23-08 - SRP - t2-3 - 1h

4 - th-05-29-08 - SRP - t30-31-32 - general cleanup - 2h

3 - m-06-09-08 - SRP - t30-31-32 - buckets & buckets - 4h

4 - tu-06-10-08 - SRP - t14-15 - 1h

5 - sa-06-14-08 - SRP - D3 - 1h

6 - sa-06-28-08 - SRP - t19-m - 30 blobs - hundreds of flecks - 3h

7 - w-07-09-08 - SRP - t32-d - 1h

8 - su-07-13-08 - SRP - t32 - 2nd debridement - 3h

9 - w-07-23-08 - t19-20 gap - irrigate w iodine - hundred of flecks - 2h

10 - f-08-01-07 - t19-20 gap - irrigate w iodone - get fairly clean - 2h

11 - f-10/24/08 -- SRP capped molar -- t19 -- iodine -- hundreds of flecks -

SUMMARY 2008 - - 27 hours of curettage & deep irrigation

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2009 - CURETTAGE - CONTINUATION OF PHASE 2

1 - m-01-19-09 - SRP - t30-31-32 - filthy - 2h

2 - sa-01-24-09 - SRP - t-30-31-32 & t2-3 - 2h

3 - th-02-12-09 -- SRP - t30-31 - buckets and buckets -- 4h

4 - th-03-05-09 -- SRP - t30-31 - filthy and deep -- 2h

5 - tu-03-17-09 - SRP - t19-20 - clear gap - 1h

6 - w-03-25-09 - SRP - t30-31 - deep pit - apex? - 1h

7 - sa-04-04-09 - SRP - t30-31 - buckets of blood - nasty - 2h

8 - su-04/26/09 -- SRP - t30-31 - light filthy -- 2h

9- tu-06-15-09 - SRP - t21 - incisor - filthy - 1h

10 - su-07-19-09 - SRP - t16m - lots of blood and flecks - 2h

11 - m-08-10/09 -- SRP - t30/31 - various blobs -- 2h

12 - th-10-29-09 - SRP - upper distals - 1h

13 - th-12/3/09 -- SRP - 30/31 - mesial -- 1h

SUMMARY 2009 - 23 hours of curettage

END OF PHASE TWO - INTERIM

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2010 - CURETTAGE - START OF PHASE 3 - PERIODONTAL ABSCESS ATTACK TOOTH #30

NOTE ON TOOTH 30 ABSCESS & EXTRACTION: One major symptom on the t30 molar abscess was the tooth started to rise up. Apparently this is caused by pressure from the infection under the tooth. Checking out the X-ray of this tooth it looks like the furcation of the tooth has an edge of calculus around it. So likely the calculus and infection got into the furcation and the pressure from below is what caused the tooth to rise up. In retrospect if I was able to have perfect knowledge about this tooth in advance, plus perfect skill, and was aggressive enough there is a slight possibility I could have saved the tooth. But once the tooth "rose up" it got root resorption, ie spontaneous self-destruction, caused by a "collision" with the surrounding bone, which ended up killing the tooth. Which again, with perfect knowledge and skill I could have combatted. However, I did not have perfect knowledge or skill and the situation was already so severe by the time it became apparent that unless I could have stopped the tooth from erupting and prevented its collision with the bone then the tooth was pretty much doomed once it erupted and started to become painful.

10/28/10 -- see dentist -- t30 - discussed late evening soreness - dentist said "Let's see what happens"

1 - sa-11-13-10 - SRP - t30-31 - pain increasing - general exploration - plus other areas - 2h

2 - f-11-19-10 - SRP t30-31 - pain getting severe - constant, critical, demanding - 1h

11/23/10 - see dentist - t30-31 - emergency - extremely painful - get antibiotics and pain killer (?) - plan to extract one or both teeth!!

11/24/10 - t30 - bloody blobs spontaneously release themselves - pain stops - cold test teeth - t31 is highly viable, almost normal - t30 definitely viable, but w apparent pulpitis (?)

3 - th-11-25-10 - SRP - t30-31 - painful curettage - release lots of blobs. - 2h

4 - sa-11-27-10 - SRP - t5-7 anteriors & t20-27 anteriors - general cleaning - 4h

5 - su - 11-28-10 - SRP - t30-31 - additional curettage - 1h

6 - tu-11-30-10 - SRP - t30-31 - additional curettage - highly subterranean - 1h

7 - tu-12-14-10 - SRP - t30-31 - curettage - 10+ major blobs - 2h

8 - th-12-16-10 - SRP - t2-3 gap - 1h

9 - f-12-17-10 - SRP - upper incisors - 1h

sa-12-18-10 - note - t#30 feels "squishy" and numb. Responds poorly to scratching. Delayed response to cold.

10 - sa-12-18-10 - SRP - lower incisors - 1h

11 - su-12-19-10 - SRP - t28 - 1h

12 - w-12-22-10 - SRP - t30-31 - major release of debris - stinky!! - irrigation into "stink central" temporarily helps flush out stink - 2h

13 - f-12-24-10 - SRP - t6-7 & t27-28 & t30-31 - stinky! - 2h

14 - tu-12-28-10 - SRP - t6-7 & t30-31 - stinky!! - 2h

NOTE - TOOTH 30 ABSCESS - There appear to be two holes on the distal portion of tooth 30. One hole is located entryway roughly the spot of the distal lingual corner of original release. Second spot is located roughly midway distal. Meanwhile approach from lingual portion becomes progressively more difficult. Approach appears blocked. Or hole seems to close. Meanwhile original approach from buccal portion starts very open and subterranean. Reaching most of the way to the lingual side. Becoming the major entryway. But over time this entryway also becomes more and more blocked. Until it becomes difficult to insert the irrigation needle into so-called stink central.

SUMMARY - 23+ hours of curettage - mostly on t30 abscessed tooth - obviously super-critical and in danger of imminent death

= = =

2011 - CURETTAGE - CONTINUATION OF #30 ABSCESS ATTACK - PHASE 3

1 - w-01-05-11 -- SRP -30/31 - t31 mesial -- successfully remove most of major ledge -- lots of bloody debris -- 3 h

2 - th-01-06-11 - SRP - t6 - t3 - assorted - 1h

3 - sa-01-08-11 - SRP - 30/31 - stink returns with vengeance -- SRP t30 distal -- significant debris -- medium bloody -- 2 h

4 - su-01-09-11 - SRP - t2-3 - t5-6 - t16-17 - assorted - 1h

5 - w-01-12-11 - SRP - 30/31 - fine SRP along the bottom edge with Micro-Mini and McCall -- significant bloody debris - 1h

6 - f-01-14-11- see periodontist - arrange for SRP

7 - sa-01-15-11- SRP - t2-3-5 - general - smelly too? - 4h

8 - su-01-16-11 - SRP - t1-2 gap - lots of crud - 5h

9 - tu-01-18-11 - t30-31 - Aspirate & irrigate w iodine - 1h credit

10 - th-01-20-11 - periodontist - SRP - lower right quad - 1h - $300

11 - f-01-21-11 - SRP - t1-5- lots of crud - smelly! - 4h

12 - sa-01-22-11 - t2-6 - aspirate - 2h credit

NOTE - ongoing daily irrigation and aspiration of abscess to relieve stink

13 - f-01-28-11 - SRP - t2-3 - t30-31 - 2h

14 - tu-02-01-11 - periodontist - SRP - upper right quad - 1-8 - $300

15 - th-02-03-11 - SRP - t17-20 - light - 2h

16 - tu-02-08-11 - periodontist - SRP - lower left quad - 1h - $300

17 - sa-02-12-11 - SRP - t2-3 gap - 1h

18 - su-02-12-11 - t3 & t16 - aspirate - 1h credit

19 - m-02-14-11 - aspirate all around - recover actual yellowish pus - 3h actual => 1h credit

20 - w-02-16-11 - SRP t2-3 gap - still filthy post periodontist - 1h?

21 - th-02-17-11 - periodontist - SRP - upper left - 1h

22 - f-02-18-11 - SRP - 3-5 gap - 20-30 blobs - fistula - 2h

23 - sa-02-19-11 - SRP - t3-5 gap & t30-30 abscess - 2h

24 - su-02-20-11 - SRP - t30-31 gap - significant blobs - 2h

25 - tu-02-22-11 - SRP - t30-31 gap - micro-mini - combat smell - 3h

26 - sa-02-26-11 - SRP - t30-31 & t2-3 - 2h

27 - su-02-27-11 - SRP - t2-3 - furcator - 2h

28 - tu-03-01-11 - SRP - t5-dl - bloody & filthy - smelly - 2h

29 - f-03-04-11 - t4-dl - aspirate & irrigate & brush pick - 1h credit

30 - tu-03-08-11 - t6-d - aspirate & irrigate - 1h credit

31 - w-03-09-11 - aspirate molars - 3h => 1h credit

32 - f-03-11-11 - SRP - t2-ml - irrigate & assorted - smelly & bloody - 1h credit

33 - m-03-14-11 - aspirate-irrigate - w SRP - t6-7 & t3 - 1h credit

34 - th-03-17-11 - see periodontist - #30 has root resporption - most likely will die a painful death

35 - f-03-18-11 - t6 - aspirate-irrigate - blobs - 1h credit

36 - tu-03-22-11 - general clean w brushpick, toothpick, needle etc = 1h credit

37 - w-03-23-11 - t6 - mostly aspirate - 1h credit

38 - th-03-24-11 - SRP - 2-3 gap - filthy! - stinky! - 1h

39 - f-03-25-11 - SRP - t2-3 - stinky! - bust hole into sinus - YIKES - 2h

NOTE - Carefully brushed out hole into sinus - antral-oral communication - with hyaluronic acid. Combined with additional aspiration and irrigation. Hole largely closed up within a day or so and largely healed without incident within a week or so. With ongoing debridement throughout the area for the next several months. Though basic hole is probably still there. Continued to carefully clean out area and it has not opened up since. Have had total of roughly 5 clear-cut oral-antral communications, all blowing air, and have gotten all of them to close up without incident. Per "bulls-eye theory" - idea being to get the outside of the hole to heal first, then work inward.

40 - su-03-27-11 - t6-7 & t30-31 - aspirate - 1h credit

41 - th-03-31-11 - t6-7 & t30-31 - aspirate - 1h credit

42 - f-04-01-11 - SRP & aspirate - t6-7 & t30-31 & assorted - 3h

43 - f-04-08-11 - see endodontist - t30 extremely painful - tooth is doomed - resorption

44 - f-04-08-11 - t30 - aspirate doomed tooth to relieve pressure and pain - successful - 1h credit

45 - m-04-11-11 - TOOTH #30 EXTRACTED - ROOT RESORPTION

SUMMARY
2011 - periodontist SRP 4 hours - 1 hour per quad
2011 - SRP - 49 hours
2011 - NEEDLES & TOOTHPICK - 14 hours equivalent credit (actual hours at least 2x higher)

END OF PHASE 3 - TOOTH #30 EXTRACTED

= = =

2011 - START OF PHASE 4 - SECOND INTERIM PHASE - POST SRP

NOTE ON ASPIRATION vs IRRIGATION - Throughout this period I largely used aspiration to clean out the deeper areas. I also used irrigation too. The reason I used aspiration largely was two-fold. First was by drawing on the plunger rather than push in the plunger I felt it was safer for the deeper tissues. Additionally I was concerned about accidentally "injecting" fluid into the deeper regions, especially any hyaluronic acid, which is hydrophillic and can expand with water. In addition I got pretty good results. HOWEVER... I have changed my opinion since then and generally feel that the time is better spend on curettage. The reason is I would get all exited about small amounts of crud liberated through aspiration and then would go back and get much larger amounts through curettage. ADDITIONALLY... I am now more favorably disposed towards irrigation, as long as the skill level is high enough to avoid jamming the needle into deep spaces.

1 - w-04-13-11 - t4-6 - assorted aspiration - zero hours credit

2 - sa-04-16-11 - SRP - general cleaning - 1h?

3 - su-04-17-11 - t3-m - assorted aspiration - 1 hour credit

4 - m-04-18-11 - t5-6 - assorted aspiration - 1 hour credit

5 - tu-04-19-11 - SRP - t5ml - bloody - gracy & irrigation - 2h

6 - tu-04-26-11 - t5-8 - aspirate - cruddy cache of debris - 1h credit

7 - m-05-02-11 - t5-7 - aspirate - lots of flecks - 2h+ => 1hr credit

8 - tu-05-03-11 - t2 - aspirate - infected - 1h credit

9 - th-05-05-11 - t2-6 - aspirate - infected - some blood - 5h => 2h credit

10 - sa-05-07-11 - t2-5 - aspirate - filthy - xenomorph - 1h credit

11 - m-05-09-11 - t6-7 - aspirate - some blood - - 1h credit

12 - w-05-18-11 - t2-3 gap - aspirate - light blood - zero hours credit

13 - th-05-19-11 - t2-7 - aspirate - serious blood & xenomorphs - 3h => 2h credit

14 - f-05-20-11 - t3-4 - aspirate - serious blood & xenomorphs - 3h => 2h credit

15 - su-05-22-11 - t2-3 gap - aspirate - serious blood & crud - - 3h => 2h credit

16 - m-05-23-11 - t5-b - aspirate - deep & bloody - 1h credit

17 - f-05-27-11 - t5-d - aspirate - deep & bloody - 1h credit

18 - m-05-30-11 - t3-7 - aspirate - fairly clean - 3h => 2h credit

19 - tu-05-31-11 - general - aspirate - 1h credit

20 - f-06-03-11 - palate-lingual t3-5 - puncture & aspirate "gum boil" - zero hours credit

21 - tu-06-07-11 - palate-lingual t3-5 - puncture & aspirate "gum boil" - zero hours credit

22 - w-06-08-11 - t3-5 aspirate "tunnel" leading to "gum boil" - filthy! - 1h credit

23 - f-06-10-11 - t6-7 - aspirate "tingly feeling" ie apical periodontitis - 1h credit

24 - su-06-19-11 - SRP - t19-m - gap not resolved - lots of deep infection - 1h

25 - w-06-22-11 - SRP - t19-20 - filthy - dig & dig - 3h

26 - tu-07-05-11 - SRP - t19-20 - filthy - dig & dig - 5h

27 - th-07-28-11 - t6-7 - aspirate "tingly feeling" ie apical periodontitis - 1h credit

28 - f-07-29-11 - SRP - t15-m & 19-m - filthy - 100s of pieces - Midnight Madness - 8h

29 - f-08-19-11 - SRP - t15-b - filthy - 2h

30 - th-08-25-11 - SRP - t8-15 w flecks - t6-7 aspiration - 3h

31 - su-07-28-11 - SRP - t2-3 & t11-12 & 12-14 - 2h?

32 - m-09-05-11 - SRP - t28-30 gap - 10 blobs - t12-15 gap - horror show - 100s of blobs - 6h

33 - m-09-12-11 - SRP - general - plus toothpick - plus irrigation - 3h

34 - th-09-22-11 - SRP - t2-d - bloody - 1h

35 - f-09-23-11 - SRP - t2-d - bloody - 1h

36 - sa-10-01-11 - SRP - t30-31 gap - filthy - 2h

37 - th-10-13-11 - SRP - t-6-9 w t7-8 gap bloody - t30-31 gap bloody - 2h

38 - sa-11-05-11 - SRP - t6-10 - dirty - 1h?

39 - m-11-14-11 - SRP - t7-8 - dirty - 1h?

40 - m-11-21-11 - SRP - t12-14 gap - 4 big blobs - 1h?

41 - f-11-25-11 - SRP - t7-8 - t15-mb - t16ml - 3h?

42 - sa-11-26-11 - SRP - t19-mb - buckets & buckets - 3h

43 - su-11-27-11 - SRP - t4-12 - linguals - semi-dirty - 2h

44 - su-12-18-11 - SRP - t9-10 - dislodge gigantic ledge - 1h

45 - tu-12-27-11 - SRP - t6-7 blob & t30-31 deep blobs - 1h

SUMMARY - SRP - 50 hours
NEEDLE - 23 hours credit

END OF 2011

= = =

START OF 2012

1 - tu-01-03-12 - SRP - t6-7 furcator blob - 1h?

2 - sa-01-28-12 - SRP - t10 - filthy - 1h?

3 - f-02-03-12 - SRP - t6-7 - furcator & mccall - 2h

4 - tu-02-07-12 - SRP - t19-d - 5+ blobs - 1h?

5 - f-02-10-12 - SRP - 15-d - plus all around - 2h

6 - m-02-13-12 - SRP - t9-11 - sickle - dirty - 3h

7 - tu-02-14-12 - SRP - t7 - dirty - 1h

8 - w-02-15-12 - SRP - t3 - sickle - aspirate - 1h

9 - tu-02-21-12 - SRP - t3 blob & t10 dozens - 2h

10 - th-03-23-12 - SRP - anteriors - 10 blobs or so - 1h?

11 - f-02-24-12 - SRP - t19-d - lots & lots - trauma - 5h+

12 - f-03-02-12 - SRP - t19-20 gap - 6 blobs - 1h?

13 - su-03-25-12 - SRP - t6-10 - light - 1h

14 - m-04-30-12 - SRP - t19-20 - major - 100s blobs - plus general - 6h+

15 - w-05-09-12 - SRP - t15-m - 20pp - 1h

16 - w-05-16-12 - SRP - t26 w micro-mini - filthy - 1h

17 - tu-06-05-12 - aspirate all around - zero hours credit

18 - f-06-15-12 - aspirate all around - plus HA - zero hours credit

19 - f-06-22-12 - SRP - t15 - filthy - plus HA - 1h?

SRP - 30 hours

= = =

END OF INTERIM SECOND INTERIM - PHASE #5
START OF SECOND ABSCESS ATTACK - PHASE #6

= = =

1 - sa-07-14-12 - SRP - t7 - filthy - 2h

2 - w-07-18-12 - SRP - t7d - 1h

3 - th-07-19-12 - SRP - t7-d - xenomorph triumph - 1h

4 - m-08-06-12 - SRP - t28 - buccal-mesial - mini-me - brute force bloodbath w granulation tissue & abscess release - 3h

5 - tu-08-07-12 - SRP - t28 - buccal-mesial - brute force - bloodbath - release abscess - 1h

6 - sa- 08-11-12 - deep needle aspiration- irrigation w HA - 1h credit

NOTE - Either the hyaluronic acid or the ongoing infection caused the salivary gland to seriously swell. Then used a massage & irrigation program to liberate crud out of the salivary gland and return gland to more normal size. Largely gland seems normalized, but continuing massage program on intermittent basis.

NOTE - In addition I ended up with a submandibular infection, which is the space including under the tongue and neck. The hole for this infection largely appears focused in the #31-32 gap. However I largely feel the two infections are mostly co-existent rather than cause-effect. Quite reasonably the original abscess on extracted tooth #30 was an original cause. Or going way back in time tooth #29, which was extracted for braces 40 years prior could have left a defect that ultimately got exploited by the periodontal disease.

NOTE - The spaces left behind by the second bicuspid teeth extracted for braces, #4, #13, #20, #29 all became centers of periodontal infection. Again, the presumption is the holes left behind became starting points for later infiltration by the infection.

7 - tu-08-14-12 - SRP - t28 - Fast Track curettage on aggressive abscess - 1h

8 - w-08-15-12 - SRP - t28 - Fast Track curettage on aggressive abscess - 1h

9 - sa-08-18-12 to su-08-26-12 - mandibular spit gland - get aggressive w deep massage & needle aspiration-irrigation - Plus light curettage - 2h credit

10 - tu-08-28-12 - SRP - t28 - distal-lingual - M-Jack sickle - 2nd abscess - bloody - deep scary drainage - lower alveolar nerve involvement - 5h

11 - m-09-03-12 - SRP - t29 - distal - 3rd abscess - deep investigation - bloody release - 7h

12 - w-09-05-12 - SRP - t6 eye - debride abscess flanking t7 - 4h

13 - su-09-09-14 - SRP - t6 - debride abscess - 2h

14 - tu-09-11-12 - SRP -t5-6 gap lingual - reak into abscess - bloodbath - bucket & buckets - 10h -     VIDEO

15 - tu-09-18-12 - SRP - t28 - 30pp - 1h

16 - w-09-19-12 - SRP - t28 - boring not much - 2h

17 - sa-09-22-12 - SRP - t3 - abscess - burst - bloody mess - 8h - make video <>

18 - su-09-23-12 - SRP - t3 - more abscess curettage - finish bleed out - 4h

19 - m-10-01-12 - SRP - t5-6-7 abscess - multi-abscess complex - 2nd major debridement - 4h

20 - f-10-04-12 - SRP - t3 - extra curettage - 1h

21 - sa-10-06-12 - SRP - t28 - general abscess curettage - w necrotic ligament - 4 hours

22 - su-10-07-12 - SRP - t28 -   general abscess curettage - w necrotic ligament - 7 hours

23 - tu-10-09-12 - SRP - t7 - secondary debridement - 3h

24 - w-10-10-12 - SRP - t5 - more secondary debridement - 3h

25 - th-10-11-12 - SRP - t28 - danger! - killer abscess alert - Attack! - 5h

26 - sa-10-13-12 - SRP - t5 - general curettage - 1h

27 - w-10-17-12 - SRP - t28 - open up abscess - bloody mess - 3h

28 - sa-10-20-12 - SRP - t3 - general debridement - 2h

29 - su-10-21-12 - SRP - t19 -   clear path to abscess - 4h

30 - m-10-22-12 - SRP - t19 -   open & bleed out double-abscess - 8h?

31 - th-10-25-12 - SRP - t21 - t3-9 - assorted debridement - 7h

32 - su-10-28-12 - SRP - t27 - clear perimeter of abscess - 6h

33 - m-10-29-12 - SRP - t3-5 - general curettage - 3h

34 - tu-10-30-12 - SRP - t3-5 - general curettage - 4h

35 - w-10-31-12 - SRP - t5 - general curettage - 1h?

36 - f-11-02-12 - SRP - t5-6-7 - general curettage - cross-abscesses - 5h

37 - su-11-04-12 - SRP - t27-28 - relieve abscess - 4th? - debride interdental calculus monstrosity - 8h

38 - w-11-14-12 - SRP - t28 - more abscess curettage - 8h?

39 - sa-11-17-12 - SRP - t3-6 - general curettage - 1h

40 - f-11-23-12 - SRP - t28 - t6 - t19 - general curettage - 3h

41 - su-11-25-12 - SRP - t28-m - more curettage - 5h

42 - tu-11-27-12 - SRP - t28 - t5-6 - general curettage - 3h

43 - w-11-28-12 - SRP - t27 - deep curettage - good release - 1h

44 - sa-12-01-12 - SRP - t31-32 gap - general curettage - 5h

45 - su-12-02-12 - SRP - t31-32 gap - general curettage - 5h

46 - f-12-07-12 - SRP - t31-32 - open up abscess - 4h

47 - su-12-09-12 - SRP - t31-32 - bleed out abscess - 1h

48 - su-12-09-12 - SRP - t6 - general debridement - 1h

49 - tu-12-11-12 - SRP - t6 - general debridement - 1h

50 - th-12-20-12 - SRP - t5-6 gap - general debridement - 4h

TOTAL SRP - 174 hours - k

= = =

START 2013

m-01-07-13 - SRP - t31-d - general curettage - 4h

th-01-10-13 - SRP - t31-d - general curettage - 4h

sa-01-12-13 - SRP - t31-d - general curettage - 1h

f-02-15-13 - SRP - t5-b - general curettage - 1h

sa-02-16-13 - SRP - t31-d - general curettage - 1h

su-02-17-13 - SRP - t31-d - general curettage - 1h

m-02-18-13 - SRP - t31-d - general curettage - 1h

sa-02-23-13 - SRP - t5-b - 40pp & blood - 3h

su-02-24-13 - SRP - t5-b - general curettage - 2h

tu-02-26-13 - SRP - t28-d - general curettage - 1h

f-03-01-13 - SRP - t6 - general curettage - 1h

su--03-03-13 - SRP - t28 - general curettage - 1h

m-03-04-13 - SRP - t5 - general curettage - 1h

w-03-06-13 - SRP - t28-m - general curettage - 2h

th-03-07-13 - SRP - t30-d - general curettage - 1h

m-03-11-13 - SRP - t5-bd - general curettage - 4h

sa-03-16-13 - SRP - t28-d - general curettage - 1h

sa-03-23-13 - SRP - t5-bd - lots of debris & deep blood - 5h

su-03-24-13 - SRP - t5bd & 32b - general curettage - 1h

sa-04-06-13 - SRP - t31-bd - general curettage - 1h

su-04-07-13 - SRP - t31-bd - general curettage - 2h

w-04-10-13 - SRP - t5d - deep - major - crud & deep blood - 6h

th-04-11-13 - SRP - t4-d - revisitation - 1h

sa-04-13-13 - SRP - 3l-d - definitive! - 7h?

su-04-14-13 - SRP - 31-L - definitive! - 3h

tu-04-16-13 - SRP - 3m - debride infraorbital nerve area - 1h

w-04-17-13 - SRP - t28 & t3-4 - general curettage - 1h

sa-04-20-13 - SRP - t31-dl - lots & lots - 2h?

m-04-22-13 - SRP - t32dl - major debride - tooth loose 2-axis - 5h

f-04-26-13 - SRP - t3-5 gap - major debride - deep blood - 6h

sa-04-27-13 - SRP - t3-5 gap - touch up debride - 1h

su-04-28-13 - SRP - t7 - filthy! - 1h?

m-04-29-13 - SRP - t-20-28 - general sweep - 3h

th-05-02-13 - SRP - t31-dl - major debride - 5h

f-05-03-13 - SRP - t31-dl - stragglers - 2h

su-05-05-13 - SRP - t5 - good debride - 3h

w-05-08-13 - SRP - t31-dl - stragglers - 1h?

sa-05-11-13 - SRP - t28 - touch-up - 1h?

tu-05-14-13 - t5 - irrigate - lots of blood - 1h credit

sa-05-18-13 - SRP - t31 - general curettage - 1h

tu-05-21-13 - SRP - t31-mb - bust into abscess - 5h

w-05-22-13 - SRP - t3-5 gap - deep primary debride - 3h

su-05-26-13 - SRP - t32-ml - major debride - bloody - 1h

tu-05-28-13 - SRP - t6 - lots & lots - 20pp - 1h?

su-06-09-13 - SRP - t31-mb - major debride - 5h

tu-06-11-13 - SRP - t3-5 - persistent necrotic periodontal membrane - 1h?

th-06-13-13 - SRP - t31-ml - major abscess debride & bleed - 4+4 = 8h

sa-06-15-13 - SRP - t31-L - more debride - necrotic membrane? - 6h

th-06-20-13 - SRP - t31-dlb - general curettage - 2h

sa-06-22-13 - SRP - t3-5 - attempt cementum & dead membrane - 1h

tu-06-25-13 - t31-ml - irrigate out lots of crud - 1h credit

th-06-27-13 - SRP - t32-ml & t5-6 - scaly stuff - 1h?

su-06-30-13 - SRP - t31-L - general curettage - 1h?

th-07-04-13 - t31 - toothpick - zero hours credit

f-07-05-13 - SRP - t5-6 - significant - 1h?

m-07-08-13 - SRP - 31-L - lots & lots - 6h

tu-07-09-13 - SRP - 31-L - general debride - 1h?

w-07-10-13 - SRP - t3-5 - QoH - 1h?

su-07-14-13 - SRP - t31 - honey irrigation - 3h => 1h credit

m-07-15-13 - SRP - t30 - significant curettage - 1h?

f-07-18-12 - SRP - t3-5 - deep abscess w granulation tissue - 5h?

sa-07-20-12 - SRP - t31-L - general curettage - 1h?

w-07-24-13 - SRP - t3-5 - furcator - 1h

th-07-25-13 - t31 - honey - zero hours credit

sa-07-27-13 - SRP - t3-5 -furcator - 1h?

tu-07-30-13 - SRP - t6 - montana jack - 1h

f-08-02-13 - t31 - honey - zero hours credit

th-08-08-13 - SRP t30 - necrotic periodontal membrane - 1h?

MORE MORE MORE - TO BE CONTINUED... REST OF 2012. PLUS 2013 & 2014... LOTS AND LOTS OF DEBRIDEMENT DONE

= = =

= = = = = = = = = = = = = = = = = = = = = = = = =
= = = = = = = = = = = = = = = = = = = = = = = = =

GENERAL NOTES

Saturday May 6, 2006 --

Cleaning my own teeth -- Cleaning out tooth 14. One article I read said that pockets might need to be cleaned out multiple times. Largely it looks like I gave tooth 14 a pretty reasonable scraping. What it sounds like is that it would be very helpful if I gave tooth 14 a regular scraping. Or at least a secondary scraping fairly soon. But not right away. In the meantime making sure to floss that one tooth very regularly. Possibly there is a chance to turn that tooth around.

tooth scraping. Additionally to working my way to some of the different teeth. It does not sound like there is any real problem there. As long as I am careful. Any reduction in the amount of plaque is good. Would be good to get an idea about the procedure. But to a degree at least it sounds like common sense. My confidence on using the dental tool has been increased. I think I can give it a reasonable go. It seems that it is in to get the angle right. Additionally if I work the one tooth then I can make improvements in the worst area. Additionally I can locate other problem areas.

Flossing. What do they call it? Preaching to the choir. Or otherwise. Time to wake up and smell the coffee. Time to start flossing.

= = =

Monday, May 8, 2006 -- 9 15 a.m.

Cleaning the teeth. The general idea is to run the dental tool under the gums with very little actual contact. Quite easily enough the dirty areas bleed. When they do... what looks like clotted blood apparently is plaque. Which apparently has a slime component to it. Combined with serious amounts of bacteria. It is this combination that poisons the gums. Otherwise the general idea is that the root surface is supposed to be fairly smooth. Rough sections are indicators of the hard stuff... known as calculus. Which also serves to attract plaque.

Identification of plaque and calculus -- resembling blood clots. In any case... what has been happening is that as I run the dental tool underneath the gums it has set off significant bleeding. When I spit out the blood it contains what looks like blood clots. Apparently these blood clots are plaque. Reason for this is the coincidence. That when I come across roughness, which suggests calculus, then I rub or scrape those areas, then I get the blood clots when I spit. This suggests that the blood clots are in fact calculus and plaque. With virtual certainty for most of them. But not with complete certainty for all of them. Basically meaning to be careful.

-- This basically refers to the ridges or ledges. Where I am afraid that I am cutting away bone. Chiseling structure of my teeth away. But... realistically... looking at the photograph of a tooth covered with calculus... it seems more likely that the tooth is covered with serious calculus. So forget about it. Does not sound likely that I am chipping away bone. Additionally I should see pieces of bone if I'm chipping it away.

Cleaning in stages. When I cleaned tooth 14 a membrane like material protruded out of the gums. Suggesting some type of attachment to an inner area. Suggesting so much filth inside the pocket that cleaning it out served to bring more filth to the fore. Or that there were layers upon layers of nasty stuff. Meaning that after a basic cleaning that there is still a significant amount of filth left over. Suggesting multiple treatments. I gave it 2 treatments. There is still more to go. As example a fairly large piece became liberated today.

Irrigation. This seems real important. to get a water pick and to get anything loose that is still in there. Idea seems to be that there is a lot of crud that did not come loose. That might just reattach itself too. So I should probably get to that right away. Can probably buy a water pick at Walgreens for like 50 bucks. Or more. Idea seeming to be to get matters taken care of with the teeth as soon as possible. With issue about whether I can realistically get that pocket clean on tooth 14. With questions about whether that is plaque at the very bottom. Suggesting that I need to get the x-rays from Dr. S.

X-rays. Need to see a periodontist. Should try to get the x-rays from Dr. S. Realistically makes no sense for me to try to do the work of the dental hygienist. But rather to simply stabilize the situation. Meaning to clean out the obvious.

= = =

Tuesday May 9, 2006 -- postmidnight

Tooth cleaning technique. The general idea was to not do anything. Simply run the tool underneath the gums. The result though was that quite extreme amounts of filth were released. Appearing as blood clots. When I squeezed them they seemed to turn into nothing. Or just a small core surrounded by bloody crud. Which corresponds with the general description of plaque. It also fulfills the basic strategy to disrupt the bacteria. And to remove the debris. The net result is that right now movement of the tool produces very little results. Suggesting that most of the plaque has been removed.

Teeth cleaning -- starting with tooth 14. So... cleaned tooth 14 late Friday night. Learning about tooth scaling and tooth planing. Putting logic together to go underneath the gum line. Sounds like I read about issue prior to getting started. Got highly concerned about the issue because I figured my teeth were still filthy after the cleaning. So what am I supposed to do ? With initial effort on tooth 14 resulting in significant numbers of those blood clots. Additionally with membranous material protruding out from the gums. Giving me a general impression that tooth 14 was quite filthy. That first evening I wrote down that I spent 3 hours cleaning tooth 14. Which sounds kind of bizarre. But not necessarily incorrect. With large clots and small clots going on and on. Additionally with areas getting scraped and becoming at least partially clean. With second round on Saturday night. Sounding like close to four hours on tooth 14. With additional time spent then checking out the general vicinity. But not in a methodical way.

Teeth cleaning -- rest of the teeth. Finally making a methodical round of all of my teeth late Sunday evening for approximately 2 hours. With a concerted amount of those blood clots becoming released. With some presumed additional activity yesterday. Along with the water pick. Specifically the areas in back of the teeth in between the teeth. Specifically got at least one blood clot yesterday that was quite huge. Obviously a pocket that was very filthy.

How many clots? If I had to guess to add up all of the big clots I would say that tooth 14 must have delivered a good 10 of them. Along with dozens upon dozens of smaller clots. Would have to say that the rest of the teeth must have delivered at least 10 additional big clots. Also along with dozens upon dozens of smaller ones. Even today I got at least one very large clot from in between my upper right back teeth.

Current situation. I have a good idea that most of my mouth has been fairly well cleaned. Do not think the technique was particularly harmful. With today producing significant amounts of blood. Seems like the next stage is to let my gums recover. Over at least a week. Realistically for 2 weeks. Maybe even forgetting about it for 3 weeks to a month. Then trying the entire process again. With a set of gums that has had ample time to recover. Kept clean with the irrigation. Quite a brave new world. Clean gums. Currently waiting for the recovery phase to take affect. As said, for at least a week. Even then sounds too soon.

= = =

Saturday June 10, 2006 -- 5 p.m. -- post Midnight Madness

Friday night cleaning -- 12am to 5am. Major scraping of upper teeth. After approximately 1 month after original cleaning sequence.. With intermittent scraping since then. With efforts largely focused on breaking ledges. Plus fighting isolated areas.... Good job. Major plaque and large blobs. Including dealing with the back side of tooth 14. Plus where it connects with tooth 15.

Progressive cleaning. Get the and idea that scraping tends to get to the most persistent large areas of plaque. With the large blobs being the destruction. Analogy is to a gang leader. Where the underlings survive the destruction. Then grow tofill in the niche left behind by the leader. With plaque clinging to the calculus. Even functioning as a mechanism to get leverage on the calculus. So... after a cleaning... the plaque will start to reform. Suggesting to go back and clean up more plaque. But... the second time around more of the individual portions of plaque and calculus will be cleaned away. Suggesting that the second round becomes cleaner than the first round. Etc.. But still working in gross proportions for at least the first 2 rounds. With its sounding like to additional rounds or four rounds are required to get toreasonable cleanliness.

Ultrasonic tooth scaler. Getting an itch to buy an ultrasonic scaler from eBay. Realistically it sounds like I am convinced to clean my own teeth. I don't trust dentists. Essentially I want to show up with a clean mouth. Based on the principle of matters not getting worse... as long as I stay on top of it. Hence $200 spent on a tooth scaler might be just as good as an investment as $200 spent on cleaning. Especially since I am getting to know my mouth.

Note -- 7/17/06 -- comment on dentists was somewhat frivolous. Think the idea is still to show up with a fairly clean mouth. Idea is to end up with a perfectly clean mouth once the dental hygienist scales my teeth. Which would seem easier to do that my teeth are already somewhat clean. Rather than completely filthy.

Realistically it would not be very smart to try to use an ultrasonic scaler myself. But the thought was reasonable. Leading to the purchase of the Gracy scalers. With additional obvious results that the initial removal of plaque was just dancing on the subject. Where I counted dozens of blobs of plaque and thought I was seeing a lot.

= = =

Wednesday June 14, 2006 -- 11:50 p.m.

Cleaned tooth 14 again this morning. For approximately 3 hours. From 8 a.m. to 11 a.m.. With much of the starting part consisting of going up against persistent blocks of plaque along the inside back portion of the tooth. Then identifying and going after the ledge. Which has seemed persistent throughout that tooth. With the idea that the ledge is difficult to get in a single encounter. But that it becomes progressively weaker when it's lieutenants are taken out. When the different sections become isolated. Had at least 2 scrapings that resulted in major blood. With the first one disappearing quickly down the drain. So it was hard to identify its components. With a second one resulting in at least one identification of what appeared to be a fairly significant block of calculus. Additionally with a stringy type substance. Plus serious blobs. Would have to say that this encounter was at least as bloody as the previous ones. Looking like tooth 14 has gotten at least 3 major sessions. Plus several minor sessions. With at least five hours spent on that one tooth.

Starve the plaque. Idea that it will take at least 3 days for tooth 14 to normalize again. Even a week. With a policy of no food residue. With idea being to give my immune system the opportunity to get ahead of the infection. Additionally get the idea that the blood that gets released also gets rid of the toxins.

tooth 14. Get the idea that tooth 14 is a lot better off than it was. With an first round initial cleaning that got rid of a lot of nasty stuff. But with it being quite clear that there was major structural issue regarding calculus. Essentially there was still a wall of plaque around the tooth. Where the first round certainly chipped a good portion of it away. But still left a lot behind. Second round within a few days went after some of those structures. This tended toisolate the ledges. Or bring them into focus or relief. With idea that the ledges are similar torings. Where the idea becomes to break part of the ring. Find it guilty. Meaning to identify it as non-tooth. Then to go after the rest of it. Then finally to get the stragglers. With trauma to the gums in the meantime. Meaning that several rounds are required. This last round I focused on the ledges. Got a major number of bloody blobs. Suggesting that the next round will go much cleaner.

Missing gum. There is a lot less gum on the left side than on the right side. Looking in the mirror. Part of this might be due to swelling. So will get a better answer in a few days. But what is even more scary is that the gum that is there feels mushy. Suggesting there isn't any bone behind it. Again do not have the answer. Worth investigating once the swelling goes down. Or in about a week. In the meantime I should ignore it and be glad that it didn't go on for another 2 years.

Multiple rounds required. With it being clear that even an extensive attempt was leaving a lot behind. Possibly this is due to burnishing the calculus. Where a gross amount of calculus is liberated. But much of what is left gets smoothed down. Hence meaning that the calculus has to get rough and began before it becomes vulnerable. Which presumably takes a little bit of time. This supports the theory of progressive cleaning. Where leftover calculus reforms itself with new plaque. Thereby becoming more vulnerable to the next round. Additionally suggesting that multiple sessions are required. Like some major splinter with minor splinters. Where the major of the minors then becomes the most present.

= = =

Thursday June 22, 2006 -- post Gracy Curettes. Tooth 14. Post gum injury. Slicing right through the gum. First breaking curette #4. Then missing causing damage. Using so-called pullout strategy. Then finally causing damage. With at least four or five total opportunities. Any one of which could have sliced clean through the gum. But where I did not learn my lesson until I sliced clean through the gum. Be thankful I did not hurt myself more. No more activity until the gum is healed. Then stay away from the gum for 2 weeks to one month. HOW COULD I DO THIS? WHY DIDN'T I WORK AROUND THE PROBLEM AREA MORE GENTLY?

Purchase arrived. Received at Gracy curettes yesterday. Boiled them. Copied a tooth map. Practiced identifying which one was which. Then got an itch to practice. Starting on my front teeth. But the curettes would not fit. Then deciding to make a go on Tooth 14.

Gracy Tooth 14. At first the curette got caught along the general surface of tooth 14. Starting in the back. Without much progress. Then working on the front. Presuming to use 7/8 for the main surface. But instead apparently using 3/4. Got the idea to try to hook the calculus under the edge of the blade.

Dangerous practices. But... the calculus was not very amenable to breaking up. With the result that after I caught WHAT I THOUGHT WAS an edge of calculus that I pulled to hard. Which was very foolish. Resulting in breaking one of the prongs on 3/4. But I did not learn my lesson well enough from that. Because I continued to pull on the calculus. Resulting in the tool slipping several times. With me rationalizing that I could point the tool in such a way that it would pop out of the gum rather than slice. But ultimately the tool sliced my gum clean through. For a little more than 1/16 of an inch. With the likely result that it will heal fine. If I am careful with it and leave it alone for several days.

Deposits on tooth 14. Practiced using the tool parallel to the tooth. Resulting in numerous releases of both plaque and calculus. With some of what was apparently calculus appearing like a piece of fiber or sponge. With the plaque identified in the usual way. With some of the blobs quite large.... In particular remember using 13/14 to come around the back edge of the tooth. Bringing in around. Resulting in a huge disgusting mess. Consisting of a blob of plaque that seemed to be like an inch long string. Including a piece of fiber that seemed to be almost as large as a kernel of corn. Good thing to get rid of that!

Up and around technique. This seemed to be a reasonable way to hook the calculus. Which was to approach from below. Catching an edge. Then bringing around the tool to pull down on the calculus. Presuming that the edge shifted around. While maintaining a secure footing. With the thinking being of collapsing the calculus like a scaffold. With the certain objective of trying to break off much larger pieces of calculus than in the immediate area. Additionally with the awareness that the calculus could not be readily approached from the inside. So it makes sense to approach largely from the side, angling from the bottom. With the idea of breaking the edge along a row. Starting from the back corner and working my way around to the front. Largely this technique seemed to work quite successfully. With no expectation that it is any panacea. But if it took me 2 hours on a single tooth then how much progress can a dental hygienist reasonably make in even an hour on the one tooth. Since I have spent roughly 9 hours on that one tooth. With a long way to go.

Summary... is that the Up and around Technique seemed to dislodge seriously large pieces of calculus. Along with the apparent dismemberment of the ledge. With a current moratorium for at least a week. If not for 2 weeks before checking out that area again. In order to allow for as complete healing as possible. Under the very unfortunate and precarious natural conditions of that tooth.

Dossier of crud. t14. With moratorium for at least a week. Because of sliced gum.

-- Gracy t13/14 wind around the front -- resulting in huge blob of plaque. Plus large piece of calculus. Both Jumbo size.

-- Gracy t7/8 -- winding around the front -- attacking ledge. With Up and Around technique. Resulting in multiple large pieces of plaque.

-- Gracy t7/8 surface "planing" -- resulting in a reasonably smooth tooth. Plus isolation of the edge. Multiple multiple blobs.

-- Back of tooth -- serious blobs of crud.

-- overall assessment -- dozens of blobs. Imagining the totality as comparable to the totality of everything removed so far. But realistically the amount of crud seemed to be at least as much as was captured and removed on other occasions

Bottom Line. Tooth 14 was filthy.

= = =

Friday, June 23, 2006 -- 9 a.m. -- post cleaning tooth 14 with gum injury.

Gum injury. 1 full day since gum injury. 36 hours with first 12 hours discounted out..... Good idea to wait until at least four days. 96 hours. Or until Monday. Then to procrastinate for a few days. Since original injury was a complete slice through the gum. Quite serious.

Tooth problems. Went to Sowell on May 5. Seven weeks ago. Cleaning tooth 14 that Saturday. Then more over the next few days. Then episodically. Mainly in the first week of June. Then a week later. Finally with the Gracy curettes. For a total of 26 hours in 13 sessions. Versus an estimate for a dental hygienist of four sessions of 2 hours each.. Or eight hours. Suggesting that the hours are somewhat reasonable compared with the task. Especially with me not knowing what I was doing. With the activity largely being to clean all of the teeth in early May. Then waiting a month and doing it again. Resulting in serious blobs. Then continuing process every few days. Finally with the Gracy curettes.

Results are that tooth 14 is loose. With concern that I might have cut into bone. But realistically... if something is butted up against the tooth then it seems likely that it is calculus and not bone. Additionally if the angle of attack comes off of tooth then the likely substance is calculus.

Analysis... If I would have gotten on to the situation right away with a periodontists I might have gained a month or so. Since I just got to real scaling on tooth 14. Alternately tooth 14 would have taken several attempts. So might not be very far behind.

Analysis.... So far I have gotten rid of quite remarkable quantities of crud. Several dozen large pieces on my first attempt. Plus multiplicities of small pieces. Additional large pieces on additional attempts. Including getting to the difficult angles that I missed the first time. Which includes events with blood on the prong. Additionally including grand bloody events. Where just running the prong underneath the gums liberated massive quantities of blood and blobs. Numbering in the dozens on almost every swipe. Meaning that a grand cleaning was taking place. From a filthy baseline. Also apparently resulting in less blood the next time around. Suggesting improvements in the gum health. From a filthy baseline.

Analysis... Presuming that the liberation of the blood is good. Indeed it is a very good process. Presuming that the poisons have worked their way into the blood. Additionally that the blood that is being liberated is largely the blood that was poisoned. So... blood blood cleansing blood... is true... blood blood cleansing blood. Additionally is the entire concept of reducing the level of poisoning. Presuming that I have eliminated say... 75%. Or even at least 50%?

Strategies...

-- Presumption to follow classic policy. Which is the removal of calculus and plaque as the primary strategy.

-- Presumption to believe classic policy. Which is that removal of plaque and strategy will provide relief to gums, bone and teeth. That that destruction becomes halted.

-- My primary strategy being to get ahead of the situation. By cleaning my teeth in advance of the hygienist. In addition by mapping out the problem. This should result in alleviating some of the symptoms. So the periodontists and the hygienist can get results faster.

-- Analogy is a timeline. Where my efforts presumably mimic the timeline. So I am doing part of what they would be doing anyway. So my progress after seven weeks is not so bad.

Concerns...

-- gap between tooth 14 and 15. With no apparent coverage by gum material. Is this an open wound? With the bone pointing out into open space. With no gum at all? Or is this remnant tooth

-- ledge on the back of tooth 14. How deep does this go?

Tactile sensations.... With ledges... it feels like I am running into a wall. Then as I wind the tool around it feels like I am leveraging a shovel underneath a rock. NOTE... seems to make sense to catch the far end of the curette on the edge of the plaque. But... this would seem natural... since the ledge is deep. Hence only likely to get the end of the curette rather than the metal.

With rough areas... it feels like I am ironing a rug. Or scraping paint off of a pane of glass with a razor blade.

Evening purchase on eBay. Checked out eBay. Saw another set of Gracy curettes for $19? Instant decision to purchase. Meanwhile purchased two different sickle scalers. The U-15/33 sickle and the H-6/7 sickle. Apparently the H-6/7 is very popular. But it turns out that both items are mainly applicable for above the gum line. With some indication that they can be used below the gum line too. Additionally I bought two dental mirrors and a probe. More or less providing me with two sets of dental tools. With reasonable variety. Though the sickle scalers seem largely wasted. Meanwhile don't seem to have anything narrow enough for the front teeth. Imagining the McCall 13/14 S. Realistically though my set of Gracy's are cheap. Real cheap. A real set would cost $150. Perhaps that would have been better than to buy two cheap sets. Perhaps I could have even bought something ergonomic. For around $140. But will let it go. Just having a set of dental tools at all is pretty cool. Much less two sets of Gracy's. Which is borderline... very strange. Having used up the Gracy.

Gracy. Additionally with Gracy being the flagship of curettes. So presumably a full set of Gracy's is a full set of curettes. Over the years other curettes have found greater favor. But the Gracy's by definition are complete all by themselves. Hence additional curettes become enhancements on the basic set. Meaning that there is nothing missing. If I can add something that is great. But if I cannot add anything that is okay to. Though Universal scalers sound kind of cool.

The whole idea of the Gracy's is pretty cool. Dr. Clayton H. Gracy teaming up with Hugo Friedman during the 1930s and 1940s. With the curettes standing the test of time.

Deep calculus dilemma. Originally thought that the sickles scaler might be good for deep calculus. But sounds like I am wrong. Since the sickles scaler is used mainly for above the gum. With the obvious implication that it is the deepest calculus that is the most dangerous. Like a bullet deep inside a person that needs to become removed. With the question how it to get to deepest calculus when the disaster was so great. With the calculus now mixed in with residual bone. Which is which?

Apparently this is a common problem. Known as the deep calculus dilemma. What to do? How to do it? What is the answer? Apparently it is ultrasonic. Meaning that curettes have a basic flaw in approaching an inside from the outside. My up and around method was my own made up strategy. Which seems to make sense. How to get more depth than you have. How to get a singular projection to cover a lot of ground. With my idea being for a small pressed section wound around to take out a nice big chunk of calculus when it gives itself up. Which I got. Some nice large pieces of calculus which presumably will not poison my gums anymore. With the hope that largely fragments are left behind. Meaning that left over pieces of ledge can be disposed of reasonably easily.

With my objective being to eliminate latent calculus below the gum line. Which is important. Where getting a good clean start is a positive step. Using the gangbusters philosophy. Whereby the small pieces takeover large areas of neighborhood. Hence making themselves vulnerable to the curette.

Issue of burnishing. Apparently with an ultrasonic at low-power. But leaving the idea that if I can break up most of the major areas of calculus then that makes it much easier for the dental hygienist. What I imagine is a fairly clean field where the dental hygienist makes it virtually spotless. NOTE -- apparently burnished calculus is a serious problem. Perhaps I have burnished a fair amount of calculus already. With the result that this calculus is difficult to remove. So perhaps it will take hours and hours of effort.

= = =

Wednesday, June 28, 2006 -- per second round with Gracy during Tuesday June 27, 2006 -- Approximately 1 hour in evening -- Clean tooth #1 with Gracy. With virtual empty space between tooth #1 and tooth #2. Clearly indicating severe bone loss. Basically meaning that all of my upper molars are in dire straits.

Gracy methodology. Regarding method... the analogy seems to be akin to a heavy and sharp wedge type blade. On a rough stone or piece of wood. Like two somewhat large masses coming together. By this... the stone or tooth seems to stop a heavy-handed light stroke right in its tracks. Additionally can almost visualize the blade scraping along the tooth. Catching and slipping as it goes.

Dangers of overzealousness. A significant slip is BAD. As I learned with my cut gum. BTW the cut gum is starting to heal after almost a week. With hesitation to do anything before now. Concerned about risk of infection. Additionally the gum around tooth #14 is still very tender. 10 days after going after the shelf ledge. Five days after the Gracy. Presuming somewhat light scraping activity on a tender area. Realistically the gum is going to stay tender for at least a few more days. Presuming to stay away for now. With other areas to work in the meantime.

Workable Gracy methodology. Seems to be to think in terms of skipping the surface. Dislodging the high points. Isolating the bulk. Otherwise there is a high risk of slipping. Especially if force is increased. Resulting in high danger. Both from possible major slips, gouges and scratches. Additionally there is a general prognosis of scratching. Best strategy seems to be to dislodge the plaque and calculus methodically. Since each time high points are removed what is left becomes more exposed and accessible.

Isolating the filth -- gangbusters. Ultimately this leads to isolating the bulk of the calculus and plaque. Can imagine a battle zone against a tank. With large rocks that stop the tank right in its tracks. Rather than to try to take out both the large rocks in the small rocks it seems to make sense to break up the larger rocks progressively. Eventually the surface is smoother than it was.

Break up large promontories. Or... similar late to any other work area. Where the first objective is to take out the large promontories. Once these are dealt with then the lower elevations will naturally become easier to work with. Previously being protected by the higher elevations. Also akin to gangbusters. Where taking out the kingpins tends to expose the underlings. Or like a rock garden. Or ballast for a train track. Where the idea is to progressively remove the large rocks. Where this progressively improves the working conditions. Leading to rocks of a consistently small size. Or in my case to light plaque that is easily scraped or washed away. That is the goal.

Objective -- small homogeneous objects. With the way to get there being start with removing the largest projections. With this also including isolating the large projections. As example a large projection might originally be too difficult to remove. But if everything else around it gets removed then it becomes isolated. Like a statue with a footing in the ground. Or surrounded with debris. Remove that and the statue becomes more vulnerable.

Progressive strategy -- per each tooth. Term has multiple meanings. One being to progressively get each tooth cleaner and cleaner. Second meaning being to progressively work from tooth to tooth. Clearly... my teeth are a lot cleaner than they were. With previously intensive infiltration and destruction from calculus and plaque. Akin to a completely filthy house filled with several feet of dirt and slime. Where an initial cleaning makes good progress. But where any objective judgment views the result as still completely filthy. With initial cleanings resulting in dozens of major blobs of plaque and calculus. Resulting in hundreds of flecks of presumed calculus and plaque. Resulting in significant hugely major blobs. Interpreted as areas of complete infestation.

Progressive strategy -- per tooth to tooth. So... the idea is that I can go from tooth to tooth in the evenings before bed. With the likelihood that each trial will result in the discovery and destruction of one or more major infestations. With each infestation being an ongoing disaster in the making. With an assumption of several attempts at each site in order to achieve a modicum of ongoing cleanliness. With an additional assumption that within a month or so the plan will be to see a periodontists. Including getting a deep cleaning. But with my activity being somewhat to an ongoing deep cleaning. Getting the process started.

Progressive strategy -- per level of progress. Additionally with a progressive strategy. As example... once I am convinced that I have isolated and disrupted most of the major pockets then it makes sense to try antibacterial strategies, such as peroxide and salt. But without a clean environment these strategies are not as effective. Idea being to save them up. With cleaning things up under the gum line being the obvious first line directive. Repeated over and over again. To the point where it can be viewed as a law of nature. Always observed as obvious.

Tooth 14. Idea seems to be to stay away from it for now. To progressively work my other teeth until the gums are not sore anymore. With presumption that tooth 14 is still filthy. Additionally that the inside contains some serious ledges. Which will require multiple attempts to dislodge. Meaning that I want to start off with the gums as healed as possible.

Open gums. Presuming that some of their open look is due to swelling. But... some of it is likely due to pathology of some type. Possibly including damage caused by me. But... I did not get a general sense of ripping open healthy gum.... But... clearly the gums are quite open right now. Possibly this effect and look will diminish over a period of time. Also possibly some of this issue might be due to use of the water pick. Plus how I brush my teeth.

Issue of plaque dynamic on gums. Also some of the open gum swelling undoubtedly is the result of continued plaque infection. Brought to watershed by the cleaning process. Like dirt under the rug that gets swept out. Causing brand-new problems that did not exist to such a degree as long as the dirt was kept under the rug. Here... disrupting the plaque released toxins in large quantities. It also created an environment amenable to brand-new high metabolism plaque. Which presumably puts out high levels of toxins. Hence a phase has been initiated and created. Idea being that the gums will likely settle out into a less swollen phase once some of the plaque gets cleared out.

Issue of tipping point environment theory. Idea that previously plaque and calculus had the upper hand. Causing ongoing destruction. That a so-called clean environment extended over a period of time would give my natural healing processes the upper hand. That between these two points are various balances between conditions. Some favoring the plaque. Some favoring my natural healing processes. That my objective is to progressively get my teeth cleaner. That in some areas it is likely that the tipping point is in favor of my natural healing processes. But where gangbusters certainly improves matters. Like shifting an area of complete disaster into simply a high crime area. Providing a basis of eventually improving matters to a hygienic level.

Components of debris -- most everything goes through some type of inspection. Does it make sense to collect any of this?

-- large bloody blobs -- look to be plaque. Sometimes with a kernel of obvious calculus. Sometimes tending to disintegrate.

-- large stringy bloody blobs -- looked to be highly significant areas of interest station. to multiple bloody blobs.

-- small to medium flecks -- Blob like and bloody. Fleck light and red. Or brown. Presume as calculus or plaque. Produced in quantities of hundreds and hundreds. As an ongoing process clearly these are filth that is being washed away.

-- pieces of fluff -- guessing these as fossilized plaque. Or possibly as a variety of calculus.

-- scum -- yellowish in composition. Guessing these as ambiguous combination of plaque and calculus.

Summary -- overall idea of getting teeth and gums progressively cleaner. Where I have conducted gang buster activities it seems highly likely that the previous balance was in favor of plaque. With possibilities that ongoing balance is also in favor of plaque. With clarity that previous environment was pathological. With assessment that lack of a pathological condition is good. It is good to reach the point where ongoing destruction is not taking place anymore. Where even a seed of health has gotten started.

= = =

Friday, June 30, 2006 -- Teeth 1, 2 and 3. Post round with Gracy scalers evening of Thursday, June 29. From 10 p.m. until 1:30 p.m.. Or almost 3 1/2 hours. With breaks. Working on Teeth 1, 2 and 3. Mostly on the insides. With major plaque and calculus. With serious pit in front of Tooth #1. With tricks to get appropriate angles.

Results. Got a general sense of getting rid of lots of crud. With several major blobs. With large numbers of smaller blobs. With flecks. Literally the scraping produced streams of blobs, flecks and crud for several hours. Obviously the area was previously quite filthy. Presumably now it is much cleaner relatively. Plus possibly reasonably clean in an overall basis.

Roughness. Sliding over rough areas can be tricky. Presumably it is a good idea to get a full layer if it is breakable. But not if there is a risk of slipping. Meanwhile riding over the top should make the plaque easier to dislodge. But not if the result is burnishing. But typically a combination of activities will result in something becoming dislodged. With blood and plaque and flecks to show for it. Meaning that it was bad. With bottom line that something which in retrospect is better off gone means that it is also better off gone before the fact. Meaning that it needs to be wiped out.

Teeth 1 through 3. Last night's activity represented my first concerted effort on multiple teeth. With an objective of achieving some kind of closure. Here the basic cleaning of three individual teeth. With enough thoroughness and investigation to consider that they... passed inspection. But with likelihood of ledges still there. Additionally with the likelihood of pockets of crud that got messed.

Strategy and methodologies for ledges.... With combination of various methods apparently necessary to achieve results.

-- up and around method -- catching an edge from the side then bringing the tool up and around. To attempt to dislodge a large section. This method seems best for very large ledges. It also seems to be a good overall practical technique.

-- down from above method -- getting past the ledge. Then down stroking. This method presumably risks breaking some of the gum attachment. Additionally it would seem to leave a thin ledge residue at the deepest portion. Which missed getting caught.

-- side to side method -- getting a clean area on one side of the ledge. Then sweeping across. This method seems like normal methodical.

-- sickle method -- this would seem to be highly unconventional. Potentially dangerous too. With idea to stab the ledge. Then twisting to dislodge it.   I have this strategy in mind for the back of tooth 14. Where there seems to be a thick deep ledge. But... there is no suggestion of this strategy in any of the literature. But... there does not seem to be much strategy regarding handling ledges anyway.

Ongoing strategy. Basic strategy is progressive. To work an area with the Gracy scalers to reasonable closure. Then to give the area at least two weeks to heal and recover. Applying gang buster philosophy. Presuming there will be ongoing filth and crud. But also realizing that in fact I just got started. With the Gracy's. Since the shepherds hook might have released a lot of plaque and crud.

But the environment was so filthy that technically it wasn't much cleaner than before. Going from perhaps a level 9 of filth to say a level 5. With a reasonable judgment being that borderline cleanliness starts to get achieved by perhaps level 2 or 3 or so. Not before.. With any environment above that being pathological

Once I have worked around most of my teeth then I will be ready to see the periodontist. With idea to go over the upper teeth to give them a thorough cleaning. Based on already being fairly clean already. So that any remnants of the ledges can be broken. So that a good thorough cleaning will result in a highly clean environment. Perhaps much cleaner than could reasonably be expected. Since my time investment per tooth is so much higher. Like 30 to 60 minutes per tooth. With the hygienist working on a tooth that has already been significantly cleaned.

Current situation -- per Tooth 14. Suggesting to generally avoid Teeth 14 through 16 until the gums have recovered. But... with some possibility for a light pass around Teeth 15 and 16 while waiting for Tooth 14 to recover. Idea here being to not do enough to get the gum sore. But only for areas that are not currently sore. Like Tooth 16 only. With idea being to perhaps capture and destroy at least a few major pockets of crud. While waiting for another week or so for tooth 14 to become better recovered.

Current situation -- otherwise. Otherwise the idea is to keep sweeping around. Particularly on my lower teeth. With both notes and memory recalling that there were significant amounts of plaque and crud. Where cleanup seems like it would not result in huge amounts of filth. But that is good! With the end result that my bottom teeth will basically become clean. Meanwhile isolating the tooth 14 area. Where several rounds of cleaning are necessary to bring about reasonable progress and to get the area into reasonable hygienic conditions. Guessing that at least two additional rounds are needed. In addition to quite a number of rounds done so far.

-- The gums around Teeth 1 through 4 are now sore. Idea being to keep track of how many days they stay sore. With basic idea to stay away from this area for at least two weeks. Until the middle of July.

-- The gums around Tooth 14 are still sore.   After... 9 days. But apparently getting better. Post major ledge break up with cut gum in the front. Which is less sore than the back. Which mostly got a cursory attempt to break up ledges.   After major soreness created five days prior. From failed attempts at breaking up ledges all around the tooth. With the shepherds hook and angled explorer. Conclusion -- current soreness is a result of activity on an area that did not get a chance to properly recover. In another week or so can work the area in spots. Staying away from the cut until at least a month has gone by.

Summary... Idea now is to work around my teeth with the Gracy scalers. I did not want to do it before because of the cut gum. Which now seems to be recovering. So I can continue the process. Largely staying away from Tooth 14. Working the more peripheral areas. Like the bottom molars. Waiting for my sickle scaler and other items. With this process taking around a week. With 16 teeth to cover on the bottom. Or at least six molars. Then presuming that my Tooth 14 won't be so sore anymore. So I can work that tooth too. With the result that in approximately 2 weeks I will have swept my entire mouth with the Gracy scalers. With presumption of an additional round of gangbusters. Then ready for the periodontist.

Other stuff...

-- Wonder about all that bacteria. Get the idea that I am getting temporarily overwhelmed. With both toxins and bacteria. Causing a fever. Sounds possibly imaginary but still likely. Did seem to get a post perio feeling. Plus additionally stick from blood. Apparently that is completely natural. To get sick from blood.

-- Salt treatment. Or other antibacterial. Like peroxide and baking soda. Get the idea that the plaque is very fortress like. Resisting penetration if it has depth. Suggesting that I might hold back on the salt treatment until after I have completed a basic sweep with the Gracy's.

-- As stated Gracy's are basically phase 2. Like approaching a filthy house. Not particularly aware that it was previously filled with 5 feet of mud. It just looks incredibly filthy. Relative to a healthy state. Hence all of the nastiness of the first round of cleanings did not really accomplish anything. The result was still a pathological condition. Just less pathological. Like a flood less flooded. The operative word is to restore to help. Which requires a hygienic environment.

-- Wondering about gum flaps. Between teeth 2 and 3. Also between 14 and 15. With appearances of bone completely exposed. Diagrammed it. With issues of bacteria penetrating into the bone. With some weirdness that I might try scraping the bone myself. But this is beyond weird. Since it puts me into a position of being like a surgeon that is blind operating on something that I not only do not understand but which I do not even know exists. Best to make the assumption that I am starting from getting a so-called normal tooth cleaning. Which presumably should have carried me for a good six months. Which is obviously a bull shit tale. But if I hadn't caught the disease I would have continued on that path. Oblivious to the fact that my mouth was filthy.

-- Wondering about the bone regeneration. In fact this is largely a bogus subject. Dealing with the final prognosis. Or end result. With reasonable expectation of at least some regrowth of ball on. Additionally with expectation that shards should tend to regenerate themselves into larger entities. With additional consideration that gum reattachment will tend to preserve functionality. Even if significant bone is lost. With ultimate expectation being... to floss

= = =

Tuesday, July 4, 2006 -

Activity with Gracy's. So... did some good activity on my teeth. With the Gracy's. With net results that both sides of my upper molars have gotten a recent treatment. With left side more fragmented and cursory. But with general sense that the overall coverage has been reasonable. And that a more comprehensive methodical cleaning can wait for a few days. To let the soreness die down. To wait until I can spend a good two hours on the subject.

Total activity is 8 hours of cleaning. With the Gracy's. That should result in some reasonable progress.

-- Tuesday 6/27/06 -- tooth #1 -- cleaned major pockets and blobs. 1 hour.

-- Wednesday 6/28/06 -- tooth #1 - #3 -- cleaned outside perimeter. Major pockets and blobs. 1 hour.

-- Thursday 6/29/06 -- tooth #1 - #2 -- cleaned inside perimeter. Major pockets and blobs. Amazingly slow. 3 1/2 hours. AMAZING.

-- Sunday 7/2/06 -- tooth #14. -- cleaned inside perimeter. Major pockets and blobs. Plus worked on ledge. 2 1/2 hours. Amazing.

Summary -- Additional 8 hours. As initial start of the Gracy phase. With pockets and blobs and ledges galore. With a good amount of ledge left on tooth 14. With other additional areas obviously problematic. With obvious amounts of major filth previously eliminated. But with this trial being the first to get matters reasonably close to becoming reasonably clean. Essentially meaning a beginning to a beginning of a clean phase. Phasing out the end of the filthy phase.

= = =
Thursday, July 6, 2006

Prior situation. Starting Wednesday, June 21. On tooth 14. After prior efforts with hook. Then purchase of Gracy's on Sunday, June 18. Leading to cleaning front of tooth 14. Dislodging and washing away great amounts of filth. Leading to cutting gum and weeklong moratorium. Then cleaning teeth 1-3. For total of perhaps five hours. With good results and methodicalness. Cleaning both the front and back up to the bicuspids. Basically finishing off the upper right molars within reason for now. With it okay to leave them alone until the gums have recovered. With gums largely recovered now. Approximately a week later. So the right upper side is okay for now.

Went back to clean the back of tooth 14 on Sunday, July 2. The reasoning was that part of its swelling was likely due to ongoing plaque combined with trauma. Whereby failed removal of plaque plus soreness exacerbated the condition. With logic to remove as much plaque is possible. With results that the back of the tooth was very filthy. So... tooth 14 was filthy both front and back. Now it is reasonable. Meanwhile the rest of the upper left side was gone over opportunistically. With it somewhat clear that both tooth 15 and 16 needed some methodical effort. With discovery on tooth 16.

GUM ABSCESS

New development -- Tooth #16 was filthy. Methodically tried to smooth out basic area under the gum. With Gracy's. Then with sickle scalers. Leading to a gradual smoothing out of the surface. With an ongoing deliverance of plaque and assorted blobs. With appearances that there was a ledge that blocked the inner gum. Once the ledge was broken I thought I was done. Working on the one tooth from 8:30 p.m. until 1 a.m.. Or 4 1/2 hours. With significant amounts of time spent trying to clear out the area at the front of the tooth. Finding it difficult to get a curette across. Rather than up and down. With the resulting release of dozens upon dozens of blobs. Over a period of time of possibly around two hours that I was working the front of the tooth.

GUM ABSCESS

The new development was that there appeared to be a very deep pocket going deep into the front of tooth 16. With ongoing roughness. With activity with the curette eventually leading to very large blobs. Becoming released in quantities of anywhere from two to five large blobs at a time. For an additional two hours. With total blobs into the dozens. In retrospect I would guess there must have been 50 or more blobs. Dozens upon dozens.. Additional new development was that the depth of the pocket reached the split in the root of the tooth. Which is very very bad. But otherwise it was good to clear out tooth 16.

New gum cut -- tooth 15. Probably cut it last night. Noticed a strange sensation while using the water pick today. Noticed problem when I decided to give the front of tooth 15 a peremptory treatment. With result that I cleaned up the front of tooth 15 to a reasonable degree. With identification of a ledge on tooth 15 too. In addition to previously identified ledge on tooth 14. With the idea now to give this entire area approximately 2 weeks to recover. So... now on moratorium for at least a week. Per cut gum. With additional policy being 100% cleanliness almost all of the time.

Summary. Can largely consider the upper left side to be completed. For now. Have gone over just about all of the molars in a reasonably methodical way. With the result that three out of six front and back surfaces were transformed from complete filth to at least a reasonable start. Additional idea that all three molars are at least rudimentarily cleaned. With ledges on the front of 14 and 15. Which can wait for now. Until everything has had a chance to recover.

Recovery and moratorium for top teeth. My presumption is that the gums will have an opportunity to make reasonable progress now that a good portion of the plaque has been removed. With the realization that the overall trauma has been high. Meaning that the recovery is likely to be slow. Where the most serious pocket on the right side is still sore after a week. But the rest seems relatively well recovered. So... this suggests... that a full two weeks is called for before even touching a scaler to the top teeth. Until July 22.

Finalizing bottom teeth -- plus top front teeth? Meanwhile I could work the bottom teeth. Since presumably they could use a treatment too. But that the treatment should be methodical and very very slow. Meaning to spend several hours at it. Even if it seems I am accomplishing nothing. Logic is that the bottom teeth should get two treatments too. But that the likely result is that a fairly reasonably high degree of health will be achieved. But not so for the top teeth. Not for a long time. If ever.

Upper teeth -- second round with Gracy's. Strategy is to scale the teeth again. After they have had an opportunity to recover sufficiently. Two weeks minimum. Maybe three weeks. Maybe a month. With it obvious that there are ledges that I never got to. That are very difficult and obstructive. With it apparent that the next attempt is likely to lead to significant amounts of trauma too. But less trauma then created so far.

Big problem is the swelling. But here my reliance is largely on the mantra. Remove the plaque and tartar. This will lead to a restoration of health. Meaning that if the pathological condition has been largely surmounted that health will become more present. This should reduce the swelling. Causing the gums to become more normal looking. So... the turnaround time is going to be towards the end of July. At that point I will be ready to see a periodontist. To get a full cleaning. Hopefully by then I will have had the opportunity to make some money too. Ideally July be at least a wash. Including periodontal.

Policies. Let cut gum heal. For one week. No candy at all. Keep teeth clean. With food exposure only during meal times. Possibly no coffee? With one week to cover basic trauma to tooth 16.

= = =

Friday, July 7, 2006 -

Summary of current situation. Scaled front of tooth 14 two weeks ago. Scaled teeth 1-3 approximately 1 week ago. With back of tooth 14 five days ago. With major work on tooth 16 two days ago. Can consider recovery time reaching a close once the cut on tooth 15 is healed and the soreness goes away. Or in about a week. Regarding the disease situation recovery time is measured in much larger quantities of time. But two days is hardly any time passed. More like a month makes sense regarding the gums getting reasonable amounts of time to heal.

Plans for second general treatment of upper left side. Can think in terms of roughly July 21 for moratorium on any work on the uppers. Though could cheat on the right hand side. For July 14 on the lowers. For a general once over. Then for a second general treatment on the left-hand side. Thinking here is that current level of hygiene is estimated at say 75%. With obvious ledges still there. Very delicately located in close proximity with my swollen gums. Where reduction of the swelling level is needed before any reasonable additional treatment. Additionally where the ledges are right next to attached gums. Additionally where plaque is located in close proximity with edges of pockets. Hence there is a certain risk of additional damage.

Gangbusters philosophy. Additionally where prior efforts were largely halted once large blocks of filth were removed. Presumably using some type of 80% rule. Meaning 20% of the filth is still there. Additionally applying gangbusters philosophy. Meaning that the available plaque and available calculus will tend to find and attract each other. Making them more accessible to shake down once they have had reasonable amounts of time to work their strategy. Essentially functioning as an on going 80% rule. Meaning that the plaque would be reduced to say 4% of its prior level. Which would presumably tip scale of health in my favor.

Call for patience and faith. Faith in the healing process. Sounds reasonable. Like a healing cut. Can presume a higher level of periodontal health within approximately a month. Or by the beginning of August. Additionally can presume an ongoing schedule of cleaning activity. Schedule. By this meaning to be patient. Eventually my gums won't be sore anymore. Once this happens I can go for a second cleaning. As example my schedule did not reach tooth 16 until two days ago. Even though its degree of filth was completely amazing. Cleaning out dozens upon dozens of pieces of bloody crud. Which was poisoning the tooth. Up until two days ago...

So... with severe plaque poisoning on tooth 16 up until a few days ago can take a long view. Thinking that it might take two weeks or more of relief just for the gum to get the of a vacation from the severe stress it has been undergoing for the past several years. Even a month would seem normal to achieve a semblance of health.

Next steps -- are the bones exposed?. Get the idea that my bones are exposed. Seems important to do a probe. With healthy recovered gums. Suggesting about a week. Also thinking about a bone brushing. With peroxide. But the original issue will be see if the bones are exposed. If so then it would seem that providing the bones with treatment is proper.

Perio brush. This also seems like a logical next step. Imagining the tufts going underneath the gums.

= = =

Tuesday, July 11, 2006 -- 9 p.m.

Tooth #12. Another disaster. Noticed tooth was loose several days ago. Just as loose as Tooth 14. Clean the tooth from approximately 11 p.m. until 3 a.m.. Or around 4 hours. With initial difficulty trying to get around the back right corner. Then coming across the inside. With general flow of crud throughout process.

Leading to working out somewhat new strategy based on general sense of roughness. Which is to go back to a rough area. Then to work lightly in a very small area. Leading to that area be coming clean. Thereby functioning somewhat as a fulcrum to form a wall up against a larger area. Have utilized this strategy before. But have become more aware of its opportunities. One of these being an area that seems kind of clean except for a certain roughness. Results were that on one of my coming around type sweeps that I retrieved a major amount of blood and blobs. Looking like a good 10 blobs at once.

Start up again. So... it has been roughly a week since I got started again with the Gracy's. With general assessment that gum healing takes approximately 4 to eight weeks.

= = =

Monday, July 17 -- 4:20 a.m.

Tooth 14. Worked around from back inside portion towards the front. With idea to clear the edge around the divot. Resulting in discovery of very very deep pocket. With angular root formation. Which means that it is close to the furcation. With mother loads of blobs in the pocket.

Also noticed... that tooth 14 does not feel so lose any more. After approximately 1 month. Additionally tooth 12 does not feel so lose any more either. After approximately 1 week.

Mother lode Blobs. Tooth 14 had several in deep pockets. Tooth 12 had at least one. Tooth 16 had one or more. By mother lode meaning the release of multiple blobs of plaque. Like 8 or 10 or even more at once. Which is a serious issue. But also certainly a major improvement to get the blobs out. With on there about how they managed to protect themselves from discovery. What happens is that I might go over the area without any results. Then a second or third attempt results in the release of massive blobs. So... it is certainly good to get rid of such large amounts of filth. Suggesting that there could be additional mother lodes.

= = =

STOP -- Summary 9/5/06 --- Never really got to Round-2. Finishing up roughly July 15th. Seeing exposed bone. Deciding to see periodontist instead. Rather than doing another round. Which would take time to do. Plus which would swell the gums again. But... since had idea about Round-2... probably discouraged by both hourglass and by exposed bone... probably did not have a good sense of completion. But did have lots and lots of hours. So that must have added up to something. Apparently deciding that a periodontist could finish things off. Plus that there were too many loose unresolved issues. Plus got the basics covered. So a cursory doctor couldn't really get the upper hand by doing bogus cursory work.

= = =

Wednesday August 30, 2006 -- Post week gap in diary. Where largely did not do anything. Including both sweets and doing no flossing. Figuring some future point. Changing that strategy to... It is always now. Floss every day. No sweets.

Missing portions of teeth 14 and 15. Monday evening worked over tooth 14. Plus other teeth. Including tooth 15. Regarding tooth 15 the idea was to come around from the back of tooth 15 towards the front on the outside. With sense of smooth tooth contour as I was coming around the corner.... Got the sense of catching an edge. Then followed up with the over and down technique. Idea being to dislodge calculus ledge. Additionally to follow the edge of the pocket along the perimeter. To try to create a clean environment.

The result was fairly large numbers of little flecks. Several dozen or more. With almost none being large. With possible exception of at least one apparent blob. Which quickly got lost down the sink. Additionally with several small pieces resembling bodily tissue. Additionally with several small fluffy pieces. These I tend to take as calculus. Like some crushed feather encased in mud. But also considering that broken bone might expand into some type of white fiber.... But otherwise do not have any reckoning of any normal item that would look like a crushed feather. Except for the presumed architecture of plaque. Hence calcified.... But nothing came out resembling large chips. Which it would seem that a broken piece of tooth would have to look like.

Summary of 14 and 15. Story seems to be repeating itself. Appearing that I caught some type of edge with the curette. Then proceeded to either scrape off or break off significant amounts of tooth. With ambiguity about what might have happened. Lots of flecks. With no large pieces. With jagged edges. With definite sense of before and after. With definite sense of damage caused to the tooth

-- Previously had no awareness of anything resembling a deficit edge.

-- Afterwards there was definitely a deficit edge. After catching an edge. Then pulling down. With lots of flecks. No large pieces. Jagged edge.

-- In both cases there was ambiguity about what the resulting interior ledge was made of. Whether bone... or tooth... or calculus. Without difficulty of any defining clear indication. With some of it appearing to be root. With some of it appearing to be exposed.

-- in both cases, afterwards there seemed to be exposed bone. Whether interpreted as root. Or definitely separate from root. With appearances of a ridge between 15 and 16. Suggesting that what appears to be a ledge of tooth might in fact be bone. Additionally suggesting that somehow I managed to destroy significant amounts of gum tissue. Which may or may not eventually regenerate.

Summary of 14 and 15.

-- Tooth 15 now, like tooth 14 previously, does not seem normal.

-- For tooth 14 a possible explanation was that I pulled off a filling. Which would seem to have definitely been there. From 1989. But there was no filling on tooth 15. So what could the explanation be there? Especially since the end results look so similar. It would seem that the cause was similar too.

-- It does not seem very likely that I can expect any reasonable answer from the periodontist.

NOTE -- Current thinking on the periodontist is to make a list of questions. But don't ask any of them. Overriding element is that a clean mouth will become a healthy mouth regardless of ancillary work. Additionally that the damage to tooth 14 and tooth 15 in some regards is not necessarily material.

Evidence and conjectures.

-- My normal curettage with the curette was fairly light. Less than the periodontist. Less than I imagine the dental hygienist.

-- The transformation... from a so-called normal contour... to the deficit contour with jagged edge... seemed to take place quickly.

-- My memory is uncertain. But I should have noticed a jagged edge at the very least. Even if mixed in with calculus.

-- There is still some ambiguity. Without clear differences in all cases... between tooth, calculus and bone. With various areas having various probabilities for each possibility. As example part of what appears to be root is probably root. But other parts seem like they might be bone. With some wondering if some of that might be latent calculus.

-- There appears to be exposed bone. In spite of what the periodontist says. Or... some bone like substance. Like a fibroblast or some healing precursor tissue.

-- There seems to be some possibility of long-term damage that I caused. But largely... regenerative processes would seem to hold more sway. Suggesting that something bad that I did might cause a delay. But that can be overcome. Or... that I might have caused some permanent damage, over and above what a professional would have caused. Such as the jagged edges. But... through either regeneration or reconstruction that this damage can largely be alleviated.

-- The regeneration process seems to be 100%. As sorts. The bone won't return to normal. But some will come back. The attachment process won't become normal either. But it should get close enough. Over a period of several years the teeth might return to a basic sense of normalcy. In addition they will be many times more healthy than they were when they existed in a diseased state. In summary... the area with periodontal disease has a good opportunity to become reasonably healthy. Even 100% healthy. Though certainly not perfect.

-- The objective is 100% cleanliness of the diseased areas. As much as this is obtainable. Perfunctory efforts are unacceptable.

Hence... current periodontist is unacceptable. Especially if he won't answer questions. Or gives smug arrogant insolent snappy comedic responses instead of answers.

Theory. I caught an edge and broke off pieces of each tooth. This seems to be the simplest explanation. That I damaged both teeth with the curettes. With the same scenario. Even though tooth 14 had a filling. But the appearances suggest additional destruction.

Pro... Both teeth seemed to have normal contour before hand. With abnormal contour afterwards. With no prior indications or memories of abnormal appearance.

Pro... in both cases the deficit and jagged edges appeared to arise fairly suddenly.

Pro... This appears to be what happened. With similar memories for both events. Catching an edge. Then bringing around the curette. Pulling down fairly hard. With a breaking away of material. Resulting in dozens of bloody colored flecks. Appearing to be calculus. But which would instead presumably be shattered cementum. Possibly mixed in with calculus. With appearances of each being roughly the same Additionally with lots of blood. Suggesting damage to the gums.

Pro... Both teeth seem to have jagged edges along the interior edges. With significant distance. Like the greater part of two edges. Suggestive of a breaking off process.

Con.... There are considerable missing portions. I should have seen more than just flecks. I should have seen broken pieces of tooth. Unless there was a complete shattering. Which suggests that the material itself was brittle.

THEORY - The tooth material was necrotic and brittle. Mixed in with calculus. This is an apologist explanation. Suggesting that the missing material was bad material. Or at best not good. Plus not to be fretted about. Additionally that the problem can largely be rectified. Or eventually bypassed. With or without intervention. Or that at least some portion of the problem was unavoidable. To have either bad cementum or missing cementum. Rather than as missing perfectly healthy cementum.

Pro... There is some suggestion in the literature of the destruction of cementum. Presumably underneath the plaque. With the cementum unable to regenerate itself due to being in a pocket. With that least some destruction of cementum being obvious. With or without detailed explanation.

Pro... The material seemed to break off too easily for being healthy. Possibly some of the calculus embedded itself in the cementum. Causing an inevitable break if the calculus was to be removed in any sort of gross fashion.

Pro... this would seem to explain both the amount of flecks and their smallness. Possibly the broken off portion was largely calculus.

Con... Explanation is apologist. Hence my preference is towards less bad happening. Or inevitable bad. Or excusing me bad.

THEORY - The tooth material was largely scraped away methodically. Because of multiple passes.

Pro.... I certainly made many passes. Would make sense that each pass would have removed material. Possibly resulting in a jagged edge.

Con... In both cases the problem of the deficit in the jagged edges appeared to arise fairly suddenly. Where a scraping away process would have taken place more slowly.

Con... The amount of missing material seems fairly large. Especially since my original touch was fairly light. Only going after places where the blade caught. With approximately 20 times the normal amount of material missing. Which does not make sense given a light touch. Even with multiple passes.

SUMMARY THEORY - That the missing material was largely diseased and brittle. That is why it broke. That it should get filed and smoothed. That perhaps it won't reattach so easily. Especially considering the gap caused by the deficit. That the gum material will have a problem going around corners.

Additional summary. The entire profession of dentistry has gotten out of control. With mediocre professionals delivering mediocre results at huge costs. In addition with deficient work being presented as professional. Additionally being charged at a premium rate. Hence creating serious problems for the consumer. Largely driven by dentists needs to make serious amounts of dollars per hour. Not just $100 an hour or even $200 an hour. But more. As much as they can get for the least amount of work.

With consumers treated arrogantly. With dentists rushing through procedures like some sort of Mao Mao dance. Cutting off questions. Acting presumptively. Such as playing games with the x-rays. Basically the dentists have the power. Which they hold over the consumers. Essentially turning teeth into hostages.

= = =

Thursday, August 30, 2006

Damage to 14 and 15. Basically damaged the cementum of both 14 and 15. Should have learned from 14. Caught the edge and pulled off the cementum. With great force. Repeated this with 15. Could have come in from the sides. Could have worked very slowly. Could have ignored problem. Results are... questions about whether the edge should get filed.

Flossing. Issue is bacteria. If I reduce places where bacteria can take hold then bacteria will only take hold in the hide out spots. Like painting a house... or some other widescale activity... if activity is performed where of available then places where it is missed can be subject to special activity. As example... if I floss but miss 75% every day then the 25% that I do accomplish will eventually add up to a much greater percentage. Even if the major focus is only on the minor portion. At the very least at least that one small area will stay clean. Additionally... the theory seems to obviate the need for comprehensiveness. As a precursor for activity. Meaning that I can literally perform a botched job every single day. Being 100% better than no job at all.

= = =

Sunday, September 3, 2006 -- general summary of gum bone separation issue.

Bone and gum separation.

-- Infected or not? My guess is it is infected. That TT might have cut it part way. But that there was a pre-existing pocket. Which was infected. Which is still infected.

-- Damaged or not? Gross situation caused by infection or TT induced damage. My best guess is that the situation preexisted..

-- Did TT clean out pocket adequately?

-- Is infection ongoing still? Current issue. Whether or not there is still significant infection there..... Or whether the amount of infection is within normal body abilities.

-- Can it reattach? Major issue. Whether the tissue will be able to reattach itself to the bone. Whether pocket will become scarred. Resulting in an open pool. Subject to issues. Similar to the problem with my foot. Where an open pool of fluid can very easily become infected. With almost any stimulation at all. Like from some left over random bacterium.

-- Is area filthy? Should I leave it alone or forget about it.

SUMMARY ANALYSIS - that possibly the situation has reached a state where my body can get the jump on the situation.

-- Estimation of cleaning. Doing left side before. This time working around the entire pocket. Assumption of previous is 60% clean. Assumption of current is 90% clean. Or... presuming 40% was left behind last time. Presuming that only 10% was left behind this time. With presumption that previous level of infection did not return to its pre-existing level. But... that it stayed fairly stagnant. Suggesting that level of dirtiness was reduced from 100% to 40% to 4%.

Basis evidence... supporting judgment of pocket as a serious pre-existing issue.

a) proximity to periodontal infection.

b) apparent openness of pocket. Admitting to some cutting separation of tissue. But suggesting it is not as much as might be imagined. That pocket did exist.

c) volume of material inside. Looking like... other pocket material. Which was positively identified as plaque and calculus. Since there was no other explanation. With possibility that material could be functional? But seriously... not likely. Per general accepted understanding of debridement issues. Additionally with understanding that suspect tissue is nonvital at best. Especially if it looks like a blob or a fleck.

SUMMARY OF ACTIVITY ... with prognosis.

-- Previously worked left side. Ignoring right side. Which was open. This time... I seemed to work the entire pocket.

-- Worked curette around perimeter. At least two or three reasonable times.... I am upset that I did not work the curette around more. Such as two or three additional times. But realistically I probably worked the curette in the pocket for a good 15 minutes of actual curetting clock time. Perhaps even more.

-- Could have worked curette more. Suggesting that my level of completion was incomplete. Suggesting that significant amounts of bacteria are still in there. But... sounds like a bad idea to go in there again.

-- Thinking that I could have worked the interdental brush in the separation. Or... that I might still work the edge.

SUMMARY OF STRATEGY - More cleaning? Periodontist or dentist would likely call this crazy. Realistically... I did a fairly reasonable job of cleaning out infectious crud. With issue of what happens to infectious crud. Does it get reabsorbed? Or get turned into something innocuous?

= = =

Sunday, September 3, 2006 -- consultation with dentist.

Saturday dental consultation. Dr. L was a true jerk. Asking me why I was there. Presumably because a simple consultation without additional work would be wasting his afternoon. Since he is there to make some money. Not to rap. Which is obviously an overstatement. But still... he was a jerk. When I said that I was going to see the periodontist in 10 days he said WTF. What sort of angle are you running? Trying to play off one doctor against another doctor? You POS. What is wrong with periodontist. Cursory, perfunctory, arrogant, presumptive. Why can't you ask him questions? He doesn't want to answer your questions? Grow up. Grow some balls. Grow some backbone. Get another periodontist if you don't like him. But don't go around asking dentists what to do about severe periodontal disease.

-- TT said that the periodontist took all of 15 minutes scale and root plane my teeth.

-- TT said that the periodontist discounted and denied any exclamations from me that I had exposed bone.

-- Dentist said that periodontist is well respected. That I should listen to what he says. That I should STFU.

Dentist said...

-- TT has severe periodontal disease. About to lose three teeth. Loss of membranes, supporting material and bone. Implying... that TT caused much of the damage. Presumably by plowing through supporting tissue. Later... discounting TT's confession about damaging two teeth. Summarizing with statement... that most of the damage that a patient might cause by trying to clean their teeth will heal itself within several days. Additional summary... the teeth might be terminal. But not necessarily right away. Their ultimate prognosis sounds hopeless. But presumably the day of reckoning can be put off for a significant amount of time.

-- Separation won't heal. Don't call it a pocket either. In particular... TT likely caused the damage. Which is a judgment. Which is an assessment of reality. With issue being... was the pocket infected with periodontal disease? Did the periodontal disease get into the geography between the bone and the gum. Then run wild. Hard to say how much agreement I got or didn't get. ... With my opinion that the periodontal disease created a gum abscess.

-- Damage was caused by the underlying condition. Meaning that the level of damage that exists now also existed in April or May. That there was no state of non-damage that now exists as damage. The damage now existed then. TT may have fussed with the problem. But... TT did not cause the damage that is there. Any damage caused by TT goes through an ongoing healing process. Damage caused by TT can be summarized as... sore gums.

-- The teeth will never be normal. Hello? Hello? Dentist is stating the obvious. Thank you.

= = =

Sunday, September 3, 2006 -- other stuff.

Periodontal cleanliness issue. There are various watchwords and expressions. Such as that... the most important piece of calculus that you remove is the very last piece. Realistically... through my various efforts... I have removed highly significant amounts of calculus. Additionally... with each additional effort removing more and more. Finalizing with basic sense that the affected teeth are fairly clean. Like 99% cleaner than they were. That to say 5% left of the original would be a gross exaggeration. That to say 1% is left sounds like a reasonable assessment.

Additionally... is the entire concept of just how filthy those teeth were. Where I spent hours upon hours releasing crud. Purchasing the Gracy curettes. Arriving 6/21/06. Starting off on tooth 14. Writing... with lots and lots of plaque and tartar... amazing how much crud I removed. With cut on gum. Plus damaged tooth... resulting in a moratorium. Starting up again on 6/27/06. Then doing the right side only. Starting again on the left side on 7/2/06. On tooth 14. Then 7/5/06. Overall quadrant six hours. Then 7/6/06. Tooth 15. Then 7/10/06 for tooth 12. Then 7/15/06. Overall quadrant five hours. That was one month before the periodontist cleaned the area.. . Or approximately 17 days before seeing the periodontist for the first time.

Transitioning from a basic state of filth two months ago... to somewhat clean six weeks ago... to perio clean three weeks ago... to touchup clean with pocket four days ago. Thereby transitioning from a state of filth then, to a state of basic cleanliness now.

With the basic philosophy that cleanliness can and will return my teeth to a state of basic health. Even though the perio condition is obviously permanent. Can imagine a future time... perhaps a month from now... perhaps six months from now... when the pockets won't be particularly deep. The pain will be gone. Presumably the bone will be back inside of the gum. Perhaps there will be issues of monitoring the gum. But what is so difficult about that? Perhaps there might be issues of the gum going episodic. But that can be dealt with when the time comes. Additionally I might wonder about the broken cementum ledges. But conceivably they will be back underneath the gum line. I might wonder about bogus dentists. But my dentist won't be one of the bogus ones.

Looking through the Internet there is reasonable belief that calculus free gums are a good start. Perhaps not the end all say all. Additionally not a tragedy if not achieved. But certainly a good idea. Additionally... it sounds like a major surgery issue is so that the periodontist can see the gums. Saving significant hours by cutting open the gums. For convenience.

I spent something like 24 hours with the Explorer, then another 24 hours with the Gracy scalers. Or a total of 48 hours cleaning my teeth. With most of those hours focused on the four bad teeth. With a very typical episode at three or four hours on a single tooth. Which would add up to 16 hours straight forward. Plus say another eight hours for generic and otherwise.

SUMMARY -- my teeth should be quite clean by this time. Reasonably so for positive therapeutic results. Significantly better than I might have reasonably expected from the perio doctor. Additionally... my teeth are probably cleaner than just about anybody's. In an situation. Since they would have not gotten as much time. Additionally since I touched up the doctors work.

SUMMARY -- by spending so much time cleaning my teeth... 48 hours... reasonably I accomplished the of a fairly high-end SRP. Additionally I explored many of the pockets in significant depth. As said for up to several hours per tooth. As example... thinking about the back inside portion of tooth 14. Where there was a nasty plaque pocket. With this as somehow to what a surgeon might find. Which in my case was discovered through deep exploration. Which a normal dental hygienist might have overlooked. Since... it was not obvious right away. Anyway... hoping my teeth are clean! If so then I have a reasonable basis for the future.

Additionally... obviously... is the issue of so-called secret pockets. With differential analysis. One theory looking at them like hidden landmines. Another theory looking at them like they can be bypassed... if they are not very material.

The issue of periodontal surgery... if there is bone there... then how can cutting away the gum do anything? It would seem that the bone would still be there regardless of whether gum is cut away. Meaning two things. One... that the cutting of the gums serves no purpose except to make it easier for the periodontist. Two... that a patient effort with the curettes is just as good as periodontal surgery. Or almost as good. Again... saying that 24 hours of Gracy's starts to add up. When compared with say four hours of strenuous debridement on a single quadrant. If you could find anybody that would actually do that. Without cutting corners... as would be expected.

With the separate issue of the gum separation. But... idyllically... perhaps I addressed the issue. With the right side cleaning. Perhaps my effort was reasonable. Getting the upper hand. Perhaps a little brushing along the edge will help. Along with 100% cleanliness. Perhaps including some irrigation. Perhaps requiring grand patience. Perhaps requiring isolation. As in... if everything else gets dealt with except for that then that problem is still left.

Additionally... with separate issue of broken cementum. Whether it needs filing. Whether it can be ignored.

With the bottom line that I am attempting to transition myself from a state of negative health into a state of positive health. Where this effort will naturally take place over a period of several months. If I give it a chance. Meanwhile... that the situation sucks. That my previous dentist was a quack. That the perio guy is close to being a quack. But... within several months I should have reduced pockets and other examples of perio health. Plus I might not be sore

Dental hygiene issues. Plus other issues. Sounds like I should follow some basic rules...

-- No sugar. This includes candy, white bread, and any type of pastry. Idea is to starve the dental plaque.

-- Post meal irrigation. Idea being to not leave any food.

-- 100% cleanliness. Idea is that I eat then clean my teeth. So there is hardly much time when my teeth are exposed to food.

-- Floss. Daily. Religiously.

-- Interdental wooden cleaners. Idea being to eliminate the slime layer. Give the teeth a chance to reattach. Per theory about reattachment.

-- Interdental brushes. Idea being to address the exposed bone issue.

-- Review of bone issue on right side. Was it there before?... Yes.... Definitely?... Quite so. Close enough. There was definitely something there. If now healed.

-- Consideration of irrigation issue. Or metameucal issue.

-- Odontology Issue -- filing broken cementum.

Knox gelatin regeneration theory. Sounds like... the idea would be to create so-called symbiosis activity times of some intermediate time. Theory being that I might not brush my teeth for a while. Additional theory being that some proximity substance will likely become absorbed. Such as chemicals. So why not vitamins? With the presumption that they do get absorbed. But just might not do anything. But... as long as they are not dangerous they should not cause any harm either.

So... idea would be to get a general grip on the antibacterial portion of the disease. This would seem to follow a general linear progression. Starting with elimination of calculus and supporting geography. Obviously suggesting issues with pockets. But... dental floss... wooden interdental devices... etc. can deal with these. With the apparent idea that there is something about metal that pisses off dentists. Just as others get pissed off about anything under the gum line. Saving the critical portion for their own particular specialty. Letting the amateurs do what is nonessential. But obviously creating a problem too.

All of this taking place in super slow motion. Leading to some essential task level. But basically... I just did the touchup perio. I just isolated the tooth 16 bone issue. Which is still unresolved. Suggesting... interdental... whatever. Leading to... the settling in of the cleanliness and hygiene. With daily flossing. With soaking in the tea oil. With possible use of the syringe. Or other mechanism for delivering the tea oil. With idea being to starve the bacteria. Though obviously they can recover as soon as they get some food. But in the meantime the longer my body has to get the upper hand the better. This to include some healing process too.. Which will help in getting the upper hand. Presumably also combined with the bacteria putting out its message, or toxins, at a low enough degree to be dealt with. Back to street gang.

Additionally... with the issues of the periodontal gum bone pocket. Also including toxin issues. Presuming... that once the area calms down slightly that some gentle irrigation will not be such a bad idea. Additionally possibly it could be combined with the water pick. Perhaps... with just enough hydrogen peroxide to sterilize the water. Followed up with a saline. Or perhaps... to waste an entire saline on a single treatment. Previously... can practice with the water pick and the syringe. See if I can get it to work.

Then... try to go deep into the pocket and use up an entire bottle of the saline. What could be wrong with that? At worst it might wash away some toxins. Again with the entire objective being to get the upper hand. Soon enough leading to pressure therapy on the dead space. Once things are calm down.

So to summarize...

-- Diet therapy as described. No sugar. Mouth 100% clean. Per obvious. Followed up by cleanliness routines. Floss, wash, brush, etc.

-- Waiting out the soreness. Which previously took a long time. Still sore previously after eight days. Presumably okay by 14 days. Or Friday 9/15/06.

-- Wait out the perio doctor. Delay a week. Possibly delay two weeks. Tell Michelle I want to impress him with my flossing. Additionally, by then the teeth might be good enough for a quick filing. While you're at it doctor... what you say.... Meanwhile... my teeth get better and better. Thanks to positive hygiene. Under these circumstances it sounds like my best interests are applied by a delay in the appointment. Fuck him.

-- Impress the perio doctor with my flossing. Plus my use of the interdental. Reducing the slime layer.

-- Consider some type of Knox gelatin therapy. Check out their product line. Plain gelatin? Normal saline? Electrolyte?

-- Floss with the tea oil. Figure about a week or so of antibacterial therapy.

-- Ponder the apparent gum abscess. With presumption that it pre-existed. With possible additional gum abscess? What about irrigation??? Finished.

= = =

Thursday, September 7, 2006 -- 12:11 p.m.

INDERDENTAL BRUSH - Deep pockets. There are several deep pockets that can be accessed with the interdental brush. Their locations are fairly well-known. On the tooth map. Largely they seem to be roughly the same as they were before. Realistically they can be cleaned with the interdental cleaners. There are deep pockets in on each side of each of the teeth. In between the teeth. Realistically they might be 10 mm deep. First step was to brush out the pockets. In several of the pockets I seem to get significant amounts of plaque on the brush. Along with blood. Second round I put several drops of melaleuca on the brush. When I was all done I got numbness on my lips. Obviously an effect of the melaleuca. But... almost a half-hour later the symptoms seem to be going away.

DEEP POCKETS - Obviously a serious issue. Thinking is that today's brushing plus the melaleuca is a step in the right direction. Quite likely my coverage was only partial. Quite realistically I will soon get quite good at brushing out those pockets. Don't know what a good schedule might be. My guess is 48 hours. In order to give the gum tissue time to rest. Additionally there are issues of comprehensiveness. But I haven't done anything so far. Just today. With the interdental brushes coming on as the obvious solution. Additionally the melaleuca treatment should have a positive affect.

SUMMARY -- presumably got rid of a reasonable percentage of what ever plaque was there. Additionally the melaleuca should either kill or knock additional plaque out of commission. Idea will be to come back in a day or two to clean out the area again. Gradually expanding my territory as I learn the pockets better. Presumably next round will be more comprehensive. That will help to set up pocket closure. Additionally... I was hardly even aware of these pockets recently. Also... none of these pockets has been cleaned out. Nor did I have a system until I got the idea of using the interdental brush.

Biogel. Sounds like... I could get a glass jar. Add water. Possibly electrolyte. Possibly boiled down electrolyte. Or salt solution. Making a salve to apply to the affected areas. Could use the sulcus is brush. With the idea that any gelatin realistically is not going to not dissolve. Meaning that... for topical use I could likely use a highly concentrated mixture. Additionally... I can use the thermometer to experiment with the viscosity. With the idea that I might cover over a periodontal area for a few days at a time. In particular that I would cover up the bony area on tooth 14. To give it a chance to get ahead. Then... I could time it to see how long it lasts.

Progressive strategy. Delivery of biogel. Basic idea is for the gum tissue to absorb the gelatin. Presumably then turning that into bone. Realistically a nutrition strategy probably makes more sense. Using the stuff that I bought. That I have not really tried out yet. But realistically the bone rebuilding process is long-term. Additionally... it sounds somewhat far-fetched that the body would take up college and out of the environment rather than nutritionally. But you never know. In the meantime the so-called biogel can function as a sort of bandage. Presumably with some type of relative the short life expectancy. So it doesn't get stuck. Meanwhile there might be some absorb and see that won't hurt. Though likely it sounds like it would go into the veins? But... if other items progress than presumably the biogel will too. Otherwise I would not have to be numbing effect from the melaleuca.

Progressive strategy. A rough order or lineup.

-- tooth 29 recovery from gum damage.

-- teeth 29 through 32. Clean in between teeth.

-- teeth 16 through 32. General cleaning. Idea here is to neutralize the gum disease throughout the mouth. Additionally to reducing the bacteriological load.

-- teeth 14 through 16. Interdental brush the deep pockets. Idea here is to create a state of basic hygiene.

-- teeth 14 through 16. Exposed bone. Intermittent pressure on the area. Using gauze pad. To try to eliminate dead space.

-- Problem -- exposed bone. Thinking biogel. Like an ointment. That will last two days

= = =

Tuesday, October 17, 2006

Dental situation. I saw the periodontist shortly before I started working on computer. Around three weeks ago. He said the disease seems to be in remission. I only flossed a few times over the next two weeks. Then I started to use the wooden interdental cleaners to remove the plaque. Especially on tooth 2 and 3. Plus the problem area between tooth 14 and 15. The plaque looked white and somewhat mediciny. Leading me to identify this as a problem area.

So... I have cleaned out three problem areas over the past two weeks. First the plaque between tooth 14 and 15. Cleaned out with the brush picks. Spending an hour or two. Basically making that area clean and hygienic.

Second problem area I cleaned was in front of tooth 14. Third problem area is the front of tooth 2. Think of the cleaning procedures as a form of capital improvement on my teeth. Since each of these areas was heavily infiltrated. Also bringing up the principle of rest. Not to be touched for several weeks. As was clear from my initial cleanings.

Additionally I had a chance to look at the open gum on tooth 2. Which I have issues about how it got started. Whether I ripped it open with the curette. Or whether it was preexistant. With its degree of filth suggesting it was preexistant. With its bloody flecks and blobs resembling infiltration from calculus and plaque. As stated a commonsense explanation is that the area was previously abscess. This is because the area was open. This also sugggests that the abscess on tooth 16 preexisted too.

Both of these problems suggest that the periodontal disease was quite severe. This should be obvious from the amount of bone loss. It should also be obvious from the depth of the pockets. Which is that the disease is an ongoing infection

Realistically it seems that periodontal disease can be divided into several categories of consideration. One category is actively destructive. A second category would be passively destructive a third category would be at a tipping point between being stable and passively destructive or a tipping point between being stable or passively healing.

= = =

Sunday, October 22, 2006 -- general update.

Since September I have cleaned out several areas...

-- tooth 16. Abscess. Curette. Irrigate.

-- tooth 2. Abscess. Curette. Irrigate.

10/28/06 -- target gum boil. With reversed sickle strategy. With two sessions. With second session mother lode.

-- tooth 14 and 15. Pockets in between. Used brush pics to remove plaque in pockets.

-- tooth 14. Front. Major plaque, calculus and pocket. Cleaned out area.

-- tooth 29. Gum laceration. Used brush pics to remove significant plaque.

-- tooth 2. Front. Major plaque, calculus and pocket. Cleaned out area.

11/2/06 -- brush pick him. 2/3 and 15/16.

-- tooth 3. Back. Cleaned out major debris area.

-- tooth 15. Significant debris and calculus in broken area.

SUMMARY -- Activity is like some search and destroy mission. Discovery and isolating areas of calculus and plaque. Cleaning them out. Hopefully setting the stage for healing. As example... the front of tooth 14. With sense that this area could return to reasonable health. As second example the front of tooth 2. With major calculus and plaque debris pocket cleared out area now should have potential to heal. This area resembles the area between tooth 14 and tooth 15. Not quite so damaged. But also bordering on the abscess on tooth 2.

Additionally...

-- See what looks like a crack on the inside of tooth 3.

-- Feel what feels like a small pimple in the outside gum above tooth 2. GUM BOIL.

-- Apparent deficit in inside gum above tooth 15 and 16.

11/16/06 -- front of tooth 3. With furcation!. Trashing gum. Surgical rest.

= = =

END -- GO TO DENTAL ACTIVITY DIARY #2

= = =

Dental Activity Diary #2

= = =

Wednesday, October 25, 2006

See perio doctor. Saw Dr. G yesterday. He was attentive and polite. Figure we spoke for around 20 minutes. His analysis. I have periodontal disease. Next step is scaling and root planing. Which makes sense regardless. Since it will be three months since Dr. S scaled the teeth.

Dr. G wondered how I found him. The long explanation was through a site called BOST. Which explained how amelogenin promotes regeneration. Which led to amelogenin and Straumann.

Dr. G sent is scaling and root planing takes about an hour. For full mouth. I made a statement largely leading to calculus as the enemy. Since it harbors plaque. That it sits deep. With my experience that the pockets go on and on in depth. Would need a submarine to find all the calculus. But that is what you have to do. Anything less is an excuse. With a certain incredulousness that it can be done in an hour. Conservatively imagining at least two hours. Or four hours. Or one hour per quadrant. Not 15 minutes per quadrant. Wondering how that could ever lead to getting to the depth of the calculus.

Space between tooth 14 and 15. Worked on cleaning that area on Tuesday evening. October 23. After seeing Dr. G. Result was discovering that the area was quite filthy. Taking several hours in the early morning. Result was traumatizing the gum. Which will presumably take at least two weeks to at least part way normalize. Conceivably it could take longer. But the general idea is that gum tissue has read generating capabilities. If given the chance. But... it might be that there isn't anything skin like to function as coverage. In which case I could be in trouble. Since there won't be anything to provide the actual coverage without serious help.

NOTE -- 2/15/07 -- Likelihood that gum trauma causeD the bone to get resorbed.

Gelatin bandage. Looking like... this might be a good application for the gelatin bandage. If I can get it to work. Idea would be to create a plug. Realistically I could jam something in there. Realistically it couldn't last more than a couple of days maximum. Meanwhile... if plaque is growing underneath it a few days would not make that much of the difference. So this is a project I can work on within the next day or so.

Precleaning the teeth. Additionally... is the idea that one hour of scaling and root planing is not very much. So it seems like it would be a good idea to try to get my teeth as clean as I can in advance. Thinking that the brush picks are a good strategy. Thinking that all of those loose flecks are representative of calculus. Idea to get a pre-cleaning approximately 2 weeks in advance the scaling and root planing. Idea to improve upon the 100% hygiene policy. With the idea that a closing of time approximately 2 months of perfect cleanliness and hygiene will result in a basic transformation. From disease to health. Though the damage will obviously remain. With some expectation of bone recovery. Plus some gum recovery. Plus possibilities of regeneration.

Sorry about my mistake. With the coffee and sugar. Chocolate. Ice cream. Dr. Z. Not getting my teeth cleaned often enough. But once a year. The cigarettes. All resulting in the destruction of my dental health for my upper molars. Additionally very sorry for my thoughts against flossing. Imagining that I could lose bone slowly.

= = =

Sunday, October 29, 2006 -- 5:06 a.m.. Post midnight madness on my gum gum abscesses per tooth 1 to 3.

Midnight madness. Cleaned the gum abscesses on teeth 1 through 3 starting at approximately 1 a.m.. Going on until 6 a.m. old-time. Or roughly 5 hours. Hard to remember exactly what I accomplished. Largely using the sickles scaler. Also using the 11/12 Gracy. In both cases shifting applications. Getting a fairly consistent amount of blobs and flecks. Representing a moderately dirty environment. With specific pockets of crud.

Blobs and flecks. Recall running the scaler along the bone and getting moderate débridement and blood. Since I did this are several hours the total volume was certainly significant. Also recall several areas along the inside of the neo-sulcus that resulted in the liberation of pockets of debris. Per prior experience. Where some type of angle with the tool results in liberating crud that did not seem to exist until its discovery. Leading to... trying to identify the specific location of the gum boil. Including running the tool backwards. From front to back.

Gum boil. I did not have much success finding the gum boil. Until I turned the tool backwards. At that point I discovered what seemed like small sock shaped pocket. When I reached it with the sickle scaler lots and lots crud came out. Quite significant volumes. to previous discoveries of crud pockets. With lots and lots of blood. Dark blood. Dark blobs. Multiple flecks. With resulting spit also containing large blobs. Bleeding fairly intensively for several minutes. Finally with the cleanup along the gum line resulting in a large set of crud too. So... I would say that there was an initial set of crud. Identifying the target. Then at least two mother loads. Then at least two follow up loads. Finalizing with a gum line load. So... sounds like there were a good five sets of crud.

Path to hygiene. Right now the bump seems to have disappeared. Which basically seems to be to identify the procedure as successful. A definite improvement to get rid of all that crud. Realistically I should compress it. To avoid the possibility of dead space. But it sounds like the gum boil might reasonably go away. Additionally... based on my general experience, it seems that an initial cleaning sets the stage for hygiene. But cannot get very far. Because the overall environment is just too unhealthy. Even in huge amounts of bacteria are removed there is always enough still there to recolonize. Especially with the defenses basically wiped out.

The first cleaning was a month ago. Presumably my gums got a break. Additionally some of crud that I just got to are remnants from the first cleaning. Using the so-called 90% rule. Or 80% rule. With this second cleaning representing an opportunity to remove much of the residue from the first cleaning. Additionally applying the hang out and conglomeration beacon type concept. Whereby plaque and calculus that was left over become a beacon. Whereby so-called invisible calculus and plaque on the first round become more present as time passes by. So a month later what is left over becomes ready to get taken out and removed.

So... sounds like reasonable progress on the gum. Additionally sounds like the open gum line was a product the periodontal disease. Since I certainly did not care open the gum line along virtually its entire length.

= = =

Monday, October 30, 2006

Gum abscess revisited. Was not completely happy with the results from using the sickle backwards on the gum boil. Got the idea I went into the gum boil hole. Moved the sickle up and down. But that I did not do a comprehensive sweep. Or was incomplete. I was reluctant to go back. But just did. Doing a sweep from the front to the back. To include the gum boil hole. Additionally trying to be comprehensive in my coverage. Going in at multi-angles. With up down and backward movement. Reasonably confident that I covered most of the area.

Results were a major dislodgement. With fairly gigantic blob. That reduced to some type of membranous formation. Imagining it as some type of bacteriological construct that then commandeered a large blood blob. Followed up by two large blobs that came out in my spit. Along with a normal number of attendant sized blobs. At least five or six. Also including flecks. With the overall assessment of this being another mother lode.

When I went back for a follow-up sweep the results were fairly clean. Doing a reasonable repeat of my first attempt. With significant pain. As previously. Doing roughly 2 follow up sweeps. With good satisfaction that the attempt was worth it. That my previous activity was incomplete. Cleaning out a fairly filthy hole. But leaving significant residue. With this attempt reasonably completing the job.

Bleeding as indicator. Additionally with the sweep yesterday the area continue to bleed when I was done. This sounds indicative of incompleteness and continued filth. Sounds like when an area becomes clean it will stop bleeding. Almost instantaneously. Even if there was a lot of prior bleeding.

Summary. Certainly the area is significantly cleaner than it was before. Which is monumentally cleaner than it was before that. With serious amounts of mother lode material being released both times. With current assessment that there is no more mother lode there. If I didn't get it the first time I certainly got it the second time.

With one caveat being that the sickle that I used only had a certain amount of depth. I pushed it in as far as it would go. I did not want to use the longer sickle. Because the shank does not have an angle. With my judgment being that I used all the angle I could with the first sickle. That there is nothing to spare. So it is not a good idea to try to use the longer sickle. But to be satisfied with what I was able to accomplish. Which is quite nasty. Cleaning my bones.

= = =

Tuesday, October 31, 2006

Gum flap. Brand-new problem. Cleaning the area between tooth 3 and 4. The gum flaps open. Like it did with the gum between 29 and 30. Somehow it got cut through. Likely when I was confused about which to that was working on. Tried to clean up the area. But my tools are dull. The 9/10. Both of them. I suppose I could have rummaged through the other tools. But I imagine trying to get a sharp tool. Then to work on the area while it is fresh. But not for very long. Quickly. Then go away. Let it rest. Idea that it is okay to interfere with fresh surgery. But not once it is a day old or so.

Sharpening tools. Presumably they have been getting dull for quite some time. Though it seems that they have been working acceptably. Or that I have been able to switch tools to use fresh ones. But now it looks like I should sharpen my tools. The hygienist textbook that just arrived has instructions. There are probably instructions on the Web too.

= = =

Thursday November 30, 2006 - Post scaling and root planing -- Major cleaning session.

Scaling and root planing. Had my appointment on Tuesday for scaling and root planing. Hygienist was interested that I used the dental tools. I told her I liked the Gracy 11/12 for the fronts. Gracy 13/14 for the backs. Plus Gracy 9/10 for general use. Liking the angle. Plus also liking the sickle. Even though I know it's dangerous. The hygienist said she likes the sickle too. So we have something in common. Like breakfast at Tiffany's.

Value of procedure. The session took about 45 minutes. The hygienist said to give the area surgical rest until I came back. Of Previously I told her I understood the concept of surgical rest. The hygienist assured me that she cleaned out the area well. $450 for a cleaning. Presuming the normal cost of a cleaning at roughly $100. Suggesting an advanced cleaning might be worth $200. Suggesting a maximum ripoff of roughly $250. But I am also getting a follow-up session. Presumably worth $100.

In addition the entire procedure sets up so-called clean mode. Meaning that... all of the things I did in the past were done to teeth that were filthy. Where all my work made them less filthy. But where there were lots and lots of nasty surprises. That remained when I was done. Such as the gum boil. On October 30. One month ago today.... Additionally... much of the work I did was up against a basically filthy environment. So that after I cleaned out a particular area it was still filthy. As demonstrated by me going back there, some time later, and discovering more filth. Or continuing the cleaning process for a while with an ongoing stream of filth. Where what was left becomes the seed for the future continuation of the disease.

Concept of perfect cleanliness. So... if ongoing activity simply takes a higher level of filth to a lower level of filth then the disease can continue. But... the idea is that it progresses from a lower level. Which could be imagined as a leak. Or noise. Where additional sessions reduce the level of filth to even less filth. Ultimately creating the present opportunity.

Opportunity to create perfect cleaning. Idea being to follow up on the scaling and root planing with the ongoing present follow-up cleaning. Sweeping out areas of plaque and calculus that got missed. Going after areas of burnished calculus. One spot at a time. Per pendulum technique. Resulting in the liberation of blobs. Quite nice. Plus systematic exploration. Which I have not quite yet completed. To be followed up by the Clorox wash. To be followed up by surgical rest. For the next several weeks.

Furcations not cleaned. When I got home I checked out the furcation on tooth three. I discovered it was fairly filthy. Meanwhile I figured out how to reverse 13/14 to get the other side of the furcation. Basic concept being to reverse the angle of the blade to get the obverse side. Presumably I am not quite done with the furcations....

Other areas also filthy. Following up with other areas I continued to find calculus. Meanwhile I figured out fairly reasonable technique to get burnished calculus. Which is to get an edge of the dental tool to catch. Presumably on a piece of calculus. Then to angle the tool back and forth. Ultimately resulting in the tool slipping. With significant occasional blobs. Pendulum method.

Estimation of results. Realistically I would count the blobs in the dozens. Even after considering the two furcations. Including a number of quasi mother lodes. Finally leading to attempted sweeps where hardly anything was gathered. In addition leading to particular angles that resulted in those bio blobs. That I associate with calculus. Either looking like a small loose piece of flesh. Or a crushed feather. Oftentimes with a red spot. That I interpret as an attach point. With the net result being that I must've gotten close to a hundred bio blobs.

Estimation of time. With breaks. For a presumption of a total input of time of at least six hours. Or certainly enough to get me quite tired.. Certainly enough to count as a good day.

SUMMARY - Idea is that I have searched out and destroyed a large proportion of all the calculus that was left in my mouth. To the point where each discovery of calculus is a significant proportion of what is left. Where my current activities largely only yield small latent portions of calculus. To the point where it is getting close to fair to say that my mouth is clean. Now... of course this cannot last. Additionally there are certainly areas of burnished calculus that I failed to dislodge. But realistically... my effort is at least 100% improvement on where the hygienist left me. Which was actually quite filthy. But which was promised as a baseline for cleanliness. Hence my current baseline of cleanliness is quite high. Perhaps several orders of magnitude higher than where I was before. Providing a reasonable basis for healing.

Additionally... providing a reasonable basis for an antibacterial strategy. Logic is that if there is very little barrier between the Clorox and the plaque then there is a reasonable opportunity for the Clorox to obliterate the plaque. Additionally to causing the plaque to become mobile and washable. Even to the point of where the base of the plaque is very low.

Mathematical progression. Concept of 2, 4, 8, 16, etc.. Where I might measure my previous base in millions. But where my present based might be measured in thousands. Where possibly quite realistically the amount of active plaque could be reduced to say 5% of the previous level. Where blasts of Clorox might even wipe out most of the plaque it is there. Essentially turning over the ecology of the pockets towards a non-plaque oriented environment.

Current plans. As described... I am finishing up a general sweep of the calculus in the periodontal areas. Perhaps include a light sweep of some of the other areas in my mouth. Also including some touchups on the furcations. Perhaps also including some irrigation with the syringe. Particularly in the furcations. With questions about mixing products. But generally thinking to keep the products separate. With original idea to do a major rinse. An energetic rinse. With a high Clorox solution. Like 25 to one. Additionally to persist at this. So my entire mouth gets a high level of disinfection.

Deadline today for surgical rest. Additionally... to complete the process today. Within the next several hours. Since it is now almost 2 days later. Where the ideal would have likely been to have finished by yesterday. But where I certainly cannot persist after today. But also where I need some energy. So I have to eat. Throwing a small wrench into all of this. Since I'm too tired to brush.

SUMMARY -- teeth marked as clean. In fact they are quite clean. If Carla's result was supposedly clean then six to eight hours later should result in significant improvement. Especially with blobs in the dozens....

-- furcation tooth 2.

-- furcation tooth 3.

-- cavern back of tooth 3. Including so-called final large blob. Or mystery blob.

-- cavern front of tooth 2.

-- cavern back of tooth 14. Large quantity.

-- cavern front outside of tooth 15. Large quantity.

-- burnished calculus front of tooth 16. Several significant blobs. -- NOTE 2/6/07-- Turned into major site of infection. Several tubfuls of blobs.

With the final result that I went over the teeth, recovering significant blobs right up until the very end. Additionally I ran the tool along the outside and inside edges of the teeth. Resulting in significant amounts. Including several fuzzy pieces of calculus right at the end. Which leads me somewhat disconcerted. Since I wonder if there are additional fuzzy pieces of calculus that I missed. But... if say hygienist got a hundred pieces of calculus. Plus I got an additional hundred pieces of calculus. Then if there are 10 pieces of calculus left then 95% of the pieces of calculus have eliminated.

Additionally... if I presume that there are significant pieces left... but... enough has been removed for a strong healing response... then... a certain number of pieces of calculus can reasonably get engulfed by the healing response. Especially if they are getting subjected to the Clorox. Additionally... it seems likely that there must be at least a few areas that are virtually spotless. These areas should get a strong healing response. Whereas areas with latent calculus will tend to have a slower healing response. What this means is that in a month or so there should be more general closure and integrity then there is right now. Additionally... once the area has had a chance to achieve a reasonable degree of surgical rest that can be traumatized again.

= = =

Friday, January 5, 2007

Waiting for purchases to arrive....

DiMarco furcation curette. Plus Langer 17/18. Both with long access and small blade. Thinned out. Realistic by Monday.

Quetin furcation curette. UAE. Realistic by next Friday.

McCall 13/14s. Plus Gracy 13/14. For a total of five different curettes. ARRIVED.

Instrument cassette case. Signature series. Five instruments. Worth $70 new.

Dental instrument guide book

Two drink mixers.

Microscope. So I can see the plaque. Maybe even ID it.

EDTA. Plus the memory enhancer.

= = =

ESSAY ON TOOTH CLEANING - 01-05-07

Idea is to do a cleaning of the furcations. Additionally cleaning the mesials. Plus a review of the buccals and linguals. With ongoing presumption that eliminating areas of calculus will lead to a diminishment of the disease. Hence... the pocket on the distal side of tooth 15 will be less dirty next time it is cleaned. Additionally... the plaque should tend to cling to the calculus. So... those dozens upon dozens of flecks that I see are actually remnant pieces of calculus. Likely of all most microscopic size. With most of their bulk created by the anti-immune response. That bulk being infected blood. Well removed. As part of the ongoing process of débridement.

Débridement theory. That dead material inside of a wound or injury stops the healing response. That lack of healing activity is largely caused by the dead material. That removal of the dead material will greatly improve healing abilities. Known as débridement. Existing as an ongoing process. For some reason... once an area has been débrided to where it appears clean... in fact it is only cleaner than it was. Part of this is because the material that gets removed previously functioned to cover up the area that is now exposed. Hence, the débridement functions as a protector.

Progressive débridement. Additionally... the living tissue right around the left over dead tissue was previously subject to a much stronger toxic onslaught. Once relieved of this toxic burden the tissue gets an opportunity to become more normal. Though this principle would not seem to relate so well to teeth. Since the gum tissue is opposite rather then contiguous. But from a practical standpoint when you scrape the teeth the gums bleed. Meanwhile the infections seem to want to continue on the surface of the teeth. So... it might be imagined that the conditions of the gum either support or discourage plaque on the teeth.

Calculus focused plaque. But largely... it looks like colonies of plaque largely center their activities around pieces of calculus. Functioning as a beacon or center. Or realistically as a colony of calculus. Could imagine it like a willow tree in a gravity free environment. Resembling a mop with mops. Originally occupying a 180° environment. Expanded through elevation. With either an initial or remnant calculus functioning similarly to a cave system. Impossible to route. With furcation resembling a cave too. But on a cosmically larger scale.

Progressive removal of calculus. Presumption of burnished or shaved off calculus. Whose surface area is only slightly less than the original. Meaning... then it will tend to support almost just as much plaque bacteria as before. Treating so-called floating tether plaque colonies as separate matter. Subject to being fairly easily removed. Also encompassing calculus. Imagining some type of harbor. Or interface between actual calculus and wanted be calculus. Imagining this transitory state to resemble crud. Or as a battle where the plaque won. Then just petered out and got superseded for the nutrients stream. Hence leading to the fossilization of the plaque into calculus.

States of removal of infection. Realistically to consider how things were going for the periodontal disease before the problem was realized. Imagine a world of calculus and plaque living underneath my gum line. With the total volume of débridement roughly representing how much calculus, bacteria, dead and diseased tissue there was. Which physically was a lot of material. As represented by numerous mother loads. Where dislodging material resembles an explosion. Where in fact most of what is liberated was part of the colony. Though I can imagine blood latching on to various pieces of crud. To make the volume appear larger than the reality. Where an underlying object might resemble a large piece of dust. Almost ready to fly. But where blood might expand the size dozens of times. So the object appears substantial.

Hence an early state of affairs regarding overall tissue is whether there are still mother loads. Once mother loads are eliminated then the next state seems to be the existence of large colonies of calculus. With each presumed as a center of destructive activity. With knowledge that they cannot all be eliminated at once. Or even close. That one débridement leads to another. That within a few weeks sites that were previously cleaned start to get dirty again. With calculus presumed as a center of focus for at the least a significant size of plaque.

With assumption that total elimination of first calculus then plaque would theoretically create a very good healing space for the body to have its best chance. Idea that right now the furcations are filthy. That a thorough cleaning would make a significant difference. That two components can be viewed as furcations and tenacious calculus. With a reasonable shot to reach some deep pieces. Imagining using the pendulum method. On a catch. With the catch contact strengthened application of short strokes. Where some will lead to catching flakes of calculus. Or even ledges.

Where the after five mini has great reach. Where presumably the elimination of some of these reservoirs of calculus would seem to have the effect of making the healing response much more powerful than the disease response. With these calculus remnants functioning as disease carriers. Which they are. Though a small amount of calculus can be successfully entombed. Possibly after a good partial removal. The codeword is biologically acceptable.

Regardless... with these pockets having a certain permanence. Representing some of the worst of the destruction. For example a particular pocket might be an area where previously there was bone. Where now there is only open space. With the idea that the area is now a chasm. How do you fill in a chasm? In fact you do not. What you can do though is to create a healthy environment surrounding the area with the most destructive results. But... this area will tend to be convoluted. Functioning as a reasonable place for calculus plaque and bacteria to hide. Additionally, at least when it starts, the area is under high assault.

TRAUMA RECOVERY PLAQUE CYCLE -- Recovering from trauma. Progressive removal of calculus. Area is curetted. Tissue gets traumatized. Takes two weeks to recover. Meanwhile... only a portion of the calculus gets removed. What is left quickly starts producing more plaque. But... in the resting period the tissue does get some relief from the infection. Giving at least a portion of the tissue an opportunity to get shielded from the infection. Giving it an opportunity to heal. Slowly resulting in a closing in. Where the ratio of the healthy amount of tissue relative to the diseased amount of tissue becomes more. So there is more healthy tissue. So there is less diseased tissue. This becomes a new standard of performance. So next time presumably there will be additional healing. With general healing seeming to get reasonably measured over approximately 2 weeks. Additionally, where the cavernous area is slightly less than before.

Colony size theory. Resource determined. To a certain degree the amount of infectious activity is resource determined. Meaning that young resource laden bacteria colonies might be just as active as colonies many times bigger than them. For practical purposes... or by standard 80/20 rule convention... can say that 20% of the colonies produce 80% of the plaque. But... if most of this 20% is eliminated, then performance will improve amongst the colonies that are left. With the presumption that a good center of mass makes for a powerful colony of plaque. But that these colonies will often times be subject to visibility. Especially as I get the opportunity soon. To invent my own furcation instrument. In the meantime will see if the universal hoe has any current existence

Colony size theory. Infrastructure determined. Idea that more calculus infrastructure will lead to higher total activity. But by less than the volume. So... let us say that a 80% reduction in the amount of calculus reduces the amount of plaque by 20%. This would sound harsh. As a practical matter it sounds reasonable too. Since presumably the amount of calculus on my teeth has been greatly reduced. By 90% or more. Could what is left be producing four times the volume it did before? No... but it could probably produce double. So... instead of just half of the plaque activity who is to say? Could 90% of the calculus also mean 90% of the plaque. If the situation is under general vigilance.? Or the plaque colonies will grow to fill up the usable space. Suggesting that the plaque will return to prior levels soon enough. With or without the available calculus. With the calculus largely functioning as a jumping off spot for colonies much larger in scale than the calculus then previously. By perhaps several times in magnitude. That will.

Purchasing an inexpensive microscope kit. For kids. Hoping it will give me an eye view of the plaque bacteria. 750 times magnification. Turns out okay. All most double 400 times. Which is where you can see bacteria. Where 1000 times magnification is a limit for much more expensive equipment. Where 400 times magnification is normal for student purposes. Get idea it might be useful to see what some of these items are.

With plaque and blood products apparently looking similar. Imagining the plaque forming into structures. Or having some other identifying quality. Additionally if I can differentiate species.

= = =

Thursday January 11, 2007 -- 6 weeks later.

From the SRP in late November... Did another cleaning three weeks later. Pre-Christmas. For several hours. Resulting in significant filth. Prior to that I used the toothpick approximately 10 days later. Resulting in significant plaque in the three or four major areas. Then... getting significant amounts of plaque on a daily basis. I estimate the total amount of plaque as borderline massive. Much more than just a small pinch every day. More like enough plaque to drip off the end of the toothpick. Literally a full drop of plaque for each separate area. Which I would judged to be approximately 10 times as much as a pimples worth of plaque. Which I imagine is a more common amount now.

Received the American Eagle curettes the Thursday after Christmas. After five minis. XP technology. Which means ultrathin. Ultra sharp. So... these curettes should last me most of my life. Being a top-of-the-line curette. With amazing special abilities. Perhaps enough to actually débride my teeth. Which is presented as an elusive and impossible goal. That there will always be more calculus. There will always be more plaque.

I did a cleaning session that evening. I was able to reach the curette into spaces that I could not reach before. I was able to liberate significant quantities of previously hidden calculus, plaque and other debris.

Progressive débridement. Got the idea about the clean sweep. That next time I clean the teeth there might be less débridement. Which would mean that there was less nasty stuff in the interim. With the idea of achieving eventual hygiene. That cannot be achieved right away. That only can be achieved by progressive débridement. That next time around the plaque that is now developing will tend to stick to the calculus that was left behind. So the next cleaning session should remove some of that calculus. Ultimately leading to an environment relatively free of calculus. With idea is to find, capture and liberate any redoubts. Possibly now is a good time to check things out with the Explorer.

= = =

Tuesday, January 30, 2007 -- 11:56 a.m.

Did some SRP on my teeth last night. Monday evening. From roughly 10 p.m. until 1 a.m.. Including injecting saline and iodine into my sinus. Which did not result in any apparent mucus. Worked on the distals plus the mesials. With significant dislodgment of debris. Including some of the areas that were presumably still filthy...

-- tooth 14 mesial lingual. Prior daily generation of pasty whitish plaque. Removed what seemed like a significant blob. Which was presumably fueling the pocket.

-- tooth 14 distal lingual. Scraping near the apex. Removed a significant calculus particle. Of half millimeter dimension. Presumably functioning as a locus of infection.

-- tooth 4 distal. Prior bleeding on probing. Identifying an infected area. Dislodged roughly 10 significant calculus particles. Functioning as significant infection.

-- tooth 16 mesial lingual. Discovered significant calculus ledge. Presumably burnished. Made reasonable progress breaking it up. But... it is tenacious and not completed.

<><>. LATER NOTE -- Tooth 16 mesial lingualTurned out to be major infected site. Several tubfuls of blobs dislodged.

-- wisdom teeth interdental. Both sides. Significant latent calculus. Addressed. Area does not seem critical. But obviously is a place where healing seems possible.

Previously did a midnight madness session on Friday night. Lasting from roughly 10 p.m. until 4:30 a.m.. Starting with hygiene. Then focusing on the apexes of the endangered teeth. 14 and 15. Definitely getting at least one significant calculus particle piece from the apex of 15. Hence... have removed significant calculus particles from the apex of both 14 and 15. Additionally it seems reasonable that the infection localized in both of those areas has been significantly reduced. Obviously the furcation on the distals side of tooth 14 is a nearby danger. But I have done my best to try to clear out this area. Also... it is certainly improved over several weeks ago.

Generalized summary.... Professional SRP at the end of November set the general stage. With most recent problems there including the gum boil and the flopped gum between three and four. Plus the utter filth on the mesials of teeth 2 and 3. My immediate follow-up session resulted in significant dislodgment. Essentially turning the SRP into a reasonable general sweep. But with obvious plaque continuation. In large quantities. In the normal plaque factory areas.

Pre-Christmas cleaning with significant as a secondary sweep. Post Christmas cleanings with the deep access curettes started the most recent healing process. That was roughly a month ago. With follow-up sessions releasing additional large quantities of debris. So that I can reasonably say that a state of general cleanliness started to take affect after roughly when I worked over the furcations with De Marcos. Or roughly 3 weeks ago. So... could start the clock then.

Alternately... there were still tenacious areas on January 21. With my most recent three sessions being 3 plus 5 plus 3 hours. Or 11 hours. Dislodging at least 20 or more identifiable objects this last time. Plus another 20 a few days ago. With realistic totals actually being more like 40 plus 40. Or a total of 80 pieces of debris. So... reasonably I might start the clock now. Especially with obvious blobs removed from areas of a persistent infection.

Additionally... with amount of daily plaque factory production seeming to be less. Over around say the last week or two. When obviously daily plaque means an active infection. Where presumably no healing is taking place. Where presumably any progress is not central. But only around the perimeter. Now thinking that this daily plaque factory production might have reached a point of significant reduction. With possibilities that some of the active sources have finally been removed. But regardless... if I got say 80 pieces of debris most recently... then clearly the plan is to go back a few weeks.

If I get another 40 pieces of debris then whatever is active must be coming closer to becoming spent. If not now then perhaps next time around. If not next time around then perhaps the time after that. With obvious issues about the furcations. But with possibilities to get some starting cleanliness there. Which I can supplement. With additional possibilities of closing up around the periphery. So that the most damaged areas are still open. But the entire field of the diseased area is no longer such a waste land. With some previously destroyed areas now becoming benign. Such is the gum boil area. Plus others. Which hopefully can become forgotten.

= = =

Tuesday, January 30, 2007 -- 4:30 p.m.

Post SRP. Woke up at 10 a.m.. Post significant SRP session with teeth. Adding up to close to 10 hours or more since the previous Sunday 1/21/06. Resulting in a reasonable assessment of reaching an objective of cleanliness and hygiene. Assessed as... running cleaner. With early January debris judged as... significant. With thinking that I am moving into a cleanliness phase. Meaning that... my periodontal tissue should start to get an opportunity to shine in the healing light of cleanliness. Once a month has gone by... then... my teeth will have experienced a month of cleanliness. Giving them an opportunity to heal. With expected results being that the periphery will start to move in towards the center. Thereby isolating the more damaged areas. Rather than having almost everything exist in a severely damaged state.

This to include interdental bony areas. Which currently seem to resemble open scaffolding. Where my internal gum anatomy is exposed and vulnerable. Where I imagine flesh starting to fill in some of the missing areas. To the point where these areas get coverage. So even if they are deep they are still functionally healthy.

Benefits of dental hygiene. As described... if all goes well tooth 14 and 15 will become saved by the end of February. In addition the furcation should close up. In addition... presuming the perioscopy... my overall dental hygiene will be quite good. Hopefully also stabilizing the furcations. Thereby setting the stage to actually make progress. Where even a little bit of closure in a clean furcation gets me that much closer to the time when I might become a candidate for regeneration therapy. With an objective to try to get regeneration starting in 2008. And... in the meantime... setting a goal of a fundamentally clean mouth within the next two months. Where there are no active undisturbed bacteria colonies.

= = =

Thursday, February 1, 2007 -- 5:45 p.m..

Did SRP yesterday evening. Original plan was to work the sides of the teeth. With results that the previous gum boil area on tooth 2 now seems largely viable. Additionally the abscess the area on tooth 16 also seems viable. Realized that I have not put much effort into approaching the diseased areas from the lingual side. Where obviously I have tried. But apparently not very hard. Which sounds strange. Considering how many hours I have devoted. But leaves the question of incompleteness. With summary that obviously I have been lacking. Should attempt to cover lingual with more dexterity. With issues of what I missed.

Tooth 14 mesial lingual. Area of interest. Which has been producing plaque on a daily basis. Going in with the after five mini I explored very deep recesses. Where tooth and bone and gum combine in a strange topology. Resembling some type of surreal landscape. With the results that I was able to recover at least one major piece of debris. Plus additional minor pieces of debris. Combining with prior recovery to suggest significant progress in this particular area. Potentially setting up a healing process. Where I imagine any small left over areas getting plastered over and fossilized. Where a significantly large piece might abscess.

Tooth 2 mesial lingual. Previously realize that I was not suitably addressing these furcations from the lingual side. Originally attempting to use the after five mini. But realizing I was up against serious calculus. Thereby switching to the Gracy 11/12. Approaching from lingual. Achieving significant depth and penetration. With it quickly and clearly becoming obvious that this area was completely filthy. Laid over with calculus. Including ledges of calculus along the interior gum line. Apparently making the gum line very sore and tender. From such close proximity to the plaque and calculus.

Did my best to try to catch an edge. Resulting in at least one truly gigantic blob. Presumably calculus. It must've been 3 mm. That I looked at under the magnifying glass. Plus at least two or three other borderline gigantic blobs. Plus at least several major blobs. Reasonably counting at least five or six major pieces of calculus. Plus many more minor pieces. With results that I could see in the tub. Where presumably I could count 20 or more pieces of debris. Or the of a significant débridement session. With the stuff recovered obviously bad. Much better washed down the drain then in my mouth.

Additionally... succinctly recall at least one occurrence where I clearly caught an edge. Then... as I pulled on the calculus... I both heard and felt a distinct snap. Then I saw the gigantic blob. Thinking that this piece of calculus alone was a major trophy. Representative of just how much amazing progress was made in clearing out the filth from this furcation. Reminding me of...

-- tooth 14 mesial lingual. Where the original secondary October blob was a mother lode. Where I am still removing remnants. With hopes of real resolution.

-- tooth 2 gum boil. Meatball surgery in October released multiple mother lodes. Results seem to be a reasonable resolution. Area now looks like it is healing.

-- tooth 15 distal buccal. Don't specifically recall mother lodes. But there was definitely significant missing open anatomy. Area now looks like it is healing.

-- wisdom teeth interdental. Both areas seem like they have good healing potential.

Summary... removal of calculus along the edge of the gum line furcation. But... because of time... and because I either created or uncovered a fistula and had to stop... there is undoubtably still a lot of calculus left. Which will presumably be open to later removal. Then have to finish off the rest of the calculus later. Once the fistula closes. But... with an open fistula it seems like a bad idea to do any more scaling. Additionally... since I saw the dentist I've done three sessions. Over 10 hours of scaling. So my teeth must be running cleaner. Additionally... there seems to be real healing taking place. Over the past two months or so. So quite realistically I can expect additional healing over the next several months. Even if the results leave the furcations open.

If some of the most vulnerable areas can get coverage than it seems reasonable to be able to put the disease into remission. Additionally... if my task becomes maintenance rather than initial débridement... and if there are no more surprises... plus... if there is closure, hence reducing the diseased area... then my area of concern might reasonably shrink. To the point where I can largely ignore the wisdom teeth. And possibly only have to concern myself in tedious form with the furcations. Where the rest of my concerns will largely be in the realm of normal.

Summary of dicey areas...

-- tooth 2/3 interdental. Fistula.

-- tooth 2 mesial furcation. Incurable. Serious. But... reasonably can stabilize. Potential resolution within several years.

-- tooth 3 distal buccal. Open topography. With good SRP possibly open to healing, pocket reduction and closure.

-- tooth 3 mesial furcation. Incurable. Serious. But... reasonably can stabilize. Potential resolution within several years.

-- tooth 4 distal. Open topography. With good SRP possibly open to healing, pocket reduction and closure.

-- tooth 13 distal. Open topography. With good SRP possibly open to healing, pocket reduction and closure.

-- tooth 14 distal lingual. Root apex exposed. Tooth is vulnerable to dying. Hope to save. Through perioscopy.

-- tooth 15 mesial lingual. Root apex exposed. Tooth is vulnerable to dying. Hope to save. Through perioscopy.

-- tooth 14/15 interdental. Open typography. With good SRP possibly open to healing, pocket reduction and closure.

Summary of areas apparently resolved....

-- tooth 2 gum boil plus abscess. Looks hygienic. Nearby mesial open topography seems to be closing somewhat. Area looks like it is healing.

-- tooth 3 abscess. Nearby distal open topography seems to be closing somewhat. Area looks like it is healing.

-- tooth 16 abscess. Looks hygienic. Area looks like it is healing.

Overall look... seems cleaner and more hygienic...

-- total amount of available debris per débridement looks like it is diminishing. Compared to previous observation. Such as when brush picking tooth 15 mesial. When I got something like 50 pieces of debris. Demonstrating area as obviously highly filthy. Overall look seems to be cleaner.

= = =

Monday, February 5, 2007 -- 8:45 p.m..

Tooth 16 mesial lingual -- Tubfuls of multiple mother lodes. Did SRP on tooth 16 mesial lingual last night. Starting at roughly 11:30 p.m.. Finishing roughly 6:30 a.m.. Or seven hours later. Originally working on mesial for two hours. Largely using the Gracy 11/12. Quite surprised by both the volume and size of debris. Originally emptying approximately 2 tub loads into the toilet. Both with at least 40 blobs. Then emptying several additional tub loads into the garbage can. With at least another 40 blobs. So up to a hundred so far. Then forgetting about it. Just dripping from mouth to tub. Looking like hundreds of blobs. For a total of at least 200 to 300 blobs. Or a blob a minute. Emptying out the tub this morning. There were so many blobs it blocked the drain.

Precipitating event. As I was attempting to dislodge the latent calculus that I was aware of I got some greater depth. Thereby reaching a deeper layer of calculus. Imagining an additional ring with at least 2 mm more depth. When I attempted to break this ledge the result was super blobs. Getting the process started. Continuing indefinitely. For hours and hours and hours. With mission and becoming to continue the process towards some type of resolution. Discovering such a completely filthy area. With natural plan then becoming to débride the area as thoroughly as reasonable. Hence converting area from total filth towards relative cleanliness. Though obviously the area will need to be cleaned again. But this precipitating event can get it started on the road towards becoming hygienic. Within a month or so. Hence converting an area from one of destructiveness towards healing.

Large size blobs -- logic defying volume. The blobs were so big they would hang off the curette. Largely they were composed of blood. Even the large blobs would reduce to fairly small stringy tissue. Imagining the stringy tissue having some type of filaments. Or where my gums would pump out blood as some type of protective mechanism against the infection. As example... a cubic centimeter would be composed of cubic 1000 mm³. But some of these blobs were easily three or more millimeters in diameter. Or 30 cubic mm³ each. Which would allow only 30 of these blobs for a cubic centimeter. With the entire surface area of the affected area realistically not much more than 5 mm square. Or 25 mm². So how could so many blobs come out of such as small area?

Realistically there was a lot of blood being released on an ongoing basis. Much of the is undoubtably due to the general disruption and the high degree of infection. So... when a piece of calculus got scraped off the tooth a lot of additional blood would come with it. But appearing as if the blood was part of some preconstruction. But... 100 large blobs would encompass roughly 3000 mm³. This is approximately 14 mm square. Which sounds conservative compared to the blood and blobs. Realistically... the volume only consists of the actual tissue. Which in the hundreds still adds up to significant volume. Averaging say a cubic millimeter? 300 mm³ would be approximately a 6 mm square. Which is still a lot. Suggesting that a significant amount of the volume of my gum between teeth 15 and 16 is now a deficit. Previously filled with infected debris. Now somewhat débrided.

Damaged gum. Mesial lingual corner. The gum is quite severely damaged. The apparent issue was that calculus ledges were going past the corner. Onto the lingual side of the wisdom tooth. Looks like I tore the gum. With some lacerated type injury. Resulting in some missing material. Hoping it can cement itself together reasonably well enough to recover. With expectation that will probably take at least a month. With hopes that it might start to look like it is healing by Friday. But with some possibility that it is much more severely damaged then I imagine. Which might result in the deficit not filling itself out very well. Or slowly healing in some type of awkward configuration. Meaning... that I should try to place the tissue in the closest resemblance possible some type of healing configuration. Using the toothpicks etc.. With some question about whether I should stay completely away. Not even attempting to go around the corner of tooth 15 distal. No matter how tempted I might be.

Summary. Previously I was concerned about the latent calculus in this area. But I had no idea at all how completely filthy the area was. How completely infected it was. So... another mother lode discovered and cleaned. On par with both the gum boil and the abscess. Or the general cleaning of tooth 2 and 3. But with so much volume! This has to be the largest infection of all so far. Hopefully will not find very many more surprises. But each one discovered is one less than there was before. So... have to be very thankful that I discovered this nasty area. With the giveaway being the latent calculus.

Plus the missing bone depth combined with an elevated gum. Suggesting that what looked like gum is really just a balloon full of infected debris.
= = =

Tuesday, February 6, 2007 -- 12:38 p.m..

Three-hour consolidation SRP. Most important progress was following up on the SRP in the 15/16 interdental area. Basically meaning that... the area previously got a gross débridement. But until last night, not tooth 15 distal. In particular... the removal of the tubfuls of debris clearly and undoubtedly is causing a regression of the internal gum line. Meaning that more of tooth 15 distal interdental is becoming exposed.

Tooth 15 distal. Unfortunately could not really SRP 15 distal lingual because of the cut gum area. Or chose not to. Or just did a very light sweep? But might reasonably presume that this area has at least been attended to reasonably well in the past. If not gone over in detail most recently. Hence... the area might be lagging somewhat. But I should not be in any great rush to get to this area again. Until after the gum heals. Which will roughly be around the end of February.

Approach from buccal. It sounds reasonable enough that I tried to SRP as close as I could from the buccal side. With the most important consideration being nonspecific débridement. As in reducing the overall bacterial load in the area. Potentially enabling the healing to take place in a closing in fashion. Additionally... presuming that there might be specific residual calculus... the likelihood is that there is not a lot of it. Additionally... it seems reasonable that what is there can be specifically addressed in several weeks. Additionally there seems to be a reasonable likelihood that the area is already reasonably clean. Say... a 50-50 likelihood. So reasonably I might not be losing very much by staying away for now.

Furcations -- teeth 2 and 3. Recent SRP 1/31/07 was good progress. In particular on the lingual side of tooth 2 furcation. Where significant filth was removed. Reasonable to say that both furcation areas have been greatly stabilized. By removal of a majority of the infection. Setting up possibilities for additional débridement in several weeks. Or... alternately... to set up the possibility for perioscopy to function as the second débridement. Or fine débridement. With obvious mission to not just maintain the furcations. But hopefully to reverse some of the process. 2 millimeters here or there would be a good start. With 100% hygiene as the presumed path.

Fistula #2. Additionally... the so called crack of breaking calculus presumably revealed the fistula. But... the removal of much of that calculus hopefully has set up the start of a healing response. Which hopefully will cause the fistula to close. I am very lucky has not been leaking air after the first day.

Cut gum. Starting the clock Monday at 6 a.m.. Presuming that four complete days will result in some reasonable progress. With basic hope that it will reach the point of no return fairly soon. When healing becomes inevitable. Hopefully. This seems to be the most likely result. But... it looks like there might be a gap. Which is presumably filled in now with lacerated tissue. So... hoping that the lacerated tissue has the potential to remodel itself back into viable tissue. Realistically this seems likely. With a normal first aid response to lacerated tissue being to push the tissue back into place as best you can. Then to presume that the tissue will revitalize itself. Which it typically does. Largely. But even where it does not do so completely, generally what happens is there's a deficit. We are healing takes place around it. But not in the deficit itself.

So... can presume that within four days or so that a significant amount of healing will take place. Enough so that the area becomes better. Certainly not worse. But more so where the area defines itself in to inevitable healing. Obviously... what I hope does not happen is for the area to define itself with a split. Or cleavage. Where there is a deficit in my gum line. Which seems possible most certainly. But not very likely. Think the tissue will come back together reasonably well enough. Hopefully. So that in a week or so it can largely be forgotten. Otherwise the cut gum sounds like it could become a major problem. Or alternately it might sit in an unhealed state. That is not so bad really. Except for taking a long time to finally get better.

Update -- Looking like the area will heal with a definite cleavage. Only question how much. Hoping what is reasonably close together right now will continue to stay close together. But realistically it looks like there is a significant gap. Enough to deserve stitches. Meaning that the deficit will most likely fill in with scar. Not normal gum tissue. Which will then presumably remodel itself. Thereby turning the initial healing into at least two week venture. But hopefully getting past the most tenuous part within several days. So far being roughly 40 hours. Approaching two days. Two days from now is Thursday evening. By then should have a better idea.

But realistically the results should be at least halfway satisfying. Probably no worse than either of the two flopped gums. Mentally I can imagine backing up the healing time. For example I can see the healing process starting right now. Rather than at the time of injury. Similarly two days from now I can look at the healing process starting then. In this fashion realistically things should probably be halfway presentable by Thursday. At least by then it will not be a fresh injury.

Summary. With mother lodes removed and area followed up on... plus with a general sweep... with specific attention paid to furcations... right now is a reasonable transition state between filth and hygiene. Quite likely I will identify additional filthy areas in two weeks or so. But most certainly these filthy areas are more isolated than previously. Per 4/5 rule. Where I can reasonably say that my teeth are 80% cleaner than they were. With only 1 out of every 5 previously filthy areas remaining. Hence... two weeks from now the areas of filth will be much more isolated than they were prior to my last SRP effort.

= = =

Tuesday, February 6, 2007 -- 8 p.m.

Dental Injury list -- fistula. Last week I got the fistula on tooth 2. Fortunately it largely feels like it has closed up. Realistically it is still there though. But possibly in latent form. Meaning that it will close up. Once it gets the opportunity. Which will presumably arrive after additional débridement.

Dental Injury list -- torn gum. Now I am nursing a torn gum on tooth 16. With likelihood of cleavage and permanent damage. Just hoping that it closes up enough that it is not annoying. Hoping that the area that looks like it is sealing together does in fact seal together. Otherwise I am screwed. Alternately the area might seal up with a scab between it. Which would royally suck. But hopefully... at worst... there will be some kind of cross tissue connection. Enough to draw the two sides closer together.

Reasonably I might see some progress by Thursday. Which will be three full days. Hopefully reaching the point of no return. If there is a left over notch I can forget about it. As long as the gum does not turn into some type of long-term split that resists healing. Main object is to avoid allowing the gum turned into a chronic injury.

SRP last night. Previous night was major extravaganza. Complete with tubfuls upon tubfuls of bloody debris. All from 16 mesial. Most amazing. But obviously quite good to deal with that particular area. A periodontal cancer in my midst. Eating up my most valuable bone. Ready to cause additional nasty surprises. Now transformed into a potential area of healing. Hopefully moving forward into a hygienic phase. Possibly functioning as a closure on the filthy phase. With an additional three hours of SRP last night. Including significant filth liberated from 15 distal. Resulting in... a basically hygienic mouth... for the present time. Waiting for recovery from the SRP. Which will take about a week. Or even two weeks. Additionally waiting for the torn gum to heal. Additionally waiting for the camera.

Seeing the doctor on Friday. Conceivably I will get additional camera guided SRP hygiene approximately a week later. Or approximately 10 days to two weeks or so after my SRP.

= = =

Friday, February 9, 2007 -- post visit to periodontist.. Left at 10 a.m.. Got back home at roughly 3 p.m.. Five hours later.

Dr. V. Periodontist took x-rays. Said that I had significant additional bone loss. Unfortunately he has the x-rays. So I can't analyze what he is referring to. But... looking at the x-rays it definitely looked like there was less bone between the first two molars.

How much less bone? What is my recollection? It seems that in early May I still had gum between 14/15. Then... before seeing the periodontist in August recall seeing gum. Then... when I saw him in October it looked like there was a lot less gum. That the gum had retracted.

As he phrased it... every time I did any SRP... It was SURGERY. Averaging at roughly 20 hours per month... trauma was caused. In particular it looks like trauma was caused to the gums. Which cover the bone. Recall being able to detect the gum between 14/15. Which looks to have largely disappeared. In addition to the scalers the inter-proxy brushes can also traumatized the gums.

Explanation -- Too much activity traumatized the gum. Lack of gum traumatized the bone. Bone regresses.

Alternate explanation -- The periodontal disease was so severe that it was going to naturally destroy additional bone. Use it up. of a bone burn rate. Akin to water damage. Where idea is to stop the process as it is taking place. Where certainly judiciousness and carefulness are important. Where a professional can remove a maximum amount of plaque and calculus with the minimum amount of trauma. Where I am just the opposite. Taking a long time to remove the calculus incompletely. Resulting in trauma. While leaving enough calculus behind to cause future problems.

As he phrased it... unless I stop using the scalers... which he called surgical instruments... then I will lose the teeth. What needs to be done now? He said that the areas need to heal. Which more or less sounds like I need to leave them alone for at least a month. It also sounds like I might want to rely more on rinsing than on the water pick type irrigation.

Summary seems to be that the gums are traumatized. Causing the bone to shrink. Periodontist said basically to stay away. Now being February 9. If it takes three months for the plaque to grow back.... Then basically get a free month. To March 9. Thinking being that... if I removed is much calculus and plaque as I think I did then there is certainly less there.

Note... Dr V did not seem to know about the DiMarco curettes. Additionally he did not seem too concerned about getting the furcations clean. Nor did he seem very concerned about the nerves.

Bottom line seems to be that the gums are traumatized. Also that adequate gum seems to be very important.

My basic problem seems to be that I could not SRP the gums reasonably well enough in a limited time frame. Or activity frame. Especially without scraping. My basic assumption being that if it didn't hurt than I was not traumatizing the gums.

Other thought... particularly on tooth 16 mesial... would be if I was breaking away gum tissue from the cementum. Answer would seem to be no. That I was removing an active infection.

Additionally...

Tooth 14 mesial was definitely filthy. Would it be better off if it was still filthy?

Tooth 16 mesial sounds like was definitely filthy. Would it be better off still filthy?

Tooth 2 definitely had a gum boil. Should I have waited so I could beg a periodontist to clean it?

Dr. V prediction. That I should get rid of the curettes. That if I kept using the curettes then that would ruin the teeth. Alternate explanation is that there was something severe going on. That I was losing bone at a high rate of speed anyway. The gum trauma that I caused was certainly a negative factor. But... it sort of looked like some gum bone was growing back!! Where might that be? To

Additional thoughts on Dr. V. Definitely do not trust him. Ready to blame the bone loss on me. And not on the disease. Where presumably the disease might cause a modest amount of additional bone loss. But not much. 1/10 mm per year Additionally he said I don't have any fistulas. When I do! Additionally... when I offered tooth 3 distal buccal as a possible communications site he checked there. Then he checked between teeth 3 and 4!!! Like it would be there. Like where are fistulas normally? But he did not check the lingual side of the inter-proximal area. Like I suggested. Very strange. Why look in the wrong site??

Then... when I said the fistula was there he doubted me. Only when I demonstrated its exact position did he seem to agree that it was there. Then with what? A shrug?

He said I do not have fistulas. That I just had deep pockets. He did not even check 13/14 before making that call. Not until I pointed it out. When I said... how could he expect the fistula to heal if it wasn't cleaned out? Where his prior answer was that it was clean. How does he know it is clean? How does he know it is not completely filthy?

Additionally... it sounds like he tried to scare me by asking me if any of the previous periodontists recommended pulling the teeth. Sounds like... he might be indifferent whether I keep the teeth or not.

Bottom line though was that he said that perioscopy would not be beneficial. Which seems to defy common sense. Fistulas. Two teeth ready to blow. He did not check their depth. Seemed indifferent. Can see that he might say the teeth should heal first. Then perioscopy. But to blow it off? Sounds like a scam. Additionally furcations.

Perioscopy... two teeth ready to blow... two fistulas... multiple furcations. Looks like three areas for perioscopy. And

Bottom line seems to be that I need a periodontist who is on the same wavelength as me. Who is forgiving. His receptionist questioned about me walking past the building. Like... hello? I might sound paranoid... but... it sounds like these folks might have a natural affinity towards replacing teeth.

But... there was definitely less bone. It looked like significantly less. What it sort of seems like is that I might have even pulled out a piece of vulnerable bone.

Should have... sat there and waited for them to make copies of the x-rays.

Realistically... it sounds like the gums are definitely traumatized. That they have been ongoingly traumatized for a period of time. So they could use some rest. That the overall situation should improve over the course of approximately a month. That the benefits of waiting well outweigh any benefits of intervention. That the downsides of intervention are high. Given that the tissue is traumatized.

Of curiosity is how long it took the trash the gum on 29 to recover. Trashed on Wednesday September 6. Nine days later looking gray. 16 days later looking gruesome. 21 days later passing inspection. Unnoticed by periodontist. Now... October, November, December, January, February. Gum now gaining elevation. Five months later. Appearing like it might even fully recover. Within a year or so.

Bottom line seems to be to largely STAY AWAY. Recovery process seems to take about a month. In the meantime it seems like I can do what I can to try to minimize the growth of bacteria. Like irrigation. I can rinse my mouth with antibacterials.

Additionally I can take a certain comfort in the fact that much of the teeth are relatively clean. So... it is a reasonable that they will not significantly degrade over the course of the next month. While in the meantime they will definitely heal from trauma. Especially in the interdental area of 13/14. Where it looks like I should stay away.

CURRENT STRATEGY...

-- recognize that what has happened has happened. There is no undoing it. You have to live with it mistakes and all.

-- stay away. For a month. Give everything time to heal. Reasonably... I am in post-SRP mode. Reasonably... current SRP mode is a reasonable approximation of what I would get from a professional. So... a month will do it good.

-- recognize disturbing aspects of additional bone loss. Including it being my fault. But... also recognize that some of it is likely ongoing. Some of it might be from the proxy brushes. Additionally... you don't have a good idea about exactly how much bone loss you caused.

-- realize that I probably could've gotten an $800 SRP early on. Conceivably this would have stop the disease in its tracks. Additionally I might have avoided more bone loss. Though realistically the furcations on teeth 2 and 3 were already there.

-- find out how much additional bone is missing. From the x-ray it looks like there was mushy bone at an angle in between 14 and 15. Now gone. Presumably this could have functioned as a platform for getting additional vertical depth. Meaning... just how much additional damage did I cause? <><>

-- note that the common opinion is that bone does not grow back. But studies suggest that a person might get 2 mm or so.

-- my strategy of trying to get progressive hygiene to 100% fell on deaf ears. Both first two periodontists thinking this ridiculous. Third periodontist apparently also thinking this ridiculous. ... No point to clean up the furcations. ... No point to clean up the areas around the fistulas. ... No point to clean up the area around the nerves.

-- but realistically... taking a long-term strategy... what seems to make sense right now is to let everything heal for at least a month. So... differences in philosophy are not much of an issue right now. Especially since I got my way. I got my 100% hygiene. With an additional 47 hours of SRP since seeing Dr. G. Presumably costing me bone. But getting rid of a lot of crud too.

-- current strategy would seem to be to discourage bacteria and try to encourage the gums to heal. So in a month or so things will be quite so traumatized. From roughly 20 hours over the past month. Plus 9 hours on the mesial 16. Where realistically a hygienist might spend eight hours. Also resulting in trauma. With the three a four-week cycle of recovery.

-- additionally it looks like my teeth are not producing so much plaque anymore. The apparent cause is that most of the calculus has been removed. Even at the price of traumatizing the gums. Even at the price of causing additional bone loss. Which might make them amenable to general antibacterial strategies.

-- some of that missing bone might reappear. Obviously not much. But maybe some. Find out how much bone you trashed. How much crying you need to do.

GENERAL HOPE...

-- does not look like there is much possibility for recovery between 14/15. Would need to get some serious vertical. Hard to even imagine it becoming stabilized. But... if it could stabilize then maybe I could get 2 or 3 mm of bone back. Or might be amenable to possibilities within a few years. Stabilization is the goal.

-- does not look like there is much possibility for the furcations to close up either. But again stabilization is the goal. And

= = =

Monday, February 12, 2007

List of Dental Problems --

.... Teeth 14 and 15 nerve involvement. Race against time.

.... Additional bone loss. Presumably caused by me. Indeterminate degree. Presumed serious damage. Especially on interdental 14/15.

.... Lack of x-rays. Have no way to document, verify or calculate the damage. To assess my actual blame. Won't know for several weeks. When I can see the x-rays.

.... Trashed gums. Per mesial 16. Presuming the calculus and blobs were part of a serious disease process. Amazingly Dr. C's hygienist just left the calculus there. So I paid $450 for an SRP and was left with a major colony of bacteria. Just sitting there. Showing that my mouth was completely infiltrated with the disease. When normally I should've had some resistance. But instead I got a runaway train. Caused by stress? Or do I have some other disease lurking?

Additionally... the trashed gum is now approximately a week old. Reasonably... within approximately another week it should start to normalize. Additionally it looks like I finished my general SRP around January 31. Where furcation 2 was filthy. Which was obviously a progression. But where I also addressed mesial 14. In particular... relating to the nerve. Where I had other nasty calculus on January 29. Roughly 2 weeks ago. So... presuming an initial healing process of approximately 2 weeks. And a general healing process of approximately 4 weeks. Then... I will be moving into a so-called normalized phase by roughly early March. In the meantime my gums will be suffering from trauma.

Also... is the general idea that the entire process of healing from periodontal disease can be very slow. Where the disease comes back. Re-infecting the gum tissue. Causing a dilemma. The reinfection slows down the healing process. But trying to remove the infection will result in additional trauma. With the infection causing loss of gum tissue. But with the trauma also causing loss of gum tissue.

.... Furcations on 2 and 3. Calculus suggests them pre-existing. Making them inevitable. But if I caused them... obviously that is bad. But realistically... they were there before. The calculus was likely there for at least several months. If not years. Whatever got my disease progressed to the point where my mouth got to be so filthy.

For example... in a week the trashed gum should start to normalize. Additionally the gum should start to normalize too. At some point reasonably soon I will be ready to see the dentist. Get my teeth cleaned. Get my x-rays. Find out what happened to the bone. But in the meantime there is nothing I can do about the bone. Additionally... largely my teeth seemed to be clean.

For example... So... there seems to be a reasonable chance my tooth nerves will hold out.... In the meantime it is a calculated risk. Where I have also been stymied by the dental professionals. Who are not taking me seriously. Who I suspect of foul play. Leading the teeth die... in favor of implants. Now becoming quite convinced that dentistry is largely a dishonest profession. Not at all honorable. Sellout the patient. Collect the money. Society is worse off. The patient is worse off. But the dentist is better off. Except for their souls. Realistically... think the teeth are a reasonably clean enough that the nerves will be able to hold out. Especially since I have spent a good 13 hours after seeing Dr. S most recently. With at least two of those hours devoted towards cleaning out the interdental 14/15.

For example... there is nothing I can reasonably do about many of the tooth issues. But... within several weeks a good amount of healing should start to take place. In addition... per Judith Carroll... I can move into the applicable space that I can create for myself. Meaning that I can get my teeth fixed by getting my work situation in order. By doing the transcripts. By doing the exercise. By sleeping well. By eating well. Etc.. Hence one goal largely gets accomplished by creating space. By taking care of other goals. So time, effort and patience can be devoted towards the applicable category at the proper time. Because other matters are... completed and finished.

= = =

Thursday February 15, 2007 -- General Issues -- BONE LOSS.

As stated... have to figure out just how much bone got lost. With obvious analysis...

-- objective is hygiene -- Ideal is to get the teeth as clean as possible... While causing as little trauma as possible.

-- cost-benefit of trauma -- Causing a lot of trauma while not getting teeth significantly cleaner is a low or negative COST/BENEFIT.

-- some inevitable bone loss -- Some of the bone loss in 14/15 looks inevitable. For some reason the infection there was highly severe. Possibly also including bone infection.

-- breaking away bone? Seem to recall feeling bone in there that then "went away." Conceivably I broke some of it off and it flushed away with the debris. Or I got confused about where I was and tramautized it.

-- contents of big gruesome blobs? -- recall at various times big blobs. Quite large. Quite gruesome looking. Possibly in July? Which would have been pre perio guy. Specifically recall a piece of debris that looked like a Christmas tree. Resembling a crushed feather. As described. Perhaps 2 mm long. Maybe three? But maybe this was bone?

-- bone blocking the way? Breaking away? -- also recall going in there with the sickle. Also the explorer. Feeling what seemed like interdental bone. Blocking the way? With likely explanation that it was interdental bone. Which I then broke off. With the differences between tooth and bone and calculus becoming obscured. Essentially getting too far gone. Where I can't reasonably differentiate between good and bad. Additionally where it becomes very difficult to remove the debris without damaging vital tissue.

-- case of disappearing gum -- pre-brush pics. Also seem to recall seeing what looked like gum between 14/15. Prior to seeing the perio-guy. Then seeing what looked like a black-gruesome mess a month or so later. Post cleaning out the area with the brush picks. Spinning the pick to snag material. Obviously causing it additional trauma.

-- confusion over causes. -- Basic paradox seems to be that I caused a lot more trauma to 14/15 prior to seeing the perio-guy than afterwards.

-- the brush picks did it! -- Looking like spinning the brush picks traumatize the gums. Thereby exposing the bone. Bone then retreated. Causing lost bone.

-- ongoing gum trauma. -- Reasonable explanation seems to be that the gum was getting traumatized on an ongoing basis, without enough time to heal in between. Additionally it was under similtaneous infectious attack. So it got a combo of Infection/Previous Trauma/Ongoing Trauma.

--RESULTS -- Would seem to be that there was not enough gum covering the bone to keep it stable. Minimal Gums => bone shrinkage.

-- seems that furcations must preexisted. Per Furcations on 2 & 3... Would seem they were there before. Unlikely they could have gotten started by me and gotten so large in such a short time. Plus the evidence for them seems to be on the x-rays...

SUMMARY --- Have to wait for several weeks for my gums to heal enough to get cleaned. Like early March.

-- Have to wait to see X-ray results. Similar to some type of testing where you have to wait for the results.

-- Should try to minimize any trauma in the meantime.

-- Once my gums have a chance to regenerate then I will have a more healthy basis to proceed.

= = =

Sunday, February 18, 2007 -- 11:19 a.m.

Per... Thursday, February 15... cleaning the furcations on 2 and 3 seemed to be the last item on my list.

Mesial 16. The calculus on tooth 16 mesial was already known about. Removing it was part of the plan to remove residual tenacious calculus. Which I worked on over the course of January. Finally finishing it off on February 5.

Furcations 2 and 3. Addressing the furcations on 2 and 3 intermittently. Finally getting to major issue of tooth 2 from the lingual side. On January 31. First round. With expectations for a second-round. That I would either do or not do. But regardless... having to wait. Like for two weeks. Which I did. Then finally doing it. Removing significant amounts of debris from the inside. Then significant amounts from the opening. Then approaching from the other side. Becoming aware of the location of the fistula. Which is right in the middle of tooth. Between the roots. Quite scary. Then becoming aware of the exposed apex on the buccal mesial side.

Hollowing out bone? Then also becoming quite amazed and afraid about what seemed like a huge amount of hollow space in the root area. Thinking reasonably that some of that would've obviously been calculus. But how much reasonably. Also wondering if I could realistically hollow out bone. Even though I am trying to do my best to always start off on tooth. Additionally that the calculus presumably can attach itself to bone too. Thereby causing a dilemma. Also realizing that there don't seem to be any reasonable answers that I read about scaling bone. It almost seems like a nonexistent topic. But... the periodontal disease would seem to create a natural connection there. Unless the coexistence of the tooth in the bone is because of some type of sloppy meatball surgery. Slicing things up. Removing pseudo healthy tissue. Thereby creating the interaction. By the process of destroying structure and soft tissue.

SRP hours. With 34 total SRP hours since Christmas. So realistically... for a total of roughly 8 teeth... have to say I covered matters. With a fairly high degree of intensity. There is no other reasonable way to view it. Additionally... I obviously trashed the gums. So the only realistic approach at this time is to stop and rest. In a month or so the gums should recover. Perhaps six weeks.

Irrigation infection control. In the meantime I can try to control the infection with irrigation and floss. Largely trying to avoid the brush. Which should be more reasonable than before. Since realistically there should not be a lot of residual calculus left. Plus... where there is residual calculus... those particular areas should be reasonably isolated. Meaning that perhaps 75% or more of the affected areas are reasonably free of calculus and should get a chance to heal. If the healing process gets an opportunity to take place then the affected diseased areas will tend to reduce themselves. Even if this involves trapping residual calculus. With the expectation that there is a resorption process taking place. Which might ultimately dissolve away the calculus. And

= = =

Friday, February 23, 2007 -- continued.

Teeth. Last night I cleaned out significant amount of bloody plaque. From 16 mesial. Additionally from 2 mesial. I did my previous irrigation, with iodine, just about a week ago. While cleaning the furcations on teeth 2 and 3. Suggesting a more frequent irrigation schedule. Thinking that I do need a 48 hour layover. This seems to be a general physical principle. Additionally... this is a form of insurance. To prevent any likelihood of iodine poisoning. Since 48 hours will give my liver twice as much time to process the poison as 24 hours. Meanwhile... 24 hours doesn't seem like a likely timeframe for the bacteria to get started. Right now thinking... 72 hours. Enough time for the bacteria to not get started too much. Enough time for my gum tissues to rest. Enough time to offer a respite. So... every three days seems to make sense for irrigation. Or rather for using the brush pics. With alternating of irrigation fluids. Iodine. Fluoride. The prescription stuff. Etc.

= = =

Wednesday, March 7, 2007 -- 10:30 a.m..

3-D x-rays. Went to see Dr. L on on Monday. To get 3-D x-rays. Bit of a contest.... I said I wanted both 2-D and 3-D. With the 2-D for a normal representation. Plus the 3-D for more detail. For consultative purposes. He originally suggested he could send to me a representative sample of x-rays via e-mail. I said I wanted all the x-rays on a disk. 500 slices. Using the Romexis software. Per advice from tech. On a DVD. Or the CD might be better. Doctor said that they are not familiar with this procedure. Said I would pay extra. Said I really want that.

Doctor also suggested that they just give me 2-D x-rays. If all the periodontal hygienist needed was those. But I said that I wanted comprehensive results. Additionally that I wanted a baseline. Doctor agreed. Finally. 2-D plus 3-D on Romexis. With viewer. So all I have to do is copy the CD. Or alternately I can add to the CD. So apparently I get what I want. Instead of getting gambited into getting what I do not want. Since I might've walked out with just a regular set of 2-D x-rays. Or representative 3-D x-rays. When I want the full thing.

Additionally... the doctor did not agree with the iodine. Asking me if a periodontist said it was okay. Skeptical about the book Web.

Issue of bone loss. Reminded of an old cartoon. We won the mug. But we lost the old machine. Where I have removed significant amounts of calculus. Presumably I could not scrape out bone. It would hurt. But I certainly could traumatize gums. Which would then either regress. Or leave the bone exposed. Which would then retreat. Alternately thinking that some of what might have appeared as bone was really calculus. Saying... where's the periodontal membrane. In this scenario the bone was gone. Replaced by calculus. With this scenario resembling Alien. Or Invasion of the Body Snatchers. Where some serious disease process took hold. With hidden dimensions. That I diligently uncovered. That there certainly was substantial bone loss. But some was inevitable. Some was really calculus. Some was caused by me.

Realistically though... I traumatized the gums. That caused the bone to regress. I lost significant bone. Measurable in millimeters. Likely unrecoverable. Likely a one-way process. Where a proper SRP right away... for $800... what have removed the basic problem a year ago. Leaving me with much more bone then I have.

Though this scenario is not without problems. Presumably the furcations were there. Realistically the $800 SRP would have set me up for a second $800 SRP. Where the second one would have gotten things reasonable.

= = =

Saturday, March 10, 2007 -- 1:30 p.m. -- IDEAS

Introducing disinfectant. One idea is to get the brush pick in the chlorhexidine. Or in straight iodine.

= = =

Friday, April 13, 2007 -- 2:51 p.m. -- post tooth cleaning. hygienist SRP. West Lawrence Avenue. Post two month gum recovery phase.

Basic closure for now -- post prophylaxis. Per generalized theory. That clean means cleaner. That rudimentary clean was achieved 1 to 2 months ago. Followed up by two month gum healing phase. Leading to secondary cleanup. Or follow-up cleanup. Or generalized sweep. With recovered gums. Starting a new phase.

Starting a new phase. With gums basically recovered. With teeth basically clean. Leading to the start of... a healing phase. But... I am still in a phase largely characterized as... Acutely Wounded.... So obviously there are many more interim phases still left. Such as healing from healing. Which can be otherwise termed as remodeling. Hopefully bordering on regeneration. But realistically that phase has not started yet. It can only start once the acutely wounded stage has somewhat completed its transition. Which only can be viewed as having taken place once two months have gone by in a state of post general healing and cleanliness. Starting the next phase in roughly June or July. By which time I should have recovered from most recent trauma. With what is left getting its chance to regroup and become more present. For the next stroke of the knife.

Culminating event. I continued to do home SRP up until Tuesday 3/20/07. On DL 3. With capture of 10 flecks/blobs. With prior BOP from Tuesday 3/6/07. Or roughly 5 weeks prior. Viewing this area as the last major stronghold of recalcitrant calculus redoubts.

Prior last major SRP battle. Basic view is that M-16 was completely filthy. As was obvious. With home SRP on Sunday 2/4/07. Viewing this as the last major battle. Reviewing the time since then as Post War. Viewing February and March largely as recovery periods. With major SRP operations the last week of January. Largely seeming to function as general sweeps. For latent isolated areas of calculus. With only a few obvious strongholds. But where afterwords I could reasonably assess my teeth as basically clean. But... with traumatized gums.

Gum healing phase. Idea is for gums to get a chance to return to a reasonable semblance of normal. Mostly in a non-diseased environment. Essentially returning to a state of reasonable health. With ongoing possibilities for regeneration. In an environment that is basically healthy. Obviously starting with the gum tissue itself. Covering wounded areas that are acutely open and exposed. Leading to more subtle regeneration. Hopefully including ligament and bone. In a phased operation. Reasonably started post ...

= = =

= = =

DIARY - 2012

sa-09-22-12 - Tooth #3 - upper-right second-molar lingual - Issue is the area is about to abscess. Gums are separated from the tooth. Plus it hurts.

w-10-11-12 - Tooth #5-6 gap - Deep pocket. Breaking in between the gums and up into the maxillary jawbone. Most likely problem is centered on furcation on top of bicuspid. Gum covering is pulled away from the tooth. Resulting in Ski-Jump Issues. Where it is easy to get confused about where the tooth ends and the bone begins. BUT the bone needs to be debrided too. Just a different type of debridement. Shouldn't scrape it too hard. Also be careful that things that appear to maybe be calculus aren't really calculus but are really gum tissue. Need to focus on staying on the tooth.

WHERE IS ABSCESS - Presumed location is on the front-inside - mesial lingual - of the molar and its corresponding portion on the bicuspid.

PLAN - OUT-FLANKING STRATEGY - So plan is to come in from a distance from both directions. First from the back to front. Then crossing the tooth to the bicuspid. Which is technically easier. Than from the from. Which is technically very very difficult and treacherous. So want the least amount there as possible.

CAUSE - The area was never properly debrided. So now the chickens are home and roosting. Previously it was like a vault. Couldn't get the curette to fit in there. Isolating the calculus. For many years. Now the calculus is pushing its cause inward. Into my upper pallate.

SOLUTION - OUT-FLANKING STRATEGY - Going to come in from the back to the front. Simple mission. Going to use straight curettes. Whatever will work. No harm to use variety. Then after awhile the area will start to release. Once it starts to become traumatized it will completely release and will literally be able to clean the teeth down to the bone.

SIDE ISSUE - DIFFERENCE BETWEEN BONE AND CALCULUS - This has always been a concern. Ripping out bone. Think what happens is the gum tissue ends up residing directly over the calculus. That is why it is fuzzy. In essence the calculus mimics the functions of the bone and the gum tissue then just covers it up. That is why the gums retreat after debridement.

THE BONE THAT WASN'T THERE - Again working this concept. How can you tell? My strategy has always been to come in from the sides. Even though I know full-well that what I am dealing with is calculus. Then the blood and the lack of pain prove it is crud and not bone. Also if can get under it then it has to be calculus. Bone does not live in the middle of the air. It has to have a base. Otherwise it is dead bone. What about Zombie Bone? Please! Forget about Zombie Bone. It's a myth!! It doesn't exist!! OK? And even if it did exist the tooth is in trouble and will just have to forget about any magical transformations involving zombie bone and just cut back to healthy tissue. And anything that is dead has to go.

WHAT DO I EXPECT TO HAPPEN - I will start to come in from the back and nothing will happen for around 20 minutes or so. Then will gradually start to get more and more crud. Then more and more. Then eventually the entire area will open up and will eventually reach the absdess. Then all hell will break loose.

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SUMMARY - EXTENSIVE INTERCONNECTING ABSCESS RUNNING FROM FIRST MOLAR TO SECOND INCISOR - Also including previous infection and ongoing trouble-spot on second molar, which is now largely appears to be in remission for now. Tooth #4 was previously extracted for braces. So, Tooth #3 Molar, Tooth #5 Bicuspid, Tooth #6 Eye-Tooth & Tooth #7 Incisor are all in big trouble. Four teeth.

GENERAL STRATEGY FOR ABSCESSES & SERIOUS STINKY STINKY INFECTIONS

1 - FINISH WHAT YOU STARTED - Only cause as much destruction as necessary in a limited field of action. Avoid mission creep. Focus on due-diligence. But also be opportunistic too. Especially when the Gums-Open-Up and Things-Get-Bloody. Don't try to be all things to all teeth or even to different parts of the same tooth. Better to focus on a highly limited mission and let time do your bidding..

2 - STRATEGIZE AROUND HEALING CYCLES - For large areas separate the fields of action into separate attacks spaced between healing cycles of roughly a week. That way a resulting four-major-attack attack can be squeezed into a reasonably narrow time period of say two months. In addition if the problem is abscesses and access you may not be able to get to the abscess right away without clearing the Clearing-the-Forest to gain access to the Gates-of-the-Abscess.

3 - WORK FROM PERIPHERY TO CENTER - THIS IS THE KEY KEY CONCEPT TO FOLLOW - LIVE IT BREATHE IT DO IT - THE CORE OF THE PROBLEM IS TO HARD TO DEAL WITH DIRECTLY - BUT KILL ITS GUARDS AND IT BECOMES HELPLESS TO STOP THE FINAL ATTACK - IN FACT IT MIGHT EVEN GIVE ITSELF UP VOLUNTARILY.

4 - ALWAYS WORK FROM THE EDGE OF A KNOWN PART OF A TOOTH - IDEALLY FROM A SMOOTH PART OF A KNOWN PART OF A TOOTH - Nothing can be more important than this. I cannot tell you how many times I have been scraping bone and come across something lodged in the gums and thought - EUREKA THIS IS IT !! - WRONG! WRONG! WRONG! - DUDE THAT IS BONE YOU ARE ABOUT TO RIP OUT - GET IT? BONE!

5 - ANY ISLANDS ON TOP OF TOOTH SURROUNDED BY GLASSY TOOTH SURFACE PLUS EXHIBITING A CLEAR EDGE AND FASTENING ONTO KNOWN TOOTH ARE BAD - (So you have live bone growing on top of your tooth? - ( NO - you do not have living or otherwise viable bone growing right on top of your tooth. Sorry it's just not possible)
So this likely piece of calculus or former cementum has the potential to get a second life? NO TYPICALLY THEY FEEL FURRY - ONCE YOU UNDERSTAND THEY ARE ISLANDS AND THAT THEY CANNOT POSSIBLY BE BONE NOR GUM YOU ARE ENTITLED TO DEVISE A STRATEGY TO RIP THEM OUT. HOW? NOT DIRECTLY - SMOOTH THE TOOTH ALL AROUND THE CHOSEN AREA - ENCIRCLE IT - THEN LIFT UP ITS EDGE LIKE YOU ARE PEELING A LABEL OFF OF A CAN. IF YOU ARE SLOW AND METHODICAL YOU CAN RIP IT OFF IN PIECES - NEVER NEVER IN LAYERS -- BAD BAD -- ALWAYS TRY TO REMOVE CALCULUS & DETRITUS IN PIECES. THE LARGER THE BETTER

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