Monthly Archives: December 2008

Stages of Periodontal Disease – Pictures and X-rays


Pictures and x-rays of periodontal disease and bone loss –

Stages of Periodontal Disease:

Early periodontal disease may be characterized by swelling and redness of the gums and early horizontal bone loss, but is usually not associated with loss of gum tissues, or gum recession.

gary retracted

Early horizontal bone loss around the teeth can be seen on the x-rays below.  Typical gum pocket depths would be 4-5mm.  Bleeding when measuring (probing) may be present.

x-ray 8.9

x-ray demonstrating early periodontal stage periodontal bone loss

Moderate Periodontal Disease: below

7D 6mm

6mm gum pocket on tooth #7

9D probing

5mm gum pocket tooth #9

The moderate stages of periodontitis are typically characterized by moderate loss of bone (see x-ray below) around the teeth – either vertical or horizontal.  Pockets can measure between 5-7mm, and there may also be associated tissue loss, or gum recession.

x-ray of moderate periodontitis for this patient below:

x-ray #9

note the loss of bone between the two front teeth (#9 and #10)

Advanced Periodontal Disease is characterized by more advanced bone loss around the teeth.  There is 50% bone loss or more.  Pockets typically measure 7-9mm or more, and there may or may not be tissue loss (recession of the gums) and mobility.

8mm gum pocket picture below:

25m 8mm

this is advanced periodontitis with severe inflammation and mobility – this patient is diabetic -note the profound difference in the tissue appearance from one half to the other.  This patient had already undergone Restorative Periodontal Endoscopy on half his mouth one week prior to taking this picture, the pink healthy tissue on one half is evident in this photo.

x-ray for this patient below:

8mm 25M x-ray

x-ray of advanced bone loss

There are many advanced case studies with pictures and x-rays throughout this web site to view.  We offer a procedure called Regenerative Periodontal Endoscopy (RPE℠) – a non-invasive and definitive affordable first phase treatment approach for all stages of periodontal disease.

All  stages of periodontitis – even the advanced stage – may not always be associated with pain, bleeding, or other obvious symptoms and signs.   See more pics. There may be no symptoms at all.  This is why a thorough examination and x-rays by a periodontist (gum disease specialist) or dentist is highly recommended.


The Cost of Periodontal Disease (Gum Disease) Treatments

The Cost of Periodontal Disease Treatments:

This post will help clarify and define the costs involved in available periodontal treatment options, including Regenerative Periodontal Endoscopy℠ (RPE℠), Perioscopy, Osseous Periodontal Surgery, Extractions, Implants, traditional laser periodontal therapy, LANAP, and root planing combined with Arestin (antibiotics). Fees may vary depending on location and independent provider.

Below is an example of a treatment plan to replace one front tooth with an implant after the extraction of one tooth.   This is a good example of just how important it is to save natural teeth, rather than undergoing extractions.

  • Simple Extraction                             $150
  • Tomographic series                          $262
  • Implant Placement                          $1900
  • Provisional temp. crown                   $250
  • Abutment placement                        $500
  • Porcelain Crown                               $1000

Total Fees for one implant =         $4062  (this fee does not include bone grafting or sinus lift)

These fees are fairly typical of what many individuals face to replace one tooth.

In contrast, the cost to save one to eight teeth in a quadrant with Regenerative Periodontal Endoscopy is only $750 – $1000, depending on the severity of bone loss and the number of teeth treated.   View an actual case comparing cost of treating one tooth with Regenerative Periodontal Endoscopy℠ (RPE℠) instead.

How much do full mouth extractions followed by implants cost? Many of our clients were facing full mouth extractions and were given a $30K – 80K treatment plan by their dentist and periodontist.  This option is certainly definitive and comprehensive, but may not be a good option for everyone.  The devastating implications of full mouth extractions can have an enormous negative impact on a person’s life and self esteem.  While the cost alone is staggering, the enormous time involved with the many follow up appointments, as well as the predictable discomfort, make this a very difficult decision if other viable, less invasive options may be available.  Below is one such example.

Before Regenerative Periodontal Endoscopy℠ (RPE℠):  5-15mm pockets (advanced periodontal disease)

After RPE℠ – health restored – gen 2-4mm, no extractions or implants necessary.  Read this patients testimonial.

What are the fees for Osseous Periodontal Surgery with or without extractions?

We have treated clients from all over the world faced with 4 quadrants (full mouth) of osseous periodontal surgery.  Fees for this procedure vary depending on how many extractions one needs, as well as bone grafts or regenerative materials are used during the surgery.  Osseous surgery fees can range from $900 – $2200 per quadrant (there are 4 quadrants in the mouth), depending on the number of teeth treated.  This may or may not involve extractions.

If teeth need to be extracted there are additional fees for replacing lost teeth, either with implants, a bridge, or partial dentures.   Fees can add up quickly, easily taking the total for one quadrant (section) to over $5000.

The patient below was facing full mouth osseous surgery:

Before RPE℠ – generized 5-9mm pockets

6 weeks after RPE℠ – health restored – pockets reattached (closed) –  no need for osseous surgery

This patient was facing a $12,000 surgical treatment plan.  By having RPE℠ instead her fees were less than a third of that total.

How much is root planing or “deep cleanings” with local delivery antibiotics such as Arestin?

This non-definitive traditional approach leaves much to be desired in results with advanced cases.   Osseous or flap surgery usually follows this non-definitive approach due to the inability of the clinician to see and remove all the disease causing deposits and plaque on the roots in deep pockets.   Learn the objective truth about the limitations of root planing. Fees for traditional root planing can range from $230 per quadrant to $375 per quadrant (there are usually 4 quadrants). Add to this the fees for Arestin (an antibiotic) placed under the gums during this non-definitive treatment.  Arestin is charged out at $35-$110 per site (one tooth may have several sites), if a patient has multiple deep pockets in one quadrant the fees can add up quickly.  The research is unremarkable, demonstrating a reduction in pocket depths of less than 1mm.   Due to the ineffectiveness of this approach it may be repeated every few months, annually, or every three years.

What is the cost of multiple rounds of traditional laser periodontal therapy?

Typical fees for traditional non-definitive laser periodontal therapy range from $250 – $400 per session (there are usually 6-8 sessions in all). There is very little research demonstrating clinical benefit for this more traditional treatment approach – tartar typically remains in deep periodontal pockets as the literature demonstrates.  Laser periodontal therapy is performed blindly under the gums in an attempt to arrest the disease by “killing bacteria”.  Since tartar in deep pockets and decay may go undetected for months or years,  any benefit of killing bacteria with the laser may be short term.    

What are the fees for LANAP?

After reviewing fees for many offices providing lanap around the country we have determined fees to have a wide range, depending on the severity and the individual clinician offering lanap.  Fees for full mouth lanap treatment range between $4000 to $15,000. The consultation for treatment may cost up to $450.  Lanap is not intended for the treatment of single teeth according to the trained clinicians providing it, therefore only full mouth treatment is performed.

What are the fees for Perioscopy?

Fees for Perioscopy (just cleaning of the roots) has generally not changed much over the past decade.  Fees can vary somewhat if the office providing perioscopy charges by “time” rather than by quadrant.   In our experience a quadrant fee can be anywhere from $350 to $900.   If antibiotics are used adjunctively, such as Arestin or Atridox, additional fees would apply, as well as examination fees; and for many offices traditional root planing fees are charged prior to the actual perioscopy treatment.

What are the fees for Regenerative Periodontal Endoscopy℠ – RPE℠?

Regenerative Periodontal Endoscopy℠ – RPE℠ can prevent steep costs by eliminating or reducing the need for extractions, traditional flap surgery, osseous surgery,  repetitive treatment with perioscopy, traditional root planing, or laser periodontal surgery.

Fees for RPE℠ can range from $750 per quadrant to $1000 per quadrant (there are 4 quadrants if all teeth are present).  Full mouth RPE℠ treatment can range from $3000 to $4000, depending on the severity of disease and the number of teeth treated.  There are no fees for the examination or digital records.  RPE℠ is performed in one appointment and local anesthetic is used for comfort.  One tooth can be treated with this modality (rather than requiring full mouth treatment as with LANAP), fees for one tooth can be $750-$900, depending on the severity.  No traditional root planing is recommended before RPE℠.

Watch a short video to see how this pioneering treatment works.

We offer complimentary periodontal consultations .  Contact us for more information.

Alzheimer’s and Periodontal Disease – Update on link

Gum Disease Now Linked to Dementia: 

All countries are experiencing an increase in the number of people over the age of 65 with Alzheimer’s.  Alzheimer’s disease is the leading cause of dementia in the US population. Current studies demonstrate a definitive link between the presence of periodontal pathogens and the inflammatory burden and oxidative stress observed in the brain’s of individuals with Alzheimer’s.

A study of dementia led by University of South California researchers revealed that missing teeth and chronic inflammation of the mouth at an early age quadruples the risk of developing Alzheimer’s disease. The study, which was presented at the first Alzheimer’s Association International Conference on Prevention of Dementia, looked at the records of over a hundred pairs of identical twins.  Each pair consisted of one twin who had developed dementia, and one who had not. Acting on the principle that identical twins share the same genetic blueprint, the study looked into external factors that could have led to the mental demise of the demented twin.

Dementia is an umbrella term that includes Alzheimer’s disease, and once correctly diagnosed in the twins examined, researchers looked into several potentially modifiable risk factors that could have brought it on.  Among these were: periodontal disease before age 35, the experience of a stroke before the onset of dementia, physical exercise between ages 25-50 and years of education.

Titled Potentially Modifiable Risk Factors From Dementia: Evidence from Identical Twins, the study found that a stroke could increase the risk of dementia six-fold in later years, while periodontal disease in early years quadruples that risk.

Effective periodontal treatment is now considered a modifiable risk factor for Alzheimer’s – new information about periodontal pathogens and Alzheimer’s:

Rev Assoc Med Bras. 2014 Mar-Apr;60(2):173-80.
Alzheimer’s disease and periodontitis–an elusive link.
Gurav AN.
Author information
Alzheimer’s disease is the preeminent cause and commonest form of dementia. It is clinically characterized by a progressive descent in the cognitive function, which commences with deterioration in memory. The exact etiology and pathophysiologic mechanism of Alzheimer’s disease is still not fully understood. However it is hypothesized that, neuroinflammation plays a critical role in the pathogenesis of Alzheimer’s disease. Alzheimer’s disease is marked by salient inflammatory features, characterized by microglial activation and escalation in the levels of pro-inflammatory cytokines in the affected regions. Studies have suggested a probable role of systemic infection conducing to inflammatory status of the central nervous system. Periodontitis is common oral infection affiliated with gram negative, anaerobic bacteria, capable of orchestrating localized and systemic infections in the subject. Periodontitis is known to elicit a “low grade systemic inflammation” by release of pro-inflammatory cytokines into systemic circulation. This review elucidates the possible role of periodontitis in exacerbating Alzheimer’s disease. Periodontitis may bear the potential to affect the onset and progression of Alzheimer’s disease. Periodontitis shares the two important features of Alzheimer’s disease namely oxidative damage and inflammation, which are exhibited in the brain pathology of Alzheimer’s disease. Periodontitis can be treated and hence it is a modifiable risk factor for Alzheimer’s disease. – Serum Antibodies to Periodontal Pathogens are a Risk Factor for Alzheimer’s Disease

this is an excellent study from the above link, read a poignant clip of it below:

In the current study, both the AD and MCI subjects demonstrated significant elevations in antibody to P. intermedia and F. nucleatum at baseline, prior to diagnosis of the neurological changes. Additionally, the AD subjects expressed significantly elevated antibody to T. denticola, and P. gingivalis at baseline. These sera were obtained years prior to the clinical diagnosis of AD or MCI, while subjects were still cognitively normal. Therefore these elevations cannot be attributed to secondary effects of the AD disease process, such as poor nutrition or other dementia-related neglect. While it could be suggested that the antibody to these oral pathogens may have been cross-reactive with antigens from other sources, the literature is replete with studies supporting the specificity of these antibodies for oral infections [20–21, 43–46], and that successful treatment and maintenance of periodontitis significantly lowers these antibody levels [47]. Comparison of these antibody levels to those described in numerous populations show levels in the AD and MCI subjects in the current study to be similar to chronic periodontitis patients [45–49]. Interestingly, the control group also showed antibody levels higher than healthy values for four of the seven bacteria (A. actinomycetemcomitans, C. rectus, T. forsythia and P gingivalis) with three of the four at levels consistent with chronic periodontal disease. This may be because the study population was older, with a mean age at baseline of 70–74 years of age and periodontal disease occurs more frequently in elder adults. Regardless, the levels of antibodies in the control group were significantly less than the levels of those who converted to AD at baseline for five of the seven bacteria studied.

Learn more about our advanced gum disease treatment to end chronic periodontal inflammation

For more information about Alzheimer’s:

Other health risks associated with periodontal disease

Definitive treatment for periodontal disease involves a multi-faceted approach to control chronic inflammation.  Putting periodontal disease into remission and ending the chronic inflammation associated with it is not achieved by merely removing tartar, the repetitive use of antibiotics (either locally or systemically), or cutting out pockets with a laser or traditional periodontal surgery.  Chronic hyper-inflammation is a host response problem and may require the addition of safe and effective anti-inflammatory medications.  Definitive treatment should also include Oral DNA salivary pathogen testing not only to target more effective treatment strategies but also to definitively determine if the therapy has been effective in eliminating periodontal pathogens.