Hygienist given me a heart attack this morning …

[EvangelicalAboutButteredToast]

I go every four months. Last time I went my score were all zero and a few ones. Today he tells me they are three in some places and he is talking about bone loss and I assume periodontal disease. Can that really happen in four months?

I have been eating a lot of crap over the last few months and not sticking to my usually very scrupulous routine. So we accepted that I’d had a torrid old time with stress and a lack of self care which could explain the inflammation. Obviously I’m going to cut out the crap and go back to my careful routine. The other stuff just freaked me out though.

I have had an X-ray done recently at another dentist and they looked at it and said everything looked fine. I have asked that the x-ray is sent across but I’m left wondering if I need to book to see a periodontist.

anyone had similar?

How do you know you have no scale? Hard tar tar builds up behind teeth. Happenes to everyone. Top and bottom teeth. You can’t see inbetween and behind every tooth yourself. It needs scraping off regularly otherwise it really damages gums.

To be honest I’ve become resigned to the Hygenist delivering a message of doom no what I eat so I’ve just resumed my usual eating habits. I don’t drink any fizzy drinks or eat a lot of sugar generally but I’ve refused to give up the odd chocolate or piece of cake. When I did give all that up, she was still admonishing me and telling me how awful my gums are so I just thought fuck it. And all the while the dentist is telling me everything looks fine?!

I access BUPA private dental care through work (no NHS spaces for miles) and the cost of each visit is eye watering. It’s mostly covered by the healthcare plan but because she has said I need to see her so frequently I’ve almost used up my allocation and have to pay an excess soon.

It’s all starting to feel like a scam tbh.

I pay £110 each visit, so £440 a year to feel absolutely terrible about myself 🤦🏻‍♀️

Your (apparent) poor health is their profit, of course they are going to tell you it’s bad! Change hygienist for second opinion, carry on what you are doing, take photos yourself if you can to track changes.
Most importantly have you noticed any difference? If they feel healthy, no pain, no blood when spitting, I would guess you are absolutely fine. You can over brush and damage your gums though so don’t go too hard on them

Funnily enough he said that too. I was over rushing and also under brushing. Bonkers lol. I came out with my head spinning.

Nothing to do with lockdown, more to do with surgery profits.
Also be aware of the upselling of tooth whitening etc.

Every single time I’ve been for the last twenty odd years they tell me I ‘have the start of gum disease’ and give me loads of warnings. My teeth are fine. Nothings ever progressed. They’re just trying to keep themselves in a job half the time

Well I saw my dentist in August and no issues. Haven’t had a filling since I was 7. I look behind my teeth . I mainly drink green tea and barely eat sugar so no staining .I floss( tape) twice a day.

I've had just the same issues and am very cynical about hygienists. I've found one who tried to imitate a dental check up when she examined my mouth, yes had all the drama, gum disease imminent etc, now at new practice ( I got fed up of funding the previous dentists costs of buying the practice). New hygienist nice but trying to flog botox.

Stay cynical everyone, i believe the USA is similar where not private treatment is available.

Sorry cannot edit my response, it should have read " usa similar where only private treatment is available "

Dental hygienists if also trained as dental therapists can carry out check ups. All dental professionals are expected to do a full check of the mouth including teeth, gums and soft tissues, including an oral cancer screening at each visit. Especially if the patient is new to them. A dental hygienist/therapist can be sued if they do not carry out the appropriate checks and make the patient aware of what they find. Dental hygienists and therapists can work under direct access now so there is no need for the patient to see a dentist first. Do you think it would be acceptable for the hygienist to just go straight to cleaning the teeth and let the patient leave without looking for any other issues? Can you imagine if someone who had been seeing a hygienist for a few years went somewhere else and was told they need 6 fillings, have rampant gum disease plus a suspicious lesion that later turns out to be cancer? Would you think oh well it’s not the hygienists fault. They’re just a hygienist so I wouldn’t expect them to be “imitating a full check up”. I can guarantee that the hygienist would be sued and likely struck off.

Undiagnosed periodontal disease/periodontal neglect is a huge part of why dentists get sued. The days when people accepted that their teeth would just “fall out” when they got older are gone. As it should be. Teeth don’t fall out due to decay. With decay they break down and crumble and could cause abscesses etc. Teeth get loose and fall out due to gum disease. Honestly if you don’t mind that happening just tell your dental hygienist/dentist that you understand what they are telling you, but you don’t wish to have any treatment and you are aware of any possible consequences. They may ask you to sign a disclaimer that you refused the treatment. And it will be written in your notes that you declined the treatment. But after that you are free to do whatever you wish. Have treatment or don’t. See hygienist or don’t. Brush your teeth or don’t. As long as you allow the dentist/hygienist to do their job of explaining what they have seen, you are free to decline anything you want. If you truly believe you don’t have gum disease and the dentist is lying the same applies. If you tried to sue them, the notes and X-rays will be looked into. If the dentist is lying then they’ll be investigated by the GDC. If they weren’t, then they at least won’t lose their job and the patient won’t be successful in a claim. So just decline whatever you don’t want. It really isn’t a big deal to most dentists. They’re not their teeth after all.

I’ve attached the full scope of practice that both hygienists and therapists can do. Just to show they are not just there to “clean teeth”.

If that was aimed at me you needn’t worry I completely believe them. I am sufficiently scared and will be booking to see a periodontist.

Sorry no it wasn’t aimed at you!

To put your mind a bit at ease though, what someone else said earlier could well be true. If you’ve recently slacked with your oral hygiene routine it could be that the 3s are from slight inflammation. A BPE of 3 can happen without significant (or any) bone loss. Slight inflammation from not great brushing can cause it to happen and it can resolve with good brushing again. A grade 4 is much more of a worry.

It was the speed of going from a score of zero four months before to him talking about moderate gum disease this time round. It completely spun my head 360 but I’m hoping you’re right. My mouth has always hated a sugar rich/refined diet and I was certainly eating crap due to other stuff that was happening in my life. Hopefully I’ve caught it quick and my gums will recover.

It's a shame you take such a distrustful view of the professionals trying to help you. This is part of the reason it's such a thankless job these days. If they have told you that, it is presumably on the basis of your clinical presentation- are they supposed to lie? Bearing in mind they could be sued for negligence if they don't inform you in full honesty.

She's been warned that she is facing the start of gum disease for 2 decades and yet nothing has progressed. Can you blame her for questioning this diagnosis?

Gum disease doesn’t always progress. It can be stabilised. It also can’t be “cured” (periodontitis that is. Gingivitis can). For example. I’m a hygienist. But due to life stresses and mental health issues I used to smoke and didn’t used to look after myself. Teeth included. I have bone loss. It’s classed as early bone loss. I no longer smoke and I look after my teeth. It hasn’t progressed in years. But it’s very much still a risk it could should I lapse again. The bone loss will never come back. But hopefully I have stabilised it enough to keep it as it is forever. Can that be guaranteed? Nope. So do I have active gum disease currently? No. Do I have early bone loss caused by previous periodontal disease? Yes. Could it come back if I don’t look after them again or start smoking or get health issues that can exacerbate it? Absolutely.

Someone repeatedly just saying “you have early gum disease” isn’t particularly helpful I admit if it’s the same person saying it. But if they have gingivitis (which CAN be a precursor to periodontitis) at every appointment what do you want the dentist/hygienist to say? Nothing? Just not mention it after the first time? Surely then the patient would think it had gone away? Gingivitis is active inflammation of the gums. It can be cured with good oral hygiene. So it is the dental professional’s responsibility to inform the patient that they have that and how to fix it. And yes, they need to inform the patient at every appointment if it is still there. If it is just historical bone loss that has stabilised (like what I have) then it could definitely be worded better. For example saying that “your previous early bone loss still seems stable Mrs Smith so keep up your good oral hygiene”.

But if someone’s brushing is bad and they have gingivitis you need to tell them each time. Otherwise IF it does progress in a few years the patient will come back demanding to know why they were never told it could get worse and then try and sue the dentist.