OK rm,

Let's take this to a philosophical level so we can take a closer look at what's involved with something being true, not true or possibly true. This level is needed to transcend the type of doctor patient relationship you are experiencing here.

First let's take a closer look at what the doctor patient relationship involves here. It involves your doctor/student perio wishing or OBLIGING you to ACCEPT what she contends is true, (that you will lose your teeth if she does not perform this procedure). The acceptance of her contention being true on your part is something she obliges you to accept for no other reason than: "I am the doctor therefore what I say is true". Certainly IF there is ANOTHER REASON, she has not made that clear to you. Hence her contention of what is true takes the SUPPOSITION of: "I am the doctor. Therefore what I say is true"

Do you accept that supposition? NO.
Are you obliged to accept that supposition just because you are the patient and she is the doctor? NO
Why? BECAUSE IT IS TRUE THAT DOCTORS CAN BE WRONG

The REAL TRUTH here is DOCTORS CAN BE WRONG. Hence, when you find a doctor taking the supposition of: 'I'm the doctor therefore I am right', you need to challenge that by realizing that if it's true that doctors can be wrong it's not ALSO TRUE that just because they are the doctor they must be right.
So, on a higher plane, there is no philosophical ground to accept the supposition of: "I am the doctor therefore I can't be wrong"

In essence, doctors requiring you or obliging you to accept what they say is true and on no other grounds other than; 'I'm the doctor therefore what I say is true' are in DENIAL and also want you to be in DENIAL of what is REALLY TRUE which is it is really true that DOCTORS CAN BE WRONG.

There is NO WAY to really know for sure IF it's really true you will lose your teeth if you don't get the gum grafting with your student perio unless you wait after not doing it and her prediction is right.

Let's take a closer look of HOW COULD THIS BE TRUE.

It could be true that you could lose your teeth IF the gum loss process is related to PERIODONTAL PATHOGENS that slowly degrade the surrounding structure of the teeth such as gums, bone and periodontal ligaments holding the teeth to the bone.

However unless that process itself is STOPPED, it would CONTINUE to persist EVEN IF she grafted the gums.

HOW IS THE PROCESS STOPPED?

The process indeed is slowed down by a DEEP ROOT PLANING. So her suggestion in that regard has some merit. The process is also stopped by an antibiotic protocol aimed at addressing known periodontal pathogens and varied hygienic measures of daily teeth cleaning habits.

WHAT CAN YOU CONCLUDE FROM HER SUGGESTION TO DO THE DEEP ROOT PLANING?

I think you could conclude that she is wanting to do the deep root planing as the first step in halting periodontal pathogens from further degrading the tooth structure as it would be a process that would need to be halted FIRST and BEFORE doing a gum graft. Otherwise, a gum graft is unlikely to be successful when it's done 'on top' of a process degrading the tooth structure as what it would tend to do would be to provide POCKETS for the periodontal pathogens to increase and further degrade tooth structure.

WHAT CAN YOU CONCLUDE A SUCCESSFUL GUM GRAFT WOULD BE CONTINGENT ON.

I think you can conclude that for the gum graft to be successful, it would be (in part) contingent on eradicating the periodontal pathogens and hence the slow degradation process they contribute to.

WHAT WOULD YOU HAVE TO KNOW FIRST BEFORE GETTING THE GUM GRAFT?

You would have to know first that the deep root planing was successful and also that your new hygiene protocol along with that was a good one.

HOW WOULD YOU KNOW THAT.

You would know that by observing that the process of further degradation to the tooth structure has STOPPED. That is to say, the gums no longer continue to recede.

WHAT ELSE CAN YOU CONLCUDE?

I think you can conclude that the gum graft itself is NOT the KEY thing needed to stop the degradation process and the gum graft itself might not be successful IF the periodontal pathogen population is not wiped out first via the deep root planing and a new hygiene protocol.

QUESTIONS TO ENTERTAIN:

'What if the periodontal pathogen population were not successfully wiped out and continued to run it's course after getting the gum graft?'

Well you would have a gum graft on top of a continued degradation process. Something that does you little good but of course, affords more employment opportunities for dentists.

'What if the periodontal pathogen population WERE successfully wiped out and stopped running it's course?'
Well, although that would be needed for the gum graft to be successful, IF you could stop the process, you might not need the gum graft.

'Who's INTEREST is it to perform a gum graft BEFORE determining FOR SURE that the proposed deep scaling, (and other hygiene measures) has indeed stopped the degradation process?' THE DENTIST'S.

'Who's INTEREST is it to determine FOR SURE that the proposed deep scaling (and other hygiene measures) indeed stop the degradation process BEFORE getting the gum graft or even as a way to AVOID getting the gum graft?' YOURS.

WHAT CONCLUSION COULD YOU NOW DRAW from this philosophical way of looking at 'truth'?

You can conclude that the proposed root planing indeed has a good chance of stopping the process that is most likely slowly degrading your tooth structures. You can also conclude that you would need to witness it did before getting the gum graft. Therefore it is in your interest to have the deep root planing but to also WAIT on the gum graft.

Possibilities:

1: Root planing is successful. Likelihood gum graft would also be successful.
2; Root planing is successful. Likelihood you would not need a gum graft because the degradation process has stopped.

3: Root planing is not successful. Likelihood gum graft would fail over time.
4: Root planing is not successful. Not having a gum graft would just be a continuation of the same degradation process going on now as would having one.

STRATEGY:

Get the root planing and WAIT to see IF it is successfully. IF it is, you have the OPTION of:

A: Getting a gum graft
B: Not getting one.

FINAL CONCLUSION:

The dentist is trying to CLOSE YOUR OPTIONS of not getting the gum graft which is an option you have IF the root planing stops the degradation process and is successful. You have the option of LETTING THEM PROVE the root planing will successfully stop the degradation process before you decide on the gum graft. After all, a successful gum graft is going to be CONTINGENT on the degradation process being stopped FIRST by the proposed root planing. So, LET THEM DO the root planing. But make them WAIT on the gum surgery until the root planing proves itself to stop the degradation process. In which case, you have 2 options: To get the gum surgery or do without it because the degradation process has been arrested by the root planing.

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Can hardly walk. Need hip replacement.

Thats why some come to me for these kind of mind lessons.

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Can hardly walk. Need hip replacement.

Wow. Thanks for taking the time to write such a thoughtful reply, MissJ. I appreciate the time you took to do that.

I hear what you are saying but from my understanding, I do NOT require a deep root planing because my recession is not due to periodontal disease but is due to improper brushing, anatomic issues: tooth malpositioning from orthodonture, and heredity/thin gum tissue. And yes, probably not stellar oral hygiene although I did floss most days (and now EVERY DAY without fail!) but I brushed incorrectly and *not* long enough. And had a crappy dentist who did not notice nor care to point out what was happening to my gums.

The student periodontist said that she would NOT be performing a deep root planing as since I do not have "pockets" between my gums and teeth. {Pockets" indicate periodontal disease...from what I have learned). My pockets are currently normal. She would, in essence, be performing a "scaling" procedure which I had done in mid-January by a dental hygienist. To have this done again in early March seemed superfluous.

Agree completely that a proper and deep cleaning would have to be performed prior to a gum graft - this is the indicated and appropriate procedure and yes, she would monitor my gums monthly after doing the cleaning. And yes, I will have this done in the next few months. Just not sure where/who yet.

The bottom line is: she completely turned me off when she brought her EGO into our conversation. I did not really challenge her, merely expressed my (admittedly heightened) anxiety, questioned the need/cost for root planing when she said I did not need this, and that I wanted to seek a second opinion with another periodontist (who I will see in a couple of weeks). She continually referred to herself as a "periodontist" when she is still a student and I found this rather off-putting as well.

Also, my take was that she had already concluded that I need the gum graft no matter what, she told me that during our last "You are going to lose your teeth" conversation. She said "nothing else is going to help you".> Since I cannot undergo the procedure until the fall anyway (unless I wish to lose several thousand dollars not to mention future employment by not being able to work during my busy season which is the summer) I decided to go have the second opinion and then decide my options.

Yes, I've learned a lot about plaque in the last two months! I agree I will need another scaling, surgery or no surgery. I saw a dentist in D avis Sq for a second opinion and he seemed to think I'd be fine coming back in June for a cleaning. I will see what this private perio says in April - I wish I had kept my appointment for March but I postponed it. I feel like this is getting worse (or else I am just more conscious of it since I am paying extra attention to it) and that I will require the grafting.

I do know Suzanne...hmmm...

The other thing the student said was that if I chose to treat with her, it was a "commitment" as if to say, I HAD to go through with her treatment plan (including the surgery). Was also thinking I could start over at another school, e.g. BU or Harvard. Tufts got the best reviews online. Or try for another student at Tufts but then when I think about this surgery, I realize I'd rather have someone do it who has done MANY. So I'll probably end up doing it with a private perio and shelling out thousands of dollars but I just want it fixed and at this point, I don't care how much it costs as long as it works.

All things considered this is a reasonable investment for a very good return. Best wishes -

hi -

His name is Mark Derkazarian, DMD...right on Mass Ave. The consult fee was $125.00.

Scheduled for my first gum graft on June 1st. I have received many conflicting opinions on the necessity of this procedure, mainly from dentists (a couple I found on line who reviewed my X-rays and photos). My prior dentist told me I did not need the surgery, that the grafts don't last, he sees patients in 3 years being told they need it done again. He later said I should probably do it....I think just to get rid of me as he failed to PREVENT this from happening in the 20 years I went to him.

The new dentist I saw told me it was "elective" but that he did not know if it would get worse or if I would sustain more bone loss from waiting to have it done. He basically said he could not advise me on whether or not to have it.

The dentist on line said "If you decide to wait, as I suggest, you can always do the surgery when and if the recession continues to get worse. I am sending you under separate e mail, the excerpt from the leading periodontal textbook. This should help with your decision. I believe the periodontist is probably suggesting what he thinks is needed and necessary. Much like the surgeons who mistakenly removed too many women's Uteri (Uteruses), the surgeons who removed too many children's tonsils, and the physicians who used leeches to drain blood from people. These people mostly thought they were doing the right thing, and the fees involved didn't help to stop these practices."

I'm tempted to wait until the fall as my busy season starts in June and even though the perio told me I would fine for my event on June 12th, I'm still very hesitant to go through with this. Fun, fun, fun.

So confused. I called the perio yesterday to postpone my first graft to the fall when my schedule is less hectic. It is scheduled for Tuesday June 1st, after the long weekend. His response today (via his office) "very bad decision" as he thinks my recession will continue to worsen.

Well, it hasn't worsened in 6 months and I have no idea how long it was even there before it was pointed out to me. I do not have active gum disease, no "pockets" and I just had a very thorough cleaning by a new hygienist. And I'm being very thorough and gentle with oral hygiene since this all was pointed out to me. I have NO symptoms.

And he can't do the other side of my mouth until the fall anyway (you can only do one side at time to allow chewing and eating), so is he worried that THAT area is going to recede by October?

I don't understand the urgency here. All the other professionals I have consulted, both online and off, have said it can wait. It seems he is using scare tactics but I don't get it. He told me he does 1000 of these a year, and at $1250 a graft, he ain't doing too badly financially.

So he scared me and I didn't cancel and now it's too late. I guess I could *still* cancel in the morning, I was told he had a long waiting list. I waited 7 weeks for this appointment but my research is telling me it might *not* be necessary. I feel like I might be asking for more problems by having this done, e.g. infection, who knows what.

I'm no doc, but I'd be surprised if your gum condition worsened at such a precipitous pace as the periodontist seems to indicate. I mean, c'mon. Did you probe him as to WHY he thinks that'd be the case? Ah whatever.

Point is, YOU seem to be inclined to have the gum graft done. And you are right about the the procedure being split into two, six months apart - to give the mouth adequate time for the grafts to really "take".

Having had this same procedure (but with skin used from my palate, not underneath it), I can tell you that your outcome will depend on your schedule and general health.

My first go-round, I got a BIG 'OL INFECTION. I'd gone right back to work after the weekend, couldn't keep my mouth shut - every aspect of my job involving copious communication. In one week, I paid for it. But I took antibiotics, shut my trap, and healed. It just slowed things down by a few weeks.

Second go-round six months later, I was totally JANGLED by having to go through it all again. This time, it was a cake walk. No prob. Cuz I said "I'm working from home this week to give my mouth a rest." And it worked. My grafts took beautifully and let me get a full metal jacket of orthodontia on at age 43.

GOOD LUCK TO YOU on the 1st.

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I Bug U

It could be that the new hygienist was just being over-enthusiastic in her observation. You know, fresh into the practice, wanting to stake a claim, make a discovery. But that is for you to sort out, having had the other consults.

And in the final analysis, you can look at the gum graft procedure as "insurance" against future periodontal problems as you age. Assuming you now know how to perform good dental hygiene on yourself, you could rest easy about ever losing a tooth or having root canal in the future.

So don't agonize too much. I know it'd bug me blind if I felt taken advantage of, but if the outcome is positive, it's gotta be a good thing.

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I Bug U