We have all faced new challenges that we had never anticipated. As we continue to apply our  experience from the past to what we do today, there are times in which we will experience  something out of our toolbox and our knowledge base. 

I recently had that experience with this particular patient. An 85-year-old gentleman came to me  with severe recession on tooth #6. He had not been a patient before. It was an unusual defect  in an older gentleman. As you can see from the probing depth, he had a severe buccal defect  probing high up through the gingival margin. Upon flapping the area the loss of buccal plate  was noted. 

I assumed this was a mucogingival defect that had never been attended to in his past. 

A surgical procedure was performed in order to cover as much of the root as possible and get  reattachment with soft tissue. The absence of facial bone was noted. 

The photo with the probe in place demonstrates what I consider to be an excellent outcome  given the challenges presented by this patient.

Fast forward eighteen months. The patient reappears in my office. He had a tremendous loss  of tissue where I had done the surgery. The photographs show the thin gingiva but I could  probe 7 millimeters beyond it. On the left cuspid a similar lesion had developed that was not  present when I first saw him. 

Somewhat perplexed, he shared with me his sleep apnea masks. He put on the one he’d been  sleeping with and I noted that it put direct pressure on the cuspid area. He then showed me a  mask he started sleeping with the night before that rested on his zygoma, not on the cuspid  area. 

The light bulb went off and at this point I realized that the wearing of his appliance, putting direct  pressure on teeth that had very thin or absent buccal plates of bone, with very thin gingiva,  caused the original problem and caused it to recur. Pressure over thin gingiva causes a  decrease in blood supply with no buccal bone over the roots. Zingo, the tissue necroses and  detaches and here we are, back where we started from. 

We both agreed that he would wear the larger mask to avoid pressure in this area. 

Another lesson learned and one I wished to share because I’m sure many of you may have  patients who wear sleep apnea masks. 

As always, I would appreciate your feedback 

Yours truly, 

Dr. Victor M. Sternberg 

By Westchester Center for Periodontal & Implant Excellence

December 31, 2023