Posts for: September, 2014
A loose permanent tooth isn’t normal — it represents a serious threat to the tooth’s survival. There may be a chance to save the tooth, however, if we can determine the cause of the looseness and treat it appropriately.
Teeth are normally held securely in place by the periodontal ligament, an elastic tissue that attaches to both the teeth and the bone. Certain conditions, however, can disrupt this attachment. The most common is advanced periodontal (gum) disease, an infectious condition caused by bacterial plaque. It can severely inflame and damage the surrounding gum tissues resulting in bone loss. As the bone is lost, the periodontal ligament is lost as they detach from the teeth. In fact, tooth looseness may be a fairly late sign of the disease.
Another major cause is teeth grinding (bruxism) and clenching habits that result in excessive biting forces. Usually stress-related, teeth grinding and clenching generate forces on the teeth outside of their normal range. As a result the periodontal ligament can become stretched, inducing tooth looseness.
Our treatment approach depends on which condition is causing the looseness, best assessed with a thorough dental examination. If gum disease is the culprit, the main treatment is to remove as much bacterial plaque and calculus (tartar) as possible using various techniques such as scaling or root planing (accessing and cleaning root surfaces). It’s also imperative for you the patient to start and maintain an effective hygiene regimen of daily brushing and flossing, along with professional cleanings every three to six months depending on your degree of vulnerability to gum disease. Subsequent healing will stimulate tissue reattachment to the teeth.
In the case of excessive biting forces, we primarily want to reduce their effect on the teeth. Treatment can include muscle relaxants or anti-inflammatory drugs, or a custom-fitted bite guard to minimize biting forces from teeth grinding during sleep. In some cases we may opt to reshape the biting surfaces of teeth through removal of small amounts of surface enamel: this will reduce the biting force by altering how the upper and lower teeth contact. It’s also possible to splint loose teeth to more stable teeth, joining them like pickets in a fence. This helps relieve the biting force on teeth with significant loss of bone support.
If you notice a loose tooth, you should make an exam appointment with us as soon as possible. The sooner we can diagnose the cause and begin treatment, the less chance you’ll lose your tooth.
If you would like more information on loose teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Loose Teeth.”
Here's an interesting tidbit of information on Wheel of Fortune host Vanna White: like many people, she grinds her teeth at night. In a detailed interview with Dear Doctor magazine, Vanna explained how she had to replace a filling in a back tooth several times because of her grinding habit. Eventually, she had her dentist make her a nightguard to protect her famous smile.
“I really try to sleep with it every night,” Vanna told the magazine. “I try to keep it on my nightstand so when I go to bed, I remember to put it in. Or I will put it by my toothbrush so I can put it in after brushing my teeth at night.”
The habit of teeth grinding or clenching is often associated with stress and/or sleep deprivation. It is referred to as “parafunctional” (“para” – outside, “function” – normal), meaning it can generate biting forces well outside the normal range — perhaps 10 times normal. This excessive force can affect many areas of the oral system. Teeth may become worn, chipped or loose; jaw joints or muscles can go into spasm; and some grinders (or “bruxers” as they are also called) may even experience discomfort of the head, ears, neck or back. Many times, a person with a grinding habit does not become aware of it until it is pointed out by a sleep partner or dental professional.
Like Vanna White's dentist, we often recommend a nightguard to those with nocturnal bruxing habits. It is made of a very thin, wear-resistant plastic that fits over the biting surfaces of the upper teeth only. The lower teeth are then free to glide or skate over the guard, which prevents them from biting into the upper teeth. Some people wear their guards during the day if they tend to clench their teeth when under stress.
If you are concerned about teeth grinding or interested in learning more about nightguards, please contact us today to schedule an appointment for a consultation. If you would like to read Dear Doctor's entire interview with Vanna White, please see “Vanna White.” Dear Doctor also has more on “Stress & Tooth Habits.”