If you've noticed one of your teeth feeling loose, you're right to believe it's not a good thing. Loose permanent teeth are a sign of an underlying problem.
Periodontal (gum) disease is usually the culprit. Caused by bacterial plaque, a thin film of food particles, gum disease causes the tissues that support teeth to weaken and detach. While a tooth can become loose from too much biting force (primary occlusal trauma), it's more likely bone loss from gum disease has caused so much damage that even the forces from normal biting can trigger looseness.
A loose tooth must be treated or you may lose it altogether. If it's from gum disease, your treatment will have two phases.
In the first phase we need to stop the gum infection by removing plaque and calculus (hardened plaque deposits). Hand instruments known as scalers or ultrasonic equipment are usually sufficient for removing plaque and calculus around or just below the gum line. If the plaque extends deeper near or around the roots, we may need to consider surgical techniques to access these deeper deposits.
Once the infection is under control and the tissues have healed, we can then undertake the second phase: reducing biting forces by breaking clenching and grinding habits, doing a bite adjustment for advanced problems and securing loose teeth with splinting.
Although there are different types of splinting — both temporary and permanent — they all link loose teeth to adjacent secure teeth much like pickets in a fence. One way is to bond dental material to the outer enamel of all the teeth involved; a more permanent technique is to cut a small channel extending across all the teeth and bond a rigid metal splint within it.
To reduce biting forces on loose teeth, we might recommend wearing a bite guard to keep the teeth from generating excessive biting forces with each other. We may also recommend orthodontics to create a better bite or reshape the teeth's biting surfaces by grinding away small selected portions of tooth material so they generate less force.
Using the right combination of methods we can repair loose teeth and make them more secure. But time is of the essence: the sooner we begin treatment for a loose tooth, the better the outcome.
If you would like more information on treating 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 “Treatment for Loose Teeth.”
For whatever reason, you’ve put off replacing a missing tooth for awhile. Now you want to fill that empty gap in your smile with a dental implant restoration.
But if your tooth’s been missing for a long time, there could be a problem with space. This is because the teeth on either side of the space may have gradually drifted into it, leaving no room for the implant. You could need orthodontic work first to return these teeth to their proper position.
We could use braces, metal orthodontic devices with wires threaded through brackets bonded to the teeth that are then anchored, usually to back teeth. The orthodontist uses elastics or springs as well as possibly incrementally tightening of the wire against the anchors. These techniques create pressure or tension on the teeth for the desired direction of movement. The teeth’s natural mechanism for movement does the rest.
But while effective, braces can be quite noticeable, an embarrassing thought for many adults having to wear them over several months of treatment. But there may be an alternative: clear aligners, a succession of slightly different plastic trays usually worn in two-week intervals. Sequentially wearing each tray gradually moves the teeth to their desired positions.
Though not appropriate for all bite situations, clear aligners have a number of benefits when they can be used. They’re nearly invisible to others and can be removed for hygiene tasks or rare special occasions. What’s more, the orthodontist may attach a temporary prosthetic (false) tooth to the trays to camouflage the missing space during treatment.
There’s one other issue you may have to deal with: if your tooth loss was related to periodontal (gum) disease, the gums and underlying bone may be in poor condition. In fact, substantial bone loss could rule out an implant altogether. But we may be able to remedy both gum and bone deficiencies through grafting or plastic surgery. It may be possible to regenerate enough bone to support the implant; and surgically repairing your gums will help ensure the implant appears natural.
If you have problems like these, don’t give up on your restoration goal just yet. With some orthodontic and dental work ahead of time, we may still be able to make implants a reality for you.
Children have a lot of energy that's often channeled through physical activities and sports. Unfortunately, this also increases their risk of injuries, particularly to their teeth.
Injuries to the mouth can endanger permanent teeth's survival. For an older tooth, a root canal treatment might be in order. Not so, though, for a pre-adolescent tooth, even if it is permanent.
A young permanent tooth is still developing dentin, the large layer just below the enamel. This growth depends on the connective tissue, blood vessels and nerves within the pulp in the center of the tooth. Because a root canal treatment removes all of this tissue, it could stunt dentin and root growth and endanger the tooth's future.
Instead, we may need to treat it with one of a number of modified versions of a root canal, depending on what we find. If the tooth's pulp is unexposed, for example, we may need only to remove the damaged dentin, while still leaving a barrier of dentin to protect the pulp. We then apply an antibacterial agent to minimize infection and fill in the area where we've removed tooth structure.
If some of the pulp is exposed, we may perform a pulpotomy to remove just the affected pulp and any overgrown tissue. We then place a substance that encourages dentin growth and seal it in with a filling. If we go deeper toward the root end, we might also perform procedures that encourage the remaining pulp to form into a root end to stabilize the tooth.
If the entire pulp has been damaged beyond salvage, we may then turn to a procedure called an apexification. In this case we clean out the pulp chamber; at the root end we place mineral trioxide aggregate (MTA), a growth stimulator that encourages surrounding bone to heal and grow. We then fill in the root canals and chamber with a special filling called gutta percha to seal the tooth.
The deeper we must penetrate into the pulp, the higher the chances the young tooth's dentin and roots won't form properly, leading to later problems and possible loss. But by employing the appropriate one of these methods, we can minimize the risk and give your child's damaged tooth a fighting chance.
If you would like more information on children and dental injuries, 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 “Saving New Permanent Teeth after Injury.”
Is a chipped tooth big news? It is if you’re Justin Bieber. When the pop singer recently posted a picture from the dental office to his instagram account, it got over 2.6 million “likes.” The snapshot shows him reclining in the chair, making peace signs with his hands as he opens wide; meanwhile, his dentist is busy working on his smile. The caption reads: “I chipped my tooth.”
Bieber may have a few more social media followers than the average person, but his dental problem is not unique. Sports injuries, mishaps at home, playground accidents and auto collisions are among the more common causes of dental trauma.
Some dental problems need to be treated as soon as possible, while others can wait a few days. Do you know which is which? Here are some basic guidelines:
A tooth that’s knocked out needs attention right away. First, try and locate the missing tooth and gently clean it with water — but avoid holding the tooth’s roots. Next, grasp the crown of the tooth and place it back in the socket facing the correct way. If that isn’t possible, place it between the cheek and gum, in a plastic bag with the patient’s saliva or a special tooth preservative, or in a glass of cold milk. Then rush to the dental office or emergency room right away. For the best chance of saving the tooth, it should be treated within five minutes.
If a tooth is loosened or displaced (pushed sideways, deeper into or out of its socket), it’s best to seek dental treatment within 6 hours. A complete examination will be needed to find out exactly what’s wrong and how best to treat it. Loosened or displaced teeth may be splinted to give them stability while they heal. In some situations, a root canal may be necessary to save the tooth.
Broken or fractured (cracked) teeth should receive treatment within 12 hours. If the injury extends into the tooth’s inner pulp tissue, root canal treatment will be needed. Depending on the severity of the injury, the tooth may need a crown (cap) to restore its function and appearance. If pieces of the tooth have been recovered, bring them with you to the office.
Chipped teeth are among the most common dental injuries, and can generally be restored successfully. Minor chips or rough edges can be polished off with a dental instrument. Teeth with slightly larger chips can often be restored via cosmetic bonding with tooth-colored resins. When more of the tooth structure is missing, the best solution may be porcelain veneers or crowns. These procedures can generally be accomplished at a scheduled office visit. However, if the tooth is painful, sensitive to heat or cold or producing other symptoms, don’t wait for an appointment — seek help right away.
Justin Bieber earned lots of “likes” by sharing a picture from the dental office. But maybe the take-home from his post is this: If you have a dental injury, be sure to get treatment when it’s needed. The ability to restore a damaged smile is one of the best things about modern dentistry.
If you have questions about dental injury, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Repairing Chipped Teeth” and “Porcelain Crowns & Veneers.”
The holidays are a season for giving. At this time of year, lots of us spend hours rushing around, looking for the perfect gifts for people we care about. But sometimes, amidst all the hustle and bustle, it doesn’t hurt to step back and think about yourself a little. If a better-looking smile has been on your list but you haven’t taken the first steps, the holiday season might be the right time to give yourself a gift.
Many smile problems, like discolored, chipped or uneven teeth, can be resolved with veneers—wafer-thin porcelain shells that cover the front surfaces of teeth. Veneers are custom-made just for you: They can have a pearly luster to match your existing teeth, or be Hollywood-white for a dazzling red-carpet smile. In just a few visits to the dental office, you can have the smile you’ve always wanted—and a whole new look for the New Year.
If damaged or missing teeth are what’s bothering you, you’ll be happy to know that there are lots of good options for replacing them. If the tooth’s roots are still in good shape, a crown or cap could be the answer. This is a sturdy replacement for the entire visible part of the tooth that not only looks great, but also functions well in your bite—and can last for years to come.
If teeth are missing or can’t be saved, we offer several options for replacement, including fixed (non-removable) bridgework and dental implants. A tried-and-true method for replacing one or more missing teeth, bridges are firmly supported by healthy teeth next to the gap in your smile. These teeth must be prepared to receive the bridge by having some of the tooth’s surface removed.
Dental implants are today’s premier option for tooth replacement. In this high-tech system, a root-like titanium insert, placed directly into the bone beneath the gum, forms a solid anchorage for the visible part of the replacement tooth. Implants look and feel completely natural, and can last for many years. Plus, they don’t require any work to be done on nearby teeth.
What kind of smile makeover is right for you? Just ask us! We will be happy to take a look at your smile and recommend a treatment plan. And in this season of generosity, there’s no better gift you can give yourself than a bright new smile.
You can learn more about smile makeovers by reading the Dear Doctor magazine article “Beautiful Smiles by Design.”
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