Tooth Symptoms (Miscellaneous)
What are some common causes of loose teeth?
Loose teeth arise from several causes. Often, if the tooth that feels loose has a crown, what appears to be tooth movement is actually the crown itself. If the tooth has had its core structure rebuilt with a special type of filling known as a core buildup, and a reinforcing post has been placed into the root canal spaces of the tooth, it is often the core buildup that has become dislodged—not loosening of the tooth itself.
Teeth which sustain injuries may be cracked, and when this occurs, part of the tooth may separate completely from the rest of the tooth, but remain held in position by the attachment fibers of the gums (gingiva). In such cases, part of the tooth loosens, and part remains immobile. Depending on where the crack is located, it may be considered favorable or unfavorable. Generally vertically oriented and oblique (angled slightly off of vertical) fractures are unfavorable fractures, especially if they extend below the gum level. Sometimes root fractures can be favorable, especially if they are horizontal, and located near the tip (apex) of the tooth root.
Baby (primary) teeth normally begin to loosen and exfoliate (fall out) around age six. Most often, the lower front teeth are lost first, followed by the upper front teeth about a year later. Loss of the primary teeth is usually something children look forward to, as it is an important milestone on their path to becoming an adult. If your child is over six years of age, and his/her teeth have not started to loosen, have a dentist evaluate them. Although there is a wide variation in the timing of primary tooth loss, in some cases the permanent teeth follow a path into the mouth that does not displace the primary teeth. The dentist will usually expose a few X-ray images of the child’s teeth to assess developmental status and tooth position.
Teeth can be moved or tipped (luxated) from trauma. If this happens, call a dentist immediately. The worst types of luxation injuries are those that drive the tooth into the jaw (intrusion). This is true of both primary and permanent teeth. In such cases, the nerves and blood vessels that enter the tooth may be damaged or severed completely. The dentist may elect to let the tooth re-erupt, while having you observe the tooth carefully for appearance of a gum blister or darkening of the tooth’s crown.
If the tooth is a primary tooth, it may need to be removed by the dentist, to eliminate the risk of inflammation damaging the permanent tooth developing beneath it in the jawbone. Permanent teeth which are forcefully intruded may require a root canal (endodontic treatment). It may be necessary to stimulate closure of the root tip in incompletely developed teeth. The procedure for this is known as apexification.
If a primary tooth is tipped inward toward the tongue (lingual luxation injury), and the upper and lower teeth still overlap properly, the tooth may require nothing more than observation because its root usually moves away from the permanent tooth developing beneath it. Watch for development of a gum blister over the tooth root, or darkening of the crown of the tooth. If you see those signs, let your dentist know immediately. Your dentist will probably expose an X-ray image to see where the developing tooth is, and to get a baseline picture of how the jawbone around the tooth looks, so it may be compared at a future date.
If the tooth is tipped inward so far that it now overlaps the wrong side of the tooth opposing it from the other jaw, the dentist may need to tip it back where it belongs. Often, no other treatment is needed except careful observation.
If a primary tooth is tipped toward the lips (labial luxation injury), there is a greater chance that its tooth root may cause damage to the developing permanent tooth beneath it.
The dentist may need to gently reposition the tooth, or may elect to remove it.
School aged children who play sports should be fitted with an athletic mouthguard to protect the teeth against luxation injuries.
Permanent teeth may also loosen and be lost as a consequence of advanced bone loss (periodontitis). Primary teeth do not loosen as a consequence of periodontitis.
My teeth are getting crooked, seem to be moving, and don’t line up anymore. What should I do?
Teeth which appear to be changing position over time frequently have a history of orthodontic tooth movement, in which the final position of the teeth was not retained for a sufficient period of time. Many orthodontists now recommend long term retention of teeth which have been orthodontically repositioned—decades to life in many cases. Frequently, patient compliance is an issue in such cases, which can be addressed by placement of fixed orthodontic retainers. These devices are commonly placed on the front six teeth of the lower jaw, and permanently bonded to the teeth where relapse of crowding is most common.
It is also common for orthodontists to recommend a final equilibration (occlusal adjustment) of the teeth at the completion of orthodontic treatment. This involves making minor adjustments to the tooth enamel (by grinding) to eliminate contact points between opposing teeth that would negatively affect the stability of the jaw joints or jaw muscles; and movement of, or damage to the teeth themselves. If this procedure is not performed when requested, the stability of the orthodontic result is uncertain.
When permanent teeth are lost, the adjacent and opposing teeth often begin to drift toward the space created by the missing tooth. This can result in an improper bite relationship (malocclusion) and excessive forces on the remaining teeth. If several teeth are lost (particularly the back ones), the jaws will rotate together farther than normal. This is known as bite collapse (loss of vertical dimension of occlusion).
The result is greater stress on the front teeth, which may cause them to tip toward the lips. In such cases, the contact points between the upper and lower front teeth begin to move toward the lips, increasing leverage on the jaw joints. Temporomandibular joint dysfunction (TMD) may result.
People who habitually clench and grind their teeth (known as bruxism) apply excessive forces which can cause the teeth to move.
People who have lost tooth supporting bone from periodontal disease may experience unwanted tooth movement, depending on the amount of bone loss and density/health of the remaining bone.
What is a dental overhang?
A dental overhang (also called an overhanging margin or simply an overhang) occurs when a dental restoration (for example, a filling, crown, inlay, onlay, veneer) does not blend smoothly with the tooth’s natural contour at the tooth-restoration interface (margin). Overhangs are undesirable because they are difficult to clean, and food and bacteria (plaque) tends to accumulate under them. This situation often leads to localized inflammation of the periodontal tissues, and secondary tooth decay (recurrent caries).
Food keeps getting stuck in my teeth. It kind of hurts. Could this lead to other problems?
Food compaction injuries are sometimes caused by the creation of a space between adjacent teeth that didn’t always have one (open contacts), or creation of a food trap by placement of poorly contoured dental restorations. They can also occur as a result of broken or chipped teeth or dental restorations, which create food traps. Food compaction around braces is common during orthodontic treatment, and in patients who have periodontal disease.
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