Loose teeth are one of the most common reasons that patients come in for emergency appointments. Even though most people think of teeth being lost because of cavities, that's much less common than it used to be. Today, the majority of teeth are lost because they became too loose to save.
So why do teeth become loose? There are many reasons, but what they all have in common is destruction of the bone that supports the tooth's root. Sometimes teeth are loosened by unconscious reflexes like clenching and grinding, and sometimes the problem is misaligned force between teeth that levers them out of the bone over time. In most cases though, loose teeth are caused by uncontrolled gum disease (periodontitis).
Gum disease is a slowly progressing infection under the gum line that eventually causes breakdown of the ligament and bone that support the teeth. Seventy percent of people have some form of gum disease, but the good news is that a full third of them having only the earliest stage of the disease. The earliest stage (gingivitis) is when only the gums at the surface are inflamed (red, sore, or bleeding easily). If your gums are red, sore, or bleed when brushing or flossing, that's an important warning sign, because it tells us that an infection has started, and treatment is needed before it begins permanently destroying the attachment of the teeth. The treatment for gingivitis is simple: a combination of professional cleanings every six months, instruction for ideal techniques to clean your teeth every day in a way that addresses your personal risk factors, and often some type of medicated rinse that will fight the bacteria causing the inflammation.
If your gum disease is treated, it can be stopped before any serious damage is done, but like most problems, if allowed to go unchecked, it gets worse and worse until teeth are lost. The x-ray below shows a patient with advanced gum disease that has destroyed a large amount of bone. The red line shows the current bone heights, and the green line is where they were when the teeth first came in. As a result of the bone loss, this patient complains of loose teeth and painful abscesses when food gets trapped deep in the resulting gum pockets and the infection in that area becomes more severe. A dental implant at the far right side of the image is replacing a tooth that became loose and was lost. Because of the prior loss of bone and gum tissue, the implant crown is longer than usual, and its appearance is less than ideal. These problems could have been avoided with improved hygiene and regular professional checkups and cleanings, but like many patients, she didn't start treatment until she felt pain, at which point quite a bit of damage was already done.
The worst situations are when the effects of gum disease are made worse by unconscious clenching or grinding, or by teeth that are misaligned so that normal biting force tips the teeth until they're wiggled out of position. The patient pictured below had unconscious nighttime grinding that caused two of his teeth to be wiggled until they came right out of their sockets.
When teeth are severely misaligned, it's only a matter of time before they become loose. In the x-ray shown below, the patient has lost all but one of her lower back teeth (molars). These teeth do most of the work of chewing because the force of biting is greatest in the back of the mouth. As she has lost each molar, the ones behind it have been tipped forward by the imbalanced biting force.
Now that only one lower molar is left, it is absorbing so much of her bite force at such an awkward angle that the bone surrounding it is being destroyed (red arrow). The molar is already loose, and if something isn't done soon to balance the forces on it, it will be lost very soon.
Any time a tooth has become loose, at least one problem with the tooth has already become severe. It's a race against the clock to do everything we can to maintain the tooth for as long as possible. That's why if any of your teeth feel loose, you should call us today at (718) 268-1561, or request a consultation.