Posts for: October, 2018
There are a lot of reasons (including a blow to the mouth) why one of your permanent teeth might become loose. The most common: advanced periodontal (gum) disease that has weakened the gum attachment to the tooth.
There's also another, less common reason: you have a grinding habit that's producing higher than normal biting forces. Besides accelerating tooth wear, the constant jaw movement and teeth clenching can stretch periodontal ligaments and loosen their attachment to a tooth.
If the gums are disease-free, teeth grinding is most likely the main culprit for the damage, what we call primary occlusal trauma. Our treatment goal here is to reduce the effect of the grinding habit and, if necessary, secure the teeth with splinting while the ligaments heal. We can often reduce the grinding effect with a custom bite guard worn while you sleep. We may also prescribe minor muscle relaxants and mild pain medication like aspirin or ibuprofen.
Sometimes we may need to perform other measures like re-shaping your teeth's biting surfaces so they don't generate as much biting force. You may also benefit from counseling or other psychological treatment to help you address and cope with stress, a prime driver for teeth grinding.
Even if you don't have a grinding habit, biting forces may still contribute to tooth looseness if you have advanced gum disease. Advanced disease results in excessive bone loss, which in turn reduces the remaining amount of ligaments attached to the tooth. This type of damage, known as secondary occlusal trauma, and ensuing tooth looseness can occur even when your biting forces are normal.
It's necessary in these cases to treat the gum disease, primarily by manually removing plaque and calculus (hardened plaque deposits), which causes and sustains the infection. Once removed, the gums can begin to heal and strengthen their attachment. We may also need to apply splinting or perform surgical procedures to encourage gum and bone reattachment.
Whatever has caused your loose tooth, our goal is to remove the cause or lessen its effects. With your tooth secure and the gums regaining their healthy attachment, we have a good chance of saving it.
If you would like more information on teeth grinding and other potentially damaging oral habits, 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: Biting Forces can Loosen Teeth.”
Placing a dental implant within the jawbone requires a surgical procedure. For most people it’s a relatively minor affair, but for some with certain health conditions it might be otherwise. Because of their condition they might have an increased risk for a bacterial infection afterward that could interfere with the implant’s integration with the bone and lead to possible failure.
To lower this risk, dentists for many years have routinely prescribed an antibiotic for patients considered at high-risk for infection to take before their implant surgery. But there’s been a lively debate among health practitioners about the true necessity for this practice and whether it’s worth the possible side effects that can accompany taking antibiotics.
While the practice still continues, current guidelines now recommend it for fewer health conditions. The American Dental Association (ADA) together with the American Heart Association (AHA) now recommend antibiotics only for surgical patients who have prosthetic heart valves, a history of infective endocarditis, a heart transplant or certain congenital heart conditions.
But patients with prosthetic joint replacements, who were once included in the recommendation for pre-surgical antibiotics, are no longer in that category. Even so, some orthopedic surgeons continue to recommend it for their joint replacement patients out of concern that a post-surgical infection could adversely affect their replaced joints.
But while these areas of disagreement about pre-surgical antibiotics still continue, a consensus may be emerging about a possible “sweet spot” in administering the therapy. Evidence from recent studies indicates just a small dose of antibiotics administered an hour before surgery may be sufficient to reduce the risk of infection-related implant failure with only minimal risk of side effects from the drug.
Because pre-surgical antibiotic therapy can be a complicated matter, it’s best that you discuss with both the physician caring for your health condition and your dentist about whether you should undergo this option to reduce the infection risk with your own implant surgery. Still, if all the factors surrounding your health indicate it, this antibiotic therapy might help you avoid losing an implant to infection.
If you would like more information on antibiotics before implant surgery, 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 “Implants & Antibiotics: Lowering Risk of Implant Failure.”
The March 27th game started off pretty well for NBA star Kevin Love. His team, the Cleveland Cavaliers, were coming off a 5-game winning streak as they faced the Miami Heat that night. Less than two minutes into the contest, Love charged in for a shot on Heat center Jordan Mickey—but instead of a basket, he got an elbow in the face that sent him to the floor (and out of the game) with an injury to his mouth.
In pictures from the aftermath, Love’s front tooth seemed clearly out of position. According to the Cavs’ official statement, “Love suffered a front tooth subluxation.” But what exactly does that mean, and how serious is his injury?
The dental term “subluxation” refers to one specific type of luxation injury—a situation where a tooth has become loosened or displaced from its proper location. A subluxation is an injury to tooth-supporting structures such as the periodontal ligament: a stretchy network of fibrous tissue that keeps the tooth in its socket. The affected tooth becomes abnormally loose, but as long as the nerves inside the tooth and the underlying bone have not been damaged, it generally has a favorable prognosis.
Treatment of a subluxation injury may involve correcting the tooth’s position immediately and/or stabilizing the tooth—often by temporarily splinting (joining) it to adjacent teeth—and maintaining a soft diet for a few weeks. This gives the injured tissues a chance to heal and helps the ligament regain proper attachment to the tooth. The condition of tooth’s pulp (soft inner tissue) must also be closely monitored; if it becomes infected, root canal treatment may be needed to preserve the tooth.
So while Kevin Love’s dental dilemma might have looked scary in the pictures, with proper care he has a good chance of keeping the tooth. Significantly, Love acknowledged on Twitter that the damage “…could have been so much worse if I wasn’t protected with [a] mouthguard.”
Love’s injury reminds us that whether they’re played at a big arena, a high school gym or an outdoor court, sports like basketball (as well as baseball, football and many others) have a high potential for facial injuries. That’s why all players should wear a mouthguard whenever they’re in the game. Custom-made mouthguards, available for a reasonable cost at the dental office, are the most comfortable to wear, and offer protection that’s superior to the kind available at big-box retailers.
If you have questions about dental injuries or custom-made mouthguards, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “The Field-Side Guide to Dental Injuries” and “Athletic Mouthguards.”