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Dr. Care
Dr. Care, DDS
Category: Dental
Satisfied Customers: 101
Experience:  General Dentistry-private practice 21 yrs. Member ADA
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My two front teeth are loose and one shifted slightly and dropped

Resolved Question:

My two front teeth are loose and one shifted slightly and dropped down about one millimetre compared to the one beside it. They were both root canalled when I was a teen and crowned twenty years ago. I am almost 50. My dentist is recommending implants due to 60 per cent bone loss. While I am waiting for an appointment to do this, is there anything I can do to stabilize them or treat the periodontal disease. I am afraid the tooth is going to fall out. Can that happen with 60 per cent bone loss. Also, my dentist wiggled it back and forth so much when he checked it out, it took about a month to not feel so tender. Could he have loosened it even more? It does not hurt now but I can feel that my bite has changed and I talk with a bit of a lisp now, maybe to protect it from knocking against my bottom teeth. Thanks for your answer!
Submitted: 2 years ago.
Category: Dental
Expert:  Dr. Care replied 2 years ago.

Dr. Care :

Hello,I hope I can be of service.

Dr. Care :

It is possible to have the two front teeth splinted together from the backside to help hold them in place. I f there is that much bone loss I doubt if even periodontal treatment would help. I also wonder if other areas have bone loss too. If so, then doing replacements for those front teeth should be part of a long range plan that would take into consideration as to how long some of the other teeth in the arch might last. I certainly question whether that area would be a good candidate to do implants with that much bone loss, and especially if the loss has spread to the adjacent teeth as well.

Customer:

Are you suggesting that my only option would be a bridge instead of implants?

Customer:

The periodontist I consulted with said that splinting does not last and he didn't recommend it

Dr. Care :

Typically an area with considerable bone loss ( that would be the case with 60%) it would be a contraindication to do implants. Is there bone loss elsewhere in the arch of teeth?

Customer:

They didn't really say other than one other crown beside the two front teeth crowns, is also loose. I take methotrexate and Enbrel for Rheumatoid Arthritis and wonder if these drugs are contributing to bone loss or periodontal disease. Have you heard of this happening?

Dr. Care :

I agree that splinting is only a short term measure. Is the periodontist recommending the implants?

Customer:

Yes, he is and also do bone grafting along with the implants...Can a tooth suddenly fall out with 60 per cent bone loss?

Dr. Care :

It's more a function of how loose the tooth is rather than just pure bone loss. I have seen teeth with that kind of loss that are still stable.

Customer:

Are salt water rinses a good idea? What about vit c and d?

Dr. Care :

If the periodontist is recommending the implants, then he/she must think that bone grafting will take care of the problem. I would say that is OK if you are in general a good candidate with healthy gums. You would hate to do two implants and then in just a few years start having problems with other teeth in the area and risk loosing them. I don't think your medication is affecting your bone. That being said, it can be that a dry mouth can be the result of medications and that can cause changes in the mouths natural bacteria and saliva flow. Salt water rinses are good, but like vitamins will not cure anything.

Customer:

I might be on a course of having all my teeth replaced with implants...maybe one per year as I can afford them

Customer:

I am going to have a ct scan to get a better picture of the bone loss ...something he couldn't see with my dentists 2 d images

Customer:

One more question...have you heard of bone grafts being done and implant placed right away with a tooth ..I don't want to have to have a temporary flapper tooth...i hope this can be done in one shot

Dr. Care :

OK. Just as long as your bone level warrants it. I would have to take second seat to your periodontist that you're a good candidate. Sounds good with the scan. That way they/you will know if you're a good candidate. Good luck. Hope this eases your concerns.

Customer:

Well, are you saying that I should only really consider a bridge instead?

Dr. Care :

I don't see any surgeons I deal with doing grafts and implants at the same time. I think healing of the graft needs to occur first, which will mean a flipper.

Dr. Care :

Even with a bridge your perio health should be good, with very little compromise of the abutment teeth as far as bone goes. I am saying that everyone should be on the same page to agree that your bone health is suitable for implants.

Customer:

Ok, thanks for your opinion.

Dr. Care, DDS
Category: Dental
Satisfied Customers: 101
Experience: General Dentistry-private practice 21 yrs. Member ADA
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