Dr. Robert Thein's Implant Dentistry Blog

I have had periodontal disease for about 5 years, since menopause. I have it currently under control and healed completely, no bleeding. My problem is one slightly loose tooth in the front. This tooth has had a root canal about 40 years ago and though slightly discoloured is still a perfectly good tooth without any caps or veneers on it. This tooth has become slightly longer than other teeth around it and hurts when I bite with it. I would like to keep this tooth and if possible push it back up a little. X-ray shows of course bone loss. Would a type of dental support stint applied on each side of the tooth help to keep it in place and with some pressure drive it back up where it belongs? What can be done to save this good tooth?
- Connie from Ontario

Connie,
If you have a front tooth that is a little loose and is getting a little longer than the adjacent teeth (we call this “extrusion”), yes there is a fairly simple way to treat that.

If the adjacent teeth are strong and your gum disease is under control, as you say it is, the teeth can be splinted together. The longer tooth probably can’t be pushed back up to where it was before, but it can be stabilized, because it will continue to drift. Then this tooth could be re-shaped so that it blends in with the others.

There are various ways to splint the teeth. It can be done as simply as just bonding a wire to the inner surface of the teeth. Or there are various mesh products that a dentist can use. The mesh fabric is a narrow strip, and it forms a matrix for the bonding material and is bonded again to the inside surfaces of your front teeth.

Once they are splinted together, you will need a special floss threader in order to get floss between these teeth, and it will be very important for you to be conscientious about keeping these clean, or you could end up losing all of the teeth to gum disease.

Links:
Click here to read more about periodontal disease  (gum disease).
Read about replacing a missing tooth on our bridge vs dental implant page.

My periodontist wants to do osseous surgery on teeth # 1,2,3 & 4. I had flap surgery done 8 years ago on all 4 sides and I have since that time had cleanings done every 3 months religiously. So far I have managed to keep things quite stable, until recently in this one area. I want to retire soon. What should I do? I already have too many teeth missing and it’s too sad to think of losing even more. Your thoughts please? Thank you kindly.
- Joanne from Wisconsin

Joanne,
The answer to your question depends entirely on what your periodontist is seeing in your mouth.

I can tell you that there has been a lot of new thinking on periodontal surgery in recent years, and that the profession is tending toward trying to manage periodontal disease with less surgery than used to be done. But whether or not the surgery would be good for you, that I can’t tell you.

If you have these doubts, I would just suggest a second opinion from another periodontist. But when you do that, don’t give the second periodontist any clue as to what the first one said, and don’t let him or her know who the first periodontist is. You want a completely blind second opinion, uninfluenced by any outside forces. So you would need to ask for a copy of the x-rays and take that to the second periodontist.

Links:
Read more about Los Angeles gum disease treatment.

Hi! Thank you for your availability.

I am going to get dental bridges or dental implants. The problem is I am thinking I do not need deep root planing as I have no bleeding or anything extraordinary going on with my gums. Other dentists haven’t said I needed anything like root planing. But in this office, the lady in the office said the dentist will not do my bridges until I did the deep root planing. I am afraid for the enamel on my teeth for all of that scratching and scraping for no apparent reason. Then unnecessary anesthesia and days off. Please advise. How do I know if I really need that deep root planing. There was nothing wrong with my gums. I had fast healing with the tooth extractions and there is no infection. I did not even need to take all of that antibiotic or pain meds. I feel like such a victim here. I want to get the bridges as soon as possible but all of that other is scaring me that it is ruining my good teeth.
Mary from Louisiana

Mary,
There is much neglect going on in the dental profession with regard to gum disease. Because there are often no symptoms to gum disease until it is quite advanced, many dentists don’t like to deal with it. It’s so hard to convince skeptical people like you that they need gum disease treatment, and they face pressure from insurance companies to shortcut this area. So their life is simpler if they just don’t deal with it.

I can’t tell from here whether you have gum disease or not. But if you wait until you have symptoms, it will be too late to save your teeth. Yes, there is trust needed in this dentist-patient relationship. From what you told me, it sounds like your dentist has principles and is trustworthy. Here’s the way I see your case. The profit in your case is in the bridgework or the implants. The dentist who is it it only for the profit motive would want to get you as quickly as possible into this expensive work. Insisting that you have the root planing first is taking a very real risk that you will bail out before completing the treatment. To me, this is an evidence of your dentist’s integrity. Implants are also vulnerable to gum disease, and gum disease should be brought under control before any implant surgery is undertaken. Why go through all the expensive bridge and implant work only to have your teeth and implants fall out later due to gum disease?