Loose Teeth

Biting Forces Can Loosen Teeth

Dear Doctor,
I haven't been to a dentist in years and my teeth feel loose. Am I going to lose my teeth or can something be done to save them?

Healthy Tooth: A healthy periodontal attachment of a tooth to bone and gum tissue receives normal biting forces with no apparent looseness.

Primary Occlusal (Bite) Trauma: Excessive forces from clenching and grinding habits can cause stretching and widening of the periodontal tissues that result in tooth looseness.

Secondary Occlusal (Bite) Trauma: Even normal forces can cause tooth looseness, when bone support has been lost due to periodontal (gum) disease.

Dear Mort,
Tooth looseness more often than not is a fairly late sign and symptom of periodontal (gum) disease. Untreated, this inflammatory disease caused by bacterial biofilm (dental plaque) destroys the supporting structures of the teeth, most importantly, bone. As bone is progressively lost, teeth gradually become loose and are unable to withstand normal biting forces. Inevitably, as the disease progresses, unabated and untreated, the teeth become so loose and uncomfortable they will be lost.

There is another less common reason for teeth becoming loose in the absence of bacterially induced inflammatory disease: excessive biting forces. Some people who clench or grind their teeth place so-called parafunctional forces on their teeth, i.e., forces outside the normal range. This can in effect stretch the periodontal ligaments, which join the teeth to the supporting bone, with the result that the teeth become loose.

In both cases the name for the condition of tooth looseness is “occlusal trauma” (“occlusal” – bite; “trauma” – damage or injury). It is useful because it helps both to define and treat it.

In primary occlusal trauma, where the forces are excessive but the amount of bone supporting the teeth is normal, the treatment approach is to reduce the forces:

• In amount;
• In frequency, how often they are applied; and
• In duration, how long they are applied.

Generally, parafunctional forces can be 20-30 times normal and can be very destructive. Treatment is aimed first at treating symptoms, which can affect the jaw joints (as in TMD syndrome), the jaw muscles generating the biting forces, or soreness of the teeth themselves. Minor muscle relaxants such as diazepam and anti-inflammatory medications such as aspirin or ibuprofen are helpful. Custom occlusal (bite) guards properly fitted and adjusted help reduce the high forces and the habits that cause them.

In secondary occlusal trauma, where gum disease has caused excessive bone loss, even normal biting forces can be damaging. Treatment must always be aimed at removing the cause. Since gum disease is bacterial in origin, removing the bacterial biofilm is key to controlling disease. This requires instruction and training in daily effective oral hygiene along with a thorough, professional cleaning of the root surfaces of the affected teeth. Often, the healing of the periodontal (gum) tissues and reduction of inflammation causes some tightening of the teeth.

It may also be helpful for your dentist or periodontist (a specialist in the gums and other structures that support the teeth) to adjust or reshape the biting surfaces of the teeth so that they receive less biting force and can withstand the forces they do receive more easily. This is accomplished by carefully reshaping (by drilling) minute amounts of tooth surface enamel to change the way upper and lower teeth contact each other, to redirect and lessen force. The teeth can even be “splinted” — joined together like pickets in a fence — to better withstand the loss of bone support in severe cases of looseness.

A Lot Can Still Be Done

In summary, it is not inevitable that you will lose your teeth, but looseness is not a good sign. The problem of loose teeth, as you can see, is complex but treatable. You should see your general dentist or a periodontist immediately for a complete and thorough examination to determine the cause and severity of your condition and what can be done to save your teeth.