Tooth loss in adults

Can you remember the sensation of pushing on a tooth and feeling it wiggle? In childhood, this is a normal rite of passage. In adulthood, it’s a sign of trouble. If you are experiencing looseness (also called mobility) of any teeth, it is important to seek treatment from your dentist or periodontist (gum specialist) right away for the best chance of preventing tooth loss. While there is no one-size-fits-all remedy for this urgent dental condition, a treatment plan can be developed for you once the cause or causes of the mobility have been identified.

Before considering how adult teeth become loose, it’s important to understand how they are held in place to begin with. Many people picture teeth as rigidly fixed in bone, but they actually form in a way that allows them a bit of mobility. The bone beneath the gums does hold in the teeth, but the teeth and bone are not actually fused together. Instead, a stretchy network of fibers called the periodontal ligament (“peri” – around; “odont” – tooth) connects a tooth root to its surrounding bone. This important ligament acts as a tiny shock absorber, allowing the tooth to move imperceptibly whenever teeth touch during normal biting and chewing. However, sometimes the periodontal ligament gets stretched so much that the tooth becomes loose. What can cause this to happen?

Plaque Attack

We’ll start with gum disease, because this common inflammatory condition is usually present when adult teeth are loose. Gum (periodontal) disease is caused by harmful oral bacteria that thrive in dental plaque. In the absence of effective daily oral hygiene, bacterial plaque can build up on the teeth and start to inflame the gums. The signs of gum disease include redness, puffiness and/or bleeding of the gums. But these signs may not always be present—particularly in smokers, who have decreased blood flow to the gums.

Gum disease that remains untreated can spread to the bone beneath the gums, where inflammation (a natural part of the body’s immune response) may actually cause the bone around the teeth to shrink away. As the bone gradually decreases around the tooth root, so does the periodontal ligament. Eventually, in severe cases of periodontal disease, the connection between tooth and bone is essentially lost and the tooth is no longer functional or even falls out.

Treatment for gum disease can take a variety of forms depending on the severity of the problem. It usually starts with a thorough cleaning of the tooth-root surfaces just below the gum line to remove plaque and tartar (hardened plaque). Sometimes, a small flap of gum tissue needs to be opened up to access and clean an infected area. Topical antibiotics may also be applied to the diseased tissue.

When a significant amount of bone or gum tissue is lost, we can actually rebuild it using various grafting techniques that have become routine in dentistry. During the course of treatment, it may also be necessary to temporarily attach a loose tooth to neighboring teeth. This process, called splinting, helps support loose teeth until the tissues around them are healed enough to keep them in place. Splinting can make teeth more difficult to keep clean, so it’s important to spend extra time on oral hygiene until the splint is removed.

In Harm’s Way

Another cause of teeth becoming loose is dental trauma. This does not necessarily mean a blow to the face, although that type of trauma can certainly loosen teeth. However, there are other types of dental trauma that may occur repeatedly day after day.

For example, you may have one tooth that sticks up a little farther than the others. This could be because the tooth is not in proper alignment, or even because it had a recent filling that was not smoothed down enough. Every time you bite down, that tooth will be over-depressed so that the rest of the teeth can touch. This causes enormous stress on that one tooth—a problem that’s sometimes compounded by a teeth-grinding habit.

If gum disease is not present, this type of problem may require only a simple fix—smoothing down a “high” filling or removing a bit of tooth enamel to make the tooth level with its neighbors. Once that constant stress is removed, the body will repair itself and the tooth will tighten up again. If it’s an alignment issue, orthodontics may be suggested to move the teeth into proper position. But there’s one type of orthodontics that can actually cause loose teeth—and this is a very alarming trend.

Do-It-Yourself Disaster

I have seen patients lately who have attempted to straighten their own teeth with clear aligners ordered directly through the mail. Unfortunately, they did not see a dentist before starting treatment, so they were not informed that they had periodontal disease—which in fact is a very common condition affecting nearly half of all adults over age 30.

Moving teeth in the presence of periodontal disease (and certain other conditions) is a recipe for disaster. I can say with certainty that no board-certified orthodontist would ever have gone through with aligner treatment for these individuals until their inflammation had been brought under control. The bone loss and tooth looseness that occurs in this situation is sometimes irreversible—even with today’s most advanced regeneration techniques.

Another trend that causes trauma to teeth (with or without gum disease present) is tongue jewelry. I have seen tremendous damage done by tongue studs shaped like little barbells. If you have one of these, it’s easy to get into the habit of clicking the barbell against the back of the teeth, where the tissue is very thin. This can cause inflammation with devastating bone loss and tooth looseness—which, again, may or may not be reversible.

The Tissue Is an Issue

There’s one more factor to consider in diagnosing the cause of loose teeth, and that is the type of gum tissue that surrounds them. The mouth has two types of soft tissue: alveolar mucosa, which lines the inside of the cheeks and lips; and gingiva, a thicker, more resilient tissue that does a much better job of protecting tooth roots against inflammation and trauma. Some people are genetically predisposed to having more of one kind than the other.

If you have more of the thinner alveolar mucosa around your tooth roots, you may be more susceptible to gum problems and less resistant to dental trauma and inflammation. If that’s the case, it’s even more important to receive regular preventive care from a periodontist.

A Fork in the Road

A person experiencing tooth mobility usually has more than one treatment option and has to decide, with the help of their periodontist, whether to replace the loose teeth or to save them if possible. I look at this moment as a fork in the road, where we can go to the left or to the right—but whichever road we pick, it is unlikely we will be able to turn around and get back to the fork. So the patient needs to understand the long-term costs and benefits of each of their options.

I am a very big fan of retaining teeth, but this may involve bite adjustments, regenerative treatments and regular maintenance that can be costly. Therefore, sometimes replacing a tooth provides a more predictable route to long-term success. Today’s preferred tooth-replacement method is the dental implant—a small titanium post that anchors a realistic-looking prosthetic dental crown. In order for any treatment plan to be successful, the patient must be willing to make an ongoing commitment to periodontal care, which includes having professional teeth cleanings every three to four months.

When a tooth becomes loose, the most important thing is to have it examined promptly and to get a complete understanding of your treatment options. The sooner you seek treatment, the better your options will be.