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Dentistry/Loose tooth

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QUESTION: Hello,

I nailed my face on a boardwalk while mounting biking 11 days ago.  My number 8 incisor went into my lip and caused me to have to get eight sutures.  The sutures have since been removed but my tooth is still loose.  I went to my dentist and she determined I still have nerve reaction (no bleeding or pain occurred after the accident).  She placed a wire that is held in place between the surrounding teeth to hold it in place while it heals.

She had mentioned that something like this causes the periodontal ligament to break and eventually the tooth dies and becomes discolored.  If I still have nerve function, how long long will this take to grab hold and hold my tooth properly?  Is there a chance that this is indeed a lost cause?  If so, how long will it take to discolor?

ANSWER: I am very sorry to hear about your accident and it appears to me your dentist did exactly the right thing and gave you solid information so if it helps any it seems you're in very good hands. To answer you she is correct it can damage the ligament which usually will heal but the greater problem would be the nerve and blood vessel that enters the tip of the root.  Bleeding inside the tooth from this blood vessel which has been broken is actually what causes the discoloration and if that did not break then your prognosis is pretty good.  It is impossible to predict this following such trauma and it's possible the tooth will still loose vitality but it does not mean that you will lose it.  If the tooth stabilizes from having been splinted and it the blood vessel has been broken then a root canal can be done and then the tooth can be crowned or capped with a white cap and you can keep it.  Usually the tooth will stabilize in about two weeks but occasionally it might be longer if the bone holding the tooth was damaged.  I don't think, from what you've told me, that this is a lost cause at all.  The time element on discoloration can be slow so if it slowly discolors over a month don't worry.  Even if it stays vital, the tooth can have a veneer or a crown placed and your tooth will look great.  Thanks for the nice question and if you need me to follow up please feel free to ask me.

Dr. Karmen

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QUESTION: Hello Dr.Karmen,

As we were discussing before, the blood vessel isn't broken and the nerve in my tooth is still working properly; is a root canal and crown necessary assuming the tooth doesn't lose color?  Is there a method to fuse my existing tooth to my jaw so I can eat an apple again?  I'm curious because it's been 9 days and I accidentally moved it this morning while eating breakfast and there is no sign of stabilization.  My follow-up appointment is on Wednesday but I figured I'd get some knowledge for my peace of mind before I go back in.

Thanks,
Luke

ANSWER: Hello again Luke,

I was under the impression that your dentist had fused the tooth, or stabilized it with a wire, I'm sorry if I misunderstood because if it was fused that way I would not have thought you could move it.  There are various methods of stabilization one is the wire that I thought had been used, the other is using a white filling material called composite resin to bond the tooth to another.  The last is a removable appliance that holds it in place, this last one being done rarely but it's an option anyway.  The tooth still might have had the blood vessel broken even though it appears to be vital, I'm not saying it is severed but sometimes this takes a while  To attempt to answer your question I'd say that by using some of the methods I've described one should be able to eat pretty normally as long as there is not any pain associated with the loose tooth. Give this some time and since you're going back in be sure and have your dentist check to see if the wire that had been placed has come loose since it had been placed initially.

If I can be of any further help please feel free to continue to contact me.

Dr. Karmen

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QUESTION: She did stabilize it but she warned that I should still avoid any use of that tooth because it's not a very strong stabilization method.  She was right; a very slight and unintentional bump showed no improvement in the stability of the tooth, even with the wire.

We'll see what happens when I go back in a couple days.  Thanks again!

Answer
You are welcome Luke, don't lose faith and make sure you are very careful of that tooth. To be honest it's not sounding great but there is still a chance.  I would have thought by now that it might be tightening a little but since you injured it again what you gained must have been lost.  I hope that the stabilization was reinforced and it sounds like your dentist is doing a great job.  I'll keep my fingers crossed for you.

Dr. Karmen

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Thomas Karmen

Expertise

All general dentistry questions, especially those related to fixed prosthetics. Endodontics, Periodontics, and implants, minor oral surgery I can't answer much about othodontics nor advanced treatment of carcinoma nor deep tissue surgery nor osseous surgery such as jaw reduction or advancement.

Experience

DDS In general practice and consulting with having done some lecturing for local dental societies.

Organizations
ADA and Florida Dental Association and Iowa Dental association

Education/Credentials
DDS degree

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