Expert: Frederick R. Liewehr DDS, MS, FICD - 11/6/2007

Question
Hi Dr. Liewehr,

I have a tricky situation here.

I had impact trauma on my front teeth while rollerblading when I was 12 years old. I'm currently 23 years old.

Now with wisdom teeth coming in on all four corners of my gum, I feel pressure constantly on my teeth especially my front teeth.

My right front tooth is pushed upwards...due to the overcrowding.

But on a recent trip to a dentist, she said that my right front tooth seems to be a little discoloured from the rest of my front teeth... a little darker. Then I told her about my impact trauma when I was 12.

She took an x-ray and the x-ray seems fine, no infections going on but a little bone loss on both right and left front teeth. Now she says she suspects my right front tooth is dying slowly and thus the tiny discolour, which is only visible if you look closely enough. WHAT???

I had an x-ray done early this year in January 2007 with another dentist, and I told the dentist about my trauma, wisdom teeth eruptions, pressure etc.

She checked the x-ray and my front teeth and said the right front tooth is not dying, because otherwise the colour change would be very significant.  

The x-ray is here http://aycu36.webshots.com/image/31475/2005841764687126955_rs.jpg


So now the two dentists are saying different things...

I just did a check on Abscessed Tooth Symptoms at http://www.webmd.com/oral-health/tc/abscessed-tooth-symptoms

And I think I might have these symptoms:
"A feeling that the tooth is being raised out of its socket..."

and my two front teeth are a tiny bit shaky... I discovered very tiny movements when i bite my teeth together and open up my jaws by placing my finger on the front teeth. My left front tooth's movement is a tiny bit larger than the right front tooth, up (when jaws closed), down (when jaws open). I think it's due to bone loss, i don't have the habit of drinking milk. what can i do to rectify this bone loss situation? spinters?

and

Is my right front tooth being raised out of its socket? It seems like it's being pushed upwards though... possibly by the overcrowding. But i'm not sure what you mean by "raised out of its socket"... (you can take a look at the photos below).

I think my right front tooth feels a little different. And I just tested putting ice on my front teeth and see if there's any abscess tooth... yes there is pain when ice gets in contact with my teeth but the pain goes away after the ice is removed.

Now after scaling done by the dentist yesterday, my gums feel a little sore...all around. is it normal? Especially the gum above my right front tooth is really sore... like i am sensitive to the pain around that area...

is it possible for an traumatised tooth to die slowly over 11 years, showing slight discoloration after that?

I want to make sure there's no possibility of my right front tooth as being abscessed.

Pls take a look at the x-ray i had done in Jan 2007.
http://aycu36.webshots.com/image/31475/2005841764687126955_rs.jpg

The rest photos are current close up shots of my front teeth.
http://aycu18.webshots.com/image/31977/2005844069334819457_rs.jpg
http://aycu11.webshots.com/image/34770/2005828334156796328_rs.jpg
http://aycu18.webshots.com/image/32657/2005856633682688944_rs.jpg
http://aycu17.webshots.com/image/32736/2005861970110078809_rs.jpg
http://aycu31.webshots.com/image/32630/2005895040659229727_rs.jpg
http://aycu04.webshots.com/image/32763/2005832687165642987_rs.jpg
http://aycu35.webshots.com/image/34114/2005844422649758976_rs.jpg
http://aycu34.webshots.com/image/34113/2005885145148335384_rs.jpg
http://aycu34.webshots.com/image/34113/2005835560667035549_rs.jpg
http://aycu37.webshots.com/image/34236/2004396600849102894_rs.jpg
http://aycu21.webshots.com/image/31580/2004308366547657937_rs.jpg


Please take a good look at these photos and tell me what I should do now....about my front teeth, especially the two front teeth in question.

Please answer my doubts Dr. Liewehr...

Merci Beaucoup!

Yours truly,
C'est Moi

Answer
Well, "It's Me", I must say, nobody has ever sent photos and radiographs; a good idea. Unfortunately, a panorex is not what I would need, and this one did not scan well, so I can't see a lot. The photos are OK, but not ideal. So, I can't be certain of what I am telling you. However, from what I can see, you have a slightly yellowish tint to your tooth, and it looks like the pulp space is obliterated on the radiograph (it is not clear, so I can't be sure). The color is consistent with this, however. This means that, as a result of the trauma, the odontoblasts (cells that make dentin) in your pulp have created a dystrophic mineralization which has filled the root canal space. This is why the tooth is yellow - it is the extra dentin you are seeing. That is a common reaction after trauma, where the pulp does not die, but is injured enough to do this mineralization bit. Sometimes the pulp dies after this process, but not often. The key is to test the pulp, which your dentists don't seem to know enough to do. One way is with an electric pulp tester, but the easiest is with cold. You cleverly did this yourself, and some pain with no lingering is the mark of a healthy tooth. Often with the added dentin, it takes a while longer to feel the cold, or you feel it less, than with the other teeth, but at least you feel it. If you put your finger on your front teeth and bite, you should feel no movement, because your front teeth should not contact in centric occlusion. However, they were probably jumbled as a result of the trauma, so you may need a little selective grinding to remove this prematurity. As for bone loss, a pano is not the radiograph I need, and particularly one that does not show up well, but I see no signs of horizontal bone loss. Probing is the necessary test for that, however. Once you have your bite adjusted so you don't bang your teeth together in centric (they hit every time you swallow), they should tighten up. The cleaning just hurt your gums; they will heal.

So, forget about an abscess, you are fine. You should have a competent dentist test your tooth for vitality every year or so, just to make sure it keeps on being healthy. Right now, however, you seem in good shape.