Oral Surgery: Bone Loss and Bite Issues, implant insertion, adult teeth

Expert:

Joel S. Teig, DMD, FABOMS

Date:

Subject:

Question

This is regarding a loose, sensitive lower right molar. I am a 43 year old female. About 10 years ago a dentist noticed the loose molar, took x-rays, and told me I had bone loss around the tooth. My current dentist has been telling me that I need to do something about the tooth for the last 5 years, however, the tooth never gave me any problems or pain. At his suggestion, 3 years ago I saw a Periodontist - he did planing, and says he there was some evidence of grinding and has suggested a bite guard.

I keep my teeth very clean, floss, see dentist 2 times a year, and have never had any cavities in my adult teeth. I haven’t had any build up of plaque or decay around the tooth and no periodontal disease. He told me that there really wasn’t much that can be done about bone loss around a tooth and I will eventually lose the tooth, but has not recommended pulling it. But he did say the the tooth movement may impact the molar next to it and it does seem like the neighboring molar is getting a little loose. I also had my kid’s orthodontist look at my teeth, and apparently my bite is off (lower jaw is too small for my upper), and the back molar gets knocked when I chew.

Recently, the tooth seems more loose and it hurts a bit when I chew on that side. Also, the molar in front of the loose tooth seems to be getting loose, making think the bone loss is spreading. I know that bacteria and infection in the gums can effect your general health. In the last few years, I’ve had serious digestive/stomach acid problems.

I really want do something about the tooth, but I don't know who to see about it. No one seems to think anything can be done.

My questions...

I know you probably can't say whether I should remove the tooth or not, but:

If I keep the tooth, what can be done to regenerate, replace or repair the bone loss?

If the tooth is removed, what can be done to replace it?

What is Implant Insertion? Is it an option with or without pulling the tooth?

I'm pretty sure the problem has to do with my bite. (See pix) The orthodontist I saw thinks my lower jaw needs to be expanded, but at my age it would involve breaking my jaw. And he thinks I would loss the back molars anyway. I may consider surgical work primarily because I think my bite is impacting all of my molars to an extent. And I think overall my face would look better.

Is a bite issue called an "occlusal discrepancy"?

Any other ideas? So far, no one has given me any options.
Thanks much!

Answer
Maria - You don't say how old you are, but it is obvious from the pictures of your teeth that you have worn the teeth down. That wear is often due to bruxing or grinding of the teeth. The act of grinding could be the initial cause of the teeth loosening. If you have extensive bone loss, removing of the tooth and insertion of an implant in that location may be the best long term solution, but it should not be done until the grinding that occurs can be resolved.

You really need you bite properly examined and you need to stop grinding your teeth. Fabrication of an appliance which you wear at night can help, but you need to see a doctor who can fully address the grinding before anything else is done.

I don't know doctors where you live to help you, but it may not be a bad idea to get examined by a local board certified oral and maxillofacial surgeon. The surgeon may be able to define the cause and might know an appropriate doctor to help. Once the extreme pressure on the teeth is relieved, you can fully address the loose tooth and the necessity for removal and replacement with an implant.

So look up a surgeon in your area and get an evaluation.

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Topic: Oral Surgery