My lower front teeth are loose! What do I do?

 

Some patients experience a loosening of their  lower front teeth. There are a couple of key causes of this. Many times the teeth are crooked which makes them very difficult to keep clean. With this alignment of teeth, periodontal disease is easier to develop leading to bone loss and subsequent mobility of the teeth. Trauma can also cause loosening of the teeth which is more severe when the teeth are already somewhat guarded due to some bone loss.

The first part of the treatment includes removing the teeth that are not salvageable. Usually it’s the four incisors (the lower front teeth) that need to be removed. Before the extraction an impression is made and sent to a laboratory to have a removable treatment partial fabricated. This appliance is delivered at the time of the extractions. It is mostly for esthetics but is usually difficult to use for chewing at that time.

The main choices for the final product are to have a fixed bridge or dental implants placed. A removable partial denture is also available.

The removable denture is the least expensive option. There are clasps placed on the partial denture to help keep the denture in while the patient bites into food. Without the clasping in the back the partial will lift when biting into food. The patient will experience this with their interim partial denture.

Another option is to have a fixed bridge placed. In this instance the canines (eye teeth) are prepared to receive a crown on each side and the missing teeth are connected. While healing, it is possible to have a temporary bridge fabricated which is more secure than the removable partial. If doing this, it is possible to have a temporary bridge made chairside at the time of the extraction and leave with a plastic bridge which will last for a few months. It usually takes 3 appointments for this: extract the teeth, do the drilling for a bridge and make a temporary bridge at appointment one; 6 weeks later when the gum tissue has healed and stabilized a bit, an impression is taken for the laboratory to fabricate the permanent bridge (made out of zirconium or porcelain fused to zirconium or metal); and the third and final appointment where the bridge is cemented. As long as there is enough bone on the canines to support a bridge, this approach works fairly well and lasts a long time.

The recommend option is to have a 4 unit implant bridge placed. This means that a dental implant is placed in the 2 furthest apart teeth to be extracted (the lower lateral incisors), and a bridge is cemented over the implants once they are secure. The surgeon has to make sure that there is enough bone to support the implant prior to implant placement. This approach has the greatest success rate because you don’t have to worry about the supporting teeth getting decay, fracturing or developing more severe periodontal disease if that is present. With either of these options the patient can chew into food comfortably, and it feels just like solid natural teeth. There are special instructions for home care which are easily learned and accomplished.