The most common cause of loose and sensitive teeth is periodontal disease. Periodontal disease includes gingivitis (inflammation of the gums) and periodontitis (inflammation of the periodontium). The periodontium is the structure that surrounds the teeth and holds them in their sockets. Periodontal disease is an infection that can cause teeth to become loose and eventually lost.

Periodontal disease is most often caused by bacterial plaque that surrounds teeth. Bacterial plaque is a sticky film that continues to form around teeth. If it isn’t removed constantly, it can continually build up and form calculus (calculus is just a hardened form of bacterial plaque). There are a number of other causes of periodontal disease.

Causes of Periodontal Disease

• Smoking: smoking causes shrinkage of some blood vessels, hence the periodontium is affected by not having enough blood flow and oxygen. Smokers tend to lose teeth more than non-smokers, because of periodontal disease.
• Hormones: gum tissue are sometimes affected by hormonal changes, for example during pregnancy or menopause
• Genetics: some individuals are more prone to periodontal disease, despite proper oral hygiene practices, because of genetic factors. Early diagnosis and treatment may help to save teeth in such individuals.
• Diabetes: diabetics have a higher risk of developing infections, including periodontal disease. Healing is also slower with diabetes, making periodontal disease a greater concern with respect to oral health. Diabetes, though not the only reason, may be a cause of necrosis (tissue death due to lack of blood and oxygen).
• Poor Nutrition: a diet that is low in necessary nutrients affects the body, including the oral cavity. Periodontal disease is a distinct infection that may worsen with poor nutrition.

Treatment of Periodontal Disease

In many cases, an individual may have had long standing or severe periodontal disease, and some teeth (in other cases, all of the teeth) cannot be saved. In these cases, extractions may be the only viable option, with replacement of the missing teeth with implants, bridges or dentures. Other treatment options are available for treating periodontal disease, each option depending on individual cases/.

• Scaling and root planning: this involves professional cleaning of plaque and calculus from root surfaces and periodontal pockets. This is the most common method used to treat periodontal disease.
• Periodontal surgery: if the tissues around the teeth are determined to be unhealthy, periodontal surgery (there are more than one types) may be necessary to treat the periodontal disease. Periodontal surgery can help to improve function.
• Cosmetic methods: this can be done to improve a patient’s appearance, smile and function, if for example a lot of roots are exposed by the periodontal disease.

Each individual’s case of periodontal disease is different, so the necessary treatment may be different for each patient. An individual with a diagnosis of periodontal disease, especially long standing or advanced, can be treated by a periodontist (a dentist with specialized training in diagnosing, preventing and treating periodontal disease). You can be referred to a periodontist by a general dentist, or be treated by a general dentist. Please be pro-active in a consulting with your dentist for a comprehensive evaluation, diagnosis and treatment.

We hope this helps!

I got into a fight on New Years eve, and took a pretty good punch to the mouth. My gums were bruised, and the gum on my right front tooth receded so that part of the root is visible.

Any help would be greatly appreciated, thanks.

Answer:

Well there are a couple of things to take into consideration when looking at your scenario.  For starters, is the tooth mobile?  This plays a HUGE role as to whether the tooth will “heal” or not.  If mobile, the tooth may need to have a splint attached by the dentist to immobilize the tooth so that healing can begin to occur.

We will answer your questions under the assumption that the tooth is not mobile.

Will it heal?

Yes and no.  Yes in that the periodontal ligaments (the fibers that attach the tooth to the socket and bone) have undergone extensive trauma and will begin to reattach so that the tooth can function normally.  No, in that the gums that have receded will not grow back over the exposed root without assistance from the dentist.  What will actually happen is that the pdl fibers will reattach on the remaining gingiva (gums).

Will I require dental surgery?

Yes.  You will need something referred to as periodontal plastic surgery (believe us, sounds much more complicated that what it actually is).  The dentist uses a free gingival graft or connective tissue graft to cover the area.  This means that he/she will remove some gum tissue from one part of your mouth, and place it over the area of recession in order to stimulate growth.

Do I need to avoid smoking?

Yes is an understatement!!  Smoking severely compromises the amount of blood supply to your gums.  Insufficient blood supply=delayed healing!

Will it get infected if I don’t take care of it?

Let’s consider the anatomy of teeth when looking at this question.  Unlike the crown of the tooth, which is covered by enamel, the root of the tooth is covered by a substance called cementum.  The composition of cementum is a little different than enamel, as it was made to function below the gums, and not actually in the mouth like enamel.  This means just continue to practice good oral hygiene, which means brushing after each meal and flossing once a day.  Be sure not to let food or any other debris accumulate in this area.

What are the signs that the tooth is dying besides turning dark?

This varies.  Some signs can include sharp pain, increased sensitivity, a long, dull, continuous pain, sensitivity to hot, cold, or when chewing, or, as you mentioned, color change.  Also, a tooth can undergo the process of necrosis (dying) with no signs or indications.  A dentist can run several tests to determine whether the pulp is still vital.

We hope these answers helped you out.  In a situation like this, it’s pretty hard to tell exactly what’s going on without running some tests and taking a look clinically.  But hopefully these answers can guide you down the right path.  It’ll be best to go to the dentist and have an x-ray taken of the tooth and a couple of diagnostic tests performed to determine the status of the tooth.  Don’t wait too long to visit the dentist, especially if the tooth is mobile.

Hope this helps and good luck!!