Tooth Mobility: Causes and Treatment Options for Periodontal Disease

Teeth may become loose?

Hello, Doctor.
I would like to ask for your advice.
I have been seeing Dr.
A for dental care for many years.
During a cleaning, Dr.
A mentioned that my lower right second molar is loose, indicating periodontal disease, and that the first molar next to it has a small bump at the gum line, which is also related to periodontal disease (the first molar and the two anterior premolars form a dental bridge).
I thought that a loose tooth due to periodontal disease indicates a late stage, so should I seek treatment promptly? However, Dr.
A only advised me to brush my teeth diligently and return for a cleaning in six months, suggesting that my tooth count is insufficient, implying no treatment.
I went to another dental clinic to consult Dr.
B for a second opinion.
Dr.
B, who does not perform periodontal treatments, took a full-mouth X-ray and noted that the first molar had undergone root canal treatment years ago (with a post) and that the root is inflamed, as there is a shadow at the root area on the X-ray (which I also observed).
However, there was no significant bone loss evident around the loose second molar on the X-ray.
Dr.
B assessed that the gum tissue appeared only mildly receded and used a hook to measure the pocket depth (though his hook is not the type specifically designed for periodontal probing).
He indicated that the pocket around the loose second molar felt shallow, stating that it was present but not severe, while the first molar with the root inflammation had a deeper pocket with bone loss.
I asked Dr.
B what could be causing the looseness of the tooth, but he was uncertain and suggested that we first address the root inflammation of the first molar before reassessing.
He did not believe it was a periodontal issue.

I would like to ask you:
1.
Can inflammation of the root of the anterior tooth cause the adjacent tooth to become loose?
2.
If the second molar, which has been filled with amalgam, suddenly breaks a corner after many years without biting anything hard—just eating bread—could this be a reason for the tooth becoming loose? Dr.
A mentioned that teeth filled with amalgam can experience pressure and may eventually fracture, advising to repair it when it breaks until it can no longer be repaired.
Could this be a contributing factor to the looseness of the tooth years later? (The wisdom tooth behind it has been extracted.)
3.
Given that Dr.
B did not use a specialized periodontal probe but rather a general dental hook to assess pocket depth, along with the X-ray indicating that the periodontal condition is not severe, can I temporarily feel relieved and rule out that this is a late-stage periodontal disease where the tooth may fall out?
4.
Can root inflammation also lead to bone loss around that tooth? Dr.
B believes that regardless, the root inflammation must be treated first, possibly requiring a microscopic root canal procedure, which may take some time.
Therefore, I want to confirm whether the looseness of the tooth is indeed a periodontal issue.

I apologize for the lengthy inquiry, and thank you, Doctor.

gigi, 40~49 year old female. Ask Date: 2017/11/23

Dr. Zeng Guanghui reply Dentistry

1.
Severe inflammation of the tooth root in the anterior teeth can lead to significant apical lesions, causing adjacent teeth to become mobile.

2.
If a previously filled amalgam restoration has cracked and remains untreated for an extended period, it can allow bacteria or food debris to gradually infiltrate the restoration and the tooth, leading to caries and inflammation of the periodontal and pulp nerves.
If the periodontal infection is severe, it can result in tooth mobility.

3.
Once a periodontal pocket is present, even if it is not deep, treatment is recommended to prevent the pocket from deepening over time.

4.
When inflammation of the tooth root becomes severe, resulting in destruction of the apical bone, the surrounding alveolar bone may also be progressively resorbed.
Therefore, it is necessary to consider retreatment with root canal therapy or to perform microsurgical intervention for remediation.

Reply Date: 2017/11/23

More Info

Tooth mobility, particularly in the context of periodontal disease, is a significant concern that can indicate underlying dental issues. Based on your description, it seems you are experiencing a complex situation involving multiple teeth, some of which have undergone previous treatments. Let's address your questions systematically.

1. Can root inflammation of one tooth lead to mobility in adjacent teeth?
Yes, root inflammation, particularly from a tooth that has undergone root canal treatment, can indeed affect neighboring teeth. The inflammation can lead to bone loss around the affected tooth, which may compromise the stability of adjacent teeth. If the first molar has an infection at the root, it can create a domino effect, weakening the supporting structures of nearby teeth, including the second molar that you mentioned is mobile.

2. Could the fracture of the second molar be related to the previous silver filling?
It is possible that the silver filling (amalgam) could contribute to the structural integrity of the tooth over time. Amalgam fillings can expand and contract with temperature changes, which might lead to stress fractures in the tooth structure, especially if the tooth has been subjected to significant chewing forces. If the tooth has a history of heavy use or if there are existing cracks, even normal activities like eating soft foods could exacerbate the situation. However, it is essential to have a thorough examination to determine the exact cause of the fracture.

3. Can I relax regarding the periodontal disease status if the probing was done with a standard instrument instead of a specialized periodontal probe?
While a standard instrument can provide some information, it is not as reliable as a specialized periodontal probe designed to measure pocket depths accurately. The absence of significant probing depth does suggest that the periodontal condition may not be severe, but it does not completely rule out periodontal disease. It is essential to monitor the situation closely and consider a follow-up with a periodontist who can provide a more comprehensive evaluation.

4. Can root inflammation lead to bone loss?
Absolutely. Root inflammation can lead to a condition known as apical periodontitis, where the infection at the root apex can cause surrounding bone to be resorbed. This bone loss can contribute to the mobility of the affected tooth and potentially impact adjacent teeth as well. If the inflammation is not addressed, it can lead to further complications, including the potential loss of the tooth.

Given your situation, it is crucial to prioritize the treatment of the root inflammation as recommended by Dr. B. Once that is addressed, a clearer picture of the periodontal health of your second molar can be established. It may also be beneficial to seek a second opinion from a periodontist, especially if you have concerns about the mobility of your teeth and the overall health of your gums.

In summary, tooth mobility can stem from various factors, including periodontal disease and root inflammation. It is essential to address these issues promptly to prevent further complications. Regular dental check-ups, maintaining good oral hygiene, and addressing any dental concerns as they arise will be key to preserving your dental health.

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