As a child, having a moving tooth is normal: the baby tooth has to fall out for the final one to grow and take its place. In adults, on the other hand, a loose tooth is a warning sign that should not be taken lightly.

When brushing or under finger pressure, the tooth is no longer stable.

When it comes off, the tooth appears longer and its root may appear above the gum which has retracted. It is not uncommon to observe bleeding when brushing your teeth. In advanced periodontitis, infected pockets can form between the gum tissue and the surface of the tooth root.

Periodontal disease

Without regular tooth brushing, bacteria from food debris produce toxins that form dental plaque, which in turn calcifies to form tartar. This tartar, if it is not removed regularly, risks attacking the gum tissue and causing gingivitis. The gum is then swollen, dark red and bleeds at the slightest contact. Left untreated, gingivitis can progress to periodontitis. It is an inflammation of the periodontium, that is to say the supporting tissues of the tooth composed of the alveolar bone, the gum, the cementum and the alveolar-dental ligament. Periodontitis can affect a single tooth or several, or even the entire dentition. If not treated in time, the teeth begin to move gradually and there is a gingival recession: the tooth is said to “come loose”. This loosening can lead to loss of teeth.

Several factors can contribute to the appearance of periodontitis: certain genetic factors, smoking, infection, poor diet, alcohol, taking certain medications, pregnancy, wearing an orthodontic appliance, etc. Periodontitis can also be a manifestation associated with certain general illnesses, such as diabetes.

Bruxism

This pathology, which affects 10 to 15% of the French population, manifests itself either by the grinding of the lower teeth against those at the top when one does not chew, or by the continuous tightening of the jaws, mainly at night. Bruxism can cause wear, loosening or even fracture of the teeth, as well as the loss of dental tissue (enamel, dentin and pulp).

Trauma to the tooth

Following a shock or a fall on a tooth, it may have shifted or become mobile. We distinguish :

• incomplete dislocation or subluxation: the tooth has moved in its socket (its bone cavity) and becomes mobile;
• the root fracture: the root of the tooth has been reached;
• alveolodental fracture: the supporting bone of the tooth is affected, causing the mobility of a block of several teeth.

A dental x-ray is necessary for the diagnosis.

Orthodontic treatment

Orthodontic treatment with too strong and too rapid traction on the tooth can weaken the root.

Tooth loss

Without proper treatment or support, a loose or loose tooth is at risk of falling out. In addition to cosmetic damage, an unreplaced tooth can lead to various complications. A single missing tooth is enough to cause migrations or premature wear of other teeth, gum problems, digestive disorders due to insufficient chewing, but also an increased risk of falls. In the elderly, the loss of a tooth without replacement or an ill-fitting prosthesis indeed promotes instability, because the jaw joint helps to maintain balance.

The general risks of periodontitis

Untreated, periodontitis can have repercussions on general health:

• a risk of infection: during a dental infection, germs can spread in the blood and reach the various organs (heart, kidneys, joints, etc.);
• a risk of worsening diabetes;
• an increased risk of cardiovascular disease;
• a risk of premature delivery in pregnant women.

Treatment of periodontitis

Treatment depends on how advanced the inflammation is. After a disinfection treatment aimed at cleaning up the mouth, a complete cleaning of the teeth, their roots and the gums is carried out in order to completely eliminate bacteria and tartar on the teeth and in the interdental spaces. In the presence of periodontal pockets, a probing of the pockets will be carried out. We talk about root planing. Antibiotic treatment may be prescribed.

If the periodontal disease is advanced, recourse to periodontal surgery may be necessary with, depending on the situation, the realization of a sanitizing flap, bone filling or tissue regeneration.

Treatment of bruxism

Strictly speaking, there is no treatment for bruxism. However, the risk of tooth wear can be prevented, for example by wearing orthoses (splints) at night.

Behavioral management of stress is also recommended, as it is one of the known factors of bruxism.

Tooth that moves after trauma

After the shock, it is recommended not to touch the tooth and to consult a dental surgeon without delay. Support will depend on the situation:

• in the event of incomplete dislocation, the tooth will be repositioned and a retainer in place, by bonding to adjacent teeth. If necessary, orthodontic traction will be put in place in order to correctly reposition the tooth;
• in the event of a root fracture, the management depends on the location of the fracture line, knowing that the deeper the root fracture, the more the maintenance of the tooth is compromised. For fractures of the proximal two-thirds, an attempt to save the tooth may be undertaken using endodontic treatments with hydroxyapatite to heal the fracture:
• in the event of an alveolodental fracture: reduction and restraint of the mobile dental unit are performed.

In all cases, careful and prolonged monitoring of the tooth is necessary. A change in color in particular indicates devitalization of the tooth.

Replace a tooth

If the tooth eventually falls out, there are several ways to replace it:

• the dental bridge makes it possible to replace one or more missing teeth. It connects one tooth to another tooth and thus fills the space left empty between the two;
• the dental implant is an artificial titanium root implanted in the bone. It can accommodate a crown, a bridge or a removable prosthesis. If the bone is not thick enough to implant the screw, a bone graft is necessary;
• a removable appliance if several teeth are missing, if there are no abutment teeth for placing a bridge or if the implant is impossible or too expensive.

Prevention

Dental hygiene is the key axis of prevention. Here are the main rules:

• regular brushing of the teeth, twice a day, for 2 minutes, in order to eliminate dental plaque;
• daily flossing every night to remove the plaque that remains between the teeth and cannot be removed by brushing the teeth;
• an annual visit to the dentist for a dental check-up and scaling.

It is also advisable to stop smoking.