Is a loose tooth a joyous occasion or cause for concern? The answer depends largely on the age at which you experience it. For a first-grader, a loose tooth signifies a normal phase of development. For an adult, it means that it’s time to see a dentist—fast. Let’s examine in more detail the conditions that cause baby teeth and adult teeth to loosen.
Loose Baby Tooth
If you are old enough to read this, you have undoubtedly experienced first-hand the process of losing baby teeth. Our 20 baby teeth begin loosening and falling out around age 6, although it can occur a year or so earlier or later. What makes them do this? It’s actually the pressure from the permanent teeth growing beneath them. As the new adult teeth push up against the roots of the baby teeth, those roots are gradually broken down and absorbed by the body. Without support from its roots, the baby tooth becomes wobbly and falls out. When you look at a baby tooth that has been shed, you may notice that it appears to be just the top part; that’s not because the roots were left beneath the gum—it’s because they have been absorbed by the body.
Having a loose primary (baby) tooth can become uncomfortable and annoying—especially while eating. It’s important, however, for a child with a loose tooth to continue to eat healthy foods (soup may be a soothing choice) and to keep up a good daily oral hygiene routine. If your child wants you to pull the tooth out, you can grasp it with a tissue and give it a gentle turn. If it is resistant, don’t force it; the tooth will shed in time.
A lost tooth can sometimes leave a small wound. You can stop any bleeding with pressure from a wet washcloth or gauze pad. Then it’s time to put the tooth under your child’s pillow! The loss of the first tooth is the perfect occasion to remind children how important it is to take good care of their “forever teeth.”
Baby teeth are usually lost in the same order in which they erupted—first, the two bottom front teeth, followed by the four top front teeth. But if a baby tooth is loosened or lost before its time as a result of a traumatic dental injury, the child should see a dentist. If the tooth has been completely knocked out, the dentist may recommend a space maintainer. This is a small loop of wire that prevents the teeth on either side of the empty space from shifting toward each other. It holds the space open for the permanent tooth that will replace the lost baby tooth and helps ensure proper bite alignment.
Loose Permanent Tooth
As with baby teeth, permanent teeth can also become wobbly when they lose support—in this case, not from the disintegration of the tooth roots, but from the loss of tooth-supporting bone. This is usually caused by advanced periodontal (gum) disease—a bacterial infection that attacks the tissues that hold the teeth in place, including gums, ligaments and bone. It usually results from ineffective oral hygiene that leads, over time, to a build-up of dental plaque and hardened plaque deposits (calculus or tartar) on the tooth root surfaces beneath the gum line. If you have periodontal disease, you will likely need to see a periodontist (gum specialist).
A less common reason for permanent teeth to become loose is from severe teeth clenching or grinding habits. In other words, there is no disease present but the teeth are being subjected to excessive forces. It’s also possible for both to be the case—periodontal disease combined with clenching/grinding.
Permanent teeth can also become loosened due to a traumatic dental injury.
Regardless of what caused the problem, loose permanent teeth need immediate care to have the best chance of being saved. Treatment will be tailored to the individual situation, but may include any of the following:
- Deep cleaning: A thorough periodontal cleaning will remove plaque deposits and bacteria from all surfaces of the teeth. This is an essential starting point for dealing with gum disease.
- Splinting: Sometimes a loose tooth can be joined to its neighbors for added support with a splint—a thin piece of metal that is bonded to the back or tops of the teeth.
- Bite adjustment: Minute amounts of tooth enamel are removed to prevent the loose tooth from receiving excessive or misdirected forces, thereby protecting it and allowing healing to take place.
- Nightguard: A smooth, plastic oral appliance that resembles a sports mouthguard can be worn at night (or during stressful times) to reduce force on the teeth and jaws.
- Periodontal surgery: In certain cases of advanced disease, the periodontist may need to access diseased areas covered by gum tissue or rebuild tissue that has been destroyed by disease.
If you are experiencing tooth looseness, the best place to start is a consultation with your general dentist.