Thursday, February 5, 2009.

Dear Dr. Mady: Please help me. My lower front two teeth are really moving. I visited two dentists. First one says to remove the two teeth and fix it with the removable ones. The other says to take out all four lower front teeth and fix with the permanent ones. Please help me with your experience, what shall I do????? I got this site while browsing the net. As I am really worried, hope you can guide me towards the right direction. Thanking you in advance.......Santosh in Riyadh, Saudi Arabia

Dear Santosh, It sounds like you have a localized and possibly a generalized gum or periodontal disease problem. The lower anterior area of the mouth is a common spot for gum disease to grow at a more rapid rate. My concern is the rest of your teeth. What is going on with them?

Periodontal disease does affect approximately nine out of ten adults at some point in their lives and it may not even hurt or you may not even be aware that you have it until a more advanced stage. In the past you have probably experienced bleeding gums, red or swollen gums, gums that look like they have pulled away from the teeth, pus between the gums and teeth, loose teeth or ones that have changed position (can make your bite feel different) or constant bad breath.

In terms of treatment, it depends on the severity of the problem. It sounds like yours in severe in that area of your mouth, but before you start entertaining options of tooth replacement you better have a complete, comprehensive dental examination. This will partially involve the taking of intra-oral x-rays of all your teeth to determine levels of bone loss, measurement of the pocket depths between the teeth and gums where tartar collects and close examination of all the surfaces of the remaining teeth.
Gum disease may be related to genetic factors, lack of professional maintenance or poor oral hygiene and sometimes neglect. Your dentist will help you determine the cause and a plan of action to fight against this problem. What is important now is to stop tooth loss before more are gone.
The first step after a comprehensive exam is usually to remove plaque and tartar (calculus) deposits from above and below the gum line (scaling). The root surfaces may also be smoothed (planing) to decrease the chance of future plaque attachment and also to facilitate healing and reattachment of gum tissue to the teeth. In more advanced stages of the disease deep pockets can form between your teeth and gums that may even make it difficult for your dentist to do a thorough job. In this case, and possibly before, you may be referred to a Periodontist (gum specialist) for evaluation.
Because you are now losing teeth, do not let it go any further. Allow your dentist to treat it, educate you about it and how to control it, and put you on a proper monitoring and maintaining schedule. The longer you wait, the worse it will get.
After proper therapy to combat the gum disease, your dentist will re-evaluate your oral condition and at that point you can discuss replacement of teeth that could not be saved like your lower front ones. The options for replacing these missing teeth are a removable prosthesis (denture or partial denture), a fixed bridge or dental implants. As far as the bridge goes, it will be determined by the condition of the supporting structures on the teeth adjacent to the missing teeth areas because these teeth bill support the fixed bridge. It can be compared to building a house on sand. If you do, the house will wash away after a couple of storms. We are referring to the foundation for the teeth and bridge.
When discussing implants, there are many factors to take into consideration, including your overall health. Also if your gum disease in those areas was left undetected or treated until a more advanced stage, you may not have enough bone support for implants without some sort of bone grafting procedure.
If immediate esthetics is your concern, have a removable flipper or partial denture fabricated to wear for a few months while the area heals. At that point you can replace them with something more permanent or add to that partial if more teeth are lost.
For any questions, please e-mail Dr. Mady at or visit his blog at (dental education network) where you can comment on articles.
This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5


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