Why does part of my tooth feels loose?

On Monday a patient came in with the following complaint- Something feels loose in my mouth. I asked him when he noticed it and he said he had been eating ice cream with frozen m&ms in it and he bit down on a particularly hard M&M when he noticed it. I looked in his mouth where he pointed and at first I didn't see anything wrong, but on my second look I noticed that the lingual cusp of his second bicuspid (#13) could be wiggled with my explorer. This was not a good sign since it indicated that his lingual cusp had fractured off and it appeared to have fractured deep under the gum to boot.

Sometimes when a patient complains about something moving it can turn out to be a loose filling or sometimes it is a smaller section of the tooth that fractures, but in this case the amount of tooth that was fractured made me suspect that his tooth had a poor prognosis.

I had my assistant take an X-ray and explained that I would numb him up and remove the broken and wiggly cusp, but I had a strong feeling that things didn't look good for his tooth. After removing the loose piece of his tooth it was apparent that his best and most straight forward option was to remove tooth #13 and have an implant placed  after bone grafting the socket.

My patient understandably was shocked and we discussed his other options ... Root canal, crown lengthening  followed by a post and crown. Aside from being expensive, this option would remove supporting bone from the adjacent teeth and might not be as a predictable option as having an implant restoration. Another way of saving the tooth involves endodontics, post and core and orthodontic extrusion, followed by crown lengthening procedures and a crown. This last option would be the most lengthy but probably would allow him to save tooth #13 without compromising either of the adjacent teeth.

After further discussion, my patient seemed to better understand the need for removing his broken tooth and he went to my colleague Dr. Philip Pack to remove #13 the following day.  Afterwards he stopped by and he was fine. The procedure went well and he felt reassured that he had done the right thing.  I explained that if he wanted , in a week or two we could take an impression for a flipper ( a one tooth all plastic denture) to temporarily replace #13, but it wasn't necessary for him to do so in order to complete his implant treatment. It would allow him to smile broadly without his missing tooth being visible.




from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2018/07/why-does-part-of-my-tooth-feels-loose.html - http://lspindelnycdds.blogspot.com/

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