Loose teeth resulting from gum disease, medically known as periodontitis, signal a serious compromise to the structures anchoring the teeth within the jawbone. Periodontitis is a chronic bacterial infection that triggers an inflammatory response, leading to the progressive destruction of the tooth’s support system. This support system consists of the alveolar bone and the periodontal ligament (PDL). When these tissues are damaged, the tooth loses its stable foundation, resulting in increased mobility. Immediate professional intervention is necessary to halt the disease progression and attempt to restore the tooth’s stability.
Treating the Periodontal Infection
The first step in addressing loose teeth is the complete elimination of the bacterial infection that is actively destroying the supporting tissue. Periodontal disease creates deep pockets between the gum and the tooth root, which become reservoirs for plaque and calculus, or hardened tartar. This environment is inaccessible to routine brushing and flossing, requiring professional deep cleaning to disrupt the bacterial colonies.
The primary non-surgical procedure is scaling and root planing (SRP), often referred to as a deep cleaning, which is performed under local anesthesia to access the infected root surfaces. Scaling involves meticulously removing plaque, toxins, and calculus deposits from both above and below the gumline. Following this, root planing smooths the tooth root surfaces to eliminate rough spots where bacteria can easily hide and to allow the gum tissue to reattach to the cleaner, healthier root.
Adjunctive therapies, such as the localized application of antimicrobials or the prescription of systemic antibiotics, are often used to enhance the effect of the mechanical cleaning. Antibiotic gels or chips may be placed directly into the deeper periodontal pockets to target residual bacteria over a period of days or weeks. Systemic antibiotics can offer additional pocket depth reduction compared to scaling and root planing alone, though they are reserved for specific cases to mitigate the risk of antibiotic resistance. This foundational treatment is mandatory because any subsequent structural repair or stabilization effort will fail if the active infection remains present and continues to erode the supporting bone.
Restoring Lost Bone and Tissue Support
Once the infection is controlled, the focus shifts to repairing the biological damage, especially in cases where the bone loss is significant. When non-surgical treatments are insufficient to reduce the deep periodontal pockets, surgical interventions become necessary to access and clean the defects and promote tissue regeneration. Periodontal flap surgery, also known as pocket reduction surgery, involves folding back the gum tissue to fully expose the root surfaces and underlying bone defects.
During this flap procedure, the periodontist can thoroughly remove all remaining disease-causing bacteria and calculus. They may also reshape the damaged bone surfaces, a procedure called osseous surgery, to eliminate irregular craters that serve as bacteria traps. This allows the gum tissue to reattach more closely to the tooth, effectively reducing the depth of the periodontal pocket and preventing further disease progression.
Regenerative Procedures
For specific defects, particularly vertical bone loss patterns, regenerative procedures are employed to encourage the body to regrow lost bone and periodontal ligament. Bone grafting involves placing specialized graft material into the bony defects. This material acts as a scaffold, stimulating the body’s natural bone-forming cells to colonize the area and regenerate the lost alveolar bone. Guided tissue regeneration (GTR) is an additional technique where a biocompatible barrier membrane is placed over the bone graft. This membrane selectively blocks the faster-growing gum tissue from migrating into the defect, reserving the space for the slower-growing bone and periodontal ligament cells to regenerate the tooth’s attachment apparatus.
Stabilizing Mobile Teeth
After the infection is managed and the underlying support structure has been treated, the final step is often mechanical stabilization of the mobile teeth to improve function and comfort. Dental splinting is a common procedure used to join a loose tooth to one or more adjacent, more stable teeth, effectively creating a single, stronger unit. This method distributes the forces of chewing across multiple teeth, reducing the stress on the weakened periodontal support of the mobile tooth.
Splinting can be temporary or permanent, with the temporary version often using a thin wire or fiber-reinforced composite resin bonded to the back surfaces of the teeth. Permanent splinting may involve fabricating crowns that are physically fused together before being cemented onto the teeth, providing maximum long-term stability and support. The splint design must be carefully planned to ensure it does not interfere with the patient’s ability to clean between the teeth.
Another important mechanical adjustment is occlusal adjustment, which involves selectively reshaping the biting surfaces of the teeth. This procedure aims to eliminate any premature or excessive contact points that place undue stress on the mobile teeth, especially during chewing or grinding habits. Reducing these traumatic forces can significantly decrease tooth mobility once the inflammation has been resolved. In instances where mobility is severe, or the supporting bone loss is too advanced for the tooth to be saved, extraction followed by replacement with a fixed bridge or a dental implant may be the final recommendation.