Grin and Bear It
Dear Dr. Crapo: I’m in my eighties. I’ve lost all my molars but I’ve been that way for many years. I get by - no problem. Last year I lost a lower front tooth. I’m not a self-conscious guy so I’ve just left it. In the last few months I noticed the other front tooth getting loose too. It feels like it might just come out. I try not to bite hard things but when I do catch it on something hard, it hurts. I decided I should have it looked at to see if the tooth was still good. The dentist said I’d lost all of the bone around the root and there was an abscess too. He said it should come out. He said I could get a flipper or partial to fill the space once the bad tooth was out. I asked about implants and he said he thought they could be done, but because I had lost so much bone he wasn’t sure that was the best idea. He said the roots of the other teeth were also close, so there might not be enough room for two implants and the crowns. I guess my lower teeth have been a bit crowded, so the roots of the remaining teeth are crowded into the space where the implants have to go. The doctor said I should have had my teeth cleaned regularly and because they were crowded the buildup formed faster, was harder to remove and the infection spread faster and was more damaging. In any case I’ve got to get something done.
Your dentist was right; crowded teeth can be a challenge for you to clean, for your body to fight infection and for the hygienist to remove the plaque and calculus. At this point if you’ve lost all the bone around the loose tooth, it’ll have to come out. In the planning phase your bite should also be evaluated and if you have an abscess on the loose tooth, every effort should be made to save as much bone as possible by grafting the extraction site. As far as an answer, consider a permanent bridge. If the teeth next to the space have good bone, so they can take a force without moving or hurting, they could be included in the bridge. Your eyeteeth usually are very stable as they have good roots and can easily support a well-placed permanent bridge. The bridge would be anchored by crowning the lateral (side) incisors and the eyetooth on both sides. That gives two anchor teeth on each side of the space. The benefit is not only beautiful, natural looking teeth, but a straightening effect that would make things much easier to clean.