June, 2002
Dear Dr. Mady: All of my front teeth, both top and bottom, have become loose and it hurts whenever I chew hard foods. I thought that I was going to lose them, but my dentist said that I can get a few years out of them with a procedure called splinting. What is this and is this possible? -Shawn on the internet
Dear Shawn: As you probably know, most individuals with loose teeth wonder if there is anything that can be done to tighten them up, permanently or temporarily. This may help you depending on the amount of loss of support that your teeth have. Loose teeth can make eating a very unpleasant experience and even biting can make them more loose than they already are. This does not happen with healthy teeth because they are securely attached to the bone and gums in the mouth. Your teeth have become mobile from either advanced periodontal (gum) disease or trauma, gum disease being the most common predator.I am assuming, because you have more than one or two moving teeth, that your diagnosis is moderate to advanced periodontal disease and I believe that your best course of action with or without the splinting is to treat the underlying disease. This periodontal treatment usually involves a procedure called scaling and root planning. At this time the plaque and tartar (hardened plaque) is removed from the root surfaces and these surfaces are smoothed to lessen the chances of future attachment and build-up of bacteria. If your periodontal support does not respond well to this therapy, then you may be referred to a periodontist for gum surgery. This involves temporary separation of the gums from the teeth and bones, while cleaning of the roots and contouring of the bone is completed. Finally the surgical flap is sutured back into position and a dressing is placed to assist in healing.
Teeth that are too far gone will have to be extracted. These missing teeth can be replaced with removable partial or full dentures, fixed bridges or dental implants. If the remaining teeth are fairly mobile but still retainable, they may be candidates for splinting. This involves attaching adjacent teeth together to strengthen them.
Splinting can be done in various ways. The most common methods are attaching teeth by using composite resin (cosmetic bonding material) interproximally (in between) or a combination of a wire joined on the front or usually back surface of each involved tooth with some sort of resin to adhere it to the teeth. At first it feels foreign but over time anyone can adapt to it and later forget it is there. The wire ligation method is also commonly used to retain the alignment of orthodontically straightened after braces are removed.
After splinting is complete, meticulous home care with respect to oral hygiene must be maintained. Because flossing will become almost impossible in these areas, one may use floss threaders to slide the floss under the splint in between each tooth. Also there is a small cone shaped interproximal toothbrush available called a proxy brush. It allows easy access in between teeth when floss cannot be slid through.
With splinting, eating will most likely become more comfortable than it was prior to the procedure. It is important to maintain regular dental visits every three to six months both for periodontal maintenance and to check the splinting.
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
