Surgery scheduled but two front teeth loose

[JawDude]

I'm scheduled to have jaw surgery in January but two of my bottom front teeth have become loose due to aggressive orthodontics. They might be able to be salvaged and I will be discussing with a periodontist this week about what should be done (e.g. bone augmentation etc). A few on the same side show gum recession, but they're not loose and don't have any problems with sensitivity.

Ideally I don't want to delay surgery any longer, but I do want to make sure my teeth are as healthy as possible. Anyone else been in this position? Should I re-assess the periodontic work after the surgery? My orthodontist suggested this at some point.

[GJ]

You have root resorption on all your incisors, both top and bottom.

If you delay surgery, you should probably take the braces off so it doesn't get worse. So long as you have a 1:1 tooth to root ratio, you should be okay in terms of stability. It seems that's the case here, but there can be some margin of error on x-rays where the roots could be longer or shorter (depending on your head angle).

[Post bimax]

I don’t think delaying surgery is a good idea. You need to get the jaws in the right spot and get the orthodontics over with so you can get the braces off asap. Otherwise you’re just going to prolong your total time spent in braces and with malocclusion, which is the fundamental cause of your resorption. Go back to the periodontist after you heal from surgery.

I’m sorry you’re having this issue. Periodontic bone grafting is often painful and can be expensive

[thedude]

I would get the surgery first and downplay the tooth issue with your doctor so it doesn’t become a distraction. Losing your teeth isn’t a big deal. Until very recently most people could be expected to have dentures by the time they were 40 or 50. If you lose them get some implants, which are really just fancy dentures screwed into your bone. You’ll want to do this after jaw surgery anyway as they will surely get in the way of your surgeon.

I will also say, although I’m going to start sounding like a stem cell fanatic, that I had some loose teeth that were bothering me like yours are that tightened right up after doing some cord blood stem cell therapy. I was amazed as I expected they would not get better and didn’t do the therapy expecting to resolve that issue. It’s considered an experimental procedure but if you are the adventurous type and have $7000 sitting around that you don’t mind investing in a procedure that isn’t guaranteed to work it might be a gamble worth taking after doing your jaw surgery. It seems to work best when you’ve kind of done everything else right and need to give your body just a little extra something to help it finish healing itself.

[kavan]

Others on this string have given you some good advice regarding root resorption as it relates to too much time in braces. As to tooth loss 'being no big deal', well I guess that would depend on whether or not you had $$$$$$ burning a hole in your pocket to invest in new modalities and/or dental implants. So, here, I'll focus on another possibility for you to explore WITH your perio.

As to the LOOSE TEETH, another possible culprit could be periodontal pathogens housed in the tartar on the roots of the teeth below the gum line. So, be sure to ask your perio to either RULE OUT that possibility OR to perform a DEEP cleaning which is when they scale the roots of the teeth to remove the tartar from there that houses the pathogenic bacteria. There is a time frame to have this before a surgery and it CAN'T be too soon before it. I think it's approx one month before. So, definitely put the discussion on the table about possible periodontal pathogens and getting a DEEP CLEANING.

[JawDude]

Thanks all for the honest responses on this. I'm meeting with my periodontist this morning to get a thorough diagnosis. Unfortunately, short roots + thin gums run in our family (mom, brother) and I had an open bite which exacerbated the issue...

Definitely +1 on not delaying the surgery any further. According to my orthodontist - and to be perfectly honest, I made a bad decision choosing him - some level of change in the ligament bone does happen during orthodontics which is fair. The degree of change here is far out of normal though as any reasonable person can tell.

Interesting idea re stem cells! I will keep that on my radar as well.

I maintain generally good dental hygiene - usually stellar, with high-end electric toothbrush + waterpik at night - but have missed a few nights recently. I will bring up that idea re deep cleaning, but I'm aware that it has pretty significant risks as well. I believe the plan of going through with the periodontic work post-surgery may be more appropriate.

Will follow up later today, thanks.

[GJ]

Yeah orthodontics after age 18 or so are a pathological process. He is not inaccurate that people should expect ligament/bone changes.

Good to hear you're flossing and waterpik-ing. That will help. After you're out of braces things will naturally firm up, too.