Hi Bryanna,

I hope you can help me understand what I've recently been told by the dentist ... I was told my front tooth #8 (actually a crown) is loose, and I have had ongoing irritation on that gum line (I sent you a photo awhile back); it is slightly longer in length than the other front tooth #9. The Dr. mentioned crown lengthening; also filed down the corresponding bottom tooth "to take some pressure off"; however the issue continues. I think he said my bottom teeth were shifting some - they are not crowned. He mentioned making a night guard/retainer for the bottom. The quote was somewhat expensive IMO and would require 2-3 visits.

My confusion is why the crown lengthening was mentioned along with the night guard, or is the crown lengthening a premise to the guard? I did ask questions, but he was somewhat rushed and I wasn't quite understanding things :-(

I am concerned since it is my front tooth, and wonder what would happen if I did not get this guard? I am still in need of much work (in the thousands), so am just trying to tolerate what I can for the time being.

Thanks in advance for any help you can give me.

Hi bchristine,

I took another look at the xrays you had sent to me. Tooth #8 and 9 both have shortened roots or blunting at the apex. This occurs for a number of reasons. Tooth #8 is more blunted than #9. In the xray that I have, the (PDL) periodontal ligament on the mesial of #8 (side of the tooth closest to #9) is widened which indicates inflammation. I believe this is the area of the gum tissue that swells up from time to time and the dentist irrigates with betadine? The margin of the crown on #8 is ill fitting, particularly on the mesial area of the tooth. So that area of the tooth and below the gum is susceptible to inflammation, thus the widening of the PDL. The tooth is a bit longer than the adjacent tooth and it is loose because over time the health and stability of the tooth becomes compromised due to the inflammation. Your body's way of dealing with the chronic irritant is to slowly avulse the tooth.

Your dentist adjusted the lower tooth so that it was hitting with less force on #8. However, #8 is going to continue to avulse as long as the inflammation is present and you can't keep adjusting the lower tooth because that will cause problems with that tooth. He suggested the night guard most likely because ... one he may see signs or suspect that you are grinding your teeth and two the night guard may slow down the rate of mobility with #8 and protect the lower teeth from becoming loose due to the grinding.

The crown lengthening is done to gain access to the root area of the tooth so it can be cleaned thoroughly and a portion of the soft tissue is removed where the inflammation is most dominant. This encourages the PDL to tighten up and new cells to form and make a tighter collar of gum tissue around the tooth. Did he discuss the pros and cons with the crown lengthening surgery? If I remember correctly, you had this procedure done on an upper right molar awhile back and the surgery was unsuccessful because that tooth had deep decay and infection.

The pros and cons with crown lengthening surgery are dependent upon.... the health of the person and their teeth and gum tissue .... as well as the skill of the dentist.

** The surgery can be done with either a scalpel or a laser. Sometimes both are used.

** The idea is to be as conservative as possible but yet as thorough as necessary.

** The gum tissue is removed in the affected area resulting in a higher or elevated gum line in the area where the surgery is done. This may be noticeable since it is your front tooth.

** The other issue is that the margin of your existing crown may be evident due to the elevation of the gum tissue which means you would have some root exposure in that area.

** Depending on how extensive the surgery is, will determine if these things are very noticeable, marginally noticeable or problematic.

Did the dentist talk to you about replacing that crown to accommodate the new height of the gum line?

I am sorry he was rushed. I assume he was discussing this with you at your dental hygiene appointment with the hygienist? If so, then he had to keep on track with not only his own schedule of patients that day but the hygienist. We cannot know ahead of time if someone will need additional time in the chair to discuss something until the problem presents itself. He knows you drive a distance to see him and was probably trying to get in as much information as possible and in a hurry to avoid having you come back for a consultation. However, I think you have some things to discuss with him as this is not something that you should just dive into. I would suggest that you call his office and ask for him to call you back to discuss his proposed treatment. The only other option would be to schedule a "follow up" consultation appointment to discuss everything. You should NOT be charged for that appointment as it is not his or your fault that he did not have time to discuss it further when you were there and you cannot be expected to understand all the info that was given to you so unexpectedly.

Questions you could ask him (not anyone else) ...

What is the health of teeth #8 and 9?

How extensive does he think the crown lengthening would be?

Does he anticipate a much higher gum line in that area?

Does he recommend a new crown on that tooth?
(He ideally would want to do a new crown because the current crown does not fit real well and a new crown would protect any exposed root surface post surgery. The problem with a new crown on #8 is that it will not match the adjacent teeth as well as the current crown due to the aging process and dye lots of the porcelains.)

What would be the sequence of having the night guard, the surgery and the new crown? The night guard will need to fit properly after the new crown was done to avoid having to do a new night guard. So it may be best to have the night guard done last. But talk to him about that.

Also, it is important to know that the surgery may not solve the tooth problem completely or be the ultimate forever cure. There is a reason or reasons why this is happening. Yes, the tooth is not real stable, the PDL is inflamed and the crown margins are not ideal all of which are contributing factors. But what if anything, is the extended systemic reason for this chronic inflammation? Do you have anything similar going on anyplace else in your mouth that you are aware of?

Often digestive or intestinal issues ... and/or being more acidic than alkaline ... are contributing factors to tooth and gum problems. Stress is a major culprit of dental problems as it not only often results in bruxism but it changes the actual microbial flora of the mouth leading to inflammation and break down of the oral tissues.

I feel badly that you are dealing with chronic dental problems ... it's been too long and just too exhausting for sure. Give some thought to what I have offered you here and when you can, take a look outside of the dental box at your overall systemic health and stress. I know this is easier said than done ... but here's a gentle nudge to take a minute or two for yourself ~'.'~

Bryanna

Thanks so much for all your expert information Bryanna. You've given me a lot to think about, and I will discuss these things with the Dr.

It sounds like there is no easy solution along with (more) financial burden no matter what I do! And you are correct ... I do have other dental issues as well; however they do not seem to be as urgent as taking care of this one; especially since it's my front tooth. I feel my years of dealing with stress has caught up with me; as I'm dealing with a few other hard-to-diagnose medical issues atm.

Thank you again for your help :-)