Loose tooth in adults: causes, what to do and can it be saved?

A loose tooth: a signal to take seriously

In an adult, a loose tooth means its supporting tissues, the bone and ligament around it, are weakened or under attack. The most common cause is periodontitis, but an injury, an infection, clenching or a root fracture can produce the same symptom. Depending on the cause and how advanced it is, the tooth can often be stabilised, provided you see a dentist without delay.

It helps to know that a healthy tooth is not completely rigid: it is suspended in its socket by the periodontal ligament, which gives it a very slight give that you never notice day to day. What should alert you is movement you can feel with your tongue or finger, a tooth that seems higher than the others when you bite, or one that is changing position.

Your dentist grades mobility in degrees, from barely perceptible movement to a tooth that can be pressed down into its socket. That grade, together with an examination of the bone and gums, guides the diagnosis and outlook.

The most common causes

Several mechanisms can loosen a tooth, sometimes in combination:

• Periodontitis: chronic plaque-related inflammation gradually destroys the bone around the roots. The tooth loses its anchorage, faster still with smoking or poorly controlled diabetes. Our article on periodontitis stages and treatment explains the disease in detail.
• Occlusal trauma: excessive force on a tooth, from clenching or grinding, a crown or filling that is too high, or a tooth carrying the chewing load alone, widens the ligament space. Where the gums and bone are healthy, this mobility is often reversible once the force is corrected.
• Injury: a blow, a fall or biting on something hard can displace the tooth in its socket or fracture the root.
• Infection: an abscess at the root tip, often from a tooth whose nerve has died, or a gum abscess can make the tooth temporarily loose and tender to bite on.
• Vertical root fracture: more common in root-filled, heavily restored teeth, it often causes mobility, pain on chewing and a localised gum swelling.

More rarely, root resorption, a cyst or a bone lesion is responsible, which is why an X-ray matters.

Other, less worrying situations

Some mobility has temporary causes:

• during orthodontic treatment, teeth move slightly: that is how treatment works;
• during pregnancy, hormonal changes can make the gums more inflamed and the teeth a little looser, which warrants a check-up;
• after gum treatment, a slight, passing increase in mobility may be seen while tissues heal, before things settle.

Even so, mobility that increases, comes with pain or swelling, or affects one tooth on its own should be examined. It is not up to you to tell a harmless cause from a serious one: that is what the clinical and X-ray examination is for.

What to do until your appointment

A few simple measures protect the tooth until you are seen:

• leave it alone: constantly testing it with your tongue or finger makes it looser;
• chew on the other side and choose soft foods;
• keep brushing gently with a soft brush: stopping out of fear makes inflammation worse;
• if you clench, try to keep your jaw relaxed, lips together and teeth apart;
• do not pull on the tooth or try to "push it back".

Some situations need to be seen the same day:

• a tooth that has shifted or become very loose after an injury;
• swelling of the gum or cheek, especially with a fever;
• severe pain on biting;
• an adult tooth knocked completely out: keep it in milk or in your mouth, do not scrub the root, and seek care immediately.

Diagnosis: understanding why the tooth is loose

Treatment depends entirely on the cause, so an accurate diagnosis is essential. The examination usually includes:

• measuring the degree of mobility and probing the pockets around the tooth;
• checking your bite to spot an excessive contact or clenching;
• vitality tests to find out whether the nerve is alive;
• X-rays to show the bone level, the condition of the root and any lesion at its tip.

In some cases, particularly when a root fracture is suspected but not visible on two-dimensional images, 3D imaging may be requested. Your dentist will tell you whether it is useful in your situation.

Can a loose tooth be saved?

Often, yes, when the cause is treated in time and enough support remains. The options depend on the diagnosis:

• periodontitis: gum treatment with deep cleaning of the roots, sometimes followed by surgery, stops further bone loss. Mobility may reduce once the inflammation clears;
• occlusal overload: adjusting the bite, correcting a high restoration and a night guard for bruxism reduce the forces;
• splinting: bonding the tooth to its neighbours with a wire improves chewing comfort, especially for front teeth. It relieves symptoms but does not treat the cause;
• infection: root canal treatment or draining the abscess often allows some bone to rebuild and the tooth to firm up;
• injury: a displaced tooth is repositioned and held with a flexible splint, with monitoring of the nerve.

On the other hand, a vertically fractured root, or a tooth with almost no bone left, has a poor outlook. Holding on to a hopeless tooth at all costs can cause further bone loss and complicate its replacement.

When the tooth must be replaced, and assessment in Agdal

If extraction is the most sensible option, it is planned with replacement in mind. A dental implant, a bridge or a removable denture may be considered, depending on the neighbouring teeth, the bone volume and your health. When a tooth has been lost to periodontitis, the disease must be treated and stabilised before an implant is placed, otherwise the same bacteria put the implant at risk.

At German Dental Clinic in Agdal, the assessment of a loose tooth combines a clinical examination, digital X-rays and a clear explanation of the cause and the options, from saving the tooth to replacing it. If you live in Rabat and a tooth is loose, do not wait for it to fall out: you can book an appointment promptly.