Some gradual tooth movement is common with age, especially crowding of the lower front teeth. But new gaps, a changed bite or movement accompanied by bleeding gums may point to a problem that needs a dentist's evaluation, according to guidance from the University of Rochester Medical Center.
Teeth sit in living bone and ligaments that continually remodel, said Alexandra Tsigardia, a gum disease specialist at URMC's Eastman Institute for Oral Health. Everyday forces from chewing, swallowing, the tongue and the lips can move teeth slowly through adulthood. Movement alone does not necessarily mean disease.
Changes that warrant an examination
Tsigardia said new or noticeable movement deserves a dental evaluation, particularly if gums are red, swollen, tender, receding or prone to bleeding. Pain when chewing, loose teeth, new gaps, teeth flaring outward or a change in how the upper and lower teeth fit together are other signs to discuss with a dentist.
Gum disease is one possible cause. Periodontitis can damage the gum tissue and bone supporting the teeth, allowing them to loosen or spread. The National Institute of Dental and Craniofacial Research likewise identifies loose or shifting teeth, painful chewing and bleeding or receding gums as possible signs of periodontal disease. The symptoms require an examination; they do not establish a diagnosis on their own.
Missing teeth can also change the forces on neighboring teeth and create space for them to drift. In some cases, a tooth opposite the empty space can move toward it, while bone loss may develop where the missing tooth was.
Teeth may shift after braces or clear-aligner treatment if a prescribed retainer is not worn consistently. Many people need long-term retainer use to maintain their results, the URMC article says. If an old retainer no longer fits, a dentist or orthodontist should assess the movement rather than having the patient assume it is harmless.
Grinding or clenching can cause wear, fractures and pain. URMC says the repeated pressure may contribute to movement when gum disease, bone loss or another problem is present, but it does not appear to be as important a cause of shifting as periodontal disease or skipped retainer use. The article also says wisdom teeth may contribute to crowding for some people but do not fully explain age-related crowding.
Treatment depends on the cause
If gum disease is driving the movement, treatment first aims to control the disease and protect the supporting tissues. Professional deep cleaning may be part of care, with other treatment considered for more advanced disease. If a tooth is missing, a dentist can discuss whether a bridge, denture or implant is appropriate. Orthodontic care may help after retainer-related movement, but an underlying disease or injury should be addressed as needed.
Prevention is not a guarantee that teeth will never move. URMC recommends brushing twice daily for at least two minutes, cleaning between teeth daily, keeping regular dental appointments, addressing missing or broken teeth and wearing a retainer for as long and as often as an orthodontist recommends. People who grind or clench their teeth should also have that evaluated.
Eastman Institute for Oral Health serves patients in the Greater Rochester region and offers periodontal, orthodontic, restorative and other dental care. A dentist can determine whether a particular change is routine, cosmetic or a sign of disease and discuss options based on the examination.
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