Invisible Breakage

“Dear doctor,

I have recently encountered a bit of a problem, and I am not sure where to go with it. If it is serious I will go to a private clinic, but if this can wait then I will book an appointment with the NHS. The problem is that one of my teeth is wobbling ever so slightly. I was playing tennis, and I got hit in the mouth with the ball, and a few days later I was eating some roast beef, and one of the strands was stuck between my teeth, and  when I sucked on it, I felt a slight movement. I checked it with my fingers, but the movement is so slight it can hardly be felt with the fingers, it can only be felt with the tongue. What is happening? Why is it moving? Am I in danger of losing my tooth? Where should I book my appointment; the NHS or a private dentist?

Thank you, Niel”

Dear Niel,

It sounds you are dealing with a case of a tooth that has broken or shifted below the gum line, and you need to see a dentist as soon as possible. This is based of course only on a preliminary analysis of the conditions that you have mentioned. Other factors may also be contributing that you are not mentioning, and some relevant information may change that analysis, but I think you probably have a fracture, and here is why.

First of all, you mentioned that the wobbling and the movement were caused by a trauma to the mouth. You may not have noticed the fracture as it was not visible, and the movement was so small that you could not see it or feel it when you move the tooth with your fingers. But when the roast beef got caught, and you sucked on it, you could feel the movement, and this is proof that the fracture is below the gum line, and the alveolus and gingival are currently holding the tooth in place.

Movement and wobbling are indicative that something has gone amiss, and you are either missing a piece of something, or some of your tissues are fractured or broken, or otherwise damaged. A healthy tooth that is whole and is surrounded by sufficient amounts of gingival, alveolar tissue and other tissues should be stable and should not move even a little.

Right now there are two things that may be going on with your tooth, and both of them require immediate dental care. First of all, you may, as I suspect, have a tooth that is broken, meaning that the tooth roots and the rest of the tooth have been separated by a fracture. The other thing that could have happened is that the tooth may have remained whole, but it may have shifted, meaning that the alveolar crest or the gingival may be damaged around it, allowing it to move. Both situations are extremely dangerous, because they imply a gap in the connective tissue, which will become infected over time. My advice is to see a dentist as soon as you can, because these issues need to be resolved.

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