Help!
My teeth have moved!
The position of the teeth is the result of several factors.
Some are genetic, linked to the growth of the skull bones and the shape of the face, and determine the spaces in which the teeth are arranged during the eruption, influencing the final result of the occlusion of each individual.
If the position of the teeth changes in adulthood, that is, if there is a pathological migration of the teeth (i.e. their displacement in an abnormal, irregular position) this could be a sign to worry about.
The most frequent site of pathological migration is the frontal one, with the so-called fanning of the incisors, which widen, lengthen and protrude with sometimes dramatic aesthetic consequences.
The displacement of the teeth is one of the most frequent consequences of severe periodontitis: in fact a variable percentage between 30% and 56% of patients can show migrations.
But how does all this happen?
Why do you suddenly notice that the teeth have moved?
Each tooth is usually stable when there is a balance of forces with the adjacent teeth, with the tongue, with the muscles of the lips, with chewing movements and any parafunctional habits such as (bruxism, clenching) and the condition of the periodontal attachment, that is of the ligament that holds the teeth to the supporting bone.
A stable occlusion and therefore maintaining the position of the teeth requires this attachment to be intact and healthy.
If the bone support is reduced and the ligament becomes less efficient (as happens in periodontitis), the teeth can move out of their position: they can stretch, they can partially overlap each other, they can rotate and even tilt.
The other important factor and often supporting the displacement of the teeth is the loss of the dental elements in the posterior chewing sites: with the loss of contacts between adjacent teeth and the reduction of the verticality of the occlusion (the so-called collapse of the bite) the residual teeth can incline in the posterior sectors while the anterior ones are no longer protected during chewing and undergo the action of excessive occlusal forces going towards the so-called fanning which is especially noticeable in the incisors, ie in the frontal area.
The consequences of dental migrations represent a vicious circle in which the modification of the position of the teeth, both of the anterior and posterior ones, leads to a deficit in the ability to chew properly.
On dental elements that have undergone the reduction of periodontal support, and in the absence of a sufficient number of teeth for chewing, the normal functions of the oral cavity (chewing, swallowing, phonation) induce an overload that can contribute to worsening the condition of the support periodontal itself.
To stop the progressive decay of the teeth and chewing, the first essential step is the control of periodontitis, of the infection related to bacterial plaque and of the resulting inflammation.
In some situations the reduction of inflammation and the pressure exerted by this on the teeth induces a recovery of the position of the migrated tooth.
More often, dental migrations require more complex interventions to restore the integrity of the dental arch and the position relationships between the individual dental elements, with surgical, prosthetic, orthodontic periodontal therapies and multidisciplinary treatment plans.
Periodontitis therefore does not always manifest itself with gingival bleeding;
its progression can be silent, more subtle and lead to aesthetic and functional consequences of importance for the quality of life and sociality of the individual, especially in the most serious stages of the disease.