18: Drifting incisors

18 Drifting incisors

Summary

Iain, a 51-year-old man, presents with spacing and mobility of his upper incisors (Fig. 18.1). What is the cause and what can be done?

image

Fig. 18.1 Occlusion at presentation.

History

Complaint

Iain complains of the spacing of his upper front teeth and looseness of all his front teeth, particularly of image and image. He is self-conscious of the spacing and is worried in case his front teeth fall out.

History of complaint

He has noticed increasing mobility of his upper front teeth over the past few months. The spacing between the teeth appeared at the same time and is becoming progressively worse. There is no pain associated with the mobility of the teeth but eating has become uncomfortable. He is also aware of mobility of his lower front teeth and of several upper and lower back teeth. Recently he has experienced an unpleasant taste in his mouth, which appears to originate from the upper front teeth.

Dental history

Iain has been a regular attender at another dental practice for many years, before moving to your area. He is highly motivated and does not wish any tooth to be lost. image was traumatized in his early twenties and has become progressively darker but he is unconcerned by this.

Medical history

Iain has diabetes which is well controlled by insulin. He is otherwise fit and well.

Social history

Iain smokes 10 cigarettes a day and has done so for 30 years.

Examination

Extraoral

There are no palpable submandibular or cervical lymph nodes.

Intraoral

image What do you notice in Figures 18.1 and 18.2?

Oral hygiene appears fair with generalized interproximal staining. Interdental gingivae related to the lower central and lateral incisors appears slightly oedematous.
Generalized gingival recession.
Heavily restored dentition with image discoloured.
7654321 present in all quadrants; 8 also in lower right quadrant.
Mild lower incisor crowding.
Uncrowded upper arch with incisor spacing.
Class III incisor relationship with minimal overbite and overjet except for image; upper and lower centrelines are not coincident.
Class I molar relationship bilaterally.
image

Fig. 18.2 (A) Lower occlusal view.

image

Fig. 18.2 (B) Upper occlusal view.

image

Fig. 18.2 (C) Right buccal occlusion.

image

Fig. 18.2 (D) Left buccal occlusion.

image Based on what you know so far, what are the possible factors implicated in respect to mobility and drifting of image?

Chronic periodontal disease is a definite possibility when the overall periodontal condition is observed.
Periapical periodontitis is another possibility but this would also tend to lead to extrusion of these teeth, which is not markedly evident.
Root resorption. This would have to be extensive to produce such spacing and mobility.
Root fractures. This is not a possibility in view of the history.
Other pathology such as radicular cyst or bony lesions are rarer possibilities.

image What would you check for specifically in relation to the history?

Degree of any tooth mobility.
Presence, extent and location of plaque and/or supragingival/subgingival calculus deposits.
Presence/site of bleeding on probing.
Presence/site of periodontal purulent exudate.
Presence/site of a sinus and/or associated exudate.
Presence/site of any deep carious lesion.
Occlusal factors that may contribute to tooth mobility, e.g. displacing occlusal contacts and/or a bruxing habit.
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Jan 2, 2015 | Posted by in Orthodontics | Comments Off on 18: Drifting incisors

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