Widened PDL

[Niki87]

Sorry I’m back, hope you are around Gordon! This is like de-ja vu, this time last year I missed out on my holiday to the carribean due to the issues I was having at the time following a traumatic lower first molar extraction. And the tooth next to it also needing work.

I have since started Invisalign and am 6 months in, to try improve alignment and bite, to give an implant the best chance. Unfortunately this tooth, next to extraction, (lower left pre-molar) stopped tracking and I had to have a rescan. It’s also very slightly wobbly. In the meantime I am staying in my current set of aligners. This tooth also had a pretty deep filling on one side, couple of Months before starting movement, and it’s the tooth that’s needed the most movement. It has remained sensitive throughout, mostly to cold.

They told me it’s likely to remain so while ever there is active movement. A recent x-ray last week showed the periodontal ligament is widened around the tooth, but they said it is uniform, all the way round the root. They have said if the sensitivity doesn’t improve with resting the tooth in this passive aligner, I may be looking at a root canal. I should also mention the tooth is a bit high, due to movement not being complete etc so the tooth above, does hit it awkwardly aswell when I eat. I am sticking to softer foods.

Questions,

I am due to travel on Saturday 4hr flight, will the widened PDL likely cause more pain due to change in pressure?

Also, is it inevitable that I am going to lose this tooth, if the nerve is being chronically irritated? I am terrified of losing another one.

My orthodontics originally had me on weekly changes and has said when I restart to go to two week changes, I feel like trying to rush it is what’s pushed the tooth too far. Even though I know a lot of people do weekly changes, I am in the ‘older’ bracket (40’s) and my understanding is bone remodelling takes longer as you age.

Sorry Gordon, I know you’re not into orthodontics, hence my questions are related to the health of this particular tooth, I am terrified of root canals but if I get to keep the tooth, it may have to be done. I’m trying to improve my situation, not lose more teeth.

Thanks in advance for any advice you may be able to give.

Also, while I am away, what are the red flag signs to see a dentist there and not wait until I get back? (obviously I hope I will not need to do that!)

 

[Gordon]

You'd expect to see a widened PDL on a tooth that's exposed to orthodontic forces, that's kind of the point, the bone gets remodelled by osteoclasts in the direction of movement and new bone laid down by osteoblasts behind it, there has to be some room for all those busy wee cells to work in

If the tooth is getting a bit of a hammering during chewing due to the position it's in, then that would cause the PDL to widen a bit too due to inflammatory cells being triggered.

You might find that putting a small smear of sensitive tooth toothpaste into the invasalign gadget around the area of the sensitive tooth might help a bit with the sensitivity. Once a day is plenty, if the sensitivity stops, then you can stop.

I wouldn't worry about flying, the change in pressure isn't a big deal.

Red flags would be the old favourites, lingering pain after hot things, spontaneous pain without triggers serious tenderness to biting on it.