Tooth Movement
Robert E. Horseman, DDS
One of the most difficult concepts for patients to grasp is the fact that teeth move. This is because teeth are connected to the jaw bone, the jaw bone is connected to the skull bone, the skull bone is….you know. Man is a creature having a spinal column with most of the bone lumped at the top and as such, this lump and its infrastructures should not be subject to willy-nilly movements.
As dentists, we know better. This whole tooth thing has been a fiasco since Day One. Meaning no disrespect, but 32 teeth! Is there a practitioner among us who doesn’t believe 28 teeth would have been plenty? Teeth should have been a specialized part of the bone. This would have done away with the tooth pulp and the peridental membrane, two signal screwups that have produced more mischief than all the religions of the world combined.
When a child grew, his jaws with their specialized, ankylosed teethbones would have grown right along with him. But, of course, this didn’t happen because that was a long time ago when you were a Senior Citizen at 28 and looking at the wrong side of the grass at 30. The only reality show was life itself and the mania for the Perfect Smile had not yet been conceived as a marketing ploy. As a result we have orthodontists whose livelihood depends on teeth that move, and their patients have retainers to discourage teeth from repopulating the old neighborhood.
That’s why endodontists have canals and pulps to play with and curse the occasional evolved tooth that has a nicely calcified canal. It’s why exodontists are able to remove an individual tooth without taking all of its companions with it. Periodontists spend way too much mind-numbing time explaining why their patients’ teeth are moving to the point of falling out. It’s why partials won’t fit after being in a sock drawer for a couple of weeks, why a crown won’t seat if the temporary crown is lost, strayed or swallowed and not replaced.
Teeth move. Why is it so hard for people to believe this? It’s because the world appears to be going to hell in a handbasket and nothing appears stable anymore. If there is one thing folks would like to hang onto, it is the notion that their teeth, at least, are always going to be right where they were last week, last year, back when they were 20 and the Golden Years were a millennium away.
Dental marketing is not going to tell them it’s not so. Dental marketing is so obsessed with the cosmetic side of dentistry that the idea of white teeth moving is simply not cost effective and downright counterproductive.
It will be interesting when an advanced alien culture finally arrives on our planet at some more metropolitan locale than Roswell, NM. With luck and perhaps a promise of a Starbucks franchise, we can study what they’ve done about teeth. Odds are that they will have only two teeth; one big maxillary tooth that extends from the distal of #2 around to the distal of #15 and a singular mandibular tooth running from the distal of #18 to the distal of #31. No interproximal spaces, no pulps, no PDMs. They’ll be solid bone with the density of a bowling ball. I foresee nicely serrated edges like a bread knife, no substandard dentin, easy maintenance and more effective than a piranha on steroids.
I can see it now and you could too if you aren’t part of the orthoperioendoexo cartel that thrives on tooth movement. You cosmetic mavens who like to be in the avant garde of dentistry, bond all of your B1 veneers together and give evolution a jumpstart.
Meanwhile, dentists will simply have to tell patients that teeth move. They drift, they extrude, they migrate. That’s the way it is and it’s not your fault—or mine
Originally published in the Journal of the California Dental Association, 02/05.