Healthy Smile: My Teeth Are All Jammed Together

by Jeffrey Gross, DDS, FAGD of The Healthy Smile

That statement was a lead-in to a question. Let me tell you about the patient and his concerns. The last time I saw this patient was a few years ago. I was in the middle of a procedure with him when he received a call concerning his wife. The call informed him that his wife was in a car accident. The circumstances surrounding that call required him to leave the office in the middle of the procedure with a numb mouth. That was the last time that I saw him as home obligations prevented him from coming in. I treated some of his friends and always asked how he was. Maybe I would have seen him sooner, but Covid got in the way.

I was excited to see him for the first time last week but not thrilled to see what happened to his teeth. I found extensive decay on many teeth in his mouth. These cavities were not present the last time that I saw him. Most of the cavities I could treat and were accessible to me. However, there was one notable exception. I found a large area of decay on his lower right canine, or as it is sometimes called his eyetooth. The tooth in question overlapped the tooth right next to it. When I mentioned the fact to him, he responded by observing how crowded his teeth were. They were a jumbled mess, as he proceeded to say.

I looked at the crowding from a different perspective. I needed to figure out how I could treat all that decay with the extreme overlap of the teeth. Allow me to spend a little time and brainstorm with you. Depending on the level of crowding, my approaches will vary. If the crowding is minimal, a simple filling is possible. The more extensive the crowding, the more complex a filling procedure becomes. It will finally reach the point of the impossible.

Impossible means that I can no longer do a correct filling. With the use of a dental crown, I will be able to treat the tooth. Often, though, I need to crown the tooth next to it also. Even if that tooth could handle a filling, a crown is necessary to help make room for the extensively decayed tooth. This level of care would not work for my patient as his crowding was very severe.

I was left with two choices for his treatment. The first choice involved moving his teeth with invisible devices called aligners. The second choice involves removing teeth and developing something to replace those teeth. Because of the tilt and position of his teeth, I felt that moving them into the correct position would take an excessive amount of time. During that long time, he would lose teeth due to neglect. Losing teeth in that fashion requires me to play catchup ball to treat the mouth.

I prefer orchestrating which teeth I remove and when I remove them. When I can control it, the entire treatment will be faster. Whether I use the natural teeth around the removed teeth as anchors to replace the missing teeth or implants to replace those teeth, the entire process will be shorter than moving his teeth. After an interruption of three years for his dental care, I opted for this very reasonable approach. I feel that it is inappropriate to spend years trying to fix the problem in this particular situation.

When I see patients with crowded teeth, I always suggest moving them and correcting the traffic jam. When we don’t address this early on, the problems that ensue can be pretty challenging to solve. Note that I said challenging, not impossible. If your teeth are crowded and unsightly, call us at 440-892-1810 and let’s come up with a plan. I look forward to meeting you.

Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.

The Healthy Smile • 27239 Wolf Road, Bay Village, OH 44140 • 440-892-1810 •

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