A loose tooth and bleeding gums

In the morning, when you brush your teeth, there is a little pink in the sink. For some time, one tooth has not felt like the others when you bite. You push it with your tongue and it gives a little. One evening, you searched for ‘loose tooth’ on your phone, then closed the page.

What you feel is a signal. By itself, it is not proof that all your teeth will be lost.

A tooth is not planted directly in the bone. It is connected to its support by tissues that include the gum, ligament and bone around the root. When the gum becomes inflamed, it may bleed. When the disease extends into the supporting tissues, periodontitis can cause bone loss and mobility. This progression is often not painful, which is why it may remain unnoticed.

The difference between gingivitis and periodontitis cannot be determined from a photograph. It requires an examination. A graduated probe can measure the space between the gum and each tooth; an X-ray can show the bone level. The aim is to assess each tooth individually: which ones are stable, which ones are vulnerable, and what may explain the mobility.

# Stabilise before replacing

Periodontal guidelines describe care in stages. It begins by controlling inflammation and biofilm, particularly through professional cleaning and suitable daily care. Scaling and root planing may be part of this first phase when the condition warrants it. A reassessment then measures how the tissues have responded. Targeted care may be discussed if some areas remain active, followed by periodontal maintenance to help monitor the situation.

An honest limit must also be stated: not every tooth can always be preserved, and lost bone does not necessarily return to its original condition. The aim is to control progression and retain what can be retained. The prognosis is made tooth by tooth, not for the entire mouth as a single unit.

The question of an implant only comes after this. If a tooth cannot be preserved, replacing it may be discussed once the gum has been assessed and stabilised. The tissues around an implant also require monitoring; an implant after periodontitis is therefore not a decision separate from gum health.

# What the assessment should clarify

• What is happening: the condition of the gum, the bone level and mobility, tooth by tooth.
• What needs prompt attention: a very loose tooth, swelling or an abscess; the rest is treated in an order defined after the examination.
• The reasonable options: controlling inflammation, reassessment, targeted care when indicated, and regular follow-up.
• The steps: phases separated by a new measurement of the tissues’ response.
• The plan: if treatment is being considered, the information needed to order the phases and establish the cost after the evaluation.

The assessment is carried out by Dr Fatima Azelmat, a dental surgeon in Kenitra. The Periodontology in Kenitra page explains the general stages of this care and its objective: to preserve natural teeth whenever their condition allows. Scheduling an assessment does not commit you to any treatment.