Hello.  I am 31 years old and have had braces on my upper teeth for
approximately 5 months.  All was going well until my last appointment.  I
noticed unusual pain in my upper front teeth for a day or two following the
tightening, along with extreme sensitivity to cold in those teeth.  The pain
subsided, but a day later I felt a strange and very brief cracking sensation
in the root of one of my central incisors.  I didn't think much of it at the
time because it was not painful.  I just figured that it was part of the
process.  A week later, that tooth is starting to discolor noticibly.  It is
turning gray.

From what little research I have done, it looks to me as if the trauma from
the last tightening caused nerve damage to the tooth. Is there anything that
can be done?  Is the process reversible?  Is the tooth dead?  I will be
seeing my orthodontist in two days, but would very much appreciate other
informed opinions.

Thanks.

I've had this happen to me a several occasions over a 20 year time period.  I
guess it is a rare risk of treatment.  It happens so frequently that I never
discuss it as a risk of treatment but I've had several patients have to have
root c{*filter*}treatment because of it.

On one occasion, a mother asked about it and wanted to blame me.  I asked her
son if he had ever had a traumatic incident with the tooth.  He first denied it
but then admitted that he and his brother were wrestling and his brother's
sweater caught in a front brace.  As his brother pulled to escape, he pulled
the tooth pretty severely.

I think there are other cases twhere this can be attributed to trauma, even
trauma that occured before the braces went on.  On the other hand, I also think
this can happen because the root tip has an unusual shape.  The small {*filter*}
vessels that feed the tooth enter at the root tip and I think that if the
conditions are just right, you can compress these vessels and cdamage the pulp.

Again, this is rare but I've seen it something less than a half dozen times in
20 years.

Charlie Ruff, DMD
Specialist in Orthodontics
Diplomate American Board of Orthodontics