Is Losing Just One Tooth A Big Deal?

 

(Single Tooth Implant)

It depends on who you talk to.  If a front tooth is lost, almost everyone is motivated to replace it because it affects one’s confidence, pride and speech. Society values a nice smile, and misjudges those without teeth, so people often hesitate to smile or speak in social settings if the front ones are gone.  The situation is quite different for molars. Because a missing molar is unseen, it is also de-valued.  Nothing could be further from the truth. Granted, the absence of one tooth may not seem impact one’s ability to chew or speak, and it usually does not.  But it may cause healthy teeth nearby to move around in the wrong directions, without any discomfort, so it goes unnoticed.  For example, teeth may shift, making an ugly, crowded or awkward bite.  They may become longer in appearance, almost resembling a fang that may be pre-cancerous.  Whenever a tooth is removed, the area needs immediate stabilization with another tooth or a temporary arrangement that maintains the space whiles other work progresses.  A change in the functional design of teeth can also contribute to a bite that no longer fits together, gradual loss of perfectly healthy teeth, or problems with opening and closing the mouth, including pain in the temple or ear.  It is truly amazing that the loss of one single tooth can create a domino effect on future dental problems!  Many people do not realize that loss of a single tooth leads to loss of bone around it, too, which can limit future replacement options.  A prudent dentist will suggest a bone graft procedure to minimize natural bone loss, should a single tooth need removal.  In short, to maintain proper function, dental health,

and a youthful appearance, all teeth need replacement unless they are wisdom teeth.

There are five main reasons for tooth loss.

1. Tooth Decay: exposure to carbohydrates that convert to sugar, in conjunction with inadequate plaque removal.

2. Bone (periodontal) and Gum Disease: plaque turns into tartar and causes an infection around the teeth.  If this infection isn’t treated, the bone disintegrates and there is no longer any foundation for the tooth.

3. Trauma: such as a sports injury, bike accident, or unfriendly violent contact.

4. Congenital Abnormalities:   the absence of one or more teeth from birth, known as anodontia, affects about 7% of the population and has a hereditary link.  It is most common with the lateral incisors, the front teeth just off center, but can affect any tooth.  For a slightly different reason, sometimes the lateral incisors appear dwarfed or conical as a result of a hereditary link, and they’re labeled “peg laterals”.  Ectodermal dysplasia is also congenital, passed on by the mother and more commonly seen in male offspring.  The enamel on the tooth is defective, and thereby weak, leaving the patient vulnerable to decay and premature loss.

5.  Missing Back Tooth:  food must be chewed for proper digestion and, if the surface area for chewing is gone, the front teeth have to handle more pressure and force, which they are not designed to do.  This leads to premature loss. When chewing food, enzymes from saliva mix with food to begin the digestion process.  When there are not enough teeth, there is not enough enzyme activity and therefore, one’s gastrointestinal system is challenged.  In this situation, people actually eat enough but do not get the proper nutrition, which lowers their metabolic rate and possible weight gain, as a result.

Please remember that the situation is even more significant when multiple teeth are missing.

 

What Can Be Done?

Fortunately, there are many options for replacing a lost tooth. Dentists typically follow this process when determining the most appropriate treatment plan, taking into account important factors such as a patient’s underlying health issues and the relationship of the teeth when the mouth is closed. Blood disorders, auto-immune diseases, and uncontrolled diabetes significant affect the outcome of treatment.  Front teeth that come in close contact or impinge on the gums can limit the options available. Of course, the amount of healthy bone around any

tooth plays a significant role in the decision. Even if a tooth has been removed from the general area, the length of time since removal affects the quality and quantity of useful bone available to support dental restorations.  Remember that it is not just about one tooth – it is about the total patient and their quality of life.

 

Look again to the shaded boxes on the decision tree.  If the dentist decides that a single tooth requires removal, one has up to five choices for treatment.  These include:

1. A removable partial denture:  Most find this option undesirable unless it is for temporary use.  It has been known to accelerate periodontal problems, if worn for a long time, and often creates decay near clasps that hold it in place.

2. A tooth-colored bridge, with 3 different designs: A three-unit bridge has ceramic construction and is permanently cemented to adjoining teeth on either side of the space.  These work well if the surrounding teeth and bone are healthy, unless the patient grinds his teeth, when a metal substrate may be necessary.  They also work well if the surrounding teeth have had root canals, often the case with trauma-induced tooth loss. Sometimes the adjoining teeth are already in perfect condition so it is difficult to justify altering them to make room for a bridge.  When this is the case, dentists may place a Maryland bridge which

attaches a false tooth to the adjoining teeth, using metal backings that are cemented to the backside of natural teeth.  Unfortunately, the Maryland bridge is hard-to-clean so the adjoining teeth can decay.  It has a high failure rate under chewing stresses, and could get swallowed.  Therefore, the author is against this option.

Newer technologies and advanced dental materials have generated the development of a veneer bridge, which eliminates the re-shaping of perfect teeth on either side of the space.  The procedure resembles fake fingernails, in that a thin sheet of porcelain is cemented to the front of each tooth, after it has been attached to the porcelain fake tooth that fills the space.  It is a very conservative treatment that rarely pops off, and can be re-attached, but it is susceptible to breakage, chipping and is difficult to floss properly.

3. A dental implant:  This is the most conservative and predictable option because the adjoining teeth remain untouched. It is a more precise and technically demanding procedure.  Should a general practice dentist get beyond their scope of comfort and expertise, they should refer the patient to a specialist.  A prosthodontist is the dental specialist with the most comfort and expertise for implants.

An implant, which is generally a titanium metal screw, represents the shape of the natural tooth root.  It is surgically placed in the area where the tooth root once thrived and is left alone for several months to adhere to the jawbone.  In many cases, an implant specialist may choose a titanium screw that is covered with bone growth enhancers.  Then, after a few, minor interim steps, the implant functions as a man-made tooth root, with a projection extending above the gum line.  If necessary, the dentist will provide a temporary replacement tooth.  Eventually, a strong, false tooth that matches the color and shape of existing teeth is attached to the projection, using a miniature screw or cement, depending on the technique used to create new, natural-looking teeth.  This tooth is easily removed by the dentist, if that is ever necessary, and will not impact the implant.

Patients enjoy long-lasting comfort, often extending their life time.

 

Please consider the dental implant as the Number One Choice because it is the most predictable treatment available. They replace a missing tooth without involving other teeth, and leave other options open if further treatment in needed in later life.  That cannot be said for bridgework or veneers.  Once natural tooth structure is altered to accommodate these restorations, one must have more elaborated treatment to replace them in later life.  In truth, choosing an option

beside implants, for whatever reason – be it insufficient insurance coverage, a desire to save some money, or a hesitancy to see a specialist – really has the potential to multiply problems in later life.

 

Dr. Anil K Agarwal – Chicago Prosthodontist

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