Your mouth is an amazing system of inter-related parts that work together to perform functions as varied as chewing, swallowing, talking and even kissing. In order to perform these complex tasks, all of the parts in the system must work together in harmony.
If one of the many parts is out of alignment or missing, the whole system will eventually break down. Because each of the parts of this system rely on each other to perform at optimum efficiency, a problem in one area will lead to a problem in another area, much like a series of dominos, where once the first domino falls, it causes the one next to it to fall and so on and so on.
That is why when one tooth is lost prematurely, a series of negative consequences can and will occur over time if the missing tooth is not replaced. Marina Del Rey Dentist, Dr. Scott Tamura has identified nine potential negative consequences of not replacing a missing tooth.
OVER GROWTH OF THE OPPOSING TOOTH (1)
If a lower tooth is lost pre-maturely, the tooth above it will grow down looking for something to bite against. This is the first domino to fall and will cause a complex series of negative consequences if the missing tooth is not replaced.
SHIFTING/TILTING OF TEETH (2)
The red lines in the figure below are drawn parallel to the long axes of the teeth. The force of biting is parallel to these red lines. The teeth are designed to withstand forces that are parallel to their long axes. As long as teeth are positioned straight up and down, they can chew with a tremendous amount of force and never crack, break or get loose in the bone.
When a tooth is lost pre-maturely, the teeth that are adjacent to the area where the tooth used to be will shift towards the space by tilting over on their sides, as indicated by the blue dotted lines in the figure to the below.
There are many negative consequences that occur as a result of this “tipping” of the teeth. Four of the most severe consequences are listed below.
EXPOSED ROOT SURFACES (3)
When a missing tooth is not replaced and the teeth adjacent to the space begin to tilt toward the space, you begin to loose bone around the teeth as they tilt. The level of the gums is an indication of the level of the underlying bone. As bone is lost around the tilted teeth, the gums recede in these areas, exposing the root surfaces. The soft root surface, called CEMENTUM, is supposed to be below the gums and is therefore not covered with a hard outer shell of enamel. Because the Cementum is so soft, it decays very easily and patients with exposed root surfaces often complain of extreme sensitivity to hot and cold.
GAPS BETWEEN THE TEETH (4)
When a tooth is lost, and not replaced, one of the byproducts of the teeth adjacent to the space tilting, is that spaces will open up between your teeth.
Once these spaces open up between your teeth, every time you eat, food will get caught in the gaps between your teeth. Once the food is stuck between your teeth, it begins to rot and smell really bad leading to incredibly bad breath.
PERIODONTAL (GUM) DISEASE (5)
When a tooth is lost and not replaced, the adjacent teeth begin to tilt toward the space and gaps open up between your teeth. When you eat, food will get stuck in these gaps and if the food is not removed through constant flossing of your teeth, the food will begin to decompose and harbor large colonies of anaerobic bacteria which not only smells really bad, but will cause an infection in the gums around your teeth. This causes your gums to bleed and pus to spread throughout your mouth as the tissue around your teeth begins to rot and eventually die.
TOOTH DECAY CAUSING ROOT CANALS (6)
When gaps open up between your teeth because a tooth was prematurely lost and not replaced and food gets caught in these gaps, the bacteria in your mouth will be attracted to the proteins in the food particles and begin to cause tooth decay. If this decay is not removed by your dentist and eats its way all the way to the nerve in the center of your tooth, your tooth will ABCESS which would necessitate either another extraction of removal of the abcessed nerve through a procedure called Root Canal.
THE BONE AROUND YOUR TEETH DISOLVING AWAY (7)
A tooth is held into the bone that surrounds it through a series of elastic fibers called the Periodontal Ligament Attachment. Whenever you bite or chew on a tooth, force is transferred through the tooth, then through its Periodontal Ligament to the bone that surrounds it, and it is this stress on the bone that keeps the bone around a tooth dense and strong. Whenever a tooth is lost, there is no longer any stress on the bone where the tooth used to be and the bone will slowly dissolve away. This loss of bone is called “Resorption”. Tooth loss can cause the bone around the teeth on either side of the missing tooth to Resorb away which can cause them to become so loose that they need to be extracted. Another way to say this is that the loss of one tooth can lead to the loss of other teeth, much like one domino falling causing other dominos to fall.
GUM DISEASE THAT LEADS TO BONE DISEASE (8)
As the tooth next to a missing tooth begins to tilt over, a “Pocket” can form between the gums and the tooth. The anaerobic bacteria inside of your mouth can colonize this pocket leading to a gum infection. This infection in the gums, if not removed, can turn into a bone infection that can be so severe that it dissolves the bone away around your teeth. As the bone around your teeth dissolves away, the teeth can become loose and eventually lead to premature tooth loss.
TRAUMATIC BITE CAUSING TOOTH DESTRUCTION (9)
The biting surfaces of your teeth are not flat. They have pointed areas called “Cusps” and valleys between the cusps called “Fossa”. When you bite together the mountains (cusps) of the upper teeth are supposed to fit into the valleys (fossa) on the lower teeth and the mountains on the lower teeth should fit into the valleys of the upper teeth. When your teeth fit together this way, they are an effective chewing mechanism. When a tooth is lost and not replaced, the remaining teeth will shift out of place and pretty soon the upper and lower teeth start hitting mountain to mountain instead of mountain to valley. This is very traumatic to your teeth and is the major cause of chipping, breaking and fracturing of both your teeth and any fillings or crowns you may have in your mouth.
THE FOUR OPTIONS AVAILABLE FOR REPLACING MISSING TEETH
There are two main options for replacing missing teeth, Fixed or Removable. There are two types of Fixed restorations and once these are placed by a dentist in your mouth, they do not come out. The two types of Fixed restorations are, Implants and Bridges. There are two types of Removable options to replace missing teeth and these are Partial Dentures and Full Dentures.