I’m missing a tooth! Now what? – Part I
After having worked 9 years or so as a dentist, there are some questions I am asked numerous times; throughout the day, even. One of those questions is “what are my options to fill this empty space” or some variation of that question. Patients come in after having a tooth extracted (pulled) and want to know what their options are to replace that now-missing tooth. Or they have a tooth that has been missing for years and now want to do something about it. Or they may have several missing teeth or all their teeth missing and want replacements for those teeth.
There are several options to replacing teeth. And each of these options have different choices within them. So, for this one question, I will answer it in several parts. Each part will discuss a different option. I have broken them up into different parts because writing about all the options would make for a very, VERY long read.
So, the first choice a patient has after having a tooth removed is to do nothing. Yes, that is an option. We don’t recommend that option, of course, but it is an option patients have. And an option that patients have chosen more than we would have liked. I find most patients who choose this option, do so because, one, they really could care less about replacing that missing tooth and are doing fine without a tooth there; two, have limited finances; or three, have had bad experiences with other options and are wary about getting those same options again.
Whatever reason a patient chooses to NOT do anything, there are several potential consequences. Basically, these are the RISKS of not doing anything to replace a missing tooth/teeth. As with most risks, these COULD happen or they may NOT happen. They could happen quickly, or they may happen slowly over a long period of time. Everyone is different as to how they respond to these conditions. Biology is difficult in that sense; we cannot say that EVERYONE will definitely experience these consequences, and we cannot predict who will exhibit these consequences and who will not. We can only say that these are things that USUALLY happen, so decide not to do any treatment option at your own discretion.
Now, whether you are missing one tooth or several teeth, the risks are pretty much the same. Basically, teeth like it where there is no stress. So, if you’re missing a tooth, the opposing tooth can start to drift down into that new space (a process called supereruption), or the teeth adjacent to that missing space will want to drift into that area. What happens if your tooth starts to drift? Well, one thing that could happen is that that tooth and an adjacent tooth will now have less contact with each other. In other words, there will be more space between that tooth and one that is next to it. If you look at the figure below, you can see in the lower jaw there is a tooth depicted with an arrow pointing to the right. There is a space forming between this tooth and the tooth to its left. This space will allow for more food to get caught between them. Food getting caught in between teeth causes irritation to the gum tissue and leads to more inflammation of that gum tissue. More inflammation could lead to more underlying bone loss. More bone loss leads to more tooth mobility (loose teeth), which can lead to even more movement of the tooth into the empty space. It’s a vicious cycle.
Not only that, but more food getting caught in between your teeth is just more annoying as well. It means having to constantly go and floss food out from between those teeth every time you eat a meal. This may not necessarily be a bad thing because it usually gets patients to finally commit to treatment of that empty space. Patients come in fed up with having to pick food out from between their teeth, and want to proceed with whatever option will prevent that from happening again.
And, if enough food gets caught, it can actually get painful. Many patients have come into my office thinking they have a toothache when, in actuality, it is just a lot of food impacted between certain teeth. Again, this tends to get patients to decide on treating their problem and not letting things linger as is.
Another issue that arises when teeth drift into the empty space is that a patient’s bite slowly changes. When a tooth moves to a different position, their bite is going to be different. Some people notice this change, but most people do not realize a change in their bite has occurred. The movement is slight enough and slow enough, that our bodies accommodate to this new position without us even realizing it. However, that initial small change in their tooth position can lead to a cascade of events. Now, patients have unknowingly changed the way they bite into food, or change the way they bite down in general. This change in bite could ignite a grinding habit or clenching habit. That change in their bite could also alter the way that their temporomandibular joint (TMJ), or jaw joint, is positioned or rotating.
If that joint is in an unideal position, it can lead to wear of the joint or the cushion between that joint and the skull. Patients may start to notice a pop or click in that joint. Eventually, that pop or click can start to cause discomfort or pain. Now the patient has developed temporomandibular disorder (TMD), a condition that can lead to severe pain in the joint itself, and even to headaches and neck, back and shoulder pains as well. All of which can lead to a diminished quality of life. And if this condition is a result of excessive wear from severe grinding or clenching, then the typical treatment is full mouth rehabilitation.
Again, this is worst case scenario, but still a potential to happen. And if it does happen, it doesn’t necessarily happen all-of-a-sudden, in a matter of days. It could take years to develop. However, these are situations that can easily be avoided by treating the initial issue; the missing tooth. As I mentioned earlier, there are patients who come in after having done nothing, to finally get treatment done to replace the missing tooth. Timing is important though. I have seen situations where a patient comes in and states that they have been having food get stuck between his teeth for years and they’ve finally had enough of it. The patient comes in finally wanting to get treatment so that he doesn’t have to constantly pick food out from his teeth after each meal or bite. However, some patients wait so long that a tooth has supererupted so much that it has drifted down into the space of the missing tooth and almost filling in the gap, or the adjacent tooth to the missing space has drifted so much that it is almost tilted at an angle greater than 45 degrees. Now the patient is in a situation where if they want to “fill in the missing tooth”, they will need to extract, get root canal treatment, or get braces to correct the supererupted tooth in order to gain room for the restoration. Or they will need to extract, get root canal treatment, or braces to correct the excessively tilted tooth in order to get a new restoration. Basically, they have to treat more than just the missing area. Timing is important.
So, although “doing nothing” is a treatment option, it is definitely not one that is recommended in most cases. And, although there are times when none of these consequences occur and patients live many, many years without any issues, more likely than not some type of complication arises. If it does, it is important to treat these issues sooner than later.
NEXT: Part II – Removable Partial Dentures