I’ve Had to Lose a Tooth! What Now??
By Dr Jannen Tan BDsc (Hons) (Melb)
The consequences of tooth loss
“Just rip ‘em out doc!” a heartbreaking phrase we Dentists hear all too frequently. Ever wondered why it saddens us so much to have to pull a tooth out? Or why we try everything we can to persuade you to keep your teeth? This is because losing even a single tooth has long standing effects on your entire mouth, with far reaching effects into the future!
A full set of adult human teeth consists of 32 teeth. Most of us have had our wisdom teeth removed, leaving us with 28. These 28 teeth are all positioned precisely, balanced evenly in our bite to allow us maximal chewing capacity and effective speech. Teeth are not anchored to our jaw bone but suspended by a ligament, consequently teeth are in a dynamic state and can move all the time. Our teeth line up and bite against each other, keeping them all in a balanced, optimal position. When a tooth is lost, all of a sudden this balance is upset. The tooth behind the space can drift and tilt forward. The tooth above the one that is lost can drift downwards, creating mobility and gum problems. The more teeth that are lost, the harder the other teeth have to work, putting greater strain on them. Uneven, excessive wear and tear eventually occurs, causing even more problems. It is indeed a vicious cycle!
What can be done to replace missing teeth?
So we know ideally we should be keeping all our teeth. But what if we have already lost some? Modern dentistry has come a long way and there are now a wide range of options to suit all budgets that will allow us to replace those missing teeth and prevent the long term ill effects of tooth loss.
Dentures are an age-old method of replacing missing teeth. Full dentures made in acrylic are for patients with no teeth. For those with some remaining teeth, partial dentures are always best as the teeth allow us to use them for support and anchorage. Types of dentures are as follows:
- Acrylic Denture: These are made purely from the same material full dentures are made of. Stainless steel clasps are used to anchor the denture onto supporting teeth. It is mainly the gums and soft tissues that support this kind of denture. This is the cheapest type of denture and good for those working within a smaller budget.
- Flexible / Valplast Denture: These are made from a newer type of semi-flexible material. They have no metal components and the flex in the material allows us to engage the teeth to hold the denture in. Mainly used for small span areas.
- Chrome Denture: The base of this denture is case in Cobalt/Chrome. It is stronger, lighter weight and much more comfortable than an Acrylic denture. Clasps and supports extending from the chrome framework anchor the denture. This kind of denture is usually more stable than Acrylic dentures as it relies more on the hard tissues (ie. Teeth) for support. This denture provides far superior comfort and fit.
A bridge is a fixed prosthesis that replaces a missing tooth / teeth. A traditional bridge involves a crown each on the teeth behind and in front of the gap, with a new tooth joined to those crowns. The entire unit gets cemented in permanently and stays in for good. Until implants, this was the only way to replace missing teeth with something fixed in that does not require daily removal. There are also variants to the traditional bridge – the Maryland bridge where the replacement tooth is bonded to the backs of neighbouring teeth with metal backings and a Cantilever bridge where the replacement tooth is attached via a crown to one or more teeth behind it. The success of a bridge and suitability is restricted by the condition of the adjacent teeth and also the length of the gap. Bridges can’t be made too long as they put too much strain on the teeth supporting them. The angulation of supporting teeth is also important. A bridge is a good permanent way to replace a missing tooth / teeth, however with the advent of implants, it has taken a back seat.
This is generally the best way to replace missing teeth. Implants have the benefit of being fixed, and also avoids involving the teeth next door (unlike a bridge). Implants are made in titanium and are placed in the jaw bone with a small surgical procedure (easily done under local anaesthetic). The titanium is bone-friendly and the jaw bone soon grows around it and anchors it in solid. We can then fabricate a tooth to fit onto that implant and attach it. Implants can be used to replace a single missing tooth, or a large span of missing teeth. Implants can also be used to assist in holding dentures in where the denture is fitted with clips that attaches to the implants. The suitability and success of implants depends on several factors like bone levels / density, medical conditions that might affect healing, smoking and several other factors that is always discussed at a consultation. If possible, implants are always preferable and by far the best method of replacing missing teeth.
Thanks to technological advances, it is no longer the end of the world if you do lose a tooth. If it happens, we have ways to get you back on track. Of course, the best would be to not get to a point where you have to lose a tooth in the first place! Remember great oral hygiene, watch your diet and regular check and cleans at the Dentist!