I Have a Tooth Missing- Now What?

I Have a Tooth Missing- Now What?

On February 11th, 2014, posted in: Dental Education for Patients by

Many people for various reasons are missing a permanent tooth at some point in their lives. The questions then are: How do I replace my tooth? Do I even have to replace my tooth? What happens if I don’t have a tooth there?

First, there are several reasons why you should replace a missing tooth. Even if a tooth is not visible, not having it present can affect you in a number of ways, besides the obvious cosmetic and potentially psychological issues.

On a basic level, missing a tooth can often affect your ability to eat. Usually, missing one posterior tooth does not affect chewing ability directly, but it can over time. This is because the forces used for chewing or clenching will now be heavier on the teeth that are still present. For example, if you have 8 molar teeth, and now you have 7, we may find that the other 7 begin to wear more than they would have before. If many of your other teeth already have large fillings or cracks, then that makes it more likely that they could be damaged when they are taking more of the force than they were before.

The biggest problem that we see when a tooth is missing is the movement of the other teeth around the space. The teeth behind the space where the tooth was will often tilt forward into that space. Sometimes, a tooth behind a space will tilt so far forward that eventually the patient is biting on the side of that tooth instead of the “occlusal” surface (the top part that you typically bite on). The other tooth that often moves after a tooth is removed is the tooth that opposes the space (this is the tooth that was biting on the now missing tooth). The opposing tooth will seemingly “search” for something to bite on and will erupt further out of the socket in its quest to find a partner. The long term consequences for this can include the loss of that tooth as well.

The third problem with a missing tooth is loss of bone. Bone can be thought of with the adage “if you don’t use it, you lose it.” Without a tooth present, the bone typically resorbs or shrinks back. The common example of this is seen when a person has had all of his or her teeth removed and wears dentures for many years. After many years without teeth, there is very little bone present for the denture to hold on to. In a one tooth space, the bone loss that occurs usually is minimal, but it is often enough to make it impossible to place an implant in the future. With more than one tooth missing, however, the bone loss can be significant enough to make the face appear collapsed and therefore older.

Once you have decided to replace a missing tooth, you have to decide how. There are 3 options for replacing a missing tooth.

The first option is to fabricate a removable appliance, typically called a “partial.” This is the least ideal choice, because it does not preserve the bone (as previously mentioned) and because you will have to take the appliance in and out of your mouth. The appliance will also need to use the teeth around the missing space in order to stay in. This can put unnecessary force on those other teeth.

The second option is a dental bridge.  A bridge is cemented in your mouth, so you do not take it out. This makes it a much better option than a removable appliance. The biggest downside to a bridge is that it requires the preparation of the teeth on either side of the missing tooth. This means that about 2mm of tooth structure from the top and the sides of the teeth on either side will be removed in order to create the bridge. This also means that if anything happens to one or both of these adjacent teeth, the whole bridge will need to be remade. The replacement of the missing tooth is therefore dependent on the health of the teeth on either side. The bridge will also not preserve the bone.

The third and usually best option is a dental implant. A dental implant involves a “root replacement” that will go into the bone where the tooth’s roots previously were. This makes it the best option for preserving the bone, because the bone is being used. The implant will then have a crown attached to it to replace the part of the tooth that is above the bone. The primary advantage of a dental implant is that it is independent of the other teeth around it, and it is most similar to having a real tooth.

If you would like to discuss replacement of a missing tooth or missing teeth, please contact us! Not all options are possible in all cases. We would be happy to see you and further explain all of your specific options.