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Missing Teeth

 

What causes missing teeth?

There are a number of reasons for teeth being lost.

Tooth decay 

This is the most common reason. 

Every time you eat or drink something containing sugars – and this means the sugars found in fruit and carbohydrates as well as actual sugar - the bacteria present in everyone’s mouths break these sugars down and produce acid. These acids attack the teeth and start to soften and dissolve the enamel, the hard protective outer coating of the tooth. About an hour after eating or drinking, the natural action of your saliva neutralises the acid, causing the enamel to re-mineralise and harden again; however snacking between meals can increase the risk of decay as the teeth do not have the time to recover.

 

Once the acid has eaten through the enamel, bacteria and acid can continue into the dentine, which lies below the enamel and makes up most of the tooth, and eventually into the pulp, the soft tissue containing blood vessels and nerves at the heart of the tooth.

 

Dentists prefer to try to save a decayed tooth with dental fillings (see The Good Dentist Guide to Dental Fillings) or root canal treatment (see The Good Dentist Guide to Root Canal Treatment) if possible, rather than removing it as this causes fewer problems. However if the decay is in an advanced stage and has destroyed most of the tooth then it will be extracted which also prevents the infection from spreading any further.

Gum disease

Gum disease (see The Good Dentist Guide to Gum Disease) is caused by a build-up of plaque on your teeth. Plaque is a sticky film of bacteria which forms every day on teeth and gums, and if this is not properly brushed away, some of these bacteria cause inflammation of the gums. If plaque is left it will harden into tartar, which adheres strongly to your teeth and is not easily removed by brushing or flossing; areas of tartar act as plaque “traps” where yet more plaque accumulates. The less serious form of gum disease, gingivitis, can develop if left untreated into periodontal disease.

 

There are a number of types of periodontal disease and they all affect the gum and bone supporting the teeth. As the disease gets worse the bone anchoring the teeth in the jaw is lost, making the teeth loose. If this is not treated, the teeth may eventually fall out. In fact, more teeth are lost through periodontal disease than through tooth decay.

Accident or injury 

It is common to lose a tooth or teeth as a result of an accident or injury. Sports injuries; a blow to the mouth or a fall which results in an injury to the face, even a one-off incident such as tripping over a step or walking into a door can result in a chipped, cracked or broken tooth which may be too badly damaged to restore. 

Congenitally missing teeth 

It is possible to be born with less than the normal complement of teeth. There are certain genes involved in tooth development and a defective gene can result in missing teeth. Missing teeth can also be a part of a congenital disorder such as cleft palate, Down’s syndrome or Rieger syndrome.

Ageing

Even if you have managed to avoid tooth decay and gum disease, the aging process results in the weakening of the muscles and skin around the jaw due to a decrease in elasticity. Also your teeth, like any other part of your body, are subject to wear and tear. They undergo a great deal of stress and strain and this starts to show after a period of time. Missing teeth can result in difficulties in eating a balanced and nutritious diet, so it is of particular importance that missing teeth should be replaced in the elderly.

Why do missing teeth cause problems?

Most obviously, a missing tooth or teeth will affect the way you look, and may make you self-conscious about smiling or opening your mouth; your speech may also be affected.  There are however more subtle problems caused by missing teeth: the lack of underlying structure can affect the muscles of the jaw, making you look older; the gap left by a missing tooth can mean greater strain is put on the teeth on either side; and the neighbouring teeth may lean into the gap, altering the way your upper and lower teeth bite together. Accumulation of food in the gap can lead to tooth decay and gum disease.

 

For all these reasons you should visit your dentist to discuss replacing your lost tooth or teeth as soon as possible.

What treatment options are there for replacing missing teeth?

There are three main treatment options for replacing missing teeth: 

  • Dental Bridges
  • Dentures
  • Dental Implants

You should discuss the various options with your dentist to agree the most suitable for you. The choice will depend upon the number of missing teeth you have, the condition and position of your remaining teeth and whether there is any loss of bone density in your jaw, as well as aesthetic and economic factors.

Dental Bridges

Dental bridges consist of one or more false teeth which are anchored onto your neighbouring natural teeth. They may be made of gold, porcelain or a combination of the two; they are not removable.

 

The most commonly used is a traditional fixed bridge: this is a false tooth, usually made of  porcelain or ceramic, fused to two dental crowns that are fitted to the teeth on either side of the gap. 

 

A resin-bonded bridge or ‘Maryland bridge’ is used when the gap to be filled is in between the front teeth and therefore highly visible, or where the teeth on either side of the gap are strong and healthy and the dentist is reluctant to remove large portions of them to fit dental crowns. The false tooth is fused to a metal ‘wing’ that is bonded to the back of the adjacent tooth using resin that is hidden from view.

 

A cantilever bridge is used when there are teeth present on only one side of the gap and the false tooth is anchored to one or more adjacent teeth on one side only.

Dental bridges can last for 10-15 years if well looked after.

Dentures

Dentures are removable replacements for your own natural teeth, designed to look and function like your teeth and surrounding gum tissues. A complete or full denture is one that replaces all of the natural teeth in either the upper or lower jaw. A partial denture fills in the spaces created by lost or missing teeth and is attached to your natural teeth with metal clasps or attachments.

 

The base of a denture is called a plate and can be made of either acrylic (plastic) or metal. The teeth are normally made of acrylic and can be made to match your natural teeth. This is especially important in the case of partial dentures. Modern-day dentures can look very realistic and natural and feel comfortable; they can even improve the look of your smile and the appearance of your face. 

 

Your dentures are custom-made to fit your mouth exactly and should be held in place by their natural suction to your gums: they can also be fixed securely in place by dental implants or mini implants (see The Good Dentist Guide to Dental Implants), provided the amount and condition of the bone in your jaw is suitable.

 

Dentures can become loose as your gums shrink and your bite changes. If this happens, your dentures may need to be relined or re-made. It is important to replace worn or badly fitting dentures before they cause problems.

 

For more information see The Good Dentist Guide to Dentures.

Dental Implants

A dental implant is a titanium screw or cylinder used, just like the root of a natural tooth, to support one or more false teeth (see The Good Dentist Guide to Dental Implants). Just like a tooth root, it is placed into the jawbone; it is made of titanium because this metal has the unique property of being able to integrate very closely with bone and so produce a very stable base for replacement teeth and it is very light in weight. A dental implant normally has some form of internal screw thread or post space that allows a variety of components to be fitted on top, such as single dental crowns or caps for replacing a single missing tooth, or bridges where more than one tooth is being replaced.

Advantages of dental implants:

  • When a tooth is lost, as well as the problems caused by the missing tooth itself, the missing root also causes a problem since the bone surrounding the hole where the root used to be will gradually shrink and disappear. A dental implant placed in this area can actually stimulate bone growth and production, preventing loss of valuable bone structure. A bridge or a denture will not have this effect of preventing bone loss.
  • By replacing lost teeth with an implant, no support is required of the adjacent teeth, and your natural teeth do not need to be prepared or altered in any way.
  • Unlike bridges and dentures, which require special cleaning instructions and extra attention, dental implants just need the same regular brushing, flossing and dental hygiene appointments as your natural teeth.
  • Dentures can come loose and look unnatural if they do not blend with your gums, and some bridges and dentures have unsightly metal clasps to hold them in place. Dental implants provide a much better cosmetic and functional end result.

 

Depending upon how well you look after them, dental implants can last a lifetime. Often, the crowns, bridges and dentures are more likely to be damaged (and are more easily replaced), than the implants that support them.

For more information seeThe Good Dentist Guide to  Dental Implants.

What is the procedure for making and fitting replacement teeth?

This will vary according to the type of replacement and materials chosen and your particular circumstances; however all are multi-visit treatments with your dentist first preparing your teeth (and jaw in the case of implants); after any necessary healing, impressions and measurements will be taken of your teeth which will be sent to a dental laboratory where your replacement teeth will be made.  In the interim you may be fitted with temporary replacements. Once your replacements are ready, these will be checked for fit and appearance before being fixed in place.  In the case of dentures, adjustments or replacements may be necessary over time.

 

You can find more information in The Good Dentist Guides to Dental Implants and Dentures.

How much will the treatment cost?

Treatment costs can vary enormously depending on the complexity of the work required, the number of missing teeth and the replacement option chosen. 

A minimum fee, for example for a single-tooth denture, would be approximately £350-400, whilst a complex, multiple implant case can be £40,000 or more.

How do I look after my replacement teeth?

You should practice good oral hygiene and see your dentist regularly.  If you have a bridge, you should take care to clean underneath it – your dentist or hygienist will advise you on this. If you have dentures, these should be taken out at night, brushed, soaked and then brushed before inserting again. It is also important to see your dentist if your dentures become worn or cease to fit properly.

 






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