Missing Teeth -Consequences and Complications 

     Losing your teeth can cause more than health problems. It directly affects your self-esteem as tooth loss impinges on your smile and the way your face looks. Here are some perceptible consequences of tooth loss:

 

  • Speech problems.- Based on the position of the missing tooth or teeth, the patient may experience problems with speech.
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  • Chewing problems.-A patient with missing teeth or significant gaps between teeth may have trouble chewing food. If all teeth are missing, patients will be reduced to “gumming” their meals and their diet will have to be adjusted to softer foods.
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  • Cosmetic Loss and social embarrassment.
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  • Anxiety and self-consciousness.
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  • Stiff jaws and problems with relaxation.-The resulting pressure on existing teeth will cause them to shift. Jaw pain is often a side effect of shifting teeth.
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  • Weakening of other teeth because there are less teeth to use when you eat.
  • Movement and inclination of other teeth and their possible loss
  • Tooth Decay — Teeth that have shifted from the pressure tend to be harder to clean, as dental tartar between crooked teeth is more difficult to reach. Regardless of how well you practice good oral hygiene, dental plaque can build up and lead to cavities and gum disease..

     

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  • Nutritional problems-   Loss of Balanced Diet- Only the easily dissolvable food is assimilated into the body and more of sugar and salt can lead to Diabetes (mellitus) and High Blood Pressure. Oils and Fats which seldom require much chewing to be absorbed into the system can lead to Lipid imbalance resulting in High cholesterol, Plaques deposits in blood vessels and heart diseases.
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  • For baby/Milk teeth, potential loss of space for adult teeth.

 

     Long term studies prove that an individual with full set of teeth is likely to live 15 healthy years more than his counterpart without teeth. What is the point in spending Lakhs or millions in hospital as patients as against spending much less and early to stay healthy, Is this littly cost towards health and happiness not worth it.

 

  • Drifting
    Loss of one or two teeth in a segment of your mouth can lead to drifting of neighboring teeth, whereby the adjacent teeth lean over into the vacant space where the teeth have been lost. Similarly, loss of a tooth or teeth can lead to shifting of opposing teeth as they drift down into the open space (super-erupt). 

  • Spacings                                                                Drifting as mentioned above leads to spaces developing between the teeth, food invariably impacts or get stuck in theses spaces, bacteria proliferate in these food debris leading to teeth decay and the vicious cycle is further propogated.In total the entire system on one side of the jaw is destabilised as a result of a single tooth loss that is not replaced promptly  .

 

  • Bone Loss 

When teeth are removed from the jaw, the bone that supports the teeth tends to shrink over time. This process is called resorption and is a natural consequence of the loss of stimulation to the bone from the forces placed on the teeth. Resorption of the alveolar bone (bone that supports the teeth) begins almost as soon as the tooth is removed and proceeds over time. The bone will lose both height and width from resorption. 

 

  • When multiple teeth are lost, with or without a prosthesis to replace them, significant loss of jaw bone can take place. This sometimes leads to difficulty wearing a removable denture due to lack of an adequate “ridge” upon which the denture can obtain stability. In the so-called “esthetic zone” of the mouth, where loss of ridge volume can be visibly apparent to the naked eye, this can lead to a cosmetic defect. As the bone resorbs, the gum which covers it also shrinks away, creating a concavity (depression in height and width) that can be unsightly as well as possibly promote food impaction under adjacent teeth. 


The bone in the body acts very similar to a muscle. When muscles are exercised, they grow strong and larger. When bone is exercised or stimulated, it also becomes stronger. For example, when an arm is broken and placed in a cast for six weeks, you can see the arm is smaller after this time frame, since the muscles have started to shrink or atrophy. In addition, if you evaluate the bone protected by the cast, it also becomes less dense and weaker in this period. Similarly, the bone of the jaw can only be stimulated by a tooth or by an implant. The connections between a tooth, or an implant, create and preserve the size and shape of the bone.
Bone needs the stimulation of the tooth roots to maintain its form, density, and strength. Scientific studies have proven that the normal chewing forces that are transmitted from the teeth to the bone of the jaw are what preserves the bone and keeps it strong.

This close relationship between the tooth and the bone continues throughout life. When a tooth is lost, the lack of stimulation to the surrounding bone results in a decrease in the density and dimensions of the bone. This means that there is a loss of width and height of the bone. In a 25-year study of patients with no teeth, x-rays demonstrated continued bone loss of the jaws during this entire time span. Therefore, a tooth is necessary both to the development of the bone around the tooth, and is also necessary for the stimulation of this bone to maintain its strength, density and shape. The loss of all of the teeth slowly, but eventually, leads to jaws with almost complete bone loss. A lower jaw, which starts out two inches in height, can be reduced to less than one-quarter of an inch by atrophy over time. That is one reason why modern dentistry is so excited about using dental implants to replace missing teeth.

Patients wearing dentures don’t realize they are losing bone. Over time, the poor fit and function of the denture is often thought to be due to its age, weight loss by the patient, or wear of the denture’s teeth. The rate and amount of bone loss may be influenced by gender (females lose more bone), hormones (lack of estrogen causes more bone loss), metabolism, medications, parafunction (grinding the teeth) and poorly fitting dentures. Despite this, almost 40% of denture wearers have been wearing the same denture for more than 10 years. Although the fact that wearing dentures day and night places greater forces on the bone and gum, and accelerates bone loss, 80% of dentures are worn both day and night.

Consider the following: The issue of bone loss after tooth loss has been ignored in the past by traditional dentistry. This is so because dentistry had no treatment to stop or prevent the process of bone loss and its consequences. As a result, doctors had to ignore the inevitable bone loss after tooth extraction. Today, the profession knows about bone loss and implants can stop bone loss because implants stimulate the bone, similar to the way the tooth did prior to its loss.

Jaws with bone loss are associated with problems, which often impair the predictable results of traditional dentures. The loss of bone first results in decreased bone width. There is a 25% decrease in width of bone during the first year after tooth loss and an overall _-inch decrease in height during the first year following extractions of several teeth. The remaining narrow bone often causes discomfort when the thin overlying gum tissues are loaded under a complete or partial denture. In the lower jaw, the continued bone loss eventually results in prominent bony projections covered by thin, movable, unattached gum tissue. As the remaining bone on the front of the jaw continues to disappear, the bony projection under the tongue rises to sit on the top of ridge. This results in pain, as the denture sits atop the sharp bony projection. In addition, there is little to prevent the denture from moving forward against the lower lip during function or speech. The problems are further compounded by the upward movement of the back of the denture during contraction of the muscles during speech and function. The resulting incline (slope) of the now deformed lower jaw compared with that of the upper jaw also creates instability and movement of the lower denture.

Loss of bone in the upper and lower jaw is not limited to the bone around the teeth; portions of the skeletal bone also may be lost especially in the back parts of the lower jaw where the patient may lose more than 80% of the bone. The nerves of the lower jaw which were surrounded by and protected by bone eventually become exposed and sit on the top of the ridge directly under the denture. As a result, acute pain and/or temporary to permanent loss of sensation or feeling of the areas supplied by the nerve is possible. The bone loss in the upper jaw may cause pain and an increase in upper denture movement during eating. The forces from eating with an ill-fitting denture are transferred directly to the surface only and not the internal structure of the bone since there are no roots. Therefore, these forces do not stimulate and maintain the bone, but instead actually decrease blood supply and increased the rate of the bone loss. Chewing forces generated by short facial types can be 3 or 4 times that of long facial types. These patients are at even greater risk to develop severe bone loss.

Many of these conditions that have been described for patients without any teeth also exist for patients where only back teeth are missing and they are wearing a removable partial denture. The above problems focus on the damage to the bone. The remaining natural teeth are also subjected to substantial damage. The teeth must support the partial denture by connections called clasps. The clasps grab onto the teeth, and by design, transfer lateral or sideward forces to the teeth, which weaken them and cause tooth loss. Since these teeth often become compromised by loss of bone due to these forces, many partial dentures are then designed to minimize the forces applied upon these teeth. The net result is an increase in movement of the removable denture, and greater pressures on the soft gum tissue over the bone. This results in more bone loss. These conditions can protect the remaining teeth, but then accelerate the bone loss in the regions without teeth.


As bone continues to lose width and height, the gum tissues gradually decrease. A very thin gum usually lies over the advanced bone loss of the lower jaw. The gum is prone to sore spots caused by the overlaying denture. In addition, unfavorable high muscle attachments and loose tissue often complicates the situation.

The tongue of the patient with no teeth often enlarges to accommodate the increase in space formerly occupied by teeth. At the same time, the tongue is used to limit the movements of the removable denture, and takes a more active role in the chewing of food. As a result, the removable denture decreases in stability. The decrease in muscular control, often associated with aging, further compounds the problems of traditional removable dentures. The ability to wear a denture successfully may be largely a learned, skilled performance. The aged patient who recently loses their teeth may lack the motor skills needed to accommodate to the new conditions. This often results in food that is not adequately chewed, resulting in digestion and nutrition problems. (See “Health Effects of Tooth Loss” below)

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