Missing Teeth

Missing Teeth

Congenitally Missing Teeth

Some of us will have 32 teeth develop during our lifetime. This has been considered a normal complement of teeth. More often than not, however, we do not develop a full set of 32 teeth. It is quite common for people to be missing one or more of the third molars (wisdom teeth). And as the jaw sizes of modern human beings have decreased in size, it is not unusual that there is no room for the proper placement of the third molars in a mouth, and they must be extracted.

Not as common, but not at all unusual, is a condition in which certain permanent front teeth never develop. When permanent teeth don’t develop, they are considered to be congenitally missing. The term for this condition is congenitally missing teeth. When this happens, it is frequently one or both of the upper lateral incisors, which are the smaller teeth on either side of the two top front teeth. Less often, the permanent eyeteeth (canines) or premolars don’t develop.

The problem that results from congenitally missing teeth involves the space where the tooth (teeth) should have been. The teeth nearest the space shift into different positions to fill in the gap, often resulting in a crowded smile—when in fact, some teeth are missing!

The problems resulting from missing permanent teeth can be reduced or eliminated with early detection and a plan for future treatment. The usual treatment involves orthodontics to move the permanent teeth into better position or keep the permanent teeth in the correct location. Because we treat missing lateral incisors so often, the treatment routine is well established. The best esthetics, the most natural look, will be achieved by leaving the adjacent permanent central incisors and canine teeth in their customary places.

When there are missing lateral incisors, it is likely that we will recommend moving the eyeteeth (canines) into their positions. This will keep the bone in the missing tooth space at the proper level. We will then recommend moving the eyeteeth back into their proper positions. This may sound like extra treatment, but it is needed to keep the bone at the proper height for future tooth replacement treatment.

The sequence of treatment is orthodontics as early as necessary to maintain the space. The further the teeth have shifted from this original position, the more orthodontic treatment will be necessary. Then, while the child and mouth are growing, a removable replacement tooth is made. This appliance is worn until the teeth are ready to receive the implant or bridge, after age 18 or so when the mouth and dental structures are more mature.

When the permanent teeth further back in the mouth are missing, it is common for baby teeth to be retained in these spaces. Sometimes the baby teeth can last for years, but they do not have the root structure to remain stable over a lifetime. Because the retained baby teeth are meant for a small mouth, they do not have the right size, shape, or function as the permanent teeth. When lost, they can be replaced with implants or a bridge. Your own particular situation will determine the best course of treatment.

Replacing Missing Teeth

Most adults can expect to have 32 teeth. The four third molars, or “wisdom” teeth, are often extracted because they do not grow into the mouth well or there is not enough room for them to remain in proper alignment. It is very unusual to have wisdom teeth replaced. But the other 28 teeth are needed. Your mouth, jaw, and body developed together over millions of years. They are designed to operate together at peak efficiency. When you lose a tooth, the efficiency decreases and function suffers. When you lose a tooth, you lose some ability to chew food properly. This may mean that you either place more stress on the other teeth in order to chew all the food you eat, or you do not chew well enough and what is swallowed is not quite ready to be digested. This can lead to digestive difficulty. Or you might switch to a diet that consists of softer foods that do not have to be chewed as much. You might have to eliminate certain favorite foods because you cannot chew them thoroughly. For each missing tooth, you lose approximately 10% of your remaining ability to chew food.

Other problems also occur. The teeth adjacent to the space left by the missing tooth will eventually shift. If for example, a lower tooth is extracted, the opposing tooth in the upper jaw will grow slowly (or sometimes quickly) longer in a downward direction into the missing tooth space. This is called extrusion or supereruption. The teeth on either side of the missing tooth space will move and tilt off their proper vertical axis and drift into the missing tooth’s space. This can make these teeth more prone to decay and gum disease because it is much harder to keep the teeth clean when they are not aligned properly. Root structure that is normally covered by gum and bone may become exposed. All this can happen if one tooth is lost. Other major problems can occur if multiple teeth are lost. There is a loss of the arch length, the distance from the back of the last tooth on one side of your mouth to the back of the last tooth on the other side of your mouth. With collapsed bite and loss of vertical dimension, the distance from your chin to the tip of your nose decreases, making your face shorter. Extrusion and movement of your maxillary (upper) alveolar bone until the gum tissue from the upper jaw can touch the teeth or gum tissue of the other jaw causes loss of facial tone and shape. The facial muscles of the cheeks and mouth sink into the edentulous (extraction) site. There can also be severe cosmetic problems when the extracted tooth’s space is visible when you talk or smile. This is not a pretty sight to anyone. There is loss of self-image and self-esteem and a feeling that you are getting old. Once you start losing teeth, you can actually start to look old. Losing a tooth is pretty serious. The longer you wait after a tooth is extracted, the more difficult and expensive it can become to make the replacement you need. With very few exceptions, it is better to replace missing teeth as soon as possible. Evolution designed you to chew your food with 28 teeth.

We will discuss with you the type of replacement that would be best suited for you. You can choose to do nothing at all and leave the space or spaces, but as you can tell, this is not usually recommended. You can have a fixed replacement made that could be an implant, a conventional bridge (crowns/caps), a bonded resin bridge, or a combination of implants and bridges. You could also have a removable partial denture made. The advantages of the fixed replacements are that they are not designed to come out of your mouth at any time, they are the easiest to live with, feel more like the original teeth, and are perhaps more cosmetic than removable dentures. A removable partial denture is held in place by metal clasps that may be visible. It is bulkier and may interfere with your speech for a period of time. However, generally, dentures cost less than a fixed replacement.

Your chewing apparatus, jaws, and teeth were evolved to function in a particular fashion. The interaction is complex and marvelous. Loss of teeth degrades this function. Preserve your health. Replace missing teeth as soon as suggested.

If you have any questions about replacing missing teeth, please call us to schedule a free consultation at a location convenient for you.