What are the Consequences of having Missing Teeth?

There are a few consequences to consider if you have missing teeth that you may not be aware of. These may give you sound reasons for wanting to have the space filled in someway.

The ones you will notice are: 

• It doesn’t look good (un-aesthetic). This is the primary reason that most people fill spaces. I often hear patients say, “Well it’s at the back so it doesn’t matter,” but if it is a front tooth and it affects their smile, confidence and how people react to them, then it is worth considering the possibilities available.

• Difficulty chewing properly. Obviously the more teeth that are missing, the more chewing becomes a problem. We discussed the idea of the shortened dental arch in the introduction; if a mouth has all of its molar teeth missing but all premolars present (i.e. teeth 5 to 5 in each quadrant) you may have sufficient teeth for adequate looks and chewing. If any solid molar teeth remain then filling the space would be a better option.

Other more subtle consequences include:

• Over-eruption of opposing teeth. Teeth maintain the ability to erupt and so if a tooth is lost, the tooth opposite (if not balanced by teeth either side of the space) may grow into the space that has been left. This often causes sensitivity, as more root surface becomes visible above the gum and since the hard enamel layer does not protect the root surface, it becomes more vulnerable to dental decay. Cleaning your teeth when this happens is more difficult due to the shape of the roots and gaps between the teeth that develop trapping food and plaque.

• Tilting of teeth either side. Imagine taking a book from your book shelf… the books either side would then tilt towards one another to find support. Teeth can drift into spaces in this way, which may make putting a tooth in at a later date very challenging and creates a difficult cleaning area. There is no way to predict exactly how teeth are going to move into a gap and to what extent, but when it occurs as you can see, it does create problems.

• Increased stress/wear on other teeth. The more teeth you have missing, the more heavily you begin to rely on the remaining teeth. With this added pressure, you often find teeth will wear more quickly and fillings/restorations may break and fracture more often under the increased pressure. Wear is most obvious in patients who lose their back teeth and start to rely on their front teeth for chewing- something they were not designed for. As a result these teeth become shorter and shorter over time and can require quite complex treatment later to open up the bite and restore the smile. Some back teeth may need to be introduced for proper chewing.

• TMJD. For any of the three reasons above your teeth move and your occlusion or bite changes- this can in susceptible individuals cause problems with the jaw joint known as’ temperomandibular dysfunction’.

• Loss of bone and support for muscles/facial structure. When a tooth is removed, certain changes occur- the bone that has been supporting the tooth becomes redundant and will shrink. The teeth and bone levels supply support for the musculature around the mouth, so by restoring spaces you can help promote a fuller, younger face and reduce associated wrinkling. There are other changes that are going on as you age, but when the back teeth have been lost and the front teeth are shorter (due to the increased wear associated with them) cheeks can sink in and folds (wrinkles) develop at the corners of the mouth.

• Further tooth loss. I have seen this many times when a patient decides to have a tooth out for whatever the reason. Let’s say their thoughts are, ‘It’s at the back and I still have plenty still left to chew with’. The next time a tooth is in question, they will often also decide to have it removed. It is a slippery slope and before they know it they are wearing a partial denture to replace all their gaps. It seems that once you have made a decision to remove one tooth, and been through the process, then deciding to have another one removed is often easier. With this in mind, I would say where absolutely possible, try your best to preserve your teeth- opt for a root canal over an extraction if the prognosis of success is good.