Missing Teeth -A Tale of Loss and Identity


Dr. Valerie Anithra Pereira

Notice the woman in the above picture? She is missing an eyebrow, yet all you notice are her missing teeth! 69% of the population between 35-45 years have at least one tooth missing! A person’s first molar tooth is the first permanent tooth to erupt and is usually the first one to be lost.

Why Do Teeth Go Missing?
Cavities are the most common cause of tooth loss. A lot of times, molars decay without any pain leading the patient to ignore the issue. But as time goes by, the tooth breaks down. Sometimes, the dentist can save it with a root canal treatment. However, many times, the tooth is beyond repair and has to be extracted.

Another cause for tooth loss is the weakening of the gums due to periodontal disease, which causes the teeth to become mobile and fall off. Sometimes, teeth may get fractured due to injury or biting into hard food. This results in requiring the fractured tooth to be removed. Sometimes, post endodontic treatment, teeth can break if a crown is not fixed.

Age-related tooth loss is a major problem. Drying of the mouth is often seen in the older population, which leads to the enamel of the tooth wearing away and eventually resulting in tooth loss. Researchers have observed a direct correlation in the elderly population between tooth loss and physical and mental health decline. A lot of older people face feelings of shame or embarrassment due to their edentulous state, leading to a loss of confidence and self-esteem. Genetics can also be a reason for tooth loss.

Consequences of Tooth Loss
What happens when one loses a tooth? The major consequence would obviously be an inability to eat in that region. Most people compensate by chewing on the opposite unaffected side. This causes unbalanced forces in the mouth, affecting the bite.
It also makes eating healthy foods like fibrous fruits and vegetables difficult, resulting in nutritional deficiencies and deterioration of health conditions like diabetes. Another issue is that the person’s smile is compromised.

In addition, there is also a loss of bone and soft tissue in the area without the tooth. The opposing tooth then supra-erupts to fill in the space. This causes a collapse in the bite leading to changes in the facial structure – like sagging of the cheek, loss of facial muscle tone, deepening of facial lines, thinning of the lip and an appearance of the lower face with sagging “jowls” or “witch’s chin”, resulting in poor aesthetics. Also, the other teeth migrate, resulting in spaces and black holes in the mouth.
A major problem that goes unidentified is bone loss and medications, age and metabolism worsens it, causing more teeth to be further lost.

How Do We Treat Missing Teeth?
With the lifespan of people increasing and people desiring a better quality of life as they age, the need to replace missing teeth becomes a non-negotiable.
Some options for replacing missing teeth are removable partial dentures, fixed partial dentures, complete dentures, dental implants, and implant-supported dentures.

A. Removable Partial Dentures
These can be used when there are a few teeth to be replaced. It consists of a pink plastic-like base with teeth on the top that can be taken off at will. Advantages include low cost and ease of fabrication.

B. Complete Dentures
Complete Dentures can be used to replace the entire set of teeth. But one must remove and clean them regularly. Also, repeated removal and replacement of dentures can cause breakage. Another disadvantage of dentures is that long-term wearing of removable partial dentures and complete dentures causes more bone loss.

C. Fixed Partial Dentures /Bridge
A fixed bridge can replace a single tooth using an artificial ceramic or metal tooth. The tooth is attached to adjacent teeth and then bonded in place. This is a good option for replacing teeth, except that adjacent teeth need to be trimmed and this may cause sensitivity and tooth decay. Also, bacteria can seep under the bridge leading to the accumulation of plaque.

D. Implants and Implant-Supported Dentures
To counter these problems, dental implants were developed. An implant is basically a titanium screw that fits in the area of the lost tooth and is covered by a tooth-like crown.

The main advantage of implants is that they don’t need to alter adjacent teeth. The other plus with implants is that since it is embedded in the bone, it feels just like a natural tooth and there is minimal loss of bone.

Prof. Branemark famously said, “No one should die with their teeth in a glass of water.” And implant-supported dentures make this a possibility. Here, the denture is attached to the implants that are fitted into the person’s jaw, thereby not needing removal. Also, the chances of them slipping while eating and talking are zero and one’s smile and confidence are greatly improved.

The drawback with implants would be one’s medical history and remaining bone would need to be assessed before one is declared to be a fit candidate for implants.

Whatever the reason for missing teeth, replacement is a must! Even a single missing tooth can wreak
havoc in a person’s mouth, causing difficulty in eating, speech and a loss of confidence.
So this Valentine’s Day , don’t worry about being single, but definitely replace that single missing tooth! Love yourself and take care of your teeth so they may serve you in the years to come.

About the Author:
Dr. Valerie Anithra Pereira is a consultant dentist who specialises in Peridontics (gums), Laser Dental treatment and Implants.

She has done her BDS from AJ Institute of Dental Sciences, Mangalore. She has practiced at Narayana Hrudayalaya in Bangalore and has done her Masters in Periodontics and Implantology (MDS) at Rajiv Gandhi University of Health Sciences in Coorg. She has served as an Assistant Professor in Periodontology at Bhopal University and Maharashtra University of Health Sciences, Nashik

She is available for consultation at Pai Dental Clinic, Panjim. She can be contacted on: 8208007184