Unique to You

If you are missing teeth, it's a condition known as edentulism. Partial edentulism is the absence of one or more teeth. Total edentulism is the absence of all teeth. Over 120 million Americans are missing at least one tooth, and more than 36 million Americans are completely edentulous (no teeth). The majority of edentulous people are over the age of 65, and the number who are at least partly edentulous is expected to rise as the population ages. Even so, there are millions of Americans younger than 65 who have lost all of their teeth.¹

Edentulism is a potentially serious condition that should be addressed as soon as possible. Failure to replace a missing tooth can impact your oral and overall health. The impact continues to increase with the more teeth you lose.

Congenitally missing teeth are missing from birth and include conditions such as hypodontia or anodontia. These conditions are considered a developmental form of edentulism and are not the result of tooth loss or removal.

The loss of a baby (primary) tooth is also not considered edentulism as a permanent tooth will normally replace it. However, the premature loss of primary teeth may result from tooth decay or other medical or dental conditions. Baby teeth that are lost before a permanent tooth is erupting should be addressed as soon as possible as they could contribute to changes in your child's bite and orthodontic issues in the future.

Teeth serve many functions, including:

• Chewing and grinding food for easier digestion and better nutrition.
• Preserving the tooth-supporting bone in the tooth socket.
• Giving the proper shape to lips and cheeks.
• Assisting in pronunciation and the creation of sounds.
• Balancing the impact of biting forces.
• Maintaining a proper bite relationship between the upper and lower jaws.

Missing teeth should almost always be replaced. An exception is wisdom teeth since they are normally not required to chew properly, may not be in the correct position, and can contribute to the development of periodontal disease in the adjacent molars.

If a second molar (the ones farthest back if wisdom teeth have been removed) falls out or is removed, your dentist will not typically recommend replacing it. However, there are many factors that your dentist will consider before making their recommendation.

These are several reasons why you should replace a missing tooth:

• The teeth on either side of a missing tooth may lean into the lost tooth's space. Also, the tooth in the opposing dental arch may extrude into the open space above or below. This will cause a change in the bite relationship between the upper and lower dental arches. It also causes the biting forces to be distributed unevenly between the teeth.
• Negative outcomes of unreplaced missing teeth may include: tooth wear, chipped teeth, cracked teeth, misaligned teeth, a greater risk of poor oral hygiene, and problems with your jaw joints. It may also lead to bone loss through bone resorption.
• Gastrointestinal and kidney problems can be the result of an inability to chew food properly.
• Poor nutrition can result from avoiding certain foods.
• Loss of multiple teeth can ultimately contribute to bite collapse.
• Loss of teeth, especially those that are more visible in your smile, can cause a decline in self-esteem and quality of life.

There are many causes of tooth loss. It is important to be aware of these causes so you can take steps to reduce contributing factors before tooth loss occurs. Awareness of these factors will also help your dentist develop a tooth repair or tooth replacement plan that has the greatest likelihood of long-term success.

• Periodontal disease is the most common cause of tooth loss in adults. Periodontal disease leads to loss of the bone surrounding the teeth, causing them to loosen and ultimately fall out.
• Severe tooth decay can lead to tooth loss.
• Excessive bite forces due to chronic grinding or clenching can cause chipped teeth and tooth wear. If extensive, both can lead to tooth loss.
• Teeth can be chipped and cracked as a result of chronic misuse of teeth.
• Trauma caused by injury (teeth may be displaced or completely knocked out).
• A severely cracked tooth may not be repairable and must be removed.
• Failing dental restorations.
• Abscesses.

• Poor oral hygiene.
• Advancing age if accompanied by periodontal disease or other risk factors, particularly if the patient's ability to take care of their teeth diminishes.
• Smoking and chewing tobacco both of which may impair blood flow to the gums and contribute to progressive periodontal disease.
• Stress leading to grinding or clenching.
• Medications that lead to dry mouth or that affect your gums.
• Using your teeth for reasons other than chewing and grinding food.
• Sports or activities (especially without proper mouth and face protection).
• Medical conditions such as heart disease, diabetes, or rheumatoid arthritis, if any of these contribute to poor blood flow to the gums or inhibit your ability to take care of your teeth.
• Poor nutrition.
• Cancer treatments such as radiation therapy or chemotherapy.
• Genetics.

If you have a tooth knocked out from trauma, you should immediately contact a dentist. If you have a tooth fall out for any other reason, call a dentist to determine how soon to schedule an appointment to address the issue.

The loss of a permanent tooth is obvious, whether it occurs by disease, accident, or has been intentionally removed for other reasons. Your dentist will formally diagnose a lost tooth by evaluating where the tooth was located.

• Reduce or eliminate the contributing factors in your control.
• Practice good oral hygiene to prevent tooth decay and periodontal disease.
• Use mouthguards, masks, or face cages to prevent a tooth from being knocked from sports or activities.
• Use occlusal guards to prevent tooth damage from grinding or clenching.

The goal of tooth replacement is to restore your mouth to the most natural state possible. Available treatment options depend on which tooth or teeth are missing and how many teeth are missing. Your dentist will also consider conditions such as tooth decay, periodontal disease, or grinding or clenching. Options also depend on the quantity and density of the bone that remains. Your dentist will discuss the best options for your specific situation.

• Bridges: Bridges can replace one or more teeth but require healthy tooth structure to be removed from the teeth adjacent to the problem area in order to hold the bridge structure. They are generally easy to clean and maintain.
• Dentures: Your dentist can create dentures to replace several teeth (partial dentures) or all teeth (complete dentures). Dentures can be fixed or removable. A fixed partial denture is also called a bridge. A fixed full denture is usually supported by dental implants.
• Dental implants: Dental implants can replace a single tooth, help replace multiple teeth by supporting a bridge, or replace all teeth by supporting a complete denture.
• Space maintainers: In children, when primary teeth are lost prematurely, space maintainers can be used to maintain proper bite alignment.

Other considerations

• There are temporary tooth replacement options. Ask your dentist whether a flipper or a clear appliance with an artificial tooth would work for you until a permanent replacement plan is developed.
• If you have lost a significant amount of bone around the missing tooth, your dentist may also recommend a bone graft before replacing the tooth.