“Doc I lost my tooth, what should I do?”

We all have many things to smile about, but losing teeth just isn’t one of them. Unfortunately this is something all of us have to deal with, sooner if not later.

There are many reasons why people lose their teeth but only the more common reasons will be discussed below.

1. Dental decay
This is also known as caries and is what is known as a hole in the tooth. The process of dental decay is in essence a bacterial facilitated breakdown of your tooth resulting in a carious lesion – the hole. The process is complex and involves many factors.

Once the decay spreads too extensively, the tooth is considered terminal and cannot be restored, resulting in extraction.

2. Periodontal disease
This is the disease of the supporting structures of your tooth and includes the gums and underlying bone which your tooth sits in. Again this is a bacterial disease and initiation and progression depends on interplay between bacteria in plaque and your immune response to the bacteria. If the condition favors disease, the bone levels and gum levels that once support the tooth drops and if allowed to progress results in the tooth becoming mobile and subsequently lost.

3. Dental trauma
This may occur in any given age group but is usually more prevalent in children and adolescence. Anything from an accidental fall to a fight and to a motoring accident may result in irreversible damage or tooth loss itself during trauma.

Just as there are many reasons why we may lose our teeth, thankfully there are multiple replacement options too.

1. Dentures
We are all so familiar with dentures and associate these objects with the elderly. Dentures may be a good solution in cases where multiple areas of tooth loss are experienced. Dentures can replace from 1 tooth to the entire dental arch. There are many benefits to choosing a denture, from affordability to allowing for lip support in cases where sunken lips are the result of severe bone loss. However they may be uncomfortable to wear initially and are removable type prosthetics.

2. Dental Bridges
Just as the name suggest, a bridge bridges the gap between 2 teeth. It involves trimming the 2 adjacent teeth to accommodate the bridge to be fitted and cemented on permanently. The artificial tooth is joined permanently to the two adjacent teeth.  Compared to dentures bridges have the advantage of being fixed rather than removable and are much less bulky and natural in feel and look. However dental bridges involved the teeth adjacent to the “gap” and sometimes require shaving down perfectly sound teeth. Needless to say, if the bridge fails, all teeth involved in the bridge are affected.

3. Dental implants
This method of tooth replacement has been the hype over the past decade and is considered by many the “Gold standard” of tooth replacement. This procedure involves a surgical placement of a titanium implant into the bone at the site of tooth loss and a crown (prosthetic tooth) attached to the titanium implant.

There are many benefits to this mode of replacement such as it being an independent structure, permanently fixed and not affecting the adjacent teeth as in the case of bridges. It also has a reported high long term success rate in the high 90% range and is constantly improving.

Dental implants can also be used to in combination with dentures where the dentures are supported by implants into bone to give superior retention in the mouth. This is especially beneficial to patients with full lower dentures which have very poor retention (loose).

However, not everyone is suitable for dental implants and require a certain quality/quantity of bone and sufficient space at the implant site.

We all understand the importance of a pleasing smile and remember fondly our childhood days of having that toothless grin during transition to adult teeth. Looking back at such photos may bring about an, “Aww that’s so cute” response but a similar response in adulthood is highly unlikely.

The main motivating factors that drive a demand for tooth replacement is firstly aesthetic concerns followed by functional concerns or a combination of both. Many patients may be comfortable without replacing a lost tooth especially in a non-aesthetic area and have sufficient teeth to function. However in the long term, the missing tooth may give rise to problems especially to neighboring and opposing teeth. Due to the “gap” these teeth may move into the missing space and cause problems with alignment, open spaces between teeth and in some cases affect your bite.

Ideally missing teeth should be replaced and is highly recommended that you seek professional consultation to jointly determine the best treatment option tailored personally for you. Now you have something to smile about!

Dr. Julius Tong Ker Wei