Problems with missing teeth

As soon as a tooth is being removed, we have to think of the options available for replacing that missing tooth. Most of us don't really know the consequences or future problems that are going to be faced by us resulting from tooth extraction.

These are some of them:
Chewing efficiency decrease
The most common problem patient face immediately after extraction it lost of chewing efficiency. He will tends to chew more on the opposite side. If the extraction involved multiple teeth, then patient will have to switch to soft diet which might result in poor digestion and malnourished. Therefore replacement of missing teeth is crucial to regain back patient's normal chewing.

Over eruption of opposite tooth
Commonly happen after extraction of the lower molar causing the upper molar to erupt further downwards. This will result in food stagnant in the interproximal (in-between of the teeth) area making the teeth easily develop dental caries.

Migration of neighbour tooth
The neighbour teeth will migrate to the extraction site as soon as the tooth was remove. Usually, the patient will begin to notice it after a year or more. In some delayed cases, tooth extraction causes the front teeth to have multiple gaping which resulted in poor aesthetic. Both migration and supra-eruption of teeth will make restoration or replacement of the missing tooth difficult.

Bone lost
Alveolar bone lost significantly after missing teeth. As the result, the upper lip looks flatten due to lost of support from the anterior alveolus bone. Lost of bone also makes implant insertion difficult which might required bone harvesting before implant insertion.

Attrition of the remaining teeth
When patient loose most of his back teeth, he will try to use his front teeth to grind food and eventually all the front teeth will look much shorter due to attrition from chewing. Attrition also will make the teeth become sensitive to cold and sweet (dentinal hypersensitivity).

Over-closure of the mouth
As the result from attrition of front teeth and lost of posterior chewing, patient tends to over close his jaw. This will make his face shorter and his lip looks thin and easily get fungal infection at the corner of the mouth

Traumatic occlusion and Jaw joint dysfunction
Missing teeth will cause parafunction (abnormal) chewing. For example, when the back teeth are missing, the front teeth will be used for grind. This abnormal force will be exerted to the remaining teeth causing bone resorption around the teeth and lead to gum problem and loosening of teeth. Heavy and abnormal chew will also causing the TMJ (jaw) joint pain.
Due to abnormal function, the remaining teeth have a very high chance of fracture.

Conclusion
Delay in restoring missing teeth will result in:
1. Loss of chewing
2. Difficult in restoration/replacing missing teeth
3. Poor dental aesthetic - short teeth, teeth gaping, deep bite
4. Poor facial aesthetic - over closure, short face, chin protrusion
4. Prone to dental decay, gum problem, tooth fracture, dentine hypersensitivity
5. And finally, making you look older....

Treatment Options for Replacing Missing Tooth/Teeth
Option 1: Denture

Advantages
1. Cheap
2. Complexity: Simple
3. No need needle injection
4. No need surgery (No pain)
5. Maintenance: Easy to take care
6. Treatment duration: Short 1 - 3 weeks
7. Easy to adjust, repair

Disadvantages
1. Feel like not real (fake teeth) - can be removed from the mouth
2. Uncomfortable - Big and bulky
3. Palate coverage - less taste when eating
4. Lower ridge coverage - no space for the tongue
5. Teeth is made of plastic - easily worn off & stained
6. Easily trap food
7. For one missing tooth - wearer is not willing to wear it, very uncomfortable
8. Chewing food not the same as the natural teeth
9. Easily break

Option 2: Bridge

Advantages
1. Feel like real teeth - cannot be removed
2. Highly aesthetic - Look like natural teeth (with full porcelain), multiple shade to select
3. Very comfortable - No palate or lower ridge coverage
4. Teeth is made of porcelain - strong, durable
5. Good for missing one or a few teeth
6. Can correct the abutment teeth to a desirable shape and position
7. Chewing food almost as real as natural teeth
8. No need surgery

Disadvantages
1. Price: Moderate
2. Complexity: Simple to complex
3. Required needle injection
4. Involved neighbour teeth - the neighbour teeth required to be ground for support
5. Easily trap food under the bridge
6. Maintenance: Difficult (Required to floss under the bridge)
7. Treatment duration: Medium 2 - 3 weeks
8. No suitable for cases such as free end saddle, fully or near to edentulous

Option 3: Dental Implant

Advantages
1. Feel like real teeth - porcelain is sitting on the implant
2. Highly aesthetic - Look like natural teeth (with full porcelain), multiple shade to select
3. Very comfortable - No palate or lower ridge coverage
4. Teeth is made of porcelain - strong, durable
5. Does not involve the neighbour teeth
6. Trap food: very minimal (just like natural teeth)
7. Maintenance: simple to take care (just like natural teeth)
8. Can replace missing teeth in edentulous and free end saddle
9. Chewing food almost as real as natural teeth

Disadvantages
1. Price: Expensive
2. Complexity: Complex - required good planning
3. Duration of treatment: Long 3 - 6 months
4. Required needle injection
5. Required to undergo surgery (maybe required second or third surgery)
6. Required sinus augmentation, bone harvesting if not enough bone height for implant insertion (additional cost, additional surgery....additional pain)
7. Higher risk of failure in smoker, diabetic and medically compromised patient
8. Risk of injuring other structure during implant insertion: ID nerve, antrum

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