Causes and Consequences of Tooth Loss

Edentulism, or tooth loss, can rob you of much more than the ability to chew and properly digest food. It has serious social, psychological and emotional consequences, impacting your quality of life, self-image and self-esteem.

Edentulism results when one or more teeth are missing, or need removing due to injury or disease. With full edentulism, all teeth are missing; with partial edentulism, one or more teeth are missing.

Risks and Causes

Although typically associated with the elderly, edentulism also affects children and adults if they do not practice proper oral hygiene.

Children: Toddlers and children run the risk of two types of traumatic tooth loss: premature loss of baby teeth and loss of permanent teeth due to injury or neglect. Dental caries are a major cause of tooth loss in children and teens.

Adults: Gum disease (gingivitis or periodontitis) and dental caries are the leading causes of tooth loss among adults. Periodontal disease is a chronic bacterial infection affecting the gums and bone supporting the teeth. As the disease destroys gum tissue and bone, teeth loosen and may require extraction. Smoking, heart disease and diabetes also are associated with tooth loss.

Elderly: Plaque accumulation and hardening, gum recession, older fillings and dry mouth put the elderly at greater risk for losing their natural teeth.

The incidence of edentulism among certain populations reflects differences in healthy behaviors and attitudes toward oral health and dental care, as well as access to and use of dental services and treatments.

Research indicates that tooth loss caused by gum disease is commonly associated with risk indicators that include age, gender (more common with males), smoking, inadequate personal oral hygiene and professional dental care, diabetes mellitus, hypertension, and rheumatoid arthritis.

Race/ethnicity and socioeconomics also play a role in tooth loss. For example, studies suggest that non-Hispanic black adults keep fewer teeth than non-Hispanic white and Mexican-American adults. Also, a higher percentage of people at every age living below the poverty level is edentulous compared to those living above the poverty level.

Other causes of edentulism include the following:

Poor oral hygiene habits: Not brushing and flossing daily can cause the development and progression of tooth decay and gum disease.
Poor diet: Foods and beverages high in sugar, carbohydrates and acid may cause irreversible tooth and gum damage.
Bad habits: Smoking, chewing tobacco and/or drug use can damage teeth.
Lack of education: A lack of education about the causes and consequences of tooth loss prevents people from taking the proper preventative lifestyle and oral health care measures, or from getting periodic dental maintenance or necessary restorative treatment.
Fear and embarrassment: Many people suffer from dental phobia, or anxiety/fear of going to the dentist, and do not seek dental treatment, even if they know they have a problem or are in pain. Others are embarrassed or ashamed to seek dental treatment because they feel they will be blamed or judged negatively for the condition of their teeth. Ignoring tooth decay or other serious dental problems can prolong and aggravate the condition.
Finances: Some people have to postpone or forgo dental visits and treatments, including regular check-ups and cleanings, due to high dental care costs and/or lack of insurance coverage. Unfortunately, prolonging or eliminating dental care increases the chances of developing serious problems and, subsequently, greater expense for repairs.
Trauma: Babies and young children are most susceptible to losing teeth prematurely due to trauma, because their tooth roots and gums are still developing. If parents do not take the proper — and often immediate — steps to deal with dental trauma, their children’s oral health can be permanently affected. Adults, particularly those who participate in sports or suffer accidents affecting the face, also are at risk for tooth loss.
Systemic conditions: Systemic conditions such as heart disease, respiratory disease, diabetes, HIV infection, malnutrition and immunosuppression are all associated with forms of periodontitis that often result in tooth loss.
Medical treatments: Certain treatments, such as chemotherapy, head radiation therapy and immunosuppresive medications, weaken the immune system. These treatments may increase the risk of tooth infections and, consequently, the need for tooth extraction.

Consequences of Tooth Loss

Mental anxiety
Changes in facial features, loss of bone and gum tissue, trouble eating and speaking, poor nutrition
Self-consciousness, dissatisfaction with appearance and loss of confidence
Pain, distress and relaxation problems
Social embarrassment and isolation (Edentulous people may feel embarrassed about their appearance and not want to go out and engage in social interaction and activities. In addition, edentulous people often have to face stereotypical perceptions of being poor, uneducated and/or unhygienic.)
Embarrassed and/or ashamed to seek dental treatment
Financial burden for costs of possible treatment options (Complex dental care ― such as dental implants ― is expensive and typically not covered by insurance).

Treatments

Patients and their dentists should develop a treatment plan that emphasizes prevention and early detection of oral diseases in order to keep the remaining teeth ― especially in cases of partial edentulism. Prevention and detection strategies include patient education about edentulism causes, consequences and treatments, and following preventive oral health practices (e.g., daily oral health care), as well as preventative and therapeutic treatment.

However, if tooth loss is unavoidable, there are several options for restoring your teeth and your smile.

Dental implants are artificial tooth roots surgically attached to the jaw to secure a replacement tooth, bridge or denture. Permanent and stable, implant-supported restorations look, feel and function like natural teeth. Dental implants also can be used with a denture for better stabilization. Some implants take two to six months for the bone and implant to bond together (osseointegrate). During this time, a removable temporary tooth replacement can be worn over the implant site. Research also has advanced to where an implant can be placed immediately following tooth extraction in certain cases.

Dentures are removable replacements for missing teeth and adjoining tissues. Partial dentures fill in the spaces created by missing teeth, keep remaining teeth from shifting and are an option if you have some natural teeth remaining. If you have lost most or all of your teeth, complete or full dentures are recommended. “Immediate” dentures are inserted immediately after removal of the natural teeth; “conventional” dentures are placed in the mouth about three to six months after tooth removal.

A Dental bridge is a false tooth that is fused between two porcelain crowns to fill in or bridge the space left by a missing tooth. The two crowns holding the dental bridge in place are cemented to your teeth on each side of the space; the bridge is secured into place and is irremovable. Some bridges also may contain two or more false teeth between the crown components, depending on the case.

Finding a Restorative Dentist

Although general dentists are qualified to provide care for edentulous patients, they may choose to consult with or refer patients to qualified specialists. The specialists most qualified to treat edentulous patients are prosthodontists, who concentrate on the replacement of missing teeth and the restoration of natural teeth, and periodontists, who focus on the prevention, diagnosis and treatment of periodontal disease and the placement of dental implants. Endodontists, specialists in pulp problems, also may be consulted for possible endodontic treatments to save “hopeless” teeth.

For a successful outcome, make sure you receive treatment from a dentist who is professional, yet also sensitive to your situation and offers options in a non-judgmental, non-pressuring manner. Ideally, your dentist should be willing to work with you to develop a treatment plan that meets your clinical, emotional, personal and financial needs. Communicate your feelings and expectations to establish realistic options and, if necessary, compromise. For instance, if money is an issue, your dentist might be able to place an extended wear temporary bridge while you arrange an affordable long-term treatment plan. Or, your dentist might be able to use a laboratory that provides economic, natural-looking prostheses.

The key to finding the right option is to overcome your embarrassment, lack of informed knowledge and shame in order to work with your dental team to establish short- and long-term esthetic, functional and financial goals that will keep your self-esteem and your smile intact.