Periodontal Disease: How it Works: Long Version-Part 3

Some might say: “OK, so I lose a tooth. So what?”

Losing a tooth is usually not an independent event and has consequences. If you have ever looked at your teeth in the mirror, you may have noticed that the top teeth look different than the bottom teeth and the front teeth look different than the back teeth (although there is a great deal of symmetry between a tooth on the left side of the dental arch and its counterpart on the right side). They have different sizes and different shapes. That is because each tooth is designed to a job and to absorb so much force generated by the powerful jaw-muscles. The teeth function as a “system” and the loss of a single tooth has an effect on that system (Think of what happens when one cylinder in a car engine stops firing. The engine still works, but very well.) You might not notice it, especially at first, and after the initial pain following the loss of the tooth has subsided, but things usually start to change. Adjacent teeth, especially those behind the lost tooth, begin to tip forward. The tooth or teeth above the missing tooth start to drop down or erupt up into the space created by the lost tooth. This in turn can result in the teeth bumping into each other or rubbing harder against each other while chewing. The loss of a tooth also means there are less teeth available to absorb and distribute the chewing forces. These increased forces can result in these teeth loosening, wearing, chipping and/or breaking in the future.

The advanced bone loss caused by periodontitis can also result in difficulties and compromises when dentistry is done to try to replace the lost tooth. If the patient desires to replace the missing tooth with an implant, there may not be enough bone left to hold an implant, forcing the patient to undergo bone grafting as part of the implant treatment plan. Although bone grafting can be done predictably, it adds time, discomfort and expense to treatment.

If the patient desires to replace the missing tooth with a cemented bridge, the previous bone loss results in a false tooth that is longer and a bridge that is more likely to trap food and one that is harder to keep clean. Bone or gum grafting can be done beforehand, but again, it adds time, discomfort and expense to treatment.

If the patient settles for a removable partial denture, partial dentures often rely on the underlying gums and jawbone for support. If the bone was lost due to untreated periodontal disease, the resulting defect could result in a partial denture that is uncomfortable, unstable and difficult to wear and use.

The more teeth that are lost, the greater these problems become and the harder (and more expensive) it becomes to restore health function and comfort