What Will Happen If You Do Not Replace A Missing Tooth?

Every effort is made to save permanent teeth from being extracted nowadays, unlike in the past when extraction was often considered the first line of treatment. However, situations do arise where it is no longer possible to treat a tooth and it has to be removed.

What now?

Replacing a missing tooth can be expensive, particularly if the patient opts for an implant or a high-quality fixed prosthesis. However, the perils of having a tooth extracted and leaving a gap in the mouth are well documented.

What Happens When A Tooth Is Extracted

An uncomplicated extraction usually takes around a week to heal, after which the extraction site is covered with gingiva. Changes to the bony socket in which the tooth was lodged continue to take place for close to three months after the procedure, changes that will not cause any physical discomfort.

One of the most commonly extracted teeth is the first molar, since it erupts early into the oral cavity and is not aesthetically visible from outside. People will almost never opt for an extraction if it is one of the front teeth or at least never leave them unreplaced even if they do have to get it removed.

Taking the first molar as an example, here are the classical steps that occur because of an unreplaced tooth.

Movement Of The Surrounding Teeth

Every tooth in the oral cavity tries to find its counterpart through eruption. This means that the tooth opposite to an empty space will attempt to find its counterpart through continued eruption. This is actually referred to as supra-eruption and is very harmful to the tooth.

As a result of this supra-eruption, the roots become exposed to the oral cavity. Enamel, which is the hardest substance found in our body, does not cover the roots. It only extends up to the part visible in the mouth, that is, the crown.

READ Dental Implants as a Solution to Missing Teeth

Since the covering of the root is not designed to be subjected to the environment present in the oral cavity, it quickly gets destroyed and the tooth starts to become acutely sensitive as a result. This supra-erupted tooth also becomes weaker due to the fact that less and less of its roots are embedded in bone. It is extremely common for such teeth to become so weak and mobile that they are of no use in the oral cavity and have to be extracted as well.

Another problem that patients frequently face due to the presence of a supra-erupted tooth is chronic trauma to the gums on the opposite side of the arch. The tooth erupts so much that it actually reaches the other jaw and then cause ulcer formation, pain, swelling and bleeding to occur.

Once a tooth moves from its normal position in the jaw, the tight contact with adjacent teeth preventing food lodgment is lost, and so some amount of food will almost always get stuck in these areas. Expectedly, these areas are highly prone to the development of tooth decay.     

Problems Caused By Unreplaced Missing Teeth 

The teeth immediately next to the tooth also start to move and cause problems of their own. The tooth behind the empty space will start to tilt forward while the tooth in front will start to tilt back. This tilting takes place quite quickly actually and can wreak havoc in the entire mouth.

Once this tilting has started to take place, the remaining teeth of the arch also start to drift apart. Tight contact with the surrounding teeth is one of the factors that keeps all the teeth in their natural position. Spacing in the front of the jaw is a common thing that happens as a result of losing a tooth in the back.

For people that have got orthodontic treatment done in the past, an unreplaced tooth can render their entire treatment useless.

All of these changes combined lead to what is referred to as a "collapse of the bite".  The facial appearance of the affected person can also change quite significantly due to a collapsed bite. The bone that surrounds a tooth only exists up until the tooth itself is present in the jaw. This means that after extraction, this bone will start to be destroyed.

Only the replacement of the tooth with an implant can prevent this from happening. Since the implant is embedded in the bone, it is able to provide sufficient stimulus for the bone to continue to exist. Only wisdom teeth when extracted from the oral cavity do not have to be replaced since they are considered as vestigial organs.

How Soon Do These Changes Start To Occur?

Since teeth have to move within the bone, the pace of change is quite slow and often does not become apparent to the patient until much later. The changes though begin almost immediately after extraction has taken place.

The safe thing to do is to schedule a treatment for the replacement of the tooth within a few months at the most.

Can These Changes Be Reversed?

Like with most things, the treatment that will be required depends on the stage at which the condition is diagnosed. A fully collapsed bite is quite difficult to treat and requires a combination of braces, appliances, prosthesis, intentional root canals and or extractions.

READ Missing Permanent Teeth? Why It Happens and What To Do about It

The amount of havoc unreplaced permanent teeth can cause is much more in younger adults than in older individuals for the simple fact that younger adults have a lot longer for all these tooth movements to take place.

Conclusion

The most common reason why a person would not get a missing tooth replaced is that it costs too much. This cost of replacement should be viewed in the context of the problems that occur afterwards as well as the time and expense needed to correct those complications.

The reality is that by leaving a missing tooth in the mouth, patients are only delaying the time when treatment will become necessary. As time passes, the amount of treatment required and cost involved will increase exponentially.