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Do you have a missing tooth (or teeth) that need to be replaced? Throughout our lives, teeth can be lost for a variety reasons. They can be lost from tooth decay, periodontal disease, nutritional neglect, and accidents. Missing teeth can compromise your eating habits, speech, health, and appearance. The loss of a front tooth can negatively affect the appearance of your smile, your speech, and your self confidence. Losing a tooth in the back of your mouth can lead to a number of issues affecting your ability to chew, your ability to properly clean your teeth, jaw collapse, teeth shifting, and the health of your remaining teeth. Replacing a lost tooth will prevent further destruction and help save your remaining teeth. Replacing lost teeth can save you time, money, keep you healthier,and prevent many other oral difficulties in the future.

The loss of a single tooth can start a devastating chain reaction of events. After a back molar tooth is lost, a series of destructive events occurs including the displacement and tilting of other teeth around it including a supra eruption (when a tooth continues to grow into the mouth because it is not being kept in place by it’s opposing tooth) of the tooth above it, decay, drifting and formation of periodontal pockets. Eventually, bone loss and periodontal disease, to the teeth surrounding the lost tooth, tend to cause further destruction. If you fail to replace a lost back tooth, you may cause the loss of other teeth.

What Can Happen If Lost Teeth Are Not Replaced?

-Shifting of Teeth - When a tooth is lost, for whatever reason, the surrounding teeth will begin to drift into the open space. This includes both adjacent teeth as well as teeth in the other arch. A once straight smile can quickly turn into a crooked one. Replacing a lost tooth sooner, rather than later, can prevent this from happening As the number of lost teeth increases, the further the damage to the overall eveness of the bite  and, making it harder to replace later on. The altered position of teeth causes the forces to be applied incorrectly while chewing, making fractures and bone loss much more likely. The incorrect forces also cause wear which can result in loss of tooth height and subsequent facial changes.

-Temperomandibular Joint Issues (TMJ Disorder) - As your teeth shift out of their normal alignment, bite issues usually develop. When the upper and lower teeth do not meet properly, it can strain and eventually damge the TMJ. This can lead to head, jaw, and ear pain, headaches, dislocations, clicking and popping, as well as permanent damage to the joint.

-Periodontal Disease - When teeth begin to shift, it makes it that much harder to keep your teeth clean. It will be harder to brush and floss certain areas which have, essentially, created a trap for plaque and food debris to build up. When plaque and bacteria are not removed and allowed to build up the result can be tooth decay and periodontal disease. When teeth shift and drift, they oftentimes create a root exposure problem, and allow forces to move them in unnatural ways. This can loosen teeth, and make them very sensitive. Periodontal disease can lead to further tooth loss.

Options For Replacing Missing Teeth

Patients have multiple options when teeth are lost. They can include fixed ( permanent and not removable) or removable options. These procedures can include:

-Removable Dentures - This option has been the longstanding traditional option when multiple teeth are missing. Removable dentures are often the fastest and least expensive alternative in the short term. There are some disadvantages to removable dentures. Removable dentures work by attaching to exisiting teeth. This often leads to these “anchor” teeth becoming loose, worn, decayed, or broken. There can also be bone loss under the denture, which over time will make the denture more and more mobile and uncomfortable. Removable dentures can also be inconvenient to clean after eating especially if out at a restaurant. Lastly, removable dentures have about 1/3 the chewing power and efficiency of natural teeth. This can lead to poor chewing and lack of good nutrition in one’s diet.

Marielaina Perrone DDS Dental Bridges-Fixed Dental Bridge - This entails cutting down surrounding teeth, and fitting them with fused crowns to replace any missing teeth. The most popular type of fixed bridge is called a 3 unit bridge. This means that the two natural teeth adjacent to the missing tooth serve as anchors. This is a very stable option but does also have disadvantages. Disadvantages include:

-Removal of good tooth structure from adjacent teeth.

-Difficulty maintaining good dental hygiene under bridges as normal flossing is not possible

-Long term prognosis of most dental bridges in between 8-10 years before it needs replacing. This is an average. Some bridges can and will last longer.

-Dental Implants – Dental implants are the largest initial investment, but most cost effective long term solution for replacement of missing teeth available today. The main disadvantage to dental implants is the time it takes to be completed. Following placement of the dental implant a 4-6 month healing time is generally needed before the tooth can be restored. Dental implants are the ideal solution for many tooth replacements in dentistry today.

-All on Four Dentures - When many or all  teeth are lost, or if you are rapidly progressing to full mouth breakdown, This dental implant/denture option is an excellent choice. The best thing about this procedure is that you have your entire procedure done and walk out with teeth the same day. There are usually 4 dental implants placed and a titanium bar supported denture placed. It is screwed down, but can be removed if needed. The biggest negatives here are price, and post operative possibility of bruising and discomfort while healing.

Tooth Replacement Conclusion

Tooth loss can happen at any time to anyone. Losing a tooth due to a trauma, dental disease, habits, etc. can be a big problem for a variety of reasons. If teeth are not replaced, they can cause issues for you including bone loss, periodontal disease, and more tooth loss. Replacing lost teeth as soon as possible will save you discomfort and greater expense in the future. Knowing your options, and being informed can help you and your dentist come up with the best treatment options for you. Remember, sooner is better than later, but know that whenever you are ready to move forward with tooth replacements there will always be options!

Avulsed Tooth is the complete displacement of a tooth from its socket in alveolar bone from trauma.

Dentists generally refer to a tooth that has been knocked out as an avulsed tooth. The accidental loss of a tooth through trauma ( avulsed tooth ) is considered a very serious dental emergency for a permanent tooth (occurs in about 1/10th of the population). For an avulsed primary tooth re-implantation is generally not successful, and is usually left alone. For a permanent tooth if you act quickly enough there is a chance the avulsed tooth can be saved and maintained for many years. Even the best techniques and intentions do not always lead to a successful outcome for an avulsed tooth.

The usual cause of an avulsed tooth is a  force sufficient to break the bond between the tooth and the connection (periodontal ligament ) to the bone. An avulsed tooth has no oxygen or blood flow and will die quickly if not re implanted. The primary goal of quick reimplementation is to maintain the periodontal ligament, so that the tooth is not rejected. The avulsed tooth will always need to be splinted to the other teeth, and usually, but not always, require a root canal. The speed in which the tooth is re implanted, the cleanliness of it, and how hydrated or wet it has been all play key roles in whether or not re-implantation of the avulsed tooth will be successful.

Instructions for an Avulsed Tooth

If a tooth has avulsed due to trauma it must be re implanted in its socket within 60 minutes (or sooner if possible) of the accident for the best chance of a positive result (i.e. tooth remains in position). It is important to keep the root surface of the avulsed tooth moist. This is the reason for the need for speed when re implanting the tooth.

An avulsed tooth, whose structure is maintained without any major fracture, must be re-implanted in its socket within an hour after the accident for best chances for it to remain in position. The best option is to attempt re-implantation within the first few minutes at the site where the accident occurred. The avulsed tooth should be attempted to be cleaned and placed back into the socket ( hole in jaw ) by an adult. This can be either the person who lost his or her tooth or by an adult if a child has suffered the trauma. If the avulsed tooth goes back into its socket where it was originally then it would be considered to be a successful re-implantation.

smileIf the avulsed tooth is dirty, it is vitally important that it is cleaned, the best way is with the patient’s own saliva by putting it in their mouth. Once the avulsed tooth is cleaned in this manner the patient should spit out any blood and dirt in mouth. While spitting, you probably will remove the blood clot forming in the avulsed tooth socket. This will allow an easier re-implantation of the avulsed tooth into the socket. the tooth can also be rinsed with cold water or milk. When the avulsed tooth is as clean as you can get it, it should be placed back in the socket as soon as possible. The quicker it is done, the better the chance for success. There are also “tooth saver” kits made to hold and keep the avulsed tooth wet for transport to a dentist.

If the avulsed tooth cannot be repositioned in its socket for any reason, then it should be brought to the dentist as soon as possible. There are a few ways to accomplish this:

1) The avulsed tooth should be rinsed and cleaned as explained above. The person who had the accident must then keep the avulsed tooth in their mouth. They should keep the avulsed tooth under the tongue or between the cheek and back teeth or lip and front teeth. If the trauma happened to a young child the previous advice should be disregarded as they can swallow the tooth. In such a case, the avulsed tooth should be rinsed and placed in milk, or in water with salt. Go to your dentist as soon as possible.

2) After cleaning with saliva, the avulsed tooth can be put in a solution of water and salt. A half a teaspoon of salt should be mixed in a cup of water. It is best to use bottled water if it is  available, but tap water can also be used in a pinch.

3) The avulsed tooth can also be placed in fresh room temperature milk. The patient and avulsed tooth in solution should be brought to the dentist as soon as possibleSave-a-tooth avulsed tooth kit

4) There is a commercial product available for the storage of an avulsed tooth. It is called Save-A-Tooth. This is a small container containing fluid to help preserve the avulsed tooth  for easy transport and re-implantation.

Exceptions to the Rule

The instructions above are recommended for adult teeth only. If a primary tooth (also called baby tooth) has avulsed following an accident, the re-implantation will not really work.

-If the adult avulsed tooth is broken or has visible fractures following the trauma, and or its root remained in the socket, the re-implantation will not be successful. This is because the tooth will not reattach to its root, and a fractured tooth will continue to break down.

Prognosis of Avulsed Tooth following Re-Implantation

It should be remembered that even if you follow all of these recommendations precisely, the tooth in question may eventually need to be extracted. If the instructions are followed correctly, chances are better that the tooth may remain in position.  An immediate splinting to the other teeth is optimal to take stress off the tooth and allow for healing. It may eventually need root canal treatment and possibly a crown to restore the avulsed tooth to its full form and function.

The re implanted  tooth can also seem to be fine for a few months or even a few years before it eventually becomes a problem.

At the Dentist Office

Putting the avulsed tooth back in its socket sometimes can be quite easy. And sometimes it can be very complicated, such as when the tooth or bone is fractured or broken. Your dentist may use water to flush debris from the socket. Then they will attempt to slide the avulsed tooth back into place. As mentioned earlier, it is most important to re implant the tooth as soon as possible. Ideally, this should occur within the hour of the accident.

The best course to take will depend upon how long the tooth was out of the mouth and amount of trauma. In either case, the dentist will splint the avulsed tooth to the teeth on either side with a soft wire and/or a resin material. This will be used to maintain the tooth in place for days-weeks.

If the bone around the tooth was not fractured, the root usually will reattach firmly to the bone in about three to four weeks. More extensive damage to the area may need 6-8 weeks of healing time.

Your dentist should examine the tooth again in three to six months to ensure the tooth is doing fine with no evidence of infection occurring. If there are no signs of infection, the next visit will be at your yearly dental examination. The dentist will then continue to monitor the tooth for the next 2-3 years to ensure that the tooth re implanted successfully.