Why Replace a Lost Tooth?

Author:  Howard M. Steinberg, DMD, MDS
Filed under:  Missing Teeth   Tags:  , ,

Throughout the course of life, teeth are lost for many reasons including cavities, gum disease, cracked roots and accidents. Missing teeth compromise your eating habits, speech and appearance. The loss of a front tooth will negatively affect the appearance of your smile and your self confidence. Losing a tooth in the back of your mouth can lead to numerous problems affecting your ability to chew, your ability to properly clean your teeth and the health of your remaining teeth. Replacing a lost tooth will prevent further destruction and save your remaining teeth.

One Lost Tooth Causes a Chain Reaction

The loss of a single tooth starts a chain reaction. After a back molar tooth is lost, a series of destructive events occurs including the eruption of other teeth, decay, tilt, drift and gum pocket formation. Eventually, bone loss and periodontal disease will cause further destruction. If you fail to replace a lost back tooth, you could eventually lose all your teeth. This article explains how.

Losing Teeth = Two for One

Missing Tooth

The extraction of a lower back tooth has created a space. See Figure 1. The tooth directly above the lost tooth is now useless, because it no longer has a lower tooth to chew against. Losing one tooth can result in the loss of the use of two teeth. The missing lower back tooth is obviously useless, and the tooth directly above it has become useless. In terms of losing teeth, this is what I call “two for one.”

Tooth Eruption = Exposed Roots

Erupted Tooth

Back teeth have a lifetime tendency to erupt (move farther into the mouth). Only the presence of a tooth to chew against keeps a back tooth from erupting. This patient had a tooth extracted from space X. The tooth immediately above the missing tooth has over-erupted. See Figure 2. This eruption has caused some of its roots to be exposed. Exposed root decays much faster than the crown of a tooth.

Uneven Teeth = Trapped Food Debris

Trapped Food Between Teeth

The resulting unevenness among the upper back teeth has created areas between these teeth that trap food debris. See Figure 3. It is very difficult to keep spaces between uneven teeth clean, despite your best efforts at brushing and flossing. The accumulation of food debris and the resulting bacteria cause inflammation of the surrounding gum tissue. The inability to easily remove the trapped food debris accelerates tooth decay.

Tilt & Drift

Tooth Tilt & Drift

When teeth are lost, the remaining adjacent teeth have a tendency to tilt (lean over) into the space the missing tooth once occupied. They also have the potential to drift or move. Now that a tooth has been extracted from position X, a space is left. This allows lower molar #7 to tilt and drift forward. Lower #7 will tilt farther and farther over time. Upper molar #7 no longer makes proper contact with the adjacent, erupted molar #6 or with tilted lower molar #7. This has caused upper molar #7 to tilt and drift backward. See Figure 4.

Gum Pocket Formation

Gum Pocket Formation

A tooth tilted over will develop a gum pocket along its forward root, as shown in Figure 5. Gum pockets are narrow, abnormal spaces or clefts that develop between the gums and the tooth root. These pockets trap food debris and bacteria. A gum pocket is a problem, because you can almost never keep it clean. The debris and bacteria that collect in a gum pocket lead to ever-worsening inflammation of the gums and the bone adjacent to the gum pocket.

Tooth Destruction Spreads

Tooth Destruction Spreads

Lower molar #7 has drifted and tilted so far forward that upper molar #7 no longer bites on it. This allows upper molar #7 to over-erupt. The adjacent upper molar #6 has already erupted. Decay has begun on upper teeth #6 and #7, particularly on the exposed portions of their roots. See Figure 6. The advancing gum pocket along the forward root of lower molar #7 causes chronic gum inflammation and eventual bone loss. Gum pockets also begin to form around the exposed roots of upper teeth #6 and #7 causing inflammation.

Eventual Bone Loss & Periodontal Disease

Periodontal Disease

When an area of the gums is constantly inflamed, as happens in a gum pocket, the bone immediately adjacent to the gum pocket also becomes inflamed. Inflamed bone softens, and slowly begins to resorb (disappear). See Fig. 7. Chronic gum inflammation and the eventual loss of underlying bone are symptoms of advanced periodontal disease. When left untreated, this condition will negatively affect your facial appearance and damage your remaining teeth.

Replacing Lost Teeth

There are a number of treatment options for replacing lost teeth:

  • Dentures – These are removable prostheses also known as false teeth.
  • Bridges – These are a series of crowns fixed onto adjacent natural teeth.
  • Implants – These are metal posts placed in the jawbone. A single crown, a full denture or a bridge is permanently screwed (fixed) on top of dental implants.

The most appropriate treatment will depend on the number of teeth you are missing, where they are in your mouth and the condition of your remaining teeth. A qualified dentist or dental specialist can help you decide which option is best for you.


If missing teeth are not replaced, a chain of damaging events may occur. Over time, one missing tooth can lead to bone loss, periodontal disease and the eventual loss of remaining teeth. Replacing a lost tooth today will avoid grief and greater expense tomorrow.

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