Missing Teeth

Dental diagnosis
Overview
A completely edentulous lower jaw.

Complete tooth loss (edentulism) of the lower jaw requiring a complete denture.

The term edentulism (missing teeth) refers to permanent teeth which are lost from a place that once had them. An edentulous site is a position in the mouth previously occupied by a tooth. An edentulous area is a region from which multiple teeth have been lost. Total edentulism is the loss of all teeth.

Edentulism is contrasted with anodontia, which is a term for congenital absence of all of the teeth (i.e. the patient never gets teeth); and hypodontia, which is a term for congenital absence of some of the teeth. Hypodontia is also called partial anodontia, which is something of a misnomer. While hypodontia is common, anodontia is rare, and is usually associated with a condition called hypohydrotic ectodermal dysplasia.

Reasons for replacing missing teeth include: to prevent the remaining teeth from moving; to prevent the remaining teeth from becoming overloaded; to preserve the ability to chew normally and maintain proper nutrition; to preserve the tooth bearing (alveolar) bone; to support the cheeks and lips; to restore the appearance of the smile.

How is this dental diagnosis established?

It is easy to diagnose missing teeth. The challenge is determining the best way to replace the missing teeth with teeth that function normally and look beautiful and natural. It is important to understand the factors leading to loss of the natural teeth, so that the likelihood of long-term success with the replacement teeth is greater.

The most common cause of missing teeth in adults is periodontal disease. Other common causes include tooth decay (caries) and bite stress. These factors need to be controlled or eliminated, or the replacement teeth are unlikely to be successful. If all of the teeth are lost, caries and periodontal disease are no longer a factor; however bite stress can be. Forceful avulsion of teeth (i.e. trauma knocks them out) is another mechanism by which teeth are commonly lost.

Treatment options

There are several options for replacing missing teeth. The best solution depends on which teeth are lost, and how many teeth are lost. Options generally include removable dentures, fixed bridges, and dental implants. Combinations of these procedures are common. Bone grafting procedures may be recommended for patients who have lost significant bone along with the loss of their teeth.

Although it can be performed at the time implants are placed, re-establishing adequate bone is usually done before bridges, dentures or implant-supported restorations are finalized. No treatment is an option, and may not be a bad one if the missing tooth is a second or third molar, at the end of the dental arch, and the patient still has healthy teeth in front of it.

Wisdom teeth (third molars) are almost never replaced when they are removed. Second molars are sometimes replaced, depending on the presence and condition of the remaining teeth, the patient’s oral hygiene, how the patient uses their teeth, among other factors.

Loss of a tooth from between other teeth is generally more serious, because the teeth on either side tend to tip into the space created by the extracted tooth; and the tooth which previously closed against the missing tooth (from the opposite dental arch), tends to extrude into the space.

The problem then becomes that the bite relationship between the upper and lower dental arches has changed, and the biting forces may not be evenly distributed between the teeth. This can lead to wearing (attrition), chipping and cracking of the remaining teeth, and potentially other problems with the jaw joints and jaw muscles.

The treatment options available to you depend on which tooth or teeth are missing; how many teeth you are missing; where in the mouth they are missing from; and whether or not you have any dental conditions such as tooth decay (caries), periodontal disease, or tooth grinding habits (bruxism). It also depends on the quantity and density of bone that remains, and several factors related to your health history (including use of certain medications, whether or not you’ve ever undergone radiation treatment affecting the jaws, and other factors).

Related diagnoses

Teeth are usually lost for one of three reasons: Poor oral hygiene, which can lead to extensive tooth decay (caries) and infection; Periodontal disease (periodontitis), which leads to loss of the bone surrounding the teeth; and excessive bite forces, through chronic bruxism.

Teeth may also be cracked from isolated events, like biting down hard on a popcorn kernel. They can be cracked as a result of chronic misuse of the teeth (factitious habits); or may be knocked out (avulsed) from traumatic injury. Loss of multiple teeth can lead to loss of vertical dimension of occlusion (bite collapse).

Author: Thomas J. Greany, D.D.S.
Editor: Ken Lambrecht
This page was reviewed by members of our review board.

This page was last updated on January 27, 2016.

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Related pages on ToothIQ.com

Attrition
Attrition
Bone Grafting
Bone Grafting
Bridges
Bridges
Bruxism
Bruxism
Caries
Caries
Dental Implants
Dental Implants
Factitious Habits
Factitious Habits
Loss of Vertical Dimension of Occlusion
Loss of Vertical Dimension of Occlusion
Periodontal Disease
Periodontal Disease
Poor Oral Hygiene
Poor Oral Hygiene
Removable Dentures
Removable Dentures

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Background information

Contact stomatitis due to palladium in dental alloys: A clinical report
Garau, Valentino, DDS, MS, PhD, et al.
The Journal of Prosthetic Dentistry
2005 93 (4): 318-320

Early prosthetic treatment of patients with ectodermal dysplasia: A clinical report
Tarjan, Ildiko, DMD, PhD, et al.
The Journal of Prosthetic Dentistry
2005 93 (5): 419-424

Ectodermal dysplasia—an unusual dental presentation
Ryan, F.S., et al.
Journal of Clinical Pediatric Dentistry
2005 30 (1): 55-57

Evaluation of the sanitization effectiveness of a denture-cleaning product on dentures contaminated with known microbial flora. An in vitro study
Glass, R. Thomas, DDS, PhD, et al.
Quintessence International
2004 35 (3): 194-199

Oral candidiasis
Akpan, A. and Morgan, R.
Postgraduate Medical Journal Online
2002 78: 455-459

Principles of biocompatibility for dental practitioners
Wataha, John C., DMD, PhD
The Journal of Prosthetic Dentistry
2001 86 (2): 203-209

Biocompatibility of dental casting alloys: A review
Wataha, John C., DMD, PhD
The Journal of Prosthetic Dentistry
2000 83 (2): 223-234

Hypohydrotic ectodermal dysplasia: an unusual presentation and management in an 11-year-old Xhosa boy
Sarvan, I., et al.
Journal of the South African Dental Association
2000 55 (1): 34-37

Dental Implants
American Association of Oral and Maxillofacial Surgeons web site
Last viewed: 7/15/2016
Editor’s notes: A useful link to the dental implants area of the American Academy of Oral and Maxillofacial Surgery web site.

Information you may wish to read before making a decision on treatment

Dental management of patients receiving oral bisphosphonate therapy: Expert panel recommendations
The Journal of the American Dental Association
2006 137 (8): 1144-1150
Notes: Association Report by American Dental Association Council on Scientific Affairs

Single-Tooth Replacement: Is a 3-Unit Fixed Partial Denture Still an Option? A 20-Year Retrospective Study
DeBacker, Hein, DDS, MScD, et al.
International Journal of Prosthodontics
2006 19 (6): 567-573

Researchers Find Nine Risk Indicators for Tooth Loss
No author specified
American Academy of Periodontology web site
Last viewed: 7/15/2016
2005 11
Editor’s notes: Among the risks cited for tooth loss, 39% of patients in the study said they had never had a dental prophylaxis or periodontal maintenance visit.

Occlusion in removable partial prosthodontics
Henderson, Davis, DDS
The Journal of Prosthetic Dentistry
2004 91 (1): 1-5

Patient Satisfaction with Mandibular Implant Overdentures and Conventional Dentures 6 Months After Delivery
Thomason, J. Mark, BDS, PhD, FDSRCS(Ed), et al.
International Journal of Prosthodontics
2003 16 (5): 467-473

Congenitally missing teeth: Orthodontic management in the adolescent patient
Kokich, Vincent O., DMD, MSD
American Journal of Orthodontics & Dentofacial Orthopedics
2002 121 (6): 594-595

Oral Health Impact on Daily Performance in Patients with Implant-Stabilized Overdentures and Patients with Conventional Complete Dentures
Melas, Fotis, DDS, et al.
The International Journal of Oral & Maxillofacial Implants
2001 16 (5)

International Congress of Oral Implantologists—Frequently Asked Questions
International Congress of Oral Implantology web site
Last viewed: 9/23/2010
Editor’s notes: Frequently asked questions, and answers are given.