Tooth loss is a process in which one or moreteeth come loose and fall out. Tooth loss is normal fordeciduous teeth (baby teeth), when they are replaced by a person'sadult teeth. Otherwise, losing teeth is undesirable and is the result of injury or disease, such asdental avulsion,tooth decay, andgum disease. The condition of being toothless or missing one or more teeth is callededentulism. Tooth loss has been shown to causally reduce overall health and wellbeing as it increases the probability of depression.[1]
Normal loss ofprimary teeth typically begins around age six and continues until age twelve. The upper and lower centralincisors are shed at age six to seven years. The upper and lower lateral incisors are shed at seven to eight years. The uppercanines are shed at ten to twelve years. The lower canines are shed at nine to twelve years. The upper and lower firstmolars are shed at nine to eleven years. The upper and lower second molars are shed at ten to twelve years.[2]
As a person ages, their permanent teeth have been exposed to normal mechanical forces, such as chewing, and also more abnormal mechanical forces, such asbruxism andtraumatic injury. Permanent teeth may also be affected by oral disease.[3] There are many ways in which a person may protect their permanent teeth from loss.
The main method of preventing tooth loss is prevention of oral diseases. Tooth loss can be due totooth decay andgum disease. Tooth decay is caused by increasedplaque retention. Bacteria can then invade the plaque and causedental caries (cavities). If cavities persist untreated for an extended period of time, tooth breakdown occurs.[4] Plaque retention and bacterial presence also affect the gums and bone and their ability to hold the teeth in place. Disease of the gums, known as periodontitis, leads to detachment of the supporting structures from the teeth and their eventual loss. Tooth loss due to tooth decay and gum disease may be prevented by practicing goodoral hygiene, and regular check-ups at adentist's office. Good oral hygiene consists of brushing two times a day with afluoridatedtoothpaste and flossing. Dental check-ups should occur every six months. Children or adults who are incapable of caring for their own teeth should be assisted with oral hygiene in order to prevent tooth loss.[5]
In contact sports, risk of mouth trauma and tooth injury is reduced by wearingmouthguards and helmets with a facemask (e.g., afootball helmet, agoalie mask).
Nightguards may also be implemented in the case of teeth grinding (bruxism) during sleep. These guards function in limiting the wear and force applied to the teeth. In turn, this minimizes the chance of loss.
In countries such as the United States, Japan, Germany, and Italy, there is a strong relationship betweencigarette smoking and tooth loss. Studies have shown that an increase in exposure to cigarette smoking can increase the risk of tooth loss. In addition, studies have also found that when people stop smoking, there is a decrease in tooth loss.[6]
Proper nutrition has been shown to prevent tooth loss by providing the nutrients necessary to maintain enamel strength.[7]
Tooth loss occurs more often in people from the lower end of the socioeconomic scale.[8][9]
Tooth loss can occur secondary or concomitantly to many diseases. Diseases may cause periodontal disease or bone loss to prompt tooth loss. Consequently, periodontal disease may cause increased infection, which may predispose a person to other diseases. Diseases commonly related to tooth loss include, but are not limited to:cardiovascular disease,[10]cancer,[11]osteoporosis[12] anddiabetes mellitus.[13] Therefore, it is important to not only maintain good oral hygiene, but also overall good health.
Maximum preservation and protection of natural teeth is best for eating and chewing; however, there are three basic ways to replace a missing tooth or teeth, including a fixeddental bridge,dentures, anddental implants. Each alternative has its own benefits and drawbacks. The patient's medical, financial, and emotional situation are considered. It has been shown that a non-removable replacement, such as a bridge or implant appears to provide patients with the best sense of security and well-being.[14]
In some cases, small missing areas can be restored by using techniques such asresin boded bridge (acid etch bridge) andmaryland bridge.
Researchers in Japan have successfully regrown fully functional teeth in mice.Epithelial andmesenchymal cells were extracted from the mice, cultured to produce a tooth "germ", and the germ was then implanted into the bone at the space of a missing tooth. A tooth of the correct external and internal structure, hardness, strength, and sensitivity later erupted in the space, eventually meeting the opposing tooth in a manner similar to an original natural tooth. This technique may be a possible future treatment for replacement of missing teeth.[15]
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