Congenitally Missing Teeth: What Are They?

Congenitally missing teeth

Most patients do not realise but that some teeth Can Be Missing because they simply have failed to appear. That can be for two reasons why they have simply failed to appear. The first reason is that they just are missing from the dental jaw hence the term congenitally missing teeth. The second reason is that they have become impacted so this is not truly missing teeth but it gives the appearance that a tooth is missing, whereas in reality it is just impacted. An impacted tooth is one that has fully or partially failed to appear in the dental Arch more than 2 years after it was supposed to have come through. The most commonly congenitally missing teeth are the last teeth in a set of teeth. Therefore within incisors, it is the lateral incisors and most commonly the upper lateral incisor. Then it is the second premolars and usually the maxillary second premolar. Within the molars, it is the third molars or wisdom teeth that are most commonly missing.

Impacted teeth are most commonly the upper canines followed by the lower canines. This is usually because the upper canine has the longest path of eruption and it usually erupts after the adjacent teeth i.e upper lateral incisor and the first premolars have erupted. The canine therefore has to sometimes squeeze in between these two teeth and if there is not enough space, it will become impacted. The other teeth which are most commonly impacted are the wisdom teeth or third molars and this is because these are the last teeth in the whole dental arch to come through and if the rest of the dental arch is already crowded, there will certainly be not anymore room for the wisdom teeth.

The effects of missing teeth

1. The Psychological aspects of having a tooth or teeth extracted can be immense and must not be underestimated. It is very easy for a dentist who will take out many teeth during their working life to become dismissive or complacent on the effect this has on a patient. It has been reported in the literature that losing a tooth or teeth can have similar effects to that suffered in a bereavement. Patients worry about how this will affect their immediate appearance, eating food and self-esteem. On a medium to long term, they worry about how the missing tooth or teeth will be replaced and their consequences including cost implications. Patients will often go to extreme lengths in order to keep a tooth in the mouth even though the prognosis maybe really poor but this is more to do with the reluctance of going to an extraction procedure but also a reluctance to accept that this tooth has been lost. They may feel guilty that they could have looked after their teeth better and there was no need to lose their teeth. This commonly occurs with children where it is the adult who feels guilty at their child having to go through with an extraction and its consequences. For adult patients, it is sometimes a reluctance to accept the loss and they feel that they are becoming old and lost their youthfulness.

2. Of course, the most obvious effect of losing a tooth or teeth is the appearance. If the gap is within the smile line, it will immediately have a huge impact. If a patient cannot have a tooth replaced immediately for any reason, they will certainly be affected in how they look, speak, socially interact and how they carry on with the occupation. Quite often is the case that even when they do have the tooth or teeth missing replaced, the result is never as good as what nature provided them in the first place, there are two reasons for this. Firstly, science can never mimic the exact properties of a real tooth although it can become close. There are however longer-term less immediate effects of losing your teeth which are related to teeth movement of other teeth. we will discuss this further below however when a gap appears in the mouth, the adjacent teeth will tend to tilt and drift into this gab and in addition the opposing tooth will tend to move into this gap from its arch and this process is known as overeruption. As well as the obvious effect on the aesthetics, this will also make future replacement of that gap more problematic.

3. The effect on chewing when you have teeth missing is obvious and indeed it is one of the main reasons why a patient may request the missing teeth to be replaced. Clinical studies show that several teeth need to be missing until there is a detrimental effect on chewing. This means that losing 1,2 or 3 teeth, will not have any detrimental effect on mastication. There is one study which showed that you can lose 3 teeth on each arch side, until there is an effect on chewing. This means that you can lose 6 lower teeth and 6 upper teeth before it’s really starting to affect your eating. On the other hand, studies show that when patients have lost multiple teeth, this certainly has a huge detrimental effect on their chewing. This will affect the patient in several ways. Firstly, they won’t be able to chew their food as effectively as when they had a full set of teeth. In addition, they will tend not to chew their food as effectively and this means that they will be swallowing food which hasn’t been masticated properly. This in theory can cause digestion issues. In addition, these patients will therefore tend to avoid foods that are difficult to chew and go for soft processed foods with which is not good for their general health. As a consequence, the effects of missing teeth on the general health and nutrition can be seen. Finally, if they have the teeth replaced with dentures, it is a well-known fact that dentures cannot produce the masticatory force of natural teeth and many patients even struggle to wear dentures in the first place.

4. Nearly all patients will not be aware of the structural and dynamic nature of the dentition. When you lose a tooth or teeth, the adjacent teeth will move into the gap. This is known as mesial and distal drifting of teeth. There is also a phenomenon called overeruption where the opposing tooth will tend to move into the gap that has been created. This in turn then causes additional tooth movement within the opposing arch of the adjacent teeth. Depending where the gap is also, a change in midline can occur which obviously has an aesthetic component. However, not all patients undergo a significant amount of drift or over eruption and each patient has to be monitored individually over a period of time.

Replacement of missing teeth

Nowadays there are many ways in which missing teeth can be replaced.

Dentures are the method majority of missing teeth in the UK are replaced. It is important to be aware that there are different types of dentures as well. The normal run-of-the-mill denture is called a plastic or an acrylic denture. However there are other dentures also available such as ones based on a cobalt chrome framework and the newer type of flexi dentures. Each denture has its own advantages and disadvantages and the dentist will discuss these with you accordingly in order to decide which one will be the best for you.

Fixed bridgework is a method to replace a tooth or teeth with something that is fixed in the mouth and you do not need to take it out to clean. Although this has obvious advantages, it is not suitable for every single patient and a dentist needs to assess this individually. Different types of bridge work are also now available such as an acid etch or an adhesive Bridge, a cantilever bridge, a fixed fixed bridge made out of either porcelain bonded to metal or an all- ceramic framework.

Finally, implants are now generally available and due to competition, they are a lot more accessible to many patients. Within implants, there are many different types available and a dentist can advise you accordingly. Finally, as well as traditional implants, there are newer types of implants which come under different names but they reduce the need for bone grafting and it also reduces the treatment time taken.

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