Problems with missing teeth

General-Dentistry

Topics

  • Problems with missing tooth/teeth
  • Treatment Options for Replacing Missing Tooth/Teeth

Problems with missing tooth/teeth

As soon as a tooth is being removed, we have to think of the options available for replacing that missing tooth. Most of us don’t really know the consequences or future problems that are going to be faced by us resulting from tooth extraction.

These are some of them:

1. Chewing efficiency decrease

The most common problem patient face immediately after extraction it lost of chewing efficiency. He will tends to chew more on the opposite side. If the extraction involved multiple teeth, then patient will have to switch to soft diet which might result in poor digestion and malnourished. Therefore replacement of missing teeth is crucial to regain back patient’s normal chewing.

2. Over eruption of opposite tooth

Over-eruption of upper molar tooth

Commonly happen after extraction of the lower molar causing the upper molar to erupt further downwards. This will result in food stagnant in the interproximal (in-between of the teeth) area making the teeth easily develop dental caries.

3. Migration of neighbour tooth

The neighbour teeth will migrate to the extraction site as soon as the tooth was remove. Usually, the patient will begin to notice it after a year or more. In some delayed cases, tooth extraction causes the front teeth to have multiple gaping which resulted in poor aesthetic. Both migration and supra-eruption of teeth will make restoration or replacement of the missing tooth difficult.

4. Bone lost

The gum become narrow due to bone loss after extraction

Alveolar bone lost significantly after missing teeth. As the result, the upper lip looks flatten due to lost of support from the anterior alveolus bone. Lost of bone also makes implant insertion difficult which might required bone harvesting before implant insertion.

5. Attrition of the remaining teeth

When patient loose most of his back teeth, he will try to use his front teeth to grind food and eventually all the front teeth will look much shorter due to attrition from chewing. Attrition also will make the teeth become sensitive to cold and sweet (dentinal hypersensitivity).

6. Over-closure of the mouth

As the result from attrition of front teeth and lost of posterior chewing, patient tends to over close his jaw. This will make his face shorter and his lip looks thin and easily get fungal infection at the corner of the mouth

7. Traumatic occlusion and Jaw joint dysfunction

Missing teeth will cause parafunction (abnormal) chewing. For example, when the back teeth are missing, the front teeth will be used for grind. This abnormal force will be exerted to the remaining teeth causing bone resorption around the teeth and lead to gum problem and loosening of teeth. Heavy and abnormal chew will also causing the TMJ (jaw) joint pain.
Due to abnormal function, the remaining teeth have a very high chance of fracture.

Conclusion

Delay in restoring missing teeth will result in:
1. Loss of chewing
2. Difficult in restoration/replacing missing teeth
3. Poor dental aesthetic – short teeth, teeth gaping, deep bite
4. Poor facial aesthetic – over closure, short face, chin protrusion
4. Prone to dental decay, gum problem, tooth fracture, dentine hypersensitivity
5. And finally, making you look older….

Smile!!

Treatment Options for Replacing Missing Tooth/Teeth

Option 1: Denture

Advantages
1. Cheap
2. Complexity: Simple
3. No need needle injection
4. No need surgery (No pain)
5. Maintenance: Easy to take care
6. Treatment duration: Short 1 – 3 weeks
7. Easy to adjust, repair

Disadvantages
1. Feel like not real (fake teeth) – can be removed from the mouth
2. Uncomfortable – Big and bulky
3. Palate coverage – less taste when eating
4. Lower ridge coverage – no space for the tongue
5. Teeth is made of plastic – easily worn off & stained
6. Easily trap food
7. For one missing tooth – wearer is not willing to wear it, very uncomfortable
8. Chewing food not the same as the natural teeth
9. Easily break

Option 2: Bridge

Advantages
1. Feel like real teeth – cannot be removed
2. Highly aesthetic – Look like natural teeth (with full porcelain), multiple shade to select
3. Very comfortable – No palate or lower ridge coverage
4. Teeth is made of porcelain – strong, durable
5. Good for missing one or a few teeth
6. Can correct the abutment teeth to a desirable shape and position
7. Chewing food almost as real as natural teeth
8. No need surgery

Disadvantages
1. Price: Moderate
2. Complexity: Simple to complex
3. Required needle injection
4. Involved neighbour teeth – the neighbour teeth required to be ground for support
5. Easily trap food under the bridge
6. Maintenance: Difficult (Required to floss under the bridge)
7. Treatment duration: Medium 2 – 3 weeks
8. No suitable for cases such as free end saddle, fully or near to edentulous

Option 3: Dental Implant

Advantages
1. Feel like real teeth – porcelain is sitting on the implant
2. Highly aesthetic – Look like natural teeth (with full porcelain), multiple shade to select
3. Very comfortable – No palate or lower ridge coverage
4. Teeth is made of porcelain – strong, durable
5. Does not involve the neighbour teeth
6. Trap food: very minimal (just like natural teeth)
7. Maintenance: simple to take care (just like natural teeth)
8. Can replace missing teeth in edentulous and free end saddle
9. Chewing food almost as real as natural teeth

Disadvantages
1. Price: Expensive
2. Complexity: Complex – required good planning
3. Duration of treatment: Long 3 – 6 months
4. Required needle injection
5. Required to undergo surgery (maybe required second or third surgery)
6. Required sinus augmentation, bone harvesting if not enough bone height for implant insertion (additional cost, additional surgery….additional pain)
7. Higher risk of failure in smoker, diabetic and medically compromised patient
8. Risk of injuring other structure during implant insertion: ID nerve, antrum

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Denture

Dental Bridge

Dental Implant

 

Sterilization/Autoclave Unit

Sterilization

Dental instrument that are used or contaminated have to be cleaned and bacteria-free before reuse. Therefore, they need to be sterilized before use.  Sterilization is a term referring to any process that eliminates (removes) or kills all forms of life, including transmissible agents (such as fungi, bacteria, viruses, spore forms, etc.) present on a surface, contained in a fluid, in medication, or in a compound such as biological culture media. Sterilization can be achieved by applying the proper combination of heat, chemicals, irradiation, high pressure, and filtration. (Source from wikipedia)

Autoclave

In dentistry, we use autoclave to sterilize our dental instruments. Autoclave is a device to sterilize equipment and supplies by subjecting them to high pressure saturated steam at 121 °C or more, typically for 15–20 minutes depending on the size of the load and the contents. It was invented by Charles Chamberland in 1879, although a precursor known as the steam digester was created by Denis Papin in 1679. The name comes from Greek auto, ultimately meaning self, and Latin clavis meaning key — a self-locking device. (Source from wikipedia)

Most dental clinic use autoclave unit to sterilize their instruments. According to the European Standard EN 13060, autoclave are divided into:

Type B- It has 3-times per-vacuum preceding vacuum drying. It can be used on wrapped and hollow instruments, which means a piece of equipment can be sterilized now for use later. This is the most effective autoclave as the steam able to penetrates deep into the pouches/wrappers or even double pouched instruments.

Type S – Comes with a one times pre-vacuum and vacuum drying function and efficient quick spraying steam generator. It can’t be used to sterilize instruments which are double pouch or the instruments which are wrapped in the thick wrapper/pouch.

Type N – This autoclave comes without vacuum function, it can be used for hollow instruments and solid instruments.This autoclaves are only suitable for a specific type of

load–for solid, unwrapped instruments.

Autoclave type B
Autoclave type B

Type B European Standard Autoclave – It has the highest standard among the type S and type N. It allows deep penetration into pouched/wrapped instrument. Type B Autoclave used widely in operating theater and it is used by our clinic too.

FAQ about orthodontic treatment?

Prestige Dental Care

Orthodontic treatment involves correcting  of malocclusions (improper bites), which may be a result of tooth irregularity, disproportionate jaw relationships, or both. It usually involves the wearing of braces (removable or fixed) and very occasionally jaw surgery (orthognathic surgery).

Why might I need orthodontic treatment?

There are 3 main reasons for having orthodontic treatment:
• To improve the appearance of the teeth and face.
• To make your gum healthier by allowing you your teeth better.
• To improve function i.e. to make it easier to eat.

Who will going to treat you?

Orthodontic can be treated by a general dental surgeon (who has undergone adequate of training in orthodontic field) or a specialist (consultant orthodontic). General dental surgeon usually pick the simpler cases whereas the orthodontic consultant sees moderate to difficult cases especially cases the require jaw surgery later. Therefore, a dental examination is required first!!

What types of braces are there?

There are those which can be removed for cleaning, known as removable braces (Usually cater for very mild teeth misalignment or for young children). The second type of brace is fixed to the teeth and cannot be removed for cleaning. This type of brace is commonly used in our practice and it can be further divides into:

  • Conventional (metal brackets)
  • Transparent (crystal brackets)
  • Lingual brace (brackets that places at the back of your teeth)

Conventional barce

Transparent brace

Lingual brace – brace that put at the back of your teeth

Removable brace (appliance)

When will the brace be fitted?

This depends very much on the teeth being present in the mouth and the stage of growth of the face and jaws.

How long will treatment take?

Treatment with braces usually takes between 6 – 36 months to complete depends on the difficulty.

If teeth need to be extracted, who will do this?

General dental surgeon usually does this.

Is it painful?

Having the brace fitted is not painful. However, it is common to have slightly tender teeth for 3 – 5 days after each fitting and adjustment appointment.

How often will I need an appointment?

Once your brace has been fitted you will need monthly appointments for it to be adjusted.

Will the brace affect what I can eat?

In order to prevent damage to both your teeth and brace, you will need to:
• Avoid eating toffees, boiled sweets, sugared chewing gum, chocolate bars, etc.
• Avoid drinking fizzy drinks (including diet drinks) and excessive amounts of fruit juice.
• Take care eating hard foods which might damage the brace such as crunchy apples, crusty bread, etc.
Cut them up first.

Will orthodontic treatment damage my teeth?

It is important you brush your teeth well, three times per day and use interdental brush to clean your brace. A fluoride mouthrinse should also be used last thing at night, after tooth brushing, to further protect the teeth. Failure to keep your teeth and brace clean will lead to permanent scarring of your teeth. Having orthodontic treatment to improve the appearance of the teeth will be pointless if such scarring is allowed to occur.

Cleaning your brace with interdental brush

Will I still need to see my regular dentist?

Yes. It will be important you still have check-ups with your regular dentist throughout orthodontic treatment so that your teeth can be checked for decay. Anyway, your teeth and brace will be checked and cleaned grossly every time you see the dentist who treat you!!

Will I still be able to play contact sports?

Yes, but it is recommended you wear a gumshield when doing so. This will also be the case if you enjoy riding a bicycle, roller-skating, or skateboarding. You will
be advised about this.

What if I play a musical instrument?

If you play a wind instrument, particularly the flute or a brass instrument, then a fixed brace may make it more difficult. You will need to discuss this with your
music teacher.

What if my brace breaks during treatment?

You will need to contact the us for an emergency appointment for the brace to be repaired as soon as possible. Repeated breakages will slow down the treatment and increase the overall treatment time.

What happens at the end of treatment?

Your teeth will try to return to their original positions. In order to prevent this you will be fitted with retaining appliances. These may be worn full time at first and
eventually worn part-time.

How successful is orthodontic treatment?

A smile that last forever!!

This very much depends on your commitment to the treatment. As a general rule, patients who co-operate well with treatment get good results, whilst
those who do not co-operate well, get poor results. Unless retainers are worn in the longer term some settling and growth changes may occur after treatment.

Composite Resin/Aesthetic White Filling

Clinical cases with white filling

We are using high quality filling materials which are not only strong but match with your teeth perfectly. No one will even notice it. Take a look at some of cases that were done in our clinic…

Gaps between teeth can be reduced with veneers or crowns. However, the simplest way to have them done is by using white fillings.

Any fractured tooth can be restored with composite fillings. You will be able to enjoy your food better and smile big smiles.

Even a chipped tooth due to a fall can be restored!!

Composite filling material was used to improve the shape and colour of old veneers of all the front teeth.

Decay and gap seen at the right central incisor was restored with aesthetic fillings.

Multiple old silver restorations was replaced with composite fillings which resulted in the fillings almost undetectable.

A large cavity on a molar was restored with white filling.

The malformed canine was contour into a nice tooth.

Another old silver filling was restored with white filling.

Extensive cavity of the tooth was restored with composite filling.

 

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Why we need regular dental check-up?

Regular Check-up

It is important to go to a DENTIST regularly for dental check-up… Even though without any problem or PAIN!! Why??

Basic Examination Tools

The answers are simple:

1. To have your teeth cleaned (or scaling)
To remove all the tartar that stick all around your teeth. (Brushing alone without scaling is not enough. You require professional help!!).

Scaling Treatment

If not, your teeth will end up like these.

Tartar on the surface of the teeth

The tartar that attach to your teeth surface will lead to gum inflammation (gingivitis) and later; gum recession and bone resorption (periodontitis). Then finally… teeth become shaky (mobile) and drop out by themselves!! – too late!!

2. To have your teeth checked
Almost all tooth decay started without any symptom (e.g. pain, sensitive). It takes about a year to grow significantly big. And treatment for SMALL DECAY is very simple – SMALL FILLING which is cheaper, painless and lasting.

However, when the tooth decay is too big (usually it gives you sensitive, pain or disturb your sleep), then the approach is different. The tooth might required large filling – uhh! (expensive, painful, required injection) or maybe root canal treatment followed by a crown (because the pulp is infected) or maybe extraction!!

Large  tooth decays

Conclusion
So, go to your dentist 6 monthly or twice a year!! or when you receive our recall postcard.

Please make an appointment with us for scaling and dental check-up if you don’t want to end up like her…

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Specialist Dental Clinic