Never Ignore A Missing Tooth!!
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Do humans need teeth to live longer and is an absence of teeth, or having a certain degree of tooth loss, associated with a shorter lifespan? If so, is the association manifested through specific disease processes? Understanding both, the strength and the mechanisms of any association relies on the presence of scientific evidence to support or refute the notion of an association. In addition, a better appreciation of the interplay between the mouth and the rest of the human body can further our ability to identify how certain oral conditions might impact mortality and can guide interventions that will yield the greatest systemic impact.
Poor oral health has been found to be associated with poor general health, lower quality of life and high morbidity. The eventual outcome of periodontal disease and dental caries, the two most common dental diseases is loss of the affected teeth and hence the number of teeth or tooth count is a proxy to the cumulative oral health status in a person.
There is evidence to show that number of teeth might be associated with mortality. Various mechanisms proposed include, effect of tooth count on masticatory ability and hence ability to maintain adequate nutrition; associated bacteremia due to oral infections that might have caused tooth loss. Various reports have also shown that periodontal disease, tooth loss and overall poor oral health are more prevalent in individuals from lower socioeconomic strata, who are less well educated, and who have poorer and/or less frequent access to care.
The relationship of dental condition and human mortality remains poorly understood. Such circumstances also are observed with greater frequency in individuals who have other chronic conditions including coronary artery disease, cardiovascular disease and rheumatoid arthritis or who have addictions/habits like smoking, that, unless managed successfully, are associated with shorter life spans. A review by Polzer et al. examined association between number of teeth and all-cause as well as circulatory mortality.
In this systematic review, we describe and summarize the current evidence describing the association between tooth count and mortality from any cause.
Teeth are required for chewing, grinding, speech, aesthetics, structural stability, and for the well-being of an individual. Maintaining a good oral health is a key source for social, economic, and personal development of individuals. With the loss of teeth, the above purposes are impaired resulting in physical and physiological, psychological disturbance to the individual.Treatment plans are formulated based on oral examination, and clinicians view point. Conversely, now, equal importance is given to other factors such as patient’s demand for treatment and self-reported oral status. There is a direct relationship between the number of teeth present and total satisfaction with oral status. With the developments and awareness in dentistry and improvement in oral health with decreasing edentulousness in many countries, a higher number of people tend to retain more teeth until later in life.
Tooth loss could result from caries, periodontal disease, trauma, infection, malignancies, or failed endodontic treatments and can present adverse consequences on the remaining dentition and on the patients’ general wellbeing.
Drifting of adjacent teeth and supra-eruption of the opposing teeth to the edentulous space in their study which looked at positional changes of adjacent teeth to edentulous spaces. Also, Kini and Muliya6 observed in a case report supra-eruption of a first mandibular premolar into the space left by an upper first premolar whose coronal tissue had broken down although the whole tooth was not lost.
In addition to the drifting and supra-eruption mentioned above is a possible facial/oral asymmetry or collapse that may result following loss of teeth. Martins-Junior and Marques showed that premature loss of a lower right deciduous canine in an 8-year old patient resulted in deviation of the lower arch from the midline to the affected side just as Tallgren et al8 reported facial collapse in patients with teeth and alveolar bone loss.
Mastication as a consequence of tooth loss are known by many patients and this may be why people in this class of condition impose dietary restriction upon themselves and thereby incurring health risk. In addition, loss of posterior teeth has been associated with impaired chewing and inadequate nutrition, the patients having the tendency to over-prepare food in an attempt to make it soft thereby loosing important nutrients.
Some studies recorded more than one consequence of tooth loss at a time. Failure to replace a posterior missing tooth may disrupt balance in stomatognathic system and trigger chains of adverse reaction such as drifting, rotation or supereruption of teeth. The consequences of these loss of teeth on the patient include altered speech, ineffective mastication, loss of self confidence, concern about appearance, and feeling of bereavement, while a study reported higher likelihood of developing ischemic stroke among study subjects with periodontal disease and less than 24 teeth in the mouth compared with those with more than 25 teeth.
Despite the enormous adverse effects of tooth loss on functional, social and psychological wellbeing of the patients as well as on the remaining dentition, many patients in our environment do not replace their missing teeth. This could be due to poor awareness that failure to replace missing teeth may cause the remaining dentition to further deteriorate. Studies have been done on socio-psychological effects of tooth loss on patient but there is dearth of information on patients’ awareness of the consequences of tooth loss on the remaining dentition.
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Article compiled by Apple Tree Dental
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