Dentist in Capitol Hill DC: Why You Should Replace a Missing Tooth


Should I replace it or not? Many patients have questions about the need to replace their missing teeth. I recently received an email from one of my own family dental care patients who wanted to know whether to replace a molar. Here’s the question and my answer:  

Hi Dr. Halim,

On your recommendation, I had a tooth pulled several months ago. I’ve done nothing about getting a bridge or implant. The tooth was a molar, 2nd from the back. I haven’t had any trouble with chewing and, from a cosmetic standpoint, I don’t have any desire to replace it. Is it important that I replace it for other reasons?

Hello _______,

I hope this email finds you well. I do recall your extraction of tooth #30 (lower right first molar) in August 2013. As I was informed by the endodontist and the oral surgeon last summer of 2013, the tooth was not restorable.

The fact that we have removed the source of the infection is always a good step in the right direction of ideal oral health. I understand your statements that it has not interfered with your chewing, nor does it bother your perception of esthetics. However, missing such a critical tooth in your mouth as your first molar can cause other collateral damage:

  1. Loss of bone in this edentulous site (missing tooth area) changes the support to your tongue, cheeks as well as to the adjacent teeth. Therefore, recession of your gum tissue may occur with the bone loss on the adjacent teeth. This creates a less stable foundation for those teeth as well as exposes their root surfaces, which are more prone to stimuli that cause sensitivity as well to decay (there is no enamel on your roots to protect against decay).
  2. Your teeth can shift without the support of #30. The teeth adjacent to the missing space may tilt and drift into this space.  This may cause the opposing teeth to occlude against #29 and 31 in a traumatic fashion. Also, the opposing tooth to the space may drift down (super-erupt) due to gravity and not having #30 present.

You can find out about the options available for replacing missing teeth in two of my previous blogs:

Replace Missing Teeth: Dental Implants and Other Options

Cosmetic Dentist in DC: What You Should Know About Replacing Teeth

Please feel free to call me with any additional questions.  I will be more than happy to schedule a consolation appointment with you to discuss this further in the office.  I would highly recommend a consultation with a surgeon to review the current status for placing a dental implant.  It is always a potential risk that bone loss beyond a certain point will require grafting in order to reestablish adequate support for an implant.

Remember, beautiful teeth are healthy teeth!

Dr. Nishan Halim

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