Tooth replacement and the shortened dental arch

all-teeth-names-chartThis may seem like a silly question, but considering the cost of tooth replacement, this topic comes up frequently in real life.  To provide the answer, lets start with the fact that adults are supposed to have 32 permanent teeth.  However, the vast majority of people in the United States have their 4 wisdom teeth (or 3rd Molars) extracted as teenagers, leaving the average American with a complement of 28 teeth.   Of these 28 teeth, each person has 14 in their upper jaw and 14 in their lower jaw.  Within each jaw, you have 4 incisors, 2 canines, 4 premolars, and 4 molars.

If you lose a single tooth, the options for replacement are rather consistent.  You could use a dental implant, a bridge, or a removable partial denture.

 removable-partial-dentures
You may also choose not to replace the tooth and instead leave it missing.   If you choose the latter, it is important to understand that your ability to chew food may be compromised, and the teeth around the missing space may begin to shift, which may change your bite or make replacement of the missing tooth difficult in the future.

Most patients will not tolerate a missing one of their front teeth, but missing a single back tooth may not be such a concern to some patients.  That said, one of the risk factors for future tooth loss is previous tooth loss, and if tooth loss continues, there will be a point when the patient notices.  The original question could then be reworded as, how many missing teeth would a patient need to replace to improve their perception of chewing ability?   Does everyone need to have all 28 teeth to feel comfortable?

The short answer is no, not every tooth that is lost needs to be replaced.   However, when a dentist sees a new patient with a number of missing teeth, it can be difficult to determine just how many that particular patient needs to feel that they can chew “better”.   This is particularly challenging when one considers the cost of various prosthetic options.

For example, a patient may be missing 3 teeth on the lower right side,missing-3-teeth-replacement-requiredand it is certainly possible to replace all 3 teeth, with dental implants.full-set-of-teeth-with-implantsIt is also possible to replace the 3 teeth with a removable partial denture, which would be significantly less expensive.  Given that most patients prefer to have replacement teeth that do not come in and out, how can we balance cost with patient preference?  One solution might be to replace just 1 tooth with a dental implant instead of all 3, which would be closer in cost to the removable partial denture, and depending on the patient, may sufficiently address the patient’s difficulty chewing.

This is one of the many reasons there is no once size fits all treatment.  As a prosthodontist, Dr. Limmer specializes in the replacement of missing teeth, which includes understanding the impact of tooth loss on a patient’s functional capacity and psychological needs.