Tooth Replacement: What Are The Options?

Losing teeth is a traumatic event.  We do not take it lightly in the dental office.  When teeth are lost it is important to know where that person is in their understanding of the problem and the possible solutions.  There are four options: do nothing, make a removable denture, make a fixed bridge or place a dental implant(s) and crown(s).

Do nothing:  This option may leave an undesirable esthetic effect with a gap somewhere in the smile.  A missing tooth will also adversely affect chewing.  Most people will chew on the side that is more effective, causing wear and tear on that may also cause some joint (TMJ) pain.  When teeth do not touch another tooth they will usually drift which can change the bite.  When a space is left it will catch more food making it harder to clean which will leave the area more susceptible to decay and gum disease.  This option starts out as the least expensive but fixing the problems caused by not replacing the tooth will cost more time and money in the long run.

Make a removable denture:  This was the option of choice many years ago before we had more stable means to replace teeth.  It is the least costly replacement option.  It can function well for chewing but it has some significant drawbacks. The biggest problem is that dentures always move which puts pressure on the gums and adjacent teeth to which they are attached.  This movement can lead to problems with the adjacent teeth.  Metal clasps are used on the adjacent teeth to hold the denture in place and may be esthetically unappealing. Removable dentures need to be removed for cleaning both the denture and the teeth.  They will catch food while eating which can be uncomfortable and unsightly.

The fixed bridge option:  Until implants became available this was the most desirable option for tooth replacement because it was cemented into place, no movement.  Bridges are traditionally made of metal with porcelain over the metal for esthetics, however, today some bridges can be made of all ceramic materials.  Bridges can be very esthetic and can be long lasting.  The biggest drawback is that to make a bridge other teeth need to be cut back to support the bridge and cleaning is difficult.  Cleaning under the bridge is very challenging especially in the back of the mouth.  This leads to an increased incidence of decay and gum disease.

The dental implant option:  Dental implants are strong, long lasting tooth replacement option. Implants have now been in regular use for 30 years. Implants can be used to replace single teeth, multiple teeth or all of the teeth.  The implant option is usually more expensive than the other options but may save money in the long run.  Let me explain that, replacing a single tooth with an implant and crown is more expensive than a bridge or removable denture the first time it is done.  However, if we live long enough, all dental materials will need to be replaced at some time.  Usually the implant does not need to be replaced but the crown may.  If you have to replace one crown on an implant that will cost less than a fixed bridge.  If you are young enough you may need to replace a crown or bridge several times.  At some point the teeth supporting a bridge or a removable denture may break to the point that they cannot be used any more and the area of treatment has now become larger and more expensive.

Should you lose a tooth or teeth be sure to explore all of these options with your dentist and the short and long term expenses associated with each.  Esthetics are certainly a concern but most importantly a full set of functioning teeth is crucial for your overall heath.

Dr. Robert A. Gallegos is a Fellow in the Academy of General Dentistry, he is on the faculty of Spear Education, a member the American Academy of Cosmetic Dentistry, the American Academy of Dental Sleep Medicine and the American Dental Association.  Dr. Gallegos practices dentistry in Middleburg, VA.

Dr. Gallegos