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IN COLLABORATION WITH:health TODAY44TUESDAY NOVEMBER 17, 2009
Missing teeth can lead to a host of health problems
EVELINE [email protected]
MORE THAN JUST A PRETTY SMILE
ORAL CARE
It’s nothing to laugh about
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36 wellnessThe whole tooth
When it comes to looking good, our smiles are one of our greatest assets. A beautiful smile comes with neatly-aligned front teeth. People who have lost teeth might feel too self-conscious to smile or talk. It’s no wonder Hollywood celebrities spend a fortune to preserve their dazzling smiles!
There is no doubt that our teeth work very hard – chomping, shredding and grinding our food. Losing our teeth, whether through old age, decay or an accident, can be a traumatic experience. As well as bringing about unattractive changes in facial appearance, missing teeth can have a negative e� ect on confi dence and self-esteem. Not to mention missing out on your favorite food. Imagine not being able to chomp on crab claws or chew spicy spare ribs? Or even crunch on an apple if you’re vegetarian?
A smile is an inexpensive way to change your looks. ~Charles Gordy
There are many reasons why we lose our teeth. Tooth decay, root canal infections, gum disease (Periodontitis), congenital defects and accidents are some examples.
Besides wiping that smile o� your face, losing a tooth or several teeth can be a traumatic
experience. Dental surgeon, DR EMILY WONG tells us the consequences of missing teeth, and
also how with advances in dental techniques like socket preservation, solutions are available.
tooth or FALSE
Our teeth are exposed to a tremendous amount of wear and tear and of course, we are all aging.
But losing teeth has far more serious e� ects apart from just a� ecting one’s smile.The gaps left by missing teeth are not only unsightly but eventually, the adjacent tooth may shift into the gap, creating aesthetically ugly gaps in front of and behind it.
Additionally, biting irregularities caused by tooth loss can have a negative e� ect on eating habits and this can lead to secondary health problems like malnutrition. Even the loss of one tooth can be harmful and have a lifelong e� ect.
Teeth start shifting into adjacent gap
Opposite missing teeth
For example, when you bite, your top tooth bites with the opposite one on the lower jaw.
Missing either tooth makes the opposite one useless, so it is the same as missing two teeth, functionally. Our back teeth (molars) work hard at grinding our food and we have four on each side of our mouth (except the third molars). When one molar is missing, the opposite molar will be non functional. More importantly, the bone tissue at the gap will start to degrade and “melt” away once no tooth is there. It is estimated that the jaw bone can lose as much as 1mm to 1.5mm of height within three months of tooth loss or extraction. Furthermore, the thickness of the jaw bone can reduce by half within a year. Two thirds of the thinning of the jaw bone will occur within three months after the tooth is lost. The thinning of jaw bone will also weaken the adjacent tooth support.
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38
TeNaoeviespla
GcattAyc
Missing teeth can also cause secondary problems like headaches or neck ache. For example, losing a molar makes chewing di� cult at that side, forcing you to use the other side of your mouth. The excess use of one side of the mouth, greatly stresses the jaw and neck muscles on that side, causing aches and pains which feel like headaches. When multiple teeth are lost, the imbalance in the mouth places some stress and strain to the jaw joints. This pain can radiate downwards towards the neck and shoulders. Also, due to the proximity of our upper back teeth to our sinuses, loss of teeth in this area can cause the sinus cavity to be exposed, which could lead to problems like sinusitis and fi stulae.
The e� ects mentioned above will be multiplied in the case of more than one missing tooth. Therefore, it is important to replace missing teeth at the earliest opportunity.
After a tooth is extracted, dentists will screen the patient and advise them on how the missing tooth can be replaced. Part of this screening process involves checking the condition of the patient’s jaw bone. As mentioned earlier, extraction or loss of a tooth results in bone loss, which could be quite dramatic within a year. This makes it di� cult to insert implants in a socket (space from where the tooth was extracted). Problems like these can be overcome by procedures such as bone grafting or socket preservation.
What is socket preservation and why do we need to preserve the socket?
Socket preservation is a procedure in which bone graft material or a sca� old is immediately placed in the socket of an extracted tooth to preserve bone ridge and density. It can greatly increase the chances for successful dental implants, especially for delayed implants. Careful management of extraction sockets after tooth extraction prevents unsightly bone loss and provides a better cosmetic outcome for tooth replacement.
Socket preservation with granules, Courtesy: www.frankcperrydds.com
Socket preservation following tooth extraction appears to o� er several clinical advantages in preparing the ridge for future implant placement as well as other restorative tooth structures like fi xed bridges, dentures etc. It may also play a part in prolonging the life of an implant.
There are a few techniques and materials available for socket preservation and a dentist will usually discuss these with the patient. Traditionally, dentists have used bone grafts when there is inadequate bone material in the patient’s jaw. Examples of bone grafts are Autograft (the patient’s own bone), Allograft (bone from another Human Being) or Xenograft (bone from animal, usually porcine or bovine origins) and Alloplast (synthetic materials which come in various forms such as granules, sca� olds, injectable pastes etc).
Autograft, is the best choice but it has its limitations plus the disadvantage of involving surgery and pain in order to harvest bone from a secondary site, not to mention the associated costs. Allografts use bone graft material from human cadavers. Xenografts obtain bone graft material from tissue of animal origin, which includes bovine (cow) or porcine (pig) bone. With allograft and xenograft, there is a very small chance of disease cross-transmission or rejection of the graft by the recipient’s immune system. For many patients, using cadaver or animal bone material may be o� ensive on religious or cultural grounds.
However, with the advance of technology, new materials are now available which are bio-inert and will not be identifi ed by the host tissue as a foreign body. Such materials are known as Alloplast. All materials have their own key benefi ts but generally, synthetic materials are preferred as they are inert and carry no animal or dead human remains. Synthetic materials are also free from cross genetic contamination. Some recent advances in technology have produced synthetic sca� olds which are a� ordable and can provide a mechanical support for the socket walls to prevent collapse, without a� ecting the natural healing process. These sca� olds can also encourage the natural growth of one’s own bone tissue, reducing the loss of jaw bone material.
wellnessThe whole tooth
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lifestyle Mar 2010 39
moon face with wrinkles and a very old appearance!
People seldom notice old clothes if you wear a big smile.~Lee Mildon
There is also the important aesthetic element that can no longer be ignored. Naturally, all patients want to look good after their dental procedures. As bone loss occurs rapidly after tooth extraction, the end result will always be insu� cient bone volume if the natural bone loss process is not immediately arrested after tooth extraction. This could cause inward-sinking of the gum lines, thus rendering a poor aesthetic appearance. Extensive bone loss can cause the face to sink in as well as other undesirable e� ects.
Gaps from missing side teeth can cause our cheeks to fall into the gap, giving a sunken appearance to the face. Losing one’s front teeth causes the lips to fall inwards, giving the mouth a loose, wrinkled appearance. And if you have the misfortune to lose all your teeth, your whole face profi le will change, giving you a concave, crescent
s,
f
r e
y,
d
LINKS:http://en.wikipedia.org/wiki/Edentulism#Preservation_of_alveolar_ridge_height
http://en.wikipedia.org/wiki/Dental_implant
http://en.wikipedia.org/wiki/Socket_Preservation
Dr Emily Wong is at Rapha Specialist Clinic (Clementi), Tel: 6779 6961
Collapsed face with missing teeth on the left. (Courtesy of www.drmartz.com)
So maintaining a good set of teeth into old age and preserving our jawbones goes far beyond conserving our smile. It could make the di� erence to our overall health, well-being and self-esteem.
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www.bio-scaffold.comA
DV
ER
TO
RIA
L
B
rid
gin
g
the G
ap
By
Dr
Hui
Che
e W
ah,
Floz
z D
enta
l Sur
gery
there
is a
lot
of a
tten
tion
on t
he
prev
entio
n of
too
th lo
ss b
ut v
ery
little
on
the
prev
entio
n of
jaw
bone
loss
. How
ever
, the
re is
a c
lear
link
betw
een
heal
thy
teet
h an
d a
stro
ng
jaw
bon
e, s
o pa
y at
tent
ion
to b
oth!
Whe
n w
e sm
ile, t
he fi
rst
thin
g ca
tche
s
the
eyes
are
the
bea
utifu
lly a
ligne
d te
eth,
follo
wed
by
the
supp
orte
d lip
s an
d ch
eeks
and
then
the
who
le f
ace.
Our
jaw
bon
e
not
only
car
ries
our
teet
h bu
t it
also
hol
ds
them
str
ongl
y in
pla
ce f
or a
ll th
e ch
ewin
g
and
bitin
g w
e do
. It
also
sup
port
s th
e
soft
tis
sue
whi
ch b
uild
s th
e ae
sthe
tic f
or
the
beau
tiful
sm
ile. O
nce
our
jaw
bon
e is
affe
cted
due
to
loss
of
the
toot
h, it
aff
ects
ever
ythi
ng a
roun
d it
incl
udin
g th
e re
st
of t
he t
eeth
and
the
gum
s an
d ch
eeks
.
A s
impl
e lo
ss o
f on
e to
oth
can
alte
r th
e
tota
l aes
thet
ic o
f th
e sm
ile a
nd f
ace.
stru
ctu
re w
hic
h,
dep
end
ing
on
th
e lo
cati
on
an
d s
ize
of
the
too
th,
vari
es in
siz
e,
shap
e an
d c
om
ple
xity
.
Act
ivit
ies
such
as
bit
ing
and
ch
ewin
g s
tim
ula
te
the
roo
t st
ruct
ure
, w
hic
h
in t
urn
sti
mu
late
s th
e
bo
ne
that
th
e to
oth
roo
t is
att
ach
ed t
o.
Wh
en t
eeth
are
mis
sin
g,
the
alve
ola
r
bo
ne
– th
e p
ort
ion
of
the
jaw
bo
ne
that
an
cho
rs t
he
teet
h
in t
he
mo
uth
– n
o lo
ng
er r
ecei
ves
this
ph
ysic
al s
tim
ula
tio
n a
nd
sta
rts
to r
eso
rb,
or
bre
ak d
ow
n,
leav
ing
a s
pac
e o
r
def
ect.
Th
e b
reak
do
wn
an
d r
ebu
ildin
g
of
bo
ne
is a
nat
ura
l, o
ng
oin
g p
roce
ss
that
mai
nta
ins
no
rmal
, h
ealt
hy
bo
ne
wh
ere
it is
nee
ded
an
d r
emo
ves
bo
ne
wh
ere
it is
no
t n
eed
ed.
Wh
en t
eeth
are
lost
, th
e b
od
y n
o lo
ng
er “
nee
ds”
th
is
bo
ne,
an
d it
su
bse
qu
entl
y g
oes
aw
ay.
On
e’s
faci
al a
pp
eara
nce
is a
ffec
ted
as t
her
e m
ay b
e a
colla
pse
of
the
faci
al
pro
file
an
d r
edu
ced
lip
su
pp
ort
. T
her
e
may
als
o b
e in
crea
sed
wri
nkl
ing
of
the
skin
aro
un
d t
he
mo
uth
an
d d
isto
rtio
n
of
oth
er f
acia
l fea
ture
s.
Ther
e is
no
do
ub
t th
at s
om
eon
e w
ho
has
lost
seve
ral t
eeth
will
ap
pea
r m
ore
ag
ed t
han
som
eon
e w
ho
has
a f
ull
set
of
teet
h.
and
diffi
culty
in c
omm
unic
atin
g.
Den
ture
s an
d b
rid
gew
ork
may
ap
pea
r
to c
orr
ect
the
pro
ble
m o
f m
issi
ng
tee
th,
at le
ast
in t
erm
s o
f ap
pea
ran
ce a
nd
fun
ctio
n,
bu
t m
ost
are
no
t d
esig
ned
to
mim
ic a
nat
ura
l to
oth
’s a
bili
ty t
o s
tim
ula
te
bo
ne
in t
he
jaw
. S
om
e d
entu
res
are
sup
po
rted
an
d h
eld
in p
lace
by
imp
lan
ts
that
may
pro
vid
e su
ffici
ent
stim
ula
tio
n
for
pre
serv
ing
bo
ne
hea
lth
. S
imila
rly,
un
anch
ore
d d
entu
res
rest
on
to
p o
f
the
gu
m li
ne
and
pro
vid
e n
o d
irect
stim
ula
tio
n o
f al
veo
lar
bo
ne.
Th
is t
ype
of
den
ture
dep
end
s o
n s
up
po
rt f
rom
th
e
gu
ms
and
th
e u
nd
erly
ing
bo
ne
stru
ctu
re
to k
eep
it in
pla
ce.
As
bo
ne
reso
rpti
on
pro
gre
sses
, p
atie
nts
oft
en r
epo
rt t
hat
thei
r d
entu
res
bec
om
e p
rog
ress
ivel
y
loo
ser
and
do
no
t fi
t as
wel
l as
they
did
wh
en t
hey
firs
t st
arte
d w
eari
ng
th
em.
Aft
er s
ever
al
year
s, b
on
e
and
gu
m t
issu
e
may
sh
rin
k to
a p
oin
t w
her
e
new
(o
r re
lined
)
den
ture
s an
d
even
den
ture
adh
esiv
es
can
no
t p
rovi
de
adeq
uat
e
rete
nti
on
.
Aft
er a
to
oth
is e
xtra
cted
,
den
tist
s w
ill
scre
en t
he
pat
ien
t an
d
advi
se t
hem
on
ho
w t
he
mis
sin
g t
oo
th c
an b
e re
pla
ced
. Pa
rt o
f th
is
scre
enin
g p
roce
ss in
volv
es c
hec
kin
g t
he
con
dit
ion
of
the
pat
ien
t’s ja
w b
on
e.
As
men
tio
ned
ear
lier,
extr
acti
on
or
loss
of
a
too
th r
esu
lts
in b
on
e lo
ss,
wh
ich
co
uld
be
qu
ite
dra
mat
ic w
ith
in a
yea
r. T
his
mak
es
it d
iffi
cult
to
inse
rt im
pla
nts
in t
he
jaw
.
Som
e o
f th
is b
on
e lo
ss c
an b
e al
levi
ated
wit
h p
roce
du
res
such
as
bo
ne
gra
ftin
g
or
pre
ven
ted
wit
h s
ock
et p
rese
rvat
ion
,
wh
ich
is t
he
mo
st e
ffec
tive
way
.
Tee
th -
An
Im
po
rta
nt
pa
rt o
f th
e S
tru
ctu
reTe
eth
are
imp
ort
ant
for
jaw
bo
ne
hea
lth
.
As
wit
h m
usc
le o
r an
y o
ther
tis
sue
in t
he
hu
man
bo
dy,
bo
ne
tiss
ue
nee
ds
to b
e
use
d t
o m
ain
tain
its
shap
e an
d o
vera
ll
hea
lth
. N
atu
ral t
eeth
are
em
bed
ded
in
the
jaw
bo
ne
and
att
ach
ed v
ia a
ro
ot
So
cket
Pre
serv
ati
on
W
hat
is s
ocke
t pr
eser
vatio
n an
d w
hy d
o
we
need
to
pres
erve
the
soc
ket?
Soc
ket
pres
erva
tion
is a
pro
cedu
re in
whi
ch b
one
graf
t m
ater
ial o
r a
scaf
fold
is im
med
iate
ly
plac
ed in
the
soc
ket
of a
n ex
trac
ted
toot
h to
pre
serv
e bo
ne h
eigh
t, w
idth
and
dens
ity. I
t ca
n gr
eatly
incr
ease
the
chan
ces
for
succ
essf
ul d
enta
l im
plan
ts,
espe
cial
ly f
or d
elay
ed im
plan
ts.
Car
eful
man
agem
ent
of e
xtra
ctio
n so
cket
s af
ter
toot
h ex
trac
tion
prev
ents
uns
ight
ly b
one
loss
and
pro
vide
s a
bett
er c
osm
etic
outc
ome
for
toot
h re
plac
emen
t. S
ocke
t
pres
erva
tion
follo
win
g to
oth
extr
actio
n
appe
ars
to o
ffer
sev
eral
clin
ical
adv
anta
ges
in p
repa
ring
the
ridge
for
fut
ure
impl
ant
plac
emen
t as
wel
l as
othe
r re
stor
ativ
e
toot
h st
ruct
ures
like
fixe
d br
idge
s,
dent
ures
etc
. It
may
als
o pl
ay a
par
t in
prol
ongi
ng t
he li
fe
of a
n im
plan
t.
Trad
ition
ally
, den
tists
use
bone
gra
fts
whe
n
ther
e is
inad
equa
te
bone
mat
eria
l in
the
patie
nt’s
jaw
. Ex
ampl
es
of b
one
graf
ts a
re A
utog
raft
(the
pat
ient
’s
own
bone
), A
llogr
aft
(bon
e fr
om a
noth
er
Hum
an B
eing
) or
Xen
ogra
ft (b
one
from
anim
al, u
sual
ly p
orci
ne o
r bo
vine
orig
ins)
and
Allo
plas
t (s
ynth
etic
mat
eria
ls w
hich
com
e in
var
ious
for
ms
such
as
gran
ules
or s
caff
olds
). A
utog
raft
is t
he b
est
choi
ce
but
ther
e is
stil
l the
nee
d to
und
ergo
surg
ery,
pai
n in
ord
er t
o ha
rves
t bo
ne
from
a s
econ
dary
site
and
the
ass
ocia
ted
cost
s. W
ith a
llogr
aft
and
xeno
graf
t,
Som
e re
cen
t ad
van
ces
in t
ech
nol
ogy
h
ave
pro
du
ced
sy
nth
etic
sca
ffol
ds
wh
ich
ar
e af
ford
able
an
d c
an p
rovi
de
a m
ech
anic
al
sup
por
t fo
r th
e so
cket
wal
ls t
o p
reve
nt
colla
pse
, w
ith
out
affe
ctin
g t
he
nat
ura
l hea
ling
pro
cess
.
Dr
Hui
is t
he c
urre
nt P
resi
dent
of
the
Soci
ety
of P
erio
dont
olog
y (S
inga
pore
) w
ww
.per
io.o
rg.s
g
A G
ap
-in
g P
rob
lem
Gap
s le
ft b
y m
issi
ng t
eeth
are
uns
ight
ly
and
may
cau
se t
he a
djac
ent
toot
h to
shift
into
the
gap
, cre
atin
g ug
ly g
aps
in
fron
t an
d be
hind
of
it. M
issi
ng e
ither
toot
h m
akes
the
opp
osite
too
th u
sele
ss,
so it
is t
he s
ame
as m
issi
ng t
wo
teet
h,
func
tiona
lly.
Mor
e im
port
antly
, the
bon
e
tissu
e at
the
gap
will
sta
rt t
o de
grad
e
and
“mel
t” a
way
onc
e no
too
th is
ther
e. I
t is
est
imat
ed t
hat
the
jaw
bon
e
can
lose
as
muc
h as
1 m
m t
o 1.
5 m
m
of h
eigh
t w
ithin
thr
ee m
onth
s of
too
th
loss
or
extr
actio
n. F
urth
erm
ore,
the
thic
knes
s of
the
jaw
bon
e ca
n re
duce
by h
alf
with
in a
yea
r. T
wo
third
s of
the
thin
ning
of
the
jaw
bon
e w
ill o
ccur
with
in
3 m
onth
s af
ter
the
toot
h is
lost
. Oth
er
prob
lem
s in
clud
e ja
w p
ain,
hea
dach
es
Ag
ein
g e
ffec
t o
n
face
wit
h t
oo
th-
less
th
in ja
w
ther
e is
a v
ery
smal
l cha
nce
of d
isea
se
cros
s-tr
ansm
issi
on o
r re
ject
ion
of t
he
graf
t by
the
rec
ipie
nt’s
imm
une
syst
em.
For
man
y pa
tient
s, u
sing
cad
aver
or
anim
al b
one
mat
eria
l may
be
offe
nsiv
e
on r
elig
ious
or
cultu
ral g
roun
ds.
Tec
hn
olo
gy
Bri
ng
s N
ewer
Ma
teri
als
How
ever
, with
the
adv
ance
of
tech
nolo
gy,
new
mat
eria
ls a
re n
ow a
vaila
ble
whi
ch a
re
bio-
iner
t an
d w
ill n
ot b
e id
entifi
ed b
y th
e
host
tis
sue
as a
for
eign
bod
y. S
ynth
etic
mat
eria
ls a
re p
refe
rred
as
they
are
iner
t
and
carr
y no
ani
mal
or
dead
hum
an
rem
ains
, and
are
fre
e fr
om c
ross
gen
etic
cont
amin
atio
n. S
ome
rece
nt a
dvan
ces
in t
echn
olog
y ha
ve p
rodu
ced
synt
hetic
scaf
fold
s w
hich
are
aff
orda
ble
and
can
prov
ide
a m
echa
nica
l sup
port
for
the
sock
et w
alls
to
prev
ent
colla
pse,
with
out
affe
ctin
g th
e na
tura
l hea
ling
proc
ess.
38 e
zyhe
alth
&be
auty
. au
g 20
10au
g 20
10 .
ezyh
ealth
&be
auty
39
Thes
e sc
affo
lds
can
also
enc
oura
ge t
he
natu
ral g
row
th o
f on
e’s
own
bone
tis
sue,
redu
cing
the
loss
of
jaw
bon
e m
ater
ial.
Mai
ntai
ning
a g
ood
set
of t
eeth
and
keep
ing
your
jaw
bone
hea
lthy
will
hel
p
cons
erve
you
r sm
ile.
And
thi
s w
ill h
ave
an im
pact
on
your
ove
rall
heal
th, w
ell-
bein
g an
d se
lf-es
teem
. Be
awar
e of
the
sign
s an
d sy
mpt
oms
of o
ral d
isea
ses
and
get
them
tre
ated
in t
ime
to p
reve
nt
toot
h lo
ss. K
eep
up t
hose
reg
ular
vis
its
to t
he d
entis
t! F
or m
ore
info
rmat
ion
on
bone
and
soc
ket
pres
erva
tion,
ple
ase
visi
t w
ww
.bio
-sca
ffo
ld.c
om
.
You
r ja
ws
– th
e b
ack
bon
e of
you
r sm
ile!
