Tooth Loss and Bone Deterioration

Your natural teeth help preserve your jawbone.  When one or more teeth are missing, it can lead to significant bone loss in that area.  This bone loss can adversely affect your appearance and overall health. You may experience pain, problems with your remaining teeth, and altered facial appearance, and eventually even the inability to speak and eat normally.

In that same way that muscles are maintained through exercise, bone tissue is maintained by use. Natural teeth are embedded in the jawbone, and stimulate the jawbone through activities such as chewing and biting. When teeth are missing, the alveolar bone, or the portion of the jawbone that anchors the teeth in the mouth, no longer receives the necessary stimulation, and begins to break down, or resorb. The body no longer uses or “needs” the jawbone, so it deteriorates and goes away.

Potential Consequences of Tooth and Jawbone Loss

  • Problems with remaining teeth, including, misalignment, drifting, loosening and loss
  • Collapsed facial profile
  • Limited lip support
  • Skin wrinkling around the mouth
  • Distortion of other facial features
  • Jaw (temporomandibular joint [TMJ]) pain, facial pain, and headaches
  • Difficulty speaking and communicating
  • Inadequate nutrition
  • Pain and discomfort when chewing
  • Sinus expansion

The following are the most common causes for jawbone deterioration and loss that may require a bone grafting procedure:

Tooth Extractions:

When an adult tooth is removed and not replaced, jawbone deterioration may occur. Natural teeth are embedded in the jawbone, and stimulate the jawbone through activities such as chewing and biting. When teeth are missing, the alveolar bone, or the portion of the jawbone that anchors the teeth in the mouth, no longer receives the necessary stimulation, and begins to break down, or resorb. The body no longer uses or “needs” the jawbone, so it deteriorates and goes away.

The rate the bone deteriorates, as well as the amount of bone loss that occurs, varies greatly among individuals. However, most lost occurs within the first eighteen months following the extraction, and continues throughout life.

Periodontal Disease:

Periodontal diseases are ongoing infections of the gums that gradually destroy the support of your natural teeth. Periodontal disease affects one or more of the periodontal tissues: alveolar bone, periodontal ligament, cementum, or gingiva. While there are many diseases which affect the tooth-supporting structures, plaque-induced inflammatory lesions make up the majority of periodontal issues, and are divided into two categories: gingivitis and periodontitis. While gingivitis, the less serious of the diseases, may never progress into periodontitis, it always precedes periodontitis.

Dental plaque is the primary cause of gingivitis in genetically-susceptible individuals. Plaque is a sticky colorless film, composed primarily of food particles and various types of bacteria, which adhere to your teeth at and below the gum line. Plaque constantly forms on your teeth, even minutes after cleaning. Bacteria found in plaque produce toxins or poisons that irritate the gums. Gums may become inflamed, red, swollen, and bleed easily. If this irritation is prolonged, the gums separate from the teeth causing pockets (spaces) to form. If daily brushing and flossing is neglected, plaque can also harden into a rough, porous substance known as calculus (or tartar). This can occur both above and below the gum line.

Periodontitis is affected by bacteria that adhere to the tooth’s surface, along with an overly aggressive immune response to these bacteria. If gingivitis progresses into periodontitis, the supporting gum tissue and bone that holds teeth in place deteriorates. The progressive loss of this bone, the alveolar, can lead to loosening and subsequent loss of teeth.

Biting Pressure from Dentures:

Traditional dentures rest on your gum tissue and apply pressure to the gum and bone tissues.  As a result this traumatic pressure causes the bone to resorb and deteriorate. Over time the shape of the jaw may flatten, making it more difficult to stabilize the denture.  People often experience loosening of their dentures and problems eating and speaking due to this increased movement. Eventually, bone loss may become so severe that dentures cannot be held in place even with strong adhesives, and a new set may be required. Although repair and relining of the denture is helpful, the best way to maintain your supporting bone is with the placement of 2 to 4 dental implants.  Dental implants help preserve your bone by allowing the denture to rest on attachments that stabilize the denture and reduce biting pressure on the gum and bone tissues.  If you have experienced loosening of your dentures, please call our office to discuss the possibility of dental implants.

Trauma:

When a tooth is knocked out or broken the supporting bone is frequently affected.  A fracture line in the remaining root serves as a pathway for infection to dissolve the supporting bone. Patients should proactively seek care as soon as possible before further deterioration of the supporting bone occurs.

In some cases a traumatized tooth may be stabilized and over time return to normal function.  In situations where the tooth cannot be saved bone grafting immediately after extraction of the tooth is recommended.

Misalignment:

Misalignment issues can create a situation in the mouth where some teeth no longer have an opposing tooth structure. The unopposed tooth can over-erupt, causing deterioration of the underlying bone.

Issues such as TMJ problems, normal wear-and-tear, and lack of treatment can also create abnormal physical forces that interfere with the teeth’s ability to grind and chew properly. Over time, bone deterioration can occur where bone is losing stimulation.

Osteomyelitis:

Osteomyelitis is a type of bacterial infection in the bone and bone marrow of the jaw. The infection leads to inflammation, which can cause a reduction of blood supply to the bone. Treatment for osteomyelitis generally requires antibiotics and removal of the affected bone. A bone graft procedure may then be required to restore bone function and growth lost during removal.

Tumors:

Benign facial tumors, though generally non-threateningly, may grow large and require removal of a portion of the jaw. Malignant mouth tumors almost always spread into the jaw, requiring removal of a section of the jaw. In both cases, reconstructive bone grafting is usually required to help restore function to the jaw. Grafting in patients with malignant tumors may be more challenging because treatment of the cancerous tumor generally requires removal of surrounding soft tissue as well.

Developmental Deformities:

Some conditions or syndromes known as birth defects are characterized by missing portions of the teeth, facial bones, jaw or skull. Dr. Drs. Laudenbach may be able to perform a bone graft procedure to restore bone function and growth where it may be absent.

Sinus Deficiencies:

When molars are removed from the upper jaw, air pressure from the air cavity in the maxilla (maxillary sinus), causes resorption of the bone that formerly helped the teeth in place. As a result, the sinuses become enlarged, a condition called hyperneumatized sinus.

This condition usually develops over several years, and may result in insufficient bone for the placement of dental implants. Dr. Drs. Laudenbach can perform a procedure called a “sinus lift” that can treat enlarged sinuses.

Click on the link below to view a patient education video on Single Tooth Loss.

Spear Education Video on Single Tooth Loss