Tooth Loss

Only a generation ago, most people expected to go through old age with false teeth or no teeth at all. This expectation has changed substantially during the last several decades. Although nearly half of people 85 or over have none of their natural teeth, the likelihood of losing teeth with aging is steadily decreasing. There are several reasons for this change: improved nutrition, better access to dental care, and better treatment for tooth decay and periodontal disease (common causes of tooth loss).

When teeth are lost, chewing is greatly hindered, and speaking becomes a challenge. The face looks dramatically different without the support teeth normally provide for the lips, cheeks, nose, and chin. In older people, loss of teeth can speed the loss of bone around the roots of teeth (alveolar bone). The loss of bone may make getting dentures that fit much harder.

The most common cause of tooth loss is not taking good care of the mouth—that is, not brushing and flossing each day and not having regular dental checkups. Even when tooth decay and periodontal disease can be treated, teeth can be lost if people are unwilling or unable to see a dentist. Sometimes teeth are removed when advanced periodontal disease makes chewing painful or ineffective.

People who have lost some or all of their teeth can still eat, but they tend to eat soft foods. Soft foods tend to be relatively high in carbohydrates and low in protein, vitamins, and minerals. Foods that are high in protein, vitamins, and minerals, such as meats, poultry, grains, and fresh fruits and vegetables, tend to be harder to chew. Consequently, people who eat mainly soft foods may become undernourished.

Replacing lost teeth is important for the same reasons as for preventing tooth loss. The type of replacement depends on the number of teeth lost, the location of the lost teeth, and the health of the remaining teeth, gums, and the bone around the teeth's roots. Teeth can be replaced with appliances that are fixed or cemented to existing teeth (bridges), implants, or removable appliances (partial or full dentures).

Bridges can replace one or a few teeth. They, like teeth, have to be cleaned daily. But unlike dentures, they are cemented to tooth surfaces and thus do not have to removed for cleaning. Floss threaded between the gum and bridge with a flexible plastic "needle" or between-the-teeth brushes (proxy) can be used. Dental implants are a safe, effective replacement for one, a few, or even all of the teeth. They involve surgery to place a metal implant into the jaw bone (upper or lower) for each tooth that is being replaced. The implant extends beyond the gum line, providing a place to attach a crown. Time is allowed for the gum around the implant to heal and the bone around it to grow and hold it firmly in place. Then, a crown is attached to each implant.

Partial or full dentures are useful for people who have lost nearly all or all of their teeth. They are used when all of the teeth of the upper jaw, lower jaw, or both are lost. Dentists carefully construct dentures so that they fit well and look natural. Dentures are also constructed to help a person chew as well as possible. Typically, constructing dentures takes several months and involves a sequence of carefully planned steps.

Dentures require a lot of care. They must be kept clean. They should be removed after each meal and cleaned with toothpaste or baking soda on a toothbrush or denture brush. Also, the mouth should be cleaned with toothpaste and a toothbrush to remove food debris. The toothbrush should also be used to massage the interior of the mouth. Dentures should be removed before going to sleep, cleaned carefully, and kept in a safe place. Soaking dentures overnight in a cleaning solution can be helpful but is not necessary if dentures are cleaned well with a toothbrush.

Just because people lose their teeth does not mean that they lose their need to see a dentist. They still need to see the dentist at least once a year. The dentist checks for cancer or other problems in the mouth and evaluates the dentures' fit. The shape of the mouth can change over time or because of weight loss or gain. Then dentures have to be refitted.

Dentures can improve appearance and speech. But they are far from a perfect solution. They restore less than 20% of the chewing ability provided by natural teeth. Dentures can also cause discomfort and interfere with tasting. Some people find dentures embarrassing. If dentures do not fit well, they can interfere with chewing and swallowing. They may also cause burning sensations and sores in the mouth.