Why Do We “Lose” Teeth ?

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Anatomy of a Natural tooth
Anatomy of a Natural tooth

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A smile can speak volumes. It is part of a universal language. And probably nothing affects our smiles as much as the appearance of our teeth. We Americans spend millions of dollars a year on our teeth, all in effort to maintain or improve our appearance. We buy toothpastes with whitening agents. We buy gels “guaranteed” to brighten our smiles. In addition to these cosmetic efforts, we schedule appointments for cleanings, fillings, crowns, and root canal treatment—all with the hope of preserving our “pearly whites.”

Good Oral Health

The better our oral health, the less likely we are to lose teeth. What constitutes good oral health? An individual with good oral health has gums that fit snugly around the teeth. The gums are light pink and do not bleed when brushed or probed. The teeth fit together in an orderly fashion and are free of decay. The tooth’s enamel is smooth and white. A tooth has two main structures-the clinical crown and the root structure. The clinical crown is the outer, white portion, which we refer to as a “tooth.” The pulp, which contains blood vessels, nerves, and arteries, is located on the inside of the tooth and extends into the root. The root structure extends into the jawbone, anchoring the tooth. The health of the root determines the long-term survival of the entire tooth. The root is like the foundation of a house-the stronger the foundation, the longer the house will last .

What Happens When Teeth Are Lost?

Aside from the cosmetics of having a missing tooth, even a small gap in your upper or lower set of teeth can create dental problems. When space is created by a missing tooth or several missing teeth, it may put stress on the remaining teeth, causing them to shift. This shifting may result in teeth that tilt and become loose. If you lose all your teeth, the gums begin to recede and the jawbone shrinks. As a result, facial tissue loses support and begins to “cave in.”

Reasons for Tooth Loss

Tooth Decay

Decay

Tooth decay is, in large part, a result of not brushing and flossing our teeth adequately, When we do not properly care for our teeth, plaque, a sticky substance loaded with bacteria, clings to our teeth. This plaque typically forms after we have eaten sugars or starchy foods- the bacteria thrive on these foods. Accumulated plaque secretes an acid that begins to “melt away” the minerals in the tooth structure. The result is what we commonly call cavities; your dentist probably refers to them as caries.

How long does it take before the bacterial acid starts eating away at your tooth? It varies with each person; however, the acid may begin eroding the tooth’s surface as soon as seventeen hours after the plaque has been allowed to collect. Interestingly, we don’t totally outgrow the tendency for tooth decay. In adults, decay often occurs around the edges of fillings or around the root structure of the tooth. If your gums recede, part of the root may be exposed. The roots are coated with cementum, a substance softer than enamel, making them susceptible to decay. According to the American Dental Association, the majority of people over fifty have some tooth-root decay.

Periondontal diseases
Periondontal diseases

Periodontal Disease

Commonly called “gum disease,” periodontal disease is an infection of the tissues and ligaments that hold the teeth in place. These tissues are like “shock absorbers,” and they stimulate bone to form next to our teeth. But the formation of bacteria and infection causes the ligaments to begin dissolving. Spaces or “pockets” form between the tooth and the gums. As bone loss occurs around the tooth, the tooth becomes loose. Advanced periodontal disease, or periodontitis, is a leading cause of tooth loss among adults. Dental health professionals diagnose periodontal disease initially by examination. They’ll see gums that are red and puffy and bleed easily. They confirm the diagnosis by “probing for pockets” around the gumline. A calibrated probe, similar to a very small millimeter ruler, is used to measure the depth of periodontal pockets-spaces between the gums, teeth, and bone. The pockets will have developed if the bone is dissolving. X rays are also helpful in detecting the presence of periodontal disease.

Healthy Teeth

Stages of Periodontal Disease

Gingivitis
Gingivitis

Stage I

Also known as gingivitis, Stage I periodontal disease is superficial inflammation of the gums, in which the gums begin to sag or pull away from the teeth. It is usually reversed with professional cleanings, followed by good hygiene- frequent brushing and flossing.

Stage Il

This stage of the disease IS marked by greater inflammation, swelling, and gums that bleed when touched. Pocket depths around the gums are three to five millimeters,

Periodontitis
Periodontitis

Stage Ill

A more advanced form of periodontal disease, Stage Ill is characterized by pocket depths of five to six millimeters. Usually more swelling is apparent, often with pus coming from the pockets, and some teeth begin to loosen in the sockets.

Serious Periodontitis
Serious Periodontitis

Stage IV

Also called “advanced periodontitis,” this form of the disease involves extensive bone loss and many teeth are loose in the sockets. There is no hope for saving these teeth. They may soon fall out or will require

extraction. Abscesses are frequently present. Periodontal disease affects three out of four adults over the age of thirty-five. Although poor hygiene is a major cause of periodontal disease, other factors such as diabetes and smoking increase one’s risk. For individuals whose diabetes is not controlled, circulation may be poor as a

result of thickened blood vessels; consequently, cells are not nourished and do not carry away waste products efficiently. This may weaken the resistance of gum and bone tissue to infection. Smokers are five times more likely to develop gum disease. Why? Smokers have a decreased response to infection and have impaired circulation. If you are a smoker,  are age forty-five or older, and have diabetes, you are twenty times more likely to develop periodontal disease. 

Accidents or Trauma

Car and sporting accidents are the two major causes of broken facial bones in the Malaysia. Understandably, many individuals lose teeth in such accidents as well. Considering all causes of accidental tooth loss, some two million teeth are lost to trauma annually. Losing even a single tooth creates more problems in the mouth than one may realize. Think of it as a “domino effect.” With a gap in the teeth, the remaining teeth start shifting, pushing against other teeth. This shifting allows bacteria to accumulate more easily between the teeth, and the biting force is no longer aligned correctly. This pressure may cause bone loss, resulting in the teeth becoming loose. In some cases a lost tooth can be reinserted; however, the tooth often becomes discolored, requires a root canal treatment, or is destroyed when the bone absorbs the root.

Congenital Anomalies

Congenital anomalies are a category of health conditions present at birth in which deviation occurs from normal growth, development, and function. The anomaly may have developed in the fetus during pregnancy or may be hereditary. Several hereditary diseases may result in a person being born with tiny permanent teeth or no permanent teeth at all. This condition is known as congenital anodontia, a term referring to the complete or the partial lack of a normal number of teeth. This condition affects about 7 percent of the population. The upper lateral incisors, those next to the “front” teeth, are the most commonly absent teeth, although the lower incisors and bicuspids are also often missing.

Ectodermal dysplasia is another such congenital anomaly. It is characterized by missing teeth or by teeth that are cone- or peg-shaped. The teeth typically have defective enamel, which increases the likelihood for decay and further tooth loss. This syndrome affects males more than females and is hereditary, passed on by the mother.

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