This is the third article in a series addressing the questions we’ve received on the controversial subject of root canals. In our first article, we focused on the relative risks of root canals that have been brought to light over the past 100 years. The second article focused on the options a person has if they currently have a root canal.
One of the options we discussed in ‘I have a root canal- now what do I do?’ was to have the root canal tooth properly removed. If you have chosen to have your root canal removed, then this is the follow-up article for you. Of course, this article also applies to anyone who is missing a tooth for whatever reason. Today, we’ll share with you the relative risks and benefits of the several options you can take if you have a missing tooth.
From our current understanding, we see that a person has five options if they are missing a tooth.
We will go through them one by one and discuss the risks and benefits associated with each option.
Our intent is to assist you in gathering the information necessary to make a wise choice within the larger context of helping you navigate to greater oral health and total well-being.
Before we jump into your options, it’s important to consider what tooth or teeth are missing. We will offer any information we have regarding which options may work better for molars vs. front teeth as we walk through these options.
The Principle Of Use It Or Lose It
In order to do this subject the justice it deserves, we need to introduce a principle that is applicable to the subject of missing teeth.
First, we use the term principle to mean a law that is inescapable. Think gravity. Whether or not we intellectually understand the law of gravity, it continually has an impact on us, every moment of every day. The principle we want to bring to light here is called: ‘Use it or lose it.’ Like all principles, ‘use it or lose it’ has far-reaching applications.
For example, we lose our cognitive ability if it is not used properly. Perhaps this is why many elderly find enjoyment in exercising their mental faculties through crossword puzzles. If we do not use our muscles, they will deteriorate. If we do not maintain the range of motion of our joints, the body will calcify around the joint to accommodate only the range of motion we regularly use. Our ability to focus our eyesight diminishes unless we exercise our ability to focus our vision at various ranges.
Another example of ‘use it or lose it’ is in maintaining bone density. We know that bone density will diminish if not used appropriately. So, the simple movement of a body weight squat to stress the long bones of the legs is an excellent exercise to maintain bone density as we age.
This principle of ‘use it or lose it’ is also directly applicable to the jaw bone. If we do not stress the jaw bone, the density of the jaw can diminish. Chewing on teeth anchored in and around the jaw provides the optimal way to stress and exercise the density of the jaw bones. You will see as we walk through the options below how our ability to stress the jaw bone changes with the various choices one has if they have teeth missing.
Your Five Options If You Have A Missing Tooth
Option 1: Do Nothing
The first option we see is to do nothing. As Robert Gammal (one of the experts we interviewed in the HealThy Mouth World Summit) put it so eloquently in his Aussie accent, “There’s nothing wrong with going ‘gappy’.”
While we appreciate Dr. Gammal’s willingness to make light of such a situation, having a missing tooth over time may cause some trouble. That’s because teeth are placeholders for one another. If a tooth is missing for a prolonged time, other teeth that are adjacent to or opposite from it (think top to bottom) may shift and change the bite. More proof that we can’t address one part of the body without affecting the whole system! When we have a missing tooth, then our other teeth can move, thus impacting the bite of that whole side of the mouth.
Another drawback of doing nothing is that you will no longer be able to stress the jaw bone at the location of the missing tooth. This results in an increased risk of losing bone density at that site. Depending on what tooth is missing, doing nothing can compromise one’s ability to effectively use that side of the mouth for chewing.
Clearly, another application of ‘use it or lose it’ suggests that we must chew on both sides of the mouth if we want to keep our teeth and jaw bones strong, healthy and functional.
On a positive note, doing nothing means that you aren’t introducing any crazy, potentially toxic materials into your system. Another positive to doing nothing is that the area will be easy to clean around, something that can become an issue with the following options.
Option 2: Traditional Bridgework
For years, conventional dentistry has encouraged traditional bridgework as the ‘go-to’ answer for a missing tooth. Despite the fact that bridgework has been a common solution for years, we are not particularly keen on this for several reasons:
It’s important to understand the general idea of traditional bridgework. (We apologize upfront to any dental professionals if we misstate the technical aspects.)
In traditional bridgework, the teeth on either side of the gap are ground down to ‘posts’ in order to attach the fixed bridge.
One main issue we have with traditional fixed bridges is that if either of the two anchor teeth become compromised, you don’t lose one tooth – you lose the whole bridge. What’s more, the anchor teeth must be compromised by radically stripping away much of the outer tooth structure to prep for the bridge. It should be no surprise then that we’ve heard numerous stories from our community about this exact situation occurring. Once one of the two anchor teeth become compromised, the person is faced with the situation of losing three teeth–or essentially their entire chewing capability on that side.
Another challenge of traditional fixed bridges is the ability to clean under the bridge. You can’t easily floss the area around a bridge. So how is someone expected to be able to disrupt and disorganize the bad bugs in the gum pockets all the way around the two anchor teeth? If I had a traditional bridge in my mouth, I know an oral irrigator (think Waterpik or Hydro Floss) would be my ‘go-to’ tool to maintain healthy tissues around those anchor teeth! You simply cannot clean around or under a bridge easily. Oil pulling could be very helpful here, though not a solution.
Now, let’s go back to the ‘use it or lose it’ principle. With a bridge, the jaw bone under the bridge is not going to get exercised.
Finally, you are essentially asking two anchor teeth to do the work of three teeth with a traditional bridge. Asking an already challenged tooth (from the stress of being prepped to carry the bridge) to do half the work of another tooth is a lot to expect.
What are the upsides to traditional bridgework?
You have a full chewing surface! Though not perfect, that’s plenty to celebrate!
If you have a traditional bridge now, do everything you can to maintain healthy gum tissue around those anchor teeth. You may want to check out our HealThy Mouth System to gain the knowledge and tools you need to care for potentially deepening gum pockets around those anchor teeth.
Option 3: Implants
I don’t think it will come as a surprise to any of you that we are not fans of implants. I remember hearing about implants many years ago; I have felt intuitively ever since that something just didn’t make sense about the idea.
With an implant, the dental specialist places a post (most commonly titanium) into the jawbone at the site of the missing tooth. After they determine that the post ‘was accepted’ by the body, then a crown is placed on the post.
Several issues surround this subject of implants.
Dr. Hal Huggins told us in his interview at the HealThy Mouth World Summit that there is trouble anytime metals in the mouth interact with microbes in the mouth. Dental metals in the wonderfully microbially diverse ‘perfect petri dish’ of the mouth tend to compel the bad bugs to adapt–and thus produce atypical toxins. This is big trouble as the body is forced to combat new toxins that can add increased stress to our immune system. (While titanium does oxidize more slowly than other dental metals, it is still a metal, and as such could be problematic.)
There is a lesser-used material for the implant screw which does offer more promise. Zirconia, the crystal created by superheating the metal zirconium, is no longer a metal; that means it is not going to activate with the bad bugs to produce atypical toxins. However, I would like to see more research demonstrating how successful zirconia implants act over decades before I would personally consider this as a viable option.
Another obvious downside to implants is the cost. The average cost per tooth is 4K to 6K.
The good news about implants is that you do activate the jaw bone by chewing on that surface. This puts you on the right side of the ‘use it or lose it’ principle. You will also have full functionality of that chewing surface, as well as a placeholder to keep other teeth from shifting in the mouth.
Option 4: Composite Bridgework
This is an interesting alternative to traditional fixed bridgework. Many dentists can now build a ‘bridge’ out of composite resin materials (the same materials the tooth-colored fillings are often made from). The main upside to composite bridge work is that the two anchor teeth won’t ground to posts. The dentist simply builds off of the adjacent teeth with composite materials to fill the gap.
While not the perfect solution, a composite bridge does offer substantial benefits when compared to the other options so far:
- It’s not metal, so there are no ‘metals and microbes’ issues.
- The anchor teeth are kept in good condition and not compromised by grinding them to posts.
- Unlike traditional fixed bridges, if one of the anchor teeth becomes compromised, you can still remove the bridge and keep at least one of the teeth.
Yet a composite bridge still isn’t the perfect solution, and here’s why:
You still have to address the issue of cleaning around and under the bridge, and you are still asking two teeth to do the work of three. I also wonder how strong these composite bridges are over time. Finally, you are not able to exercise the bone under the bridge.
If you would like to look more into composite bridgework as a solution, check out this video on the ‘Carlson bridge’. Dr. Ronald Carlson, a biological dentist in Hawaii, has a kit that he sells to dentists to educate them on what they need to build a composite bridge. Called the Carlson Bridge ‘winged pontic’, this kit is something your local dentist could purchase for you upon your request.
Our Personal Recommendations
If I were missing a front tooth, I would carefully consider having a composite bridge placed to span the gap. It makes sense that these composite bridges could be effective for front teeth, an area that receives greater importance in large part to cultural vanity. I question the long term strength of composite bridge work for molars. On a side note, we have a friend who is missing several front teeth from an accident with a bridge across the whole span. He loves to bless the world with his beautiful smile! That said, a dentist friend of mine (whose work I trust) recently informed me that these composite bridges don’t hold up very well. It’s certainly a mixed bag…
Update: We received a comment from a friend and dentist, Dr. Paul Rubin, who shared that the Carlson Bridge technology isn’t the only way to go for non-traditional bridgework. You can have a piece milled either by a lab or in the office via CEREC technology and have that piece cemented into place. Thank you, Dr. Rubin for adding this piece to the puzzle!
Option 5: Removable Bridge
The last option we see to span the gap of a missing tooth is with some form of a removable bridge. There are several styles of removable bridges, and they have many names. A few of these ‘out of style’ options are removable partials, a flipper, and Nesbit.
As their names suggest, each of these options can be removed from the gap. So, it’s easy to clean around them. Each of these solutions would also help to maintain the space to avoid any changes in bite and teeth shifting. As they do sit directly on the gum tissue of the missing tooth, they may also put some demand on the jaw bone, thus working with our ‘use it or lose it’ principle.
There are some possible downsides to removable options. First, they may not fit well and can be uncomfortable. They would require that you be conscious when eating (which isn’t such a bad habit) as they are not cemented into place and could come loose while chewing. You would also have to be diligent about removing it after eating to clean around the space. (Don’t forget to be mindful as to where you put the removable bridge when you do clean the space!)
Perhaps the biggest challenge with removable options is finding a dentist who is comfortable helping you fit one. Removable solutions are very much ‘out of fashion’ in our high tech, implant frenzy dentistry culture of today.
Finally, don’t forget the material that a removable bridge is made from. We haven’t researched this in its entirety, but it appears that dental acrylic is commonly used, which isn’t the most benign of materials.
All this said, if faced with a missing molar, we would look closely into what removable solution would best suit the specifics of our need to fill that gap.
Update: One reader made us aware that removable partials should be made from clear acrylic. Partials that are colored contain potentially harmful components. Thank you, Kathy!)
A Possible Option 6?
Although we’re generally not fans of hoping that technology will rescue us from any given current mess we humans have created (it shrugs our responsibility to live more responsibility), there is some hope that we will be able to grow new teeth from stem cell research. As we hear more about this possible option, you’ll be the first to learn about our findings! 🙂
We hope that this analysis of the various options we have found available to fill the space of a missing tooth will help you along your path to greater oral health and whole being wellness.
In our next article, we address the question: “My dentist says I need a root canal – what are my options?”
Please share this article with anyone you know who may benefit from learning more about all of their options when dealing with a missing tooth.
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