Growing up, many of us were taught that we only need to go to the dentist when we experience dental pain. I want you all to get that out of your mind because it is completely WRONG! The word I want you to focus on is PREVENTION.
What are the Options to Replace Missing Teeth?
Preventative oral care
This is the idea of preventing something from happening. For example, when you get into your car, you put your seatbelt on to prevent you from flying out of your car when in an accident. Imagine if you didn’t have a seatbelt on when you had an accident. The injuries would be much worse. This is safety. This is prevention. Preventing serious injuries from occurring. The same goes for your oral health.
You don’t always feel dental pain when you have a cavity. As a matter of fact when I tell my patients that they have a cavity, they reply back with “yeah, but it doesn’t hurt though?” I hear this so often that I had to make a whole song about it and you can find it on my YouTube Channel. When I hear this, the patient is essentially telling me we can just leave it alone and not address it. Again, WRONG!
Your teeth are not like the rest of your body and what I mean by that is they don’t have the same abilities to heal themselves. If you get a cut on your finger, you put an bandaid on there and allow it to clot up and create a scab and then boom, it’s healed.
With your teeth, once there is actual cavitation in your tooth and it has gone through your enamel, it only gets bigger and bigger over time. If you don’t floss or brush your teeth regularly, the cavity gets much larger and faster.
The structure of teeth
Your teeth have 3 layers: Enamel (outer layer that is white), Dentin (the middle layer that is yellowish-brown), and then there is your pulp aka your nerve. When you experience dental pain with sweets or with cold/hot foods/drinks, it means that the cavitation is getting close to your nerve.
Think about the enamel and the dentin as being jackets for your nerve. The cavity is like taking off the jacket that protects the nerve and therefore it gets more sensitive. Once the cavity reaches the nerve, that’s when the serious issues can start, for example, swelling, throbbing pain (feels like a heartbeat in your jaw), pus draining out, and so much more.
This could have been prevented but because we waited for the pain to start, it’s too late now to simply do a filling. Now we are talking about a root canal (the removal the infected nerve) or an extraction (taking the tooth out).
For some of you, you know exactly what I’m talking about. You have been given those options and because you were in so much pain, many of you opted to just “rip that sucker outta there.” But guess what, now you are missing a whole tooth! For some of you, you are missing multiple teeth!
At that exact moment, you didn’t think about how missing these teeth would affect your confidence when smiling, your ability to get a job with missing teeth, your ability to properly chew your food, or the fact that you now need to consider options to replace your missing teeth.
Which brings me to the main topic for today, what are the main options to replace missing teeth? Some of these options may not be a good fit for you. I always recommend you talk to your dentist about the options to replace missing teeth and she/he can give you the best options for your specific needs and oral health status.
Ok, let’s get into the options.
Bridge vs. Implant vs. Dentures
PARTIAL DENTURES
Typically the least expensive option and is usually covered by Insurance companies, including Medicaid (in some states). Partial dentures can replace multiple teeth with one appliance.
If you are missing a front tooth, you can get something called a “Flipper” which is a partial denture but only replaces a couple of teeth for aesthetic purposes only. For example, you are playing softball and get injured and now need to have your front tooth taken out because it cannot be saved.
The flipper gets made before you have your tooth extracted so that once they extract it, they deliver the flipper immediately and you don’t risk walking around for weeks with a missing front tooth.
The downsides to partial dentures are: they are removable, so you need to take them out before bed, they can feel bulky or odd in your mouth, they can make you feel “old” because you now have a denture. Partial dentures can be used as a temporary solution while you save up for the a dental bridge or implants.
DENTAL BRIDGE
Think about 2 islands separated by a body of water. Got it? How can a car drive from one island to the other? With a bridge. That’s essentially what a dental bridge is. The islands are your teeth, the body of water is the gaps where you are missing teeth. Another way to think about it is try to put your hand up with your palm facing towards you.
Now put down your middle and ring fingers. You should have your pinky and index fingers up like you’re ready to rock out! Now, your pinky and your index finger represent your existing teeth. The ring finger and middle finger represent the two teeth you had extracted and are now missing.
To form a dental bridge, we shave down your pinky and index finger, and place a crown on them. Then, we take 2 fake crowns and attached them to the crowns on your index finger and pinky to connect them all together. This forms the bridge.
Now, some of you are missing multiple teeth in between your natural teeth, meaning your body of water between the two islands is a lot larger. This is fine because we can make a bridge longer and replace multiple teeth with one bridge. There are limits though. We don’t typically like to stretch a bridge too far because it can become weak in certain areas and not last as long as it is supposed to.
Dental bridges are great but they are typically not covered by your dental insurance, can be costly, and require us to shave down your anchor teeth (islands). If your teeth are healthy, this might mean that we need to shave down a healthy tooth to place a crown on it for the bridge to anchor off of.
When you have a bridge made, the teeth are shaved down, then an impression is taken by either using alginate or PVS or some other impression material (this is the mushy stuffy they put in your mouth and have to hold it in for a certain amount of time).
Some dental offices have digital dentistry available which means instead of the “mushy” stuff, they use a scanner to scan your teeth into a software that they then use to design and make your bridge. Digital dentistry makes it easy to get your bridge placed the same day.
If your dentist does not have digital dentistry available, you will need to have a temporary bridge placed to protect you teeth while we wait for the lab to send back your permanent bridge.
DENTAL IMPLANTS
These are Ferrari of dental treatments for missing teeth. Yes, they can be pricey but they are amazing! You can replace one tooth or all of your teeth with dental implants. You can also make a bridge with dental implants and use them to hold in a complete or partial denture! Here is how they work.
First, you will need a CBCT scan. This is a 3D scan of your head that shows the doctor the quantity and quality of your bone in the area where you want to have a dental implant placed. It also shows the doctor where some of your important nerves are and where your sinus is, so that they can plan around them.
With regular X-Rays, you can’t really see much detail as to the quantity and quality of the bone, nor can you map out the nerves and sinus. That is because they are in 2D and are a flat image.
So if you want to get dental implants, you will need this scan to be done. This scan will determine if you are a good candidate for a dental implant and it will help the doctor map out and create a plan for where each implant needs to be placed to fit your needs.
Once the scan is complete, your doctor will plan for surgery. Some providers use something called a surgical guide, which is exactly as it sounds. It has your implant placements all mapped out and guides the doctor as to where each implant needs to be placed and at what angle.
The surgical guide is something your doctor designs custom for your specific needs. Once the implant(s) is/are in, a healing cap is placed on each implant. Then, your gums are placed over the implant to allow the area to heal.
What do I mean by heal? The implant is like a screw and it has grooves on it. The healing part is basically allowing your bone to grow into the grooves of the implant to make it solid and one with your bone. The healing process is typically a minimum of 4 months.
“So, Dr. Gibbz, you are saying I have to walk around with a missing tooth for 4 months before I can get it replaced?” Well, yes and no. For example, you can use a complete denture (if you are missing all of your teeth) or a partial denture (missing some teeth) to act as a temporary replacement while you wait for the healing process.
The complete denture or partial denture will just sit on top of the healing gums while the implant and bone get married. You can have teeth while you wait, you can chew and eat foods, you can smile, etc.
Some doctors can also offer you immediate implant loads meaning there is no healing period because they can design the crown or denture and place it on the same day your implants are placed. Now, this is not for everyone and you may or may not not be a good candidate for this. Ask your dentist.
Assuming you went the traditional route and waited a minimum 4 months, you will come back to your doctor for a follow-up and they will take an impression, similar to how I explained it above in the dental bridge section.
Then, they will start to make your prosthesis (this is a general term for a crown, bridge, or denture). Once it is made, they will try it in and secure it into place, and boom, you’re done!
Missing teeth can affect your speech, your confidence, your ability to get a job, and your overall health. Talk to your dentist about your options to replace your missing teeth.
Always remember, we can prevent tooth decay and going down this avenue of replacing missing teeth by simply maintaining your oral hygiene.
FRBR: Floss - Rinse - Brush - Repeat!
You only have to floss and brush the teeth you want to keep. You are in charge of your oral health and your teeth. Your dentist is there to help you tackle these issues and to help guide you towards a healthy mouth.
As I always say, please talk to your dentist about your specific oral health needs. I am happy to answer your dental questions.
You can reach out via Instagram (@Dr_Gibbz). You can also check out my YouTube channel where I have several dental education videos to help you feel more confident and comfortable the next time you see your dentist.
Dr. Gibbz (Public Health Dentist)
Disclaimer: This article is for educational purposes only and there is no doctor/patient relationship being established by reading this article. Always consult with your dentist or primary care provider. This article is not intended to offer medical or dental advice to anyone, it is not intended to diagnose any medical or dental conditions that you may have. There are no warranties and/or guarantees being made with the information being presented in this article.
