Modern dentistry has experienced a tremendous shift in relating dental and oral health to overall health. I remember during my time in dental school, one of my clinical instructors gave me one of the most important pieces of advice: “Always remember there is a whole person attached to the mouth you’re treating.”
It’s a simple phrase, but it still resonates with me today, almost seven years after graduation.
As dental clinicians, it is our responsibility to focus on and treat the oral cavity, but we also need to bring attention to the overall health implications of oral diseases—especially missing teeth. We all know there are three main ways to replace missing teeth:
- Bridges (natural tooth);
- Implants (single-unit, implant bridges or implant dentures); and
- Removable conventional partial dentures or complete dentures.
Why replace the missing teeth, though?
The World Health Organization (WHO) defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
How can missing teeth influence the physical, mental and social well-being of a person?
Physical:
Missing teeth can affect physical health in many ways. One missing tooth will initially have an effect locally on the oral cavity by causing other teeth to shift, whether it’s by supra-eruption, mesial or distal drifting.
See the bitewing in this image of an existing patient in our practice. Missing #30 causes supra-eruption of #2 with mesial drifting, along with mesial and distal drifting of #31 and #29, respectively.
Also, what happened to #3?
In this case alone, missing one tooth has caused the shifting of three other teeth, in addition to possibly causing the loss of a fourth tooth (#3).
In 1993, a study conducted by A. Van Der Bilt et al. concluded that there is a significant difference in chewing efficiency and performance between patients with missing post canine teeth and of a control group with complete dentitions, especially when missing more than five (5) teeth.
Nutrition is a key aspect of overall physical health, and missing teeth along with decreased chewing capacity can result in patients not getting the required nutrition from different categories of food. This, in turn, affects their overall mood and physical health.
Caries, bone loss and periodontal disease as a result of missing teeth have been linked to other medical conditions such as heart diseases, strokes, and osteoporosis, among others.
Mental:
The psychological effect of missing teeth is one that needs further studying. There are contradictory studies in this area, but many studies and clinicians agree that there is link between missing teeth and mental health.
A systemic review done by Zaki Kudsi et.al in 2020, found six studies that suggested a significant number of patients have difficulties in accepting tooth loss, were less confident, and had emotional distress related to tooth loss.
They concluded that tooth loss could cause psychological disturbance (i.e., depression) in some patients, but there is a lack of available tools that are suitable to screen and measure psychological disturbance in those patients.
Social:
The same systematic review by Kudsi et al. concluded there is a marked impact on functional activities and social interaction.
The link between missing teeth and social impact increases as the missing teeth are more anterior, or in the aesthetic zone, according to a study published in 2021 in the Indian Journal of Forensic Medicine and Toxicology.
In the same study, they found that speech impediments (or distortions) are also more prevalent in patients missing teeth.
Missing teeth can impact a person and keep them from having healthy normal social interactions within their personal lives.
It can also harm the confidence they have in their professional lives, whether it’s in a current job or an interview for a future position.
In general, there is a lot of evidence to support that missing teeth can have significant effects on overall health.
It is imperative that we, as dental clinicians, explain to our patients every day in our practices the importance of replacing missing teeth as it relates to their overall physical, mental, and social well-being.
ABOUT THE AUTHOR
Michael Massoud, DMD, is the co-founder of SiRa Dentistry in Spotswood, New Jersey, https://www.siradentistrynj.com. He received his Bachelor of Arts degree in Biological Sciences from Rutgers University and his Doctor of Dental Medicine degree from Temple University Kornberg School of Dentistry. His professional philosophy is to treat patients as family, developing interpersonal, doctor-patient relationships by using his passion for the art and science that is dentistry.
He is an active member of the New Jersey Dental Association and American Dental Association. Dr. Massoud continuously seeks to advance his knowledge through continuing education courses, especially in aesthetic dentistry and advanced restorative procedures, and dental implants. Growing up in Montreal, Canada and being raised by an Egyptian family, Dr. Massoud is trilingual and fluent in English, French and Arabic. He enjoys spending his spare time with family and friends, playing soccer, and traveling the world with his wife, Sherri.
