Patients often ask- Is this tooth necessary, do i need it? The short answer is Yes & No... (a very helpful reply!)
There are many things we should take into account when deciding whether or not to extract a tooth and or replace it. These include things such as the position of the tooth, condition of the neighbouring teeth (do we expect them to last long), the wants and needs of an individual, and the general health of an individual.
As all of the above factors can vary quite a bit, so does the answer!
Generally many people do have missing teeth and live happy lives, however it is important to be aware of the unintended longer term ramifications that go with a loss of a tooth, should it not be replaced.
Studies (1, 2,) demonstrate that the loss of a tooth results in unintentional movement of the adjacent teeth either side it, including its opposing upper or lower tooth. This process of uncontrolled drifting of the teeth following an extraction can-depending upon the way the remaining teeth meet- result in the creation of spaces away from the extraction sites. These spaces can then become troublesome food traps making cleaning between the teeth more challenging and increase the chances of dental disease. (Colgate has created an excellent animation which illustrates this process quite well.)
The second thing patients ask: How soon should I replace the tooth?
Thankfully this question is a little bit more easier, my answer- if you are thinking of replacing a missing tooth, the sooner the better. Unwanted tooth movements begin within weeks of having a tooth removed. Although it doesn’t mean we wont be able to help if it does occur, it does mean that once the teeth have shifted- we either have the choice of correcting the unwanted drift of the teeth using a form of orthodontic treatment (eg: invisalign), or accepting the new positioning and doing our best to manage around it.
Below are examples of two of patients where implants have been used to restore the missing teeth. For Patient 1. a molar tooth was lost many, many years ago, and more recently his second premolar tooth leaving a gap. Looking closely, we can see the larger molar tooth has tilted forwards significantly and the opposing molar tooth has been restored due to previous decay between the upper teeth.
Compare this to Patient 2. who has had the tooth extracted and replaced in time span of a couple of weeks, we can see the teeth are level, with limited spaces in between. This makes it easier for the patient to clean interdentally and maintain his teeth in comparison to Patient 1., who often finds he needs to floss after each meal.
The consequence of the unwanted tooth movement for Patient 1. mean he has had to particularly fastidiously in order to reduce his risk of further dental decay and periodontal diease compared to Patient 2.
Patient 1: Unrestored space- after many years there has been significant drifting of the neighbouring teeth
Patient 2: Immediately after extraction, no tooth drifting
Patient 1: Implant placed and restored to match the neighbouring teeth and bite- note gaps between the teeth will persist.
Patient 2: Two months later, due to limited drifting, there are limited gaps in the bite and between the teeth.
So how do I prevent unwanted tooth movement?
Again this is a question which can only be answered on a case by case basis, but essentially, as long as something is either occupying the space in the form of either a denture, implant or bridge OR an orthodontic retainer is used, unwanted tooth movement can be avoided, eliminating the need for further more invasive future interventions to treat it.