Missing teeth for years: your options and when to act

Many people leave a missing back tooth for years because "nobody can see it" and they can still chew on the other side. But that gap does not stay still. Over time the neighbouring teeth tip into it, the opposing tooth drifts down, and the jawbone where the tooth was slowly shrinks. This article covers those changes, the ways a missing tooth can be replaced, and why an examination and X-rays matter before you choose.

What a missing tooth does to chewing and the teeth around it

• Neighbours tip, the opposing tooth over-erupts. Teeth always look for support. Left long enough, the teeth on either side lean into the gap and the tooth opposite grows down into it. The space becomes distorted, which makes later replacement harder.
• Bone shrinks. The bone around a root is kept by the chewing forces that pass through the tooth. Without a tooth, the bone there becomes thinner and lower. The longer you wait, the less bone there is for an implant, and bone grafting may be needed.
• One-sided chewing. Leads to a tired jaw joint, wear on the side that does all the work, and more tartar on the side that does not.
• Food packing. The gap and the spaces opened by tipping teeth trap food, causing decay and gum inflammation in the neighbouring teeth.
• Several missing teeth: sunken cheeks, deeper lines around the mouth, changed speech.

Your options

Removable denture

Artificial teeth on an acrylic or metal base that rests on the gum and clips to the remaining natural teeth. Can replace several teeth at once, is quick to make and the least expensive. Drawbacks: weaker chewing, may loosen as the bone keeps shrinking, has to be removed and cleaned daily, and the clasps can wear the teeth they hold on to.

Dental bridge

The two teeth next to the gap are trimmed to act as supports and a row of joined porcelain teeth is cemented across. Fixed, chews well, looks good, done in a few visits. Drawbacks: healthy natural teeth have to be trimmed, the supporting teeth carry extra load and are at risk later, the bone under the bridge still shrinks, and cleaning under it takes effort.

Dental implant

A titanium post is placed in the jawbone in place of the root; once it has fused with the bone, a porcelain crown is fitted on top. No trimming of neighbouring teeth, chewing close to a natural tooth, and the bone at the site is preserved. Drawbacks: minor surgery, several months to complete, higher cost, and it needs enough bone and good general health. At Asahii Dental Clinic implants are placed by Dr. Tran Van Thang, the clinic's oral surgeon and implantologist, using Straumann and Neodent (Switzerland), Megagen AnyRidge and Dio (Korea), Kontact Biotech (France) and Adin systems; for several missing teeth or a whole arch there is also an implant-supported full-arch (All-on) option. See How dental implant treatment works, step by step.

Which one?

There is no single right answer. Your dentist weighs:

• Where the gap is and how many teeth are missing; whether the neighbouring teeth are sound or already filled, heavily decayed or root-treated.
• How much bone there is at the site, and its quality, which only X-rays show.
• General health: diabetes, osteoporosis, medicines, smoking.
• Your age, chewing needs, appearance, and the time and budget you are prepared for.

For example, with one missing molar and sound teeth on either side, many dentists favour an implant so the healthy teeth are not trimmed. If the neighbouring teeth already have crowns or large fillings, a bridge may be sensible. For several missing teeth in an older person with medical conditions, a removable denture remains a good choice.

Why an examination and X-rays come first

The bone under the gum cannot be seen by eye. A panoramic X-ray shows bone height, the roots of the neighbouring teeth, the sinus and the nerve canal. For an implant the dentist usually also needs a cone-beam CT scan to measure bone width and height in three dimensions, and to decide whether grafting or a sinus lift is needed. The examination also checks your bite, whether there is still enough space, and whether the gums are healthy. Only after this can the plan and the cost be stated accurately. At Asahii the doctor walks you through each point on the scan, sets the options side by side and gives clear prices; the plan is written down item by item with its costs, you confirm before anything starts, and the scans and records are kept in the clinic's system for you to look at again.

When to act

The sooner the better, while the bone has not shrunk much and the neighbours have not tipped. After an extraction the dentist usually reviews you after a few weeks to months to choose the right moment. A tooth missing for many years can still be replaced; it may just need bone grafting or straightening of the neighbouring teeth first.

When to see us straight away

• Pain or swelling at the gap or in the neighbouring teeth.
• A neighbouring tooth that is loose or persistently sensitive.
• A denture that causes ulcers or pain, or that you cannot eat with.
• Frequent food packing at the gap, or bad breath.

The right option can only be chosen after a doctor has examined you and read your X-rays. See our prosthetics and implants page or book an examination and X-rays by hotline 0928 888 121, Zalo or the clinic's Mini App.