Does it matter missing a single tooth?

In modern society, missing a tooth at the front can be devastating because it is visible. A conspicuous black hole at the front makes you unattractive and diminishes your socioeconomic status unless you are a well-known NHL player. Most people would not think twice before having missing front teeth restored.

What if the missing tooth is in the back of your mouth out of the vision of other people? Because it is out of sight, some people do not see the immediate need to replace it because it is out of the mind. However, leaving a space at the back of your mouth can severely affect your health, appearance, and daily life.

A healthy tooth has many roles to play in the back of your mouth. It not only helps you chew and crush food without a problem, but it also mutually supports the teeth’ stabilities around it. Besides, a tooth stimulates the cells and maintains the jaw bone’s healthiness, keeps the cheek or lip full, prevents the lower jaw from over closure that affects the look of the face, and facilitates articulation.

Once a tooth is missing due to extraction, gum disease, gross decay or tooth fracture, there will be a space where the tooth occupies before. The teeth beside the void will gradually drift and tip into the hole, resulting in open contacts (small gaps) between the other teeth further away from that void. The small gaps form food traps that can lead to more gum disease, bone loss and cavities further out from the original space, like a domino effect.

Moreover, the opposing tooth on the opposite jaw of the space may over-erupt into the void, causing excessive and uneven wear of the enamel of the tipped teeth, interference of chewing movement of the lower jaw, and possibly loosening of the tipped or over-erupted teeth.

The jaw bone where the missing tooth’s roots were embedded shrinks in all three dimensions to make the matter worse. The gum tissues overlying the shrinking bone will follow the contour of the shrinking bone and become thinner and smaller.

There will be less support of the lips and the cheeks because of the space and diminishing bone. Hence the facial appearance will change – wrinkles, suck-in look, saggy cheeks etc.

Because of all the aforementioned adverse effects, there will be a chain reaction of unwanted consequences. Food chewing can be inefficient, with more chances of losing the other teeth because of gum disease and constant banging on the tipped or over-erupted teeth during food grinding and bruxing. Higher prevalence of cavities and bad breath, Lack of confidence because of the changed appearance, and possible damage to the temporal mandibular joints are all the sequelae of just one missing tooth.

With the technology we have, we can replace a missing tooth with a replacement tooth. The replacement tooth can be anchored to the adjacent teeth to bridge the gap literally. The material utilized for making the false tooth is natural-looking ceramics such as zirconium, acrylic, composite resin or porcelain fused on a metal substructure. The replacement tooth using the surrounding teeth for support and anchorage can be fixed like a bridge or removable like a denture. The replacement tooth can also be attached to an implant embedded in the jaw bone. An implant-supported replacement tooth will not need to rely on the adjacent teeth for any support because it does not attach to the other teeth at all, which is one of the advantages of an independently self-supporting structure. The additional advantage would be the embedded implant will maintain the quality and quantity of the surrounding jaw bone – so that the bone would not shrink.

The different options have their merits and cons. You will need to consult with your dentist to find out which one is the most suitable for you to replace your missing teeth.


Did dentists invent Halloween?

Probably not! Halloween began as an ancient Celtic holiday called Samhain.  The Gaelic festival marks the end of the harvest season and the beginning of winter, considered “the dark half of the year.” Celebrants believe that it is the day of the dead. On that day, the boundary between the worlds of the living and the dead became blurred. Thus the ghosts can return to the living world for a visit during that day.

Trick-or-treating going from door-to-door, singing songs or praying to the dead is part of the festivities. Traditionally, food and drinks were given out to the mummers, but nowadays, candy and sweets are the main giveaways.

Children come home with bags of candy and sweets after an evening of door-to-door trick-or-treating. So what can the parents do to maintain their family’s oral health with all the candy and sweets collected?

It is alright to enjoy the candy collected from Halloween, but consuming the sweets with the following plans and patterns is important to stay healthy.

  1. Eat Halloween candy with meals or shortly after mealtime. During meals or shortly after, the saliva production and flows are at the highest level; this helps wash out the food debris, neutralizes the acids produced by bacteria in your mouth, and remineralizes the enamel surfaces with the calcium and phosphate ions in the saliva.
  2. Store the candy away between meals so that the children cannot snack on the sweets anytime between meals.
  3. Limit the amount of candy your children can have a day.
  4. Avoid hard candy and other sweets that stay in your mouth for a long time. The length of time sugary food is in your mouth plays a role in tooth decay. Candies that remain in the mouth for a long time subject teeth to an increased risk of tooth decay.
  5. Sticky sweets like caramel toffee and gummy are chewy. They stick to the teeth, especially firmly into the pits and grooves on your teeth, making them hard to wash and even brush away.
  6. Look for organizations that collect candies or donate to some dental offices that have a candy take-back program.
  7. Drink more water after eating the candy, and brush your teeth with fluoridated toothpaste one more time per day.
  8. Maintain a healthy diet by having rough fresh vegetables and fruit like apples to help to scrap the plaque away from the gums. Snacking on cheddar, mozzarella, and Swiss cheese stimulate saliva and have shown cavity-fighting properties.
  9. Reduce other sugary intakes like soda and sports drinks.
  10. Chewing sugarless gum helps to increase saliva flow. But chewing gum too long and too often can cause excessive enamel wear, TMJ disorder and increase the likelihood of teeth chipping. It is advisable not to chew gum for more than 20 minutes a day.
  11. Flossing the teeth can help to remove food and debris between teeth that toothbrushes cannot reach.

Medical Emergencies in the Dental Office

A medical emergency can happen, usually when least expected, in a dental clinic during treatment. Approximately 90% of the crises were mild, but 8% were more serious. Only 35% of the patient who had medical emergencies were known to have some underlying disease, while only 33% of those patients were found to have a cardiovascular disorder. In other words, medical emergencies can arise in any person who has no alarming medical conditions during routine dental treatment.

The most common medical emergencies to occur in a dental office:

  • Vasovagal syncope (faint)
  • Hyperventilation due to panic attack
  • Acute asthma attack
  • Angina/myocardial infarction
  • Epileptic seizures
  • Diabetic emergencies – likely low blood sugar level
  • Allergies/hypersensitivity reactions
  • Choking and aspiration
  • Adrenal insufficiency
  • Cardiac arrest

Medical emergencies were most likely to occur during and after local anesthesia, primarily during complicated tooth extraction and prolonged root canal treatment that required multiple local anesthetic injections to remove the pain. Among the different emergencies, over 60% were syncope, with low blood sugar level the next most frequent at 44%, followed by mild allergic reaction at 8.8% and ingestion of foreign bodies at 4.1%.

This blog focuses on the prevention of medical emergencies from happening during a dental or surgical procedure.

To mitigate the frequency and severity of medical emergencies in dental offices, the patients can play an essential role by telling the dentists all their past medical history, including health conditions, hospitalization and surgeries. The medications they are taking and their dosages can also give the treating dentist an idea about the severity of the medical conditions.

The patients need to disclose the history of medical emergencies during their previous dental treatments, anxiety and reactions, a dental experience like painful TMJs after a lengthy procedure, and difficulty in having good freezing from the local anesthesia in their previous treatments.

Dentists and their team should be skilful in picking out the predisposing medical conditions when reviewing medical and dental history. The medical and dental questionnaire forms should be simple for the patient to complete, yet inducive of any pertinent medical and dental information to screen potential medical complications. The medical and dental history takings are crucial to screen out the patients who are prone to having medical complications during dental treatments. The vital signs of all patients should be noted and taken. Patients of high risk should have a medical consultation with their physicians and medical specialists before extensive dental treatments.

Proper treatment planning can help to minimize the risk of eliciting medical issues. The planning involves looking for alternative procedures like extractions instead of root canal therapy, using silver diamine on the cavities instead of fillings, placing a fixed bridge instead of an implant to replace a missing tooth.

When it comes to local anesthetics, the dentist can choose those without epinephrine to minimize the cardiovascular workload.

The dentist can break a long appointment into two shorter appointments, and sedation can be a helpful adjunct for some instances.

The treating dentist and the team should be well prepared to deal with medical emergencies when they happen. Everyone in the office should be trained and certified in doing CPR. The recognition of the symptoms is essential because if the symptoms are not recognized early on, the medical condition can spiral down quickly if not appropriately managed early on.

The components of a sound medical emergency plan for the dental office should include:

  • Medical emergency prevention
  • Development of an action plan
  • Recognizing a patient’s distress and management of medical emergencies
  • Emergency drugs and equipment

During the dental procedure, the vital signs are checked periodically with a machine. The patient is asked regularly about the feeling to make sure they are in good condition.

A thorough pre-operative discussion with the patient can reduce the anxiety by answering questions the patient may have about the procedures, pain during and after the process, expectations etc. Showing empathy and care to the patient can calm the patient down. The more detail the dental team has, the better and more effective a plan of action can be

There are some other techniques that the office and the patient can do to alleviate anxiety include:

  • Deep breathing during times of particular stress.
  • Distraction through music, podcasts or video.
  • Discuss medication and sedation options that might be right for you.
  • Establish control through hand signals so your dentist knows when to stop.
  • If sedation is not used, advise patients, especially those who are anxious, to eat before treatment to maintain a stable blood glucose level during stressful treatment.
  • Recline the patient in a supine or semi-supine position for treatment.