When a tooth is lost — whether from decay, fracture, or extraction — the most common response is relief that the problem is over. The pain is gone. The tooth is gone. Move on.
But the problem isn’t over. In many ways, it’s just beginning.
A missing tooth sets off a chain of events in your mouth that unfolds slowly, quietly, and expensively over the months and years that follow. Understanding what happens is one of the most important things a dental patient can know — because the cost of doing nothing is almost always far greater than the cost of replacing the tooth.
Your jawbone exists, in large part, because your teeth exist. Every time you bite and chew, the roots of your teeth transmit force into the bone, which signals the body to maintain it. When a tooth is lost, that signal disappears. The bone in that area no longer receives stimulation, and the body — efficient as it is — begins to resorb it. It uses those minerals elsewhere.
This process, called bone resorption, begins within the first few months of tooth loss. In the first year alone, you can lose up to 25% of the bone width in that area. Over several years, the bone continues to shrink in both width and height.
The consequences are significant. Neighboring teeth lose support and begin to tilt or drift. The opposing tooth (the one that used to bite against the missing tooth) begins to over-erupt — it grows downward or upward into the empty space because it no longer has anything to stop it. Your bite changes. Your face can actually change shape over time as bone volume is lost.
And critically: the longer you wait to place an implant, the less bone you have to place it into — which often means bone grafting becomes necessary before an implant can even be considered.
Teeth are held in position by a combination of their roots, the surrounding bone, and pressure from neighboring and opposing teeth. Remove one tooth and that entire system is disrupted.
Drifting and tilting. The teeth on either side of the gap will slowly lean into the space. This happens gradually — you won’t notice it week to week — but over a year or two the misalignment can become pronounced. Teeth that have drifted are harder to clean, more prone to decay, and much more complex to restore if you later decide to get an implant.
Over-eruption. The opposing tooth grows into the gap. This can cause it to become loose over time, and it often creates bite problems that lead to jaw pain and headaches.
Increased decay and gum disease risk. Teeth that have shifted are harder to keep clean. Food traps form in new places. The risk of decay and periodontal disease increases throughout the area.
Here is where the math becomes sobering.
A single dental implant placed promptly — before bone loss occurs — is a straightforward, well-understood procedure. The cost is predictable.
Wait a year or two, and now there may not be enough bone for a straightforward implant. Bone grafting is required. The cost increases substantially.
Wait longer, and the neighboring teeth have drifted. If you want an implant now, the space may need to be orthodontically reopened first — adding cost and time.
Meanwhile, the over-erupted opposing tooth may have become problematic and require its own treatment. The teeth that drifted into the gap may have developed decay in the new tight contacts they’ve created.
A single missing tooth, left untreated, can cascade into a treatment plan that costs two, three, or four times what a timely implant would have.
A bridge — the traditional alternative — replaces the visible tooth but does nothing for the underlying bone. Bone resorption continues beneath it. Additionally, a bridge requires grinding down the two healthy teeth on either side to serve as anchors. You are sacrificing healthy tooth structure to replace a missing one.
A dental implant replaces the root as well as the crown. The titanium post integrates with your jawbone and restores the stimulation that keeps the bone alive. It preserves the bone, protects the neighboring teeth, and functions exactly like a natural tooth. With proper care, it lasts a lifetime.
The best time to replace a missing tooth is as soon as the area has healed from the extraction — typically a few months. The bone is still present. The neighboring teeth haven’t moved. The procedure is simpler, less expensive, and produces the best long-term outcome.
The second-best time is right now, whatever the situation is.
As the first full-service implant dentist in Southern Utah — handling diagnosis, bone grafting, placement, and restoration all in-house — we see the results of delayed treatment regularly. We also see the relief patients feel when they finally address a missing tooth they’ve been putting off for years.
If you have a missing tooth or are facing an extraction, we’d be glad to talk through your options honestly. Complimentary consultations are available.
— Dr. Dane Boren
