If a missing tooth is not replaced, the jawbone in the area where the tooth was removed gradually begins to lose volume; this is often accompanied by neighboring teeth tilting into the gap, the opposing tooth in the other jaw over-erupting and changes in the bite. Because these changes usually progress slowly, they may go unnoticed in the first months. In the long term, however, they can affect both chewing function and the planning of future treatments. In this article, we look step by step at what can happen in the jawbone and the mouth after a tooth is lost.
Why Does Bone Shrink After a Tooth Is Removed?
The part of the jawbone that holds the teeth is called the alveolar bone. This bone owes its existence largely to the presence of teeth and to the forces transmitted through them during chewing. The tooth root sends constant stimulation to the bone during chewing, and this stimulation helps the bone renew itself.
When a tooth is removed, this stimulation disappears. Over time, the body remodels the bone tissue it perceives as no longer functional, and the bone can decrease in both width and height. Studies show that a significant part of this change takes place in the first months after extraction and can then continue more slowly over the years. The amount of bone loss can vary depending on factors such as the reason for the extraction, the location of the area, the gum structure and the person’s general health.
Changes That Can Occur If a Missing Tooth Is Not Replaced
A missing tooth can affect not only its own area but also the surrounding structures and the balance of the whole mouth. The most common changes are:
- Shifting of neighboring teeth: The teeth on either side of the gap can tilt or drift into the space due to loss of support.
- Over-eruption of the opposing tooth: When the tooth in the opposite jaw no longer has a tooth to meet, it can grow into the gap (extrusion).
- Gaps between teeth: As teeth shift, new spaces can form and food can collect in them.
- Gum problems: Because the area around tilted teeth is harder to clean, the risk of gum inflammation and decay can increase.
- Changes in chewing patterns: A person may unknowingly start chewing on the other side of the mouth, which can put more load on the other teeth.
What Happens When Several Teeth Are Missing?
Especially when several back teeth are missing, support for the bite (the way the teeth fit together) can decrease. In this case, more force may be placed on the front teeth, and over time gaps may open between the front teeth or they may flare forward.
Effects on Facial Appearance
When many teeth are missing for a long time, the resulting bone loss can lead to a reduction in lower facial height. When support for the lips and cheeks decreases, changes such as a sunken appearance around the mouth or more pronounced wrinkles can appear. These effects can be more noticeable in people who have no teeth at all and have worn removable dentures for many years.
The Jaw Joint and Muscles
Changes in the balance of the bite may contribute to strain on the jaw joint and chewing muscles in some people. However, because jaw joint disorders have many contributing factors, they should not be attributed to missing teeth alone. For information on such complaints, you can visit our jaw joint (TMJ) disorders page.
How Does Bone Loss Affect Future Treatment?
The longer a tooth has been missing, the more likely it is that additional steps will be needed when planning treatments such as dental implants. For an implant to be placed, there must be bone of sufficient width and height in the area. When bone volume has decreased, the dentist may consider the following options:
- Increasing the volume of the area with bone grafts and membranes
- Sinus floor elevation in the back of the upper jaw
- Planning an implant of a different size or angle
- Considering alternatives to an implant, such as a bridge or a removable denture
You can find detailed information on the methods used in areas with reduced bone volume in our article on bone grafting methods for bone loss. Where neighboring teeth have shifted, aligning the teeth with orthodontic treatment before an implant or prosthesis may be considered.
Can Bone Loss After Tooth Extraction Be Reduced?
When an extraction is unavoidable, certain methods can aim to limit bone loss. These include causing as little damage as possible to the surrounding tissues during extraction, placing graft material in the extraction socket where appropriate (socket preservation) and planning the implant with suitable timing. Which method is appropriate is determined by the dentist based on the reason for extraction, the presence of infection and the anatomy of the area.
Treatment options that can be considered for a missing tooth include dental implants, bridges and removable dentures. Because an implant transmits chewing forces to the bone through a root-like structure, it can help maintain stimulation of the bone. Who may be a candidate for a dental implant becomes clear after an examination and three-dimensional imaging.
When choosing a treatment, not only the number of missing teeth but also the condition of the other teeth, gum health, the bite relationship and the person’s expectations are assessed. For example, a bridge may require the healthy teeth on either side of the gap to be prepared, whereas an implant can be planned without touching these teeth. Removable dentures can be considered an option when many teeth are missing or for people for whom a surgical procedure is not considered suitable. Because each method has its own advantages and limitations, the decision is made individually based on examination and imaging findings. Until a suitable treatment plan is prepared, taking care to clean the area of the missing tooth and the neighboring teeth also helps protect oral health.
When Should You See a Dentist?
After a tooth is extracted or lost, discussing how to replace it with your dentist early on makes it easier to plan the next steps. For people who have had a missing tooth for a long time, the current bone condition, the position of neighboring teeth and the bite can also be assessed through examination and imaging. Planning is carried out individually according to the person’s oral structure and expectations.
Frequently Asked Questions
Can a single missing tooth also cause bone loss?
Yes, a loss of bone volume can occur in the area even when only a single tooth is missing. The amount of loss varies from person to person and can also affect the position of neighboring teeth over time.
How long after an extraction can an implant be placed?
The timing is determined by the reason for extraction, the presence of infection and the condition of the bone. In some cases, the implant can be planned at the time of extraction, and in others after a healing period.
Can an implant still be placed where a tooth has been missing for a long time?
A long gap in time does not in itself rule out an implant. If bone volume is insufficient, additional procedures such as grafting can be considered; the decision is made after a CBCT scan and an examination.
Note: This article is for general information purposes only. Whether treatment is needed and which method is appropriate are determined individually by your dentist after an examination and any necessary tests.
