Complicated bone loss issues are becoming more and more prevalent for many segments of young and older adult populations that didn’t seem to exist several years ago.
Dentures: A Functional Paradox
Long term denture wearers, as a group, are discovering that early, sensible choices of dentures or partials are now causing severe loss of bone height and width within the upper or lower jaw.
Conscientious denture wearers who obtained frequent relines or denture replacements through the years are now facing the prospect of having near total resorption that can prevent the use of replacement dentures or implant devices.
Dentures typically cause up to 70% bone loss within the first several years of use. Partials can have similar effects. Denture prosthetics are designed to rest or ride on gum tissue and do not provide direct stimulation to the jawbone as normal teeth or implants do.
While many denture wearers perceive a loss of gum tissue as they continue to wear denture products, there is a misconception that relining a denture is a common fix. Relines do a wonderful job of creating a new snug fit, but in reality are compensating for the loss of underlying bone and loss of gum tissue volume.
Gum Disease – Periodontitis
Adult gum disease is also responsible for complex bone loss that can accrue to the loss of teeth (extracted or otherwise) and the disease process operating directly on the connective tissues (periodontal ligaments) and jawbone.
Effective management of adult gum disease has historically been difficult. The abnormally high incidence rate in adults (80%) is indirectly caused by inadequate oral health habits, untimely treatments of common dental problems that later create the environment for disease, insurance factors and finance considerations.
Many older adults, members of the current baby boomer generation, are now treating gum disease conditions that have accrued due to their tendency to focus on assuring dental health maintenance for their families first and delaying routine treatments for themselves.
Periodontitis, which typically progresses from untreated or inadequately treated gingivitis, can cause wholesale destruction of jawbone integrity very quickly. Fortunately, thanks to Mother Nature, different segments of our jawbones possess different densities, enabling most gum disease patients to benefit from advanced prosthodontic bone grafting technologies and creative acrylic or titanium based fixed or removable prosthetics.
Cumulative Extractions Cause Malocclusion – Super Eruptions
Untreated tooth extractions are discussed on the Normal Bone Loss page. The abuse of extraction dentistry accelerates immediate bone loss in the extraction site(s) and almost routinely impacts healthy bone of adjacent teeth. Patients oftentimes report beginning events of shifting teeth as the resorption of bone spreads to adjacent tooth roots and connective tissues.
Extreme abuse of extracting teeth also caused severe disruptions in the occlusal plane. Super eruptions of opposing teeth can also exacerbate a bad bite. Normal canine guidance fails and a mismatch between the biting surfaces of our upper and lower teeth can exert lateral or sideways forces on teeth causing more teeth to shift, loosen and sustain more bone loss.
Inadequate or unsuccessful orthodontic treatments can also cause, for adult patients, bone loss events. Orthodontic needs that were never treated can cause a variety of malocclusion issues especially when significant conditions of underbite, overbite or flared teeth exist.
Orthodontic concerns that appear to be benign during teenage or young adult years can become a destructive force with the dentition of a middle aged or older adult. Teeth can shift, rotate, tilt, become wobbly, grind away on opposing tooth enamel or strike opposing gums and jawbone (including the palate).
The last picture in our series shows what can happen to adult teeth and bite, over several years, when routine orthodontic alignment issues (easily addressed during our developmental years) are repeatedly postponed creating treatment needs that are complex and unnecessarily costly.
The bone loss on the lower, central anterior teeth was caused, for the most part, by the super eruption process that occurred due to a defective occlusal plane (upper and lower jaws don’t line up properly).
In this extreme example, the lower teeth are actually “hitting” the upper jaw gum tissue, further complicating the loss of tissue on the upper arch.
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