What happens if I don't get a pulled tooth replaced?
July 29, 2016 6:41 AM   Subscribe

I have to have one molar on the left side, third from the back (counting the wisdom tooth) pulled. I am 72 years old. Do I have to have the tooth replaced (probably with an implant)? What happens if I don't have it replaced?

The tooth has already had a root canal and a crown (years ago) and is now infected, having two cracked roots. So pulled it must be. But can I just leave the hole and let it heal, or does something have to be put in its place?
posted by mbarryf to Health & Fitness (19 answers total) 4 users marked this as a favorite
I just went through this counseling a few days ago with my endodontist. You're not required to have anything implanted if you feel like you can live without it. You pull the tooth, they'll stitch it up, and eventually it'll heal up.

If you elect to have an implant, when they pull the tooth they'll start the bone grafting procedure to grow the bone in your jaw. A few months later, they'll put in a steel screw, then let it heal for a few more months, after which a crown can be screwed onto the tooth. It's pretty expensive.

Alternatives are: Getting a bridge put in (essentially a piece that mounts on the teeth before and after the pulled tooth), or a denture/flipper. These are cheaper and will still allow you to have chewing capacity on that side.
posted by Karaage at 6:46 AM on July 29, 2016

i had a tooth removed years ago. i had kind-of crowded teeth anyway, so they just left it. now i have a small gap.
posted by andrewcooke at 6:48 AM on July 29, 2016

First of all: You don't have to do anything to replace a missing tooth, regardless of any hard selling of dental concerns of doom from the dentist. Your body, your right to determine path of treatment.

Concerns regarding missing a tooth. Is it the only missing tooth? Does having it gone impact chewing surface/efficiency? When a tooth is missing, the teeth behind can drift forward and lean into the space, and the opposing tooth that would have been hitting against the tooth can begin to supererupt into the gap. So: when you close teeth together, do your teeth offset and bite against two teeth? That will help keep teeth in place, or great reduce the amount of time drifting can take. If you have periodontal disease, bone support is reduced so drifting can happen more quickly.

Is it in a place that will show as you speak to others, and does that prospect bother you? Can you easily afford the recommended treatment? Even at 72, if you are reasonably healthy, you can expect what, 15 years or more life expectancy, so even getting your money's worth for improved dentition is still in your favor.
posted by Jazz Hands at 7:08 AM on July 29, 2016 [1 favorite]

The other teeth in your mouth will slowly migrate to make the gap smaller where the tooth is missing which will create wider spaces between them. Depending on how many teeth you have and how sensitive they are and how well they meet now it could make it hard to chew or make your teeth visually appear unsymmetrical.

Badly fitting matching teeth can encourage you to grind your teeth in your sleep which can lead to tooth pain, broken teeth and tooth sensitivity and problems chewing. None of this is a given; it's just a possible.

How much of a problem a missing tooth will create depends on what your teeth are like now and how fast the migration occurs. It is always possible that the change in positioning will be negligible.

The necessity to replace the missing tooth is dependent on your remaining teeth and bone density. One missing tooth may not make it necessary for you to change your chewing habits at all. If you have to stop chewing on that side it will make the likelihood of problems greater as exercise keeps your teeth firm and keeps the bone density high. If you have ostheoporosis you are more likely to have problems with not replacing the tooth and the teeth on both sides of the gap could start to loosen, or absolute worst case scenario, fall out.

The longer you go without a replacement the more the hole in your jawbone will expand, which means getting a replacement tooth to fit three years from now will be harder than doing it this month and getting a new tooth put in ten years from now will likely be impossible.

If your teeth are now very tightly spaced and hard to floss they may become easier to floss.

Many people do just fine without getting a tooth replaced or a bridge put in. Many people end up with problems.
posted by Jane the Brown at 7:10 AM on July 29, 2016 [3 favorites]

If it is a bottom molar, the top tooth may start to migrate down and you'll end up having to have that one removed too. Things can cascade from there. I (in my 30's) had a lower molar removed and did nothing. A few years later I had to have the top tooth removed because it had migrated sideways enough that the root was starting to push through the roof of my mouth. Not saying that will happen to you, just that it is a possibility. I probably should have gotten it replaced- either implant or bridge would have saved me a tooth.
posted by PorcineWithMe at 7:17 AM on July 29, 2016 [2 favorites]

I think there may also be worries with bone loss where the tooth was.
posted by thelonius at 7:27 AM on July 29, 2016 [2 favorites]

I had that same tooth removed ~ 20 years ago. I'm younger than you (currently 36) but the only side effect has been the spacing issues others referenced above. I'm currently undergoing Invisalign for other reasons, but the side effect is it's fixing the space. No chewing or other health issues
posted by TravellingCari at 7:34 AM on July 29, 2016

My mom is a few years older than you and had one yanked a while ago. No problems so far. I can't speak to any of the other potential problems, but if you develop bruxism, you can get a mouth guard made. I'm addicted to mine and can't sleep as well without it--and I never bite my tongue or my cheek in my sleep anymore. It's been a boon.
posted by Don Pepino at 7:44 AM on July 29, 2016

I'm 33 and I'm now missing four of my molars on the left side of my mouth - two on top, two on the bottom. I can't have dental implants for health reasons. I wear a mouth guard on top that keeps my teeth aligned and prevents bruxism (the reason I lost all these teeth is mostly that I fractured them in my sleep from grinding so hard and the multiple root canals on each tooth did not take).

I don't chew on the left side of my mouth and have noticed that I'm a much messier eater than most people but aside from that it's fine. Talk to your dentist, get a second opinion if you need to, but you do not have to go the implant route if you decide it's not right for you. A "flipper" - basically a retainer with a tooth in it - is also another option to consider that is much less invasive.
posted by sockermom at 8:13 AM on July 29, 2016

I've had molars removed and not replaced, and removed and replaced with a bridge. No implants. No problems.

I'd certainly opt for a bridge over an implant unless the dentist offered a convincing medical reason otherwise. And, if I was getting an implant hard sell, I'd not trust that opinon and find a new dentist.

Healing after an extraction takes a few weeks. No reason to hurry your decision.
posted by justcorbly at 8:28 AM on July 29, 2016 [1 favorite]

I had tooth #3 (third molar from the back, upper right) pulled after it lost a battle with an olive pit fragment. I was 46 at the time. My dentist recommended an implant, but she didn't give me a hard sell, and in any case, she didn't do implants, though her office handled the crown once the implant was ready for it.

The argument in favor of doing something was that without treatment, #2 would start to move into the gap (my wisdom teeth were removed when I was 16 or 17), and it was also more likely to weaken. The argument in favor of an implant, specifically, was that at my age, I'd probably need several bridges, since they don't last forever, and an implant produces a more normal chewing experience.

I went for an implant, because I had some money set aside for medical emergencies and I decided with over three decades of life expectancy, it was worth the longer-term fix. I travel a lot and having problems with a bridge during a two-month trip didn't seem like a lot of fun.
posted by brianogilvie at 8:46 AM on July 29, 2016

I'm having a missing molar replaced with an implant myself right now (I'm 64) because it really interferes with chewing and because teeth migrate more and more as I get older. Being able to eat as you get older is more and more important. I went through it with my mother who had Parkinson's, and was very grateful her teeth were still in good shape; even though she was increasingly less able to feed herself, she could still chew, and she enjoyed her food. My teeth are probably more important to my health, if I can keep them, than any other part of my body beside my brain. That was why I even got braces in my 50s and sleep with a biteplate to this day.

My husband doesn't have the option - he has false teeth because his nutrition and dental care in his youth produced an absolutely destroyed mouth - but if you can do it, why not? At least get a bridge.

The heck with how your teeth look, it's what they do for you that matters.
posted by Peach at 8:46 AM on July 29, 2016 [1 favorite]

I don't know that much about the risks of having a gap. I had one for a few years, and went with an implant because it was annoying to eat around the gap. I had no pressure to decide right away, and I'm mostly satisfied with the implant.
posted by CBrachyrhynchos at 9:20 AM on July 29, 2016

I have had 2 teeth molars next to each other removed, nothing significant happens. You have to watch for a dry socket after it's removed, it heals quickly & easily & you go on with your life. You have a gap in your teeth, your other teeth don't move in any significant way. You will loose some bone density in the immediate area, which means if you go too long you will not be able to get an implant at a later point as there isn't enough bone to put the pin into. Bridges are always an option, in my case at lease but they damage other teeth so I have chosen not to go that route as the gap isn't visible unless I point it out to people.

You may have to alter the side you chew on but you get used to it, but even then with only one molar at the bottom back on one side I manage to chew everything I want just fine.

One thing I learned after moving to the US from Australia though is Americans are super rude & judgmental about teeth so don't make the mistake I did & mention to people you had any removed & you'll be fine.
posted by wwax at 9:21 AM on July 29, 2016 [1 favorite]

If I were you, I wouldn't bother with any implants or flippers. I have two missing rear molars on the bottom, one each side. No problems at all, and it has been more than 15 years on both.

If there are aesthetic concerns, well, I'm the guy who did this.
posted by yesster at 1:10 PM on July 29, 2016 [1 favorite]

I had an implant but it was 99% because I didn't want the gap. It was a tooth on the side but towards the front. It had had a root canal, been pulled, been replaced by two different crowns that failed. It was a gap, but not visible all the time. I was still self-concious about it. Even while I was uninsured, after talking to my dentist I wanted to do the implant. Once I had insurance again (thanks Obama!) I finally did it. I hate anything dental-related and my stress level was at 120% through the whole process, but now, months later, I'm so happy that my smile looks good and that I can chew on both sides of my mouth.

That said, after the last crown failed, I lived with a missing tooth for over a year. No one ever commented or said anything, but I always felt self-concious about it.

At your age you just have to consider how you want to present yourself. There's a surplus of older women out there, if that's what you're into, you might want to do it up.
posted by bendy at 6:53 PM on July 29, 2016

I had four teeth removed about twenty years ago, and no implant or anything to replace them. (They are not visible unless I smile very widely).

The teeth around them have indeed moved slightly over the years so that the gaps are much smaller. The teeth directly next to the gaps have leaned slightly sideways because of this. Again, it's not visible, and the dentist doesn't think it causes any health issues. The top teeth have migrated enough that the gaps are almost non-existent now, but again, this took about twenty years to occur. Even five or so years ago, I recall the gaps being bigger (enough to get popcorn stuck in, for example). The bottom teeth haven't moved as much, and the gaps are still quite wide. Neither case bothers me at all.

In your circumstance, I wouldn't bother with an implant unless the dentist tells you you need it for jaw health for some reason.
posted by lollusc at 7:44 PM on July 29, 2016 [1 favorite]

I had my back two lower molars removed on one side in my late twenties and was told if I didn't have implants terrible things would happen, especially to my upper teeth and jawline. I'm almost 50 now and there have been no problems. That side of my face/mouth is ever so slightly different but not enough that it bothers me. My current dentist feels there's no pressing need for implants since everything looks okay still to him. Just one more datapoint.
posted by stagewhisper at 8:58 PM on July 29, 2016

I am only a bit over half your age but had a molar pulled about 5 years ago. I was advised to get it crowned or otherwise keep it but for various reasons elected to have it pulled and not replaced with anything. Absolutely no problems have resulted and I saved myself a whole lot of bother and three grand.
posted by deadwax at 12:38 AM on July 30, 2016 [1 favorite]

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