Question

I (m., 58) had to have my upper right wisdom tooth extracted. Afterwards it turned out that the tooth in front of it also had to be removed. My dentist is now suggesting that I replace this tooth with an (expensive) implant. I think that I can eat well without this last tooth and could do without the implant. The other teeth are still in good condition. E. L. in B. 

Short answer

A missing tooth in the posterior region does not necessarily have to be replaced after a certain age. Scientific studies and clinical experience show that in older patients (60+), 10 teeth (natural or artificial) per jaw may be sufficient in individual cases. However, there are major differences depending on the patient, which must be clarified individually by the dentist.

Whenever a tooth is to be removed, the question arises as to whether it needs to be replaced at all in order to ensure normal function, support and aesthetics of the dentition or pronunciation in the long term. A missing tooth at your age and in this position (second large molar or tooth no. 7) does not necessarily have to be replaced. Nevertheless, there are some aspects to consider. If you are already missing several teeth due to previous extractions or due to missing teeth (congenitally missing teeth), the loss of tooth no. 7 can also lead to a critical condition. The chewing efficiency and support of the dentition could be so severely reduced that teeth would have to be replaced, possibly at another location. Scientific studies and clinical experience show that in older patients (60+), 10 teeth (natural or artificial) per jaw may be sufficient in individual cases. However, this number can vary greatly from case to case. Aesthetics, support or even speech can be permanently impaired even after the loss of far fewer teeth. 

One-sided food 

If you consciously or unconsciously only chew on the opposite side due to tooth loss, it is advisable to replace the missing tooth so that the dentition, jaw joints and muscles are not strained on one side. If, as in your case, the opposing tooth is no longer supported, it will most likely grow out. If it starts to interfere with your chewing, it can be ground down with short-term effect, but sooner or later it will have to be removed. 

Beware of gaps 

The loss of the rearmost teeth in a row of teeth is often more problem-free than the absence of a tooth within the row. In these cases, chewing on the side of the gap can become impossible because food constantly "falls" into the gap. In addition, not only does the opposing tooth grow out, but the neighboring teeth also begin to tilt towards the gap. After a few years, this can lead to very disturbing and now difficult to treat dental situations. It is essential to avoid such a development. 

Author: Dr. med. dent. Jürg Eppenberger
Published in: Neue Luzerner Zeitung on April 21, 2010