Preventing Patient Tooth Loss: Why It Matters and How to Achieve It

As a dentist, saving teeth features highly among your goals. When well informed about their options, most patients want to keep their natural teeth for a better quality of life. In fact, tooth loss has serious repercussions on patients not only physically, but also psychologically. Not only is tooth loss prevention essential for patients’ health, but it also wards off future complicated procedures, avoiding patient pain and anxiety. You can prevent tooth loss by implementing strong patient education and preventative care treatments. 

 

Why tooth loss happens

 

While old age accelerates tooth loss, patients can prematurely lose teeth for a number of other reasons, the biggest factors being poor oral health, disease, and trauma. 

Poor oral health can lead to caries, pulp infection, tooth decay, and possible removal. One study done in Kuwait on patients who’d suffered tooth loss showed a strong statistical link to infrequent or nonexistent dental visits and poor oral health habits, proving the importance of regular check-ups. [1] Periodontal (gum) disease is the highest predictor of tooth loss in adults, estimated to affect about 20-50% of the population around the globe, including 10% with severe gum disease that can lead to tooth loss.[2],[3] Heavy smoking also damages oral health, so smokers often feature among patients treated for gum disease.[4] 

Furthermore, medical research has established a strong link between tooth loss and some diseases such as Type-2 diabetes (higher blood sugar leading to more tooth decay), while other diseases may show a possible correlation, such as rheumatoid arthritis and hypertension.[5],[6] Physical injury or trauma can also cause tooth loss, including accidents like falls or sports-related injuries, and harmful behaviors that put unwanted pressure on teeth.

 

Does genetics play a role in tooth loss?

 

According to scientific research, “no gene to date has been identified that has as large an impact on periodontal disease as do environmental influences, such as smoking or diabetes”[7], and “heritable bacteria are not associated with dental caries.”[8] Nevertheless, up to 30% of the population may be genetically predisposed to gum disease, especially those diagnosed with diabetes - so ask your patients about their family history.[9] While some genetic factors may influence the degree to which patients are susceptible to tooth decay, they cannot alone predict tooth loss; this is rather the result of complex gene-environment interactions.[10] As a dentist, you can use these factors to establish at-risk profiles for patients, for instance, those with weak enamel, crowded teeth, and acidic saliva.    

 

Why is it important to prevent tooth loss? 

 

Good oral health is a strong basis for a high quality of life and good self-confidence.[11] Conversely, tooth loss can affect patients’ overall quality of life, both physically and psychologically.[12] When patients lose teeth, many physical symptoms will disrupt their daily life, in both basic and complex ways. They can feel pain and discomfort, and experience difficulty eating or chewing that can incur diet changes, compounding a lower quality of life.[13] For instance, patients may opt for more soft and processed foods, which are poorer in nutrition. 

Furthermore, tooth loss affects psychological health because it changes patients’ appearance, which can lead to lower self-confidence. Tooth loss causes disorder in daily life, making simple communications and social activities more difficult, which may lead some patients to self-isolate or feel alienated from their community, thereby creating conditions for anxiety and depression.

Psychological and physical impacts are often linked, as physical discomfort can lead to impaired social interactions, which then leads to poor mental health. This is especially true for older patients who are more susceptible to losing teeth with serious effects on their daily life.[14] What’s more, a meta-analysis of existing studies shows that more teeth lost result in stronger negative impacts, especially if they are anterior teeth.[15] 

 

Prevention for easier procedures and patient satisfaction

 

When interviewed, dentists report that they strongly enjoy saving teeth as part of their practice, and what drives them the most is patient satisfaction.[16],[17] Saving natural teeth naturally generates goodwill in patients, enabling you to run a smooth practice with lower stress levels for everyone. This is because tooth loss prevention will help avoid complex and time-consuming procedures, such as endodontics, tooth extractions, root canal treatments, tooth replacements, and prosthetics, which are much more challenging and stressful for dentists.[18] These procedures can also induce more anxiety in patients due to the higher risk of pain and be a cause of patient dissatisfaction. So by focusing on tooth loss prevention, not only are you supporting patients’ health, you’re setting the basis for a more peaceful practice. 

 

How to prevent tooth loss

 

Focus on patient education and preventive care to launch a virtuous cycle in your practice. You’re probably familiar with most of these, but here’s a reminder of actions you can take to minimize tooth loss for your patients.

One of the dentists’ favorite tasks in the course of their practice is patient education.[19] What’s more, patients truly appreciate it when you make time for them. You can help prevent tooth decay and tooth loss by working with your patients to establish a regular dental care routine. First, establish your patient profile and evaluate their cavity risks. Are they high-risk due to their age or other health conditions? Educate patients on home care measures to establish healthy habits like effective brushing, flossing, and fluoride intake. Advise them on the best tools and latest products for oral health. Warn them about which traps to avoid (dietary and drinking choices, smoking, etc.). And of course, get your patients on board with preventive care: encourage them to schedule regular sessions for cleanings and check-ups, every year or more frequently depending on profile types.

Preventive care treatments can take on many forms in your practice: from oral exams, teeth cleaning, and x-rays, to the use of dental sealants. While often routine, check-ups and cleanings must not be overlooked. A thorough oral exam may uncover symptoms of periodontal diseases or other serious medical conditions. Diagnostic x-rays are crucial to prevent tooth loss, as they are often necessary to detect pathologies such as bone loss, decay, cysts, and tumors. Restorations must also be checked regularly for defects and wear. 

If your patients’ teeth are at risk of decay, you can use fluoride treatments to fortify teeth through remineralization and repair weakened enamel. A more permanent treatment is to use dental sealants, which are especially useful on molars and hard-to-reach teeth. In fact, according to the ADA, sealants on permanent molars reduce the risk of cavities by 80%, which in turn can prevent tooth loss.[20] And when prevention fails, you can rely on bioactive treatments such as Biodentine to protect teeth from further decay. Biodentine is a dentin substitute used to preserve pulp vitality with bioactive properties that prevent bacteria proliferation thanks to high pH (12).

 

References:

[1] Hitti, M. 9 Risk Factors for Tooth Loss. webmd.com. Nov 11, 2005. Accessed June 22, 2021. 
<https://www.webmd.com/oral-health/news/20051111/9-risk-factors-for-tooth-loss>

[2] Oral Health. who.int. March 25, 2020. Accessed June 22, 2021.
 <https://www.who.int/news-room/fact-sheets/detail/oral-health> 

[3] Nazir, M A. “Prevalence of periodontal disease, its association with systemic diseases and prevention.” International journal of health sciences vol. 11,2 (2017): 72-80. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426403/ >

[4] Stuart, A. Are You at Risk for Tooth Loss? webmd.com. October 12, 2010. Accessed June 22, 2021. <https://www.webmd.com/oral-health/features/tooth-loss-risks#1> 

[5] Hitti, M. 9 Risk Factors for Tooth Loss. Ibid.

[6] Stuart, A. Are You at Risk for Tooth Loss? Ibid.

[7] Oral Health Topics: Genetics and Oral Health. ada.org. Last Updated: July 13, 2021. Accessed June 22, 2021. <https://www.ada.org/en/member-center/oral-health-topics/genetics-and-oral-health> 

[8] Gomez, A et al. Host Genetic Control of the Oral Microbiome in Health and Disease. Cell Host & Microbe. Volume 22, Issue 3, 13 September 2017, Pages 269-278.e3. https://doi.org/10.1016/j.chom.2017.08.013 <https://www.sciencedirect.com/science/article/pii/S1931312817303463>

[9] Casanova L, Hughes FJ, Preshaw PM. Diabetes and periodontal disease: A two-way relationship. Br Dent J. 2014;217:433–7.  

[10] University of Melbourne. Your genetic make-up has little impact on your dental health, new study finds. ScienceDaily. 30 April 2019 <www.sciencedaily.com/releases/2019/04/190430091838.htm>

[11] Werner CW. Odontologia Geriátrica. Rev FOL UNIMEP 1998; 11: 62–70. 

[12] Gerritsen, Anneloes E et al. Tooth loss and oral health-related quality of life: a systematic review and meta-analysis. Health and quality of life outcomes, vol. 8 126. 5 Nov. 2010, doi:10.1186/1477-7525-8-126  <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992503/> 

[13] Brennan, D. S. et al. Tooth loss, chewing ability and quality of life. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation, 17(2), 227–235. 2008. https://doi.org/10.1007/s11136-007-9293-2 <https://psycnet.apa.org/record/2008-05056-005>

[14] Saintrain, M. V., & de Souza, E. H. (2012). Impact of tooth loss on the quality of life. Gerodontology, 29(2), e632–e636. https://doi.org/10.1111/j.1741-2358.2011.00535.x <https://pubmed.ncbi.nlm.nih.gov/21883422/>


[15] Gerritsen, Anneloes E et al. Tooth loss and oral health-related quality of life: a systematic review and meta-analysis. Health and quality of life outcomes vol. 8 126. 5 Nov. 2010, doi:10.1186/1477-7525-8-126 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992503/  

[16] Healthcare Market Research Worldwide. Dentistry Needs. 2019

[17] Suazio Consulting commissioned by Septodont. Dental Professionals - Insights. 2014 

[18] Dentistry Needs. Ibid.

[19] Healthcare Market Research Worldwide. Dentistry Needs. 2019

[20] Wright, John T et al. Sealants for Preventing and Arresting Pit-and-fissure Occlusal Caries in Primary and Permanent Molars. The Journal of the American Dental Association, vol. 147, issue 8, P631-645.E18, August 01, 2016 https://doi.org/10.1016/j.adaj.2016.06.003