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Periodontal disease is actually a group of diseases and some forms are just more aggressive and more difficult to control than others - even when you\'re doing \"all the right things\". They are the result of interactions between bacteria in dental plaque and your body\'s immune system which determines your resistance to disease. In some highly \"susceptible\" individuals, their resistance to periodontal disease is low. Resistance to disease is genetically controlled and difficult to change, or to put it another way, some people are just more prone to disease than others. Stress can also affect resistance to disease, and especially when stress levels are high, periodontal breakdown can get worse. On the other side of the coin, the particular bacteria that make up the \"plaque\", that you try so hard to keep under control with your brushing and flossing, can also be a factor in perpetuating the problem. These issues can be tested for both genetic susceptibility and differing strains of bacteria. You should speak to your periodontist about them. Sometimes, however, periodontal (gum) disease may have already affected your teeth in an advanced way before anyone ever had the chance to treat it.

For a minority of people, it\'s not always possible to control all the factors that both cause and perpetuate periodontal (gum) disease. What this all says is that it\'s not just about whether or not you had periodontal surgery, which attempts to control the disease and problems that already exist. What you must realize is that the majority of times we can control the disease but there is no cure for periodontal disease.

A better and perhaps more realistic way to look at the situation is this: in cases of advanced disease that are difficult to control, what treatment does is to change \"the house odds\" in your favor, perhaps not to keep your teeth forever, but for years longer! According to what you\'re saying that sounds very much like the case.

In telling you \"to think about implants\", you\'re at least being given a warning of what\'s to come if tooth loss is in fact inevitable, a method of replacing the lost teeth, and time to prepare emotionally, psychologically and financially.

Lastly, dental implants are modern dentistry\'s most successful tooth replacements. The most fortunate thing about them is that in most cases if they are maintained properly, they will be healthier, stronger and last longer than the teeth that have been affected by periodontal disease.

As health professionals we want you to be as healthy and happy as possible, but there are realities to face based on each person\'s differing situation

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Osteoporosis (from "osteo," meaning bone, and "porous," meaning sieve - or sponge-like) is a condition in which the bones lose calcium, becoming thinner and more prone to fracture. An ongoing process called bone remodeling, in which old areas of damaged bone are removed ("resorbed") and replaced with new structurally-intact bone, is normal for adults. Under ideal circumstances, these two processes - bone resorption and bone formation - are balanced. Living bones are not like the dry bones of skeletons you see in a museum, which are static and unchanging. Many things can change the balance between normal bone resorption and formation. In osteoporosis, the balance is tipped toward resorption, so more bone is removed than is replaced, resulting in a gradual decrease in the bone density over the years. In recent years, oral (taken by mouth) drugs in a class known as bisphosphonates have been widely used to treat osteoporosis. They act by slowing the excessive bone resorption, establishing a better balance between resorption and formation and increasing bone density.

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Because missing front teeth are considered aesthetically and socially unacceptable, most people consider their replacement a higher priority than back (posterior) teeth normally hidden from sight. From a dental point of view, however, you should definitely consider their replacement, if not for cosmetic reasons, then for the loss of function created by their absence. 

Besides their obvious role in chewing, the posterior teeth affect the overall bite and help ease some of the excessive pressure on the front teeth created by chewing. Dentists generally agree the loss of posterior teeth can lead to a wide array of consequences, especially involving the remaining teeth, gums, jaw muscles, ligaments and joints:



    • Decrease in chewing efficiency


    • Tipping, migration and rotation of remaining adjacent teeth


    • Eruption or extrusion of unopposed teeth


    • Excessive wear or erosion of remaining teeth


    • Loss of alveolar jaw bone and reduction of the residual boney ridges


    • Painful dysfunction of the temporomandibular joints (TMD) that unite the lower jaw with the skull



And, just because the site of the missing teeth is hidden from view doesn\'t mean there won\'t be changes to your appearance. For instance, the loss of the posterior teeth can cause a reduction in facial height that becomes increasingly noticeable over time.

Unfortunately, that\'s only the beginning of problems you may encounter from missing posterior teeth. Some of the above factors, particularly shifting or migration of teeth, can set off a chain reaction that weakens the overall dental system.

For instance, teeth normally move to maintain contact with adjacent and opposing teeth as natural wear slowly occurs over time (you won\'t notice this movement because of the equilibrium created by the teeth touching each other). When you lose a tooth, however, the remaining teeth tend to shift at an accelerated rate. This creates a force greater than normal along the tooth, causing abnormal displacement of the tooth in the jaw bone. If these teeth shift too much they may become worthless in the future.

Along the same lines, if the teeth erupt too much there may not be enough room to replace the missing teeth below them. Also, as a tooth moves, it changes the relationship of how the jaw bone is attached to the tooth. This change may leave the tooth more vulnerable to periodontal disease.

Obviously, then, replacement would help deter some of these consequences - but which method is best? Dentists now recognize implants as the best option for replacing missing teeth. They have some obvious benefits: as a free-standing restoration, adjacent teeth aren\'t usually affected by the preparation process and the replacements are easier to clean and can contribute to the support of the bite.

The most critical factor for implantation is that adequate bone height and volume exists where an implant will be placed. If not, a non-removable fixed bridge is the second best option, although there are a number of considerations to take into account.

First, teeth must be present on both sides of the missing teeth to create a fixed bridge - and you are actually asking two teeth to do the work of three. The adjacent teeth have to be drilled down for bridge placement, so there is a greater risk to the nerves - a future root canal treatment may be necessary. There is also a greater risk of trapped food under a bridge than around an implant restoration.

A third and least favorable option is a removable partial denture. Removable restorations can be difficult to wear and trap more food. Because they are moveable, they may put additional stress on the teeth that hold them in place, which could lead to loosening and loss of those teeth.

In summary, I think you can now see the importance of replacing missing teeth, seen or unseen. Excellent options in dental implants or bridgework are worth looking into and discussing with your dentist.