Many people are affected by bone loss in the mouth. In many cases this may not result in loosening of teeth however, in severe cases the effects of bone loss can be significant. The teeth may become loose and teeth may also become more prone to infections as a result of bone loss. In some patients, the pattern of bone loss is such that only a few teeth in the mouth are affected at first. prompt treatment on these localised teeth can slow down, or even halt, the spread of bone loss to the other ‘healthy’ teeth in the mouth. Unfortunately, when prompt treatment is not performed, many more teeth may become affected which can lead to the loss of many more teeth.
The good news is that there are a number of ways that teeth with bone loss can be saved, before it reaches the stage of losing your teeth all-together. Proper periodontal therapy in combination with good home oral hygiene (proper tooth brushing, flossing and interdental cleaning) can eradicate the disease and even regrow some of the bone loss. The bone surrounding your teeth can be regenerated through regenerative grafting in order to optimise bone support and keep your teeth in place. The bone can also be regenerated after losing your teeth in order to place dental implants to replace and restore the missing or lost teeth.
What Are The Common Reasons For Dental Bone Loss?
A healthy jawbone structure is essential to good oral health. If the jawbone condition is compromised, your teeth lose their support and can loosen or fall out, even without any other signs of damage or decay. Many factors can contribute to dental bone loss; understanding them will help you take preventive measures.
TOOTH EXTRACTIONS
The amount of jawbone mass is maintained by the presence of the teeth that are embedded in it. The constant force applied by the teeth on the jawbone when you chew and bite stimulates the bone, which helps maintain its integrity. When a tooth is removed and is not replaced by an artificial tooth, the jawbone will no longer receive the stimulation in that area. Bone resorption occurs and the bone is slowly broken down.
PERIODONTAL (GUM) DISEASE
Bacteria present in the plaque that forms on the surface of the teeth can cause gingivitis, where the gums swell, become red, and bleed. If the condition becomes more serious gingivitis progresses to periodontitis, where the plaque extends beyond the gum line and the gum tissue becomes irritated. As inflammation intensifies, separation between the gums and the teeth can create pockets that easily trap bacteria and become more infected. Chronic inflammation of the gum tissue will cause the bones supporting the teeth to break down. Over time the teeth in the affected areas will start to loosen and fall out. Periodontal disease is usually a result of poor oral hygiene and can be prevented with regular cleanings by your dentist, along with good oral hygiene practices at home.
BRIDGES AND DENTURES
Dental bridges and dentures are common treatments to replace some or all of a person’s missing teeth. Both are very effective in restoring the natural function of teeth while providing very natural-looking results. Often bridges and dentures are unanchored, however, leaving a gap between the appliance and the jawbone. The jawbone no longer receives the stimulation it needs to maintain its integrity resulting in bone loss. In dentures especially, the lack of bone stimulation causes the jawbone mass to decrease continually, requiring regular refitting of the unsupported dentures.
Dental implants can be used with bridges and dentures to make these appliances more permanent. Those implants, because they are implanted into the jawbone, act like normal teeth, creating force against the jawbone when chewing and biting, maintaining bone mass.
TRAUMA
Tooth trauma can lead to bone loss. If a tooth is broken off, the biting surface is removed and the jawbone is no longer stimulated in the site of that tooth. In addition to teeth being knocked out or broken, we also come across cases where a patient’s jawbone has been fractured and has failed to heal, again causing trauma and bone loss.
ISSUES WITH ALIGNMENT
Even misaligned teeth can result in decreasing jawbone mass. Misaligned teeth create problems with chewing and biting and over time this will cause the bone to deteriorate. Proper orthodontic treatment, however, can restore a normal bite and recreate proper bone stimulation.
TUMORS
The removal of benign and malignant tumors in the area near the jaw often requires an entire portion of the jawbone to be grafted.
HOW WILL YOU KNOW IF YOU ARE SUFFERING FROM BONE LOSS?
If your teeth have started to move, loosen, or your gums have shrunk, swollen or bleed when you brush your teeth, then it’s likely you are suffering from gum disease and bone loss. It’s vital that you seek professional advice and treatment straight away, as you could ultimately end up losing your teeth.
Common signs are a gap or gaps opening up between the teeth, bad breath, mobile teeth, swollen or bleeding gums or gum recession. If you experience any of these symptoms, you should contact your dentist straight away.
How Is Lost Bone Replaced?
There are different types of bone grafts, and which include:
- Autograft
- Xenograft
- Allograft
- Alloplast
Autograft
An autograft uses bone removed from another site in your body, typically from your chin or jaw, or possibly from your hip or leg. The advantage of an autograft is that it eliminates any small risk of rejection or other adverse reactions, and the bone used is alive, so it enhances the production of new bone. But it does mean you will need another surgical procedure to remove the bone graft.
Xenograft
A xenograft uses bone taken from another species, and which is normally bovine. The bone is extensively processed and sterilized and is rigorously tested to make sure it is safe for use. A xenograft provides a scaffold or framework for your bone, encouraging it to grow in areas where it is needed for dental implants.
Allograft
An allograft also uses donor bone but which is human. It is rigorously tested and is sterilized and highly processed to ensure it is safe for use. An allograft also provides a scaffold on which new bone cells can grow, as the material is inert and won’t produce bone cells of its own.
Alloplast
An alloplast consists of entirely synthetic materials and is a sophisticated type of graft that may contain growth factors, proteins, and collagen designed to promote new bone growth and healing.
Bone Grafting Techniques
If you do need a bone graft, dentists can discuss all these solutions with you to determine which type of bone graft is most suitable for your preferences and needs. There are different types of bone grafting techniques that are used depending on the areas requiring additional bone. These bone grafting techniques include:
- Socket preservation
- Ridge augmentation
- Sinus lift or sinus augmentation
Socket Preservation
When you have a tooth removed, the bony socket around it can become damaged during the removal process or by disease or infection. Socket preservation is a technique where the empty socket is filled with suitable bone grafting material immediately after removing the natural tooth. Afterward, the material is covered up with an artificial membrane containing special growth proteins, helping to stimulate your body to repair the empty socket.
The membrane also prevents gum tissue from growing in the socket. Once the membrane is in place, it is covered with gum to protect it during healing.
Socket preservation is a highly successful technique that can eliminate the collapse and shrinkage of bone and gum tissue and which creates a strong foundation for the dental implant. It also helps to enhance the appearance of your dental implant by ensuring it is surrounded by the right amount of healthy bone and gum, creating a more aesthetically pleasing outcome. We may suggest socket preservation when replacing front teeth and where aesthetics are important or when using mini dental implants.
Ridge Augmentation
When we remove a natural tooth, it leaves an empty socket in the alveolar ridge, which is the raised bony ridge that used to support your teeth and which helps to protect tooth sockets. Usually, after a tooth extraction, the empty socket will heal well without additional treatment, as new bone and gum tissue are created. However, sometimes, the alveolar bone surrounding the empty socket will break down, creating a loss of height and width in the alveolar ridge.
A ridge augmentation restores the ridge to its original width and height, ensuring there is plenty of bone to support dental implants. A ridge augmentation also helps to ensure good aesthetics once restored with implant teeth.
Sometimes ridge augmentation is carried out at the same time as tooth removal, and we insert bone grafting material into the empty socket. It is a process that can also be carried out later when empty sockets have healed, and undesirable bone loss has occurred. Usually, a ridge augmentation must heal for 4 to 6 months, but sometimes it is possible to insert the implant at the same time as the bone graft.
Sinus Lift
Many people will need a sinus lift when replacing upper back teeth as the maxillary sinuses are located just above these teeth. Maxillary sinuses are air-filled cavities, and often the bone in this area is thinner and more fragile naturally, and sometimes natural tooth roots extend into the maxillary sinuses. When we take out natural teeth, there is often only a thin wall of bone between the mouth and sinuses and which isn’t adequate to support dental implants. A sinus lift strengthens and builds up the bone around the sinuses, creating enough healthy bone to support dental implants.
During this procedure, an incision is made into the gums to expose the bone underneath. A small opening is cut into the bone, so dental implant dentist can see the membrane separating the bone from your sinuses. The membrane is carefully pushed upward or ‘lifted,’ creating a space between the jawbone and membrane, which we fill with bone grafting material.
Once in place, your gums are stitched, and the graft is left to heal. When only a small amount of bone is needed, it’s sometimes possible to have a sinus augmentation at the same time as your dental implant. If you need a greater amount of bone, a sinus lift will be more successful when completed as a stand-alone procedure and must be left to heal for several months before implant surgery.
Preventing bone loss
Prevention is always better than a cure! Good home dental care and oral hygiene, proper tooth brushing (a good electric tooth brush and using it correctly), interdental cleaning with dental floss and/or interdental brushes, a healthy diet and lifestyle, quitting or avoiding smoking and excessive alcohol are all good habits that will keep your teeth and gums healthy.
Most people don’t really know how to brush their teeth correctly so it’s always a great idea to have your dentist, dental hygienist or other dental care professional show you the best way to look after your teeth and gums.
Bone loss can be prevented by giving the jawbone a replacement tooth with a root that can exert the same or similar pressure as natural teeth. This is done immediately after extraction by replacing single teeth with dental implants, or by using a fixed implant-supported bridge or denture.
A single-tooth implant or a dental bridge with three to four teeth supported by two implants provide a chewing power of 99% of natural bite force. A denture secured with dental implants, such as Same Day Teeth procedure, provides about 70% to 80% of normal biting force and helps considerably in preventing bone loss.
