I occasionally hear from patients that they only care about their front teeth and their smile. I understand, but ignoring your back teeth can eventually cause problems for your front teeth!


Case in point – There is a patient in his late 50s that I have been seeing for several years. This patient is a white male in his late 50’s. In his early 50’s he kept up with his restorative dentistry but developed severe root decay on his lower molars and then later his premolars. So now on his lowers, he is down to the front 6 teeth. His upper teeth were unaffected by this root decay and he still has the full complement.


He recently came to the office complaining of some intermittent tooth pain on a lower canine, most recently triggered by eating sugar. The pain did not keep him up at night.

An x-ray of the tooth showed no radiolucency (a dark area at the end of the tooth which indicates that the nerve is dead).

Upon examination I noticed that he had a cervical (the gumline part of the tooth) filling which was done 5 years ago to treat a loss of tooth structure due to abfraction (tooth structure lost at the gum line due to grinding). The filling was there, but there was a further abfraction (more loss of tooth structure) due to more grinding and not enough support from the back teeth since they are missing.


The tooth was treated with a new glass ionomer filling (a tooth colored cement filling material that bonds to the tooth and works very well in this situation).


What has been recommended for this patient is a partial denture to provide support for his back teeth and give some support for his front teeth.(Implants are the recommended treatment if the patient has enough bone for implants and can afford the cost of this treatment.)


Other problems can develop from missing many teeth in the back area. The upper front teeth tend to flare out, which not only causes an esthetic problem but over closes the bite (the nose to chin distance becomes smaller). The longer this condition exists, the more damage is done to the teeth/gum/bite, becoming very difficult to treat.


The moral is – take care of ALL your teeth!