Edentulism refers to the state of complete tooth loss, where an individual no longer possesses any natural teeth in either the upper (maxillary) or lower (mandibular) arch or both. When someone has reached a point where no remaining permanent teeth are present in their mouth, they are classified as edentulous. This condition can significantly impact one’s ability to bite, chew, and speak and may also affect their self-esteem and overall quality of life. Individuals experiencing edentulism commonly utilize dental prosthetic options, such as dentures or dental implants, to restore oral function and aesthetics.
The human dentition consists of various types of teeth, including central incisors, lateral incisors, canines, premolars, and molars. Partial or complete tooth loss can occur due to a range of factors. Patients may experience the loss of a single tooth or multiple teeth, leading to partial dentition. In such cases, individuals have lost one or more teeth out of 32. On the other hand, complete edentulism refers to the absence of any teeth in the oral cavity. This condition can manifest as either an edentulous maxilla (upper jaw), edentulous mandible (lower jaw), or in some instances, both.
Etiology of Edentulism
Like other dental conditions, edentulism also has various causes. It can be idiopathic. If it is idiopathic, then the cause of teeth shedding is unknown. However, idiopathic edentulism is very rare. It is common for edentulism to be associated with one or more underlying causes. Let’s look into a few of the reasons:
Poor Oral Hygiene:
The condition of the oral cavity worsens when an individual fails to keep the oral microbial flora in balance. Inefficient brushing, lack of tongue cleansing, and no awareness about flossing are a few important yet potential means of poor oral hygiene. It degrades the tooth’s natural anatomical structures, leading to the loss of its integrity and stability in the mouth.
Poor oral hygiene1Lauritano, D., Moreo, G., Della Vella, F., Di Stasio, D., Carinci, F., Lucchese, A., & Petruzzi, M. (2019). Oral Health Status and Need for Oral Care in an Aging Population: A Systematic Review. International journal of environmental research and public health, 16(22), 4558. https://doi.org/10.3390/ijerph16224558 often leads to the destruction of the periodontium. In simpler terms, we can consider the periodontium as the collection of tissues and structures that hold the tooth in its position and prevent it from becoming dislodged. However, due to genetic, hygienic, local, and systemic conditions, periodontal diseases like periodontitis and gingivitis have become very common. Diabetes is one of the major systemic diseases which leads to edentulism.
Small, neglected cavities on one or more different surfaces on the tooth can turn into deep, wide, and extensive ones if left untreated. Thereby, these cavities must be restored as soon as they are detected. If they progress, they can invade adjacent teeth and deeper tooth structures like pulp and dentin and make the situation worse. Eventually, ending up in edentulism.
With the passage of age, the main defense system of the body weakens. The body becomes much more prone to infections and diseases. Different comorbidities2Felton D. A. (2016). Complete Edentulism and Comorbid Diseases: An Update. Journal of prosthodontics : official journal of the American College of Prosthodontists, 25(1), 5–20. https://doi.org/10.1111/jopr.12350, like arthritis, diabetes, etc., make it difficult to maintain optimal oral hygiene. Therefore, with advancing age3Starr, J. M., & Hall, R. (2010). Predictors and correlates of edentulism in healthy older people. Current opinion in clinical nutrition and metabolic care, 13(1), 19–23. https://doi.org/10.1097/MCO.0b013e328333aa37, the probability of edentulism increases.
Trauma and accidents can result in the loss of multiple teeth and a bad condition of the remaining teeth. In such conditions, one of the options is to extract the remaining faulty ones, making the patient edentulous.
Nutrition & Habits:
Inadequate nutrition, characterized by a deficiency in essential minerals, vitamins, and micronutrients, can negatively impact the blood supply that nourishes the teeth. A poor diet can compromise the overall health of the teeth and gums, emphasizing the importance of proper nutrition in maintaining optimal oral health for instance, a deficiency of vitamin C affects the rate of wound healing and collagen formation. On the other hand, vitamin A deficiency slows down the process of tooth development and the formation of bone. Other vitamin and mineral deficiency also affects in different ways. All this leads to the loosening of teeth, eventually resulting in edentulism.
In many instances, habits such as smoking complement poor nutrition, and they contribute to not only periodontitis but also various other oral conditions. Together these can result in edentulism.
Individuals with abnormalities in their genomes and chromosomes often experience significant dental irregularities, which can lead to edentulism (tooth loss). Conditions such as Down Syndrome, Ehlers-Danlos Syndrome, and others are known to contribute to these abnormalities and increase the risk of tooth loss.
Classification of Edentulism
There are two types of classification systems of edentulism. There is partial and complete edentulism.
The classification4McGarry, T. J., Nimmo, A., Skiba, J. F., Ahlstrom, R. H., Smith, C. R., & Koumjian, J. H. (1999). Classification system for complete edentulism. The American College of Prosthodontics. Journal of prosthodontics : official journal of the American College of Prosthodontists, 8(1), 27–39. https://doi.org/10.1111/j.1532-849x.1999.tb00005.x of edentulism as per the American College of Prosthodontists is stated next:
Complete edentulism is classified based on the extent of tooth loss in an individual’s mouth. It is categorized into two main types:
- Complete Maxillary Edentulism: This refers to the condition where all the teeth in the upper jaw (maxilla) are missing, leaving the individual without any natural teeth in the upper arch.
- Complete Mandibular Edentulism: This type of complete edentulism occurs when all the teeth in the lower jaw (mandible) are missing, resulting in the absence of natural teeth in the lower arch.
When both the upper and lower jaws are affected, and a person has lost all their natural teeth, it is referred to as Complete Bimaxillary Edentulism.
The PDI Classification for Complete Edentulism
Another classification system, The PDI classification, has been developed by the American College of Prosthodontists.5McGarry, T. J., Nimmo, A., Skiba, J. F., Ahlstrom, R. H., Smith, C. R., & Koumjian, J. H. (1999). Classification system for complete edentulism. The American College of Prosthodontics. Journal of prosthodontics : official journal of the American College of Prosthodontists, 8(1), 27–39. https://doi.org/10.1111/j.1532-849x.1999.tb00005.x
The Prosthodontic Diagnostic Index (PDI) is a classification system used in prosthodontics to assess the severity and complexity of complete edentulism cases, particularly when considering different treatment options and planning dental prosthetic replacements.
The PDI takes into account various factors related to the patient’s oral health, bone structure, and overall condition. It aids prosthodontists in determining the most appropriate and effective treatment approach for patients with complete edentulism. The classification helps guide decisions about the type of dental prostheses (such as complete dentures or dental implants) and the complexity of the treatment plan.
The classification system encompasses four defined categories, ranging from Class I to Class IV. Class I indicates an uncomplicated clinical scenario, while a Class IV patient represents the most complex and higher-risk situation. Each class is distinguished by specific diagnostic criteria. This system is specifically designed for dental professionals involved in diagnosing patients requiring treatment for complete edentulism. The potential benefits of implementing this system include:
- Enhancing patient care
- Improving professional communication
- Facilitating appropriate insurance reimbursement
- Serving as a valuable screening tool for dental school admission clinics
- Establishing standardized criteria for outcomes assessment.
Partial edentulism is a class of edentulism in which the patient has lost a few of his teeth. The patient still has the presence of teeth in the mouth.
Kennedy’s Classification of Partial Edentulism
Dr. Edward Kennedy introduced the classification system for partial edentulism.6Ireland, R., & Yeung, C. A. (2020). Kennedy’s classification. In A Dictionary of Dentistry (2nd ed.). Oxford University Press. https://doi.org/10.1093/acref/9780191828621.001.0001 In this system, the classification is based on the specific location and extent of tooth loss, guiding dental professionals in determining appropriate treatment options for patients with this condition.
Class I comprises bilateral edentulous areas located posterior to the remaining natural teeth. This class includes patients where there are missing teeth on both sides of the arch(jaw), but there are natural teeth present anteriorly.
According to Kennedy, in class II unilateral edentulous area is located posterior to the remaining natural teeth. This class of patients in which there is a missing tooth or edentulous space on one side of the arch, with natural teeth present on the opposite side.
Unilateral edentulous area with natural teeth remaining only anterior or only posterior to it. In this scenario, there is a single edentulous space and natural teeth remaining either anteriorly or posteriorly.
Class IV of Kennedy’s classification is signified by the presence of an Edentulous area located anteriorly to the remaining natural teeth. This class includes cases where there are missing teeth in the anterior region, with natural teeth remaining posteriorly.
Consequences & Repercussions of Edentulism
Edentulism affects the entire life of a person. Without teeth, life becomes bland. The joy in having and tasting food reduces. Basic functions like mastication and chewing food become difficult. The differences in speech are also evident. Let’s look into all these repercussions one by one:
The compromised aesthetics in edentulism significantly affect the natural support to the lips provided by the teeth, which is a major concern. Nevertheless, placing dentures or implants can help overcome this issue.
Teeth play a major role in phonetics. They help in the efficient and accurate production of sounds and words. However, when a patient wears a denture, it can effectively address the issue of improper or depressed production of many sounds that arise in the case of edentulism.
When an edentulous patient does not get any treatment done for quite some time, the level of the underlying bone decreases. The bone resorbs. Therefore, dental professionals recommend getting a denture or implant placement done right after the mucosa heals to avoid the need for additional procedures like bone grafting before placing any prosthesis.
Altered Alveolar Ridge
In edentulous patients, the height of the alveolar ridge decreases due to bone loss, which progresses over time. As mentioned earlier, this alteration is observed in individuals with tooth loss. Before proceeding with any treatment, procedures such as alveolar ridge augmentation and bone grafting may be necessary to restore the ridge’s level and provide a suitable foundation for further dental interventions. In some cases, failure to smooth out the pointed edges of the remaining bone during tooth extraction may result in alveolar ridge alteration.
Poor aesthetics directly affect a patient’s self-esteem. He feels uncomfortable while talking, smiling, or even sitting with people because they have to face the strange questions and looks of people due to their altered appearance. However, once the patient has been treated, self-esteem is restored. The patient can once again converse and spend time with people like previous times.
Treatment of Edentulism
Edentulism can be an extremely distressing and challenging experience for individuals. The loss of natural teeth can cause immense stress and impact various aspects of life. However, thankfully, there are several options available to address the consequences of edentulism and help patients regain their oral function and quality of life. Prostheses, though not a perfect substitute for natural teeth, provide enough strength to support individuals and enable them to navigate life with confidence and vitality. These prostheses effectively address concerns related to chewing, aesthetics, and overall well-being, offering a renewed sense of self-assurance and the ability to lead a fulfilling and satisfying life. A few of these are mentioned next:
Fixed Prostheses (Dental Implants)
Implants are permanent artificial teeth. Though not a complete match of natural teeth in terms of strength and efficacy, they are, so far, the best replacement for lost teeth. Parts of an implant include a screw, an abutment, a crown, and a fixture. We can use the All-on-4 and All-on-6 Implant techniques can be used.
The 4-Implant Technique
It is a dental implant procedure that utilizes four strategically placed implants to support a full arch of teeth.
The 6-Implant Technique
It is a dental implant procedure that involves the placement of six implants to provide increased stability and support for a full arch of teeth.
Dental implants cannot be removed once placed. They are the best replacement for natural dentition, provided sufficient bone is available. If the bone is not sufficient then bone grafting is done. Special oral hygiene maintenance is necessary for optimal sustenance. However, if they are not maintained properly, diseases like peri-implantitis can result. 7Jepsen, S., Berglundh, T., Genco, R., Aass, A. M., Demirel, K., Derks, J., Figuero, E., Giovannoli, J. L., Goldstein, M., Lambert, F., Ortiz-Vigon, A., Polyzois, I., Salvi, G. E., Schwarz, F., Serino, G., Tomasi, C., & Zitzmann, N. U. (2015). Primary prevention of peri-implantitis: managing peri-implant mucositis. Journal of clinical periodontology, 42 Suppl 16, S152–S157. https://doi.org/10.1111/jcpe.12369 can result.
Temporary Prostheses (Dentures)
Dentures are the second best treatment to overcome edentulism. For partial edentulism, prosthodontists recommend using a partial denture as a replacement for natural teeth.
In the case of complete edentulism, prosthodontists give the respective patient a complete denture. The procedure is slightly time taking and the patient has to pay multiple visits to the clinic. However, it is a completely non-invasive procedure. They can be removed. Maintenance of dentures requires good care.
Limitations of Dentures
While dentures can improve aesthetics to some extent, they cannot fully restore the natural appearance. Speech can also be affected by wearing dentures. Patients with severe bone loss and aggressive, uncontrolled gum disease are not eligible for dentures. Even though temporary prostheses can be provided to patients with Sjogren’s syndrome and xerostomia, managing them poses significant challenges. Hence, temporary prostheses are not recommended for such patients.
Care & Maintenance
The denture wearers must take care of their dentures. Cleaning them with a toothbrush is mandatory. Thereby, it is recommended to clean them thoroughly and then rinse them with water after every meal or at least twice a day.
Implant Supported Dentures
This is one of the latest advancements in modern dentistry. Firstly, the dental implants are placed as abutments in the jawbone, followed by the formation of dentures. The benefit of implant-supported dentures is that they provide better support, retention, and stability.
In conclusion, edentulism is the complete loss of natural teeth, resulting in significant impacts on an individual’s quality of life. Poor oral hygiene, periodontal diseases, cavities, age, trauma, nutrition, and genetic factors can contribute to edentulism. Therefore, this condition affects mastication, speech, aesthetics, and self-confidence. Fortunately, there are treatment options available, such as dental implants and dentures, which can help restore oral function and improve the overall well-being of edentulous individuals. Dental implants offer a permanent solution, while dentures provide a removable option. However, proper maintenance and regular dental visits are important for the success of these prosthetic replacements.
- 1Lauritano, D., Moreo, G., Della Vella, F., Di Stasio, D., Carinci, F., Lucchese, A., & Petruzzi, M. (2019). Oral Health Status and Need for Oral Care in an Aging Population: A Systematic Review. International journal of environmental research and public health, 16(22), 4558. https://doi.org/10.3390/ijerph16224558
- 2Felton D. A. (2016). Complete Edentulism and Comorbid Diseases: An Update. Journal of prosthodontics : official journal of the American College of Prosthodontists, 25(1), 5–20. https://doi.org/10.1111/jopr.12350
- 3Starr, J. M., & Hall, R. (2010). Predictors and correlates of edentulism in healthy older people. Current opinion in clinical nutrition and metabolic care, 13(1), 19–23. https://doi.org/10.1097/MCO.0b013e328333aa37
- 4McGarry, T. J., Nimmo, A., Skiba, J. F., Ahlstrom, R. H., Smith, C. R., & Koumjian, J. H. (1999). Classification system for complete edentulism. The American College of Prosthodontics. Journal of prosthodontics : official journal of the American College of Prosthodontists, 8(1), 27–39. https://doi.org/10.1111/j.1532-849x.1999.tb00005.x
- 5McGarry, T. J., Nimmo, A., Skiba, J. F., Ahlstrom, R. H., Smith, C. R., & Koumjian, J. H. (1999). Classification system for complete edentulism. The American College of Prosthodontics. Journal of prosthodontics : official journal of the American College of Prosthodontists, 8(1), 27–39. https://doi.org/10.1111/j.1532-849x.1999.tb00005.x
- 6Ireland, R., & Yeung, C. A. (2020). Kennedy’s classification. In A Dictionary of Dentistry (2nd ed.). Oxford University Press. https://doi.org/10.1093/acref/9780191828621.001.0001
- 7Jepsen, S., Berglundh, T., Genco, R., Aass, A. M., Demirel, K., Derks, J., Figuero, E., Giovannoli, J. L., Goldstein, M., Lambert, F., Ortiz-Vigon, A., Polyzois, I., Salvi, G. E., Schwarz, F., Serino, G., Tomasi, C., & Zitzmann, N. U. (2015). Primary prevention of peri-implantitis: managing peri-implant mucositis. Journal of clinical periodontology, 42 Suppl 16, S152–S157. https://doi.org/10.1111/jcpe.12369