Free Essay

Sequelae of Tooth Loss


Submitted By kevin813
Words 1727
Pages 7
Tooth loss and dental extractions have existed for centuries with the latter being the main tool for providing relief from dental pain and removing diseased tissues (Torabinejad). There was an estimated 50 million dental extractions performed in the United States in 1979 (Bullock). With the increased number of people living in the United States for a longer period of time, the occurrence of dental extractions and tooth loss has certainly risen exponentially. Unfortunately, tooth loss, whether it is through dental extractions or other means, has long term clinical sequelae associated with it. Osteonecrosis of the jaw, bacteremia, orbital cellulitis, and other psychological and physiological clinical sequelae that impact the well-being of the patient will be discussed.
Osteonecrosis of the jaw (ONJ) is defined as the presence of exposed bone in the mouth that fails to heal after appropriate intervention over a period of 6 to 8 weeks (Reid), and results in chronic osteomyelitis with areas of bone necrosis. Most commonly affecting the mandible (Bagan), patients with ONJ experience symptoms that range from painless exposed bone to severe jaw pain (Sambrook). The majority of cases of ONJ have been found to be initiated and associated with tooth extraction procedures as a result of the introduction of oral flora to the exposed jaw bone that prevents healing and becomes infected (Ruggiero).
In addition to tooth extractions being a precipitating event to ONJ, it has been found that ONJ occurs in patients who have previously undergone chemotherapy treatment for cancer and take bisphosphonate medications to counteract the effects of osteoporosis. Bisphosphonates are used for cancer treatment and osteoporosis because of its anti-angiogenic properties and ability to inhibit osteoclast action, respectively. This in turn manages the hypercalcemia that is seen in bone disease (Bagan).
ONJ is a pathological condition that has long-term negative effects on patients. Several studies have created protocols and suggestions in order to prevent the condition from occurring. An obvious suggestion is to prevent the need for tooth extractions in the first place. Regular professional dental cleanings at least every six months with proper oral hygiene that consists of brushing at least twice a day and flossing once a day would go a long way in preventing dental disease and potentially completely eliminate the possibility of ONJ in cancer patients. If the dentist is aware that the patient has to undergo chemotherapy and use bisphosphonates, dental treatment of the patient before beginning bisphosphonate therapy to reduce the need for extractions during bisphosphonate therapy has been found to be effective in preventing ONJ. Unfortunately, patients undergoing active chemotherapy and bisphosphonate treatment can also present to the dental office with symptoms that require dental extractions. In these instances, it is recommended that extractions be avoided. If extraction treatment is absolutely necessary, informed consent must be obtained and the treatment must be performed under antibiotic prophylaxis with minimal trauma (Sambrook). To prevent the manifestation of ONJ after the procedure, patients should be routinely recalled for professional oral hygiene and be prescribed chlorhexidine mouthwash and gels (Lodi).
In addition to ONJ, bacteremia has been found to be another example of long term clinical pathology that can occur after tooth loss through dental extractions. Defined as the presence of bacteria in the blood, bacteremia has been determined to be caused most often by dental extractions due to its invasiveness and introduction of blood to oral flora that can eventually find its way back into systemic circulation through the ulcerated crevicular tissue surrounding the tooth (Lockhart). The resulting effects can take the form of bacterial endocarditis, septic shock, and death if left untreated (Lockhart).
Just like with ONJ, bacteremia as a result of tooth extractions can be avoided through the prevention of dental disease through proper oral hygiene. In instances where this is not possible and dental extractions are needed, antibiotic prophylaxis with penicillin, amoxicillin, or erythromycin before and after the procedure has been shown to be effective in eliminating or minimizing bacteremia in both adults and children (Coulter).
ONJ and bacteremia have been discussed extensively through numerous studies. Other long term clinical pathologies as a result of tooth loss exist such as orbital cellulitis. Orbital cellulitis is an infection of eye tissue posterior to the orbital septum that can result in blindness and death (Bullock). In Bullock’s study, the incidence of orbital cellulitis with regards to dental extraction was most common with maxillary molar extractions. This was due to the proximity of the maxillary molar roots to the paranasal sinus. Upon extraction, the floor of the sinus was perforated which allowed for the introduction of oral flora bacteria into the cavity. Due to the intimate anatomic relationship of the paranasal sinus to the orbit, the bacteria were able to travel through the vasculature and cause orbital cellulitis (Bullock).
The long term clinical sequelae described above are mainly, if not strictly, observed as a result of tooth loss through surgical extractions. Teeth can also be removed from the oral cavity naturally and through trauma. These cases produce negative long term clinical effects that are not as detrimental to the patient as the ones mentioned above.
Space loss occurs through the loss of dentition. Most notably, the premature loss of primary maxillary first molars results in the mesial eruption of premolars, impaction of permanent canines, and reduction in arch length (Northway). In addition to the tilting of adjacent teeth, space loss can also result from the hypereruption of dentition into the space from the opposing arch. Periodontal problems, disruption of occlusion, and increased risk for caries development all result from the adaptation of dentition in the oral cavity to the new space created by the loss of a single tooth (Shugars).
The effects of alveolar ridge resorption can be considered long term clinical sequelae when prosthodontic treatment is involved because prosthodontics requires sufficient alveolar bone volume in order to have successful results (Schropp). Schropp’s study stated that up to 50% of alveolar bone loss occurs after the loss of a tooth. Not only does the volume and thickness of the alveolar ridge decrease, but the overall arch length decreases as well (Pietrokovski). All three of these factors present challenges for prosthodontic treatment and the long term oral function of patients.
Long term clinical sequelae cannot be limited to physiological characteristics. Psychological issues as a result of tooth loss must also be taken into account. Patients who experienced tooth loss exhibited qualities that included lowered self-confidence, dislike of appearance, and grief (Davis). Dietary choices, food enjoyment, and daily life activities of patients were also affected (Davis). The effects of these issues on top of other mental issues described in other studies can have a detrimental effect on the mental well-being of patients.
With the cases of ONJ, bacteremia, and orbital cellulitis, the long term clinical effects have a negative impact on the physiological state of patients that can ultimately result in death if unaddressed. Tooth loss can also result in clinical sequelae that are not as debilitating including alveolar bone resorption and space loss. Finally, the psychological aspect of patients can be affected and result in mental qualities that include lowered self-confidence, grief, and dislike of appearance. In conclusion, the effects of tooth loss regardless of method are broad and incorporate both the physiological and psychological states of those affected. Therefore, it is essential that both the dental practitioner and patient be aware of the consequences of dental extractions and other methods of tooth loss in order to be able to predict the resulting long term clinical effects.


Bagan, J. V., J. Murillo, Y. Jimenez, R. Poveda, M. A. Milian, J. M. Sanchis, F. J. Silvestre, and C. Scully. "Avascular Jaw Osteonecrosis in Association with Cancer Chemotherapy: Series of 10 Cases." Journal of Oral Pathology and Medicine 34.2 (2005): 120-23.
Bullock, John D., and John A. Fleishman. "Orbital Cellulitis Following Dental Extraction."Transactions of the American Ophthalmological Society 82 (1984): 111-33.
Coulter, W. A., A. Coffey, I. Saunders, and A. M. Emmerson. "Bacteremia in Children Following Dental Extraction." Journal of Dental Research 69.10 (1990): 1691-695.
Davis, D. M., J. Fiske, B. Scott, and D. R. Radford. "The Emotional Effects of Tooth Loss in a Group of Partially Dentate People: A Quantitative Study." The European Journal of Prosthodontics and Restorative Dentistry 9.2 (2001): 53-57.
Lockhart, Peter B. "An Analysis of Bacteremias During Dental Extractions." Archives of Internal Medicine 156 (1996): 513-20.
Lockhart, P. B., M. T. Brennan, H. C. Sasser, P. C. Fox, B. J. Paster, and F. K. Bahrani-Mougeot. "Bacteremia Associated With Toothbrushing and Dental Extraction."Circulation 117.24 (2008): 3118-125.
Lodi, Giovanni, Andrea Sardella, Annalisa Salis, Federica Demarosi, Marco Tarozzi, and Antonio Carrassi. "Tooth Extraction in Patients Taking Intravenous Bisphosphonates: A Preventive Protocol and Case Series." Journal of Oral and Maxillofacial Surgery68.1 (2010): 107-10.
Northway, William M. "The Not-so-harmless Maxillary Primary First Molar Extraction." The Journal of the American Dental Association 131 (2000): 1711-720.
Pietrokovski, J., and M. Massler. "Residual Ridge Remodeling After Tooth Extraction in Monkeys." The Journal of Prosthetic Dentistry 26.2 (1971): 119-29.
Reid, Ian R., and Tim Cundy. "Osteonecrosis of the Jaw." Skeletal Radiology 38.1 (2009): 5-9.
Ruggiero, S. L., B. Mehrotra, T. J. Rosenberg, and S. L. Engroff. "Osteonecrosis of the Jaws Associated with the Use of Bisphosphonates: a Review of 63 Cases." Journal of Oral and Maxillofacial Surgery 62.5 (2004): 527-34.
Sambrook, Philip, Ian Olver, and Alastair Goss. "Bisphosphonates and Osteonecrosis of the Jaw." Australian Family Physician 35.10 (2006): 801-03.
Schropp, Lars, Ann Wenzel, Lambros Kostopoulos, and Thorkild Karring. "Bone Healing and Soft Tissue Contour Changes Following Single-Tooth Extraction: A Clinical and Radiographic 12-Month Prospective Study." The International Journal of Periodontics and Restorative Dentistry 23.4 (2003): 313-23.
Shugars, Daniel A., James D. Bader, S. W. Phillips, B. A. White, and C. F. Brantley. "The Consequences of Not Replacing a Missing Posterior Tooth." The Journal of the American Dental Association 131 (2000): 1317-323.
Torabinejad, M., P. Anderson, J. Bader, L. Brown, L. Chen, C. Goodacre, M. Kattadiyil, D. Kutsenko, J. Lozada, and R. Patel. "Outcomes of Root Canal Treatment and Restoration, Implant-supported Single Crowns, Fixed Partial Dentures, and Extraction without Replacement: A Systematic Review." The Journal of Prosthetic Dentistry 98.4 (2007): 285-311.

Similar Documents

Free Essay


...HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use ADDERALL XR safely and effectively. See full prescribing information for ADDERALL XR. ADDERALL XR® (mixed salts of a single-entity amphetamine product) dextroamphetamine sulfate, dextroamphetamine saccharate, amphetamine aspartate monohydrate, amphetamine sulfate capsules, CII Initial U.S. Approval: 2001 WARNING: POTENTIAL FOR ABUSE See full prescribing information for complete boxed warning • Amphetamines have a high potential for abuse; prolonged administration may lead to dependence. (9) • Misuse of amphetamines may cause sudden death and serious cardiovascular adverse reactions. -----RECENT MAJOR CHANGES----Warnings and Precautions (5.5) 6/2013 -----INDICATIONS AND USAGE----ADDERALL XR, a CNS stimulant, is indicated for the treatment of attention deficit hyperactivity disorder (ADHD). (1) • Children (ages 6-12): Efficacy was established in one 3-week outpatient, controlled trial and one analogue classroom, controlled trial in children with ADHD. (14) • Adolescents (ages 13-17): Efficacy was established in one 4-week controlled trial in adolescents with ADHD. (14) • Adults: Efficacy was established in one 4-week controlled trial in adults with ADHD. (14) -----DOSAGE AND ADMINISTRATION----• Pediatric patients (ages 6-17): 10 mg once daily in the morning. The maximum dose for children 6-12 is 30 mg once daily. (2.1, 2.2, 2.3) • Adults: 20 mg once daily...

Words: 10856 - Pages: 44

Free Essay


...Clinical guidelines Diagnosis and treatment manual for curative programmes in hospitals and dispensaries guidance for prescribing 2010 EDITION © Médecins Sans Frontières – January 2010 All rights reserved for all countries. No reproduction, translation and adaptation may be done without the prior permission of the Copyright owner. ISBN 2-906498-81-5 Clinical guidelines Diagnosis and treatment manual Editorial Committee: I. Broek (MD), N. Harris (MD), M. Henkens (MD), H. Mekaoui (MD), P.P. Palma (MD), E. Szumilin (MD) and V. Grouzard (N, general editor) Contributors: P. Albajar (MD), S. Balkan (MD), P. Barel (MD), E. Baron (MD), M. Biot (MD), F. Boillot (S), L. Bonte (L), M.C. Bottineau (MD), M.E. Burny (N), M. Cereceda (MD), F. Charles (MD), M.J de Chazelles (MD), D. Chédorge (N), A.S. Coutin (MD), C. Danet (MD), B. Dehaye (S), K. Dilworth (MD), F. Fermon (N), B. Graz (MD), B. Guyard-Boileau (MD), G. Hanquet (MD), G. Harczi (N), M. van Herp (MD), C. Hook (MD), K. de Jong (P), S. Lagrange (MD), X. Lassalle (AA), D. Laureillard (MD), M. Lekkerkerker (MD), J. Maritoux (Ph), J. Menschik (MD), D. Mesia (MD), A. Minetti (MD), R. Murphy (MD), J. Pinel (Ph), J. Rigal (MD), M. de Smet (MD), S. Seyfert (MD), F. Varaine (MD), B. Vasset (MD) (S) Surgeon, (L) Laboratory technician, (MD) Medical Doctor, (N) Nurse, (AA) Anaesthetist-assistant, (Ph) Pharmacist, (P) Psychologist We would like to thank the following doctors for their invaluable help:...

Words: 86687 - Pages: 347

Free Essay

Research Paper

...When it comes to understanding animals and the diseases they have, contract, and carry there is no limits. From dogs and cats to livestock and exotics it is necessary to learn and understand diseases from metabolic to degenerative or idiopathic, Neoplastic diseases and Toxic poisonings, Congenital and Genetic diseases to Immune related diseases, and Infectious and Contagious diseases to Parasitic Infections. There is a world that one can get lost in when it comes to learning about theses things. Some diseases have been around for years while others are still being studied with new ones occurring today in the modern world. Along with these diseases it is important to study and understand what causes them, what signs to look for, what species to look for them in, how to treat them, and how to prevent them from happening, IF you can even prevent them. Some diseases and conditions have vaccines to help with prevention and some do not, while some diseases are zoonotic meaning that they can be transmitted from animal to human. While there are hundreds upon hundreds of diseases to be looked at, the ten researched below are the ones once prevalent among the veterinary technicians job in the clinic; Hip Dysplasia and Ethylene Glycol poisoning in dogs, Hyperthyroidism and Rabies in cats, Strangles and Equine Recurrent Uveitits in Horses, Cryptosporidium and Fasciola Hepatica in Ruminants and Swine, Idiopathic Epilepsy in Aviaries, and Lymphoma in Ferrets. Hip Dysplasia in dogs is a congenial...

Words: 17767 - Pages: 72

Free Essay

Why Fingers Are Weird

...[pic] ICAK-USA Research The Following is a Compilation of Applied Kinesiology Research Papers Published in the Collected Papers of the International College of Applied Kinesiology for the year 2005-2006 -- Edited by Scott Cuthbert, D.C. Functional Systems Approach to Central Nervous System Evaluation Richard Belli, D.C., D.A.C.N.B. ABSTRACT Objective: This study investigates the clinical utility of testing functional systems within the central nervous system, compared to testing individual motor nerves with manual muscle testing. Design: Private practice. Study Subjects: Patients were examined by the treating chiropractor from his existing patient pool. Methods: Chiropractic management was decided on by the treating chiropractor. A series of twelve tests were designed to discover disorders of functional systems within the CNS. The tests described were to evaluate the function of 12 systems: 1) spinal cord, 2) myelencephalon/reticular formation, 3) vagal system, 4) trigeminal motor system-muscles of mastication, 5) vestibulospinal system, and bulbo reticular area, 6) reticular formation, 7) diencephalons and gait locomotion system, 8) mesencephalon, 9) cardiac sympathetic autonomic system, 10) pyramidal system, 11) limbic system, 12) sensory system. Results: This chiropractic approach tests the nervous system after provocation of functional systems...

Words: 29879 - Pages: 120

Free Essay


...Acquisitions Editor: Crystal Taylor Product Managers: Kelley A. Squazzo & Catherine A. Noonan Designer: Doug Smock Compositor: SPi Technologies First Edition © 2011 Lippincott Williams & Wilkins, a Wolters Kluwer business. 351 West Camden Street Baltimore, MD 21201 Printed in China All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the abovementioned copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market street, Philadelphia, PA 19103 USA, via email at, or via website at (products and services). Library of Congress Cataloging-in-Publication Data Lambert, Harold Wayne, 1972– Lippincott’s illustrated Q&A review of anatomy and embryology / H. Wayne Lambert, Lawrence E. Wineski ; with special contributions from Jeffery P. Hogg, Pat Abramson, Bruce Palmer. — 1st ed. p. ; cm. Includes index. ISBN 978-1-60547-315-4 1. Human anatomy—Examinations, questions, etc. I. Wineski, Lawrence E. II. Title. [DNLM: 1. Anatomy—Examination Questions...

Words: 201595 - Pages: 807

Free Essay

Bad Bug Book

...Bad Bug Book   Handbook of Foodborne Pathogenic Microorganisms and Natural Toxins                                              Introduction  Food safety is a complex issue that has an impact on all segments of society, from the general public to government, industry, and academia. The second edition of the Bad Bug Book, published by the Center for Food Safety and Applied Nutrition, of the Food and Drug Administration (FDA), U.S. Department of Health and Human Services, provides current information about the major known agents that cause foodborne illness. The information provided in this handbook is abbreviated and general in nature, and is intended for practical use. It is not intended to be a comprehensive scientific or clinical reference. Under the laws administered by FDA, a food is adulterated if it contains (1) a poisonous or otherwise harmful substance that is not an inherent natural constituent of the food itself, in an amount that poses a reasonable possibility of injury to health, or (2) a substance that is an inherent natural constituent of the food itself; is not the result of environmental, agricultural, industrial, or other contamination; and is present in an amount that ordinarily renders the food injurious to health. The first includes, for example, a toxin produced by a fungus that has contaminated a food, or a pathogenic bacterium or virus, if the amount present in the food may be injurious to health. An example of the second...

Words: 91823 - Pages: 368

Free Essay

Nxclex Questions

...NCSBN ON-LINE REVIEW 1.A client has been hospitalized after an automobile accident. A full leg cast was applied in the emergency room. reason for the nurse to elevate the casted leg is to A) Promote the client's comfort B) Reduce the drying time C) Decrease irritation to the skin D) Improve venous return The most important D: Improve venous return. Elevating the leg both improves venous return and reduces swelling. Client comfort will be improved as well. 2. The nurse is reviewing with a client how to collect a clean catch urine specimen. What is the appropriate sequence to teach the client? A) B) C) D) Clean the meatus, begin voiding, then catch urine stream Void a little, clean the meatus, then collect specimen Clean the meatus, then urinate into container Void continuously and catch some of the urine A: Clean the meatus, begin voiding, then catch urine stream. A clean catch urine is difficult to obtain and requires clear directions. Instructing the client to carefully clean the meatus, then void naturally with a steady stream prevents surface bacteria from contaminating the urine specimen. As starting and stopping flow can be difficult, once the client begins voiding it’s best to just slip the container into the stream. Other responses do not reflect correct technique 3. Following change-of-shift report on an orthopedic unit, which client should the nurse see first? A) B) C) D) 16 year-old who had an open reduction of a fractured wrist 10 hours ago 20 year-old...

Words: 53396 - Pages: 214

Free Essay


...SITUATION : Arthur, A registered nurse, witnessed an old woman hit by a motorcycle while crossing a train railway. The old woman fell at the railway. Arthur rushed at the scene. 1. As a registered nurse, Arthur knew that the first thing that he will do at the scene is  A. Stay with the person, Encourage her to remain still and Immobilize the leg while While waiting for the ambulance. B. Leave the person for a few moments to call for help. C. Reduce the fracture manually. D. Move the person to a safer place. 2. Arthur suspects a hip fracture when he noticed that the old woman’s leg is  A. Lengthened, Abducted and Internally Rotated. B. Shortened, Abducted and Externally Rotated. C. Shortened, Adducted and Internally Rotated. D. Shortened, Adducted and Externally Rotated. 3. The old woman complains of pain. John noticed that the knee is reddened, warm to touch and swollen. John interprets that this signs and symptoms are likely related to  A. Infection B. Thrombophlebitis C. Inflammation D. Degenerative disease 4. The old woman told John that she has osteoporosis; Arthur knew that all of the following factors would contribute to osteoporosis except  A. Hypothyroidism B. End stage renal disease C. Cushing’s Disease D. Taking Furosemide and Phenytoin. 5. Martha, The old woman was now Immobilized and brought to the emergency room. The X-ray shows a fractured femur and pelvis. The ER Nurse would carefully monitor Martha for which of the following...

Words: 53501 - Pages: 215

Free Essay

Medical Surgical Nursing

...00_078973706x_fm.qxd 1/14/08 2:42 PM Page i NCLEX-PN ® SECOND EDITION Wilda Rinehart Diann Sloan Clara Hurd 00_078973706x_fm.qxd 1/14/08 2:42 PM Page ii NCLEX-PN® Exam Cram, Second Edition Copyright © 2008 by Pearson Education All rights reserved. No part of this book shall be reproduced, stored in a retrieval system, or transmitted by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. No patent liability is assumed with respect to the use of the information contained herein. Although every precaution has been taken in the preparation of this book, the publisher and author assume no responsibility for errors or omissions. Nor is any liability assumed for damages resulting from the use of the information contained herein. ISBN-13:978-0-7897-2706-9 ISBN-10: 0-7897-3706-x Library of Congress Cataloging-in-Publication Data Rinehart, Wilda. NCLEX-PN exam cram / Wilda Rinehart, Diann Sloan, Clara Hurd. -- 2nd ed. p. cm. ISBN 978-0-7897-3706-9 (pbk. w/cd) 1. Practical nursing--Examinations, questions, etc. 2. Nursing--Examinations, questions, etc. 3. National Council Licensure Examination for Practical/Vocational Nurses--Study guides. I. Sloan, Diann. II. Hurd, Clara. III. Title. RT62.R55 2008 610.73'076--dc22 2008000133 Printed in the United States of America First Printing: February 2008 Trademarks All terms mentioned in this book that are known to be trademarks or service marks have been appropriately...

Words: 177674 - Pages: 711