Does Crowding of teeth lead to early tooth loss?
I always try to temper initial exams when it comes to advising perspective patients of my services; sometimes I even may preface what I recommend by telling borderline cases that we want to avoid picking at everything slightly out of alignment just because I am an orthodontist. Similar to a neck doctor that may always see neck/back issues or a foot doctor that can always seem to find a foot problem, I do not want to recommend treatment on every single case with just the mildest of rotations or crowding and certainly if they are more concerned about function and health and less so about esthetics.
That being said, there is an issue that has been debated in multiple disciplines of dentistry that is a significant consideration when making a decision to correct crowded teeth or leave them. Before we entertain this though Americans in particular should realize that recent generations are keeping their teeth well into their older years and this is a good thing. Our General Dentists have done a great job at restoring damaged teeth, protecting developing teeth (fluoride and regular cleanings) and keeping teeth that in the past may have been lost due to fracture, infection or simple neglect.
With keeping the teeth longer, we now have to focus on the supporting bone around the teeth; the gum tissue and alveolar bone. Today, loss of teeth is mostly from Periodontal disease (disease of the supporting tissue around teeth) which is a bacterial infection of the gums that destroys bone and eventually causes the loss of supporting tissue for teeth; forces from chewing then eventually loosen the teeth to the point that the bone no longer can support the tooth or teeth and they are lost. Of course there is a more complex mechanism leading to the bone loss which is dependent on types of bacteria and toxins released, but the idea can be summarized as an infection of the gums. Clearly, as a dental professional, one of our main goals is to prevent prevalence and progression of Periodontal disease at every stage of patients’ lives in order to maintain the teeth as long as possible.
One significant factor to Periodontal disease can be crowding or spacing of teeth.
So do crowded teeth cause Periodontal disease?
The answer is no; bacteria is the primary cause of the disease. But the real question is how does the bacteria become detrimental in specific areas and mouths?
What are the ways crowded teeth can affect Periodontal Disease?
The most recent study in the AJO-DO explains this best by concluding that certain positions of teeth or “traits” such as incisor crowding provides “a poor environment for maintaining periodontal health …. due to food retention and subsequent plaque accumulation. (1)”
Consider the crowding in the patient below:
Crowding here has completely blocked the surfaces of several teeth from being cleaned; even with floss, cleaning these overlapped teeth is nearly impossible. Over time, it is highly likely these teeth will be lost if not corrected.
After correction you can see how the teeth can easily be cleaned and maintained.
Additionally, as teeth cross over and crowd, the roots are drawn closer together leaving less bone and supporting tissue between teeth. This also can lead to more rapid progression of periodontal disease between adjacent teeth. Soft tissue becomes obliterated from a lack of space to develop and there is less protection against bacteria between these teeth.
Finally, teeth that are crowded can push other teeth out of the arch and out of the bone. This can lead very thin tissue on the outside of the teeth leaving these teeth more susceptible to periodontal disease (see the picture below).
Note in this patient how the severe crowding has caused the canines to be pushed essentially out of the bone which has led to recession of the gum tissue and loss of bone at the neck of these teeth.
How can spacing between teeth affect Periodontal disease?
Spacing specifically between upper incisors was also shown to contribute to Periodontal disease (2) by allowing food to pack between teeth and leading to chronic inflammation and eventual progression into periodontal disease and loss of bone.
This type of spacing has been shown to lead to more rapid progression of periodontal disease by allowing food to pack in between teeth.
Following correction, you can see how the area between front teeth is now protected from impaction of food and can be easily cleaned.
What can you do to make sure your teeth are not at risk of Periodontal disease from crowding?
Clearly the only way to reduce or eliminate this risk is to align teeth that are moderately crowded. Research has shown that the areas of the dentition most at risk from crowding are the upper and lower incisors (2). When these incisors are crowded or overlapped, pockets are created that are not easily cleaned and although daily and meticulous flossing should theoretically prevent plaque formation in these areas, all too often we are not effective enough in our oral hygiene to fully clean these areas.
|Prior to Correction with braces.|