EP #11: The Dental Domino Effect

A tooth extraction can feel like the finish line: the pain stops, you get back to your schedule, and you don’t want to think about it again. But what we see clinically is the opposite. When one tooth goes missing, the mouth adapts, and those adaptations can quietly reshape your bite, your jaw comfort, and even your future treatment options. We call it the domino effect, and it’s one of the most misunderstood parts of oral health.

We walk through a case study of a busy patient who ignores intermittent pain, ends up needing an emergency removal, and then unknowingly starts a chain reaction. We unpack what’s happening “under the hood” after tooth loss: jawbone resorption (bone loss), the way neighboring teeth drift and tip into the space, and why angled forces can lead to cracks, gum recession, food trapping, and more dental problems. We also talk about why chewing on one side can create muscle imbalance and contribute to TMJ symptoms like clenching, grinding, headaches, and jaw tension.

Then we get practical. We share what to watch for, why socket preservation and a tooth replacement plan matter, and how options like dental implants fit into protecting long-term bite alignment and quality of life. If you’re missing a tooth or you’ve been putting off a fix, this conversation is built to help you ask better questions at your next dental visit. Subscribe, leave a review, share this with a friend, and drop a comment with the dental question you want us to tackle next.

Transcript

Welcome And Why Oral Health Matters

SPEAKER_00 0:00

Welcome to the Semeday Dental Podcast. We're here to provide you expert insights on how dentistry can improve your quality of life and extend your health span. I'm Alex Semeday and I'm a practicing dentist, and I'll be your host, along with Jeremy Wolf. Enjoy the show.

SPEAKER_01 0:18

Hello, hello, everyone, and welcome back to another episode of the Semeday Dental Podcast. Jeremy Wolf here alongside your host, the man, the myth, the legend, Dr. Alex Semeday. Dr. Alex, always a pleasure, brother.

SPEAKER_00 0:30

Yeah, man. Good to be back. Good to be recording. Um, super excited about today's episode because I think a lot of people are going to be able to relate to it. And uh, you know, hopefully we spark some good conversations.

SPEAKER_01 0:44

Oh, well, I I myself can certainly relate to it because uh I have uh I have had this issue myself. Today we're talking about the domino effect, right? Why one missing tooth is never just one tooth, right?

SPEAKER_00 0:59

Right. So the way I like for for folks to think about this is you know the mouth doesn't lose a tooth, right? It loses stability, right? Because oftentimes we sort of think as of teeth as like these single, you know, standing units, but really they're they're part of a system, right? And that system, the mouth, has a lot of moving parts to it, and it's a very dynamic environment, it changes very rapidly. And when we remove a key component of that system, systems adapt. And that adaptation is what we call the domino effect.

SPEAKER_01 1:44

What wouldn't the body though? Like, I'm just thinking about this out loud in my own head. Like, if you just like you said, the body adapts, right? So if you if you lost a tooth, you had a problem, you go and you get an extraction. Wouldn't the body adapt for that? And like I would think that there wouldn't be any further problems, right? The body would recognize, okay, there's nothing there. We're gonna do things to kind of strengthen the area around there and and prevent future problems. That's how I would think about it, anyway.

A Busy Patient Puts Off Pain

SPEAKER_00 2:10

Uh, that's a very like engineering-minded approach of yours. Um, and yeah, I mean, our bodies are incredible, right? They are they are incredibly efficient, um, resilient, adaptive. Um but those adaptations lead to changes that in some cases really can compromise our our quality of life, right? And that's kind of what we what we want to discuss here today. What are the downstream effects of fixing that problem in the immediate sense, right? And what happens, what happens down the line. So let's take a little case, a little case study. We have a young patient, we'll call her Isabel, and she's in her mid-30s, right? She's got she's got a full-time job, she's got she's a mother, she's a wife, she's got a couple of kids. Um, and as parents, we know all of the things that that entails, right? Like you got pickups and drop-offs and practices and recitals, and it seems like your schedule is overwhelmed constantly. And as an aside, I don't know about you, but growing up, I don't remember this much structure. And I've got two kids, they both got extracurricular activities multiple times a week. My parents didn't take me anywhere after school. Like you do your homework and go play with the kids in the in the neighborhood, sort of thing. But today, like we have these crazy busy schedules, right? And we've talked about it in the podcast before, where sometimes, because of our busy schedules, parents and non-parents, right? We we tend to put things aside, right, and not be super proactive about things because we're swamped, right? And that's just it is what it is. Um, so she's super busy, she's got a little bit of discomfort down here on her bottom left, thinks nothing of it. It comes and goes. Maybe it's gotten a little bit more frequent in the last couple of months, but still sort of like ignores it. I've got other things that are more pressing that I have to attend to right now. Perfectly understandable, right? Especially when it comes to like dental things, right? Like who I get it, I'm a dentist. I understand that I don't want to make time in my schedule to deal with a toothache, right? So we postpone things, and inevitably they tend to progress and get worse. So now that occasional discomfort becomes a more frequent thing, and we're not chewing on the left side, we sort of favor the right side, and the problem keeps getting worse and worse until one day we have pain, we have an emergency dental visit, the tooth is removed, and there's no more pain.

SPEAKER_01 5:10

Problem solved, right?

Bone Loss And Teeth Drift Explained

SPEAKER_00 5:11

Yeah, easy peasy, easy peasy. So, what if I told you that that's exactly the moment where clinical changes and adaptations and problems start. So I I love this analogy. I always use this analogy with my patients. Okay. Let's say taking your tooth out is like removing a fence post out of sand, right? You grab that fence post, you kind of wiggle it around, you make some space in the sand, and you pop it out. And now you're left with a hole in the sand, right? So, what happens if you just let that hole be and sort of heal on its own? Well, the level of the sand would sort of like cave into the hole, right? And it would drop the level of the sand all the way around.

SPEAKER_01 6:06

Oh, that thing happens. That's gonna affect all the other posts at some level. Interesting. Exactly, exactly.

SPEAKER_00 6:12

So our bodies are incredibly efficient, right? And they don't like wasting resources. So what happens? You remove that tooth, and now the bone that held that tooth in place really serves no purpose. So, what does our body do? It breaks it down so that it doesn't have to spend resources maintaining it because it doesn't serve a purpose, it's not holding a tooth anymore. Okay, that we can start to see how that starts leading to to changes, like you said, like that kind of compromises the sand level, right, for the other posts, so they're affected slightly. I heard someone use this analogy a couple months ago, and it really stuck with me. I'm I'm big on analogies, uh, it helps me understand because I'm not a very bright man.

SPEAKER_01 7:09

Everybody loves a good analogy.

SPEAKER_00 7:10

Who doesn't love a good analogy? So think of this: you've got a bookshelf with all of your books lined up, and you take a book out from the middle. What happens to the other books?

SPEAKER_01 7:24

Yeah, right.

SPEAKER_00 7:26

So we see that just like that in the mouth, right? You take one tooth out from the middle, the teeth on the other side start to drift inward, right? And you say, okay, big deal, right? Who cares if if they drift a little bit, right? But our teeth are designed beautifully, if I do say so myself. It is it is a it is a work of art, the the engineering, the art and the science that goes into how our mouths are are designed. Now, our teeth can withstand compression, so forces down, like chewing forces or clenching forces, very, very well along the long axis of the tooth, right?

SPEAKER_01 8:16

So if the tooth is upright and you press on it down, you can withstand a lot of pressure directly going down, but not a lot of pressure, not like angular necessarily.

SPEAKER_00 8:25

Exactly. But the moment that tooth starts tipping over, right now the forces aren't down the way the tooth is designed.

SPEAKER_01 8:31

That makes sense. The structural, if it's if it's leaning, right? The structural, there's gonna be an angle with the structure, it just it's yeah, it seems like force would affect it differently if it's not in its place.

SPEAKER_00 8:41

100% that makes sense. 100%, and that leads to damage to the tooth, it leads to damage to further damage to the underlying bone, gum recession, teeth break and crack, right? Because now they're they're withstanding forces that in a way that they're just not designed to.

SPEAKER_01 9:01

Yeah, but it's it's just how many teeth we have in the mouth, Doc?

SPEAKER_00 9:05

32, including your wisdom teeth.

SPEAKER_01 9:06

So 32. So you lose it's just one tooth, right? One one, if you to lose one tooth, that's not surely that's not gonna affect the whole thing. Are you are you saying that just one issue in one tooth over time could create significant changes in the mouth?

SPEAKER_00 9:25

Yeah, absolutely.

SPEAKER_01 9:27

So then what do we what do we do about this?

Replacement Planning Before Problems Start

SPEAKER_00 9:31

Well, one of the things is is uh understanding how we can restore that that foundation to the mouth, right? Like that stability to the mouth. Uh a big thing that you know has really helped a lot of our patients out is how we do how we manage the socket, right, or the the hole once teeth are removed. Uh, do we have a plan in place to replace those teeth before all of this tipping and drifting and bone loss and other changes happen? Um, so those are things that we discuss with patients when we before the fact, right? Before we take that tooth out, we have a conversation and decide what do we want for the future and how do we set ourselves up to get there. All right. So we wrote we wrote the blog and it really breaks down all of the dominoes in sequence. And if folks are interested in it, I urge them to take a look. Um, because that can spark a very good conversation between them and their dentist. Uh, but for today's today's podcast, I really kind of wanted to break things down into like what is happening inside the mouth behind the scenes. What do we see? What are the symptoms that we get once those changes start happening? So things to really be on the lookout for. And of course, how we can prevent all of those things and and you know, not have a difficult situation on our hands.

SPEAKER_01 11:12

Yep. Prevention, we talk about it all the time, right? Ounce of prevention worth a pound of cure. Can't talk about it enough. Developing the the right habits when it comes to taking care of your like everything in life, but we're talking about oral health, right? Uh, flossing every day, making sure you brush, making sure you do the preventative things required so you don't have issues in the future. And then ultimately, if you do have an issue, right? Finding a dentist that you could work with that that can go and make sure, because it just seems to me, like if you'd have to, if you actually have to have an extraction, like I had to get I lost a couple teeth myself. Like, I don't know why you wouldn't want to get an implant. I think that there's probably a lot of people out there that that the biggest impediment to doing that are probably is for their financial situation, I'd imagine. There's a lot of people out there you see missing teeth, and they just have they've never fixed it. I could only imagine the reason, the only reason why you wouldn't fix it is related to finance, like financial the financial component of it. Because it seems like such like such an important thing, right? You lose a tooth. Well, let's get a new one in there. Let's do whatever we can to get a new one in there.

SPEAKER_00 12:11

I would argue that above and beyond the finances, and and I agree, it's it's definitely an investment, right? And dentistry done well just isn't cheap. Um, but I would argue that the number one impediment for for people not being more proactive about making sure that their teeth are replaced is they just don't know. You know, it's they're not they haven't been educated as to what is actually happening, right? And what are the downstream effects of losing a tooth and not replacing it? So, you know, I think that's why this conversation is important, right? So that folks do understand, you know, even if it is one missing tooth, have a conversation with your dentist. Hey, is this causing any of these issues? Am I gonna be okay? Does everyone absolutely have to replace every tooth that's that's been removed? No, right? Like we can live without any teeth, right? But it is it is a a quality of life decision, right? That actually impacts your health in in in very significant ways.

SPEAKER_01 13:27

Yeah, man, it's it's it's hard. Sometimes it's hard to see see things through other perspectives. Like from where I sit, I lose a tooth, I'm just like, I'm gonna get a new tooth. There's just no, like I I wouldn't want to have like for multiple reasons, right? Like aesthetically, it looks odd when you smile and you're missing a tooth, but then also like running running your tongue through the missing spot, and just like all that. And that these are just like superficial things at that point, and now you're talking about all these additional downstream problems related to the stability, the structure of the mouth, and like how not fixing that issue now can ultimately lead to many, many future problems that are gonna cost more money, more problems, and just more issues later.

unknown 14:04

Right.

SPEAKER_01 14:04

Seems like a no-brainer to me.

TMJ Symptoms And The Downward Spiral

SPEAKER_00 14:06

Right. Uh, absolutely. You know, the generally the the quicker we the more proactively we tackle things, the the better the long-term the outcome is, right? And uh the the mouth charges interest, man. It's like the longer, the longer we wait, the the more the more uncomfortable and expensive things become. There's just no no getting around that, right? So kind of going back to our to our little case study of of Isabel, right? Like she went right back to her super busy schedule, as one would do, right? The tooth was removed and problem solved, no more pain, and went back to you know about her business, busy schedule, picking up the kids, drop off, games, whatever. Months go by, right? These changes start happening, the bone starts dissolving, teeth start drifting a little bit. Sometimes we don't even notice that those changes are happening. But maybe we start trapping a little bit of food between a couple of teeth and the gums are irritated. Something that we see a lot with people is development of TMJ symptoms, right? Clenching and grinding type behaviors, headaches, jaw tension. Because what happens, right? As those shifts are happening in the mouth, the system loses stability, muscles try to start compensating for things, right? And by this point, Isabel had been avoiding the left side for months because it was kind of achy, right? So we were chewing on the right side all the time. Now the tooth was removed, so it's sore for a couple of weeks, and we're definitely not chewing on the left side. And then after it's healed, well, shoot, I got a gap in the left side. It's just a lot more comfortable to keep chewing on the right side. Right? And now it's like we're we're walking by just taking steps forward with our right leg. Right? Things are gonna happen, your hips are gonna start hurting, your lower back is gonna start hurting, um, muscles are gonna atrophy because you're not using them properly. So it creates these imbalances, and we're kind of quick to chalk up all TMJ issues to stress, right? Because it is a really significant component in it, but the stability and the harmony of the mouth influences it too, right? So that's one of the things that we see happen a lot, and people honestly would just never make the connection between those two things, right? Like, how can losing a tooth lead me to lose more teeth? Well, you lost the tooth, teeth drift, now they're taking forces in ways they're not intended to. That can damage the tooth or damage the gums and bone underneath it. You start developing TMJ symptoms, and we start clenching and grinding, which puts more stress on our teeth. So now they're more likely to crack and fracture and things like that.

SPEAKER_01 17:03

Right?

SPEAKER_00 17:04

So it becomes this this spiral that, of course, it doesn't it doesn't mean if you lose a tooth, all of your teeth are gonna break out of your head in a year. Right? Like that's not that's not what we're saying here, but these changes do happen and people should be aware of them. Yeah, it's my job to bring them that information.

SPEAKER_01 17:27

And I think the fact that everything we're talking about is so gradual, and it's not something you can feel, right? It's out of sight, out of mind, and it it's something that you don't really have to pay attention to because it's not going to be an issue for a long time. But once it is an issue, it's a big issue. So I think like the biggest takeaway from what we're talking about here is like to everybody out there, like take care of yourself. We only have this one life, we only have this one body, right? Take care of it. Put the time in, put the effort in. And when I kind of said it before, I'll say it again. And this is something that I I struggle with myself. We're not alone here, but like just brushing diligently, brushing your teeth. Flossing is one of those things. I think you speak to a lot of people, and they probably don't floss regularly. It's such an easy thing to do, yet we for whatever reason, we just don't do it, and then these things become bigger problems. And then if you do have a bigger problem, get it taken care of. Don't wait until it becomes a bigger problem because you're just gonna have more pain, more investment, more issues to fix in the future.

SPEAKER_00 18:29

Yeah, a hundred percent. Like, you know, the the ancient Chinese proverb, the best time to plant a tree was 10 years ago, the second best time is right now. Yep, right. Like at any point, you can decide to be proactive, right? Isabel could have been proactive when the tooth first started hurting, and it probably would have been a relatively minor, you know, solution. Um, or we can choose to be proactive when the tooth is removed so that you know all of these downstream, all these dominoes, right, don't end up falling. So, whatever stage you're at, just have a conversation with your provider, with your dentist, right? Um, if you've noticed, if you're missing a tooth and you've noticed any of these changes happening, I hope this conversation just really sparks um sparks a discussion for what the possibilities are.

SPEAKER_01 19:19

Raising awareness one tooth at a time, my friend.

SPEAKER_00 19:23

That's what we do.

Prevention Mindset And Closing Requests

SPEAKER_01 19:25

Beautiful. All right, well, let's leave it at that. Thanks everyone for tuning in, joining with joining us on this journey. Um, let us know. You know, don't forget to like, subscribe, all that fun stuff. But if if we missed anything, if there's anything going on in your world, we want to hear about it, let us know in the comments. We're always interested to hear your feedback, and we'll look forward to catching everyone next time on the next episode of the Semaday Dental Podcast. Take care.

SPEAKER_00 19:52

Thanks for tuning in to this episode of the Semaday Dental Podcast. We hope you enjoyed the show. Don't forget to subscribe, leave a review, follow us on social media for the latest episodes. You can find us at Semaday Dental. If you have any questions, feel free to reach out. We're always happy to help you. Until then, keep smiling. Take care.