Most adults can expect to have 32 teeth. The four third molars, or “wisdom” teeth, are often extracted because they do not grow into the mouth well or there is not enough room for them to remain in proper alignment. It is very unusual to have wisdom teeth replaced. But the other 28 teeth are needed.Extraction is basically removing a decayed or broken tooth which cannot be saved. Removal of teeth is gradually not the first option for a lot of dental issues. However, a large number of dental infections and other causes end in extraction. The front teeth, because of their visibility, are more likely to be replaced by patients for the sole purpose of aesthetics/looks. The back teeth are often neglected and not replaced since they are not visible, though they play a higher role in terms of chewing, food digestion and function. In many patients, reasons for impaired bite and crooked tooth are traced back to failure to replace a removed tooth. A few people consider removal of teeth as their first option in order to get rid of the pain, but what they do not realize is the after-effects of extraction.When you lose a tooth, the efficiency decreases and function suffers. When you lose a tooth, you lose some ability to chew food properly. This may mean that you either place more stress on the other teeth in order to chew all the food you eat, or you do not chew well enough and what is swallowed is not quite ready to be digested. This can lead to digestive difficulty. You might have to eliminate certain favorite foods because you cannot chew them thoroughly.Let us look at the some of the issues as a result of not replacing a missing tooth:1. Reduced chewing/digestive efficiency (Indigestion): The back teeth play a significant role in chewing the food and contributing to the initial stage of digestion. The salivary enzymes play a significant role in digestion when the food is chewed and missing back teeth tends to make people swallow food faster without chewing properly than if good amount of chewing were to happen. Studies show that loss of each posterior tooth (molars especially) reduces tooth efficiency by 10%.2. Malocclusion (Improper alignment of teeth): A malocclusion happens due to the empty space created, into which 3 teeth are trying to move. The tooth before and after the empty space tend to slowly tilt towards the empty space in between. Also, the opposing upper or lower tooth supra erupts into this space. Each tooth plays a critical role in maintaining the adjacent and opposing tooth in place, which is lost when a tooth is not replaced after removal. As the teeth keep encroaching in the empty space, chewing efficacy reduces leading to lesser usage of that side, eventually making that side unusable.3. Bone loss: The tooth also is essential for maintaining healthy bone, and if not replaced, it can lead to accelerated loss of alveolar bone. Good bone support is very essential for construction of dentures and/or placement of implants (fixed replacement of missing teeth), especially in old age, when complete dentures which are almost always removable need to be done and when implants are not possible due to increased bone loss. This is true especially in the lower teeth, where denture retention is a big challenge.4. Extra pressure on other teeth: Not replacing a tooth puts additional pressure on the remaining teeth, leading to accelerated bone loss and wearing off of the enamel. The remaining teeth are loaded with extra work since one/few of the teeth are missing. The excess work load eventually reduces the life of the remaining teeth.5. Aesthetics: Removal of teeth makes you look older as there will b sinking in of the face when back teeth are not replaced, leading to a puckering. In case of extraction of canines, the supporting pillar of the face is lost and the face starts sagging. There is loss of self-image and self-esteem and a feeling that you are getting old. Once you start losing teeth, you can actually start to look old.So, the next time, think twice before extracting a tooth. In cases where tooth loss is inevitable, ensure you plan how to replace it in the earliest possible time period. The more replacement of missing tooth is delayed, the more difficult it is to replace it later and the more expensive it will turn out for the patient. Fixed dentures or removable dentures can be the options, depending on age, food habits, finances, etc. Implants also could be another option, which is the new-age solution for replacing teeth. A detailed discussion with your dentist regarding replacement, before removal of a tooth will help you plan better.