<b>Edentulism Beyond The Mouth: Oral Microbes And Social Identity Crisis – A Narrative Review</b>

Abstract

Background: Tooth loss (edentulism) affects millions of Nigerians, with consequences that extend beyond oral function to psychosocial well-being.¹ However, the link between oral microbes—the primary agents of tooth loss—and the social identity consequences of edentulism remains underexplored, particularly in African contexts. Objective: This review synthesizes available evidence on oral microbiology, psychosocial impacts of tooth loss, and cultural dimensions of edentulism to examine whether edentulism can be understood as a social identity crisis mediated by oral microbes, and to identify implications for Nigerian dental practice. Methods: This narrative review followed the SANRA (Scale for the Assessment of Narrative Review Articles) guidelines.¹² We systematically searched high-impact journals indexed in PubMed and Google Scholar for peer-reviewed publications published between 2000 and 2026. Articles that did not undergo peer review, articles published in languages other than English, or those that were not accessible because access was closed unless key information was available through abstracts or summaries were excluded. Findings: Oral microbes including Porphyromonas gingivalis and Streptococcus mutans drive the caries and periodontitis that lead to tooth loss.³˒⁴ Synthesized evidence from quantitative studies shows that 45–49% of edentulous individuals report difficulty coming to terms with tooth loss, with documented emotional effects including sadness (12.9%), depression (6.4%), and feeling of lost body part (14%).¹ Visible caries operate as social stigma, with experimental studies showing lower ratings of intelligence, social skills, and happiness based solely on visible decay.²³ Halitosis from microbial metabolism causes documented social avoidance and workplace discrimination.¹⁹˒²⁵ A Yoruba proverb captures this understanding: "Bi eyin ba ti ka, ile erin a wo" (when teeth are lost, the house of laughter collapses). Current evidence indicates that no published Nigerian studies have tested whether cultural frameworks interpret edentulism as self-mutilation or norm violation.⁷ Conclusion: Available evidence supports understanding edentulism as a social identity crisis mediated by oral microbes. Research gaps include the absence of qualitative Nigerian studies on patient experience and untested cultural hypotheses.⁷ Keywords: Edentulism, oral microbiota, social identity, psychosocial impact, Nigerian dentistry