Dental Bridges: Dentistry's Approach to Filling in the Gaps
Whether damaged or diseased, teeth may either be lost as you age or require extraction. While the prospect of having a missing tooth in your smile can be a frightening one, there are dental approaches that can provide a cosmetic and healthy solution. One such approach is the dental bridge.
To say dental bridges have been around for a while is an understatement. The National Museum of Dentistry in Baltimore, Md., houses a bridge from ancient Egypt dating back to 3,000 B.C. The Egyptians used gold wires to bind replacement teeth together. Today, of course, the materials are more sophisticated and the look more seamless.
Simply put, dental bridges are used to fill the space left by one or more missing teeth. If you lose a tooth, this can weaken the entire structure of your surrounding teeth and cause your remaining teeth to tilt toward the empty space. This can contribute to decay because tipped teeth are more difficult to clean. You may find you are not able to bite down as evenly as you once did, which places added stress on your teeth and jaws and can increase the risk for tooth damage.
A dental bridge consists of one or more false teeth (called pontics) that are placed between two natural or implant teeth (known as abutment teeth). The bridge is attached to the abutment teeth by crowns.
The choice for dental bridges extends beyond cosmetic appeal. Bridges offer the following benefits:
- Enhanced ability to chew and speak clearly
- Even chewing of food
- Proper position maintenance for remaining teeth
Popularity and Common Uses of Dental Bridges
The world market for dental crowns and bridges amounts to approximately 110,000,000 teeth per year! Approximately 85 percent of dental crowns and bridges are metal based and the remaining 15 percent are ceramic based.
Patients older than age 50 tend to have the most dental bridge procedures. As members of the baby-boom generation advance into middle age, more and more people will require bridge work. According to a survey by the American Academy of Cosmetic Dentistry (AACD), the most common procedures for patients over 50 are crowns and bridges.
The use of ceramics in bridges is quickly growing in popularity. Many patients prefer ceramic bridges over metal because they offer a more natural and beautiful appearance.
Which Type of Dental Bridge Is for You?
Because no two sets of teeth are alike, there are different dental bridge options to choose from based on your desired results, area needing to be fixed and procedure cost. Three chief types exist – traditional fixed bridge, resin-bonded bridges and cantilever bridges – and you can speak to your dentist about the best choice for you.
Traditional Fixed Bridge: Fixed bridges are composed of two crowns cemented to abutment teeth on either side of the missing tooth space. These porcelain crowns hold a pontic in place. The pontic is then fused between the crowns. Unlike partial dentures, fixed bridges cannot be taken out of the mouth. With good oral hygiene and maintenance, fixed bridges can last 10 years or more.
Resin Bonded Bridge ("Maryland" Bridge): The resin-bonded bridge is used when the abutment teeth are healthy and do not have large fillings, thereby reducing the amount of preparation on the adjacent teeth. This bridge is used primarily for the front teeth. The pontic is fused to metal bands that have been bonded to the abutment teeth with resin. Another term for this bridge type is acid-bonded bridge.
Cantilever Bridge: When there are teeth on only one side of the open space, cantilever bridges are used. The cantilever bridge involves securing the pontic to one side over one or more adjacent teeth.
How to Prep for Dental Bridge Procedures
Full disclosure of all the medications you are taking and any medical conditions you have can help your dentist evaluate if you are the best candidate for a dental bridge. This is especially important if you have a heart condition because dental procedures may put you at increased risk for endocarditis, a condition that occurs when bacteria from your mouth infect your heart. Your dentist may recommend taking antibiotics prior to the procedure to prevent infection. Also, if you are taking blood-thinning medications, this can increase your risk for bleeding during the procedure.
What the Dental Bridge Procedure Entails
Getting a dental bridge is a multi-step process that often requires two or three visits to ensure proper and comfortable fit. The first visit typically takes about an hour and involves placing temporary crowns over the teeth that will provide support. The second visit takes about 45 minutes to install the permanent crowns and pontic. However, your dentist may recommend an additional visit to ensure proper placement. Always tell your dentist if you are experiencing discomfort or difficulty maintaining your bite.
The Initial Visit for Dental Bridge Fitting
On the first visit, you will be given a local anesthetic to numb the gum area where the bridge will be installed. Depending upon the type of local anesthetic used, you can expect to be numb for one to four hours.
The dentist then removes an area of each abutment tooth on either side of the missing tooth space to accommodate for the thickness of the crowns to be installed. If the abutment teeth already have fillings, part of the filling may be left in place to help as a foundation for the crown.
Your dentist will prepare the tooth in a specific way to retain the new porcelain-to-metal crown. A thin piece of retraction cord is placed around the tooth to get the impression material under the gum where the crown ends. The dentist or dental assistant will place a temporary crown (or bridge, if multiple teeth are involved) on the tooth. These plastic restorations are placed on teeth to protect the teeth and the gum tissues between dental visits.
The dentist will make an impression of the open space, which will serve as the model for the dental laboratory to make the bridge, the false teeth and the crowns. To protect the teeth and gums, a temporary bridge may be placed in the mouth until the next dental visit.
The impressions of the teeth are sent to the lab to get custom-made bridges. The cost of the lab work is usually included in the procedure cost and should be discussed with your dentist.
Some cosmetic dentists may require their patients to use a flipper appliance (a false tooth) to temporarily take the place of a missing tooth before the permanent bridge is cemented. A dental flipper can be attached using a wire or a plastic piece that fits in the roof of the mouth.
Proper home care is vital between the first and second visits. Tooth brushing and flossing can keep your teeth in good health. Your dentist also may recommend undergoing a dental cleaning before the permanent bridge is put in place.
Applying the Permanent Bridge on Your Second Visit
During the next visit to the dentist, the temporary bridge is removed and the new permanent bridge is fitted. This typically occurs about a week after the initial visit. Your dentist will use special cement or bonding solution to adhere the crowns and bridge to your teeth and gums. Your dentist will evaluate how the bridge affects your bite, check for accuracy, make adjustments for any bite discrepancies and evaluate the esthetics. If there are any areas where you cannot bite down evenly, your dentist can polish the cusps of your teeth. Always tell your physician if the bridge feels uncomfortable or incorrectly placed. The crown is then cemented to the tooth.
Another option is to apply a temporary cement to the dental bridge, which allows you to wear the bridge for a few weeks before permanently cementing it to your teeth. This allows you to ensure the bridge’s comfort and fit.
Considering the Costs of Dental Bridges
Depending on which type of dental bridge procedure you choose, the cost ranges from $200 to $2,000 per tooth. Dental insurance will typically pay for about half the cost of a bridge procedure. Always work with your physician’s office prior to the procedure to ensure your insurance will pay a portion of the costs. If your insurance does not or if you do not have dental insurance, your dentist may offer installment payment plans that allow you to pay a portion of the costs over time.
Recovering from the Dental Bridge Procedure
After the first visit, a patient can experience a slight degree of discomfort, but nothing that cannot be remedied with ordinary over-the-counter, non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen or aspirin. You may experience sensitivity to heat, cold or pressure in the first few days post-surgery. If sensitivity persists or worsens, call your dentist as soon as possible. With bridges or crowns, recovery is quick, and teeth are back to normal within one or two days. It is strongly recommended you avoid eating sticky foods like gum, caramels and taffy. Avoid hard candy and definitely do not chew ice cubes!
If anesthetic was used during the procedure, avoid chewing for at least 30 minutes to allow the temporary cement to set and ensure the numbness has worn off. If possible, chew food only on the opposite side of your mouth from your bridge or crown. Brush normally, but floss very carefully. Dentists often recommend special floss, brushes or other cleaning aids to keep the area free of bacteria.
Use one teaspoon of salt in one cup of warm water to rinse your mouth three times a day. This will reduce any discomfort or swelling in the mouth. It is normal for gums to be sore for several days. Call your dentist immediately if:
- The temporary bridge comes off
- The temporary bridge does not fit properly, the bite feels uneven, or you have persistent sensitivity or discomfort
- Your pain worsens instead of improves
Once your teeth have had time to heal, you may find eating will become easier because you have the support of an additional tooth. However, you may want to cut foods into smaller pieces or choose soft, easy-to-chew foods until your teeth have time to heal. You also may notice you can speak more easily with the dental bridge because you no longer have a tooth missing. This is especially true for missing front teeth.
Extending the Life of Your Dental Bridge
Like your own teeth, dental bridges require special care to make them last as long as possible. Talk to your dentist if you should practice any special care measures in caring for your crowns and bridges. Barring extra considerations, you should brush and floss your teeth at least twice per day to prevent cavities and damage to your surrounding healthy teeth. Although your dental bridge is not composed of true tooth material, you must care for the surrounding teeth carefully. You also should maintain regular cleaning appointments with your dentist to intervene as early as possible should a cavity occur.
Brushing your teeth after every meal can help dislodge any food material or bacteria that may attach to your teeth and cause cavities. If you have difficulty flossing between your bridge you may be able to use a special floss type designed for hard-to-reach places that allows you to reach the area between the bridge. You may wish to avoid sticky or hard foods that could loosen or break the dental bridge. Examples include popcorn, chewy candy, caramel and nuts.
With proper care, crowns and bridges can last between five and 15 years, although some can endure significantly longer. The ultimate timeframe depends upon your oral health habits.