What You Should Know About Getting a Dental Bridge

When you are missing a tooth, one option is a dental bridge. This permanent appliance is comprised of several pieces that are fused together to fit into the open space in place of a missing tooth. It involves one or more fabricated teeth—called pontics—held by two (or more) crown abutments on either side of the pontic. The bridge is used to replace a missing permanent tooth, to provide an ample chewing surface, and to aesthetically replace a missing tooth or teeth.

The false tooth is constructed to be similar in shape and size to the actual missing tooth/teeth.  The crowns serve to keep the false tooth/teeth located in the middle of the bridge in place. The crowns can be supported by a person’s natural teeth, or they can be placed over dental implants.

The bridge may be made of several different types of material, including gold, alloys, or porcelain. When replacing a front tooth, porcelain is most often the material of choice because it can be matched to a person’s natural tooth color.

Dental bridges can serve to provide many benefits, including:

• Restoring a natural look to a person’s mouth/smile
• Restoring the ability to speak normally
• Maintaining normal facial structure (by preventing bone loss from the jaw at the site of the missing tooth/teeth).
• Restoring the ability to chew food efficiently
• Preventing adjacent teeth from moving (A gap in the teeth that involves a missing tooth can lead to a shift in the position of the adjacent teeth. This can cause problems with the bite, and result in other complications.)

There are several disadvantages to dental bridges. These include:

• Once the bridge is fitted, the adjacent teeth that hold the bridge in place may become damaged.
• A risk of decay is present if the crowns over the abutting teeth are ill-fitting (from allowing bacteria and plaque underneath the crowns)
• The crowns may change the structure of the teeth.
• The supporting teeth on each side of the bridge may not be strong enough to support the bridge (this could result in the collapse of the bridge).
• The abutment teeth may suffer so much damage that they may have to be replaced by dental implants.

There are primarily three types of bridges. These include:

1. Traditional fixed bridges: The most common type of bridge, including two or more crowns and a false or filler tooth (pontic). There may be more than one false tooth which attaches to the abutting crowns (depending on the number of missing teeth that the bridge is replacing).
2. Cantilever bridges: This type of bridge is no longer commonly used. It is implemented when the missing tooth abuts next to a tooth only on one side. This type of bridge is attached to just one crown. It should not be placed in the back of the mouth because it can put too much force on other teeth, potentially causing damage.
3. Maryland bonded bridges or resin-bonded bridges: This type of bridge is often used to replace missing teeth in the front of the mouth. It is made of porcelain that is fused to metal teeth, supported by a metal framework.

Not everyone is a good candidate for a dental bridge. According to the University of Rochester, there are several factors which contribute to a person being a good candidate for a bridge, these include:

• Missing one or more permanent teeth
• Being in overall in good health (no severe health conditions, infections or other health problems)
• Having teeth that support the bridge which are in good shape and have strong bone structure.
• Having good oral health.
• Performing good oral hygiene (to maintain the condition of the dental bridge)

According to the University of Rochester’s Health Encyclopedia, “The difference between correct and incorrect oral hygiene is an important factor in the success of the dental bridge.” 

Receiving a dental bridge will involve at least two dental appointments and procedures.

Step 1. Once the decision is made for a dental bridge, the first dental appointment will involve preparing the abutment teeth for the crowns that will hold the bridge in place. The abutment teeth are prepared by removal of some of the enamel (the outside layer of the teeth) so that there is room for the crown to be placed over them.

An impression of the teeth will be taken by using a soft putty-like material that the patient bites into, leaving an indentation of the exact outline of the teeth. Next, a plaster-like material is poured into the impressions to make a model of the teeth—in which the bridge will be made in a dental lab. The dental lab uses this indented model to make the permanent bridge.  A temporary bridge will be placed over the abutment teeth to protect them until the permanent crown is constructed by the dental lab.

Step 2. During the second visit to the dentist, the temporary crowns will be removed, and the permanent crowns will be checked for proper fitting, then cemented in place using a strong, permanent type of cement. Next, the dentist will check the crowns to ensure that the patient’s bite is not too high and adjust it accordingly. Subsequent visits may be necessary to adjust the bite. Some dentists initially use temporary cement to affix the permanent bridge, allowing for some time to ensure a proper fit before permanently cementing the new bridge in place.

Common questions that people who are going to be getting a dental bridge may ask, include:

How long can I expect my dental bridge to last?

With good oral hygiene and regular dental visits for prophylactic care (cleaning and dental exams) it’s possible for a dental bridge to last over a decade. The average amount of time that many dental bridges last is between five to seven years, but some bridges can last even longer.

Are there foods I won’t be able to eat once I have a dental bridge?

When your bridge is initially cemented, it’s advisable to eat soft foods until you become accustomed to the bridge. Later, eating a diet high in fruit, vegetables and fiber, instead of a diet rich in meat, provides good oral (and general) health. Foods to avoid after placement of a dental bridge include:

• Chewy/sticky candy (which could pull the crowns off of the abutment teeth)
• Hard candy or snacks
• Sugary foods (to prevent tooth decay under the crowns)
• Popcorn
• Nuts

Can a dental bridge change the way I talk?

When teeth are missing, it can impede proper enunciation of words. Wearing a dental bridge can help a person’s speech return to normal (particularly bridges that replace the front teeth).

How can I ensure a long-life for my bridge?

Good oral hygiene is important to keep remaining teeth strong and healthy, as well as to maintain a long healthy lifespan for your bridge. It is essential to brush your teeth at least twice each day and floss to remove debris that may be caught under the bridge. This will help prevent gum disease and tooth decay. Your dentist or dental hygienist will demonstrate how to properly floss and clean around the new bridge. In addition, it’s important to see the dentist regularly for dental cleaning and exams.

A study that was performed over a long time span (called a longitudinal study) involved a group of 102 dental patients who received dental bridges. The bridges were made by dental students at the University of Oslo. The study participants received regular dental checkups in which the dentists were able to examine the condition of the crowned teeth on the bridge compared with the control teeth (the teeth that were not crowned). The study authors concluded:

• The plaque level did not differ between the teeth that were crowned compared to the non-crowned teeth.
• No difference was noted in changes in the bone structure between the crowned teeth and the control teeth.
• The condition of the gums (measured as a GI score) worsened slightly for the crowned teeth (compared to the control teeth).
• Pocket depth (a measure of the health of the surrounding gums by inserting a dental probe beside the tooth beneath the gum line) showed a slight increase in mean pocket depth in the crowned teeth, but no change was noted in the control teeth over the 15 year study period. Note: An increase in pocket depth indicates that the gums are at higher risk of (or involve) periodontal gum disease.

Although there are advantages and disadvantages to getting a dental bridge, studies have shown that with regular dental cleanings and exams, and good oral hygiene, a dental bridge can be a long-lasting solution to having missing teeth. But, each situation and person is different and several factors are involved in who is and who is not a good candidate. It’s always important to consult with a dental professional to help decide whether a dental bridge is the right choice for you.