Avoiding common problems with dental bridges

Adhesive Bridges

Adhesive bridges are attached to the surface of minimally prepared (or unprepared) natural teeth and therefore occupy more space than the original dentition [1]. The bridge has wings on either side of the false tooth and these are bonded onto the back surfaces of the adjacent teeth.

They are a lot more conservative and require little to no tooth preparation. However, these can be used only in certain circumstances (i.e. a sound, healthy tooth with no gum disease).

Loss of Retention of Bridge

Is your dental bridge becoming loose? Does it wobble about when you’re biting on something hard? The best way to carry out a self-examination of a loose bridge is to stand in front of a mirror and press your bridge up and down using gentle force. If there are small bubbles at the margin of the gums where the bridge is, or if it is giving you the slightest bit of discomfort, don’t suffer in silence. Get in touch with your dentist and arrange an appointment to see them as soon as possible.

Possible causes of the loss of retention of your bridge are:

1. Inadequate tooth preparation for the bridge,
2. The bridge retainer becoming loose from the supporting tooth,
3. Dental decay developing rapidly underneath the supporting tooth of the bridge, compromising tooth structure,
4. Inadequate cementation of the bridge (tooth was not dried and isolated properly before cementing, cement was not fixed properly, not removing any cement remnants that interferes with retention).

Mechanical Failures

The most common cause of mechanical failure of a dental bridge are fractures. Stress is most likely to develop within the porcelain bridge due to trauma. If the restoration has served successfully for some time, it should be replaced by another porcelain restoration. However, if this failure occurs due to normal function, your dentist should consider replacing the material to a metal-ceramic bridge.

Secondary Dental Caries

Secondary (or recurrent) dental caries refers to a carious lesion associated with restorations (fillings) or sealants. The main culprit that causes decay underneath crowns is plaque and bacteria.

After the consumption of food, debris that is left on the tooth becomes a reservoir for harmful bacteria. Bacteria metabolizes the food in our teeth and converts them to acid which attacks and damages the enamel. Decay starts at the edges of natural tooth under the crown and progresses very quickly towards dentine.

Your dentist can spot decay underneath your bridge through an X-ray. If the decay is extensive, the bridge will need to be taken apart using high speed rotary instruments to access and remove all the decay. Deep carious lesions can lead to severe destruction of hard tissues and loss of even more tooth structure.

Periodontal Disease

The junction between the bridge and gums are a common place for the accumulation of plaque. This can induce inflammation around the gums as well as adjacent tissues. Signs of gingivitis include red and puffy gums that bleed on brushing. Untreated gingivitis can progress on to periodontitis (gum disease), which can lead to receding gums, jawbone shrinkage and eventually, tooth loss.

If the loss of your periodontal (gum) attachment is diagnosed early enough, and the cause removed, no further treatment is needed. However, if the extent of the disease has progressed to a point where the prognosis of the tooth is significantly reduced, the tooth itself may have to be removed.

Loss of vitality of the tooth

The pulp is the nerve of the tooth and great care is needed to protect this structure so that the tooth does not lose its vitality. The main causes of pulp injuries are:

● Secondary dental caries,
● An excessive amount of heat generated by the dental handpieces during the procedure when drilling,
● Chemical irritation from various dental cements,
● Microorganisms and bacteria,
● Trauma.