Dental Bridge: Everything You Need To Know – Forbes
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By the time most of us reach adulthood, we should have 32 permanent teeth, including wisdom teeth. But the National Institute of Dental and Craniofacial Research reports that as of 2016, U.S. adults aged 20 to 64 had an average of just 24.92 permanent teeth, meaning several never erupted or were extracted or lost.
In fact, according to the American College of Prosthodontists, 120 million Americans are missing at least one tooth.
Tooth loss can be due to a variety of reasons, from cavities, to gum disease, to injury and congenital abnormalities, among others. But regardless of how the tooth was lost, a missing tooth can cause more than just a cosmetic problem. When one tooth is missing, the others can shift, causing jaw instability, pain, changes to the shape of your face, gum disease and issues with chewing and speaking.
One option to restore your smile and help your mouth start functioning the way it should is a dental bridge. Here’s what you need to know about dental bridges, from cost to care.
As the name implies, a dental bridge is a dental prosthesis that “bridges” a gap in your mouth created when teeth are missing.
The procedure typically involves fitting natural teeth on either side of the gap with crowns in order to shore them up. These supporting teeth are called abutment teeth. A dental professional will then place a false tooth (or teeth) called a pontic into the gap and cement the “floating” tooth to the neighboring teeth on each side.
The “bridge,” which is commonly made of porcelain, ceramic, metal or zirconia (a ceramic that acts like a metal), remains fixed in your mouth. This means you don’t have to remove the bridge the way you have to remove dentures.
A dental bridge is a viable option for most people with a missing tooth (or teeth) who have healthy teeth surrounding the gap.
“Bridges rely on the health of the adjacent teeth and the health of the surrounding tissues to support them,” says Martin Hogan, D.D.S., an assistant professor in the department of surgery at Loyola University Chicago. “Patients who don’t have healthy remaining dentition (dental tissue that lies below the enamel) are usually not good candidates. Patients with severe bone loss on surrounding teeth and poor oral hygiene (they don’t brush or floss regularly) are also not good candidates,” Dr. Hogan continues. “The surrounding teeth that are going to be used to cement the bridge must have strong bone support, good gum health and be strong enough to support teeth.”
If your teeth or gums aren’t healthy enough for a bridge, you can also opt for a dental implant, which involves inserting a titanium post into the space where the lost tooth’s roots used to be. After the post integrates with existing bone, an artificial tooth is placed on top.
A dental bridge can have psychological as well as physical benefits.
A bridge replaces lost teeth, thereby restoring your smile and—for many people—their self-confidence. It prevents your teeth from shifting, and with teeth in their proper place, you can maintain your ability to chew and speak without issue. Your face also retains its shape, as missing teeth can cause parts of your face to look sunken or collapsed.
A dental bridge also doesn’t require invasive surgery, the way a dental implant does.
There are four types of dental bridges, and which one your dentist recommends will depend on which teeth are affected and the overall health of your mouth.
This is the most common type of bridge. It involves using a resin cement to affix a false tooth (or several teeth) to two healthy abutment teeth that have been fitted with crowns. This type of bridge is typically made of metal, porcelain or ceramic. “Your dentist will help you decide on a material that works best for your situation, depending on how many teeth need to be replaced and the position of the missing teeth in the jaw,” says Viensuong Nguyen, D.D.S., a clinical assistant professor at the School of Dental Medicine at the University of Colorado.
The cantilever bridge differs from a traditional fixed bridge in that it’s anchored to only one abutment tooth instead of two (a crown is still placed on the abutment tooth). It’s often used when there’s no tooth (or no healthy tooth) on the other side of the gap to cement the false tooth to.
However, because it’s unsupported on one side, it can be weaker than a traditional bridge and is generally not used in the back of the mouth where chewing can create more force than the bridge can withstand.
Also called a resin-bonded bridge, this is a popular option when people need to replace teeth in the front of the mouth where there isn’t a lot of force from chewing. Instead of being fitted with crowns, the abutment teeth connect to the false tooth with “wings,” or flaps, typically made of metal or ceramic. These flaps are placed on the backs of the teeth so they’re invisible from the front.
Instead of using natural teeth as abutments, an implant-supported bridge uses dental implants to anchor the false tooth (or teeth) in place. Your dentist may recommend an implant-supported bridge if your natural teeth aren’t healthy enough to support a traditional fixed bridge.
One major drawback of a dental bridge is that it changes the structure of your abutment teeth. That’s because your dentist will intentionally damage these healthy teeth by filing away some of the enamel in order to fit the crown over the tooth and make it flush with the other teeth in your mouth.
However, both dental bridges and dental implants have their merits. Your dentist will discuss which option is best for you.
“Both a dental bridge and dental implant are clinically and scientifically documented, and the clinician chooses one versus the other depending on the level of comfort, expertise and also the condition of the adjacent (supporting) teeth,” explains Konstantinos Chochlidakis, D.D.S., an associate professor of dentistry at the University of Rochester’s Eastman Institute of Oral Health. “The main advantage when you compare an implant with a tooth bridge is that with the dental implant, there is no intervention on the teeth. Basically, the teeth close to the one missing do not need to be shaved off to make space for the bridge, saving tooth enamel. An implant is also not affected by cavities, so for people who suffer from reoccurrence of cavities (which can occur on the teeth supporting a bridge) an implant is a safer choice.”
Despite the advantages, dental implants require surgery, and that makes them an inappropriate choice for people who have problems with wound healing, such as smokers or those with diabetes, says Samantha Rawdin, D.M.D., a prosthodontist in New York City and chair of the public relations committee for the American College of Prosthodontists. Another drawback: Because bone has to fuse with the post, a dental implant procedure can take months to complete.
Although implants are not affected by tooth decay, they are susceptible to gum disease just like teeth. Someone with a history of moderate to severe gum disease may not be a good candidate for dental implants.
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Different bridges require different procedures.
For example, if you’re getting a traditional fixed bridge or a cantilever bridge, your dentist will prepare your abutment teeth for crowns by filing down the enamel (you’ll receive a local anesthetic injected into your gum to minimize discomfort). Then an impression of your teeth will be made using a computer scan or by biting into a putty-like material to create a mold. The impression is sent to a lab where a technician creates your permanent bridge.
Because it uses wings instead of crowns, your teeth won’t have to be filed if you get a Maryland bridge. Instead, your dentist will bond the wings to the backs of the adjacent teeth using composite resin.
Implant-supported bridges are the most invasive of all. A titanium post is inserted into the place where the extracted tooth’s root once sat and is surgically secured to the jawbone. It can take several months for the bone in your jaw to fuse to the post.
Overall, dental bridge procedures are fairly safe, notes Dr. Hogan. “Prior to beginning the process of fabricating a bridge, if the proper steps are taken and an appropriate evaluation—including exam and images— taken, risks can be decreased,” he continues, going on to note that individuals need to maintain good oral hygiene afterward and care for the bridge and surrounding teeth by brushing and flossing daily and using a recommended mouthwash.
The cost of a bridge depends on which type you select, how many teeth are involved, what materials are used, the dental practice you go to and even where you live. On average, though, a bridge can cost between $1,000-$5,000 per tooth involved, says Dr. Rawdin.
Dental bridges last five to seven years, and many last even longer. One study of anterior resin-bonded bridges found that 98% last five years, 97.2% are still going strong at 10 years and 95% last a whopping 12 to 21 years.
The best way to maximize the life of your bridge? Practice good oral hygiene. Experts advise that you:
See your dental team as soon as possible if something doesn’t look or feel right or is causing pain, notes Dr. Hogan. He recommends that you make an appointment with your dentist if:
It’s not uncommon to have missing teeth, but there are ways you can restore your smile and the health of your mouth. Talk to your dentist about whether you’re a good candidate for a dental bridge and, if so, what the procedure might look like for you.
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Donna Christiano Campisano is a freelance writer specializing in women and children’s health issues. She has written for numerous consumer publications and websites, including Parents, Woman’s Day, Good Housekeeping, Healthline and Verywell Health. She has also served on the staffs of both Glamour and Brides magazines as a researcher and copywriter. In addition to freelance writing, Christiano also works as a staff writer at the University of South Florida’s College of Public Health. She lives in the Tampa area with her family and beagle, Bananas.
Dr. Holli Careswell is a board-certified general and cosmetic dentist with a private practice in Lee’s Summit, Missouri. She has taken hundreds of hours of continuing education, focusing on cosmetic dentistry, implant dentistry and facial esthetic procedures. She enjoys all aspects of general dentistry and has a special interest in cosmetic dentistry. Dr. Careswell was recently featured on the Emmy award winning Netflix original series Queer Eye, and has been recognized as one of Kansas City’s Top Dentists by the Kansas City 435 magazine for the past five years. She is known for her beautiful cosmetic dentistry and has patients regularly travel across the U.S. to see her for their dental work. Dr. Careswell is married to Vinny and together they have two wonderful boys, Camden and Boston, and two mini-goldendoodles. She enjoys watching her boys’ sporting events, boating, skiing, photography and working out.