When an adult loses a tooth, things start to happen. The empty space seems to invite the neighbors to move in. They do move. Slowly, but surely. And so do their neighbors, and then theirs. It’s chaos! The new gaps invite food bits to get comfortable where the brush can’t come. Dental hygiene becomes more difficult, decay becomes more probable. Dental bridges are one treatment option. Untreated, things get worse.
THE SNOWBALLING EFFECT
Top and bottom teeth that used to mate, don’t mate anymore. This spells trouble all around. First, the tooth opposite a new gap is now fairly useless for chewing. Moreover, it’s now also at risk of overeruption due to the lack of counter-pressure from its now-missing opposite number. Overeruption (or supereruption) over time can expose the tooth’s root and loosen it. Hence, it may become the next one to go. And thereby start another chain of problems
This downward spiral has got to be stopped.
FOCUS ON THE NUMBERS
This happens a lot. About 69% of us in the 35-44 age group have lost at least one tooth to decay, accident, or disease. That’s much better than it was in our great-grandparents’ time. Nonetheless, the data tell us that most of us will have to deal with losing a permanent tooth at some point in our lives. Yes, we can keep that risk to the minimum through good dental hygiene and regular checkups. We can take reasonable steps to precautions avoid injury. But like they say, life happens. There are no guarantees.
A missing tooth is not a pretty sight. In addition, the downside goes beyond a wounded smile. As we noted, a chain of consequences starts right away after tooth loss. This cascade can and does snowball. The outcomes can become pretty bad. For example, losing more teeth. One last number? About 40 million Americans have lost all their natural teeth. Sadly, this includes 30% of seniors aged 65 – 74.
Let’s not go there. Bridges are one way to get to a better place.
Bridges have been around for many years. In the simplest case of one missing tooth, a bridge is an artificial tooth resting on the gum, in the gap. It’s held in place there by the two next-door natural teeth. The artificial tooth, called a pontic, looks and acts like the one it’s replaced. It keeps its neighbors from shifting and provides a point of contact for its biting mate.
At least two appointments are needed to install a bridge.First the dentist prepares the teeth on both sides of the gap, called abutment teeth. He gets them ready for their new duty supporting the pontic. Crowns on the abutment teeth will anchor the pontic between them. Hence, the first step is the removal of enamel from the abutments to accommodate the crowns. Next, the dentist takes impressions of the abutment teeth. He or she sends these to the lab for custom fabrication of the bridge, crowns and the pontic. The dentist then installs a temporary bridge. This fills the gap and protects the abutment teeth. After a week or two, the lab returns the permanent bridge.
During the next appointment the dentist removes the temporary bridge and inspects the teeth and gums. Next, he or she installs the custom-made permanent bridge. A dentist takes great care to make sure the fit is perfect. This fine-tuning may require one or more additional visits with adjustments. Most dentists at this stage use temporary cement. That makes it easier to adjust things. Then, when the dentist is satisfied that the fit and bite are perfect, her or she completes installation with permanent bonding.
Those are the basics of putting in a dental bridge. More complex situations call for variations on the procedure and hardware described here. A common example is a missing tooth with only one next-door neighbor. Another is when more than one tooth is missing. Sometimes, more than one abutment tooth is needed to support an end of the bridge.
Dental labs make pontics with a porcelain exterior. The porcelain is fused on to metal alloys, or to ceramic. Pontics look, feel, and function like natural teeth. A dental bridge’s useful lifetime is in the range of 7-15 years, with 10 years as a reasonable expectation. When a bridge comes to the end of its useful life, the solution is to replace it. There’s not much choice, since the reshaping of the abutment teeth is permanent and irreversible. These have to be kept covered with crowns. Patients can extend the service lives of their dental bridges by practicing good hygiene habits. Likewise, regular checkups go a long way toward extending a bridge’s term of service.
There are a few ways in which a dental bridge falls a bit short in solving the problem of a missing tooth. Preparing the abutment teeth often means grinding away perfectly healthy enamel. That can leave these teeth more prone to decay. These teeth are then sometimes more vulnerable to decay. Thus, the patient needs to be extra diligent about cleaning them. In addition, the pontic, doesn’t replace the root of the missing tooth. The absence of a root accelerates degeneration of bone tissue in the jaw. Finally, some loss of gum tissue is not uncommon.
ALTERNATIVES TO DENTAL BRIDGES
This brings us to the other solution for missing teeth, which is implants. This option offers several advantages compared to dental bridges. To begin with, implants have longer service lives. For patients over 40 years old, they are generally for life and never require replacement. Furthermore, Implants rest on artificial metal roots sunk into the jawbone. This mitigates the bone and gum loss promoted by “rootless” dental bridges. Third, the artificial implant tooth itself is immune to decay. Finally, an implant also doesn’t require modification of abutment teeth, so there’s no added risk of decay there either.
However, these many pros don’t come without costs, financial and otherwise. Implants are a lot more expensive than bridges. In general, they’re are less likely to be covered by insurance. In fact, the low-end cost of an implant is higher than the high-end cost of a bridge. Implant treatment costs are more than $10,000 in many cases. Unlike bridge installation, the implant procedure is outright surgery. Also, it’s in the nature of things that more complex procedures are more subject to complications. For example, bone grafts may be necessary, notably when the tooth has been missing for a long time. The dentist may need to do additional CT imagery. In fact, some patients are not candidates for implants at all due to poor jaw bone density. Finally, the procedure takes longer, start to finish, than a bridge.
Dental bridges are a reliable and cost-effective treatment for missing teeth. They’ve been in standard dental practice for a very long time. Thus, they’re unlikely to run into complications. Compared with implants getting a bridge takes less of a patient’s time and money. The outcomes are very good in most respects. Implants are undoubtedly better in certain ways. A patient who wants and can afford implants should certainly seek evaluation for the procedure. It’s important, too, to have a complete understanding of what to expect.
If we take cost out of the equation, there’s another way to look at it. That is, to choose the most conservative solution that gets the job done. Making that choice is easier than it may seem here. In fact, for most people it’ll be made simple by a dental exam, evaluation, and discussion with the dentist.