Sometimes, people lose teeth. It can’t be helped. Face meets baseball bat, sidewalk, steering wheel, or, any other immovable object. Sometimes people are missing teeth they never had, for genetic reasons. But over the years, most lose their teeth by default, due to neglect, severe decay, and gum disease. The usual culprit is plaque.

Plaque can cause both tooth decay and periodontal disease, and if left untreated, these conditions can lead to tooth loss. While the number of people with no teeth was much higher twenty-five years ago than it is today, and while fewer people are in fact losing fewer teeth, many people are still losing them for the same old reasons: poor oral hygiene habits, lack of access to professional oral health care among certain groups in our native-born population, and the influx of immigrants from countries where oral health care and prevention information are not readily available.

A bridge is preferable to dentures, which over time can irritate and even damage gum tissues and the underlying bone.

The rule of thumb is, use a fixed bridge whenever possible before deciding on a removable denture. It is more comfortable, will provide greater function for chewing, and is likely to survive over the long haul, if the supporting teeth remain healthy.

Chipped, fractured or worn teeth can be beautifully restoredusing life-like all-porcelain veneers or crowns. Also, because we are living longer, we need to hold onto our teeth longer. Or if they’re gone, we need to replace them, not only to maintain efficient chewing, but to support the facial muscles. If a span of teeth is missing, it can be bridged. The news about bridges is that, thanks to twenty-first century technology and advanced materials, they are more natural looking, longer lasting, and easier to place than ever before. Bridges are critical for keeping the remaining teeth from drifting. If teeth start shifting, they also start to slant. This may increase the depth of any gingival pockets, which in turn will trigger periodontal problems, and possibly lead to the loss of more teeth.

Bridges, which have been uses for hundreds of years, are the classic option for replacing up to four teeth missing in a row, whether in the front of the mouth or on one side. Unlike removable dentures, a bridge is basically a fixed (cemented) permanent denture designed to float prosthetic teeth (called pontics) between sound natural teeth (called abutments), which serve as their anchors. Bridges are affixed to existing natural teeth or a dental implant with crowns and cement.

Because missing multiple teeth can be replaced with several types of restorations, to select the right one, the dentist and patient must make some decisions together, based on the patients lifestyle, oral and general health, and finances. For many dentists, the treatment of choice today is an implant. An implant doesn’t require other teeth to hold it in place. But the patient needs to be in good health. If he or she has a chronic health condition, or bad habits (such as smoking or neglecting to floss and brush), an implant procedure would be hard pressed to succeed. If the teeth on either side of a gap are already decayed and have fillings anyway, the patient is better off if these teeth are crowned to support a bridge.

Fabricating a bridge takes anywhere from two to multiple appointments, depending on the complexity of the treatment. Once inserted into the patient’s mouth, it does not involve months of healing time, and only a dentist can take it out. Bridges can be made from the same materials as crowns, using practically the same techniques.

For a fixed crown and bridge, Dr. Glerum first prepares the abutment teeth as though they needed crowns (see illustration above).

Traditionally, after the teeth are prepared, impressions are made and a cast is then made of the prepared teeth. Dr. Glerum then request a skilled laboratory technician to make it, prescribing the exact dimensions needed to the lab. Bridges must be taken care of as well as or better than natural teeth. There is a common misconception that bridges protect the teeth. They don’t. The abutment teeth are still vulnerable to decay, usually at the bridge/tooth junction. And it’s not easy getting in there, especially for elderly patients. Good plaque control is also extremely important in maintaining bridges.

The reality is that it’s up to you, the patient, to maintain your bridge. Periodontal disease and recurrent decay are the most common causes of bridge failure. However, food can get trapped around and under the bridge. This makes home care particularly challenging. You will need to brush, floss, and have your teeth professionally cleaned as often as you did before, or even more diligently. Bridge maintenance is entirely your responsibility, although Dr. Glerum and her team (your personal bridge authority) will help you keep an eye on it. With today’s technology, advanced materials, an increasing awareness of the critical importance of overall health, losing teeth is on the decline, while saving or replacing teeth is becoming the easy and practical standard. So, if you and Dr. Glerum decide it’s time for you to cross over to a bridge, and you take good care of it, you can be sure it will stand up to wear and tear as well as the Golden Gate, the Brooklyn, or the Mackinac have done.