One way of replacing a missing tooth is with a fixed partial denture that is commonly called a bridge. A bridge replaces the missing tooth by spanning the area that has no tooth. The bridge is cemented to natural teeth and the replacement tooth is attached to the cemented teeth. The natural teeth that receive the cemented portion of the bridge are called abutments and hold the bridge in place. Bridges can replace more than one missing tooth. The longer the span of the bridge i.e. the greater the number of missing teeth being replaced, the weaker the bridge becomes, and it is more susceptible to failure.
Missing teeth should be replaced with restorations like a bridge to prevent complications with other teeth, gums and bone. All teeth in the mouth are important. Many people place more value on their front teeth because they affect their smile and overall esthetic appearance. The front teeth and back teeth have different functions. The front teeth bite off food and the back teeth grind up food so we can swallow the food for nutrition. Unfortunately, back teeth are often not replaced resulting in a significant long-term deterioration of the mouth. When the back teeth are not replaced the front teeth are overused to compensate for the back tooth loss at the expense of their overall dental health. All teeth are required in your mouth so they can maintain proper alignment between each other and the teeth in the opposing jaw.
When missing teeth are not replaced, the remaining teeth will become crooked by drifting into the space left by the missing tooth. Teeth in the opposing arch will move looking for a tooth to bite against causing the teeth to further misalign. Interferences in the bite may cause changes in the chewing pattern, problems with the jaw joint (TMJ) or muscle spasms of the head and neck muscles. If enough back teeth are missing, the front teeth may start to wear down resulting in a poor smile. Difficulties in cleaning crooked teeth may lead to further tooth loss due to decay and gum disease. With all of the bad things that can happen when a tooth is lost, the best course of action is to replace it.
The loss of tooth structure can occur in both young and older people, but is mostly seen in older people.
Attrition is the wearing away of the teeth due to strong tooth-to-tooth contact and is limited to the contacting surfaces of teeth. The amount of tooth loss varies from person to person and is related to the strength and amount of tooth contact. Attrition occurs on the biting surfaces of teeth and may vary from person to person. A small amount of wear is common in most people, however, some people severely damage their teeth to the point of tooth loss. Tooth wear increases with age and as the teeth become shorter, the relationship between the upper and lower jaw changes. As a result, the facial features change, making the person look older than their age. The chin becomes closer to the nose and the lower face has more wrinkles.
The first sign of attrition is small wear areas on the enamel of teeth. Over time, as the wear continues, the teeth become flat and holes appear in the enamel exposing the softer inner dentin layer. At this point the wear increases rapidly. Attrition can continue until the teeth are worn down to the gums.
Treatment of attrition depends on the amount of destruction that has occurred. During the early stages of attrition the remaining teeth can be protected through the use of an occlusal guard. (It is like an athletic mouth protector). It can be worn at night if the individual is suspected of tooth grinding while asleep. The occlusal guard keeps the teeth apart and helps to slow down the wear process. If more advanced wear has occurred, the teeth will have to be restored, with caps or crowns to cover the teeth and replace the lost tooth structure. In advanced situations the teeth are extracted and either implant supported teeth or complete or removable partial dentures are fabricated to replace the lost teeth. Attrition, if left untreated, is a serious dental situation.
Abrasion is the loss of tooth structure by mechanical means other than tooth-to-tooth contact. An example is aggressive brushing of teeth with abrasive toothpaste.
Erosion is the loss of tooth structure through a chemical process other than products from bacteria. Stomach acids contacting the teeth from gastro esophageal reflux disease, or eating disorders are common causes of erosion. People who are alcoholics, or who drink excessive amounts of soda or eat large amounts of acid containing fruits are also susceptible to erosion.
Removable partial dentures can be a great help to people who have lost some of their natural teeth. Partial dentures are usually attached to the adjoining teeth by metal clasps.
Wearing a partial denture helps your remaining teeth stay in position. When there are spaces between teeth, the teeth may drift or tip causing stress on the tissues. Tipped teeth are difficult to clean and therefore more prone to tooth decay and periodontal disease. A partial denture also makes chewing easier and more comfortable by replacing missing teeth. Finally, a partial denture benefits speech and appearance. Your teeth help to make sounds properly and also maintain the natural shape of your face by supporting your lips and cheeks.
Your partial denture may feel bulky at first because your mouth must become adjusted to the presence of a foreign object. After the tissues adapt, the sensation of bulkiness should disappear. Initially, your partial denture should be worn all the time. This will quickly identify those parts of the denture that need adjustment. The denture may need several adjustments before it fits comfortably.
When you first wear your partial denture, eat small pieces of food and chew slowly. This will allow you to adjusted to eating with your denture. Avoid sticky, hard or coarse foods.
Initially, it may be difficult for you to pronounce certain sounds. This is because your mouth is not accustomed to the denture. With practice, however, your speech will soon improve.
The success of partial denture wearing is dependent on many things. The number of your own teeth remaining and the health and amount of bone under the denture plays a role in satisfaction. Normal bone and strong healthy gums over the bone do not necessarily result in successful dentures. As people grow older the bone decreases and the tissues become more fragile.
As a result, the ability to wear dentures often diminishes. The persistence of an individual and their ability to adapt are important factors in successfully mastering dentures. Most people adapt to partial dentures while some individual cannot wear them.
Once it has been determined that crown and bridge treatment is indicated, you will be given a series of appointments. Changes in your appointment schedule may cause treatment delays and thereby allow further tooth movement before treatment can be completed.
The first step is to prepare your teeth for the crown and bridge. The tooth or teeth to be treated are numbed with an anesthetic. Next, during the preparation phase, your tooth or teeth to be crowned are trimmed down.
This allows sufficient space for the crown or bridge to fit over your teeth.
After the preparation stage has been completed, an impression of your teeth is made. Modern impression materials make it possible to make an extremely accurate stone replica helping to make the best possible restoration for your mouth. At the same appointment, we make plastic temporary crowns in the office to protect your teeth and provide temporary esthetics and function.
The next appointment involves the try-in of a gold alloy substructure which forms the internal support for the restorations. In some treatments this appointment may not be required.
At the last appointment, the crown and bridge is adjusted for proper fit prior to cementation. It is often necessary to fine trim and polish the new crown or bridge. Other factors that we consider include:
Losing a tooth can be of social and psychological concern.
Teeth are lost for a number of reasons including:
When a permanent tooth is lost, the neighboring teeth are affected. The support and chewing forces become altered and the remaining teeth will begin to shift. The teeth on either side of the lost tooth will tip into the space. The tooth above or below the one that was lost will begin to move up and out of its socket. These movements in turn accelerate periodontal (gum) disease and cause further breakdown and deterioration in the dental arch. If the missing tooth is not replaced, more teeth may eventually be lost due to the improper forces exerted on the remaining teeth during chewing.
A crown is placed on an individual tooth, (somewhat like a thimble over your finger) where there is no longer sufficient tooth structure left to place a filling. A bridge spans a space where one or more teeth have been lost in the dental arch. The teeth on either end of the span are crowned, and are referred to as abutments or retainers. The teeth being replaced by the bridge are referred to as pontics. A fixed bridge can be used to replace one or several teeth, however, the longer the span of the bridge, the weaker it becomes, and is more susceptible to fracture.
Crowns and bridges are most often made from superior materials such as precious metals (gold), semi-precious metals, porcelain or a combination of metal fused to porcelain. Both esthetics (appearance) and function are considered when selecting the material most suitable for you.
When you first begin to wear dentures, they may feel loose. This is normal until you learn to keep them in place with the muscles of your cheek and tongue. The dentures will also feel bulky and may cause a slight gagging sensation. Your mouth may feel sore and irritated and your saliva flow may increase. As you become adjusted to wearing the dentures, these problems often decrease.
Dentures may improve your appearance by changing the shape of your face and reducing facial creases at the corners of your lips. Your facial expression may seem different initially until the facial muscles adapt to the dentures.
Initially, when you are learning to use your dentures, it is best to eat soft foods. When the dentures feel more comfortable, gradually try coarser and harder foods until you are able to eat a normal diet. Avoid sticky or very hard foods. Learning to chew properly with your new dentures will take some practice.
Wearing dentures can make a difference in the way you pronounce certain words. Practice reading aloud to overcome any speech difficulties. Any problems should be mentioned to your dentist.
Initially, your dentures should be worn as much as possible. This helps to quickly identify any areas of the denture, which may need adjusting by your dentist. Your dentures should also be taken out at night before going to bed. This gives the tissues in your mouth a chance to rest and helps maintain oral health.
The success of denture wearing is dependent on many things. The health and amount of bone under the denture plays a role in patient satisfaction. Normal bone and strong healthy gums over the bone do not necessarily result in successful dentures. As people grow older the bone decreases and the tissues become more fragile. As a result, the ability to wear dentures often diminishes. The persistence of a patient is an important factor in the ability to master complete dentures. Research has shown that complete dentures chew at about 1/5 the chewing capacity of natural teeth and therefore seldom perform ideally. Lower dentures move as much as 10mm during function while upper dentures move about 1mm. This is why most difficulties occur with lower dentures. While most patients find complete dentures satisfactory, there are usually some associated problems with speech, comfort and chewing and as a result some patients cannot wear their dentures. They either stop wearing them or seek additional treatment in the form of dental implants.