A couple of weeks ago, I met a new patient. He knew that he needed extensive work and was looking for a second opinion. The fee quoted by another office was beyond his affordability, and he had heard that our costs were fair and more in line with his finances. Besides seeking monetary relief, he was looking for pain relief as his first upper molar was in dire straits. He presented with an infected tooth and sought my advice.
Unfortunately, his upper left tooth was beyond repair, and I advised him to remove the cause of the infection and pain. He was troubled that removing his upper molar would leave a gap in his mouth. I noted immediately that he was unlike many patients who don’t care about spaces in the back of the mouth. As long as the space does not show when they smile, these patients do not understand the importance of replacing the missing tooth. Those of you who read this column or are my patients know all the problems that will develop when we ignore missing back teeth. As I always say, if you want to maintain your smile, replace all missing back teeth.
I was impressed that a non-dental person understood the importance of back teeth and wanted a replacement. Over the past few years, I have written extensively about the advances in implant dentistry that allow me to replace an extracted tooth with a dental implant on the same day. This procedure saves time and money for the patient. My new patient was a perfect fit for immediate implants, which is the term we use when I remove a tooth and place an implant on the same day. There was only one problem; he was not interested in this procedure.
He had permanent bridges in other areas of his mouth, and a permanent bridge was what he wanted for this back tooth. Placing an implant on the same day or even following the older protocol and waiting a few months before implant placement was not his choice. Before implants became part of dentistry, the best way to replace a missing tooth involved using a permanent bridge.
Let’s review and describe a permanent bridge. Unlike a bridge that comes in and out of the mouth, a permanent bridge anchors itself to adjacent teeth. The anchoring method typically involves crowning or capping the teeth on either side of the missing tooth. The bridge attaches firmly to these teeth and is secured with a special dental glue called dental cement. These types of cement are manufactured under strict guidelines and are designed to withstand saliva and all types of acids that appear in the mouth. Dental materials like these seal the gap between a crown or special filling to prevent the intrusion of bacteria, leading to decay.
Connected to the anchor tooth is a floating tooth that “bridges the gap” created by the missing tooth. This floating tooth rests upon the gum area without too small or a large space between it and the underlying gum. Too little space creates gum irritation, and too large becomes a food trap. After a tooth is removed, the gum will heal and shrink away from the surface. If we make a bridge before sufficient healing occurs, the floating tooth will create a problem. I usually wait for 4-6 weeks before making a permanent bridge over a recent extraction area.
Waiting a sufficient amount of time for the final bridge ensures that the floating tooth fits well and creates a hygienic area. If you just lost a tooth and are wondering what is the right procedure for you or even which procedure is the right fit, please feel free to call and ask to schedule a meeting with me. Together we will come up with the right affordable treatment for you. You can reach us at 440.892.1810, and I look forward to meeting you.
Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.
The Healthy Smile • 27239 Wolf Road, Bay Village, OH 44140 • 440-892-1810 • www.jeffreygrossdds.com