A dental bridge is a fixed prosthetic device used to replace missing teeth, anchoring artificial teeth (pontics) to crowns placed over adjacent natural teeth (abutments). While durable, these restorations are not permanent and can occasionally come loose. A loose bridge can frequently be salvaged through recementation, provided the underlying teeth and the bridge remain sound. Timeliness is essential, as a delay can lead to decay or damage that complicates the repair.
Immediate Steps While Waiting for the Dentist
If your dental bridge feels loose or detaches, contact your dental office immediately for an emergency evaluation. Avoid chewing or placing pressure on the loose bridge or the exposed abutment teeth, as this can cause fracture or further damage. The exposed natural teeth may feel sensitive, so avoid very hot or cold foods and drinks.
If the bridge has detached, gently clean it with water and handle it carefully to prevent damage, such as chipping or bending. Store the bridge in a secure container until your appointment to ensure it is not lost. Never attempt to re-cement the bridge yourself using household glues or superglue, as these products are toxic and can permanently damage the restoration or the underlying teeth.
A temporary re-attachment using an over-the-counter dental cement kit may be an option if you cannot see a dentist right away, but this is only a short-term fix. The primary goal is to protect the bridge and the abutment teeth from further trauma and contamination until a professional can assess the situation and determine if recementation is appropriate.
Common Reasons Bridges Come Loose
Loosening indicates a failure in the components holding the restoration in place. The most straightforward cause is the breakdown of the dental cement bonding the crown to the abutment tooth. Over time, chewing forces and saliva exposure cause the cement to wash out from beneath the crown margins. This creates a micro-gap, allowing the bridge to shift slightly and eventually dislodge.
A more serious cause is the development of tooth decay (secondary caries) underneath the abutment crowns. Poor oral hygiene allows bacteria to accumulate at the crown margins, leading to cavities in the natural tooth structure. As decay progresses, it destroys the underlying tooth material supporting the crown, causing the bridge to lose its secure fit. This scenario requires extensive repair of the abutment tooth before any restoration can be placed.
Excessive biting forces, often due to clenching or teeth grinding (bruxism), are another significant factor. These repetitive forces stress the restoration, potentially cracking the bridge material or causing the cement bond to fail prematurely. Changes in underlying anatomy, such as bone loss from periodontal disease or gum recession, can also affect the bridge’s fit and stability.
Recementing vs. Replacement: The Clinical Decision
The professional evaluation begins with a thorough clinical examination of the bridge and the exposed abutment teeth. The dentist assesses the structural integrity of the bridge, checking for cracks, fractures, or significant wear that would compromise its function. X-rays are routinely taken to determine the health of the abutment teeth and surrounding bone, specifically looking for decay or infection beneath the crown margins.
Recementation is the preferred solution if the bridge is structurally sound and the underlying abutment teeth are healthy. This procedure involves meticulously cleaning the inside surface of the bridge to remove old cement residue or debris. The abutment teeth are also cleaned and prepared to maximize the bond with fresh dental cement. The bridge is then seated back into its original position, often restoring function immediately.
Replacement is necessary when the bridge is damaged beyond repair, such as a fractured framework, or when there is significant decay in the abutment teeth. If the supporting tooth is severely compromised, the decay must be treated first, which can alter the tooth’s shape so much that the old bridge no longer fits accurately. In these cases, a new bridge must be custom-fabricated from a fresh impression to ensure a precise, long-lasting fit.