A fixed dental bridge replaces one or more missing teeth using an artificial tooth (pontic) anchored to crowns placed on adjacent natural teeth (abutments). While the restoration itself is not susceptible to decay, the underlying natural teeth and surrounding gum tissue remain vulnerable to plaque and bacteria accumulation. Specialized cleaning techniques are necessary because the bridge’s fixed structure creates an inaccessible space between the pontic and the gumline where debris and microbes can easily become trapped. Failure to meticulously clean this area can lead to gum inflammation, decay in the supporting abutment teeth, and eventual bone loss, which compromises the longevity of the entire restoration.
Essential Tools for Bridge Maintenance
Cleaning a fixed bridge effectively requires specialized tools to access the unique spaces beneath the pontic and around the supporting teeth. These tools are necessary because standard toothbrushes and traditional floss cannot navigate the fixed structure of the restoration.
Floss threaders are flexible plastic loops designed to guide dental floss underneath the fixed structure of the bridge. They allow standard or specialized floss to be pulled through the small space between the pontic and the gum tissue. Specialized bridge floss, often called Superfloss, includes a stiffened end that serves the same threading purpose, transitioning into a thick, spongy section intended for cleaning wider spaces.
Interdental brushes are small, cone-shaped brushes available in various sizes to fit different gaps. These brushes are useful for removing plaque and food particles from the sides of the abutment teeth and the space directly under the bridge, provided the gap is wide enough to accommodate the brush without forcing it. Oral irrigators, commonly known as water flossers, use a pressurized stream of pulsating water to flush out debris, providing a non-mechanical method to clean along the gumline and under the bridge.
Targeted Cleaning Techniques for the Pontic Area
The most challenging aspect of bridge maintenance is cleaning the sub-pontic area, the space directly beneath the artificial tooth that rests above the gumline. This requires a precise and gentle technique to ensure plaque removal without irritating the delicate gum tissue.
To use a floss threader, first insert a section of regular floss or Superfloss through the threader’s eye. Carefully guide the stiff end of the threader underneath the bridge, through the space between the pontic and the abutment crown, or directly beneath the pontic itself. Once the threader is pulled through to the other side, it carries the floss with it, allowing you to grasp both ends of the floss.
With the floss positioned under the pontic, the cleaning motion involves moving the floss back and forth and gently wiping the underside of the artificial tooth. If using Superfloss, the spongy, thicker section should be worked against the internal surface of the pontic to maximize debris removal. Avoid a harsh, sawing motion, which can cause trauma to the gum tissue surrounding the abutments. Instead, use a gentle, firm pressure to scrape away the accumulated biofilm.
Interdental brushes are used where the space beneath the pontic is wider, allowing the brush head to pass without resistance. The brush should be inserted gently into the gap and moved in a soft, in-and-out motion to scrub the internal surfaces of the bridge and the adjacent gums. Selecting the correct brush size is important, as a brush that is too large can cause abrasion, and one that is too small will not clean effectively.
A water flosser provides an alternative method for cleaning the sub-pontic space and is particularly beneficial for individuals with limited manual dexterity. Fill the device with lukewarm water and direct the nozzle tip toward the area where the pontic meets the gum tissue. The pulsating water stream dislodges trapped food and bacteria, effectively flushing out the area. Start on a low-pressure setting and gradually increase it to a comfortable level, ensuring the entire underside of the bridge is thoroughly rinsed.
Daily Care for Abutment Teeth and Overall Bridge Structure
While the specialized techniques focus on the inaccessible area, the visible surfaces of the bridge and the crowns covering the abutment teeth require routine, general hygiene. These surfaces are brushed similarly to natural teeth, using a soft-bristled toothbrush and a non-abrasive fluoride toothpaste. The crowns covering the abutment teeth are still fixed to natural tooth structure, which remains susceptible to decay at the margins.
The brushing technique should employ small, gentle, circular motions, focusing particular attention on the gum line where the crown meets the soft tissue. Angling the brush head at a 45-degree angle toward the gums helps to sweep plaque away from the gingival margin. Proper cleaning of the abutment crowns is necessary to prevent recurrent decay, which can compromise the entire bridge structure.
Beyond brushing, rinsing with an antibacterial or fluoridated mouthwash can supplement the mechanical cleaning efforts. Rinsing helps to reduce the overall bacterial load in the mouth and washes away any residual food particles loosened during flossing and brushing. Choosing an alcohol-free mouthwash is recommended to prevent potential irritation to the gums and drying of the oral tissues.
Maintaining the gum line health around the abutment teeth is important, as inflammation in this area can lead to periodontal disease and bone loss, jeopardizing the bridge’s support. The accessible surfaces of the pontic and the crowns should be brushed twice daily for at least two minutes. This routine care, combined with the specialized sub-pontic cleaning, ensures the longevity and health of the entire dental restoration.