A dental bridge is a fixed prosthetic device used to replace missing teeth, anchored by crowns on adjacent natural teeth or implants (abutments). Pain when chewing with a bridge is a concerning symptom that indicates an underlying issue requiring professional evaluation. Abutment teeth bear the chewing forces transferred through the bridge. Discomfort under pressure suggests a problem with the fit, the supporting teeth, or the surrounding soft tissues. Prompt assessment by a dentist is necessary to determine the cause and prevent further complications.
Identifying the Source Mechanical and Fit Issues
Pain when biting down often points to a mechanical or structural problem with the bridge. The most frequent issue is an improper bite alignment, or a “high spot,” on the chewing surface. This high spot causes premature contact with the opposing tooth, concentrating excessive force onto the abutment tooth’s ligament and bone. This excessive pressure irritates the periodontal ligament, leading to inflammation and discomfort with every bite.
The restoration relies on a secure fit, and a loose or fractured bridge can also cause pain. If the cement seal weakens, the bridge can slightly shift or rock under pressure, irritating the prepared abutment teeth underneath. This movement allows bacteria to seep into the gap, initiating decay or irritating the gum tissue. A fracture in the porcelain or framework compromises structural integrity, leading to pain when force is applied during chewing.
Biological Causes Affecting Abutment Teeth
The causes of bridge pain often involve the biological health of the abutment teeth supporting the structure. Even though these teeth are covered by crowns, they remain living and vulnerable to decay and disease.
Secondary Decay
Secondary decay is a common biological issue, forming at the margin where the crown meets the natural tooth structure, often below the gum line. When this seal is compromised, bacteria infiltrate the space and create a cavity. Chewing pressure on a decayed tooth presses on sensitive inner structures, leading to sharp, localized pain. This decay threatens the structural stability of the abutment tooth, which is essential for the bridge’s long-term success.
Pulpitis/Nerve Inflammation
Pain can signal inflammation or infection within the tooth’s innermost part (the pulp), a condition called pulpitis. Preparing the abutment teeth for crowns can sometimes traumatize the pulp tissue, leading to nerve sensitivity or inflammation. Deep decay progressing toward the pulp chamber can also cause this reaction, and chewing amplifies the pressure on the inflamed nerve. If the pulp becomes necrotic, an infection or abscess can form at the root tip, causing throbbing or persistent pain exacerbated by biting.
Periodontal Issues
The supporting gum and bone tissue around the abutment teeth are susceptible to disease that causes pain during chewing. Inadequate hygiene can lead to plaque accumulation, causing gingivitis or periodontitis. Periodontitis involves inflammation and progressive bone loss around the root, compromising the abutment’s support. When structural support is weakened, chewing forces strain the loosened tooth, resulting in tenderness and sensitivity.
Diagnostic Procedures and Professional Assessment
A professional assessment begins with a thorough clinical examination using specific tools to pinpoint the source of pain. Dental X-rays are a foundational diagnostic step, providing a view of the tooth roots, surrounding bone, and the area beneath the crown margins. These images help identify hidden issues such as secondary decay, bone loss from periodontal disease, or an abscess at the root tip.
To evaluate the mechanical fit, the dentist uses articulating paper (bite paper), a thin, colored film. The patient bites on this paper, and the marks left on the bridge highlight any high spots or uneven contact points causing traumatic pressure. The nerve’s health is assessed using percussion, gently tapping the tooth to check for sensitivity suggesting apical inflammation. Thermal testing, using cold spray or a heated instrument, helps determine the vitality and inflammatory status of the pulp tissue.
Periodontal probing is performed by inserting a calibrated instrument between the gum and the tooth surface to measure the depth of the gum pocket. Increased pocket depth around an abutment tooth signals gum inflammation or bone loss, which can cause pain when pressure is applied. Combining these diagnostic methods allows the professional to identify the exact cause, whether mechanical, structural, or biological.
Treatment Pathways for Resolution
The resolution of dental bridge pain depends entirely upon the underlying cause identified during diagnosis. For mechanical issues, treatment is often straightforward, involving simple occlusal adjustment. If articulating paper reveals a high spot, the dentist can grind and polish the porcelain surface to achieve even contact with the opposing teeth, immediately relieving pressure-related pain.
If the bridge is loose but the abutment teeth are healthy, the dentist may clean and re-cement the existing restoration with a new adhesive. If the bridge is fractured, has a poor original fit, or if the underlying decay is extensive, a complete replacement is necessary. Biological issues demand more involved procedures to save the abutment teeth and preserve the bridge foundation.
For shallow secondary decay, the dentist may remove the bridge, treat the cavity with a filling, and re-cement the original bridge. If decay has progressed to cause pulpitis, a root canal procedure is required to remove the inflamed or infected nerve tissue from the abutment tooth. If the decay is too severe or structural failure has occurred, the abutment tooth may need extraction, necessitating a new, longer bridge or an alternative solution like a dental implant.