A dental bridge is a fixed prosthetic solution designed to replace one or more missing teeth, effectively “bridging” the gap by anchoring to natural teeth or implants on either side. The presence of pain beneath or around a dental bridge is never a normal occurrence and serves as a clear indication that a biological or mechanical problem has developed. While the bridge is made of inert materials, the underlying structures remain vulnerable to damage and disease. This discomfort is a serious symptom requiring professional diagnosis to identify the precise underlying cause, which may range from issues with the supporting teeth to problems with the bridge’s fit or the surrounding gum tissue.
Pain Related to the Abutment Teeth
The most frequent source of pain beneath a fixed bridge originates from the abutment teeth that support the entire restoration. These natural teeth, which are prepared and covered with crowns, remain susceptible to secondary decay (caries) at the crown margin. This decay often progresses undetected because it is hidden from view beneath the prosthetic and the gum line, allowing bacteria to penetrate the tooth structure. If the decay is not addressed early, it can reach the pulp, leading to a painful condition known as irreversible pulpitis.
This deep infection causes severe, throbbing pain and typically necessitates root canal treatment, which is a complex procedure when performed through an existing bridge. Another significant cause of pain is the development of a root fracture in an abutment tooth, often due to the immense biting forces concentrated on the bridge structure. A fracture can cause sharp, intense pain upon chewing and may lead to leakage and infection.
Problems with the Bridge Structure or Fit
Pain can also arise from a mechanical failure of the bridge itself or the integrity of its connection to the abutment teeth. A common mechanical issue is the washout of the luting cement, the material used to bond the bridge to the prepared teeth. Over time, the cement can dissolve, creating a microscopic gap between the inner surface of the crown and the tooth structure. This gap facilitates micro-leakage, allowing saliva, bacteria, and debris to seep into the interface, which can initiate secondary decay on the abutment tooth or cause sensitivity.
The quality of the marginal fit—the seal where the crown meets the tooth—is paramount, as discrepancies in fit increase the risk of micro-leakage and recurrent caries. An uneven distribution of force, known as occlusal trauma, also creates pain if the bridge is positioned too high or is improperly contoured. This excessive biting pressure stresses the periodontal ligament and bone supporting the abutment teeth, causing inflammation and discomfort whenever the patient bites down.
Gum and Soft Tissue Inflammation
Inflammation and infection of the soft tissues surrounding the bridge are another common source of discomfort. The difficulty in cleaning under the bridge’s false tooth, or pontic, can lead to a buildup of plaque and food debris. This accumulation often accelerates the progression of gingivitis or, more seriously, periodontitis, which is the infection of the gums and the underlying bone supporting the teeth.
Poorly designed or ill-fitting pontics can also cause physical irritation, leading to pressure necrosis or a chronic ulceration of the gum tissue directly beneath the restoration. The tight contact of the pontic against the gum ridge can restrict blood flow and create a constant source of localized soreness and inflammation. While the bridge itself is not the direct cause of gum disease, it creates areas that are challenging to maintain with routine brushing and flossing. This hygiene challenge increases the risk of soft tissue problems, which manifest as redness, swelling, and bleeding gums around the abutments.
When to Seek Urgent Dental Care
Certain symptoms demand immediate professional attention to prevent the problem from escalating into a serious health concern. Urgent indicators include severe, persistent throbbing pain that does not respond to over-the-counter pain relievers, visible swelling in the face or jaw, or the presence of pus draining from the gum tissue near the bridge. A sudden feeling that the bridge has become loose or has completely fallen out also requires an emergency dental appointment.
While waiting for the appointment, temporary relief can be achieved by gently rinsing the mouth with warm salt water to soothe inflamed tissues and manage bacteria. A definitive diagnosis requires the use of specialized imaging, such as radiographic images, to evaluate the health of the abutment teeth and the supporting bone. X-rays are necessary because the cause of pain is often hidden beneath the bridge structure, revealing deep decay, root fractures, or bone loss that is invisible during a standard visual examination.