Keeping in touch by blog!

Thank you for spending a few minutes and checking out my blog!

This is a great way for me to keep you informed about what's new at Oakdale Dental.  You'll find stories about todays dentistry and how it can make your life better and healthier, and sometimes some random thoughts I hope you find interesting. 

If you are already one of my patients, let me know what you think.  Any topics you would like to read about or questions you have, just send me an email.There is lots of information already on this site and my other practice website: Oakdale Dental! 

For those of you who I have not had the pleasure to meet yet, I'm glad to have here and feel free to drop by and pay us a visit at Oakdale Dental in beautiful Oakville.

So, come back once in a while...I try to post regularly and have some interesting things for you to check out and maybe a story or two to tell.


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"Great things start with a smile!" Dr Rosenblat

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Friday
Nov112011

How long will a (dental) bridge last?

I was at a great lecture last week at the Toronto Academy of Cosmetic Dentistry.  The speaker was one of the gurus we all line up to hear; Dr Carl Misch.  He was talking about dental implants. 

Before we could replace missing teeth with dental implants, the most lifelike way to replace missing teeth was to make a "bridge".  Now you can only have a bridge if there are teeth on either side of the space where the lost teeth were.  These teeth have to anchor the replacement faux teeth and to do that we have to shape them as if they were to be crowned.  Now this isn't without risks - see below.   Dr Steven Rosenblat Oakville Dental Implants This is not to say you should avoid a crown or bridge but if you have an alternative treatment option that will give you a better result than a bridge, why involve the teeth adjacent to space from missing teeth?

So why do non removable dental bridges fail?  According to Dr Misch the four biggest reasons are, in descending order:

1.  decay of the anchoring teeth

2.  need to root canal the anchoring teeth

3.  the crowns on the anchoring teeth detach because the cement fails

4.  the porcelain breaks

Why do these things happen?  Well the decay on the anchoring teeth occurs because it's hard work to keep a bridge clean.  The faux tooth/teeth spanning the space between the anchoring teeth trap plaque and food debris, hidden underneath them ( plaque-that soft stuff that you can clean off your teeth with a brush and floss and is loaded with bacteria).  Most people don't do a very good job of cleaning under a bridge, if they try at all.  So decay is almost inevitable. And if the cement seal breaks down the bacteria get right under the crown where the dentist cannot see it work away at destroying the anchor teeth.  Well what about root canal?   Reshaping a tooth for a crown/bridge according to Dr Misch results in a 5.7% chance of irreversible inflammation of the nerve of the tooth so that it will need a root canal. That is a 1 in 20 chance.  And an anchor tooth in a bridge that has had root canal has a four (4) times greater chance of fracture and being lost  if it is an anchor tooth of a bridge, than if it is a non root canaled anchor tooth!  ( and any root canaled tooth has a 10% failure rate at 8 years according to Dr Misch).  If the neighboring anchor teeth have little or no fillings I really don't want to reshape them to make a bridge.  I don't want to take away healthy enamel and dentine.  The porcelain fractures ( and cement failure too) is often a result of the bridge flexing.  Chewing causes the bridge to bend and the more teeth that are missing the longer the bridge is and  the more it bends when you bite down.  

Dr Misch calls the often inevitable damage resulting from  placing a non-removable dental bridge a "cascade of destruction". ( by the way, removable bridges or what dentists call partial dentures, damage nearby teeth too)

According to Dr Misch, one of the anchor teeth of a bridge is lost at a rate of about 3% after 5 years, 13% after 10 years and 30% after 14 years.  Other studies he sites says on average, after a bridge is place it will be lost or replaces at a rate of 30% in 10 years, 50 after 15 years. 

Does this mean you should not have a non removable bridge placed?  No it does not.  What it means is that we know why a bridge fails and if we can replace missing teeth with a long lasting life like replacement that does not involve the adjacent teeth in the replacement, that should be the first choice. 

What is that 1st choice?  The "gold standard" in replacing missing teeth today.  You guessed it, dental implants.

A bridge can still be an option to replace missing teeth but it is definetly a second choice.