For many years Fixed Partial Dentures (FPDs or Fixed Bridges) were the high-end standard of care to replace a missing tooth. With the advent of dental implants, that perception has shifted. Why? Because an FPD essentially takes a 1 tooth problem (a missing tooth) and makes it into a 3 tooth problem.
To do an FPD, the teeth on either side of your missing tooth must be ground down to create space for a crown. Sometimes another type of connector to the adjacent teeth is used, but a crown is the most common. The teeth on either side of the missing tooth are called abutment teeth. 80% of abutment teeth have only small or no fillings or other dental restorations before they become the abutment teeth for your FPD—this means we are often taking away healthy tooth structure in order to replace your missing tooth. (You can learn more about FPDs here: Crowns & Bridgework)
The way an FPD is made, the crowns and replacement tooth are all connected together. (If you’ve never seen an FPD, ask your dentist to show you an example of one.) You can brush these FPDs or Fixed Bridges as you normally do, but because they are connected, you cannot floss them like you floss your natural teeth. Flossing them is possible, and your dentist or dental hygienist can show you how to do so. But we know that most people don’t take the time to floss their natural teeth—so are they really going to go through the more time-consuming process to floss their Fixed Bridge or FPD?
The two most common reasons that we need to recommend replacement of a Fixed Bridge or FPD are (1) decay on one of the abutment teeth or (2) periodontal disease (gum disease) around one of the abutment teeth.
So why does the title say “Making a 1 Tooth Problem Into a 3 Tooth Problem”? Because most FPDs will fail after 5-10 years and once the FPD fails, even if the decay or periodontal disease is only on one of the two abutment teeth, you’re looking at dealing with 3 teeth in order to fix it not just one. A problem that greatly increases the cost of fixing it.
Think it won’t happen to you? Studies show that 8-12% of abutment teeth are lost in the first 10 years and 30% are lost after 15 years! Compare that to dental implants which have a success rate of 98% and don’t require you to grind down adjacent teeth. Though dental implants cost more at the beginning, studies show they cost less over time. (By 5-7 years out the dental implants starts earning you money when you don’t have to pay out to replace your failing FPD). One graph I’ve seen shows that at approximately the 7 year mark the expense lines cross and the FPD starts being more expensive than a dental implant. You can learn more about dental implants here: Top Reasons to Choose Dental Implants and Dental Implants FAQs
Of course, the FPD or Fixed Bridge still has a place. There are times when a dental implant cannot be placed or the condition of the adjacent teeth may mean they’d require crowns anyway (though that still doesn’t negate the possibility of it becoming a 3 tooth problem down the road if the abutment teeth fail.)
If you do find that you need to make a decision about replacing a missing tooth, talk with your dentist about your options and don’t be afraid to ask questions about dental implants, FPDs, or removable options—and be sure you understand the pros and cons of each choice.
**Note: The information in this article is not meant to replace the clinical judgement of your healthcare professionals.
Jennifer G. Robb, DMD is a general dentist who sees both adults and children.
Most dental procedures today only require local anesthesia to numb just the affected area. It's a safer approach than general anesthesia: the unconscious state created by putting someone "to sleep" can lead to some unpleasant complications.
But patient comfort involves more than preventing physical pain during a procedure. There's also the emotional factor—many people experience nervousness, anxiety or fear during dental visits. It's especially problematic for an estimated 15% of the population whose dental visit anxiety is so great they often try to avoid dental care altogether.
One option is to use general anesthesia for patients with acute anxiety rather than local anesthesia. This removes them consciously from their anxiety, but they must then be monitored closely for complications.
But there's a safer way to relax patients with high anxiety called intravenous or IV sedation. The method delivers a sedative medication directly into a patient's bloodstream through a small needle or catheter inserted into a vein. The sedative places the patient in a relaxed "semi-awake" state, taking the edge off their anxiety while still enabling them to respond to verbal commands.
Coupled with local anesthesia, they won't experience any pain and very little if any discomfort. And many of the sedatives used also have an amnesiac effect so that the patient won't remember the procedures being performed.
IV sedation does require monitoring of vital signs, but the patient won't need help maintaining their breathing or heart function. And although the medication can be adjusted to reduce any lingering after-effects, a patient will still need someone to accompany them to and from their visit.
For lesser anxiety or nervousness, dentists sometimes prescribe an oral sedative to take just before a visit. This can help take the edge off your nerves and help you relax. With either method, though, sedation can help you overcome fear and anxiety and have a more pleasant treatment experience.
If you would like more information on IV sedation, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “IV Sedation in Dentistry.”
If something flies “in the teeth of” something else it is opposing it. This uses opposing as a verb (action word). In dentistry, opposing is used as an adjective (describing word) to talk about the tooth or teeth that meet up with the tooth or teeth your dentist is working on. In a large case, opposing could mean the entire other arch (upper or lower). This is why your dentist sometimes takes an impression of the top when you’re having work done on a bottom tooth or the bottom teeth when you’re having work done on a top tooth. In order to make sure dental appliances fit you correctly, we need to know what the opposite side looks like and how your teeth come together.
Opposing teeth are also why we ask you to bite on a marking paper after we’ve done a filling or crown. We want to see how your teeth come together. If an area is hitting too hard or too high, it can break the filling material or cause you discomfort—sometimes a lot of discomfort! Teeth are used to sharing the load of chewing and biting. A high spot puts more stress on that particular tooth. For many people, that extra stress makes the tooth sensitive to everything (hot, cold, breathing etc.) Even a small adjustment can often make the tooth feel much better! (This is why it is often what we suggest trying first if you’ve had a recent filling and developed these symptoms shortly after.)
Your dentist should be your ally in creating your best dental health rather than an opponent! Most want to make your visit as pleasant an experience as possible.
NOTE: Information in this article is not meant to replace the clinical judgement of your healthcare professionals.
Dr. Jennifer Robb is taking new patients. She has over 20 years experience with 16 of them being at her current location of 1612 Cooper Foster Park Rd., Lorain, OH. Call 440-960-1940 to schedule. Find more information at www.drjrobb.com or find us on Facebook at www.facebook.com/DrJenniferRobb
Some moviegoers have been known to crunch popcorn, bite their fingers or grab their neighbor’s hands during the intense scenes of a thriller. But for one fan, the on-screen action in the new superhero film Black Panther led to a different reaction.
Sophia Robb, an 18-year-old Californian, had to make an emergency visit to the orthodontic office because she snapped the steel wire on her retainer while watching a battle scene featuring her Hollywood crush, Michael B. Jordan. Her jaw-clenching mishap went viral and even prompted an unexpected reply from the actor himself!
Meanwhile, Sophia got her retainer fixed pronto—which was exactly the right thing to do. The retention phase is a very important part of orthodontic treatment: If you don’t wear a retainer, the beautiful new smile you’re enjoying could become crooked again. That’s because if the teeth are not held in their new positions, they will naturally begin to drift back into their former locations—and you may have to start treatment all over again…
While it’s much more common to lose a removable retainer than to damage one, it is possible for even sturdy retainers to wear out or break. This includes traditional plastic-and-wire types (also called Hawley retainers), clear plastic retainers that are molded to fit your teeth (sometimes called Essix retainers), and bonded retainers: the kind that consists of a wire that’s permanently attached to the back side of your teeth. So whichever kind you use, do what Sophia did if you feel that anything is amiss—have it looked at right away!
When Black Panther co-star Michael B. Jordan heard about the retainer mishap, he sent a message to the teen: “Since I feel partly responsible for breaking your retainers let me know if I can replace them.” His young fan was grateful for the offer—but even more thrilled to have a celebrity twitter follower.
If you have questions about orthodontic retainers, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “The Importance of Orthodontic Retainers” and “Bonded Retainers.”
Your gums form a sort of “turtleneck” around your teeth. When you wear a turtleneck shirt, you can slide a finger between the cloth and your neck. The same thing happens on a smaller scale with your teeth and gums. There’s an area where floss and your toothbrush’s bristles can slide between your teeth and gums to clean. This is true even for healthy gums! We call this space a periodontal pocket. Perio means around and dontal refers to the teeth (gums are around your teeth, right? There’s also bone around your teeth, which is covered by your gums).
We measure your periodontal pocket in millimeters (mm). What we have found is that depths of 0-3 mm are ones where your toothbrush and floss are able to keep the pocket clean. Depths of 4-5 mm indicate early gum disease and depths of 6 mm or higher indicate advanced gum disease.
What’s happening as the periodontal pocket measurement numbers are getting larger is that the bone around your tooth reacts to long-term inflammation of your gums. The bone moves away from the biting surface of your tooth and toward the root of your tooth when this happens—this means there is less bone around your tooth to hold it in your jaw. Once this happens, your gums have three choices:
- Follow the bone down the root of your tooth.
- Stay at the height it was before.
- A combination of the above (it follows the bone some of the way toward the root but not all the way toward the root.)
If the gum stays at the height it was before the bone changed, the space we can measure gets larger. (We’ll often say the periodontal pocket gets deeper.) The larger, deeper space traps more bacteria and food—and as the pocket gets deeper, your toothbrush and floss can no longer clean it out effectively, so the process becomes self-perpetuating. (It will keep getting worse until you have periodontal treatment of some kind.)
(Just as a side note—if your gum follows the bone down the root of your tooth, we call that gingival recession. Gingiva is the fancy name for your gums.)
I like to explain the periodontal pockets like clothes pockets. When I was in school, the popular jeans had a tiny little pocket inside the pocket on the right hand side. This pocket was about the size of a quarter or half-dollar coin—you could probably only get one or two fingers into it at a time—this is the ultra-healthy periodontal pocket.
The regular pockets on jeans or your pants where you can put your hands in and easily find your keys or whatever you’re looking for are the 1-3 mm or maybe even the 4 mm periodontal pockets.
Pockets on cargo pants—those deeper pockets that are harder to reach into and pull out what you need—are like the 5 mm and larger pockets.
I hope this explanation of periodontal pockets makes sense to you and allows you to better understand what your dentist means when she or he discusses periodontal pockets or does a periodontal charting.
*Note: Information in this article is not meant to replace the clinical judgment of your healthcare professionals.
Dr. Jennifer Robb is a general dentist who treats both adults and children.
1612 Cooper Foster Park Rd.
Lorain, OH 44053
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