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Dental Bridge: Oral Hygiene Tips

The long-term success of a dental bridge is inextricably linked to the patient’s ability to maintain a plaque-free environment around the restoration. Unlike natural teeth, a bridge connects multiple units, making it impossible to use standard dental floss between the teeth. This unique architecture creates “blind spots” underneath the pontics and around the connectors where biofilm can accumulate undisturbed. If left unchecked, this biofilm leads to gingival inflammation (mucositis) and, more critically, secondary caries (decay) at the crown margins, which is the leading cause of bridge failure. At Liv Hospital, we provide customized oral hygiene instruction, equipping patients with the specific tools and techniques required to navigate the complex topography of their fixed prosthesis.

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Interproximal and Sub Pontic Cleaning

DENTISTRY

The most critical area to clean is the space between the pontic (false tooth) and the underlying gum tissue.

  • Floss Threaders: Since floss cannot be snapped down between the fused crowns, a floss threader, a flexible, needle-like plastic device, is used. The floss is threaded through the loop and then guided horizontally underneath the pontic.
  • Superfloss: This specialized floss is pre-cut into segments. It features a stiffened end for threading, a spongy middle section for cleaning wide spaces, and a regular floss end. The spongy section is particularly effective at sweeping out food debris and plaque from the tissue surface of the pontic without causing trauma to the gingiva.
  • Technique: The floss should be moved in a back-and-forth “shoe-shine” motion, ensuring it wraps around the adjacent abutment teeth to clean the distal and mesial surfaces where the crown meets the root.
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Interdental Brushing

DENTISTRY

For many patients, especially those with larger embrasure spaces or limited manual dexterity, interdental brushes (proxabrushes) are superior to floss.

  • Design: These are small, cylindrical, or cone-shaped brushes attached to a handle.
  • Application: The brush is gently inserted into the space between the gum and the bridge connector. It relies on friction to disrupt the biofilm.

Selection: Choosing the correct size is vital; the brush should fill the space snugly but should not require force to insert. Using a brush that is too large can traumatize the tissue, while one that is too small will not effectively clean the root concavities.

Water Flossers (Oral Irrigation)

Water flossers utilize a pulsating stream of water to flush out plaque, food particles, and bacteria from deep periodontal pockets and subgingival areas.

  • Mechanism: The pulsation creates a compression-decompression phase that flushes out pro-inflammatory mediators and unattached bacteria.
  • Efficacy: Studies suggest water flossers are highly effective for patients with dental bridges, dental crowns, and dental implants, as the liquid can navigate around complex geometries that mechanical tools might miss.
  • Usage: Patients should direct the tip at a 90-degree angle to the tooth axis, tracing the gumline and pausing between teeth.

Sulcular Brushing

The margin where the crown meets the tooth structure is the “Achilles’ heel” of any restoration.

  • Modified Bass Technique: The toothbrush bristles should be angled at 45 degrees towards the gum line. A gentle vibratory motion is used to allow the bristles to penetrate slightly into the gingival sulcus and clean the margin.
  • Brush Type: An electric toothbrush with a pressure sensor is highly recommended. It ensures consistent cleaning action without the risk of abrasion or gingival recession, which could expose the unsightly root or crown margin.

Chemical Plaque Control

Adjunctive use of antimicrobial agents can support mechanical hygiene.

  • Chlorhexidine Gluconate: For short-term management of inflammation or after implant surgery, a prescription chlorhexidine rinse may be used.
  • Essential Oils/CPC: Daily use of over the counter therapeutic mouthrinses containing critical oils or Cetylpyridinium Chloride (CPC) can help reduce the overall bacterial load in the oral cavity.

Fluoride Therapy: High-concentration fluoride toothpastes or varnishes are crucial for preventing decay on the natural tooth structure supporting the bridge, especially in patients with a history of high caries risk.

Dietary Considerations

  • Sugar Frequency: Reducing the frequency of sugar intake limits the acid attacks that can demineralize tooth structure at the bridge margins.
  • Texture: Patients should avoid biting directly into tough foods (such as ice or bones), as this can fracture porcelain. Sticky foods (like caramel) can destabilize the cement seal over time.

Professional Maintenance

  • Home care must be supplemented by professional prophylaxis.

    • Scaling: Dental hygienists use specialized instruments (plastic or titanium scalers) to clean around dental implants and ceramic bridges without scratching the surface. Scratches on the surface can increase plaque retention.
    • Examination: Regular check-ups allow the dentist to check for “washout” of the cement, which is often asymptomatic until significant decay has occurred.

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FREQUENTLY ASKED QUESTIONS

Can food get stuck under a dental bridge?

Yes, if there is a gap between the pontic and the gum, food can accumulate; using interdental brushes or superfloss is essential to remove it.

Yes, water flossers are safe and highly recommended for cleaning under bridges as they flush out debris without damaging the restoration.

You should clean under your bridge at least once a day, preferably at night, in addition to your regular twice-daily brushing.

A non-abrasive, fluoride-containing toothpaste is best; avoid harsh whitening toothpastes that can scratch the ceramic glaze.

A hygienist can remove hardened tartar that you cannot remove at home and check for early signs of gum disease or decay around the bridge margins.

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