Recently, a woman came into my office for a second opinion about her dental condition. Two other dentists had told her that she needed a new fixed bridge for her upper teeth. (A fixed bridge is a series of crowns or caps that are joined together to rebuild existing teeth and also to permanently replace missing teeth. The procedure usually yields excellent results, but the cost can be substantial.) To evaluate her situation, I took a few x-rays of her teeth, and then did a clinical (hands-on) evaluation. My conclusion was that her bridge, although 25 years old, was in very good condition, and that replacement was not needed. She then showed me her dentist's estimate for the unnecessary bridge, with a cost of seven thousand dollars.
After she left my office, I wondered how many other people faced a similar situation. I consider dentists to be highly ethical people as a group, but there are always a few exceptions. So what can you do? The first thing is to be armed with some information that can help. What you need to know is why a bridge should be replaced and how long a bridge should last. Some of the main problems that may require a bridge to be replaced include: deep cavities that get under the crown margins (the area where the crown ends and tooth begins), severe gum disease that weakens a tooth or teeth that support the bridge, and breakage of the porcelain or metal that gives the bridge its structural support. Some patients may also want a bridge replaced to improve its appearance, as when the gum recedes to expose the dark and unattractive crown margins.
If your dentist suggests that your bridge should be replaced, you should ask him or her why. If you are not satisfied with the answer, ask if he or she would mind if you took the x-rays to another dentist or to a dental school for a second opinion (x-rays are one great way for a dentist to evaluate if a bridge is still in good shape). If your dentist is resistant and unwilling, that might be a red flag, and you should consider getting that second or third opinion before making any treatment decisions.
Finally, it is important to know how long a bridge should last. Although every case is different, it is reasonable to expect that your bridge should last at least 8-10 years. I have seen some bridges have lasted for as long as forty years or more- believe me; they're out there. So here's what you can do to increase the longevity of your bridge. First, it is very important to maintain good oral hygiene. Next, I would also suggest that you avoid hard and sticky foods (pretzels, hard candy, caramels, chewing gum, etc.), and also use a custom athletic mouthguard if you are involved in contact sports. Lastly, make an effort to see your dentist for examination and a professional cleaning at least twice a year.