Pain and Concerns with Dental Bridges: What You Need to Know

Q: Pain and Concerns with Dental Bridges: What You Need to Know

Hello： <br>1. <br>Soft tissue lesions typically require an experienced physician to make an initial diagnosis through direct visual examination, and may even need to be sent for pathological testing. <br>However, since you mentioned that X-rays were taken and confirmed that there

Occasionally, a dental bridge may cause pain?

Hello Dr.
Lin: After undergoing root canal treatment on my front tooth, I developed a dental abscess, and the doctor determined it was due to a root fracture, so the tooth was extracted and replaced with a bridge (the adjacent healthy tooth did not undergo root canal treatment).
Initially, when I tried the bridge, I experienced sensitivity to hot and cold, but this diminished once it was permanently cemented.
However, due to my previous habit of biting on hard objects, sometimes the healthy tooth would hurt the next day if I bit down too hard.
I had previously experienced sensitivity to hot and cold, but it has mostly resolved now.
One day while using a dental floss pick, I felt something above the gum line of the healthy tooth, so I touched it with my finger and felt a soft, movable area, but when I pressed it, I couldn't feel it anymore.
There was no bleeding or pus, but I noticed a small white discharge inside my lip, similar to what one might find at the corner of the mouth upon waking up.
Concerned that it might be an abscess, I scheduled a dental cleaning the next day and asked the doctor to examine it and take X-rays (which appeared normal).
The doctor mentioned that what I felt was likely the tissue behind the labial frenum, and the movable area could possibly be the mucogingival junction, as there seemed to be similar areas elsewhere.
I would like to ask the doctor: 1.
If it were an abscess, shouldn't it be immovable, and would there be blood and white pus after it ruptured? 2.
If there were an abscess, the doctor should be able to see signs of rupture and some pus the day after it burst, correct? After seeing the doctor, I felt something unusual while brushing my teeth three days later, but the situation seemed the same as on the first day.
Since I spent a considerable amount of money on the bridge after the tooth fractured, I am feeling a bit anxious.
If there is indeed an abscess, is there a way to perform root canal treatment without removing the bridge?

Danxin de ren, 30~39 year old female. Ask Date: 2021/11/22

Dr. Lin Jiayong reply Dentistry

Hello:
1.
Soft tissue lesions typically require an experienced physician to make an initial diagnosis through direct visual examination, and may even need to be sent for pathological testing.
However, since you mentioned that X-rays were taken and confirmed that there are no issues with the hard tissue, there should be no need for excessive concern.

2.
For a denture that is already firmly bonded, unless it is absolutely necessary (such as in cases of pulp necrosis leading to a fistula) to perform root canal treatment, the safest and most ideal approach is to remove the dental bridge to access the root canal completely.

P.S.
If the physician has already examined and confirmed that everything is "normal" at this time, there is no need to worry excessively about potential issues in the future.

Respectfully,
Lin Chia-Yung, Department of Dentistry, Taichung Hospital, Ministry of Health and Welfare

Reply Date: 2021/11/22

More Info

Understanding pain and concerns associated with dental bridges is crucial for both patients and dental professionals. Your situation highlights several important aspects of dental health, particularly after undergoing procedures like root canal therapy and dental bridge placement.

Firstly, it's essential to recognize that pain following the placement of a dental bridge can arise from various factors. These may include issues related to the supporting teeth (abutment teeth), the fit and alignment of the bridge itself, or even underlying conditions that may not be immediately apparent. In your case, you mentioned experiencing sensitivity to hot and cold, which can indicate that the supporting teeth may still be sensitive or that there could be issues with the bridge's fit.

1. Understanding Abscesses and Pain: Regarding your concerns about a possible abscess, it is generally true that an abscess would not be movable and would typically present with symptoms such as swelling, pain, and possibly drainage of pus. If an abscess were to rupture, it would likely result in visible signs such as blood or pus, and a dentist would be able to identify this during an examination. The fact that you did not observe these symptoms is reassuring, but it’s still important to monitor the situation closely.

2. X-ray Findings: You mentioned that an X-ray was taken and showed normal results. This is a positive sign, as it suggests that there are no significant issues with the roots of the teeth or surrounding bone structure. However, X-rays cannot always detect soft tissue problems or minor infections that may not have progressed to a stage visible on imaging.

3. Mobility and Sensitivity: The sensation of something movable in your mouth could be related to the soft tissue around the teeth or the dental bridge itself. It’s not uncommon for patients to feel some degree of movement in the gums or soft tissue, especially if there is inflammation or irritation. If the bridge is well-fitted and stable, any movement should ideally be minimal.

4. Treatment Options: If there is indeed an abscess or infection, the standard approach would typically involve addressing the infection first. In some cases, it may be necessary to remove the bridge to access the underlying tooth for root canal treatment. However, if the bridge is stable and the dentist believes the issue can be managed without removal, they may recommend other treatments such as antibiotics or localized treatments to reduce inflammation.

5. Follow-Up Care: Given your ongoing discomfort and the complexity of your dental history, it is advisable to maintain open communication with your dentist. If symptoms persist or worsen, seeking a second opinion or further evaluation from a specialist, such as an endodontist (root canal specialist), may provide additional insights and treatment options.

In summary, while your concerns about pain and potential abscesses are valid, the absence of significant findings on X-rays and the nature of your symptoms suggest that careful monitoring and possibly further evaluation are warranted. It’s crucial to continue discussing your symptoms with your dentist, ensuring that any necessary adjustments or treatments are made promptly to alleviate your discomfort and protect your dental health.

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