Dr. Noah's Dentistry Blog

Questions About Dentistry Answered

Worried About Maryland Bridge Before Dental Implant

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I have a 13 year old daughter who needed orthodontics and has a congenitally missing tooth. We’re finished with her braces and our long term plan is to get a dental implant for her missing tooth. We just need to keep that space open until she is old enough for the procedure, in the meantime.

Our dentist has suggested that we use a Maryland Bridge. He’s been doing one with a ceramic back, but it keeps falling off. He is talking about doing a metal one, but I’m not crazy about that. I worry it will stain her teeth. What do you think? Would a different cement on the ceramic one work better?

Abigail

Dear Abigail,

Two illustrations of a Maryland Bridge

I’m glad you wrote. The good news is that your choice of a dental implant is perfect. It is the best tooth replacement you can give her once she is older. I don’t think this dentist is serving your daughter (or your bank account) well. I am sure he has the best of intentions, but I don’t like his choice of a temporary tooth replacement. A Maryland Bridge isn’t really a temporary tooth replacement. That is because in order for it to really stay in place, the dentist has to cut a notch into the tooth, such as in the image above. Anything that changes the structure of your teeth is not a temporary tooth replacement. Once she is ready for her dental implant, she will need dental bonding in order to fill in the notch needed for the bridge.

The fact that your dentist cannot keep the Maryland Bridge on makes me wonder if he did that notch. If he didn’t, don’t have him do it. Instead, I want you to get a real temporary tooth replacement— a dental flipper. In fact, get one either way and get a refund on the Maryland Bridge. As an additional benefit, not only will the dental flipper not change any of her tooth structure, but it is significantly cheaper than the Maryland Bridge your dentist suggested.

I hope this helps.
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Tooth Replacements for Hockey Players

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My son is on a hockey team. They just finished their season. However, in the last game he took a direct hit and lost a tooth. We were planning on getting it replaced with a dental implant because I wanted him to have something permanent. However, one of his teammates said that a dental implant is a bad idea in case he gets hit again. What do you recommend? His appointment is coming up soon and I want to make sure he’s getting the right treatment.

Katherine

Dear Katherine,

Dental Implant Diagram

I’m glad you wrote. First, in normal circumstances, dental implants are the absolute best tooth replacement available, so you choose well. I was thinking about his teammate’s comments and believe I have a solution. Go forward with his appointment to have the dental implant placed. Having that implant in there will prevent him from having bone loss in that area.

The part I want you to put off is having the dental crown attached to the implant. If he were to get hit in that area again and the crown was secured to the implant it could cause some bone damage as the implant is ripped out.

Instead, what he needs is a temporary replacement to fit in the space above the implant. You could do a removable partial denture, or even a dental flipper. Either one of those will be inexpensive and provide him with a tooth until he can have a permanent crown safely placed when he’s done with his hockey career.

Thank you for writing about such an interesting problem.
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Affordable Solution for a Missing Front Tooth

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I lost a front tooth and look absolutely ridiculous. My dentist wanted me to get a dental implant but I didn’t have enough money for that. So, he suggested a snap-on smile. I got that because it was in my budget. I’m really disappointed in it. My smile looks WAY bulkier. I almost feel like I have horse teeth. Are there other options or am I stuck choosing between being a horse or a hillbilly?

Pamela

Dear Pamela,

Illustration of Snap-on Smile

I’m actually really surprised that your dentist suggested snap-on smile for your situation. It has its uses, but this isn’t a use I’d think was a natural fit. The bulkiness issue is because snap-on smile fits over your teeth. There is no way to avoid that.

Instead of covering your entire upper arch, for a missing tooth you just want to replace that tooth. Yes, dental implants are the best option, but not everyone can afford that. I don’t understand why he didn’t tell you about the more affordable tooth replacement options. Ethically speaking, a dentist is supposed to give you all of your treatment options.

For a missing tooth there are quite a few options, such as:

I put those in order of cost so if you are looking for the least expensive option, then I would just get a dental flipper to put in the place of the missing tooth.

What you don’t want to do is leave the space open too long because you have the snap-on smile. If you do, the adjacent teeth will begin to shift into the open spot. This will throw off your bite and can lead to jaw pain, headaches, and even TMJ problems.

If I understand what you were wanting, which is an affordable means of replacing a tooth, not just hiding the hole, then your dentist is giving you bad advice. Even if you just asked for a way to cover the space, he should have warned you about shifting and given you the options I mentioned above.

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Dentist Said I Need Implants that I Cannot Afford

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I don’t know what to do. I lost two teeth a year ago and need to fill the space. My dentist wants me to fill it with dental implants but I just can’t afford to do that, especially because he wants full payment up front. Do I have any other options that are more affordable? I hate looking like a hillbilly.

Kevin

Dear Kevin,

Hockey player with missing tooth

The good news is that you do have options. Before going into them, I want to make sure you understand how important it is that you do get these teeth replaced. When you have open spaces in your bite, the adjacent teeth will begin to shift or tip into that space, which will throw off your bite. Aside from an unsightly smile, that can also lead to painful TMJ disorder.

While dental implants are your best option because they protect you from bone loss in your jaw, they are not your only option. Sometimes, you need to get an affordable option while you save up for the ideal procedure.

Tooth replacements, other than a dental implant, range from a dental bridge, which is also permanent, all the way down to a dental flipper, which is removable and meant to be temporary. If you plan on saving up to get dental implants, then I would get the dental flipper. It is your least expensive option and will keep your teeth in place while you work toward your goal.

If you have no intention of getting dental implants, then I would lean toward the dental bridge. It is permanent and will give you a greater sense of security. You’ll also have a much higher chewing capacity than if you were to get something like a removable partial denture.

Finally, bear in mind that dentists differ in their willingness to work with patients financially. If you look for a dentist who advertises him or herself as an affordable dentist, they may be willing to let you pay your treatment out slowly. This could give you a more realistic chance of getting the better procedure.

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Will a Dental Flipper Make My Teeth Look Straight?

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I really don’t want braces. They take forever, hurt, and look horrible. Would a dental flipper work to just make them look straight?

Ben

Dear Ben,

A woman placing her Invisaliagn aligners

Orthodontics no longer has to mean metal braces

I like how you like to think out of the box. That shows a creative mind open to new ideas. Unfortunately, the dental flipper won’t be a viable solution for you. It’s meant as a temporary tooth replacement option. However, I do have two great solutions for you.

The first will do what you were hoping a dental flipper would accomplish. Snap-on Smile will fit snap over your teeth and make them appear straight. However, because they fit over your teeth they tend to make your smile look bulky. You also need to understand their limitations. These aren’t going to be a beautiful smile makeover like porcelain veneers. They’ll look okay. They can even look attractive. But, they won’t be stunning.

Invisalign—The Modern Alternative to Braces

You no longer have to wear traditional braces with their ugly, uncomfortable wires and brackets. Invisalign uses clear, comfortable aligners. You wear them in two-week intervals and switch them out for the next set. They’re nicknamed invisible braces because no one can tell you’re wearing them, even at a conversational distance.

Because they’re removable, you can eat whatever you want. Additionally, it makes it easier to brush and floss. You simply remove your aligners and brush and floss as you normally would.

A little-known side benefit of Invisalign is the aligners can double as teeth whitening trays. This allows you to get two procedures knocked out in one go. It’s like getting a mini smile makeover. You’ll look and feel great. You’ll also be surprised how much more confidence a nice smile brings you.

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Orthodontist vs. General Dentist: Who’s Right?

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I’m having trouble figuring out what’s going on with my son’s teeth. We have a great orthodontist and what I thought was a good dentist, but now I’m not so sure. My son is missing a tooth on the upper right, near the front. We planned to have an implant done for him when he’s older, so the orthodontist straightened everything out and left a space for the implant. He said we could either get a retainer to keep everything in place or have the family dentist make something else. Well, that something else wound up being a “Maryland bridge,” to put a false tooth in place for the next few years. On the first round, the dentist created something with clasps and it fell out right away. He said it was the cement, so he put it back in with something stronger. It fell out again within a few days. Now he wants to have the whole thing remade with metal clasps and I’m a little worried that the same thing will happen. I mentioned it to the orthodontist and he said he wasn’t sure why the family dentist was going this route and suggested we get a flipper instead. I’m really torn. Was the orthodontist saying the dentist did something wrong? Should we switch gears and get a flipper? Do we need a new dentist?

Thanks,

Jocelyn

Dear Jocelyn,

The problem probably wasn’t the cement. It was the way that the teeth were prepared. The adjacent teeth needed notches cut in them to hold the bridge in place, but in an effort to be conservative, the dentist probably made them too shallow. For this reason, the replacement bridge will probably do the exact same thing. The only real fix is to make those grooves deeper, but that will permanently alter the structure of those teeth. Since they’re healthy, that would not be the best form of treatment.

It’s unclear why your dentist chose this route over a flipper to begin with, unless it’s because you passed on the retainer and they’re similar in build. Your best bet is to request the flipper, instead of going forward with a new bridge. This is something that your family dentist should be able to create for you, but if you have trouble, you may want to find out who the orthodontist prefers for general dentistry and get an opinion from that office.

I hope this helps you make a decision.

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Replacing a bottom tooth

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Is it possible to get a dental flipper placed on a bottom tooth?

Parker S.- Texas

Parker,

Yes, it is possible to get a dental flipper placed on a bottom tooth. Bear in mind that these are not very sturdy. It consists of a false tooth attached to a plastic plate that snaps in with some wires. These are generally used as a temporary replacement while you get a permanent fix arranged. My suggestion would be to get a dental implant as your permanent tooth replacement. They are much sturdier and will protect you from bone loss at the extraction site.

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