Oral Hygiene for Fixed Bridgework

Flossing around dental implants helps prevent gum disease

Dear Doctor,
I don't have my natural teeth anymore — just bridgework supported by dental implants. Do I really still need to floss?

Dear Jeffrey,
The short answer to your question is: absolutely! You still need to floss every day. Although your implants and crowns themselves can't actually decay, the supporting structures around them — namely, your gum and bone tissues — can break down if bacteria and food debris are not effectively removed. The best way to remove the sticky film that clings to surfaces inside your mouth is by brushing and flossing daily. In fact, floss is the only tool you can use at home that lets you clean below the gum line.

It will take some effort to become proficient at the flossing techniques you'll need to use. But believe me: Flossing is an essential way to protect the investment you have made in your new teeth, and to make sure you reap all the benefits that go along with getting your smile back. Now for the long answer, which will explain why it's important and how to go about it.

Achieving Success With Dental Implants

As you probably know, your dental implants are strategically positioned in the bone beneath your gums to hold your replacement teeth securely in place. The implants are made of biocompatible titanium, and are threaded like screws. Both of these features allow the implants to fuse with the bone in your jaw. In the weeks following your implant surgery, your body began depositing new bone cells all along those tiny threads, forming a solid connection between the implants and your own bone. That connection to the bone is all-important — if lost, the implants will actually become more difficult to clean, as the screw threads become exposed. Ultimately, as more bone is lost, they could become loose; then they would have to be removed.

This is a relatively infrequent occurrence, but it does happen. And when it does, it's often because the gum and bone around the implants became infected. How does this type of infection start? Usually, with an accumulation of food debris and bacteria that are not cleaned from around the implants.

It's the same way that gum disease progresses around natural teeth: Protected pockets of bacteria begin to attack the bone tissue, resulting in a loss of bone around the tooth roots, and eventually causing the roots to be exposed. However, in the case of implant-supported teeth, loss of bone causes the threaded implant surface to become exposed. Once this happens, hardened bacterial plaque called tartar can form on the threads and cause even further bone loss.

Eventually, the implant can lose too much bone support to remain viable. No dentist or patient wants to see this happen; and with good oral hygiene, it really shouldn't.

How to Floss Under Implant-Supported Bridgework

While the procedure for brushing natural teeth and implant teeth is pretty much the same, flossing is quite different. The prosthetic teeth that are attached to your implants, called a fixed bridge or a fixed denture, do not need to be flossed individually. In fact, you can't floss between them, because they are all connected as one unit. Instead, what you need to do is get under this unit and clean around the implants.

The best device for cleaning your implant bridge is a floss threader. This small, hand-held tool has a loop at one end and a stiff plastic edge to thread with. It is used in a "needle and thread" technique. Here's how to do it:

Place an 18" length of dental floss through the loop. Then, directing the straight edge of the threader at the gum line between the teeth or implants, gently guide the threader under the bridge from the cheek/lip-side of the teeth to the palate/tongue side. Next, hold one end of the floss and pull the other end through. Now release the threader and wrap the two ends of floss around your middle fingers on each hand. Pull the floss taut and use your index finger to guide it: The floss will form a "C" shape as you work it against the surfaces being cleaned. Keeping the floss close to the area you are cleaning, move it gently under the gum and work it up and down along each side of the implant.

As an alternative, some people prefer to use floss designed to work without a threader. This type of floss has a stiffened end that can be pushed through the space without using an auxiliary device. You can find it under the brand names Super Floss® or Postcare®.

Another oral hygiene aid that can be used to clean between implants is the interproximal brush. This hand-held device has a thin plastic bristle on the end, which looks a bit like a pipe cleaner. Interproximal brushes can be used when threading floss under the bridge cannot be accomplished. For cleaning around implants, always choose an interproximal brush that is not constructed with a metal wire. Metal can scratch the titanium implant: That's why your dentist and dental hygienist will only use plastic instruments to clean your implants.

Still another device to consider is an oral irrigator or "water pick." This is a small electronic appliance that cleans by irrigation — that is, using water. A steady stream of water at low speed is directed towards the implant, and is moved all around to flush away as much plaque and debris as possible. The water should never be directed into the gum, since this may inadvertently push debris into the gum. An antibacterial rinse or plain water may be used with this appliance.

Based on your own unique situation, your dentist will schedule routine examinations and professional cleanings at regular intervals. At those visits, your hygienist can demonstrate these devices for you and help you develop an effective oral hygiene routine that will work for you.

Dental implants were designed to last a lifetime. And with conscientious oral hygiene — both at home and at the dentist's office — they'll do exactly that.