The Gum Under Her False Tooth Was Always Sore

Quick answer: Persistent soreness, bleeding or bad smell under the false tooth of a bridge is usually a design problem, not a cleaning problem. If the underside of the pontic saddles the gum in a way you cannot get floss beneath, no amount of brushing will fix it.

The call

Yocheved, 52, from Mishkafayim, had a bridge replacing an upper premolar, fitted eight years earlier. The gum beneath the false tooth had been red, tender and prone to bleeding for most of that time. There was a smell she was self-conscious about.

She had been told at three separate appointments, by different people, to clean it better. She had bought every interdental device on the market. She had come to believe the problem was her.

What we found

The abutment teeth were sound. No decay at the margins, no mobility, both vital, and the bridge was firmly cemented. The x-ray was unremarkable.

The problem was the shape of the pontic — the false tooth. It was a saddle pontic: the underside was concave, straddling the ridge like a saddle on a horse, contacting the gum across a broad area on both the cheek and palate sides.

That design is now regarded as obsolete, for one reason. There is no way to clean beneath it. Floss cannot be threaded under a concave surface that wraps the ridge; it catches and stops. A brush cannot reach. So a layer of plaque sits permanently against gum tissue, in the dark, undisturbed, for years. The tissue responds exactly as you would expect: chronically inflamed, bleeding, and producing the sulphur compounds responsible for the smell.

Her cleaning was, in fact, meticulous. She simply could not reach the one place it mattered.

The modern designs:

Modified ridge lap. Contacts the ridge only on the visible cheek side, in a narrow line, and is relieved on the palatal side so floss passes straight through. The standard for back teeth. Ovate pontic. A convex, bullet-shaped underside sitting in a shallow depression in the gum, giving an excellent appearance for front teeth and cleanable with floss. Sanitary pontic. Clear of the gum entirely. Very cleanable, only used where appearance does not matter.

The rule underlying all of them is simple: floss must be able to pass under the false tooth from one side to the other in a single sweep. If it cannot, the design has failed.

What we did

Removed the bridge — the abutments were healthy, so this was about the pontic alone — and made a new one with a modified ridge lap pontic, relieved on the palatal side.

Before fitting, we let the gum recover for four weeks under a temporary bridge with a properly shaped pontic. The tissue was significantly healthier by the time the definitive bridge went in, which also improved the fit and appearance.

Then we spent fifteen minutes teaching her to use superfloss with a threader, and had her demonstrate it back to us. Being handed a device and being taught to use it are different things.

The outcome

The gum was healthy within six weeks. The smell resolved completely. At three years the tissue under the pontic is indistinguishable from the gum elsewhere.

She had spent eight years believing she was failing at something that was not her fault.

What to do if this happens to you

1. Check whether floss passes under the false tooth. If it will not, the design is the problem.
2. Do not accept "clean it better" without a demonstration that cleaning is physically possible.
3. Take persistent bad breath from one spot seriously.
4. Ask about pontic design before a bridge is made, not afterwards.
5. Use superfloss or a threader daily under any bridge, from day one.
6. Get bridges reviewed yearly, including the tissue beneath the pontic.

Sore gum or bad smell under a bridge? Ramat Beit Shemesh Urgent Dental Care will look at the design, not just your brushing. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.