Modern Restorative Dentistry provides us with the means to repair/restore practically any tooth, even if it is seriously damaged. But, not every tooth. Sometimes a tooth is too damaged, or without sufficient bone support, that repair is not possible.

Mother Nature, however, has another idea. When teeth are damaged in whatever way, Nature’s objective is for that tooth to be lost, eventually. Dentists are constantly in a battle with Mother Nature to maintain and keep damaged teeth in the patient’s mouth for as long as possible; putting off, as far into the future as possible, the eventual loss of those teeth.

Yet, despite everything, at a certain point, it becomes necessary to remove teeth.

Some teeth that were lost never got replaced. We understand that circumstances can impose that on people. Under ideal conditions, teeth that are lost would get replaced.

 

When all the teeth in either the upper or lower jaw are lost, or when they have to be extracted, most people prefer not to remain toothless – what we call: edentulous – and they usually consider a complete denture to be one of the solutions.

Let us be frank, and let us be clear: a denture is not an alternative to natural teeth. A denture is an alternative to no-teeth.

Just like nobody would have an arm or a leg removed just so they could wear a prosthesis, so nobody should have teeth removed just so they could wear a denture.

But, like a prosthetic arm or leg, etc., enables someone whose natural arm or leg was lost, to function more normally, so, too, a denture helps someone whose natural teeth were lost, to function more normally. But, not completely like they functioned with their natural teeth.

What are some of the problems that denture-wearers encounter?

1. The physical presence of a foreign device:

The denture has to cover a sufficient amount of the oral structures to be stable, and to have some retention. Upper dentures are usually much more stable and secure than lower dentures.

Lower dentures tend to move around a lot more because:

• The lower jaw itself moves in function (eating, speaking, etc.,)
• The tongue moves around in function
• The cheeks exert an upward pull on the denture
• The lips, also move, in function.

Generally, because of the “newness” of the new denture in the mouth, there is a tendency for there to be more saliva than before. This is because the mouth is thinking of the new denture as “food”, since it was not in the mouth before – even someone who has been wearing dentures for years.

2. A change in the perception of food:

Especially for people with upper dentures, there is a loss of the sensation that food creates when it comes into contact with the natural upper palate and roof of the mouth, because those structures are covered with the hard plastic of the denture base. So people sometimes sense that food doesn’t feel like it used-to

3. A change in the way food is chewed:

Chewing with dentures is different than with natural teeth. The denture is sitting on soft tissues that are resilient, that cover the jawbone that lies underneath. The laws of physics take over when people chew: they will chew on the left side, and find that the denture might tend to come loose on the right side, or vice-versa. It takes a bit of time until the new denture-wearer actually learns to eat all over again. It can be a bit frustrating at times, too.

And, at best, a set of complete upper and lower dentures is only up to 35% as efficient as natural teeth.

4. A change in the way food tastes and feels:

Already explained above, the loss of the sensation of the presence of food in the mouth, there is another problem associated with that. Although the major taste receptors are located on the surface of the tongue, there are secondary taste receptors scattered all around the mouth. So, when some of them are covered by the denture, the perception of taste often gets altered.

5. A change in the ability to bite into many foods:

Many patients report that they cannot bite into some foods that they enjoyed previously: like raw apples, sandwiches, raw carrots. Because, when they try to do that, the denture seems to dislodge or (in the case of an upper denture) to come down.

6. Movement of the denture in function:

Most denture-wearers find that the dentures move around in function, especially the lower denture.

7. A change in speech and phonation:

The position of the denture teeth relative to the lips and tongue can have an effect on proper pronunciation and phonation. Sometimes the denture base changes the relationship of the tongue to the teeth, and there is a slight “whistle” sound when enunciating certain letters.

8. A change in appearance:

A denture usually changes the appearance. Sometimes that is intentional. But, most of the time, there is a difference the way people look with a denture, compared to how they looked with their natural teeth.

How do we address these issues?

In the comments below, there will be repetition of certain points in relation to various problems.

1. The physical presence of a foreign device:

Eventually, almost all patients get used to having the denture in their mouth. It is important to know that, unless the physiological tolerance limits of the body are violated, people will get used to the denture. What is needed is patience. Sometimes, people will resort to having implants (especially in the upper arch where four implants or more can be placed) so that the denture can be modified to leave the palate uncovered by the denture base.

About extra salivation: this will moderate and return to normal after a short while.

2. A change in the perception of food:

There isn’t much that can be done about this, but, with time, it becomes less of a problem.

3. A change in the way food is chewed:

People need to learn how to chew food differently, and also that some things that may have formerly been enjoyed, must now be avoided, because they aren’t “denture-friendly”. It is important to remember that, at best, dentures may only be up to 35% as efficient as real teeth.

We suggest the following:

• Eat soft food, cut into small pieces; chew slowly.
• Avoid tough, hard, sticky foods.
• Chew slowly on both sides at the same time, to keep the denture as stable as possible.
• Chew with an up-down motion, rather than side-to-side like natural teeth.
• Wait to become used to the new dentures before going back to the previous diet.

As a general principle, denture teeth should be set directly over the crest of bony ridge of the jaw. Sometimes, there are compelling reasons why the teeth have to be set outside the crest of the bony ridge, and this is one contributing factor to the leverage-forces that tend to dislodge dentures.

4. A change in the way food tastes and feels:

People get used to these changes, and accept it as a minor inconvenience.

5. A change in the ability to bite into many foods:

The foods that, for them, are “denture-unfriendly” have to be eaten in a different way. For example: cutting raw apples into smaller pieces, rather than biting into the raw apple.

6. Movement of the denture in function:

Most people get used to the movement of the denture. And they learn to compensate for it; and they choose to eat certain foods in preference to others.Each person is different, and each person learns, over time, what works best for them.

More and more people who wear complete dentures that move around too much for their liking, consider the placement of at least two implants (in the lower jaw) or four implants in the upper jaw, to help stabilize the complete denture. The result is very dramatic, and most people find that the dentures more closely function like natural teeth as a result.

7. A change in speech and phonation:

Initially, the best way to overcome speech changes is to read out loud. Often, sitting on a chair, facing into the corner of a room, and reading aloud helps to quickly teach the body how to make changes that bring the speech back to the way it was with natural teeth. It happens more-or-less “automatically” as a result of the audio feedback that helps the brain compensate and make changes. Practice by counting aloud from 65 to 70.

8. A change in appearance:

Although, immediate dentures pose significant challenges when it comes to a change in the facial appearance, usually we have the opportunity to try-in the denture setup before it is processed. We can evaluate the appearance, the smile, the position of the teeth, the shade and shape, among other things, at that time, and avoid unpleasant surprises.

Especially with new dentures, but occasionally with dentures that have been in service for a while, it is likely to have several points of irritation on the soft tissues caused by friction of the denture. When this happens, even a very tiny sore-spot can feel very painful. Generally, the remedy for this to have the spot on the denture, that is causing the sore, ground away by the dentist.

What is the process for having a denture made?

For someone without teeth in one or both jaws, there are six steps involved in making a denture, or a set of dentures.

1. Preliminary impressions:

We take impressions with alginate, in stock metal trays of the edentulous (toothless) arch.We use the models that we make from these impressions to fabricate custom impression trays. Custom trays conform better to the dental arches, and help us obtain much more accurate impressions, thus ensuring a better fit and retention of the denture.

2. Final impressions:

Using the custom impression trays, we use special dental waxes and vinyl impression materials to develop what we call a functional/border-moulded impression of high detail and accuracy.This is then sent to the dental laboratory where denture analogues, called baseplates, are made. The baseplates are used in the next step.

3. Determination of the vertical height, and normal occlusion:

This is a very important and critical step in creating a natural-looking denture. We need to determine the vertical height of the face, and where the upper front teeth should be located, relative to the height of the face, and the upper lip. We also need to determine the horizontal plane and the anterior-posterior plane. We then record the relationship between the upper and lower baseplates (this is called “centric occlusion”) so the dental technician can set the teeth.

4. Try-in of the denture setup:

With the denture setup in wax on the baseplates, we try them in the mouth and check to see that everything is correct:

• The vertical height is correct
• There is sufficient interarch space, at rest
• The smile is natural
• The teeth are in the correct position
• The mid-line of the arch corresponds with the mid-line of the face
• The position of the upper teeth corresponds with a “line” from the side of the nose to the tragus of the ear.
• The teeth are the right shade
• The retention, and the comfort level, etc. etc.

The waxup is then sent back to the lab for processing in hard denture acrylic.

5. Delivery of the denture(s):

The denture(s) is delivered to the patient. An initial examination is made to make sure there are no obvious points of irritation.

Sometimes, the initial retention of a new denture seems to be deficient. It is often merely necessary to wear it for a few hours – keeping it sufficiently wet – for the retention to develop properly.

6. Post-delivery follow-up:

Almost everyone needs some adjustments after delivery. Sometimes sore-spots are apparent very soon after delivery. Sometimes they develop weeks later. But we like to follow-up and see how patients are doing about a week after delivery.

A denture sore-spot should be attended-to promptly. Best thing is to call our office early in the day, so we can schedule an adjustment on the same day. This applies for a new denture, or for one that has been in service for a while.

How is the procedure different for an “Immediate Denture”?

An “immediate denture” is when we take the front teeth out at the same appointment as we deliver the denture.

There are a few differences:

1. We do all the preliminary stages: impressions & bite registrations.
2. Sometimes we can do a try-in of the setup of the posterior teeth.
3. We cannot try-in the front teeth. This necessitates certain esthetic compromises on occasion.
4. The denture is delivered at the same appointment as the front teeth are extracted.

How long should a denture serve?

Although some people trade their cars in, every four or five years, many people expect dentures to serve for twenty years or more.

That, however, is way beyond the limit. When teeth are lost, the supporting bone is gradually resorbed by the body, and disappears. In the upper jaw, the bone recedes upward and backward. In the lower jaw, the bone recedes downward, and forward. For someone with very old dentures, the chin appears very prominent, and the upper lip seems to collapse.

Properly done, a denture or set of dentures, should be expected to serve for about 10 years. This is not the case for an immediate denture. An immediate denture will need to be relined from time to time, and eventually replaced with a completely new denture about 2 – 3 years after initial delivery.

One of the most important things that the patient must do is to keep the dentures clean. This means frequent rinsing during the day, and daily home-care with a denture-brush, denture paste, and denture cleanser.

It is easier to keep a denture clean, than to get it clean.

Finally:  While many people function quite well with complete dentures, there are some for whom this is a challenge that they cannot overcome. Some people have a very sensitive gag-reflex which makes wearing a complete denture very difficult, if not impossible. Some people have insufficient tissue to support and retain a complete denture.

Fortunately, most of the time, dental implants placed into the jawbones, can be of tremendous help to such people. Complete dentures that are supported/retained by implants can be made with much less bulk, and often no coverage of the roof of the mouth, and no encroachment on the gag-sensitive soft palate tissues.

Candidates for implants must be, otherwise, healthy, and be non-smokers.

 

 

© Dr William Klein, for Creative Dentistry, and Amity Management.