Dentures
are a solution of last resort.
Many people assume that they will require complete
dentures as they age. Loosing teeth is not a normal
part of the aging process, nor does it have to be.
If you care for your teeth well and guard against
periodontal (gum) disease, you should be able to
keep your teeth for a lifetime. Saving even a few
natural teeth is better than losing them all.
Natural teeth or even portions of natural teeth
(roots) can help you retain bone in your jaw and
can act as stable supports for bridges, overdentures
or partial dentures. Dr. Perry will try, or suggest
to save as many of your natural teeth as possible.
If that is not possible, you may have to consider
a complete denture or an implant-supported denture.
The good news is that dentures are not what they
used to be. With newer materials and improved technology,
dentures can be fashioned to fit comfortably, appear
natural and help you stay healthier. Denture problems,
such as clicking, slipping, gum irritation, staining
and odor are signs your dentures are not fitting
properly and may need to be relined, adjusted or
remade.
Although dentures may look like your natural teeth,
they cannot work like them. Like artificial limbs,
dentures cannot truly replace their natural counterparts.
You will have to learn how to use your dentures,
which can take several months. Simple actions like
speaking and eating may feel different, and you
may have to learn to make adjustments. Some people
never get used to wearing dentures, they interfere
with taste, speaking and eating.
Types
of Dentures: Complete or Partial
Complete
Dentures Complete
dentures cover your entire jaw, either upper or
lower. Some people refer to them as "plates".
Complete dentures rest directly on the gum that
covers the bone. However, a type of full denture,
called an overdenture, fits over a few remaining
teeth that have been shaped.
Maintaining a few natural teeth and replacing the
missing teeth with an overdenture has several advantages:
Your natural teeth help
preserve bone.
Your remaining natural teeth bear some of the chewing
pressure, which reduces pressure on other areas
of the jaw. The teeth improve the stability of the
denture and make it less likely to shift in your
mouth. Your sense of where your jaw is in space
and how much pressure you are putting on it is better
than the sense you have after losing all of your
teeth. Keeping some teeth can help you psychologically
accept your denture.
An overdenture is used in the lower jaw where a
few teeth can be maintained and is an option for
almost anyone. However, the teeth that will be preserved
must meet certain standards of health. Canines and
premolars are the most common teeth selected because
of their root length and position in the jaw. The
teeth will have to be shaped or contoured to fit
the denture. Since the shaping may expose the tooth's
living pulp, the teeth usually need root-canal treatment,
which removes the pulp and replaces it with filling
material. The teeth are next covered with thin metal
castings called copings, which fit into openings
in the denture. Attachments also can be put on the
copings so the denture is better retained in the
mouth. Overdentures can also fit over implants instead
of natural teeth. In fact, implants were originally
developed to give people "artificial roots"
on which to place bridges or dentures in the lower
jaw. The denture may fit directly onto the implants,
or a metal bar can link implants together, providing
support for the denture.
Partial Dentures
In today’s practice
of restorative dentistry, we very rarely use
partial removable dentures to replace teeth.
The modern option is a fixed bridge or a dental
implant. Nevertheless, here is the story on
partial dentures for those of you that already
have them or are not candidates for any other
restorative treatment. Partial dentures are
composed of metal framework usually yellow
gold or chromium cobalt, with plastic teeth
and gum areas. The framework includes metal
clasps or other attachments, which hold the
denture in place.
However, partial dentures are easily removed
for cleaning by the patient. Fixed partial
dentures, which most people call bridges,
are cemented in place and better simulate
natural teeth. Bridges are more expensive
than partial dentures, and require healthy
adjacent teeth to support them. Two types
of attachments are used in partial dentures:
metal clasps and precision attachments. Metal
clasps are C-shaped parts of the denture framework
that fit around neighboring natural teeth.
These teeth may require shaping to help hold
the clasps and keep the denture securely in
place.
For a precision attachment, a receptacle is
created within a remaining tooth, which is
usually crowned. An extending part on the
denture fits closely into the receptacle.
Precision attachments have advantages. The
denture is attached within the crowns of remaining
teeth, so there are no visible clasps and
the forces of chewing are better distributed
along the tooth.
However, precision attachments are more expensive
than metal clasps, so most partial dentures
are still made using clasps.
Special Types of Partial Dentures
In today’s practice of restorative dentistry,
we very rarely use partial removable dentures
to replace teeth. The modern option is a fixed
bridge or a dental implant. Nevertheless,
here is the story on partial dentures for
those of you that already have them or are
not candidates for any other restorative treatment.
Partial dentures are composed of metal framework
usually yellow gold or chromium cobalt, with
plastic teeth and gum areas. The framework
includes metal clasps or other attachments,
which hold the denture in place.
However, partial dentures are easily removed
for cleaning by the patient. Fixed partial
dentures, which most people call bridges,
are cemented in place and better simulate
natural teeth. Bridges are more expensive
than partial dentures, and require healthy
adjacent teeth to support them. Two types
of attachments are used in partial dentures:
metal clasps and precision attachments.
Metal clasps are C-shaped parts of the denture
framework that fit around neighboring natural
teeth. These teeth may require shaping to
help hold the clasps and keep the denture
securely in place.
For a precision attachment, a receptacle
is created within a remaining tooth, which
is usually crowned. An extending part on
the denture fits closely into the receptacle.
Precision attachments have advantages. The
denture is attached within the crowns of
remaining teeth, so there are no visible
clasps and the forces of chewing are better
distributed along the tooth.
However, precision attachments are more
expensive than metal clasps, so most partial
dentures are still made using clasps.
Special Types of Partial Dentures
Nesbit Denture. A Nesbit denture can replace
one or more lost back teeth. Metal clasps
fit around the teeth on either side of the
space. However, because a Nesbit denture
is not supported by teeth on the other side
of the mouth, it can place extreme pressure
on the clasped teeth.
Also, there is a danger of dislodging or
swallowing a Nesbit, during eating sleeping
or just at rest. Dr. Perry try to stray
away from a Nesbit partial and suggest a
more safe alternative which is supported
by teeth on both sides of the mouth, giving
bilateral stabilization, even if the missing
teeth are on one side of the jaw.
Another type of denture is a flipper denture.
A flipper denture replaces one or more front
teeth temporarily until another form of
treatment (bridge, implants) can be completed.
Such a denture can be placed immediately
after tooth extraction, but it is not meant
to be a permanent solution
Getting
Your Dentures:
Conventional
or Immediate Dentures
are classified in two ways. They are either
conventional or immediate.
Conventional dentures are made and inserted after
your teeth have been taken out and the gums have
healed. If you are having teeth removed and getting
a conventional denture, you will be without teeth
while your denture is being made.
A conventional denture takes about six or seven
appointments over one to two months. The process
starts with an appointment with Dr. Perry for an
exam and a discussion of what will work best for
you. At a subsequent visit, impressions of your
mouth will be taken and a bite will be established.
You and Dr. Perry will select the teeth for your
denture. The size, shape and color of the teeth
will depend on many factors, including reference
points in your mouth, your skin tone and the shape
of your skull, photographs, etc. Just before the
final denture is complete, the teeth are held in
the base with wax while you have a trial fitting.
You can see how the denture looks and feels in your
mouth, and Dr. Perry can make sure it fits and functions
correctly and harmonizes with the rest of your face.
This is your denture "try-in." If this
goes well, you will receive the completed denture
at the next visit, along with instructions on eating,
speaking, denture care and oral hygiene. Finally,
you will need to see Dr. Perry for a series of follow-up
visits over the next few weeks and months to check
the fit and comfort of your denture. In some instances
a series of appointments every other day or so may
be needed. Denture adjustments are made in small
increments and usually guided by a soar spot in
the mouth. If you do not wear your dentures and
only put them in for adjustment appointments then
it will be impossible to guess were the denture
will have to be adjusted.
Immediate or transitional dentures are made while
you still have teeth. An impression is made before
your teeth are removed, and the denture is created
and inserted immediately after the extraction. If
your remaining teeth are so loose they would not
be able to withstand the impression process, you
cannot receive an immediate denture. Generally,
immediate or transitional dentures are used for
aesthetic or training purposes for patients who
need to have their upper-front teeth removed or
have to get used to something in their mouths. Especially
after many years of missing teeth and poor jaw alignment.
The advantage to an immediate denture is that you
are not left without teeth. However, you will not
have a chance to see and test the denture before
it is inserted. Also, your bones and gums will shrink
after your teeth are removed, and your denture may
need to be refitted (relined) after several months.
In almost all cases an entire new denture or set
of dentures is made.
You will receive your immediate or transitional
denture at the same appointment your teeth are removed.
Having the denture in your mouth helps control some
of the post-operative swelling. Dr. Perry will tell
you not to remove the denture for one or two days
and nights, except to rinse it. Two days (or one)
after receiving your denture, you will visit the
doctor for an exam to make sure it is fitting properly
and the bite is correct. After this visit, you can
remove the denture at night and treat it like a
conventional denture.
Adjusting
To Your Dentures
Eating If you have just received
your dentures, avoid raw vegetables, fibrous meats
and sticky foods for the first few months.
Cut your food into small pieces. When biting, avoid
using your front teeth. Instead, use your canine
teeth (the pointed ones) and the teeth just behind
them. Do not pull or tear your food in a forward
direction; instead, push back as you bite. When
you chew, try to have some food on either side of
your mouth to stabilize your dentures. Do not expect
the same eating efficiency you had with your natural
teeth, even after you become experienced.
Eating a proper diet is especially important for
people who wear dentures. As a group, denture wearers
tend to have lower-quality diets than do people
with most or all of their natural teeth. They may
not get enough of certain nutrients, such as vitamin
B6, vitamin E, and zinc, which are found in hard-to-chew
foods such as fruits, vegetables, nuts and meat.
Speaking Speak slowly and quietly
when you first get your dentures. You can
practice by reading aloud at home in front of a
mirror, repeating words that seem difficult. Other
Changes that you may notice is more saliva in your
mouth when you get your new dentures. When you sneeze,
cough or yawn, your dentures may loosen. This is
not an indication of improper fit.
The tissues under your dentures will need a rest
every day, so you will be instructed to take your
dentures out when you sleep. Your mouth and the
bone in your jaw that supports your dentures will
continue to change. After years of denture wear,
your jaws — especially your lower jaw, or
mandible — become smaller as the bone melts.
This can make your dentures become ill fitting and
difficult to use. Regular visits to Dr. Perry are
just as important for people with dentures as they
are for people with all their natural teeth. Everyone
with dentures should visit their dentists at least
every six months; people who visit their doctors
more frequently like, diabetics or people with compromised
immune systems, should also visit their dentists
more frequently. Regular visits help ensure that
your dentures continue to fit and operate correctly.
In addition, Dr. Perry will examine your mouth for
signs of bone loss, oral cancer, infections and
other conditions. He will suggest that right after
your immediate dentures are placed that you consult
with an oral surgeon to be evaluated for implant
placement. This is the most crucial part of restoring
your mouth. As soon as the denture rests on bone,
the area for placement of dental implants becomes
very difficult. In all cases Dr. Perry would have
suggested this before treatment is even begun to
ensure that you are fully aware of all of your restorative
options.
Caring
For Your Dentures Denture
teeth are made of porcelain or plastic. The
rest of the denture is made of plastic, which is
sometimes reinforced with metal. Dentures usually
last about five to seven years. The teeth can fracture
or wear down. Most dentures have plastic teeth.
Porcelain teeth are available. They last longer
than plastic teeth and have a slightly more lifelike
appearance. However, the porcelain teeth are very
hard on the underlying bone or ridge and will cause
it to resorb even faster. So please ask about plastic
teeth. The new advances in denture teeth technology
make the plastic ones hard to tell from natural.
Discuss the selection of material with Dr. Perry.
Dentures are not permanent fixtures in your mouth;
you need to take them out at least once a day. Most
people leave their dentures out at night when they
sleep. Store them in water or in commercially available
denture cleaning solutions in a covered container.
Change the water or solution daily and wash the
container. Your dentures need to be cleaned thoroughly
twice a day using specially designed denture brushes.
The tissues in your mouth also need to be brushed
and massaged to clean away debris. This also helps
maintain good circulation in your gums. When the
dentures are out of your mouth for cleaning be sure
to hold them over a counter or sink. If you drop
them, they will break. When out of your mouth for
cleaning or overnight keep them in a safe place.
Usually keeping them is a dresser drawer is best
or the medicine cabinet in the bathroom. Pets love
to eat their owner’s dentures. You will never
see them again and this can be an expensive disaster.
Some people use denture adhesives, such as powders
or pastes. Adhesives can be useful in keeping dentures
from slipping or falling out, especially in people
whose jawbones have shrunk considerably. However,
they should not be used to compensate for poorly
fitting dentures. If your dentures start slipping
or become uncomfortable, visit Dr. Perry to see
if your dentures need adjusting or refitting. Or
perhaps you are ready for implant placement.
Denture
Problems and Their Possible Solutions
Adjustments
and Relines Your
dentures may need alterations periodically as the
tissues and bone underneath them change, especially
during the first year if your denture is of the
immediate type. Relining involves resurfacing
the portion of the denture that fits against your
tissue. It can be done while you wait in the dentist's
office, so you are not left without your denture.
Rebasing, which is less common than relining, involves
replacing the entire denture except the teeth. It
is also a more complex process, involving two or
three dental visits. You will be without your dentures
for a period of time.
If your dentures fracture, the teeth wear down or
your bones and tissues change significantly, you
may need a completely new set of dentures.
Never attempt to fix your dentures yourself. Most
repairs can be done right in our office, so you
will not spend days without your dentures.
Possible
Complications Rarely
people are allergic to a common type of plastic
used in dentures. In these cases, other plastics
can be used instead. In addition, some people have
had allergic reactions to a component of the metal
used in partial dentures. Dr. Perry will use yellow
gold in all instances of partial denture work therefore
this allergy is generally not an issue.
Of the 36 million people aged 18 to 74 wearing dentures
in the United States, about 75% of them have some
type of complication. Most complications result
from poor oral hygiene or not following the dentist
instructions. For example, if you do not clean your
dentures properly, the tissue can become irritated.
If you don't eat a balanced diet, you may be more
susceptible to fungal infections in your mouth.
If you follow Dr. Perry’s instructions by
cleaning your dentures and oral tissues daily and
contacting him if your dentures seem ill fitting
or painful, you should have few problems. Oh and
by the way most people will never complain about
their dentures whether they are having a problem
or not. Therefore, you are in the transitional stages
of getting used to your dentures or partial; try
not to listen to others. They will most often drive
you crazy because they probably forgot how long
it took to get used to their partial or full dentures,
and most of all how long they took to make.
Televisionitis?
Watching enough television and you could be convinced
that everyone with dentures should be using an adhesive.
Talk to some dentists and you might be convinced
that no one should use an adhesive. The reality
lies somewhere between the extremes. Denture adhesives
do have a role in the use of complete dentures.
Many dentists think it is a negative statement on
their ability to create well-fitting dentures if
patients have to use adhesives, but that is not
so. Even if a denture is well fitting, many patients
may have problems adapting to the denture in their
mouths and keeping them stable. In addition, the
bone that supports the denture, called the residual
ridge, starts to resorb or melt after the teeth
are lost. The loss of this bone, and the shrinkage
of the tissues covering the bone, makes dentures
more likely to move during use. A denture could
fit well, but that does not mean it is retentive,
it could still move. Patients with a well-fitting
denture may also need an adhesive, particularly
if the ridge [bone] has undergone significant shrinkage
prior to the construction of the denture. Denture
adhesives should not be used to compensate for poorly
fitting dentures, which should be adjusted by Dr.
Perry. How do you know whether you need an adhesive
or an adjustment? Patients who need dentures in
the future should talk to Dr. Perry about adhesives
at the first visit. If you already have dentures,
visit regularly, every six months. Especially if
you notice changes in the comfort of your denture,
set up an appointment as soon as possible. You may
think you need an adhesive when you actually need
an adjustment, such as a refitting of the denture.
On the other hand, if you are already wearing dentures
and you do not use an adhesive that does not mean
you would not benefit from a check up, patients
whose dentures are not retentive, but the patients
have adapted and know how to keep them in place,
often have hidden problems. Adhesives might make
things easier for you, however there is also a psychological
component to the use of adhesive. Some people, especially
first-time denture-wearers, are worried their dentures
might slip or fall out in public. Proper use of
adhesives will alleviate this concern.
I always suggest adhesives as a training aid for
a patient that has never worn a denture before.
They know it will stay in place, this makes learning
to use dentures an easier and less frustrating experience,
as long as the adhesive is properly used, and the
denture and tissues are kept clean. The powder is
easier to clean off the denture, the tissue, the
paste is more difficult to clean, and it can interfere
with the bite because it is placed in the denture
in a thicker layer. If I feel the paste is necessary,
I will teach a patient how to apply it so it does
not affect the bite. To use the powdered adhesive,
first clean and rinse your denture, and then shake
a thin layer of powder onto the denture, moisten
it, and then place the denture, how long the adhesive
lasts depends on various factors. Adhesives usually
are effective for a longer period in upper dentures.
Relining
and Rebasing
Dentures usually need
periodic alterations because the tissues and
bone supporting the dentures change over time.
Relining and rebasing are alterations that
adjust the fit of your dentures to make them
more secure on your gums. Rebasing involves
making an entirely new denture base, while
relining modifies the existing one. Both procedures
maintain the denture's existing artificial
teeth.
Relining
Relining involves resurfacing the portion
of the denture that fits against your gum
tissue. After teeth are extracted, the bone
that once held your teeth shrinks (a process
called bone resorption), and it is common
to discover that your dentures no longer fit
properly as the resorption continues. If the
denture is otherwise in good shape, your dentist
may recommend an office reline.
An in office reline takes about 30 to 60 minutes.
During the procedure:
Dr. Perry will clean the denture thoroughly
and remove 2 to 3 millimeters of the denture's
tissue surface.
In some cases, a bonding agent is used to
secure the reline material to the denture.
The reline material (an acrylic resin) is
mixed and placed in the denture.
The denture is placed in your mouth while
the resin is still soft and flowable.
An impression of your gum tissue is made inside
the denture as it sits in your mouth.
The reline material hardens in a shape that
conforms to your gums and enhances the fit.
Dr. Perry will check the new surface and polishes
the denture.
Relining
Soft and hard relines use different materials.
The material for soft relines remains somewhat
flexible. If you pressed the material with
your fingernail, you would see an impression.
Resin used for hard relines does not have
this flexibility.
Soft relines are generally considered temporary.
The material used is biodegradable and is
not meant to last more than a few months.
Soft relines can be repeated at regular intervals
if your jawbone cannot tolerate the force
of a hard-reline material. The softer material
absorbs some of the stress of chewing. Some
people receive a soft reline if the gum tissue
needs time to heal from the effects of an
ill-fitting denture or other stresses that
have caused injury. In this situation, after
the gums are healthy, a hard reline would
usually be done.
Rebasings
Rebasing, which is less common than relining,
involves replacing the entire base of the
denture, but keeping the teeth. It is a
more complex process, involving two or three
dental visits. You will be without your
dentures for a period, perhaps one day,
but sometimes several days.
If your dentures need rebasing, Dr. Perry
will take an impression of your gums within
the denture. The denture will be sent to
the lab and serve as a model for the new
base. During this process, the teeth are
maintained in the new base in their original
positions. The rebased dentures usually
need to be adjusted.
Which One Is Right For You?
An office reline can be done quickly and
less expensively than a rebase. However,
the material used in a reline is not as
dense as that used in rebasing. Because
relining materials are not as dense, they
are more likely to discolor or take on unpleasant
odors.
In some cases, such as a fractured denture
base, rebasing might be your only option.
Talk to the doctor if you are concerned
about which procedure is right for you.
There
are more opportunities for food and fluids to loosen
a lower denture, which may be an indication to use
the paste form for the lower denture. The biggest
problem with the lower denture is the movement of
the tongue. When the denture is removed, place it
in water with an effervescent cleansing product,
there are also special toothbrushes that are very
soft and have two sides to help clean both sides
of the dentures. Massage your tissues with a soft
brush or gauze pads to keep them clean and healthy.
The bottom line: Practice good oral hygiene and
visit your dentist regularly whether you use adhesives
or not. Many people believe that once they have
dentures, they no longer require the services of
a dentist and that is not true. Seeing your dentist
regularly allows him or her to observe changes in
the denture or the supporting tissues and correct
the situation.
The most important thing when wearing dentures is
not to wait to long before you convert them to dentures
over implants. Many people put it off because by
the time they make the transition to the dentures
they have had enough. Do not loose site of the big
picture. This is only a small part of your life.
Ask for an implant consultation immediately.
The
New Denture Experience
It takes time to become acclimated to new dentures.
Try to compare it breaking a leg or arm and having
it immobilized for a period of time. After the cast
comes off you will need some therapy to retrain
the proper muscle coordination and movements. But
after this adjustment period you can hop, jump and
skip and run the same way as in the past. The same
goes for new dentures it will take time, adjustment
and patients to learn to use this great new tool.
The first couple of weeks will require that you
eat soft foods, over time you may start trying to
add more solid foods to your diet. The keys is to
cut your food into small bites in place even amounts
of food on both sides during chewing, this make
the dentures more stable remember to slow down when
eating and you’ll learn the tricks to master
your new dentures more rapidly. It is perfectly
normal to experience some discomfort associated
with sore spots during the adjustment. Think about
it! your soft gums were never intended to have a
hard plastic piece pushed and rubbed against them.
Adjustments and toughening of the gum tissues will
be necessary before comfort can be achieved.
Do not attempt to adjust your new dentures yourself.
If an ulcer forms or the dentures stay very sore
for a couple of days we want you to return to our
office with the dentures in your mouth so we can
find the problem and make the necessary adjustments.
This may need to be done every other day or every
day for a week or so. If you do not call and let
the soar spot get worse, it will take that much
longer for the adjustments to become affective and
for you to be able to use your dentures properly.
Talking may be difficult initially too, it may seem
as if you have a mouthful of saliva and your tongue
may seem boxed in, you may have some difficulty
with specific sounds. Give this some time and you
will overcome these obstacles. Reading aloud is
always helpful to improve phonetics of the new dentures.
Dentures
need to be kept clean, they should be brushed twice
a day with a very soft toothbrush or denture toothbrush
with toothpaste. This will keep your dentures from
staining and your breath fresh; don’t forget
to clean your gums and tongue to prevent buildup
of bacteria and bad breath too. At night, we recommend
taking your dentures out, this allows the tissue
to breathe and removes the tremendous pressure that
is placed on the gums all day long. Dentures should
be kept in water when out of your mouth to prevent
warping. Always keep your dentures in a safe place
as to not misplace them or let the family pet get
at them because you will never see them again. Cats
and Dogs love their masters tasty dentures.
Remember the gum tissue is in constant state of
change, and that dentures are not. Over time your
dentures may loosen and need to be professionally
relined. So you should make an appointment to see
us at least once a year to check for proper fit
and soar spots. Even if you don’t feel the
need. We sometimes can determine soar spots before
you can.
In the even that you are unhappy with the fit of
your dentures please don’t hesitate to ask
for alternate treatment plans after your dentures
are placed. In most cases patients will choose to
have some implants placed to add to retention of
their dentures. The bone of the jaws must be evaluated
soon after placement of the dentures for implants.
Good luck and keep in contact with Dr. Perry’s
office.
