Dentures

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.

denture

  • Type of Dentures: Complete or Partial
  • Getting Dentures: Conventional or Immediate
  • Adjusting to Your Dentures
  • Denture Problems and Possible Solutions
  • Televisionitis?
  • Relining and Re-basing
  • The New Denture Experience

Type of Dentures: Complete or Partial

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.

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.

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.

Relining and Re-basing

Relining and Re-basing Dentures usually need periodic alterations because the tissues and bone supporting the dentures change over time. Relining and re basing are alterations that adjust the fit of your dentures to make them more secure on your gums. Re-basing 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.

Re-basing

Re-basing, 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 re-basing, 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 re-based 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.

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.

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.

This applies to complete upper and/or lower denture‘s

Including immediate upper denture and/or immediate lower denture full arches.

This applies to complete upper and/or complete lower implant supported removable denture.

This also applies to partial upper and/or partial lower dentures

Removable Dentures

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 sore 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 master’s 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 sore spots. Even if you don’t feel the need. We sometimes can determine sore 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. – Author – Frank C Perry DDS