DENTURES

INTRODUCTION

Dentures are a solution of last resort. Many people assume that they will require dentures as they age, but losing teeth is not a normal part of the aging process. 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 removable partial dentures. Your dentist will try to save as many as possible of your natural teeth. If that’s not possible, you may have to consider a complete denture or an implant-supported denture.

The good news is that dentures aren’t what they used to be. With newer materials and improved technology, dentists can fashion dentures that fit comfortably, appear natural, and help you stay healthier. Denture problems, such as clicking, slipping, gum irritation, staining, and odor are signs your dentures aren’t fitting properly and may need to be adjusted, relined 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.

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 by your dentist.

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.
• Your remaining 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 the pressure you are placing on the denture 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 usually 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 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 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 also can fit over implants instead of natural teeth. In fact, implants originally were developed to give people ” artificial roots” on which to place bridges or dentures in the lower jaw. The denture can fit directly onto the implants, or a metal bar can link implants together, providing support for the denture.

PARTIAL DENTURES

Removable partial dentures are composed of a metal framework with plastic teeth and gum areas. The framework includes metal clasps or other attachments, which hold the denture in place. However, partial dentures are removed easily for cleaning. Fixed partial dentures, which most people call bridges, are cemented in place and better simulate natural teeth. Bridges are more expensive than removable partial dentures, however, 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.

A precision attachment involves creating a receptacle within a remaining tooth. The receptacle usually is covered with a crown, and an extending part on the denture fits 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 with the teeth. However, precision attachments are more expensive than metal clasps, so most partial dentures still use clasps for retention.

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 also 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 denture in an accident. You should consider a bilateral partial denture, which is supported by teeth on both sides of the mouth, even if the missing teeth are on one side of the jaw.

Flipper Denture – A flipper denture replaces one or more front teeth temporarily until another form of treatment (bridge, implants) can be made or decided upon. Such a denture can be placed immediately or soon after a tooth is extracted, but it is not meant to be a permanent solution.

GETTING YOUR DENTURES: CONVENTIONAL OR IMMEDIATE

Complete 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 appointments over one to two months. The process starts with an appointment with your dentist for an exam and a discussion of what will work best for you. In subsequent visits, your dentist will take impressions of your mouth and establish the bite (the way your teeth come together). You and your dentist 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.

At a very important appointment, 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 your dentist can make sure it fits and functions correctly and harmonizes with the rest of your face. This is your denture preview, or ” try-in.” If this goes well, you will receive the completed denture at the next visit, along with instructions from your dentist on eating, speaking, denture care, and oral hygiene. Finally, you will need to see your dentist for a series of follow-up visits over the next few weeks and months to check the fit and comfort of your denture.

Immediate 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 dentures are used for aesthetic reasons in people who need to have their upper-front teeth removed.

The advantage of 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. You may even need an entirely new denture.

You will receive your immediate denture at the same appointment your teeth are removed. Having the denture in your mouth helps control some of the post-operative swellings. Your dentist will tell you not to remove the denture for one or two days and nights, except to rinse it. Two days after receiving your denture, you’ll visit the dentist 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.