Kenneth Cheng, D.D.S.
Dentures are prosthetic restorations that replace missing teeth with artificial teeth embedded in an acrylic, gum-like denture basewhich fits over the upper or lower jawbone. They can be worn with comfort, have a realistic appearance and can help to preserve the patient’s health. Dentures can be used if a patient has lost all, most, or even just a few natural teeth, and can be used on one or both arches (top and/or bottom jaw). In general, a denture rests directly on the gum and is held in place by a combination of suction, the facial muscles and the tongue. Dentures which replace only a few teeth may have clasps.
There are two main categories of dentures. Full or complete dentures replace all the teeth in either the upper or lower jaw while partial dentures replace some of the teeth.
Within the two main categories, there are numerous different types of dentures available. An overdenture fits over two or more natural teeth which are specially prepared or implants, which secure the denture in place and stabilize it. Immediate dentures are placed in the mouth at the time of tooth extractions, without waiting for the gums to heal so patients do not have to be toothless. Conventional dentures are not placed in the mouth until the gum tissue has healed following any necessary tooth extractions.
Before a denture can be created and placed, a patient needs to have an initial consultation and evaluation by a general dentist or a prosthodontist. This will include a comprehensive dental examination and a medical and dental history.
A denture is a restoration that requires multiple visits to the dental office. One visit is necessary to prepare the mouth and any remaining teeth. Impressions or molds of the mouth and gums are taken and sent to a dental laboratory where the denture will be made. The impressions may be made before or after the teeth and mouth have been repaired, depending on the type of denture used. Finally, the denture needs to be placed and adjusted for the best fit. This may require several follow-up appointments.
Patients need time to adjust to their new dentures. They may feel bulky, loose and awkward at first. Patients may experience soreness, discomfort or excessive production of saliva until they become accustomed to the dentures. They may also need to make some changes in their eating habits.
Despite the lack of natural teeth, people with dentures still require regular dental examinations. Natural changes in the mouth and jaw occur with age and dentures need adjustments or over time, may even need to be replaced. Adjustments may be made by the dentist in a dental office. Dentures can be damaged beyond repair by patients who attempt to fix or modify them.
Dentures also have disadvantages. No artificial teeth work as well as natural, healthy teeth. Dentures can break, chip or crack. They may be associated with certain oral infections when they are not worn and cared for as instructed by a dentist. Poorly fitting dentures can cause sores and irritations. Dentures require special care. Different types of dentures may require different types of specific care. A dentist will explain how to care for a given denture, including when to wear and remove it and how to clean it.
Dentures are removable dental appliances that replace missing teeth with artificial teeth attached to a gum-like denture base. Modern dentures are greatly improved over earlier versions. They can be worn with comfort, have an appearance similar to natural teeth and can help to preserve the patient’s health. However, dentures still have their limitations. Like other artificial teeth, they do not perform as well as natural teeth. Dentists usually advise people with even a few natural teeth remaining to keep them and get dental appliances to work with those teeth, rather than removing all the teeth.
Dentures may be used to replace teeth that are missing for any reason, including injury, tooth decay or periodontal disease. They can be used if a patient has lost all, most, or even just a few natural teeth. They can be used on one or both arches (top and/or bottom jaw).
Dentures have a pink-colored base that resembles the gums and soft tissue. It is composed of acrylic resin and is placed over the alveolar ridge. There may be extensions from the base, such as across the roof of the mouth (palate), to help stabilize the denture. The artificial teeth of dentures are made to look like natural teeth. They may be composed of porcelain or acrylic resin materials. Partial dentures may have additional pieces (e.g., metal clasps, bars, interlocking mechanisms) to secure them to remaining teeth. In previous years, tooth loss and dentures were considered an inevitable part of aging. Some people had many healthy teeth removed and replaced with complete dentures.
This practice has lessened in recent years. The U.S. Centers for Disease Control and Prevention (CDC) reported in 2002 that 25 percent of the population age 60 or older was edentulous, or missing all their teeth. This percentage had declined from 1988, when 31 percent of that population had no teeth. With diligent dental hygiene and care, including regular dental examinations, most patients can retain their natural teeth for their entire lives.
Types and differences of dentures
Dentures may be classified by type (complete or partial) and by time of placement (immediate or conventional). In general, a denture rests directly on the jawbone and is held in place by a combination of suction, the facial muscles and the tongue. Partial dentures may have clasps, bars or interlocking mechanisms. Patients may use a denture adhesive, but that should not be necessary if dentures fit well.
Dentures can be classified by how many teeth are being replaced. Complete dentures, which are also called plates, replace an entire arch of teeth. A pair of complete dentures is often used to replace the entire set of teeth in both upper and lower arches.
A partial denture, orremovable partial denture (RPD), replaces some of the natural teeth in an arch. It attaches to and fits around the natural teeth and is held in place by clasps, bars or interlocking mechanisms. Categories of RPD include:
- Cast metal RPD. The most common removable partial denture. Consists of a metal framework with retainers and teeth.
- Acrylic RPD. This consists of a plastic framework and wire clasps. Designed for temporary use, such as while waiting for an implant to integrate. An acrylic RPD that replaces a single front tooth is called a flipper.
- Valplast RPD. Made of flexible plastic. Doesn’t require metal clasps, and clasps made of valplace can be tooth or gum colored and not visible.
An overdenture fits over two or more natural teeth which are specially prepared or implants, which secure the denture in place and stabilize it. An overdenture is most commonly used on the lower jaw, but can also be used on the upper jaw. It is particularly beneficial because the presence of teeth or implants helps to preserve the jawbone. An overdenture also helps to dissipate some of the pressure and stress of chewing, which can help prevent sores and irritation. If natural teeth are used, they have to be reshaped by a dentist to fit with an overdenture. If implants are used, the denture may attach directly to the implants or may use a bar attachment.
Dentures may also be classified by when they are placed in the mouth. An immediate denture is placed in the mouth at the time of tooth extractions, without waiting for the gums to heal. The patient does not have to go without teeth, but these dentures do not tend to fit as well as conventional dentures. They generally require frequent adjustments (e.g., relining, rebasing) or even replacement because the shape of the jaws can change considerably during the healing process. They are frequently used for aesthetic purposes when the front teeth have to be removed but may not be an option for all patients. Conventional dentures are not placed until the gum tissue has healed after tooth extractions. This leaves the patient without teeth for an extended period of time, usually six weeks or more.
Before and during the denture procedure
Before a denture can be created and placed, a patient needs to have an initial consultation and evaluation by a general dentist or a prosthodontist. This will include a comprehensive dental examination and a medical and dental history. X-rays and impressions of the teeth may be taken. This information will allow the dentist and patient to discuss options and preferences.
Teeth usually must be extracted or otherwise prepared for the denture. Dentists typically try to save as many natural teeth as possible because no form of artificial teeth performs as well as natural teeth. Retaining some natural teeth also enables the use of overdentures or partial dentures, which tend to be more stable and secure than conventional dentures.
The time it takes to place a denture and the process used depends on the type of denture to be placed. For conventional dentures, impressions are made after the teeth have been extracted so that the gums have time to heal before the denture is placed. The impressions are sent to a dental laboratory, where the denture is made.
The denture is typically sent back incomplete. In another appointment, the artificial teeth are secured on the denture base with wax for a trial fitting. This helps ensure that the color, shape and fit of the denture works well for both the patient and the dentist. Some patients may have multiple trial fittings, or “try-ins,” before the best fit, occlusion (bite) and match is achieved. After the fit, occlusion and match are adequate, the teeth can be permanently secured onto the base.
If an immediate denture is planned, impressions are made before the teeth are extracted so that the denture can be placed during the same appointment as the extraction. For a partial denture, the adjoining abutment teeth usually need to be prepared, such as with an artificial crown. If an overdenture is planned, the teeth that will support the denture are reshaped by a dentist to fit the denture. These teeth usually need a root canal treatment prior to the reshaping. The reshaped teeth are covered with copings (metal castings) to improve their fit with the dentures. If natural teeth are not available, implants may be used. An impression is made after the natural teeth have been shaped or the implants are in place. Implants usually require several visits that take place over a period of months.
After the denture procedure
Patients should closely follow their dentist’s instructions when they receive dentures. Dentures will usually require several follow-up appointments in the first few weeks and months to ensure proper fit and check for any irritation.
Most patients need time to adjust to their dentures. They may feel loose until the patient’s facial muscles and tongue learn to help secure the dentures. They may loosen when the patient coughs, sneezes, yawns or laughs. The dentures can generally be resecured by gently biting down and swallowing.
Dentures may feel bulky and awkward at first. Patients will eventually get used to the feel of these dental appliances. Patients may experience some discomfort and soreness at first, but this will improve over time. The presence of the denture in the mouth may also cause more saliva to be produced until the mouth adapts to it.
Patients may need to make some changes in their eating habits while becoming accustomed to wearing a denture. Soft foods that are cut into small pieces are typically recommended. Certain foods (e.g., tough meats, raw vegetables, sticky foods) may need to be avoided. After patients have become accustomed their dentures, they may return to their previous eating habits, or at least adopt similar eating habits.
Patients who have difficulty making certain sounds after a denture has been placed are encouraged to practice speaking. Speaking slowly and quietly, reading aloud and repeating troublesome words often helps patients adapt to speaking with dentures in their mouths. This will also help to keep dentures from clicking during speech.
Regular dental examinations are important whether or not the patient wears dentures. A dentist can recommend how often a patient should make a dental appointment. Dental examinations are also important to maintain a proper fit over time. Natural changes in the mouth and jaw occur with age. The dentist can make many of these adjustments in the dental office. However, in some cases, a new denture may be required.
There are two major types of adjustments that dentures tend to require over time. For both of these procedures, the denture teeth of the previous denture are reused.
- Relining. Typically takes around 30 to 60 minutes in the dental office. Two or three millimeters of the denture base are removed and a relining material of acrylic resin is secured in place. The relining material is still very soft when it is placed against the gum. This allows it to conform to the shape of the gum before hardening. A soft or hard relining material may be used. The soft material may be used temporarily (e.g., while irritated gums heal) and it is generally replaced with a hard reline at a later date.
- Rebasing. This is not done as frequently as relining. An impression is made of the patient’s gums. The impression and dentures are sent to a dental laboratory where the denture base is completely replaced. The patient will have to go without dentures for a short time (e.g., about a day).
Risks and benefits of dentures
The greatest benefit of dentures is the replacement of missing teeth. The teeth are necessary to chew properly and are used to help form the sounds in words. They also help to establish and maintain the shape of the face by preventing the sagging of facial muscles. Missing teeth can place increased stress on the jaw that can lead to problems with the muscles and the temporomandibular joint (jaw joint). In addition, teeth preserve the positions of neighboring teeth. If a tooth is missing, the nearby teeth may shift into the open area. Finally, replacing missing teeth can improve a person’s physical appearance and, in turn, boost their confidence and self-esteem.
However, dentures also have disadvantages. No artificial teeth can perform as well as natural teeth. Dentures also require numerous visits to the dental office as well as special care. They can break, chip or crack and an artificial tooth may come loose. Dentures can also be damaged beyond repair by patients who attempt to fix or modify them. Because of this, it is important to see a dentist for any repairs or adjustments.
Patients who wear dentures may avoid certain foods, especially those that may be difficult to chew. This can result in poor nutrition, which can cause a number of health problems, including increasing the risk for an oral infection, such as denture-induced stomatitis. Denture-induced stomatitis can be caused by poorly fitting dentures, poor hygiene and a buildup of yeast in the mouth. This condition causes inflammation that may occur just under the denture or may be more widespread.
Poor-fitting dentures can cause sores and irritations. Some patients may have an allergic reaction to the plastics or metals used in dentures. If this occurs, other plastics or metals can be used instead. Dentures that do not fit properly can also trap certain substances against the gums or any remaining natural teeth. This can greatly increase the risk of tooth decay. Furthermore, if cancer-causing substances (e.g., alcohol, tobacco) are trapped against the gum, the risk of oral cancer may be increased.
Researchers and scientists continue to experiment with denture materials and techniques. New compounds may help to make dentures stronger and sturdier, as well as more comfortable. New methods of producing and securing dentures may help prevent denture-related infection, reduce speaking difficulties and expand the numbers of foods that can be comfortably eaten with dentures.
Lifestyle considerations with dentures
Different types of dentures may require different types of specific care. A dentist will explain how to care for a given denture, including when to wear and when to remove it. It is typically recommended that they are removed at night while the patient sleeps to allow the gums to rest. Dentures need to be kept moist when not in place. They may be kept in a cup of water or a denture solution. Do not place a denture in hot or boiling water, which can warp it. Also, to prevent damage to metal parts, do not soak partial dentures in a solution for more than 15 minutes.
Some patients may benefit from the use of a denture adhesive. These can help secure properly fitting dentures and keep them from shifting. However, they should not be used to compensate for ill-fitting dentures or for an extended period of time. Denture adhesives need to be cleaned off both the denture and the gums daily. Many dentists recommend powdered adhesives because they are easier to clean.
Dentures can be relatively fragile. They can break, chip or fracture if dropped or struck. Standing over a folded towel or a sink filled with water when inserting or removing a denture can help protect the denture if it falls.
It is important to clean and massage the gum, tongue and palate with a soft brush or gauze pad before inserting the dentures. It is also important that any remaining teeth are kept healthy with diligent dental hygiene. If the natural teeth that support a partial denture are damaged, the denture will not fit well.
The denture itself needs to be removed from the mouth and cleaned daily to eliminate food particles and plaque and to prevent stains. A dentist may recommend a special two-sided brush designed for cleaning dentures. However, a regular soft-bristled toothbrush may also be appropriate. Toothbrushes with hard bristles can damage the denture. Patients are generally advised to avoid using abrasive toothpastes, powdered household cleaners or bleach on the denture because these can damage the denture. A gentle toothpaste, hand soap or mild dishwashing liquid may be acceptable cleaning agents. A dentist may also recommend a special denture cleanser. Patients are encouraged to brush gently to avoid damaging the denture and to cover all surfaces of the denture to ensure the best cleaning.
Patients with dentures may have to make some permanent adjustments to their eating habits. Certain foods (e.g., very sticky foods, very hard foods) may need to be avoided to prevent damaging the denture. Patients may also need to relearn how to eat. They are generally encouraged to use both sides of the mouth to chew to prevent tipping the denture. They are also typically advised to use the canine teeth and those behind them to bite, avoiding the use of the incisors, and to push food back with a bite instead of tearing it in a forward direction.
In addition, patients may experience difficulty speaking clearly when dentures are in the mouth. This occurs because the size and/or shape of the mouth has been changed by the presence of the dentures. For example, it may be difficult to pronounce certain sounds (e.g., “s” and “f” sounds). It may feel as though there is not enough room in the mouth for the tongue, or that a person is speaking with a mouth full of marbles. This condition may be temporary as patients adjust to speaking with a dental appliance in the mouth. This may take a few weeks, although it differs from patient to patient.
Tips for adjusting to speaking clearly with a new denture include practicing reading out loud, especially those sounds or words that are troublesome. Repetition can help a patient become accustomed to speaking with the denture. If dentures click while speaking, patients can try speaking more slowly. If speech difficulties continue, patients should consult their dentist. If dentures slip out of place, they can be repositioned by gently biting down and swallowing. Although dentures may never feel exactly like a patient’s real teeth, they can become both comfortable and functional over time.
Questions for your doctor regarding dentures
Preparing questions in advance can help patients to have more meaningful discussions regarding their treatment options. Patients may wish to ask their doctor the following denture-related questions:
- What type of denture is right for me?
- Will I have to have any teeth removed?
- How many visits will it take to prepare my teeth and mouth for my denture?
- Will I need to have a root canal treatment before a denture can be placed?
- Will I have to go without teeth for a while? For how long?
- How should I care for my denture?
- How often should I schedule an appointment to check the fit of my denture and make any necessary adjustments?
- How often will my denture need rebasing or relining?
- How long is my denture likely to last?
- Are there any alternatives to dentures for replacing my missing teeth?