Problems with Dentures

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Modern dentistry has managed to do away with dentures as far as many people are concerned, having found new and better ways to replace missing teeth by bridging from other teeth or by means of implants, but there are still plenty of people with missing teeth who cannot take advantage of quite such sophisticated treatments because of the cost, or who just prefer a simpler solution, and so are wearing either full or partial dentures.

It has to be said that full dentures cause the most problems due to lack of adequate support and retention in many cases. The full denture replaces all the natural teeth with artificial plastic teeth fitted to a plastic plate made to fit to the shape of the alveolar, or bony ridge, left in the mouth when all the natural teeth are gone. The problem is that bone is not a fixed tissue, but actually resorbs and is replaced throughout our lifetime, or at least is replaced where there is a perceived need to. Once a tooth is lost there is no perceived need by the body for all the bone that there was, and so, the bone tends to gradually shrink away and is not replaced. This gradual bony resorption is a natural consequence of having teeth removed, and continues on throughout life. This means that someone having all their teeth out in their thirties is going to have lost a lot of bone by the age of fifty, yet may still have many years to live. During the remaining years of life such a person may have to struggle with dentures that don’t stay put very well during talking and eating, but slide around making life rather difficult. This is a major reason why people are encouraged these days to keep their own teeth for life, rather than having to rely on false teeth which are never quite as good.

If you have some of your own natural teeth then it is possible to make a well-fitting partial denture that is held firmly in place by the other teeth, but if you have no teeth of your own then you are relying simply on the retention afforded by the ridges of gums, which may be less than adequate.

A person with full dentures may need to have them replaced or relined every few years in order to compensate for the gum and bone shrinkage and restore the fit, and this will help with their ability to cope.

The condition of a dry mouth (xerostomia) is caused by certain conditions or medications, and because of the lack of saliva, can exacerbate the problem of wearing dentures.

Some denture problems relate to the size and shape of the remaining bony ridges in the mouth, and more commonly in the lower jaw because resorption here is more marked than in the upper. The lower alveolar ridge may not shrink uniformly but sometimes leaves irregularities or even a knife edge of bone which causes pressure points under dentures and considerable pain. In such cases it may be necessary to provide a soft lining in order to provide some comfort for the wearer. A similar situation occurs when there is little or no bony ridge left at all in the lower jaw, causing undue pressure on the bone beneath the thin mucosa, and the problem here is compounded by a flat surface for the denture to sit upon, rather than a ridge, which gives no stability or retention at all. This can be one of the most challenging kinds of cases, and where implants are possible, they may be the solution. Often however, in such a vase there is insufficient bone remaining to enable implants to be placed. The only recourse is to make dentures with teeth that are well within the neutral zone so that they are not so easily displaced by muscle movements during talking and eating. The dentures might need also to be somewhat smaller than standard to deter their displacement.

Unfortunately, aesthetic considerations may run counter to the functional requirements outlined above, since the loss of basal bone in upper and lower jaws can give rise to lack of support for the lips, making them look more wrinkled and slack, and can also cause an over closing tendency with the jaws when they meet together, due to the loss of overall vertical height. Both of these effects are somewhat aging as far as appearance is concerned and the only recourse may be to build out dentures to restore some fullness to the lips and height to the face. Unfortunately this may make it more difficult to provide dentures that are stable and retentive. It is an experienced dentist who can reach an adequate compromise in these circumstances and one that is acceptable to the patient.

Loss of vertical dimension from alveolar resorption sometimes causes saliva to dribble at the corners of the mouth leading to soreness, and this situation can often be improved with new dentures that increase some, if not all, lost vertical height.

The upper jaw has the advantage of the larger surface area of the palate to help with suction of an upper denture, but of course has gravity working against it, and sometimes a patient may have difficulty in keeping an upper denture in place. The same principles apply in respect of avoiding the insertions of muscles by careful shaping of the denture as in the lower jaw, and suction can usually be achieved by obtaining a good impression and hence a close fit for the denture. Care needs to be taken too, not to extend the denture to far back in the region of the palate, certainly not on to the soft palate, or else this drastically reduces tolerance.

General problems of isolated sore spots in the mouth can usually be addressed by means of relieving specific areas on the fit surface of dentures or providing a new fitting surface as appropriate.

Problems with dentures are not uncommon and often require a good deal of patience on the part of both patient and dentist in order to overcome them!