Frequently Asked Questions
Addressing Our Patients' Most Common Concerns about Dentures
Dr. Joseph J. Massad, DDS wants his patients to be well-informed about the denture options he provides at our Tulsa practice. We have compiled and answered the most common questions and concerns patients have brought up over the years. This makes for a useful reference for both patients and other dental professionals.
Porcelain Versus Plastic Denture Teeth
If a patient has successfully worn dentures with porcelain teeth, their next denture(s) may continue to use the same kind of materials. Switching to plastic teeth would also be a reasonable alternative, thanks to the advances in plastic denture teeth.
If the patient has natural teeth that will be in contact with a denture, plastic teeth are recommended to avoid excessive wear of the natural teeth. No matter which tooth material is used for the denture, regular evaluations and maintenance by a certified dentist are the keys to successful function and oral health.
Balanced bite and force transmission: The contact between the upper and lower denture teeth is formally called denture occlusion. Frequent modification of the denture is necessary to maintain it, as a uniform and even contact (balanced bite) is desirable.
Evolution of denture occlusion over time may reflect:
- Changes in the jawbone
- Uneven or significant wear of the denture teeth
Unless denture occlusion is checked and balanced regularly, plastic teeth would probably be a preferred choice over porcelain teeth.
Noise: If porcelain denture teeth are vigorously brought into contact, they can produce a "clacking" sound. Plastic teeth may muffle this sound during normal denture function and habitual jaw motions.
Tooth strength: Because porcelain teeth are extremely hard when compared to plastic teeth, they tend to chip and crack easier. Cleaning dentures with porcelain teeth should be handled over a sink filled with water or over a towel. This may help reduce the risk of tooth breakage if the denture accidentally falls.
Porcelain denture teeth used to be a favorite option over plastic due to greater durability and improved appearance. Progress in polymer science has created very durable plastic denture teeth, which have become popular. Good quality plastic teeth now look as good as porcelain teeth, and most dentures use plastic teeth because the cost is similar.
Soft Denture Liners
- Continuously deteriorate, harden, and collect microorganisms
- Must be replaced regularly (at least annually)
- Due to pain reduction, patients may skip mandatory routine exams and necessary denture repairs and adjustments
- Are generally more expensive than conventional hard denture liners
- Offers a soft denture surface for patients with sensitive gum tissues.
- Accurately conforms to the constantly changing contours of the jawbone's surface.
Denture liners are typically special medical-grade rubber or silicone compounds. Since they must be reasonably thick, the dentist will determine what amount of the pink plastic of the hard plastic to remove before placing the soft liner. This may weaken the denture and require reinforcing the pink denture plastic with a metal framework. Soft denture liners harden over time, but the process may be so gradual that the patient doesn't realize it. A dentist will have to evaluate the situation.
These liners are also microscopically porous, which contributes to both deteriorations of the material and accumulation of microorganisms. If the soft denture liner gets contaminated with potentially disease-causing microorganisms, replacing it may be necessary.
A soft denture liner may provide comfort for patients experiencing severe pain when wearing hard plastic dentures. This soft liner is applied to the tissue surface of the denture, which is in contact with the gums. Soft denture liners may also help patients who experience dry mouth, although the liners require extensive denture hygiene
When the patient has a low pain threshold and/or thin gum tissues, replacing the hard denture surface with a soft liner may reduce or eliminate the painful tissue compression between the jawbone and denture plastic. While soft denture liners help prevent pain from dentures, they are not a long-term substitute for professional adjustments.
Use of Denture Adhesives
- Extend the required cleaning time for both the denture and the mouth.
- The patient may develop a false sense of security with a denture that requires professional maintenance, adjustment, or even replacement.
- Improve denture retention by effectively filling the gap between a denture's plastic and the underlying gum tissue.
- Facilitates acceptance of new dentures and builds the patient's confidence.
- May reduce food collection between the denture and the gums by sealing the denture borders.
- May assist the patient in opening their mouth wider for more confident biting and chewing.
- Decreases the irritation due to denture movement across the gums if the patient has a habit of grinding their teeth.
- May facilitate wearing a denture for individuals with persistent dry mouth.
Removing the adhesive from the denture can be difficult. The denture is best cleaned with a denture brush, soap, and running water, or with a weak solution of white vinegar distilled in water. All adhesives should be removed from the mouth daily, which involves vigorous rinsing with warm water or saltwater. Using a soft-bristled toothbrush or a washcloth helps remove the adhesive from the oral tissues.
Although some patients may prefer powder adhesives, thin paste adhesives may be superior since their viscous consistency is easier to manage and apply. The dentist will discuss which option works best for the patient. Pea-sized portions of the paste should be placed in the jaw ridge and palate portions of the upper denture. A thin film of adhesive will spread across the denture's surface before placing the denture in the mouth.
If the patient notices that excess amounts of adhesive are required to achieve acceptable retention, they should see their dentist. The patient may need to experiment with how often to apply adhesives. Some apply it before each meal while others are fine with only one daily application.
Regardless of the denture fabrication process, there is always a slight space between the pink denture plastic and the patient's gums. This space is present due to fabrication limitations and the continuous changing contours of the jawbone over time. Typically, a slight space between the denture plastic and the gums is filled with saliva, resulting in an adequately retained denture. However, as this gap increases the denture becomes less retentive and stable. Denture adhesives help minimize this space and increase a denture's function and retention, which helps to reduce the collection of food debris between the denture and the gums.
Not all patients need to use denture adhesive, and the decision to use this treatment is determined by the amount of retention between the denture and the underlying gum tissue. Even on properly constructed and well-fitting dentures, the correct use of denture adhesives can further improve retention.
Replacing Old Dentures
Every patient's denture needs are different, but a dentist generally takes the following factors into account when evaluating the necessity to replace a denture:
Vertical dimension: Unique to each person, the linear distance between the upper jaw and the lower jaw is called the "vertical dimension." A dentist physically measures this distance on a patient in a relaxed, upright posture between two dots placed on the patient: one on the tip of their nose and the other on their chin. In the years following the loss of natural teeth, the jawbone both changes shape and shrinks, which may cause the patient’s nose and chin to become closer and their dentures to become loose. Since this loss of vertical dimension is a slow, but progressive, phenomenon, the patients may have gradually adapted to their changing condition.
Outward signs of the loss of vertical dimension may include:
- A shrunken, hollow facial appearance, particularly around the mouth
- The temporomandibular joints (TMJs) may be adversely affected
- The patient's ability to function may be reduced
Relining the denture may correct the situation. The dentist would add extra pink denture plastic to the inside of a loose denture to regain stability. Unfortunately, relining does not predictably and accurately restore the patient's optimal vertical dimension. A reduction of 3 millimeters in the vertical dimension generally requires the construction of a new complete denture.
Tooth wear: Excess wear of the denture teeth contributes to problems associated with lost vertical dimension.
Deterioration of denture materials: The deterioration, wear, and dimensional changes that happen over time will eventually require a denture replacement. Aging pink denture plastic loses its natural appearance, making it look artificial. Deteriorating denture plastics may also become excessively contaminated with microorganisms, which may contribute to mouth irritations, bad tastes, and socially unacceptable odors.
Dentures should typically be replaced every four to eight years for optimal condition and oral health. Replacing a complete denture is usually due to:
- Deterioration of the materials used to construct the dentures
- Irreversible changes in the contour of the patient's jaws that impact their denture’s fit
All dentures require regular maintenance to accommodate changes in the patient’s jaw and to repair and/or replace any of the denture materials that need it. Some maintenance operations can be done within a single visit while others may require several days.
If the patient has a duplicate denture, it may facilitate their day-to-day life during lengthy maintenance procedures. This second denture is usually made immediately after the patient gets a new denture, although it may be constructed at any time. This other denture is not of the same quality as the original one but is appropriate for its intended short-term use. Its cost is normally considerably less than the primary denture.
The duplicate denture should be adjusted or relined on an annual basis, just like the original one does. Making sure this second denture is ready whenever the patient needs is important, and its annual maintenance can be completed during a single visit at the dentist’s office.
Even the strongest denture plastics are susceptible to both fracture and wear under certain circumstances. Accidentally dropping the denture onto a hard surface may result in fractures of the pink denture base or chipping of the denture teeth. Exceptionally strong biting force or subconscious grinding of the teeth causes extra wear. Vigorous scrubbing of the denture with highly abrasive cleaning agents and overly stiff brushes may result in a slow deterioration of both the denture base and denture teeth, making them susceptible to fracture.
Comprehensive Denture Check-Ups
- Maintain a proper relationship between the upper and the lower jaws
- May help improve the denture’s and patient’s appearance
- Help provide optimal support to the facial tissues and prevent premature sagging
- Ensure the temporomandibular joints (TMJs), which are the joints located in front of each ear, don’t experience unhealthy bone remodeling (which may cause improper jaw function, headaches, and neck pains).
- Help detect serious oral conditions, such as cancer, which can then be treated in earlier stages.
Seeing a dentist for regular and comprehensive examinations is essential to ensure the continued proper functioning of the denture. This is also important for your overall dental health. The main reasons to schedule routine check-ups for your denture include:
- Your denture may loosen: The jawbone often shrinks in size due to bone resorption (gradual and continuing bone loss), which happens following the loss of all natural teeth.
- Your denture may wear: This process may be faster if the patient unconsciously grinds, or bruxes, the teeth together. Uneven and irregular tooth wear may develop if the denture shifts as it becomes loose. This may accelerate bone resorption.
- Your denture may cause sore spots: With the loosening and wear of the denture, its shifting against the underlying gum tissue frequently results in irritation and soreness of the gums. This is a gradual and continuous process that may result in progressive bone loss, thinning of overlying gum tissues, and the need to prematurely replace a denture.
Regular dental exams help detect such problems and correct them promptly to prevent damage to the dentures and/or the mouth. Treatment may involve relining (also known as rebasing) the denture. This process adds plastic to the inside of a denture to reestablish an accurate fit. Individual denture teeth can also be treated appropriately. Check-ups help determine when constructing new dentures is necessary for proper oral health and function.
Dry Mouth and the Denture Patient
Implant-supported dentures can be a good alternative for patients with severe xerostomia. The increased denture stability offered by dental implants may reduce tissue irritation caused by denture movement when chewing, swallowing, and speaking. These patients must maintain intense oral hygiene practices to keep the implants healthy in the presence of reduced salivary production. A qualified dentist can help the patient determine which treatment is best for them.
The cause of dry mouth must be determined and, if possible, eliminated. When this is not possible, and the condition is persistent and progressive, alternative approaches exist. Options to manage xerostomia include:
- Modify medications: If a certain medication is suspected to cause xerostomia, consultation with the patient's physician may allow the substitution to an equally effective drug that does not cause dry mouth or causes it to a lesser extent. Changing the medication may not be possible. A patient should never discontinue or attempt to change their treatment without their doctor’s approval because it could result in serious complications.
- Sialagogues: These substances stimulate the production of saliva, and they exist in two forms. Gustatory sialagogues, like sugar-free hard candies, frequently increase salivation. While sugar-free gum, specially formulated to avoid sticking to dentures, has been recommended to stimulate saliva production, chewing it may irritate already poorly lubricated tissues. Pharmaceutical sialagogues may improve saliva production but must be prescribed by a physician when the patient’s health permits it.
- Salivary substitutes: Solutions are commercially available to help keep the mouth moist and lubricated. Frequent application of these solutions is necessary, and the patient must always have the saliva substitute with them.
- Water: Water is often used instead of more expensive salivary substitutes. Regularly drinking small amounts of water may both hydrate tissues and stimulate saliva production. Increased intake of water is generally healthy, but patients with specific medical conditions like congestive heart failure should check with their physician before changing their consumption of water.
- Medications: Xerostomia is a possible side effect for many commonly prescribed medications, especially for seniors. The probability increases with multiple prescription medications.
- Aging: Salivary flow may diminish with age and/or certain medications.
- Illnesses: Specific medical conditions are associated with xerostomia, including but not limited to chronic diarrhea, liver dysfunction, diabetes, anemia, and Sjogren's syndrome.
- Radiation therapy: The radiation treatment of cancer patients, particularly when affected areas involve the head and neck regions, may result in dry mouth. The damage to the salivary glands and the extent of saliva reduction depends on the type and amount of radiation used.
- Oral habits: Chronic mouth breathing and/or inadequate fluid consumption are very common causes of xerostomia.
To achieve and maintain comfort and stability, dentures must be in immediate contact with the underlying gums during chewing, swallowing, and speaking. The presence of an adequate amount and consistency of saliva is essential. When the dentures fit properly, the physical adherence of saliva to the denture and the gums helps with denture retention and stability. Without saliva's lubricating effects, the gum, cheek, and lip tissues may become irritated as the dentures move during chewing, swallowing, and speaking.
Persistent dry mouth, or xerostomia, is a condition where the salivary glands don’t produce enough saliva to wet an individual’s mouth. This can limit the patient's ability to manage their dentures comfortably and functionally because saliva helps to promote oral health and facilitates both eating and digestion.
The dentist will have to create a second/definitive denture once the extraction sites have healed, which increases the overall cost for the patient.
- A patient never has to be without their teeth, which improves their day-to-day life.
- The immediate denture helps to protect the tooth extraction site during healing.
Although not recommended, it is possible to extract all teeth, back, and front, in one procedure and insert the immediate denture on the same day. This approach is discouraged unless the patient has no other alternatives.
Another alternative is to extract all teeth at one time but to hold off on placing an immediate denture while the extraction sites heal. Because the need for an immediate denture is eliminated with this treatment, this can be a more economical approach. However, the patient must be without teeth for several months.
Following proper healing, the definitive denture is constructed based on an accurate impression made earlier in the process. The dentist will place this second denture in the patient’s mouth to ensure a comfortable and practical fit.
Approximately six months later, it may be necessary to complete a denture reline procedure to accurately adapt the denture to the gums following additional recontouring and jawbone healing. The frequency of relines over the life of the denture is an individual matter and is best determined by a licensed dentist during biannual follow-up examinations.
Before the extraction of the front teeth, the back teeth are removed, and the extraction site heals for at least six weeks. An impression is then made to help with the construction of the first (immediate) denture. The remaining front teeth are extracted, and the immediate denture is placed in the mouth. This is normally no more uncomfortable than going without the denture. The patient can manage any discomfort with appropriate pain medication.
The immediate denture holds tissues together, supports clot formation, and protects the extraction sites from debris contamination. Typically, the immediate denture is not removed until the day following a tooth extraction, at which time the surgical area is checked and all necessary denture adjustments are made.
As healing progresses over the next several weeks, the immediate denture will loosen due to changes in the contour of the gums and jawbone. Temporary denture soft liners may be placed to help maintain a reasonable fit. It may be necessary to reline the denture several times during the healing period. Denture adhesives may also be used to assist in denture retention and stability.
Immediate dentures are placed in the mouth on the same day the remaining teeth are extracted. When the patient prefers to leave the dental office with a prosthetic replacement for the missing teeth, the patient would normally wait for several months while the extraction sockets heal, and a conventional denture is fabricated. If they prefer to leave the dental office with replacement teeth right away, the dentist can provide them with the first set of dentures: the immediate one. This will be a temporary solution until the definitive dentures are built and ready to be inserted.
First Time Wearing Dentures
New complete denture wearers often have the following concerns:
- Full feeling: When new dentures are first placed in the mouth, the patient may perceive a feeling of fullness or a lack of adequate space for the tongue. This is particularly true for patients that have been without natural teeth or prosthetic replacements for extended periods. The bulky feeling of the new denture should subside after a short time. The individual may also experience this full sensation with facial tissues, lips, and cheeks. The new denture typically helps regain the facial tissue support that was lost due to missing teeth. The facial tissues adapt rapidly to their new support system, which improves comfort and appearance.
- Speech difficulty: The sounds we produce during normal conversation are greatly influenced by the position and contours of the face’s oral structures, including teeth. With a new denture, the patient must adjust to subtle alterations in tooth position and denture base shape. These minor changes in speech sounds are usually more noticeable to the patient than others and are only temporary. During this short period of accommodation, the patient should try to speak slowly and clearly, pronouncing words very precisely. The tongue and facial muscles will quickly adapt. Reading out loud may be a useful exercise.
- Sore spots and irritations: Localized and frequently painful sore spots may develop following the placement of a new complete denture. This requires careful adjustments to be made to the dentures, subtle grinding on the pink denture plastic around the sore spot, or precise adjustment of the contacts between opposing denture teeth. When sore spots occur, the patient must inform the dentists as soon as possible to have the appropriate correction made. Taking dentures out of the mouth until adjustment can be made may improve the patient's comfort and will limit the extent of the irritation.
- Chewing patterns: The patient must adjust to the precise jaw movements required to effectively chew food. This may take several weeks. The re-learning process should begin with small pieces of soft food, gradually increasing the food's firmness over time. Denture stability during chewing generally improves if the food is chewed on both sides of the mouth at the same time using only the back teeth. Using the front teeth to cut through food typically causes the dentures to loosen and move away from the gums. Front teeth are considered primarily for appearance and speech. Pieces of food should be held by the dentures, near the corners of the mouth, and torn off by rotating the hand holding food in a downward motion. This will increase chewing efficiency and reduce denture dislodgment.
- Psychological wellbeing: A denture patient needs to take control of their situation and keep a positive attitude for optimal results. Working closely with the dentists is essential to successfully adapt to new complete dentures!
Complete dentures may not be a perfect replacement for natural teeth but they have been proven to restore the patient's ability to comfortably smile, chew, swallow, and speak, which significantly improve their quality of life. For patients with reasonable expectations, they can get used to complete dentures in a relatively short time. Patients must practice with their new teeth and learn the limitations and compensations needed to achieve successful adaptation.