A denture may be defined as a dental prosthesis that replaces the natural teeth with artificial substitutes. Dentures are essentially prosthesis that are custom made for each patient, take support of oral tissues and can be removed by the patient. These prosthesis can be variably classified based on the material with which they are made from, the number of teeth they replace or the tissue from which they get their support. The aim of giving dentures is to restore the appearance and function of a patient.
Based on number of teeth they replace, dentures may be classified as:
When dentures replace some of your teeth, they may be referred to as partial dentures. These dentures take support from both soft tissue and teeth. They may be bound to your teeth using metal wires known as clasps.
These dentures may be made of acrylic or metal. In the latter situation, they are called cast partial dentures as the denture framework is made by casting of the metal.
When dentures replace all your teeth, they are known as complete dentures. These dentures are most often made of acrylic as they can be coloured to replicate the colour of your gums. These dentures can take support from the oral soft and hard tissues. In some cases, these prosthesis may be fabricated by taking support from dental implants and tooth roots that have been root canal treated. In the former case, they are referred to as tooth supported over dentures and in the latter as implant supported over dentures.
Based on the tissue from which they take support, complete dentures may be classified as:
Conventional complete dentures:
Conventional complete dentures take support from the soft tissue and bone of the jaws. These are the most commonly fabricated dentures. The chief advantage of these prosthesis is their relative cost effectiveness compared to the other treatment options.
Tooth supported over dentures:
In case some of the tooth can be preserved in the oral cavity, the dentist might decide to treat them with root canal treatment and reduce them to the level of your gums. Over dentures offer the advantage of better retention and also help in preserving jaw bone.
However, the disadvantage with this prosthesis is that the treatment time is longer as compared to a conventional prosthesis and also the costs are greater.
Implant supported over dentures:
In some cases, dental implants may be placed in the jaw bone to increase the retention and support to the denture. The number of implants that need to be placed may be from 2 to 6; however, greater number of implants may necessary based on the amount of bone that is available. These prosthesis offer the advantage of having excellent retention. The only disadvantage of this treatment option is the relatively greater cost and a longer treatment time.
The treatment time is greater as there must be a time gap of 3-6 months between the surgery for implant placement till the final prosthesis is given. However, in the interim period the patient can do with a conventional denture.
Materials for Dentures:
Materials used to fabricate dentures include acrylic resins, nylon based plastics (flexible dentures) and metal denture base materials.
Acrylic resins are the most commonly used materials. These materials have excellent aesthetics and are easy for the dentist to adjust.
Flexible denture base materials are made up of nylon based polymers. These dentures have greater flexibility and better translucency than acrylics. These properties make wearing of these dentures more comfortable. Their translucency picks up the colour of the underlying tissue making them more aesthetic. However, they have a tendency to pick up stains of foods and beverages.
Metal denture bases are not used very often and are used only in cases when the dentist deems it necessary.
A patient will have to visit the dentist for a minimum of 5-6 times for a conventional denture.
During the initial visit, the dentist will record a primary impression of the patients upper and lower ridges. This will be used to construct a model on which a custom tray is made. This tray will help record a more accurate impression of the patient. The final or second impression is used to construct the master cast. The dentist will then record the jaw relation that is the relation of the upper and lower jaws. The teeth are them arranged on a temporary denture base and the dentist will try in this temporary denture in the patients mouth. This allows the patient to suggest changes about the shade and position of teeth. This will be followed by the final appointment when the processed denture can be given to the patient.
Problems with Dentures
As with all prosthesis, dentures have an inherent adjustment period.
As with any prosthesis, dentures are artificial replacements to your natural teeth that are often resting on a movable foundation. There is an adjustment period after a new prosthesis is given. Over time if the patient does not take adequate care of the prosthesis, it can also lead to problems. Some of the common problems associated with dentures are:
► Problems with new dentures
Ulcers and soreness: This is one of the most common problem in patients with new dentures. It is most often due to sharp edges or nodules. The dentist will simply trim off the offending part to ensure relief.
Difficulty in speech and mastication: A new denture acts as a foreign object in the mouth and the patient must not expect it to function like your natural teeth. Like all prosthesis, you must learn to use them efficiently. The dentist will give instructions on how to eat and learn to speak with your new dentures. The problem should not last very long with a properly constructed denture. However, if the problem persists, be sure to visit your dentist.
Loose dentures: In certain cases, the denture may be loose and get displaced while eating and speaking. The cause of this problem could range from a poorly constructed prosthesis to minor overextensions that can be corrected. In the former case, a new prosthesis may need to be made. In some cases, a loose denture could be because of the poor bone of the patient; in such cases, it is better to opt for more sophisticated treatment options such as implant supported over dentures.
Excessive salivation: The denture acts as a foreign object in the mouth and could cause excessive salivation. This is a self-limiting problem and subsides with time.
Allergic reaction: Some patients may experience an allergic reaction to a new denture. The symptoms may range from inflammation and burning sensation to more severe symptoms such as respiratory distress. In case a patient suspects an allergic reaction, he should stop wearing the denture at once and consult his dentist or physician.
Clicking sounds: You will probable experience clicking sounds with your new denture. This is due to the contact of your upper and lower teeth. The problem will correct with time. However, if it persists contact your dentist.
► Problems with old dentures:
Stomatitis: Stomatitis refers to the inflammation of the oral tissues. It is most often caused by candidiasis. The cause of this problem is often poor oral and denture hygiene.
Loss of masticatory efficiency: This may be due to prolong use of dentures and the only solution is to get new dentures made.
Sagging and ulcers at the corners of your mouth: This is due to loss of tooth material. The solution to the problem is to get a new denture made.
Lip and cheek biting: With time the denture material wears off. The solution to this problem is getting a new denture made.
Getting used to New Dentures:
New denture require practice to get use to and use efficiently.
► How to eat with new dentures?
It takes time to start eating with new dentures. Start with soft and semi-sold foods that are easy to chew. Once you are comfortable with these foods, start on more solid foods.
Cut food into small pieces and chew foods on both sides. This will keep your dentures stable.
Dont try to take bites of hard foods such as an apple with your front teeth; this will dislodge your denture.
Chew on food with your back teeth.
While drinking water or beverages take small sips; Do not use a straw as this can lead to dislodging of your dentures.
► How to speak with new dentures?
Learning to speak with new dentures is difficult as the new denture may feel awkward and the problem is further compounded by increased salivary flow. Try reading a newspaper aloud, alone or in front of a mirror; this will help you identify mispronunciations and also increase your confidence.
► Pain and soreness:
New dentures may often cause pain and soreness. Your dentist will tell you to visit him on the 2nd or 3 rd day.
Your denture may get dislodged when you cough or sneeze; this is a normal occurrence. Keep your hand or handkerchief in front of your mouth to prevent this.
Guidelines for the Care and Maintenance of Dentures:
It is important that the patient regularly cleans his mouth and denture to prevent infections and foul odour.
Daily removal of the bacteria present in the oral cavity and on complete dentures is of paramount importance to minimize denture stomatitis and to help contribute to good oral and general health. Based on the best available evidence, an American College of Prosthodontists task force has suggested the following guidelines for the care and maintenance of dentures:
► Oral hygiene maintenance:
Brush your remaining teeth, gums and tongue every morning and evening with fluoride-containing toothpaste to prevent tooth decay and gum disease. In a completely edentulous patient, massage your denture bearing tissue with your finger; this ensures adequate blood supply to these tissues and keeps them healthy.
Give proper rest to your denture-bearing tissues by removing your denture overnight.
► Denture care instructions:
It is important that the denture be kept clean; this will prevent infection of your tissues and foul odour. The following measures can be taken to keep your denture clean:
Dentures should be cleaned daily. A non-abrasive cleaner such as a soft brush and paste or cleansing tablets and solutions should be used.
Do not use any of these products inside your mouth as they may contain harmful chemicals.
Rinse the denture properly before reinserting in the mouth.
Manufacturer instructions regarding denture cleansers should be followed carefully.
Dentures should be cleaned annually by a dentist or dental professional by using ultrasonic cleansers.
Dentures should never be placed in boiling water this can distort your denture.
Dentures should not be soaked in sodium hypochlorite bleach, or in products containing sodium hypochlorite, for periods not exceeding 10 minutes.
Dentures should be stored immersed in water after cleaning or when not replaced in the mouth, to avoid distortion.
A yearly check up of your denture is a must.
These are powder or pastes that help improve the retention / fit of your denture.
Denture adhesives are available as powders or pastes and can improve the retention/fit of your denture. A well-made denture will not require a denture adhesive to have a good fit. Your dentist will only recommend an adhesive if he/she feels that you bone quality is poor and even with a well made denture is not possible to have a good fit.
To use a paste adhesive:
Wet your denture and place pea sized amounts of the cream on the inner surface of your denture. Place the same in your mouth.
To use a powdered adhesive:
Clean and rinse your denture, sprinkle a layer of the powder on the denture you can then place the denture in your mouth.
On an average, a denture adhesive will last for 4-5 hours. In case you consume food or hot beverages, you may need to re-apply the same. It is important that the adhesive be removed properly before you decide to place a second layer. Thoroughly clean the denture with a soft tooth brush and then place it in water. Apply the adhesive only after you make sure the denture is clean.