Living with dentures
It is, for some people, the only solution to restore missing teeth. Dentures whether full or partial are generally associated with senior citizens. Let me enlighten you, this is not always the case. The smile of this handsome young man (opposite) depicts is a prime example. He is wearing a full upper denture.
Teeth are not necessarily lost through neglect. There may be a number of reasons-birth defects such as cleft palates, sports injuries, car accidents and tumours, to name but a few. Denture work (Prosthetics) is a field of dentistry that is rarely discussed publicly because of the social stigma surrounding it. Thus remaining the one area I feel is so poorly understood both by the public.
Having to adjust to wearing dentures is for some, a difficult and humiliating process. It may in turn, be associated with a number of factors – lack of confidence, embarrassment, depression and occasionally psychological dysfunction. This can often spill over into many areas of a person’s life that people who are non denture wearers simply take for granted. For example eating, talking, smiling, -not to mention kissing.
A person who may have undergone extensive crown and bridgework, bleaching or even implants are more likely to discuss their treatment with friends and family following its completion. However there are few who are likely to discuss their new dentures.
To be frank, it was not until I undertook a postgraduate course on dentures given by Dr John Besford, Harley Street, London, who specialises in prosthetics (dentures) that I began to fully appreciate the significance of it all. I learnt so much about ‘the patient’ and how dentures affected their lives that it changed my whole outlook in this area of dentistry.
Traditionally, dentures were provided to replace missing teeth, allowing a person to function comfortably, eat and speak whilst supporting the face and lips. Achieving a natural appearance was not high on the agenda. Maybe this is why Prosthetics, until recently, remained one area of dentistry that was often limited when trying to achieve natural aesthetics.
Fortunately, technology has progressed and there are some excellent natural looking teeth available to us today. These teeth combined with techniques that tint both the teeth and gums, ultimately provide a more natural appearance.
Ideally dentures should be a replication of the patient’s original teeth adding wear or ageing when appropriate. They should harmonise with a person’s features such as hair, eye and skin colour. Photographs of a patient’s natural teeth from as young as 14 years of age can be a useful adjunct choosing the correct shape and size of teeth together with tooth positioning.
Denture design, in particular the length of the teeth and tooth positioning, can have dramatic affects to the face. As the photographs show a patient wearing a denture that is inadequately supporting the lips and cheeks. The lips look thin and overall the patient appears unhappy and sullen when his lips are at rest.
Simply changing the tooth position and increasing the size of the teeth changed the patient’s face, at rest, creating a more confident and aesthetic appearance. Notice the lips look much fuller and generally better supported. The corner of the mouth is now turned upwards leaving the patient appearing happier.
It is a well-known fact that people make a judgement on a person within the first few minutes of meeting. Imagine the impact this transition could have in a person’s daily life- whether it is at work or socially. For those denture wearers who are considering collagen – it may be time to review your dentures!
Dentures can have a consequence on a person’s health. It is well understood that they are important in the digestive process. But there are other aspects that are rarely spoken of. Dentures, whether full or partial, when worn support the jaws and maintain the oral gap (the tongue space between the jaws).
When this space is lost the tongue can fall backwards towards the throat and block the airway. It has been standard practice with the dental profession to recommend removing dentures at night. This was primarily for hygiene reasons. In today’s society though people have access to better preventative dental care and mouth care instruction. Removing dentures, at night or at any time in the day, can be severely embarrassing but it is now known that it can also be detrimental to a person’s health.
Recent studies have found that by removing complete dentures during sleep promoted respiratory disorders as well as increasing the risk of hypertension and cardiovascular disease. For those patients without a full compliment of teeth failure to replace teeth especially in the back of the mouth can result in breakdown of the remaining natural teeth, jaw dysfunction, headaches, tinnitus to name but a few.
Partial dentures can be designed to be light and inconspicuous. Chrome skeleton partial dentures can combine the support of the patient’s own teeth and gums. This has the advantage of preventing sinking and ultimately damage to the underlying soft tissues.
Ideally the borders of the denture should be kept as far away from the natural teeth as possible to maintain the health of the teeth and the gums that surround them. Together with the facility to add clasps and attachments problems with retention can be easily overcome. Should there be only two or three teeth remaining in one jaw, there is always the possibility of creating what is termed an overdenture.
The natural teeth are reduced to gum level and utilised to assist retention by means of attachments. These come in many forms including magnets depending on the amount of space available. This can be a simple solution for patients where stability is a prime concern.
Dentures should never be regarded as the ‘end of the road’. They may simply be a means by which a person’s dignity can be preserved for a period of time whilst implants are integrating with the underlying bone. Dental implants, as few as two, are often combined with dentures to improve stability and retention.
Dentures, whether replacing a small number or the full compliment of missing natural teeth, will continue to be an essential part of dentistry and patient care. It is, for me, a most rewarding aspect of the practice. After all, what could be more satisfying than to restore a person’s smile and dignity.