The fitting and care of dentures
As we age, our teeth gradually deteriorate. Ageing teeth become brittle and crack or chip more readily. A deep decay adds to the problem. If present, severe gum disease (called Periodontitis) may damage gums and jawbone, leading to tooth loss. If teeth are badly affected by wear, trauma, decay or gum disease, your dentist may suggest extraction as the best treatment option.
Even at a relatively young age, some people have extensive loss of teeth. When many teeth are lost or extracted, a denture may have to be fitted to maintain normal chewing, bite (occlusion), speech and the appearance of the upper and lower jaw. Millions of people worldwide wear dentures. With today’s technology, they look more natural and fit better than ever before. For many people dentures vastly improve their oral health and appearance. A denture is called prosthesis, and the fitting of the denture is called prosthodontics; you may hear your dentist use these terms.
TYPES OF DENTURES
A partial denture is made to fill the space left by a few missing teeth. To hold the partial denture in position, clasps are used to secure the denture to nearby natural teeth.
A full denture is made when all the natural teeth are missing. It is fitted to replace the upper teeth, lower teeth, or both.
Immediate denture: the dentist inserts an immediate denture at the same appointment as the teeth are extracted. The advantage is that the patient avoids a period without teeth.
- Over denture: an over-denture is a denture that fits:
- Over the top of remaining teeth
- Over tooth roots that have had root canal treatment, or
- By attachment to dental implants.
Remaining teeth or dental implants act as anchors to secure it in place.
Materials: denture can be made of acrylic or metal. Your dentist will advise you about the best material for you.
Talk to your dentist
This pamphlet is intended to provide you with general information about the fitting and care of dentures. It is not substitute for advice from your dentist and does not contain all known facts about dentures. It should be used only in consultation with your dentist. Technical terms are used in this pamphlet that may require further explanation by your dentist. If you do not understand something, or are not sure about the process of being fitted with dentures, your dentist will be pleased to answer any questions or concerns you may have.
Closely follow any additional instructions that your dentist gives you. Give your dentist your full medical and dental history, including any medications you have taken or are taking, reactions to medicines (especially antibiotics), and bleeding disorders. This information is always confidential.
Making and fitting the dentures
Dentures are composed of artificial teeth bonded to a plastic base. The dentist makes an impression of the dental arch and remaining teeth (if any), using a special dental a material. The colour and shape of the artificial teeth can be closely matched to your natural teeth.
The dentist will help you with these decisions. The dental laboratory uses the impression and the dentist specification to make the dentures.
Your dentist will advise you about how long to wear your new dentures each day. A few days or weeks are needed to become accustomed to the dentures. Over the first few days:
- The denture mat feel tight and uncomfortable
- The denture may feel bulky, as if crowding the mouth
- Your gums may feel sore
- Some people experience a gagging sensation at the back of the throat
- You may notice an increase in the amount of saliva in your mouth
- Eat soft foods
- Speech may be affected but will improve. Wearers of partial dentures may find their speech improves immediately because missing teeth have been replaced.
After some time, the denture may feel loose and awkward. Your dentist can adjust the fit. This is by placing an inner lining in the denture. Several adjustments may be required before the final fit is satisfactory for the longer term. Over denture and partial dentures usually fewer adjustments than full dentures. People who have retained some natural teeth usually have less gum shrinkage and fewer changes in the under lying jawbone, so their dentures may retain a good fit for longer. Loose dentures can cause irritation and ulcers of the gums that are painful and may become infected. If your dentures become loose, see your dentist to have them adjusted. Do not try to adjust your own denture. It has been carefully made to fit your mouth. Home repairs will end up causing more harm than good.
Cleaning your dentures
Clean your dentures after each meal or at least twice a day. Remove them, and rinse away food particles with warm or cold water. Some people also like to use a mouthwash.
If you have a partial denture, be sure that you thoroughly clean it to reduce the risk of losing more teeth. Your dentist can show you how to use a toothbrush and dental floss correctly so you can efficiently remove food particles and plaque from remaining teeth. Brush both the inside and outside surface of your dentures with a soft toothbrush and unperformed, mild soap or other approved denture cleaner. Many good products are available in pharmacies and supermarkets. It is best to avoid the use of standard toothpastes as many brands are too abrasive.
Do not use:
- Hot or boiling water because dentures will warp
- Methylated spirits
- Other strong chemicals of any kind.
For the cleaning of denture, many dentists recommend the use of a specially designed brush and unperformed, mild soap or denture-cleaning cream. While brushing, hold the denture over a basin of water or towelling to avoid breakage if dropped. Be careful not to use toothbrushes and toothpaste that are to abrasive as they may damage your denture. Wear your spectacles while cleaning so you can see that all debris has been removed.
Daily living with dentures
Insertion and removal
Your dentist will show you how to place and remove your dentures. Be sure you can do this properly before you leave the surgery. Never use force to remove a denture.
Comfort and adaption
Even if you have worn dentures before, your new dentures may feel uncomfortable at first. Your mouth needs time to adapt to them.
Eating with dentures
Learning to eat with dentures takes practice and time after the first few days of eating soft foods. Cut food into small pieces, take small mouthfuls, and chew slowly. This helps to keep the dentures in place. Avoid biting with your front teeth because this can cause the dentures to tip and may place excess pressure on the gums. Instead, bite with the canine teeth, the pointed teeth next to the front teeth. Until you get used to sensing the temperature oh hot food, treat hot food with caution. Avoid sticky food (such as toffee) and sharp or hard food, such as nuts or raw carrots.
As you gain confidence with your denture, widen your diet to ensure healthy nutrition. Your dentist can advise you on maintaining good nutrition.
After the first week or two, most people find that dentures do not interfere significantly with speech. Sometimes certain words may be difficult to pronounce at first. It may help o repeat them aloud in front of a mirror. If your dentures “click” when you talk, try to speak more slowly if your denture slips when you speak. Bite gently to reposition it and swallow. Your tongue and cheek muscles will soon learn to keep it in place. If you have a persistent problem with speech, inform your dentist.
Denture adhesive can give you added confidence that your denture will not slip out of place. Your dentist can advice you about which denture adhesives are likely to work well for you. Denture adhesive is not the answer to a poorly fitting denture. If it doesn’t fit well, see your dentist.
If soreness develops under a denture, call your dentist for an appointment. The denture probably needs to be adjusted. If the soreness worsens, remove the denture for at least part of the day. Before your appointment, wear the denture for several hours. This will help the dentist determine where adjustment is needed.
Be careful to maintain good hygiene of your mouth. This is best done with a wet towelling cloth, face washer or similar material. Simply rub the gum tissue over which the denture fits, and also rub the top of your tongue. Your dentist will show you if you are in doubt.
Protect against breakage
Dentures are delicate to break easily. When cleaning a denture, hold it over a towel or a basin of water, to cushion the fall if you drop it. brush them gently. If you break a denture or damage the clasp of a partial denture, stop wearing it. Telephone your dentist for an appointment. Do not glue the parts together because the wrong glue will permanently damage, or even ruin, the denture. Do not bend or modify a clasp of a partial denture in any way as this could break it.
You should discuss with your dentist the advantage of removing your dentures before going to bed. Ideally, the denture should be removed as this allows the gum tissue a chance to rest. Removal of full dentures also prevents grinding and clenching of the teeth which increase wear on them in a special cleaning solution of water. Denture should never be allowed to dry out as this can cause warpage.
Regular dental check-ups are a must for all denture wearers. Your dentist will examine your mouth to make sure your denture fits well and check any teeth that remain. Visit your dentist immediately if you have sore gums or if a denture chips or breaks. Over time, dentures need to be remade due to normal wear.
Instruction for immediate dentures
For the fitting foe immediate dentures, the dentist takes impression of the remaining teeth and dental arch while the teeth are still in place. After the teeth have been extracted, the immediate dentures are placed in the mouth while you are still in the dental surgery. This helps to keep the swelling of gums to a minimum. Following extraction, rapid changes in the gum take place as the gum tissue and jawbone heal to form a firm base for the denture. During the healing period, you may need to visit the dentist several times for small adjustments. As immediate dentures cannot be tested in the mouth before the teeth are removed, the fit and appearance of the denture may need to be adjusted. The gums and jawbone take about three months to heal completely. During healing, the gums shrink and the fit of the immediate denture becomes loose. It then needs relining or possible remaking. This is a good time to make changes to the aesthetics of the denture, if you with. The old immediate denture can be kept as an emergency spare.
Important points about immediate dentures
- While the local anaesthetic is still effective in the hour after extraction, be careful that you don’t bite your tongue, lips or cheek.
- Do not drink hot fluids for at least for hours after the extraction
- Your dentist will give you instruction as to when you should remove your denture for cleaning, in most cases; this advice will be that you leave the in place for at least 24 hours. An appointment will be made for the dentist to remove your dentures, attend to any problems, and give you further instructions.
- If bleeding occurs in the early stages, bite firmly on a clean handkerchief or cotton wool pad for 20 minutes. This will usually help to stop any bleeding
- Eat soft food. Do not eat hard foods until advised by your dentist
- If the denture becomes loose, put it back into place immediately if you can do so without discomfort or the use of force. Keep pressing it into place with your tongue. If you are unable to replace you denture, rinse it and keep it wet in a plastic bag. Make an appointment with your dentist at once
- Five hours after extractions, rinse your mouth gently, leaving the dentures in. use a mouthwash of salt and lukewarm water (one-half teaspoon of salt in a glass of water). For the next few days. Rinse regularly and gently with the salt water.
- While the gums are healing, do not smoke because it impairs healing. It is best to quit smoking
- If you have severe pain or other serious difficulty, telephone for advice or a further appointment
- Be certain to attend your review appointments because an adjustment is likely to be needed to improve comfort of the denture
Possible complication of dentures
- Even the best fitting denture can fell awkward at first. For some people, several months or more may need to pass before a denture feels comfortable.
- For people who wear both upper and lower dentures, more time is needed to become accustomed to the lower denture
- Some people require several months before speech returns to normal. Rarely, speech therapy may be necessary. Some minor speech difficulties may persists
- There can be additional cost when gums shrink more than expected. The denture may have to be relined or remade
- There may be a change in facial shape due to the missing teeth ad replacement by a prosthesis
- The flow of saliva may increase; this is usually temporary
- Although the material and techniques of making dentures are advanced, denture prosthodontics cannot perfectly reproduce your natural teeth
- It is not uncommon to become discouraged for a while when getting used to the feel and appearance of a denture
- As the shapes of the gums and underlying jawbone change, and dentures wear out, they may need to be relined or remade every three to seven years. Regular examination of your mouth and denture id advised
- If denture are not removed every day and cleaned properly, a fungal infection can develop in the gums
- Over time, a badly fitting denture can cause a chronic inflammation of the gum tissue called denture stomatitis
- If you have dry mouth, denture retention may be difficult
Bisphosphonate treatment and oral health
People who take a bisphosphonate to treat a bone condition may rarely develop a complication called osteonerosis of the jaw.
Medicines called bisphosphonate (pronounced bix-fos-fon-ates) have been very effective in treating some bone disease, preventing fractures and controlling pain. About 300,000 Australian take a bisphosphonate.
These medicines have been helpful in treating:
- Osteoporosis or “thinning” of the bone, where calcium is lost from bone structure. Bones then become brittle and prone to fracture. The condition worsens with age and is often seen in postmenopausal women. The most common use of bisphosphonate is to treat osteoporosis. Of every 100 people taking a bisphosphonate, 95 take it for osteoporosis. Of all Australian older than 55, about five in every 100 have osteoporosis and take an oral bisphosphonate.
- Paget’s disease of bone, where normal bone tissue is replaced by bone that is abnormal and fragile. The condition is often painful and affects mostly the pelvis, legs and skull of elderly people. Bisphosphonate helps to reduce pain and strengthen the bone
- Cancer involving bone. Some of the more common cancers such a breast, prostate and gut cancers may spread to the bones. Uncommon cancers, for example multiple myeloma, may also involve the bones. The pain and disability of cancer involving bone can be well controlled with intravenous bisphosphonate.
Osteonecrosis of the jaws
Bisphosphonate have been associated with a condition called osteoporosis of the jaws (ONJ). Osteoporosis means, literally, ‘bone death’. ONJ is an uncommon condition where affected dbone of the upper jaw or lower jaw becomes exposed and open to the mouth (the oral cavity).
Effect of ONJ include pain of the gums and lips, bad breath (halitosis), loose teeth, loss of one or more teeth, difficulty in eating , severe infection of the jaw and neck, and deformation of the jaw, which can affect facial appearance. ONJ tends to heal slowly and sometimes incompletely or poorly, usually in cancer patients treated with higher doses of bisphosphonate. People can have different degrees of ONJ, from mild to severe. Even mild cases can persist for a year or more. It is crucial that your dentist knows whether you take a bisphosphonate and if you have had any signs or symptoms of ONJ. ONJ is limited to the jaws and does not affect other bones in the body.
Cause of ONJ: the cause of ONJ is not precisely known. It is thought that bisphosphonates slow down the renewal and replacement (called “turnover”) of jawbone more than they affect the turnover of other bones. When jawbone becomes exposed, for example, by a tooth extraction, bacteria in the mouth get into the jawbone. Then, due to poor bone turnover, poor blood supply and the presence of bacteria, the socket does not heal and ONJ occurs.
The first case of bisphosphonate related ONJ were reported in the US in 2003. In the same year, cases were reported in Australia .ONJ has since been reported in all countries where bisphosphonates are prescribed.
ONJ and dental surgery
Anyone taking a bisphosphonate is at risk of developing ONJ, although the risk is low in healing people. The risk of ONJ increases greatly if the person taking a bisphosphonate has any of the following:
- Extraction of a tooth (or teeth); this is known to be strongly associated with ONJ, accounting for three out of four cases of ONJ
- Denture-related trauma
- Gum (periodontal) disease
- Dental implants.
- Elderly and ill patients with weak immune systems are most at risk.
Risk of ONJ
About 60 in 100 patients who have ONJ will have severe cases that heal very slowly and imperfectly. ONJ resolves within a year in about one in four cases. The risk of ONJ must be balanced against the significant benefits of taking a bisphosphonate for your bone condition. Untreated osteoporosis has a high risk of generalized bone pain and fractures.
Dental treatment before staring a bisphosphonate
It is best to complete all necessary dental work, especially if “invasive” treatment is needed, such as a tooth extraction.
If you have good dental and oral health before taking a bisphosphonate, with no need for a tooth extraction, the risk of ONJ is very low.
Once you have stated bisphosphonate treatment, an intensive procedure on jawbone is best avoided. However, that is not always possible because teeth require ongoing care, particularly in elderly patients.
Dental treatment during bisphosphonate treatment
If you are taking a bisphosphonate, discuss the risk of ONJ with your dentist before having dental work. People with o symptoms of ONJ can develop ONJ after dental work. The risk varies depending on dose, length of time taking a bisphosphonate, type of bisphosphonate, extent of invasive dental treatment, age and level of health.
If you are taking a high dose of intravenous bisphosphonate, the risk of ONJ is higher. Your dentist may refer you to a specialist dentist, particularly if you need extraction. Stopping the bisphosphonate even for a few months before dental treatment will not necessarily prevent ONJ because the bisphosphonate persists in the jaw bone for a long time. If a tooth needs to be extracted or treated, your dentist will try methods that may help to reduce the risk of ONJ. However, your dentist cannot guarantee that ONJ will not be triggered by dental treatment.
After you start to take a bisphosphonate, have regular dental check-ups. If you have pain in your mouth or jaw, tell your dentist and prescribing doctor immediately.
If you wear dentures, they must fit well. Use well-maintained soft liners to reduce injury to the gums and other oral tissues. If your dentures do not fit well, leave them out and have them assessed by your dentist. You may need new dentures that fit better.
Treatment of ONJ
There is no simple treatment to reverse ONJ. It may persist for months or years. However, your dentist, specialist or doctor can apply a range of treatments to minimise symptoms and risks of ONJ. Patients with ONJ require special management. They may be referred to an oral and maxillofacial surgeon or a specialist in special needs dentistry. Treatment may involve mouth rinses and antibiotics to control infection. Further treatment (for example, surgery) will depend on whether the ONJ worsens.
Talk to your dentist
This pamphlet is intended to provide you with general information about bisphosphonate and the risk of ONJ. It does not replace advice from your dentist and does not contain all known facts on this subject. If you are not sure about the risk if ONJ while taking bisphosphonates, your dentist will be pleased to answer any questions. Give your dentist your full medical and dental history, including any medications you have taken or are taking (including any bisphosphonates you have ever taken), and any reactions to medicines. If you are taking or plan to take a bisphosphonate, you must maintain a high standard of dental health and oral hygiene. As this condition has been a recent development and much is being discovered, stay in touch with your dentist for advice about ONJ and bisphosphonate without the advice of your doctor. Your doctor will be able to advise you on the most effective way to treat your bone disease