Dr. Brian Saby's Dental Blog

It appears that there are still many people out there who are slightly misguided when it comes to complete loss of teeth.  I would like to spend this week’s column discussing dentures and the common misconceptions surrounding these artificial body part replacements.

First and foremost, you do not naturally lose your teeth when you get older.  In the past, when dental care was not generally available, it became very common for people to eventually have all their teeth out.  As it takes a while for dental disease to eventually claim all the teeth, tooth loss became associated with aging. 

In reality, there is no reason to lose your teeth, as you get older, today it is generally accepted that most people will have their teeth for their entire life and the necessity to have complete dentures is most often the result of conscious decisions.

Dentures are not a substitute for natural teeth; they are a substitute for NO teeth.  It is widely believed that removable complete dentures will give the same function as natural teeth, but even the best-made dentures cannot come close to providing the function of natural teeth.  It has been shown that the biting forces generated by dentures approach only 10 – 20% of that of fixed teeth.  Dentures are by their very nature, are loose.  Even a properly fitting upper denture is not fixed in place, but held in by suction.  Lower dentures, with 1/6 the surface area for suction and a tongue moving around are even worse.

Dentures are not factory original parts but after-market add-ons.  The gums remaining after teeth have been removed were never intended to support acrylic bases and denture teeth.  As a matter of fact, immediately following tooth extraction, the bone that was there to support the teeth, starts to disappear.  The additional load from the denture hastens this shrinkage.   As this bone loss progresses, the fit of the denture will change.  The denture wearer may adapt to this change as it happens slowly so they may not notice the subtle degradation of the fit and function.

So, yes, even though you have dentures, you should see your dentist at least once a year.  At this appointment your dentist will do an oral cancer exam and soft tissue check.  He will also evaluate and clean your denture.  If the fit is not adequate, he may suggest a reline.  If the teeth are worn out he may suggest a new denture.  We recommend that a denture be relined every two years and that they be replaced every five years.

At your regular denture and gum check, your dentist will also be able to discuss with you some of the possibilities available today where you can have a fixed solution to your problem using dental implants.

Like everything else in the world, technological breakthroughs have changed dentistry.  Today, the modern dentist is doing things, which were technically impossible even five years ago and unimaginable twenty years ago.  With all this change, the average perception of a dental visit has not changed.  When most people go for a dental check up, they expect the dentist to tell them what is wrong, and what “needs to be done”.   This attitude is still shared by many dentists as well.  The dentist will look for problems and disease and fix these.  This “patch and fill” approach has served us well for many years, however, there is another approach which is better.  Give the patient some choices!

One of the first things you and your dentist should do when deciding you get together is determine your long-term objectives concerning your teeth.  Do you want to have your teeth for the rest of your life?  If you want to keep your teeth (most people do, and most should have no problem in this regard) is there anything you would change about the appearance, or function?  Would you like to prevent any future dental problems?   Once you have determined these goals, your dentist should perform a very thorough examination and give you some treatment options to help you achieve the desired results.  It is morally and ethically imperative that your dentist present to you a treatment plan which outlines the best treatment that is available in 1999 style dentistry.  This treatment plan should achieve your dental goals; cost, time of treatment, complexity or other factors should not be part of this planning phase.  You have the right to know what is the best available, and the dentist is morally and ethically obligated to let you know what you could have, if you so choose.  Now that you have an idea what could be done, you can now look at the other factors involved in making the decision: How many appointments would it take?  Would braces be required?  How much would it cost?  Would there be any discomfort?  Your dentist should be able to answer all of your questions or concerns.  If the treatment plan is not to your liking, it may be possible that there are other treatment modalities available which would be acceptable to you.  The dentist’s job is to let you know what treatment is available, your job is to determine if this is something you would like, is this the right dentist to perform the treatment, and what time frame you would like to do the treatment.       

Today, a person can have almost anything they want when it comes to how they would like their mouth and smile.  People without teeth can now have teeth implanted so they no longer require dentures.  Those unhappy with the appearance of their teeth can have their smile changed to give them a perfect smile.  Dental restoration can be constructed which will last a very long time, and broken teeth can be avoided.  Fillings can be made that look just like natural teeth, giving the appearance of having no fillings.  Unfilled teeth can be sealed to prevent cavities.  Missing teeth can be replaced easily.  Worn and aged appearing teeth can be restored to give a more youthful appearance.  All you have to do is decide what you want.