Dentures Explained
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Dentures
A denture is a removable replacement for missing teeth and surrounding tissues. Two types of dentures are available – complete and partial dentures. Complete dentures are used when all the teeth are missing, while partial dentures are used when some natural teeth remain.

Complete dentures

Complete dentures can be either "conventional" or "immediate." Made after the teeth have been removed and the gum tissue has begun to heal, a conventional denture is ready for placement in the mouth about 8 to 12 weeks after the teeth have been removed.



Unlike conventional dentures, immediate dentures are made in advance and can be positioned as soon as the teeth are removed. As a result, the wearer does not have to be without teeth during the healing period. However, bones and gums shrink over time, especially during the healing period following tooth removal. Therefore, a disadvantage of immediate dentures compared with conventional dentures is that they require more adjustments to fit properly during the healing process and generally should only be considered a temporary solution until conventional dentures can be made.



Partial dentures

A removable partial denture or bridge usually consists of replacement teeth attached to a pink or gum-colored plastic base, which is connected by metal framework that holds the denture in place in the mouth. Partial dentures are used when one or more natural teeth remain in the upper or lower jaw. A fixed (permanent) partial denture replaces one or more teeth by placing crowns on the teeth on either side of the space and attaching artificial teeth to them. This "bridge" is then cemented into place. Not only does a partial denture fill in the spaces created by missing teeth, it prevents other teeth from changing position.



Are there alternatives to dentures?

Yes, dental implants can be used to support permanently cemented bridges, eliminating the need for a denture. The cost is usually greater, but the implants and bridges more closely resemble the feel of real teeth. Dental implants are becoming the alternative to dentures, but not everyone is a candidate for implants. Consult your dentist for advice.



Does insurance cover the cost of dentures?


Most dental insurance providers cover some or all of the cost of dentures. However, contact your company to find out the specifics of what they will cover.



How are dentures made?

The denture development process takes about 1 month and several appointments. Once your dentist or prosthodontist (a dentist who specializes in the restoration and replacement of teeth) determines what type of appliance is best for you, the general steps are to:

Make a series of impressions of your jaw and take measurements of how your jaws relate to one another and how much space is between them.
Create models, wax forms, and/or plastic patterns in the exact shape and position of the denture to be made. You will "try in" this model several times and the denture will be assessed for color, shape, and fit before the final denture is cast.
Cast a final denture.
Make adjustments as necessary.


What do new dentures feel like?

New dentures may feel a little odd or loose for a few weeks until the muscles of your cheek and tongue learn to keep them in place and you get comfortable inserting and removing them. Also, it is not unusual for minor irritation or soreness to occur and for saliva flow to increase when you first start wearing dentures, but these problems will diminish as your mouth adjusts to the new denture.



Will dentures make me look different?

Dentures are made to closely resemble your natural teeth, so there should be no noticeable change to your appearance. In fact, dentures may even improve your smile and fill out your facial appearance.



Will eating with new dentures be difficult?

Eating with new dentures will take a little practice and may be uncomfortable for some wearers for a few weeks. To get used to the new denture, start with soft foods cut into small pieces. Chew slowly, using both sides of your mouth. As you get used to your new dentures, add other foods until you return to your normal diet. Be cautious with hot or hard foods and sharp-edged bones or shells. And, avoid foods that are extremely sticky or hard. You may want to avoid chewing gum while you adjust to the denture. Also, don't use toothpicks while wearing dentures.



Will dentures change how I speak?


You may have difficulty pronouncing certain words. If so, practice by saying the difficult words out loud. With practice and with time you will become accustomed to speaking properly with your denture.



If your dentures "click" while you're talking, you should contact your dentist. Your dentures may occasionally slip when you laugh, cough, or smile. Reposition the dentures by gently biting down and swallowing. If any speaking problem persists, consult your dentist or prosthodontist.



Are dentures worn 24 hours a day?

Your dentist or prosthodontist will instruct you as to how long to wear your denture and when to remove it. During the first several days after receiving your denture, you may be asked to wear it all the time, including while you sleep. Although this may be temporarily uncomfortable, it is the quickest way to identify the areas on your denture that may need adjustment. Once adjustments are made, you should remove your dentures before going to bed. This allows gum tissues to rest and allows normal stimulation and cleansing by the tongue and saliva. The denture can be put back in your mouth in the morning.



Should I use a denture adhesive?

A denture adhesive may be considered under the following circumstances:

1. To enhance your satisfaction with a properly constructed denture. Adhesives enhance retention, stability, bite force, and an individual's sense of security

To assist individuals with dry mouth conditions that lessen denture adherence, such as individuals taking cold medications, those with neurologic disabilities including strokes, and the elderly
To provide added stability and security for those who place unusual demands on their facial muscles, such as public speakers or musicians


When shouldn't adhesives be considered?

When used as a "fix" for ill-fitting or poorly constructed dentures. If your dentures begin to feel loose, cause discomfort or cause sores to develop, contact your dentist as soon as possible.
When a dentist has not evaluated your dentures for a long time. Dentures rest on gum tissue and your jawbone, which shrink and deteriorate, respectively, over time. Therefore, the real problem might be a need for a denture adjustment or new dentures.
When oral hygiene practices cannot be sustained
When adhesives have been used for a long time, especially when visits to the dentist are infrequent, and when the frequency and volume of the adhesive use increase. These developments may indicate the need for a denture adjustment or new dentures.
When any known allergy exists to the adhesive's ingredients


How are denture adhesives applied?

Here are some tips to consider when applying denture adhesives:

Use the minimum amount necessary to provide the maximum benefit. Apply less than you think you need, and then gradually increase the amount until you feel comfortable.
Distribute the adhesive evenly on the tissue-bearing surface of the denture.
Apply or reapply when necessary to provide the desired effect.
Always apply the adhesive to a thoroughly clean denture.
Remember adhesives work best with a well-fitting denture.


What are the types of adhesives?


Paste application. Apply to a dry or preferably wet denture. Avoid placing adhesive close to the denture borders. If the adhesive oozes, use less of the product. For dentures on the upper jaw, apply three short strips of adhesive-or s series of small dots-along the ridge area and one down the center. For dentures on the lower jaw, apply three short strips of adhesive-or s series of small dots-in the center of the ridge area.
Powder application. Sprinkle a thin, uniform layer throughout the tissue-bearing surface of the denture. Shake off excess powder and press the denture into place. Powders may be preferred over pastes because they are easier to clean off the denture and tissue. In addition, they don't have the same tendency as pastes do to "shim" (keep the denture away from the tissue).


Are denture adhesives safe?


Dental adhesives are safe as long as they are used as they were meant to be used. If the denture is well-fitting and the adhesive is only used to give added stability, there should be no ill effects. If adhesives are used excessively to fill voids for an ill-fitting denture, they can be harmful to the underlying soft and hard tissues. Occasionally, in these cases, inflammation of the soft tissues can result. In addition, because of its movement on the soft tissue and underlying bone, an ill-fitting denture can cause bone loss.
Dentures are prosthetic teeth constructed to replace missing teeth, which are supported by surrounding soft and hard tissues of the oral cavity. Conventional dentures are removable, however there are many different denture designs, some which rely on bonding or clipping onto teeth or dental implants. There are two main categories of dentures, depending on whether they are used to replace missing teeth on the mandibular arch or the maxillary arch. There are many informal names for dentures such as dental plate, false teeth and falsies)
History
The first European sets of dentures date from the 15th century and most probably existed before that time. They were carved from bone or ivory, or made up of teeth sourced from graveyards, the recent dead or living donors who exchanged their teeth for profit. These dentures were uncomfortable, attached visibly to a base supported by any remaining teeth with a thread of metal or silk. The false teeth were often made with ivory from the hippopotamus or walrus, and usually rotted after extended use.[citation needed]

London's Peter de la Roche is believed to be one of the first 'Operators for the Teeth', men who fashioned themselves as specialists in dental work. Often these men were professional goldsmiths, ivory turners or students of barber-surgeons.[1]

The first porcelain dentures were made around 1770 by Alexis Duchâteau. In 1791 the first British patent was granted to Nicholas Dubois De Chemant, previously assistant to Duchateau, for De Chemant's Specification, "a composition for the purpose of making of artificial teeth either single double or in rows or in complete sets and also springs for fastening or affixing the same in a more easy and effectual manner than any hitherto discovered which said teeth may be made of any shade or colour, which they will retain for any length of time and will consequently more perfectly resemble the natural teeth." He began selling his wares in 1792 with most of his porcelain paste supplied by Wedgwood.[citation needed] Single teeth in porcelain were made since 1808. Later dentures were made of vulcanite and then, in the 20th century, acrylic resin and other plastics. In Britain in 1968 79% of those aged 65-74 had no natural teeth, by 1998 this proportion had fallen to 36%.[citation needed]


Problems with Complete Dentures
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Problems with dentures include the fact that patients are not used to having something in their mouth that is not food. The brain senses this appliance as "food" and sends messages to the salivary glands to produce more saliva and to secrete it at a higher rate. New dentures will also be the inevitable cause of sore spots as they rub and press on the mucosa. A few denture adjustments for the weeks following insertion of the dentures can take care of this issue. Gagging is another problem encountered by some patients. At times, this may be due to a denture that is too loose fitting, too thick or not extended far enough posteriorly onto the soft palate. At times, gagging may also be attributed to psychological denial of the denture. (Psychological gagging is the most difficult to treat since it is out of the dentist's control. In such cases, an implant supported palateless denture may have to be constructed or a hypnotist may need to be consulted). Sometimes there could be a gingivitis under the full dentures, which is caused by accumulation of dental plaque.

Another problem with dentures is keeping them in place. There are three rules governing the existence of removable oral appliances: support, stability and retention.


Prosthodontic principles of dentures

[edit] Support
Support is the principle that describes how well the underlying mucosa (oral tissues, including gums and the vestibules} keeps the denture from moving in the vertical plane towards the arch in question, and thus being excessively depressed and moving deeper into the arch. For the mandibular arch, this function is provided by the gingiva (gums) and the buccal shelf (region extending laterally from the posterior ridges), whereas in the maxillary arch, the palate joins in to help support the denture. The larger the denture flanges (part of the denture that extends into the vestibule), the better the support.

More recently, there has been a move to increase denture stability with implants. When pressure is applied to alveolar bone bereft of teeth (alveolar bone is the bone in which teeth normally reside), the bone reacts to this pressure by resorbing. After many years of denture wearing, the ridges upon which the dentures rest deteriorate and can easily all but disappear. The insertion of implants into the bone below the dentures can help to seriously combat this unfortunate occurrence. The implants are strategically placed to bear the brunt of the pressure when the denture is used for chewing, keeping the bone from melting away. When implants are integrated into treatment, the denture is now referred to as being an implant supported overdenture and the implants are referred to as overdenture abutments.


Stability
Stability is the principle that describes how well the denture base is prevented from moving in the horizontal plane, and thus from sliding side to side or front and back. The more the denture base (pink material) runs in smooth and continuous contact with the edentulous ridge (the hill upon which the teeth used to reside, but now consists of only residual alveolar bone with overlying mucosa), the better the stability. Of course, the higher and broader the ridge, the better the stability will be, but this is usually just a result of patient anatomy, barring surgical intervention (bone grafts, etc.).


Retention
Retention is the principle that describes how well the denture is prevented from moving in the vertical plane in the opposite direction of insertion. The better the topographical mimicry of the intaglio (interior) surface of the denture base to the surface of the underlying mucosa, the better the retention will be (in removable partial dentures, the clasps are a major provider of retention), as surface tension, suction and just plain old friction will aid in keeping the denture base from breaking intimate contact with the mucosal surface. It is important to note that the most critical element in the retentive design of a full maxillary denture is a complete and total border seal in order to achieve 'suction'. The border seal is composed of the edges of the anterior and lateral aspects AND the posterior palatal seal. The posterior palatal seal design is accomplished by covering the entire hard palate and extending beyond and ending onto the soft palate.

As mentioned above, implant technology can vastly improve the patient's denture-wearing experience by increasing stability and saving his or her bone from wearing away. Implant can also help with the retention factor. Instead of merely placing the implants to serve as blocking mechanism against the denture pushing on the alveolar bone, small retentive appliances can be attached to the implants that can then snap into a modified denture base to allow for tremendously increased retention. Options available include a metal Hader bar or precision balls attachments, among other things.


Complications and Recommendations
The fabrication of a set of complete dentures is a challenge for any dentist, including those who are experienced. There are many axioms in the production of dentures that must be understood, of which ignorance of one axiom can lead to failure of the denture case. In the vast majority of cases, complete dentures should be comfortable soon after insertion, although almost always at least two adjustment visits will be necessary to remove sore spots. One of the most critical aspects of dentures is that the impression of the denture must be perfectly made and used with perfect technique to make a model of the patient's edentulous (toothless) gums. The dentist must use a process called border molding to ensure that the denture flanges are properly extended. An endless array of never-ending problems with denture may occur if the final impression of the denture is not made properly. It takes considerable patience and experience for a dentist to know how to make a denture, and for this reason it may be in the patient's best interest to seek a specialist, either a Denturist or a Prosthodontist, to make the denture. A general dentist may do a good job, but only if he or she is meticulous and usually he or she must be experienced.

The maxillary denture (the top denture) is usually relatively straightforward to manufacture so that it is stable without slippage. The lower full denture tends to be the most difficult because there is no "suction" holding it in place. For this reason, dentists in the late 1990s have come to a general conclusion that a lower full denture should or must be supported by 2-4 implants placed in the lower jaw for support. A lower denture supported by 2-4 implants is a far superior product than a lower denture without implants, held in place with weak lower mouth muscles. It is routine to be able to bite into an apple or corn-on-the-cob with a lower denture anchored by implants. Without implants, it is quite difficult or even impossible to do so.

Some patients who believe they have "bad teeth" may think it is in their best interests to have all their teeth extracted and full dentures placed. However, statistics show that the majority of patients who actually receive this treatment wind up regretting they did so. This is because full dentures have only 10% of the chewing power of natural teeth, and it is difficult to get them fitted satisfactorily, particularly in the mandibular arch. Even if a patient retains one tooth, that will contribute to the denture's stability. However, retention of just one or two teeth in the upper jaw does not contribute much to the overall stability of a denture, since a full upper denture tends to be very stable, in contrast to a full lower denture. It is thus advised that patients keep their natural teeth as long as possible, especially their lower teeth.


Conclusion
As can be expected with any removable appliance placed in the mouth, there will be some problems (in respect to the three principles mentioned above) with dentures no matter how well they are made. This is because the best the dentist can do is fabricate the upper denture to work in harmony with the lower denture when the patient is at rest. If the only variables in the equation are the patient's edentulous ridges and the two dentures, the dentist can set the teeth in certain ways to help prevent dislodgement during opening, closing and swallowing. Once food enters into the picture, though, the stability of the denture bases is not impervious to disruption. During chewing, the denture bases will sometimes act as class 1 levers, and when the patient bites down on the anterior, or front, teeth, the posterior, or rear, teeth are bound to move away from the ridge. Although the ideals of denture design will have it that the intaglio surface is in perfect, intimate contact with the ridge and the margins of the denture base will create a perfect suction seal (the seal is actually only on the maxillary denture), ideals are rarely if ever met in this imperfect world, and thus some movement is to be expected. Denture adhesive can then be utilized to compete against the forces trying to pull the denture base away from the mucosa. In a perfect world, a patient with a perfect edentulous ridge with a perfectly fitting denture would require no adhesive, as the actual form of the denture base should work in tandem with the three principles mentioned above, thus precluding movement in any way, shape or form.