Problems with Dentures
Understanding The broken Denture
Even though dentures are fabricated from extremely durable materials they will break, wear out, or a tooth will come out and their fit will change.
Accidents happen, dogs still like to chew on plates of the dental kind, and trash compactors have never taken kindly to dentures. In fact, it is frequently not a matter of "if" but rather a matter of "when" will a denture become broken, lost or damaged beyond repair.
One can be assured that a problem will likely happen when least expected, and immediate, usually important, plans will definitely be altered – – unless a person is prepared.
How to expect the unexpected and be prepared
A short-term use duplicate denture will bridge the gap of being without a regular denture while it is being repaired, renovated of replaced. Sometimes this type of denture is referred to an "embarrassment denture" because it helps a person avoid the embarrassment of being without teeth in an emergency or during planned denture maintenance.
While this type of denture may be made at any time from an existing functional denture, it is generally fabricated immediately after a new denture is made. The embarrassment denture is neither as accurate nor as esthetic and durable as the original, but it is adequate and only meant for short-term use. The cost is generally considerably less than the original denture.
Such an interim prosthesis may be relined annually and adjusted in advance to fit the current changing shape of an individual’s jaws, and therefore be ready to use at a moments notice.
However, some individuals choose to have their embarrassment denture relined and adjusted only when they need the short-term denture. Following this latter course means that they will have to wait to wear their interim denture until an appointment can be scheduled with a dental professional to complete the reline and any adjustments. But a reline for an embarrassment denture can be done in the dental professional’s office during a single appointment so a patient may leave with it refitted in the mouth.
In either case, a person would not be without a prosthesis while their regular denture is being worked on.
The embarrassment denture facilitates planned periodic maintenance
All dentures need to be periodically relined to accommodate the constant change in shape of a person’s jaws. There are also times when the plastic body of a denture needs to be changed due to deterioration, or the entire denture replaced because of wear or poor fit from changing mouth conditions that can no longer be remedied by relining.
While relines can be completed in a one appointment office visit, more durable relines may require that a dental professional keep a denture for several days. Replacing the plastic body of a denture (called a rebase) takes several days and making a replacement denture takes several weeks.
It becomes easy to see how an embarrassment denture would solve being without one’s regular denture for a period of time, even for planned maintenance, while getting on with one’s life.
Are Lower Dentures Always A Problem?
While dentures are marginally adequate substitutes for missing natural teeth, the lower denture can be troublesome for many individuals.
Inherent lower denture problems
A lower denture interfaces with more movable mouth surfaces than an upper denture.
The lower denture has less stabilizing surface to rest upon – – for example, there is no broad palatal surface (roof of the mouth) as in an upper denture.
Loss of jaw bone over time brings a lower denture into closer contact with tissue extensions called frenum attachments which create dislodging forces.
While these problems are inherent to lower dentures, every person is different and not affected in the same way. There are ways to approach these problems.
Some considerations for improving lower denture stability
A thin band-like tissue extension (called a frenum) may attach between a jaw ridge (called alveolar ridge) and the inside of the cheek. This strip of tissue may become active while eating or speaking and can lift a denture from its alveolar ridge. This frenum attachment may be surgically moved (this is called a frenectomy).
Alveolar ridge bone profile lessens or literally comes closer to the floor of the mouth as jaw bone is lost over time. The bone loss is called resorption. This reduces the vestibule or space between the lip and alveolar ridge. Surgical extension of this vestibule (called vestibuloplasty) provides more alveolar ridge exposure for a denture to rest upon and reduces muscle pull due to a high frenum attachment.
As an alveolar ridge losses bone, it may often be built-up by surgically placing various substances beneath the gum tissue to increase both bulk and height of the ridge. This is called alveolar ridge augmentation.
As a person eats and speaks, the lips and cheeks exert forces towards the inside of the mouth while the tongue exerts an outward counter force. There is a space between the tongue and lips and cheeks, called the neutral zone, where there are balanced forces during function. These opposing forces can help maintain a denture in place, with surprising power, if the denture is fabricated so that it’s bulk and teeth rest within this space.
Inserting metal implants into the jaw bone and fabricating a lower denture to receive and connect with these implants, in various ways, will help stabilize a lower denture – – while still allowing for comfortable and easy removal of the prosthesis for cleaning.
Ensuring that upper and lower teeth contact optimally during function (called balanced occlusion) is a basic means of stabilizing a lower denture. If one tooth strikes on one side only, the denture will rock. Even contact or biting is a necessity.
Fabrication of a denture that completely avoids contact with all potentially dislodging structures and having metal base for strength and some weight, will often facilitate stability.
What’s the best approach?
Frequently several approaches are combined, and not all may be suitable for a particular patient. After a thorough examination, a licensed dental professional can best advise an individual as to the best means of helping stabilize a lower denture in their unique situation.
Usefulness Of Denture Adhesives And How To Clean-up
Denture adhesives enhance the retentive interface between the surface of a denture and underlying tissues upon which a denture rests.
Optimizing the interface space
There is a slight space at the interface between the inside of a denture and the jaw that is usually filled with saliva. As this gap increases a denture becomes less retentive and stable.
The interface space arises because of material and fabrication limitations used in making a denture. This gap is also contributed to by the constant changing contour and shrinkage of jaw bone.
While an interface space exists in all dentures and increases with time, optimum denture function and retention depends upon reducing it. Denture adhesives fill this increasing space and improve suction, and also create a sticky contact between a denture and underlying surfaces. This also helps resist foods from collecting under the denture base.
How to use denture adhesives
Thin paste adhesives are preferred to powders since they are already fluid and easier to manage and apply. However, some prefer powder types. Whatever works best for an individual should be used.
Pea sized amounts of the paste may be placed in a few places within a denture where jaw ridges fit and middle where the roof of the mouth contacts. A thin film of adhesive spreads out as a denture seats in the mouth. Use the least amount to do the “job.”
If excess amounts are necessary, then the opinion of a dental professional should be sought since denture maintenance may be necessary. A licensed dental professional should be routinely seen at six-month intervals for routine oral examinations and bite adjustments.
A person needs to experiment with how often to apply adhesives. Some apply it before meals while others function satisfactorily all day with one application.
A denture and mouth should be cleaned of all adhesives at least once a day, and the denture should be left out of a cleaned and rinsed mouth for at least an hour a day.
How to clean up
It can be difficult removing adhesives. The denture may be cleaned with a brush, soap and running water or with a little white distilled vinegar in water.
All adhesives should be removed from the mouth for hygienic purposes. Rinsing with extremely warm water or salt water helps removal. It may be necessary to use a soft toothbrush or wash cloth-like material to assist removal from the mouth tissues.
Advantages of adhesives
- Effectively fills the interface gap between a denture and underlying jaw.
- Provides a sense of security with wearing dentures, even with well fitting dentures when additional confidence is desired.
- Facilitates acceptability and builds confidence with wearing new dentures.
- Reduces food impaction beneath dentures by closing prosthesis borders.
- Helps an individual open their mouth wider for more confident chewing (increases the chewing stroke) rather than eating with small strokes to compensate for concerns about the potential for a denture coming loose.
- Decreases the irritation and chafing of mouth tissues from habits such as grinding teeth together (parafunctional activities).
- Facilitates wearing dentures for individuals with persistent dry mouth (xerostomia).
Disadvantages of adhesives
- Difficult to remove adhesive from the mouth and denture.
- A false sense of security that a denture is still satisfactory may develop using adhesives with a poorly fitting denture that should be relined, replaced or maintained in different ways.
When Should A Denture Be Replaced
There is no specifically agreed-upon chronological answer to, ”when should a denture be replaced?” There are instances where dentures have been replaced after one year or less, and on the opposite side of the spectrum, we have all heard of people who have worn the same denture for twenty-five or more years. These ranges are obviously extremes.
However, on average, dental professionals seem to be replacing dentures somewhere between four to eight years. This would seem to imply that the average denture fabricated from contemporary biomaterials will wear out and deteriorate within that time and/or the average denture patient’s jaws have changed so much that a new denture must be redone.
Each individual’s denture needs are different. There are some factors that a licensed dental professional takes into consideration when evaluating the need to replace dentures.
Denture longevity considerations
Lost vertical dimension: The proper linear distance relationship between the upper and lower jaws is called vertical dimension. This is unique for each individual.As jaw bone changes and the ridges upon which dentures rest shrink, a denture becomes loose and vertical dimension begins to change (the vertical dimension is said to be lost by a certain linear measurement unit such as millimeters). Additional plastic (acrylic resin) is added to the inside of a loosening denture (called relining a denture) to stabilize it by reducing looseness caused from jaw shrinkage. However, relining does not restore vertical dimension in an accurate way.
The current position, held by most dental professionals is that when vertical dimension has been lost by three millimeters or more a new denture should be fabricated in order to restore vertical dimension and maintain functional health.
There are individuals who have worn the same denture for extended periods with considerable loss of vertical dimension over time. Since vertical dimension loss is a slow, but nevertheless progressive, process they have gradually adapted to a continually increasing closed bite position. These individuals often have a sunken facial appearance and usually appear much older than their chronological age.
Functioning in such a progressive and excessively closing vertical dimension position may eventually result in alterations of the temporomandibular joints (TMJ, the jaw joint located in front of the ears). This can lead to significant pain and difficulty with effective eating and even the jaw motions involved with speech. It frequently becomes quite difficult, if not impossible, to restore such individual’s proper vertical dimension and chewing efficiency by relining and repairing this older denture.
Tooth wear: Aside from impaired ability to chew effectively, excess tooth wear will adversely affect esthetics and cause other problems associated with lost vertical dimension, as described above. While porcelain denture teeth will wear at a slower rate than plastic teeth, they nevertheless will wear and are more susceptible to chipping and cracking. Multiple cracked teeth will ned to be replaced.
Deterioration: While the biomaterials used to fabricate dentures today are quite durable, they still deteriorate and exhibit dimensional change over time – – no longer properly fitting, even after relining.Aging plastic looses its natural appearance and texture, and coloration fades, making dentures look quite artificial.
Deteriorating plastic also makes it easier for dentures to become excessively contaminated with microorganisms. This contributes to mouth irritation and bad taste, and socially unacceptable odors will develop that no amount of denture cleaning will seem to eliminate.
Keeping regular dental check ups so that one’s dentures, soft tissues and jaw bone may be checked is essential to extending the life of a denture and maintaining oral health.