“I have a top denture and a lower partial denture. I am very concerned about preserving my existing teeth and preventing gum shrinkage.
Not to mention that my current dentures are ill-fitting. It’s time for my six month cleaning but I am not happy with my existing dental care – I want a dentist who will listen to me and answer my questions one by one. Can you help?”
– Question from Janine of Chermside West in Brisbane
Dr David Kerr replies:
Our first recommendation would be to talk to your existing dentist about your concerns. If you are not comfortable with that, and since you are due for your six month cleaning, then it is a good opportunity to ‘try’ another dentist and see if their style of communication suits you better.
I absolutely agree with you that the most important thing is to have someone who listens to you and is able to answer all your concerns, especially because these days there are so many options available to you. It is important that you choose the best option for yourself, not just what someone else thinks is best for you.
With regard to the shrinkage of the gum, that is a natural thing that will happen with all dentures. That is why one set of dentures don’t fit and last forever. It depends on how old your current set of dentures are, but usually they will need relining every 3 – 5 years and replacing every 10 years or so. These are just averages, it does vary a lot with usage and individual shrinkage rates.
You are right to be concerned about your existing teeth. Whilst a full upper denture is one thing, a full lower denture is a completely different animal. You never get the suction and the chewing ability of a full lower denture compared to an upper one. So those existing lower teeth are crucial to retaining that partial lower denture that you already have.
The loss of teeth and starting with dentures
Most people will usually loose their back molar teeth first because that is where most disease occurs. Statistically the lower front teeth are the least susceptible to decay and therefore it is not uncommon to see patients still with their six front lower teeth.
Gum shrinkage and having teeth removed
The problem you have when teeth are removed there is not nearly enough gum and bone down the bottom as opposed to the upper, any shrinkage that occurs is more likely to affect the stability of the lower denture much more than the same amount of shrinkage would affect the upper set of dentures.
This is one of the reasons that upper dentures are generally more successful than lower ones.
A large percentage of denture wearers endure ill-fitting dentures
A lot of people who wear dentures are just not aware of the problems that can develop when your dentures don’t fit very well. This includes things like ulcerations or fungal infections. Another one we call hyperplasia, where because the denture doesn’t fit the gum properly the gum then becomes irritated, actually grows to fill that space and then becomes infected.
The other problem to be aware of is that the bone shrinkage accelerates when the dentures aren’t fitting properly because the chewing forces aren’t being effectively transferred to the bone – this mean that the bone is gradually replaced by scar tissue.
We quite often see this when someone has had their teeth removed, hasn’t been diligently getting their dentures relined and fitted properly – then the bone shrinks really quickly. This scar tissue that is left under the denture is unstable and even despite the best fitting denture it will be “wobbly“, ie still move around all over the place due to the tissue below no longer being solid. This is a huge problem, because at that point the dentures won’t sit properly or stay in place.
Our recommendations to our denture patients
Those patients of ours that still have existing teeth to take care of, we recommend they maintain 6 monthly active maintenance visits. For those patients that have lost all their natural teeth and have a full set dentures we generally recommend visiting every 12-24 months.
The likelihood of decay to existing teeth with dentures
If you have a full upper denture against a lower jaw of natural teeth then there is no more likelihood of decay than normal. However if you have a partial denture, because the denture has to clip around the existing teeth, then there is often irritation to the gum. There might also be plaque accumulation because the dentures by nature are slightly porous and therefore more bacteria attaches to them. The clips can put extra strain on the teeth, so when you bite down on the denture the teeth that they are attached to suffer from more wear and tear.
Most of the denture wearing patients that I see are not aware of most of these problems. Whilst patients are told a great deal of information ‘in-the-chair’, by nature of the stressful position they are in, they will not remember even half of what they are told. This is why we give our patients a print out with everything in it for our patients to take away with them.