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Snap On Dentures – Everything you should know
It is generally the top teeth that have all been lost and some bottom teeth that remain, rather than the other way round. Perhaps due to the denser bone we have in our bottom jaws.
Here is an example of a complete set of dentures (‘full/full’ in dentist speak)- this patient no longer has any of their own teeth, so they must all be replaced by a prosthesis. That is a full upper and full lower denture. It is one of the most difficult things to get just right from a dentist perspective, and takes the most getting used to on the patient side.
The number of people who are edentulous- a posh word for having no teeth, has as you would imagine decreased quite a lot over the past twenty years. The majority of these people unsurprisingly are aged 65 or over. Periodontal disease has a large part to play in the tooth loss of the majority of cases.
How do Complete Dentures Stay in?
Complete dentures stay in place by suction and muscle control.
Suction is created by the forces that act on saliva between the base of the denture and your gums. Have you ever tried to get a thin sheet of plastic or something similar off a wet surface and the thing just appears glued in placed? Do you know what I mean? The same basic forces that are at work there, are at work in your mouth. But because the mouth is a complicated moving 3D shape and not just a flat surface, it is a little harder to achieve.
Some dentures have remarkable suction, and with just the simple forces of saliva, take some real effort getting out. These patients have a particularly favourable environment for dentures, namely good anatomy (ridges), good saliva and a correctly made set of dentures. I delve into more detail about successful complete dentures in another article.
When you have a new denture, the worst thing you can do, is coat it copiously with denture adhesives to hold it in. The acrylic surface of your denture needs to be properly wetted by your saliva before it starts to get some good suction and this can take a good week. There are many other factors involved in making, achieving and keeping this suction and I will go through them in this series.
The reason having a single tooth to hold in a denture is often a bad idea, is that this tooth allows air underneath the denture base, breaking the seal and suction that the saliva is trying to create. Yes the tooth may have a clasp on that stops the denture from falling out but it is also preventing the denture from sticking in. As with the plastic sheet on the wet surface… once you manage to get air underneath, breaking the seal, it no longer grips and comes off easily.
How often do i need a check-up if i have complete dentures?
If you wear a full set of dentures, you still need to visit the dentist for a check up, but once a year is enough unless of course you have any problems.
It is very important for the dentist to continue to check your gums and ridges for any abnormalities, such as infection or oral cancer and to check your dentures to make sure they are fitting and functioning well and that you are able to clean them effectively. It only takes a few minutes to do and can help to identify problems early before they do damage.
An example would be an poorly fitting denture that is rocking, causing your ridges to be resorbed more quickly than if there was a even pressure being applied to your gums. Good ridges play such an important role in gripping and stabilizing your dentures, that if left untreated, the next set of dentures that you need made could be much less effective.
Is there a specialist for this type of treatment?
If you have had a number of sets of dentures made and each dentist you visit makes a set that doesn’t seem to improve on the last- it would be sensible to consider seeing a specialist called a Prosthodontist. They are specialists in the field of replacing and restoring teeth (both fixed and removable options) and assessing/ modifying jaw relationships if necessary to provide you the best possible solution. It may be that your mouth is simply not a favourable shape, that your expectations of what the dentures can do are unrealistic or that you need to consider the cost of having dental implants to stabilise the denture.
There are a vast number of different problems associated with complete dentures and if you read a dental book on them- unlike a lot of other treatments, you will notice there is always a thick chapter on correcting denture problems- this says it all!
Patient Assessment for Complete Dentures
There are four aspects to the examination for dentures. Each will provide information that will help in making the best and most successful dentures possible. We are looking at both the normal anatomy of your mouth, and any pathology or abnormality that may effect treatment, or need to be addressed before making the dentures. As always, it is important to also discuss your expectations and any alternative treatment options there may be.
Assessments are needed of your:
(i) We look for any signs of retained tooth roots, unerupted teeth, enlarged tubersoities or bony prominences that may interfere with the denture such as mandibular tori.
(ii) We look at the quality of your ridges- how tall, wide and firm they are, as this directly effects the success of the denture,do you have any large undercuts on your ridges or a very fine what we call ‘knife edge’ ridge which if not relieved during the making of the denture could be painful.
(i) We look at the tone of your lips, cheeks and tongue and how they relate to your denture during speaking and biting.
(ii) We look at your oral mucosa for any signs of abnormality, infection or problems such as denture stomatitis, angelar chelitis or ulcers.
(iii) We look at where your muscles attach and how this relates to where your denture will sit at rest and during movement.
(iv) We look to see if there are any growths of gum (ginival hyperplasia) or squashy tissue on your ridges that may affect the seal and stability of your denture.
Here we get a good idea of your denture wearing history, giving us a useful insight into providing you with successful dentures.
As we have identified, this is key in getting good suction. This can also effect your taste and cause problems with friction (rubbing) and damage to your gums from the denture.
(i) When did you first start wearing dentures?
(ii) How old are the current dentures?
(iii) How many sets have you had? How often are they replaced?
(iv) How do you get on with them?
(v) What are your main problems/issues with them?
(vi) Were you happy when they were first made?
(vii) Are they painful, sore, loose?
(viii) Do you have any speech problems?
(ix) What can and can’t you eat with them?
(i) The general condition
(ii) The hygiene
(iii) The state of wear
(iv) The bite
(v) The height of the teeth (occluso-vertical dimension)
(vi) The extension of the denture
(vii) The function- speech and chewing
(viii) The fit
(ix) The look – tooth colour, shape and size, gum colour
(x) The presence and position of the post dam ( a special tiny ridge on the top denture that helps to create a seal and improve suction)
(xi) The stability (do they rock?)
(xii) The retention (do they drop?)
(xiii) The position of the teeth
(xiv) The support of the lips and cheeks
(xv) The amount of freeway space ( we discuss this later)
It is the role of the dentist and the team to provide you with information- (like I am doing) to help you understand and appreciate the advantages,disadvantages and limitations of dentures and any alternative treatments.
If the dentist doesn’t feel he can meet your expectations after this discussion, it will save you and them a lot of time and headaches, if you are referred to a specialist or someone more experienced.
All this information that we have collected, gives us an appreciation of the good and bad aspects of your dentures as you see it, and as we see it. This can help us decide whether we:
- Do nothing
- Make small adjustments such as to the extension or bite and re-evaluate things
- Reline or rebase your dentures
- Copy your existing dentures if they have been largely successful
- Make you a completely new set
- Consider an implant retained denture
- Refer you to a specialist.
Alternatives to Full Dentures
If you are edentulous, meaning you have no teeth, the options are:
- A traditional complete denture (most common)
- A complete denture with implants for extra retention (better solution)
- Implants then a partial denture
- Implants then fixed bridge work
Remember, you can be edentulous just on the top, just on the bottom or both. If you have teeth in the other arch then you will have more treatment options to consider. You may not need anything if you have all (or sufficient) of your teeth, or if you have some missing teeth, depending on the circumstances a bridge, implant, partial denture or some combination may be considered. These options are discussed more thoroughly in- Missing teeth options.
I hear from time to time, some confusion regarding the concept of dental implants.
I have had patients ask about popping implants in one at a time to replace the natural teeth as they are lost, or even thinking that they can do away with the complete dentures all together- literally replacing every single tooth in the mouth with these new implant teeth. Whilst theoretically possible, the cost alone would be enough to put 99 percent of people off, let alone the surgery involved.
There are a number of possible ways in which implants can be used, this however is generally not one of them. If you wanted something fixed in your mouth to replace your complete denture, the greatest number of implants you would normally consider is 8, which would be used to support some kind of fixed bridgework. Not an easy feat by any dentists standards and best done by dentists experienced in this area.
I think ‘implants’ need a little more understanding and appreciation for exactly what they are and do… calling them a ‘tooth replacement’ , is just a little too easy and doesn’t really paint an accurate picture of the reality. They are not without their risks, and failures are more frequent than you would probably like to think. The chewing experience is not the same as a normal tooth since they do not have a ligament surrounding them, that provides feedback about pressure and the chewing experience. They are a fantastic way to replace missing teeth and the future of dentistry but not the same as growing a new tooth.
They receive a lot of attention in the newspapers, magazines and on TV because they are a new solution to an old problem and the latest technology. Unfortunately, a lot of patients are not suitable or can’t afford an implant retained prosthesis or denture. Don’t let this dishearten you, most edentulous patients will only have implants to help hold in and support their denture, they are not getting all their teeth put back in. Traditional full dentures are often able to look and function quite well, implants just provide added security and confidence particularly where the anatomy of your mouth is not favourable.
Times Frames and Procedures Information
Procedure for a Complete Denture
Making a complete denture is not as simple as you wold imagine (to get right at least!. Anyone who has worn them will testify to this. Patients experiencing problems with their teeth, often say… “Doc, wouldn’t it be easier just to rip them all out and give me falsies”…. Simple answer, “Not on your life!”.
Obviously when making a new complete denture, we don’t have to consider any of the teeth (because there aren’t any) which makes the design easier than a partial denture; it’s simply a complete denture.
Sequence of Events for
Making a Complete Denture
If you have broken a tooth or the denture in half, or if it is hurting in some way- it is best to get this sorted first so that you have something comfortable to wear whilst a new set is being made. In my opinion, it can always be a good idea to have a spare set, since you never know what might happen, and where you will be
Your dental and medical history.
Patient and denture assessment – soft tissues, hard tissues and your current set of dentures, including what features you like and what you would like to change?
Discussion of expectations, complete denture costs and making a treatment plan.
Such as removing a decayed retained root or for specific problems with your gums or ridges that may effect making your dentures. We want the most time for healing before making a new set. Surgery also includes placing implants if you are having them.
Note: The procedure for an immediate complete denture is slightly different as you cannot try the denture in, in the same way.
Similar to taking them for a partial denture, except this will involve using a different type of tray to accommodate the fact that there are no teeth. Zinc oxide eugonal, impression compound, alginate or silicone materials may all be used depending on what the dentist prefers. The key here is to get the full extension of where the denture will sit in the impression and this may involve modifying the borders first with something called greenstick to make sure your muscles attachments are nicely recorded. I like to wipe alginate all up inside the lips and cheeks to stop air bubbles- gets a bit messy but gives a good impression.
These may not be needed if the stock tray and first impression is good enough. If it isn’t, a special tray that fits the individual shape of your mouth will be requested from the lab and a new impression taken- this is called the master impression and it will be poured up to make a model of your mouth on which the complete denture will be made. When taking impressions the dentist needs to mould the impression to the muscles of your cheeks, tongue and lips. To do this they will gently pull and massage them whilst holding the tray down and ask you to stick your tongue out and from side to side. They may ask you to purse your lips, say ‘ooooh’ and ‘eeeeh’ and swallow. There are time when modifications to the techniques may be needed e.g. for a flabby ridge.
If you only have all your teeth missing in one arch the process is slightly simpler and a combination of the description here and the one for partial dentures is used. What I am about to describe is for complete dentures on the top and bottom- it is one of the trickiest things to get exactly right in dentistry. Because you have no teeth, you have no natural biting position so we have to use the only reproducible position you have- RCP which I explained.
Partial denture try in stage. It is not uncommon to have more than one try in appointment to get things right. The dentist may take off or reposition some or all of the teeth in the process, and send the denture back to the lab to be re-set. Now is the time to make comments about the size, shape and colour of your teeth because once they are finished they are finished. Only when you and the dentist are both happy should the denture(s) be finished in acrylic. Don’t worry too much about the suction at this point- wax doesn’t grip well at all compared to acrylic so they often drop a little at this stage.
Note. If you have a history of fractured dentures because you have a particularly strong bite (not from just from dropping them!) then it is possible to put a metal plate into the denture to help strength it.
So you finally have the denture or dentures to take home with you! I bet you didn’t think it was such a long and involved process- helps you appreciate the cost a little more doesn’t it! See- Fitting a partial denture for more details.
The dentist will discuss how to care for your dentures and maybe provide you with some written instructions to help jog your memory – it can be difficult to take it all in at once.
Snap On Dentures
Snap on Dentures are dentures supported by Mini-Implants or full body Implants. While normal denture or traditional dentures rest on the gum, it is not supported by implants and tends to fit less firmly.
The snap on dentures, MDI supported dentures, fixed hybrid implant dentures can be remove and place easily. Although some people prefer to have a permanent bridgework done dentures are a great alternative.
How do Snap-on dentures work?
There are two types of denture with the snap-on effect. Bar retained and ball retained. Either will be made from acrylic base and acrylic or porcelain teeth that will look natural.
What are Mini-Implants?
Mini implants (MDI) are small titanium screw that are designed to be placed on your jaw bone. They act like regular Implants but are not as invasive as regular implants.
How long does it take to get Snap on dentures?
The procedure can be completed in just 7 days, or in two days if you want to continue using your current dentures.
How much do Snap on dentures cost?
The cost is usually directly related to the number of implant s placed each mini implant has a cost of 450$ USD, and the dentures with 0-rings have a cost of 900$. Contact us for more information and promotions.
Well, let’s say that a successful denture is one that allows you to eat, chew and smile normally without pain, discomfort or worry. The look of the dentures comes down to selecting the right size, shape, colour and position for your teeth and making sure you are keeping them nice and clean. The feel, fit and ability to chew comes down to both you and the dentist– both parties play a vital role in successful complete dentures.
The ‘you’ factors include:
Your Mouth The anatomy of your mouth is a key factor in the fit of your dentures.
Height– if you good high stable ridges then these will help the denture stay in and help stop sideways forces from moving the denture. If you have virtually no ridge (most common on the bottom), then no matter how well made the denture is, it is likely to slide around somewhat with little suction being achieved. How much this happens, will of course depend on your level of muscle control, but in these circumstances, sometimes denture adehesives and implants may be the only solution.
Consistency are your ridges firm or squishy (flabby)? If they are firm the denture will not move at all and the seal will be good, if your ridges are squidgy then there will be some movement towards your gums when you chew and this can break the seal. Sometimes surgery is required before making dentures to correct this, if it is perceived to by a big problem.
Other are there any other problems that may prevent your complete dentures from sitting and functioning as they should,for example a mandibular or maxillary tori? These may require a surgical procedure to correct.
- Your Muscles where your muscles attach to your ridges (those responsible for moving your lips, cheeks and tongue) and how they move during chewing, will effect the shape of your denture and your control. See- Neutral zone, below.
- Your Shape if you have a very high palate it is more difficult to get get suction than a very flat palate- think of the plastic experiment again- the flatter the two surfaces in contact the more difficult it is too separate them. Also the more area for suction, the better, so bigger mouths and anatomy (all else being equal) will give you more grip.
- Your Saliva. As we have said previously “‘saliva” is a key ingredient in getting suction. It is not just the amount of saliva but also the quality of the saliva (how thick it is) that affects the suction. If you have dry mouth for any reason, the this lack of saliva will certainly affect your denture’s suction.
- Your muscle control. Muscle control will always be important in your ability to control your dentures during eating and speaking. We are amazing creatures and our ability to learn is just remarkable, though this does dwindle a touch as we get older. The human body is an incredible machine and you will automatically learn (with perseverance) and the various feedback systems we possess, the necessary skills to use your denture. So have faith and it will come. Where anatomy is not on your side- a helping hand may be needed in the form of implants or denture fixative. Remember that even counting to ten was a challenge before you learnt how to do it!
The ‘dentist’ is responsible for constructing a great fitting denture. They need to make sure that the following things are right:
- Maximum contact. Your denture needs to cover the maximum amount of your ridges and palate (the bony parts) without extending too far onto the soft tissues and muscle attachments of your mouth- your cheeks, tongue, lips and soft palate, (the bit that wobbles when you say “arrrr”). We call this the neutral zone and it is where the denture must be made if it is to stay in place and be balanced. If the denture sits on a muscle attachment, for example your lip, the moment you talk and try to eat the denture will jump around like someone on hot sand. To see what I mean grab your lip and pull it down and up in the mirror (video) you can see where the lip attaches, if the denture sits into this movable bit then you have a game of hop scotch on your hands and it will be easily dislodged.
- The bite. The dentist needs to make sure the bite is right and balanced evenly on both sides. Getting the bite right is crucial- if you chew unevenly, biting on one side first for example, will cause the other side to drop down, the seal/suction will be lost and the denture will move. In the same way, biting on the front teeth first will cause the back to drop and air to get in. As dentists, this is exactly how we break the seal when we want to take your dentures out – by applying a little forward pressure to the front teeth. Dentures are usually made, not to contact on the front teeth for this very reason, though as they wear the front teeth often come to contact.
- Peripheral seal. The dentist wants your denture to stay sealed with salival forces connecting it to the gum, stopping air from getting underneath and losing its grip. To do this, the factors discussed above must be right- that’s the bite, the extension and something new called a post dam, must be added. A post dam is simply a little ridge on the back of your denture that presses just slightly into your palate to help keep the seal
- Closeness of the fit. A close fit of the denture base to your gums, means better grip and suction. The more your mouth changes (e.g. when your ridges resob), the poorer the fit becomes and the looser they will be. In such cases, a denture reline can help improve this fit.
In summary, there are two main dentist words associated with making complete dentures: retention and stability. Everything we do, is in one way or another is related to trying to improving these two aspects. Note: both the “dentist” and the‘you’ factors are important in achieving these.)
- Retention. This is the ability of the denture to stay up (or to not drop). It is affected by the
- Closeness of the fit
- Seal of your denture fit in relation to your muscles and moving tissues
- Contact area the shape of your mouth and ridges
It is a matter of the dentist making sure that there are no problems with the actual fit and construction of the denture, adjusting them if there are, and then you persevering with wearing them. I understand it can be a bit discouraging at times, but you will get used to the feel and appearance if you stick with it.
It is important to understand and appreciate that wearing dentures, and eating and speaking with them is very different to doing it with normal teeth. As such, it takes some getting used to. The patients who struggle the most to get on with their full dentures, are those who have the most unrealistic expectations about what they will be like. Often young patients with many problems (needing repeated fillings etc.) say facetiously – “Oh just take them all out doc, that will solve all my problems” … they have no idea
Denture problems can be a result of patient factors- ‘you factors’, ‘dentist factors’ or some combination of both. The dentist should discuss the ‘you factors’ with you, so that you can appreciate your mouth fully and the limitations of traditional set of dentures. The same grip and experience for chewing cannot be expected if you have no ridges for the denture to sit on, compared to if you have good, tall, solid ridges to hold them in. Sometimes it is a ‘best possible’ scenario, where we know that things are not in our favour and we just have to do the best we possibly can. It is important the dentist clearly explains this to you, so you have realistic expectations about what can be achieved.
The main denture complaints are discomfort (pain), looseness and problems with adapting to a new set of dentures. There are many possible causes for such problems as you are probably beginning to appreciate, and often more than one thing is contributing. Below is a discussion of the different issues that a denture wearer can come across:
Pain This generally takes the form of ulceration, redness or inflammation. It could be due to a number of causes:
(i) Roughness under the denture– the surface of the denture against your gum is rough or sharp.
(ii) Over-exteneded denture- the denture flange (‘sides’) are too long and dig into your gums.
(iii) Undercuts on the denture not relieved- your ridges are often slightly bulbous in shape and the hard acrylic of the denture is not flexible so it can scrape your gums. This creates pain on putting the denture in and taking it out, often resulting in a nasty little ulcer. This undercut just needs to be indentified and smoothed, then the denture left out at any opportunity while this heals up- generally about a week.
(iv) Lack of freeway space- if your denture teeth touch when you your mouth is totally at rest (just after you swallow), this can causes your muscles around your mouth to be in constant tension causing pain.
(v) Errors in the bite– uneven chewing can cause pain and pressure in certain areas or lead to looseness.
(vi) Grinding- if you grind on your dentures, in the same way that if you did it with natural teeth you are putting your gums, mouth and muscles under considerable pressure and stresses.
(vii) Movement of the denture- see- Looseness, below
(ix) Mental nerve pain- you have a nerve supplying sensation to your lower lip and jaw that sits nicely hidden in bone when you have teeth. Over time, resorbtion of the ridges can mean that this nerve comes to lie on top of the ridge in the premolar region. This can be painful to any pressure from the denture often requiring a soft lining if it happens.
(x) A warped denture- doesn’t fit and sit down properly
(xi) Retained roots or bony tori- toriare bony areas that occur in the palate (roof of your mouth) and on the inside of your lower jaw opposite the premolars. They can potentially effect how the denture sits down if they are large and may need to be corrected with surgery before making your dentures. Tori have very little gum overlying them to cushion the denture, so can often be painful to pressure from the denture if the denture hasn’t been adjusted to give sufficient space around them.
(xii) Xerostomia- a lack of lubrication can cause friction and inadequate suction.e final processing stage occurs.
(xiii) Not enough space for muscle attachments. If you hold up your lip, you will see muscle attachments that connect your cheeks and lips to your gums (ridges). As your ridges resorb over time, the muscle attachments will come to lie higher up, and if the denture doesn’t make way for these, impinging on them, it will certainly rub and move the denture.
Looseness. You may feel the dentures are rocking, falling (if it is an upper) lifting or shifting (if it is a lower) or feel like the dentures are just too big. As we have seen, this could be due to ‘you factors’ such as poor ridges, difficult high-up muscle attachments, not enough good saliva or poor muscular control. Or it could be faults with the denture, such as the teeth not being in the right position, an uneven bite, problems with the extension of the denture- too short or too long and so not achieving a good seal at the border- ‘peripheral seal’ This is most commonly a complaint with the lower full denture, which is easily dislodged by the the tongue, lips and cheeks when poor resorbed ridges are present.
Appearance. You may feel the denture doesn’t look right because of things friends or relatives have said- the teeth are too big or small, too light or dark, you show too much tooth or too little, they are too even or too irregular, the lip may be too bulky or not supported enough, the colour of the denture base (gum coloured acrylic) may be felt to be unnatural – any number of possibilites. Not a lot can be done once the dentures are processed from wax to acrylic. This is why at the trial stage, it is so important to speak your mind. If in doubt, bring your partner or relative with you to the appointment so they can give you their opinion.
Cheek biting. Often when you have a new set of dentures, this can happen and as you know once you bite your cheek, it swells up a bit and makes you more likely to bite it again. Your mouth and muscles will learn how to bite with them, you just need to take it slowly when chewing to begin with and allow your brain to work things out. If cheek or lip biting continues it may be that the width of the denture in the cheek or lip area isn’t enough to hold the soft tissues out of the way. If the teeth aren’t in the right position (neutral zone) then some adjustments to your bottom denture teeth may be necessary.
Gagging. For full dentures this can pose a bit of a problem, since we identified earlier that the more surface area on the denture- the better the grip and suction. The more you take away from the base of the top denture, the worse the retention. So when you ask your dentist to grind out the middle, you need to be aware of how this can effect them staying up. If you have a partial denture then there is generally a bit more that can be done, since some retention is gained from the teeth and the design can be adjusted, to cover less of the sensitive areas. Implants and a smaller denture that attaches into them or a fixed dental bridge is a possible solution. Some people are just more susceptible to gagging than others and it is not uncommon for someone to have problems even cleaning their own teeth. If it occurs after a while of wearing the dentures (so not an initial psychological reflex) it may be due to looseness or the denture rocking. If you are having problems with a new set, the palate (roof) of your denture could be too thick, the post dam too far back, the top teeth placed too far towards the inside (palatally) or too far down so they contact the tongue. These possible causes would need to be investigated by your dentist.
Fracture. Aside of ‘accidental’ reasons, such as dropping your dentures or a bang to your mouth, dentures can fracture from the stresses of normal use if the acrylic becomes fatigued. If the denture repeatedly flexes because it isn’t fitting closely (e.g. due to resporbtion or because of flabby ridges) or from an uneven bite, this will create extra stress. Some of you, simply generate one hell of a force when you bite and grinding is also bound to take its toll. If you have very prominent muscle attachments, your denture may need to be deeply notched (relieved) in this area so they don’t rub or displace the denture and this can weaken the denture considerably. Thin dentures are more likely to fracture than thick dentures and where fractures occur repeatedly, it is possible for the technician to incorporate a metal plate to give this some extra strength.
Teeth coming off. This can happen occasionally. Normally it is just a single tooth, which can be stuck back in by the lab technician. If this happens, assuming you don’t accidentally swallow it, you must bring it with you to your dentist- it will make the whole process easier, faster and cheaper.
Wear of teeth. After wearing your denture for a number of years, the teeth often become very flat with no normal pattern or ridges on. This can make it more difficult to chew food. If you already have a denture take it out and have a look- do the teeth still have patterns on them or are they smooth and rounded. If they are and you have trouble chewing food this may be part of the problem.
Resorbtion. Your bottom ridges tend to wear down more quickly than your upper ridges but both will naturally resorb somewhat overtime with the pressures of chewing. As your bone shrinks down, the denture fit will obviously get worse, and this lack of a close fit, will lead to less grip and stability and more movement in your dentures.
This can cause:
(i) Further and faster resorbtion
(ii) More difficulty chewing and speaking normally
(iii) Inflammation of your gums
(iv) Possible infection, such as yeast infections (candida) denture stomatitis or angular chelitis
(v) Burning mouth sydrome- This condition described as a ‘burning’ or ‘tingling’ sensation may caused by a lack of freeway space when your mouth is at rest, the height of your dentures being too much (occluso-vertical dimension) or due to a sensitivity to the monomer in the acrylic base.
Angelar chelitis. This is an infection of the creases, at the corner of your mouth. It could be that there is not enough lip support from the dentures, that the dentures are too small in height (making you over close) or a problem with the position of the front teeth.
Bite problems. An uneven bite (biting one side before the other) may cause tilting of the denture and/ or it to lose suction and drop during eating. Teeth can catch, as you try to close into a normal bite (this is called a ‘premature contact’), from which you slide into a comfortable bite position. This happens when the teeth haven’t been made in quite the correct position (RCP), and some adjustment to the bite is likely to be needed.
Diffiuclty eating. Unstable dentures may move during chewing, causing soreness and problems. It is important to maximize all the features that provide grip or retention and minimize any displacing forces. Sometimes chewing can be a problem- ‘eating steaks’ for example can be difficult with blunt teeth or where narrow teeth have been replaced with wider teeth, or cuspless teeth, or teeth have been ground down to make the bite fit,. All of these changes will affect how you manage to crush your food. If you are struggling to open wide enough to put food in, then some issue (e.g. the dentures are too high to tolerate, or as a consequence of TMJD) is affecting the muscles around your mouth.
TMJD. This is a painful click on opening or closing, or a tenderness in the muscles that control your jaw. It most commonly occurs from large changes to the vertical height of your new dentures beyond your adaptive capabilities and often gets worse throughout the day. It could also be, that your denture is too thick around the tuberosity region (back top area) preventing the normal movement of your jaw during opening and closing.
Speech. Sometimes a new denture can effect your speech, most of the time it just takes you a little time to adapt. Very occasionally, you may have persisting difficulty with f, v, d, p, b ,s and t sounds, if the position of the front teeth is considerably out.
Noise. Some noise from chewing with your dentures is normal, but considerable clicking from the denture teeth may indicate:
(i) The denture height is too much (excessive OVD)
(ii)There is not enough retention (due to the denture, lack of muscle control- sometimes both) so they are dropping and making a sound.
(iii) There is interference in the bite.
Denture hyperplasia. Over-extension of the denture is common if the ridges have resorbed and then denture now sits lower down than it did before. This can cause looseness, soreness, swelling and ulceration. It can also cause hyperplasia (an overgrowth of gum) as a result of long term irritation- this is often painless but some patients get worried that this growth could be oral cancerbecause it can look a little scarey. The treatment is for the dentist to identify the overextended areas and correct it. Sometimes a soft lining is needed initially during the healing period, then a new denture should be considered.
Allergy. Very occasionally this occurs to the unreacted monomer in the acrylic, if an error with the final processing stage occurs.
Your dentist is the only person who can help diagnose and solve the problem- so make an appointment to see them and get your issues investigated.
Sometimes the issue is obvious and easy to correct, and other times it may be a matter of trying a number of different approaches.
Wearing complete dentures successfully depends on your ability to control them. This muscular control is learned by practice and perseverance with your dentures over many years. The older you get, the more difficult it becomes to adapt to a new set.
If you are having problems with a new set and you have previously worn a full set of dentures, you will know that this part of the course. In the Denture review- we discuss how a couple of adjustments will nearly always be needed, that a period of adaptation is required and how best to go about this. The more the new set differs from your old set, the more time required to get used to them.
For this reason, where possible, replacement dentures should closely resemble the current set (obviously correcting any of problems that made a remake necessary). Copy denture techniques have been developed to help do this. Moulds of the old dentures are taken and the dentist decides which features they would like to keep and which they would like to change- such as the size and shape of the dentures, the position and height of the teeth etc. Aside of this technique, simply copying a few features from your old set, will help with your adaptation.
If this is your first time with a complete set of dentures, it is going to be that bit harder to get used to them. Perhaps you have had a partial denture for a long time and the remaining teeth for one reason or another, required extraction e.g. dental caries or periodontal disease. The full denture doesn’t have a couple of teeth to support it, and as we have seen, relies totally on suction and muscle control which takes time to develop. If you have implants for your denture and attachments made to hold your denture in place, this period of adaption will be far quicker.
- If you have a sore spot or pain in one area
Sometimes it may just be a matter of applying something called Fitchecker (or equivalent)- a special paste that highlights any parts of the underside of the denture, that may be too high and need relieving.
Fit checker (or pressure indicating paste) is first mixed and put on the inside of your denture. It is then sat in the mouth whilst your cheeks are moulded by the dentist, before being asked to bite together and stay together, while the material sets. This will show any high spots or over extended areas that need to be adjusted.
Sometimes a special pencil is used to apply a bit of dye to the ulcer or area of redness and when the denture is placed in, the dye transfers to the denture showing the corresponding part that is causing the problem.
After the area is adjusted – assuming the dentist gets the right spot, you should feel some instant relief. The area is still going to be sore, especially if there is a nasty ulcer, until some healing has taken place. It is best to leave out the denture as much as you can and do some warm, hot salt rinses to speed your recovery.
The dentist will want to recheck you in 1-2 weeks and further adjustment may be needed if you haven’t fully healed. Areas of denture hyperplasia (gum growth) may take up to 6 weeks to subside, after which, if they haven’t fully some minor surgery may be needed to remove them.
- If the bite is incorrect
Then it may be a matter of just adjusting your denture teeth a little bit at a time. Here, we will use some articulating or ‘bite’ paper (a very thin inky paper) that marks your teeth when you tap down on it and ask you to bite together and scrunch your teeth around.
It is the same process for checking the bite after a filling. Adjustments will be made until your teeth meet more evenly at the back on both sides, and your bite feels comfortable.
- If your denture is loose
It depends on the cause of the looseness- in cases where an excellent denture is made but the issues stem from ‘you factors’ such as unfavourable anatomy (e.g. a lack of ridge form) or absence of much needed saliva then denture fixative may be required or implants into which the denture can be attached and held in place. If the looseness comes from resorbtion of the ridges and the denture no longer fitting closely against your gums then a denture reline can be performed.
There are far too many possibilities to cover here; I wanted to just give you a couple of examples to help you appreciate the relm of complete dentures.
If you have had a series of unsuccessful dentures, it suggests that your case may be a little more tricky and in these cases, instead of having a regular dentist add to the collection, it may be advisable to see a specialist- at least for an opinion. This may be a prosthodontist, or at a teaching facility if you can get in. Sometimes, it is more about appreciating the limitations of your situation, than it is about getting a ‘decent’ set of dentures made. Perhaps a dentist may modify an old denture to see if they can improve things first somewhat before going ahead and making a new one.
That depends on if the issue or issues are solvable by other means… often adjustments can be made and problems repaired. The main adjustments that can be made to complete dentures are discussed in Denture repairs and relines.
If the issue cannot be solved such as:
- Your current bite is too far away from being correct
- The colour or position of the teeth is wrong
- There is inadequate freeway space (space in your mouth at rest).
Or you have multiple issues going on, such as very worn teeth and a poor fitting denture, then a new set would be a sensible option.
As mentioned previously, 8-10 years is the average lifespan of a complete denture, so you can use this as a rough guide for whether a new set may be required. This lifespan does vary and each case should be judged individually. I see some patients who have a mouth that undergoes a rapid change and with their bite and lack of care, can make a 3 year old denture look like a 30 year old! Others, have dentures which despite been worn for 15 years, fit well and look relatively new. In these circumstances, making a new denture wouldn’t really be worth it, unless you decide you want a spare set, incase anything should happen to your current ones.
Your dentist can advise you on the best course of action after examining your mouth, your set of dentures and asking you some questions.
Some of the things they will ask and look at include:
- How old is the denture?
- How worn are the teeth? Are the teeth flat or do they still have a pattern on the top?
- Does it still have good suction?
- How is the bite?
- Your facial height- has it changed?
- Does the denture still fit your gums closely? Or have your ridges resorbed?
- Is there any evidence of denture stomatitis or angeluar chelitis?
- How are the aesthetics? Is the appearance still good and natural? Are you happy with how they look?
- How do you get on with them- eating, speaking etc?
- Are they still as good as they were?
- What are your main concerns and issues?
All the factors that affect a successful denture will be looked at.
Some people are naturally better and quicker at adapting, others take more time. Some factors that influence adapting to dentures are:
- Previous experience. Those of you who have worn full dentures before, will take less time to adapt to the second set, then the initial one. Those who have worn a poorly fitting acrylic denture before progressing to a full denture, will have likely have been forced into developing a certain amount of control. If you have suffered severe gum disease (periodontal disease) and require an full immediate denture- that is, having all the hopelessly loose teeth extracted and a complete denture put straight in, obviously this is going to be a major shock to the system and require the most getting used to.
- Age. As we age, our ability to adapt and cope with changes and learn new skills diminishes. This means older patients can find it more difficult to get used to them than younger ones.
- Soft tissue and hard tissue factors. There are certain times when the anatomy of your mouth is not favourable for complete dentures. For example if the bony ridges on which the denture sits are almost non existent, much more muscle control is going to be needed.
- Saliva. As we have said, a lack of saliva can be a real problem in achieving good suction. Therefore more muscle control is required.
- The individual. Full dentures on the top and bottom require far more control than partial dentures since they are only held in by suction. It is easier for cheeks, tongues and lips to dislodge them when they move, so whilst the dentist must make sure the denture is extended just the right amount, learning to control them is the other half of the equation. The lower denture seems to be a particular problem, given that it has the tongue to contend with, and that gravity and pressure often cause the ridges here to resorb significantly more than on the top.
I have had a patient before, who had such good muscle control, that even when the top denture broke in half and was in two completely separate pieces, they were still able to speak and chew as before. That’s muscle control!
If you have any natural teeth remaining, whether you wear a partial denture) or you don’t, it is important to go to the dentist every six months. If you are wearing a full denture, you know how nice it would be, if you had just a few teeth left there to help support it- so looking after your remaining teeth is incredibly important.
If you have no teeth and wear a full set of dentures, it would be a good idea to see a dentist about once a year. Regular examinations of your mouth and dentures are needed as your gums and underlying jaw bone will slowly change shape. Your dentures will also wear, requiring adjustments to prevent problems further down the track.
A denture reline may be needed every few years and a replacement denture once in a while. Oral pathology and problems such as angelar chelitis, oral thrush, oral cancer, denture stomatitis and other conditions can be picked up at such appointments and treated. Some are obviously more serious than others, and how early they are picked up, can make a big difference to the treatment needed and the ultimate outcome.
If your denture is dropping when you speak and chew, try to do so more slowly. Bite down gently and swallow to reposition the dentures- your cheeks, lips and tongue will soon learn to help control the denture.
If the situation doesn’t seem to be improving, there could be factors to do with the dentures themselves that are contributing to them dropping. Make an appointment with a dentist to get this checked out if you are struggling.
If you have full dentures, avoid biting with your front teeth as this will tend to tip the denture forward, breaking the seal and causing them to drop. Instead bite on your back teeth in an up and down motion. If you chew the way we do, when we have natural teeth- that’s a more round and round chewing motion- (think of a horse or a camel chewing for an exaggerated idea), you will rock the denture, disrupt the seal and cause it to lose suction. When biting into (incising) food, such as a sandwhich it is better to use your canine or eye teeth. Sometimes a patient will support the back of the denture by humping up their tongue against the denture when doing this.
Watch out for hot food- since the palate is covered by acrylic, it is not always easy to tell just how hot things are!
Your speech might feel a bit funny and be slightly affected to begin with. Most people adapt pretty rapidly and it is hardly noticeable within a few weeks. Certain sounds, that require control of the lips and tongue in relation to your front teeth, tend to be the problem and practicing speaking and reading out loud will help to overcome the issue.
If speech problems persist you need to see the dentist to investigate things- very rarely it can be a problem with the tooth position on the denture. The more teeth on the denture and the less grip and retention your denture has, the more time it will generally take to get used to speaking with them.
How to clean your dentures is discussed in our Denture care section, and is absolutely essential reading (and doing!)
This is a question I am always getting asked… If you have a new set then I would recommend leaving them in at night for a week or two. This just allows you to get used to the dimensions more quickly and unconsciously whilst you are asleep.
As a rule of thumb though- taking your dentures out at night is recommended. It gives your gums a chance to breath and helps to prevent denture stomatitis. Clenching and grinding can also occur at night and so leaving them out can help reduce wear and prevent occasional fractures, if you have a particularly heavy bite.
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