What exactly is a denture?
A denture is a prosthesis that is made to replace missing teeth.
A complete denture is made when a patient is missing a full arch of teeth. This is made of acrylic material and mimics the look of natural teeth and gums. The denture will sit right over the gum tissue.
A partial denture is used when a patient is missing teeth but still has some healthy teeth remaining to hold onto a prosthesis. A partial denture will clasp onto these remaining teeth and then fill in the missing spaces with denture teeth. Partials are normally made out of metal and acrylic.
What is the process of making a denture?
Making a complete denture or partial denture takes planning between you and your dentist.
First, it will depend on if there are still teeth remaining that need to be extracted. If your teeth are already missing, preparation can begin right away for a conventional denture. The first steps involve a series of impressions to capture the detailed anatomy of your arch. Following that will be a jaw relations appointment where your dentist analyzes dimensions of your bite, speaking space, and lip support. The final appointment before completion is an esthetic try in where the denture and teeth are tried in in a wax mock up. This is an appointment that allows your dentist to confirm the proper dimensions along with giving you a chance to check if you are pleased with the esthetics of the teeth such as their positioning, shape, and shade. Since this is done in wax it gives you the opportunity to make changes before the final processing. The final appointment is the delivery of your denture.
If there are still teeth remaining that need to be extracted then you have options of pursuing an immediate denture or a conventional denture. A conventional denture takes the same steps as above, but the denture making process would need to wait until your remaining teeth are extracted and have time to properly heal. An appropriate amount of healing time before beginning fabrication of the denture is normally at least 4 – 6 weeks, but every person heals at a different rate. As your dental arch heals from extractions it will go through a series of changes- the tissue will shrink and the bone will remodel over time. This means that the longer you wait to fabricate your denture after extractions the more true of a fit the denture will be. However, one major hesitation patients have with this method is that through the entire healing period and through the steps of fabricating the denture they are without teeth, which can be difficult in terms of both esthetics and function. A conventional denture fits very true to your final anatomy and normally results in less adjustments, but you have to be willing to be without teeth during that transition period.
An alternative to a conventional denture is an immediate denture. An immediate denture allows you to never be without teeth. This means that all the steps to fabricating your denture will be done prior to the appointment for extractions. Normally this involves having the posterior teeth extracted ahead of time and giving them time to heal while maintaining the front teeth. This way the tissue and bone are allowed to remodel in the posterior areas, but esthetically and functionally you still have your front teeth. First, all of the necessary steps will be taken to fabricate the denture. Then, on the same day of the dental extractions the denture will be delivered, so you never have to be without teeth. Another positive is that the denture acts like a bandage to help compress and protect the extraction sockets while they heal.
Most people really gravitate toward the immediate denture route and for good reason; being without teeth is hard! However, patients need to be aware that an immediate denture comes with some limitations. First, there will be a lot more adjustments. As your tissue heals and remodels over time following extractions it is going to change the fit of the denture. This can be managed with temporary relines of the inside of the denture where your dentist will add material that helps to adapt to the changing tissue. Another limitation is that because all of the denture fabrication steps are taken with some teeth remaining it means that you are not able to see the esthetics of the denture before processing. While most of the time the denture will look just fine there can be discrepancies in the positioning of teeth because the placement of the teeth in the denture is more of a prediction of where things will heal. Because of these limitations, often times your dentist will strongly recommend planning for a new complete denture or a new permanent reline about 6 months to a year after healing.
The process of making a partial denture is almost the same as making a denture- impression, jaw relations, and an esthetic try in. A partial denture with a metal framework may require additional try in steps to assess for proper fit of the framework. If preparing for a partial denture requires extractions, it can also be done immediately with similar limitations to an immediate regular denture.
How does a denture stay in place?
A complete denture relies on tissue contact to create a suction effect to stay in place. We often find upper dentures to be more retentive than lower dentures because the upper denture is able to cover the entire palate and by covering more surface area it helps improve the suction. A lower denture has more difficulty with retention because the location of the tongue does not allow for as much surface area to be covered, along with movement of your tongue when eating and talking. Retention of a denture is also dependent on the anatomy of the ridge. Ridges that have more bone support and healthy tissue tend to provide better retention for a denture. Staying hydrated and keeping your tissue lubricated is also helpful in improving retention. A partial denture stays in place by a combination of clasping to teeth and retentive tissue contact.
It is important to note that dentures and partial dentures are removable devices that are not fixed into place, so there is always some movement to be expected. If you find that you are having difficulty with your denture staying in place then see if any adjustments need to be made with your dental team. Denture adhesives are also extremely helpful in improving the retention of a denture. These products come in gels, powders, or strips and can be found at a local drug store or online. Popular brands used are Poligrip and Fixodent.
What lifestyle changes can I expect with a denture?
As with anything new, adapting to your new dentures takes a little bit of practice and patience. When you are first starting out it’s recommended to take things slowly with eating- start with softer foods and cutting things into smaller pieces. As you get used to your dentures you can begin to get a more ambitious, but in general you will need to use caution with sticky or hard foods as these can be a little more difficult with a denture.
Another adjustment will be with speaking. In the steps to make the denture your dentist will analyze the spacing and positioning of the teeth so that they are in an appropriate position for normal speech. However, having something new in your mouth will take some getting used to.
Overall, dentures are a great aid to restore patients back to normal function. After a bit of time and practice most patients are quite successful with their dentures and it becomes a new normal.
How do I care for my denture?
It is important to take your dentures or partials out at nighttime to give your tissues a rest. Keeping your dentures in overnight can lead to tissue irritation and bacterial or fungal build up. Cleaning your denture is also important. Dentures can be soaked in water with denture tablets and then brushed. Warm water, dish liquid, and a denture brush is also another helpful cleaning mechanism. It is recommended to avoid toothpaste as this can be too abrasive and cause micro-scratches over time that may catch stain or bacteria. Also be sure to be careful not to drop your denture when cleaning it because they can fracture if they fall into a hard sink! Try lining your sink with a towel or filling it with water to be extra cautious.
When do I need to see my dentist if I have a denture?
At first you may need to see your dentist a bit more frequently because like a new pair of shoes, a new denture can cause sore spots in your mouth. This is an easy fix- your dentist can adjust any spots that may be rubbing too hard. If you have full complete dentures then seeing your dentist once a year to check the health of your mouth and the fit of your denture should be sufficient. You can also call your dentist and schedule appointments as needed for adjustments if any areas of concern arise. If you have a partial denture with teeth still remaining then you should be keeping up with your routine hygiene visits to ensure good health of your remaining teeth. Your partial denture can be checked at these appointment and adjusted as needed.
What if I want something with more retention?
Implants have helped dentistry come a long way in improving retention of full arch devices.
There's so much to say about implant supported devices that it deserves it's own blog post- stay tuned!