Tuesday, September 24, 2013

Loose Dentures

Unfortunately, many people do not keep their teeth. They most often get dentures to improve function and aesthetics. There are many potential problems that occur with dentures. The ability to keep them in place is one of the most common problems. There are many more, but at this time I will only discuss the looseness of dentures and some solutions.
 Let's describe what typically happens. When teeth are lost, the bone resorbs (disappears; melts away). In many cases dentures are fabricated prior or shortly after the teeth are extracted (removed). Most of the dramatic changes of the bony architecture occur within the first six months after having teeth extracted and will continue at a slower rate throughout life.
So what is the significance of the bone loss? Initially, the recently fabricated dentures will fit. However, after approximately the first six months, you may notice that the dentures have significantly loosened up.
Initially denture adhesives may not be necessary. Over time you may find that more and more adhesive is required to keep the dentures in place.
There are many types of adhesives.
This is just one example.
There will be a point where no matter how much adhesive is used, adequate or satisfactory retention cannot attained. At this point, we can reline the denture. We simply add material to the internal surface of the denture where the bone and gums have pulled away.
A denture being relined.

After  a while, relines will not help the denture and a new one should be fabricated. On average, a denture should be replaced after about 5 years.

Notice the muscle attachments are at the same level
 as the bone. Also notice that the tongue sits higher than the bone.
As time passes, there will be so much bone loss, that a conventional denture will not stay no matter how much adhesive of reline material is used. Take a look at the picture on the right. Here we see that the musculature of the face will dislodge the denture anytime the muscles contract. The floor of the mouth and tongue will also displace the denture.

Fortunately, we can help these people with an implant supported denture. In this case, the implants hold the denture in place. No adhesives nor reline materials are required. In addition, the denture doesn't have to be anywhere near as bulky as a conventional denture which enables better comfort and function.

Implant supported denture
The last option is by far the best option. However, it is also the most expensive option. Implants are also placed. In this case, many more implants are placed and are restored as either individual teeth or as bridges as in the picture below. 
Upper teeth restored with implant crowns and bridges

If you have loose dentures, discuss your concerns with a dentist to help you decide which option is best for you.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit www.advanced-smiles.com

Wednesday, September 11, 2013

Question and Answer About Partial Dentures

I just recently received a question online from the Q&A Panel at LocateADoc.com. I thought that since this is a common problem, that I would share the question and answer here.

Here is the question:

"About two years ago I got an upper denture. The dentist left some top teeth in for support (I guess) of that denture. However, because of this, the denture extends out like an awning above my lower teeth, and looks terrible. All you see coming at you is big teeth on top. Now it doesn't even fit well, and I would like to get it re-done. I wonder if I should have those 5 remaining upper, natural teeth of mine removed before trying to re-do it? Is there really such a thing as a "natural" looking denture? Sometimes you can spot them a mile away, but on others you are surprised to find out they are wearing dentures. What makes the difference exactly in a natural look VS I'm wearing dentures and hate that you know. I can afford a "good" denture, but cannot afford implants unfortunately.
Thank you,
L. Burns

Here is my answer:

Hello L. Burns,

I'll answer as best I can with the information I have. Trying to assess a condition without actually seeing it is like diagnosing a car problem over the phone.

If the remaining teeth are in good shape, you certainly want to keep them. This will enable the preservation of bone and will certainly help keep the partial denture in place.

As far as the fit is concerned, over time, the bone and gums will resorb away from the denture. When this happens, there will be spaces between the denture and the soft tissue of the mouth making retention much more challenging. Either a new partial denture will need to be fabricated to fit better, or you can also reline the internal surface of the denture to improve the fit. In your case since you don't like the appearance, I suggest you get a new one so that you can have a more aesthetic prosthesis.

I certainly hate dentures that you can spot a mile away. I want things to look completely natural. When you get a new partial denture, have a discussion with your dentist on how you want them to look. This will eliminate the guesswork. The position, shape, color and overall aesthetics can be changed to get the look you're looking for.

Hope this helps!

Dr. Martin J. Cisneros

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit www.advanced-smiles.com

Wednesday, September 4, 2013

Is Excessive Gum Chewing Bad?

I'm certainly not going to make the case that one should never chew gum. However, I will certainly try to discourage excessive gum chewing.

Now what is excessive gum chewing? There is no precise answer for this. The good news is that there are some indicators that might give you some clues. For example, sore muscles, joint pain and tooth decay.

Four things immediately come to mind:
  1. More cavities
  2. Excessive tooth wear
  3. Decreased facial dimensions
  4. Joint and muscle issues (TMD--temporal mandibular disorders)

When chewing gum that is loaded with sugar, the results are very predictable. More sugar equals more cavities. However, chewing sugar-free gum can actually decrease the potential for cavities. If after eating a meal you find that you don't have a toothbrush readily available, I recommend rinsing with water. If water is not available, then sugar-free gum can be helpful in removing debris from the teeth thereby decreasing the potential for cavity formation.

Excessive tooth wear
Excessive chewing will lead to excessive tooth wear. Take a look at the picture on the right. You can see that it appears as though someone has taken a file to these teeth and have made them completely flat. This likely wasn't the case. It's more likely that other issues such as clenching/grinding may have been the primary cause of wear in this particular case.

This next picture demonstrates TMD and a decrease in the vertical dimensions of the face. Notice the size of her jaw muscles. They are incredibly well developed. Overuse will lead to muscle/joint pain, damage and dysfunction. 

Also notice that her teeth have worn down and her face has gotten shorter. Cosmetically, it makes people appear much older. In this case, Dr. Sam Muslin improved her overall appearance by not only fixing her teeth, but by increasing her vertical dimensions.

Courtesy of Dr. Sam Muslin

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit www.advanced-smiles.com