Patients normally look forward to the day when they receive their new dentures. They are happy about the prospect that former dental problems will soon be over. Then, the day arrive then the new dentures are inserted and they are frequently shocked that a new array of dental problems are just beginning. In order to receive the maximum service and satisfaction from new dentures, the patient must understand certain relevant and pertinent facts – whether they have previously worn dentures or not. Many misconceptions and erroneous ideas exist concerning the use and care of complete dentures.
Printed instructions have an important role in modern informed consent; and it is essential that the expectations of the patient and dentist are alike. It must be emphasized that both the dentist and the patient have an important role in the outcome of the complete denture service. The following patient instructions are based on the research and experience of many prosthodontists, over many years, and are intended to provide practical methots for mastering the use and care of new dentures.
Introduction
The art and science of prosthetic dentistry had advanced rapidly during recent years and new techniques and materials have greatly improved our abillity to replace missing tissues with functional and natural looking artificial appliances or prostheses. However, it must be remembered from the outset that no prosthesis or artificaial substitue, regardless of how painstaikingly fabricated, will ever function as efficiently as the original living tissues. Research has shown that the chewing efficiency of experienced denture patiens is, at best, less than twenty percent as efficient as the average chewing efficiency of patients with natural teeth.
Your mental atittude and adaptability are of utmost improtance to learning to use new dentures. Do not expect too much from them, especially at first. The dentist can only provide the denture treatment and then advise you. You must have the patience and perseverance to learn to use the dentures.
Just as learning to swim, or skate, or ski, or ride a bicycle can be traumatic experiences, so it may be learning to use new dentures. These are all physical skills that must be learned and no one is an expert in the beginning. The length of time required to learn to use dentures varies and depends on many factors such as age, general health, nuturtion, muscle tone, tissue condition, coordination, and mental attitude. Since no two patients are exactly alike, all patients cannot expect the same degree of skill or success in using dentures. However, it should be remembered that millions of other people have learned this skill and the odds are likely that you will too.
Please beware of relatives and friends who are denture wearers. Most dentures wearers consider themselves experts on the subject and are eager to give you advice based on their experience. Such advice can be inaccurate and harmful to you. Seek the advice of only one expert, your dentist, who has the training and experience to treat your specific problems.
Many denture patients would like to ignore the fact that they are, to a degree, handicapped. It is evident that a man with an artificial leg would have great difficulty becoming a professional football player. The denture patient must also learn to live with certain limitations. Since you will be wearing dentures from now on, it is no disgrace to use them in a manner that will help insure your ability to wear them in the future. Despite the limitations, your dentures will restore your appearance, speech and ability to chew – when you master their use.
The First Few Days
For the first days after receiving new dentures you should expect only to be able to keep the dentures in your mouth. Chewing should be limited to soft foods and the dentures should be worn all night the first night only. Dentists normally insist on an adjustment the next day. Movement of the dentures during function sometimes causes red spots to develop during the first 24 hours which would become painful denture ulcers, if not treated.
Some patients experiece an initial abundance of saliva which is stimulated by the presence of the new dentures. Soon the salivary glands will adjust to the presence of the dentures and resume their normal production. Until then, you should simply swallow more frequently.
Occasionally, patients experience a gagging sensation when they first begin to wear dentures. Gagging is a reaction that will gradually disappear as the dentures are worn. Do not insist that the upper denture is too long. Anatomic landmarks determine the exact length of the denture and the seal or suction will be destroyed if the denture is shortened. If this problem occurs, consult your dentist, but remember that this is a problem that you must largely overcome through perseverance.
Frequently patients have the sensation that the tongue is too confined and interferes with the stability of the lower denture. This is particularly true if the back teeth have been missing a long time or if a previous denture was not properly below the flattened, filling the space of the missing teeth. As the new denture is worn, the tongue will retain its muscle tone and become narrower and more rounded. The dentist may thin the tongue sides of the denture to help this problem.
Denture irritations or sore spots will invariably develop and will require adjustment by the dentist. These irritations are caused by movement of the denture during function. Time is available each week for such appaintments, so please call and reserve a time if problems develop. Never attempt to adjust or repair a denture yourself. If an area is particularly sore, leave the denture our as much as possible until the day of the adjustment appointment and rinse your mouth requently with warm salt rinses.
Difficulty in speaking is another hurdle which must be overome with patience and practice. Speech patterns will improve only after the tissues of the mouth become accustomed to the new dentures and control of the lower denture is learned. If you watch yourself in a mirror and say the sounds that give you trouble, this sometimes helps the speech “computer” adapt to the new dentures.
Mastication (Chewing)
The greatest problem by far is relearning to eat. Eating with complete dentures is quite different from eating with natural teeth. Natural teeth are embedded in bone and have individual sensory nerves capable of sensing pain, pressure and temerature. A denture, however, functions as a single tooth, is anchored to nothing, feels nother, and rests on soft, movable tissues covering the jaw bones.
If a denture is to remain stable during chewing, the forces of chewing must be distributed uniformly over the denture bearing surfaces. Forces applied to only one side of the denture will compress the tissue under that side, while tipping the other side away from the tissue and breaking the seal. Although some patient are proud of the fact that they can take bites out of such things as apples and corn-on-the-cob, it must be pointed out that dentures were never intended for biting things off with the front teeth. A denture is like a canoe – if you stand up in front of a canoe, it will tent to upset. The long term relust of this practice is damage to the underlying bone.
One solution to the problem of chewing with complete dentures is learning to chew simultaneously on both sides. Brittle foods such as saltine crackers may offer good practice. Place half a small cracker on one side and half on the other side. Attempt to chew slowly and thoroughly and then swallow. At first, this two-sided chewing may seem difficult because we tend to chew on one side onlay with natural teeth. Two-sided chewing can be learning and it is probably better to chew on both sides at once with complete dentures.
Get in the habit early, especially in social situations, of selecting foods which can be eaten with a knife and fork. Cut the food into very small bites which can be placed on the back teeth. Methodically chew on both sides at once until it can be swallowed. Gradually, this process will become natural and rarely will anyone be aware of your denture limitations – unless you call attention to them yourself. Some patients find that the use of commercial denture adhesives are helpful during this learning period and they often become accustomed to the confidence proveded by additional adhesion.
Certain foods are often avoided by denture patients, i.e., tough fibrous meats, tough breads and hard rolls. Tiny, hard particles that cannot be softened by saliva can be extremely painful if they get under the dentures. Examples are strawberry and raspberry seeds and particles of nuts and carrots. Sticky substances such as chewing gum and caramels can stick to the dentures and should be avoided.
Proper nutrition and fluid balance are important to both your general health and to your success in wearing dentures. Taking a daily mulitple vitamin is recommended. Avoid the usual tendency to overindulg in doft carbohydrates (sweets) that are high in calories and low in food value. A well balanced diet should contain some daily portion of the following types of food: low fat milk, cheese, bread, cereals, meats (especially fish or fowl), green and yellow vegetables, fruit and water (2 quarts per day).
Above all, wear the dentures at mealtime despite the difficulties. Do not become discouraged. Don’t fall back on the “crutch” of using old dentures or doing without. This will only prolong the adjustment period. Remember, millions have learned these skills and you can too.
Mouth and Denture Care
Dentures should remain out of the mouth for an eight hour period during each twenty four hours. This period is essential for the long-term health of the denture supporting tissues. Research had shown that certain pathologic conditions occur only if the dentures are worn continuously. The gums stay healthier and jaw bones shrink less with a daily rest period. Most patients find it convenient to rest the mouth during sleeping. Taking the dentures out at night has thus become the recommended procedure.
Dentures tend to collect even more food debris that natural teeth. Dentures must be removed from the mouth and cleaned after eating and before retiring at night. The complete denture patient should have two brushes, a denture brush for cleaning the dentures and a soft toothbrush for brushing the gums and tongue. The denture brush had a small tuft of bristles on one side which help clean inside the denture. Please do not use toothpaste on the dentures. The abrasives in regular toothpaste polish enamel without damage but can be damaging over time to the plastic denture bases and artificial teeth. Use a dentifrice made specifically for dentures, or simply soak them with liquid soap or plain water. Since the plastic denture material is breakable, it is an excellent idea to brush the dentures over a sink partially filled with water. Many dentures have been broken by dropping them into an empty sink.
Remember that tartar or calculus can form on dentures just as on natural teeth. Stain and tartar generally do not form on dentures that are thoroughly brushed daily. Remember also that “denture breath” is caused by unclean dentures in an unclean mouth.
Whenever dentures are out of the mouth they should be stored in clean water. Failure to keep dentures wet results in the material drying out and warpage can occur. Dentutres should be stored overnight in a denture cup and commercial denture cleaner may be used if desired. Such cleaners can make drntures taste and smell better but should not be considered a substitute for brushing.
Future Denture Service
As a child develops, his or her jaw bones grow for the purpose of supporting the teeth. When the teeth are removed, the body knows that bone is no longer needed, and the bone that supports the teeth immediately begins to shrink away. This shrinkage is greatest during the first year after teeth are removed but continues slowly in a chronic, progressive, and irreversible manner throughout life. The lower jaw shrinks four times faster than the upper jaw. Studies have shown that wearing dentures accelerates this process. It is generally accepted that changes in the jaw bones and soft tissues occur in six to ten years to require the construction of new dentures. However, there is wide variation among patients and sometimes the internal surface needs to be updated earlier by what is called a reline procedure.
For the reline procedure, and impression is made inside the denture between the current inside denture base and the existing ridge. Acrylic is reprocessed to refit the denture. This does not change the apperaance, teeth, or bite on the denture. While this will improve the fit of the denture, you may have to readjust to the relined denture just as if they are a new set of dentures and all thier associated problems.
Since we know the tissues of the mouth were never intended to support artificial dentures, and that dentures can damage these tissues, it is important for denture patients to be examined by the dentist at least once each year. Any unusual changes in the mouth should be reported to the dentist immediately. Patients who use tobacco and drink consist of an oral examination to evaluate the fit and bite of the denture, an oral cancer evaluation, and cleaning of the dentures.
There are some patients who never master the use of complete dentures. Perhaps they cannot learn to keep the lower denture stable enough to chew, or perhaps they cannot get accustomed to having the whole palate covered by the denture. In the past, little could be done for these patients. Today, such problems can often be managed through the use of dental implants. For example, as few as two dental implants can markedly improve the retention and stability of a lower denture. Implants are alawys a better alternative to traditional denture retention and support. However, some patients might need extensive and expensive bone grafting to receive implants thus making implant treatment complex and lengthy. Even if obtaining implant treatment is not easy, it is still a better alternative to traditional denture therapy.