Many misconceptions and much mis-information exists concerning the use and care of artifical dentures. In order to receive the maximum possible service and satisfaction from your dentures, it is important for you to know certain relevant and pertinent information (whether you have previously worn dentures or not). The purpose of this instruction is to assist you in the transition from your own natural teeth or previous denture to your new one(s).
At the onset it should be thoroughly understood that any prosthesis (or denture), whether it be complete or partial in composition, is an artificial substitute for the natural. NO substitute, regardless of how painstakingly fabricated, will ever function as efficiently as the original natural teeth….implants being its competitor, of course.
The art and science of prosthodontics has advanced rapidly during the past few years. Your dentist and his laboratory, with new techniques and materials, can now make you a natural looking denture. The responsibility for the success of these dentures is divided; you must accept your share of that responsibility.
Learning to wear and use artificial dentures is a time-consuming process that demands patience and determination. The length of time required depends upon many factors: patience, perserverance and determination of the individual, age, general health, jaw relations, muscle formation and tissue tone. No two individuals are alike.
Some people learn to use dentures more easily than others. There is a great difference in the natural support (gum/bone ridge) presented by each patient and considerable difference among the patients in the physiological tissue tolerance to denture pressures. This may manifest in soreness, rapid shrinkage or development of other abnormal changes in the gum and bone. Therefore, it is difficult to say how long it will take a new denture wearer to learn to use the dentures, or to indicate the extent the dentures will be able to be utilized at all. Some patients (many, if not most) have an improved quality of life converting to implant supported prostheses as compared to ‘conventional’ complete or partial dentures.
Tell your difficulties to your dentist and he/ she will help you more than any other person. Take their advice rather than that of a well-meaning friend or relative.
Your mental attitude is of utmost importance. Do not expect too much from your dentures, especially at first. Do not become discouraged; some people are getting along well with their artificial dentures, and so can you.
Read the following pages and you will learn how to care for your dntrues and what to expect from them. If you have questions about the information presented ask the dentist!
1) DIFFERENCES BETWEEN NATURAL TEETH AND ARTIFICIAL DENTURES:
Artificial dentures are mechanical substitutes for the natural teeth and some of the supporting tissues of the teeth, which are lost during the natural healing and shrinking process that follows extraction. Like all mechanical appliances, their use must be learned.
Eating with artificial dentures is quite different from eating with natural teeth. The artificial denture is supported by the resilient gum tissue, while the natural teeth are firmly embedded in bone. The natural teeth have sensory nerve fibers in their interior canal, and also tactile nerve fibers in the membrane surrounding each root of the tooth. The artificial denture is virtualy a mass of lifeless, foreign material in the mouth.
Natural teeth are individually supported in bone. Although interrelated, forces applied to a single tooth or several teeth are accepted by those teeth individually, without reference to the other teeth in the arch.
The maxillary or mandibular denture functions as a SINGLE TOOTH. This SINGLE TOOTH is not supported by bone; it rests on soft, sensitive, moveable tissue which overlies bone. Consequently, forces exerted on any area are transmitted throughout the denture base, compressing the soft tissue under the denture base on the side on which the forces are applied, while breaking the border seal on the opposite side. Unilateral chewing results in a constant tendency for rocking the denture base and concentration of force in a small area on the chewing side. You must learn to chew on both sides simultaneously and on the back teeth; never chew on the front teeth. This is referred to as bilaterally balanced occlusion.
Alveolar bone (tooth supporting bone) is developed in the mandible and maxillae for the sole purpose of supporting your natural teeth. When they are lost, the normal stimulation for the internal supporting structures of the teeth is also lost, and the bone resorbs (shrinks) given time. For some individuals, bone resorption is a very slow proces, while for others it is very rapid. The denture is an unchanging piece of material, while the body dynamically modifies itself. Therefore, you, not the denture become loose.
These differences make artificial dentures quite inefficient when compared to the healthy natural teeth. Experiments have shown that, well-fitting artificial dentures in mouths of patients who are experienced in their use, at best, develop only 15-20 percent of the efficiency they had with their natural teeth.
2) THE FIRST FEW DAYS:
For the first few days following the insertion of the new dentures, you should expect only to be able to keep the dentures in the mouth. A feeling of bulk or unusual fullness in not uncommon, especially if this is the first experience with dentures. This sensation soon passes as the tissues become adapted to the denture.
There is sometimes an initial abundance of saliva until the salivary glands adjust themselves to the presence of the denture and then resume their normal function. Until this occurs, you should simply swallow more frequently.
No attempt to eat with the new dentures should be made until the denture begins to feel like a part of the mouth and not like a bulky foreign object. After several days, or sooner if you have adapted more rapidly, when the mouth has become accustomed to the dentures, you may start experimenting with brittle foods such as crackers. Do not become discouraged during the first few days!
The oral tissues supporting the denture were never intended to be used in this manner. However, some edentulous (toothless) ridges are covered with tissues that have a good resistant surface and a relatively thick and resilient underlying layer of tissue, enabling the patient to wear the denture comfortably and to chew vigorously with minimum discomfort.
Some edentulous ridges have very thin tissues covering the alveolar bone (a minimally resistant surface), and no appreciable underlying layer to act as a cushion between the hard alveolar bone and the denture base. This is particularly true on the mandibular ridge. These tissues are thin, easily irritated, and can become constantly painful; and it is almost impossible for these individuals to wear and utilize dentures in the usual way comfortably. (Bubble gum therapy may help).
Many thousands of people wear dentures successfully; but it took time and patience on their part before they became able to comfortably wear them.
3) THE FIRST FEW WEEKS:
The tissue of the mouth will gradually accept the dentures; and eventually your mouth will feel unnatural when you take them out. You will learn by experimenting that biting in some ways upsets the dentures, while biting in other ways seats them in place.
You must learn to chew with your back teeth on both sides at the same time. Break or cut a normal bite into two pieces and place one piece on each side before starting to chew them. After a time this becomes a habit, and you will not realize that you are chewing any differently than you did with your natural teeth.
You will not be able to bite on your front teeth without upsetting the dentures or concentrating excess pressure on the anterior (front) part of the ridge, causing early loss of bone support. Some people learn to bite into apples and eat corn-on-the-cob this way; but biting on the front teeth puts undue stress on the supporting ridges, so you must learn to cut food or break it before putting it into your mouth. In that way, you will not have to bite on the front teeth. Dentures are constructed for eating on the back teeth. The front teeth must be set for appearance, and so are forward of the underlying support; therefore, dentures tip when pressure is put on these teeth, and this results in ridge destruction.
4) CLEANING THE DENTURES:
Artificial dentures are less self-cleaning than natural teeth, so they should be removed and brushed after each meal. The patient who wears complete dentures should have two brushes – one for brushing the dentures and a soft toothbrush for cleaning the gums. You can find these at most drug stores or big-box stores.
Denture brushes are on the market in many shapes; but one that is tapered on one side is the best for getting into all of the hard-to-reach spots on your denture. You may use your regular hand soap to clean your dentures.
You should brush not only your dentures, but also your gums and tongue. Use toothpaste on them, because the mouth, as well as the dentures, must be thoroughly cleaned. Small particles of food always become lodged under the denture; and in function, these particles are forced into the many crevices found on the palate and the ridges. Unless they are carefully brushed out, they remain in these areas when the dentures are reinserted. Then the bacteria break these particles down and irritate the tissues. In addition, the brushing of your gums supplies these tissues with a light massage and frictional stimulation which increases circulation, and thus health, in these tissues.
Brush the dentures first, with the denture brush and Dial hand soap. Brush them over a sink that is half filled with water, so if dropped, the water will cushion the fall (preventing fracture). Brush the gums with a soft-bristle toothbrush. Use a toothpaste with a flavor that you like. After the ridges and tongue have been brushed, rinse the dentures again to remove the taste of the soap. It is emphasized that the entire tissue surface of the mouth, which supports the dentures, should be gently and thoroughly brushed at least once a day, preferably after each meal.
Denture brushes, soap, water
Clorox (bleach) diluted in a glass of water with 1 teaspoon Clorox and two teaspoons Calgon (15 mins.)
If metal exists on your denture (especially for partial denture patients), then no bleach!!
Soak denture daily in commercial denture cleanser
Soak denture during your bedtime
Avoid toothpaste, as it scratches
Vinegar for calcium deposits (tartar)
Brush your soft tissues with a soft tooth brush
Homecare Instructions: Take prosthesis out and rest tissues, 7-8 hrs/day or night
Clean prosthesis after each meal
Learn to chew and talk with prosthesis in place
Have Patience: it may take days to months to adjust to the prosthesis
USEFUL SUPPLIES & EQUIPMENT:
A DENTURE CLEANER: (for complete dentures only)
· One Tablespoon of Clorox
· Two Tablespoons of Calgon
· Glass of Water
Mix the above ingredients together and soak the dentures in the resulting solution for 15 minutes, once a week, then rinse. This solution is only to freshen the dentures; you must still clean them after each meal as outlined in the text above.
A DENTURE CLEANING BRUSH:
· Oral-B Denture Brush
A SOFT TISSUE CLEANING BRUSH:
· Oral B-60 with soft bristles
· Cepacol, Diluted Listerine, Etc.
5) WEARING THE DENTURES:
Dentures must remain out of the mouth for an 8 hour period during every 24 hours, to permit the tissues to recover from the wear and tear of the pressures exerted on them. Research has shown that in mouths demonstrating unhealthy changes in the supporting tissues, the one common factor was that all of these patients wore their dentures 24 hours a day.
The majority of individuals find it convenient to leave their dentures out of the mouth at night. It is mandatory that all patients follow this procedure for both partial and complete dentures. If you seem to encounter problems, check with your dentist. Perhaps some other recommendations can be made. However, it is your mouth that will pay the price; therefore, until you receive other instructions from your dentist, always remove your dentures before bedtime, and place them in clean water for the night.
Adjustments of the dentures are almost always necessary before they become comfortable. This is because the tissues underneath the denture bases vary in resiliency and thickness, and because we extend the denture bases as much as possible for maximum support. Therefore, it is often necessary to reduce the inside of the denture when a functioning muscle causes irritation, or where a nodule of underlying bone has only a thin covering of soft tissue. These adjustments are corrections that function makes necessary; and they have no relationship to the accuracy or fit of the original impressions.
Some mechanically minded patients are tempted to whittle or file on their own dentures, feeling that they know just where it is pressing too hard. The dentures are your property and if you want to take the responsibility, it is your privilege. However, if you take this responsibility, it is yours from then on; do not expect the dentist to adjust dentures that you have attempted to adjust and ruined, or to remake them at no charge.
7) SERVICING THE DENTURES:
Modern denture materials are very stable and reliable and do not change in form over the months or years. However, the tissues of the mouth do change, and some individuals exhibit this change more rapidly than others. This is referred to as ridge atrophy or ridge resorption of the bone/tissues.
The mouth tissues change more rapidly during the first few months after the extraction of the natural teeth. Therefore, it is necessary to have dentures rebased (refitted) after some period of time, and also to have the occlusion (bite) of the teeth adjusted at intervals.
Some patients’ mouths change very rapidly and they may need new dentures after a relatively short period of time. There is such a wide individual difference in this respect that no hard and fast rules can be laid down; but the denture wearer should be aware that the supporting tissues will change and some servicing & adjustments will be necessary, at regular intervals, to keep the dentures efficient and comfortable, and the mouth healthy. Dentures should be considered for re-fabrication after a period of time, if possible; if not possible, then perhaps an implant supported prosthesis should be considered.
Some patients experience a gagging sensation in varying degrees when they first wear dentures. It may be physical; but sometimes this is largely a mental reaction and will be overcome as the dentures are worn. It is one of the discomforts the patient must overcome on their own initiative and responsibility. The dentist, after determining that the dentures are correct in length in the posterior part of the mouth, can do little to overcome your gagging. Above all, do not insist that the denture is too long. The doctor judges the length by anatomic landmarks; and if you insist that they be made shorter, the retentive qualities of the denture may be sacrificed. Patience and perseverance will overcome the difficulty. Don’t become discouraged – others have gone through this and have overcome it, and you can do it too. If not, then dentures are not a solution for your clinical problem.
Difficulty in speaking is another hurdle that the patient must overcome with patience and practice. If there is considerable difficulty in speaking, the patient should practice reading aloud at home. New habits of tongue placement in speaking must be learned, since you will need to accommodate the bulk of the denture base.
10) MASTICATON OF FOOD:
The biggest problem by far is re-learning to eat. Previous eating habits developed over the years must be broken and new ones quickly formed. You now have a denture which is a moveable substitute for teeth that were once firmly anchored in bone.
For the first few weeks, eat only soft foods, especially if this is your first experience with a denture. Hard foods combined with unskillful use of the denture will cause tissue irritation, no matter how good the dentures may be.
Learn to eat in stages. First learn to swallow and then learn to chew. Practice on foods that normally require little chewing (such as whipped potatoes) to get the feel of chewing with new dentures.
Upon mastering these two stages, and only then, move on to the more difficult task of biting and incising food. Don’t rush yourself. Remember that you must first learn to crawl before you can walk.
While eating with your natural teeth, the tongue would shift the bolus of food from side to side until sufficiently prepared for swallowing. Now, with a denture, you must attempt to divide the food so that chewing will be done on both sides at the same time. This will help prevent rocking the denture loose.
Avoid tearing or breaking certain foods ( i.e., hard bread, raw fruit & vegetables). Instead, cut them into small bite-sized pieces and then enjoy chewing them.
Large, bulky or tough foods can make the dentures mechanically unstable. Any object suitable to be bitten should be pressed upward & backward against the upper denture which will tend to seat the denture more firmly.
Whenever possible, move to the more stable areas at the corners of the mouth when biting is absolutely necessary. Chewing should be done on the back teeth where more stability exists. Remember, eat slowly, take smaller bites and above all, be patient. Practice will lead to proficiency.
Most importantly, wear the dentures at meal time despite difficulties. Don’t fall back on the “crutch” of an old denture or doing without, it if this is your first denture. This will only prolong the adjustment period markedly.
For the first few days, while becoming used to your new dentures, do not attempt any solid foods that require chewing. However, be selective about your “liquid soft” diet. The usual tendency is to overindulge in carbohydrates which are high in calories. A well-balanced diet should be followed. Only from a well-balanced diet can we be sure that the body is obtaining its correct proportions of calories (energy), proteins (growth), carbohydrates (energy) and minerals (water-electrolyte balance).
Remember, certain foods should never be attempted by the denture patient. Tough fibrous meats, raw carrots, hard nuts and certain hard breads and rolls. However, the use of an electric blender to liquify and puree food is an excellent aid to the new denture patient. Implant supported dentures or perhaps a hybrid can solve your problem if conventional complete dentures are not performing to your satisfaction.
If your nutrition is not balanced, then this can affect your bodily fluid requirements. This, in turn, will affect tissue firmness and ultimately the fit of your denture. Vitamin supplements are usually not required if you are eating a well balanced diet.
12) ADHESIVE PASTES – PADS AND POWDERS:
In general, it will not be necessary for you to use adhesives with your dentures. However, in certain instances, they may be necessary for the use of your dentures to be a success. Never use them on your own; always let your dentist instruct you on when and how to use them. In reality, you should never alter your dentures in any way, unless on the advice of your dentist. Fixodent can be tried.
Artificial dentures are not comparable to your healthy natural teeth and supporting structures (soft tissue and bone); but for many people they are definitely better than diseased natural teeth and gums, or no prosthesis at all.
When your teeth, gums and bone become so infected by dental caries (decay) and periodontal disease that your dentist advises extractions, you will be a healthier person with your dentures than with your infected tissues. However, it will be a big adjustment. New habits will have to be formed and you will have to put up with many initial discomforts. Success with artificial dentures takes some perseverance and determination on the part of the patient. It is a new skill that must be learned.
As previously stated at different times in these instructions, a lot of people have difficulty adjusting to removable partial dentures or complete dentures. That said, implant supported restorative options exist – such as implant supported over-dentures, hybrid prosthesis, etc. Inquire if you have concerns or would like to learn more. Dr. Kiser will be happy to consult with you about more stable options, if you desire improved or greatly improved circumstances, which require surgery, time and cost.