With proper dental care, few people should lose all their teeth
It would appear to dental professionals that it is strange for many people to expect to lose their teeth eventually because their parents ended up with dentures. They think all their dental problems will be over with false teeth – also called a plate. Such is not the case. My maternal grandmother died at age 85 and never had a tooth extracted. Among the big sales items in drugstores are denture adhesives and do-it-yourself reliners, and better yet, the dental “quacks” have a field day providing dentures for these people under delusion.
Although I do not have statistical data at hand I know that the number of edentulous (toothless) persons in Guyana is decreasing. Among the reasons are the reduction of tooth decay and consequent tooth loss and the increasing availability of dental facilities and personnel provided by the government. In addition, the National Insurance Scheme’s traditional programme as well as the one this author introduced for pensioners in 1991 mitigate the need for expensive restorative treatment rather than extractions. With proper dental care, few people should lose all their teeth. Nevertheless, by age 65, one of three people (33 percent, down from 46 percent 20 years ago) of the population is edentulous. When all the permanent teeth are lost in the same arch (upper or lower), a full denture is necessary to restore function and appearance.
Some patients ask for dentures as a deliverance from their fear of dental treatment. Good dentists should be able to assuage their irrational anxieties. They will persuade their patients to keep at least a few strategic teeth that can be clasped for support of a removable partial denture. They will not extract sound teeth. Extracting healthy teeth at the request of a patient is essentially mutilation by consensus. In any case, dentists were taught that for a tooth to be extracted it has to present at least one of five criteria. None has to do with toothache or a request by the patient.
If the anterior teeth cannot be saved, it is sometimes customary to have an immediate denture placed at the same time that these teeth are extracted. The back molars and bicuspids will have been removed at least a month earlier to allow healing and better control over the construction of the new denture. Since the underlying bone and gums continue to shrink following extractions, an immediate denture gradually loosens and may have to be relined. The permanent relining should be delayed for at least six months to allow complete ridge healing. During the interim, the denture can be tightened with a soft, gel-like lining material called tissue conditioner. Tissue conditioner can last several months and may also be used as a semi- permanent reliner by a denture wearer who otherwise never gets a satisfactory fit.
Dentures have a way of breaking on Saturday night just before you are going out to dinner or when one is about to leave for work. Do-it-yourself emergency denture repair kits are available. But if you can afford it, there are immediate dentures which should be replaced by a new one and the immediate denture kept as a spare. A completely new denture allows improvement of the bite, of the overall fit of the denture base, and of the appearance of the artificial teeth.
An immediate denture does not have to be replaced if the fit is satisfactory after the gums have healed and the base has been relined. In fact, the great majority of the patients whom I have made immediate dentures for never bother to replace them because the need for such is seldom evident. Often, a duplicate denture can be made by the dental laboratory at a fraction of the cost of a new denture. It can be worn for a short time while the regular denture is being repaired. When not in use, the duplicate denture should be stored in soapy water or a dilute denture cleaner to prevent the plastic base from drying out and losing its fit.
When a tooth is extracted, the top part of the bone that surrounded the root is resorbed while the lower part of the tooth socket fills in with new bone. In other words, there is a levelling process that reduces the crest or height of the alveolar ridge. When many teeth are extracted because of advanced periodontal bone loss, the entire ridge flattens out, making denture retention and stability very difficult. This is more likely to occur in lower jaw where the entire alveolar ridge is resorbed, leaving a thin horseshoe or U shaped jawbone termed atrophied mandible. The only way to achieve any degree of stability on an atrophied mandible is to build up the ridge artificially with a graft or by inserting an implant with posts to support the denture base. Of course, the cheapest way to solve the problem is to use denture adhesive paste, powder or wafer.
As long as roots are present, resorption of the alveolar bone is slowed if not completely prevented. Even where teeth are too weak to support a denture, it is sometimes possible to save a few roots, ideally of the cuspids. The top parts of the roots may be left above the gum for direct support of the denture – now called an overdenture – or they may be cut off to the level of the bone and covered over by the gum. Either way, the roots remain, giving support not only to the denture above but also to the alveolar ridge bone. Although this principle applies to both arches, it is particularly relevant to the lower arch, or mandible since that is the location of most denture problems.
More positive retention is obtained by inserting special attachments (connectors) into these roots. The connectors stick out above the gum and snap into the overdenture base. The attachments should be designed to allow minor movement of the base caused by chewing without torquing and loosening the roots. Another concern is decay of the exposed roots. All surfaces must be kept clean and free of plaque to prevent root decay.
(Dr. BERTRAND R. STUART D.D.S)