PROBABLY my scariest experience occurred when I was about seven years old. My paternal grandfather took out his total upper dentures and showed them to me. I remember running away and screaming with fright, believing he had removed his upper jaw. Eventually, when my parents calmed me down, it was explained to me that when people lose all their teeth, they are replaced with fake ones. My young mind remained perplexed for a long time, and I was afraid to ask the many questions that plagued me. For instance, what kind of accident would make someone lose all their teeth and not cause physical damage to their face and lips?

Most people do not realise the problems that arise after dentures are placed. How would you like to have an artificial leg rather than your natural leg? I feel safe in assuming that you would certainly answer: “Definitely not!” So, replacing your natural teeth with either a full or partial denture is about as desirable as having an artificial leg.

Dentures allow you to chew; an artificial leg allows you to walk. The problem in both instances is the performance quality of the artificial replacement in comparison to what nature originally provided. The artificial replacement will never function as well as your natural teeth, no matter how good it looks.

Dentures are not maintenance-free; they need adjustments. It is not that the denture change. The tissues under the dentures change. A denture adjustment is necessary when the denture material must be removed from the denture to relieve pressure at pressure spots that occur when bone and tissue shrink. Since tissue shrinks as it heals, dentures that are placed immediately after the teeth are extracted sometimes need to be relined as soon as the tissue has healed. All dentures need to be relined periodically to adjust for normal tissue changes. So a denture is not a one-shot cure. It is very important to see your dentist once a year so the tissue under the denture can be monitored.

With this overview, let me offer a word of caution. Your dentist may offer you options on types of tooth replacements possible in your case. Offering you treatment options is part of your dentist’s obligation. You need to become a wise, informed dental consumer so you can discuss the best decision for your situation with him.

As a general rule of thumb, fixed prosthodontics (crowns and bridges) are more expensive than removable prosthodontics (full or partial dentures). However, fixed prosthodontics is usually a more desirable replacement. Dentures also vary in cost depending on the type of teeth, the material used to make the denture base, and the number of steps followed to construct the prosthetic device. If you find a place that claims to be able to make your denture in one day for much less than the fee being charged in the area by most other dentists, you will probably get exactly what you pay for. Let the buyer beware! They are no bargains in healthcare!

The name immediate dentures sound like something produced by a fast-food version of a dental office. However, ‘immediate’ in this context means that the denture is placed immediately after the dentist or oral and maxillofacial surgeon extracts the teeth.

Here is a typical example of what happens in preparation for an immediate denture. The first phase is the removal of all teeth posterior to (behind) the cuspid teeth. These ridges are then allowed to heal and act as a stable base for the future denture. After the healing has occurred, the denture is constructed. Then, the natural teeth are extracted and the dentures are immediately placed in the mouth. This keeps the patient from having to be without his or her anterior (front) teeth at any time.

There are many advantages to immediate dentures besides the immediate esthetic considerations. They protect sensitive extraction sites, help control bleeding from the tooth sockets, and protect the surgical area by covering it, thus keeping food and debris out of the extraction sockets.

An additional advantage that you might consider worth the extra expense of the immediate denture is that your dentist knows how your “natural” teeth appear. Thus, he is likely to be able to construct a denture that more closely resembles your natural teeth. This makes the transition easier when you see your friends and family because your appearance is minimally changed. The other option is that it is possible, if you want, to change your appearance with new dentures.

Finally, an immediate denture gives the dentist a better idea of how your natural teeth were biting. He can construct a denture that better stimulates your bite before extractions.

Aesthetically, immediate dentures are a better way to have dentures inserted than dentures made after a toothless period. However, they do not present more problems.

More denture adjustments are needed when immediate dentures are placed, and these dentures sometimes need to be relined a short time after they are seated. The reason is that the tissue, including the bone in the area, shrinks during the healing process after the teeth are removed. The healing process lasts about six months. This shrinking causes the denture to become loose and alter the fit. Relining is not needed as soon for conventional dentures fitted on ridges where time has lapsed after the teeth are extracted.

Usually, the immediate dentures themselves are not any more expensive than conventional dentures. However, since immediate dentures usually have to be relined as soon as the ridges have healed, the reline is usually an additional charge.