Loose DenturesFeb 2009
Q. My dentures no longer fit properly. What are my options?
A. Many patients with dentures say that their dentures fit at first, but now no longer do, or that they can’t eat anything without reapplying denture adhesive. Some patients tend to rationalize the problem, blaming their loose dentures on the dentist who made them, certain medications or significant weight loss. But the truth is that a poorly fitting denture is rarely related to any of these factors.
Edentulism is a condition of missing teeth. It is estimated that 10 percent of Americans are completely edentulous, meaning they have no natural teeth. Another 70 percent are partially edentulous, or missing at least one tooth. Many of these patients, discouraged by the high cost of fixing problem teeth, opt to have them extracted instead, hoping to put an end to their dental problems. Instead, they find themselves with new, irreversible problems.
Having missing teeth increases a person’s risk of developing problems in adjacent teeth such as poor bite function, periodontal disease, misalignment and bone loss, which shortens facial height and causes skin to wrinkle around the corners of the mouth.
Patients often think they can avoid all of these problems with a removable denture that would replace the missing teeth and would never have to be replaced. The problem is that the jawbone shrinks and weakens when dentures are repeatedly applied on the gums, compressing the tissue and causing a breakdown of bone. It is estimated that up to 40 percent of jawbone height and width can be lost during just the first year of wearing dentures. An additional 10 percent (or 1 millimeter) of bone may be lost each year thereafter. Eventually the patient may reach a point when the supporting bone is all but gone, leaving him or her with not only a debilitating physical condition but an emotional one as well. What can a person do to correct or prevent this situation?
First, don’t despair. If you are already wearing dentures, seek an evaluation. While in time the jawbone will shrink and dentures will grow loose, a properly fitting denture will cause less severe and slower shrinkage than a poorly fitting one. A dentist can readapt an existing denture to tissue that has changed over the years. Called a reline or rebase, the procedure improves the fit and lengthens the lifespan of the denture. Or, your dentist can fabricate new dentures if the tissue changes have been drastic since the last reline. However, if the bone is inadequate due to years or decades of denture wear and improper maintenance, then a reline or new denture may not be enough. The best denture in the world would fall short if the patient lacks the bone or tissue to support it. In such cases, the patient may have to consider dental implants.
Dental implants are used to replace missing teeth. Rather than destroying bone, they maintain it, preserving facial height and structure and, ultimately, reducing the look of sagging skin and wrinkling around the corners of the mouth. There are several types of dental implants; the correct one will be chosen to match your bone type and other special needs. All dental implants are designed to allow natural-looking teeth to “snap” or be cemented onto mechanical attachments. Patients whose teeth have been restored with dental implants often cite their increased confidence, because of their ability to readily eat and smile, as the single most profound benefit.
All patients are candidates for dental implants, even patients who have been told they are not candidates due to poor bone quantity or quality. These patients may benefit from bone grafting procedures. Bone grafting involves growing new bone onto existing bone to create a base for cylindrical implants, the most common type of implants used in dental offices. Bone can come from the patient’s own body or from a cadaver. For the patient wary of bone grafting procedures, some dentists offer specialized types of dental implants. For example, some implants are designed to rest in a narrow ridge of bone too thin for a cylindrical implant. Others are designed to rest over the bone, which can help patients with a minimal amount of bone when the patient does not want a bone grafting procedure. All implants can be adapted for either fixed or removable teeth depending on the specific needs of the patient.
Many people who rely on full or partial dentures wind up feeling inconvenienced by poorly fitting dentures that worsen over time. Implants are a longer-lasting alternative that can provide the look and feel of beautiful, functional teeth. Healthy, youthful and confident smiles lead to more active social lifestyles and increased confidence. Below are some tips to keep in mind if you are currently wearing dentures:
• Even if you are missing some teeth or are fully edentulous, you still need to consult a dentist annually to minimize future dental problems as well as gain solutions to existing ones. A properly maintained denture can minimize bone resorption and maximize denture retention.
• Remember that the bone supporting a denture is always deteriorating. As bone shrinks away, solutions become more difficult and costly to achieve. It will never be cheaper or easier to solve your problem than it is right now.
• If you are committed to dentures without implants, consider the benefits of a denture reline every two to five years. When reline is not recommended, consider the merits of a new denture if recommended by your dentist.
• Consult with a dentist who is well-versed in the area of implant dentistry. Implants reduce the forces that shrink bone and can retain fixed or removable teeth that are beautiful and more functional than regular dentures.