Partial Dentures
 

What Problems can you get with Partial Dentures?

We have seen the potential risks of having a removable partial denture, and if you do not look after your teeth, gums and denture with the necessary care, you will inevitably end up with problems.

Partial denture wearers can experience similar problems to those wearing full dentures. This is most true for mucosal borne acrylic partial dentures which have many teeth on them, since they most closely resemble a full denture in their construction, and the way you wear them.

Unlike complete dentures, the fact that you have teeth, adds a whole new dimension to the potential problems you can get and the changes that may be needed.

The issue (and solution) depends on the:

  • Tooth or teeth in question
  • Severity of the problem
  • Other teeth and support available
  • Tooth’s importance to the denture and the role it plays in gripping and stabilising
  • Type and design of the denture you are wearing.

And we must also take the following into account when planning treatment, your:

  • Finances
  • Wants and expectantions
  • Medical history.

There are no strict answers since there are infinite variables and as such, every case is different. So I hope after reading the following information, you will start to develop a bit of a better understanding and appreciation of what may need done and why. Don’t worry- you don’t need to remember any of this, your dentist will talk to you, give you the options and walk you through everything- if and when things happen.

If you are a partial denture wearer, you can get problems with your teeth, with the denture, with your gums or some combination of all three.

Let's look at each of them separately…

1. What Problems can you get with Gums?

Your gums can be affected by the constant wear of your partial dentures, especially if they are not kept clean.

This can take the form of:

  • Worsening of tooth mobility or resorbtion of bone

2. What Problems can you get with your Partial Dentures?

As with complete dentures, pain and looseness are the major gripes.

Let's look at these with a specific reference to partial dentures:

  • Looseness
The less natural teeth you have available to support and hold the denture, the more this tends to be a problem. If you only have one tooth remaining on the top, you may be better having it removed and moving to a complete denture for the added grip that the suction with your gum gives.

Cobalt chrome dentures and flexidentures tend to grip better but with repeated taking in and out, the clasps that grip around the teeth can become loose, and need to be tightened. This is done very easily by the dentist with a pair of plyers- but please don’t try this at home, I know some of you are tempted… so I will repeat DO NOT try this at home… it is very easy to apply a little bit too much pressure and snap them off and end up paying for a more costly repair.

The clasps are made to be bent in certain directions and from certain points on the clasp- bend them inappropriately and you will regret it. It is important that the dentist ensures that this is the only reason for the looseness, ruling out other possible causes- a tight clasp is not a solution for a poorly fitting denture!

Ask your dentist when you are having your check up, to activate or tighten the clasps. As it only takes a couple of minutes to do, the chances are you won’t be charged.

In relation to chrome dentures, or tooth borne dentures, where the denture relys on the teeth for support, anything affecting these supporting teeth could be an issue. These dentures are made very precisely, with rests that sit on teeth or fillings, to help direct the forces of chewing appropriately down the teeth. Should a filling in this position need to be re-done for whatever reason, it is never quite the same as when it is made to measure.

  • Pain
Pain from the denture could stem from many sources, such as problems with the bite or errors with the extension that rub on your gums. See- Complete dentures where we look at the various denture related issues in much more detail.

In general, pain associated with a tooth, is much more likely to be from dental disease, (dental caries or periodontal disease) than from the denture.

Pain from a single tooth on a partial denture however, could occasionally be because:

(i) The tooth is being overstressed, supporting too much load and taking too much pressure. This is a particular problem where some gum disease has already being experienced on the tooth.

(ii) Leverage is being put on the tooth, due to an unstable or badly designed denture.

(iii) The clasp arm gripping the tooth could be too tight.

(iv) A galvanic reaction between an amalgam and the metal of the denture is happening (this is very rare).

3. What Sort of Teeth Problems can you get?

Teeth problems result from the extra plaque that can collects around your partial denture, if you are not looking after it properly.

This can lead to dental caries or periodontal disease, or both and all the consequences of these diseases including pain, tooth abcesses, fillings, loose teeth, root canal treatment, extractions - to name a few. It just depends on how much they progress and whether problems are picked up early and dealt with.

It could be minor such as needing a filling, (the location of which, may or may not affect the fit of the denture) or major, such as caries that goes into the nerve and so far under the gum that your tooth needs to be taken out.

It is probably easiest to highlight the potential problems with a case I had recently. A patient came in to see me with an upper partial denture. She was missing all her back top teeth, except one large molar that was providing much needed support and grip to the whole denture.

When she took the denture out, there was masses of dental decay going into the nerve and that wrapped around the whole of the tooth. It had been 4 years since her last dental visit. This tooth was key to the comfort, fit and support of her denture- without it, control of the denture would be much more difficult as the back would have a tendency to drop down. Where no teeth exist at the back to hold the denture, we typically get some rocking and movement- this is known as a 'free- end saddle' . If you have this on one side, it tends not to be too bad, but where this situation occurs on both sides, much more muscle control is needed.

So what could we do for her?

Choices:

(i) Root canal treatment and crown the tooth- (about $3500)

(ii) Extract the tooth and add it onto the denture- (about $500)

(iii) Extract the tooth, place an implant and an attachment into a new denture- (about $5000), or an implant and crown for the partial denture to grip around- (about $6000).

Obviously finances come into this, hence why I put the figures in brackets, so you can understand all the implications. Now ideally, I think we would do option (i). However, the amount of decay has weakened the tooth, making the long term prognosis a little more questionable, especially when you add in to the mix, the bit of periodontal disease that has been going on simultaneously. Option (ii), the cheapest, would lose virtually all the grip and support, the denture would be harder to control and make developing good muscle control an absolute must. Option (iii), a great long term solution but the most involved- is there sufficient bone for the procedure without grafting? A suitable medical history? Does the 6 month time frame fit in with the patient? Lots of additional things to consider.

I sat her down and we went through each of the options, and the benefits and limitations of each, not just the costs, but also the procedures and the timeframes. This dilemma all started because of an issue with one important tooth!

If the issue had been with a less important tooth, extracting it and adding it to the denture may not have affected the wearing experience in the slightest. Each case is different and needs to be assessed in the context of you- the teeth, the mouth, and the dentist doing it. You can begin to appreciate that what may look like a simple problem, may actually have more consequences to consider.

This is not a one off case, we see happening all the time and it can be a real pain (for you)… learning to properly care for your denture is absolutely essential.

I Cannot get Used to Partial Dentures - What can I do?

It always amazes me- the different adaptive capibilities of us as humans. Some of you are able to tolerate and adapt to almost anything we put in your mouth, yet for others, the most technically perfect denture doesn't even stand a chance. We are pretty much all able to adapt if we persevere long enough, there are some exceptions, but most of the time it comes down to a question of mental attitude and expectations.

I hope your expectations are a little more realistic after going through our information. I could put a denture in on one person with a very poor fit, which only bites on two teeth and when I ask, "How does that feel?" the response is (rather surprisingly) ,“It feels great - I hardly know I am wearing it!” That same situation in someone else could produce a violent response!

If you have tried and tried with your partial denture and you still aren’t happy then something needs to be done. Here we are assuming that all the little adjustments necessary for comfortable wearing have been made and the denture itself is appropriately designed.

Sometimes a different design or a different type of denture could make the difference between being able to wear it and not being able to wear it - so it is important to try and identify what exactly the problem is.

Otherwise - well it’s back to square one and time to look again at the other options for replacing missing teeth, or the consequences of simply doing nothing. Perhaps you are able to afford a fixed solution or take a payment plan in order to pay for this.

Maybe your anatomy, the number of teeth missing, or your gag reflex is making it hard to control or tolerate the denture, in which case, a dental implant and a precision attachment could maybe help produce a slimmer more stable and ‘grippy’ partial denture.

There are things that can be done and every mouth is a different obstacle course, so you need to sit down with your dentist and go over the options of exactly what could work for you.