What Happens at the Patient Assessment for Complete Dentures?
There are four aspects to the examination for dentures. Each will provide information that will help in making the best and most successful dentures possible. We are looking at both the normal anatomy of your mouth, and any pathology or abnormality that may effect treatment, or need to be addressed before making the dentures. As always, it is important to also discuss your expectations and any alternative treatment options there may be.
Assessments are needed of your:
- Soft tissues (gums, cheeks, lips, tongue, floor and roof of your mouth)
(i) We look at the tone of your lips, cheeks and tongue and how they relate to your denture during speaking and biting.
(ii) We look at your oral mucosa for any signs of abnormality, infection or problems such as denture stomatitis, angelar chelitis or ulcers.
(iii) We look at where your muscles attach and how this relates to where your denture will sit at rest and during movement.
(iv) We look to see if there are any growths of gum (ginival hyperplasia) or squashy tissue on your ridges that may affect the seal and stability of your denture.
- Hard tissues (your ridges, roots, jaw bone, tori)
(i) We look for any signs of retained tooth roots, unerupted teeth, enlarged tubersoities or bony prominences that may interfere with the denture such as mandibular tori.
(ii) We look at the quality of your ridges- how tall, wide and firm they are, as this directly effects the success of the denture,do you have any large undercuts on your ridges or a very fine what we call ‘knife edge’ ridge which if not relieved during the making of the denture could be painful.
- Saliva – As we have identified, this is key in getting good suction. This can also effect your taste and cause problems with friction (rubbing) and damage to your gums from the denture.
- Existing dentures- Here we get a good idea of your denture wearing history, giving us a useful insight into providing you with successful dentures.
These are the sorts of questions you may be asked:
(i) When did you first start wearing dentures?
(ii) How old are the current dentures?
(iii) How many sets have you had? How often are they replaced?
(iv) How do you get on with them?
(v) What are your main problems/issues with them?
(vi) Were you happy when they were first made?
(vii) Are they painful, sore, loose?
(viii) Do you have any speech problems?
(ix) What can and can’t you eat with them?
The dentist will need to examine the dentures carefully- looking at the following:
(i) The general condition
(ii) The hygiene
(iii) The state of wear
(iv) The bite
(v) The height of the teeth (occluso-vertical dimension)
(vi) The extension of the denture
(vii) The function- speech and chewing
(viii) The fit
(ix) The look – tooth colour, shape and size, gum colour
(x) The presence and position of the post dam ( a special tiny ridge on the top denture that helps to create a seal and improve suction)
(xi) The stability (do they rock?)
(xii) The retention (do they drop?)
(xiii) The position of the teeth
(xiv) The support of the lips and cheeks
(xv) The amount of freeway space ( we discuss this later)
What are your Expectations?
As I keep saying throughout the website, realistic expectations are key to your happiness.
It is the role of the dentist and the team to provide you with information- (like I am doing) to help you understand and appreciate the advantages,disadvantages and limitations of dentures and any alternative treatments.
If the dentist doesn’t feel he can meet your expectations after this discussion, it will save you and them a lot of time and headaches, if you are referred to a specialist or someone more experienced.
All this information that we have collected, gives us an appreciation of the good and bad aspects of your dentures as you see it, and as we see it. This can help us decide whether we:
- Do nothing
- Make small adjustments such as to the extension or bite and re-evaluate things
- Reline or rebase your dentures
- Copy your existing dentures if they have been largely successful
- Make you a completely new set
- Consider an implant retained denture
- Refer you to a specialist.
What are the Alternatives to Full Dentures?
If you are edentulous, meaning you have no teeth, the options are:
- A traditional complete denture (most common)
- A complete denture with implants for extra retention (better solution)
- Implants then a partial denture
- Implants then fixed bridge work
Remember, you can be edentulous just on the top, just on the bottom or both. If you have teeth in the other arch then you will have more treatment options to consider. You may not need anything if you have all (or sufficient) of your teeth, or if you have some missing teeth, depending on the circumstances a bridge, implant, partial denture or some combination may be considered. These options are discussed more thoroughly in- Missing teeth options.
I hear from time to time, some confusion regarding the concept of dental implants. I have had patients ask about popping implants in one at a time to replace the natural teeth as they are lost, or even thinking that they can do away with the complete dentures all together- literally replacing every single tooth in the mouth with these new implant teeth. Whilst theoretically possible, the cost alone would be enough to put 99 percent of people off, let alone the surgery involved.
There are a number of possible ways in which implants can be used, this however is generally not one of them. If you wanted something fixed in your mouth to replace your complete denture, the greatest number of implants you would normally consider is 8, which would be used to support some kind of fixed bridgework. Not an easy feat by any dentists standards and best done by dentists experienced in this area.
I think ‘implants’ need a little more understanding and appreciation for exactly what they are and do… calling them a ‘tooth replacement’ , is just a little too easy and doesn’t really paint an accurate picture of the reality. They are not without their risks, and failures are more frequent than you would probably like to think. The chewing experience is not the same as a normal tooth since they do not have a ligament surrounding them, that provides feedback about pressure and the chewing experience. They are a fantastic way to replace missing teeth and the future of dentistry but not the same as growing a new tooth.
They receive a lot of attention in the newspapers, magazines and on TV because they are a new solution to an old problem and the latest technology. Unfortunately, a lot of patients are not suitable or can’t afford an implant retained prosthesis or denture. Don’t let this dishearten you, most edentulous patients will only have implants to help hold in and support their denture, they are not getting all their teeth put back in. Traditional full dentures are often able to look and function quite well, implants just provide added security and confidence particularly where the anatomy of your mouth is not favourable.