What are the Reasons for having a Removable Partial Denture?

Well firstly…. you have a missing tooth or teeth!

The main complaints that lead to getting a partial denture are:

• It doesn’t look good with a gap or gaps in your smile (not aesthetic)

• Embarrassment/self esteem problems

• Difficulty chewing properly

• Teeth pain and aching jaws

• Loss of bone and support for your muscles and facial structure (ageing effect)

• Speech problems

• Problems with the old partial denture.

If you or the dentist notice any of the consequences of the missing teeth, it is advisable to act sooner rather than later. At the very least, weigh up the available options for replacing the space since delaying treatment could make things more complicated down the track.

Partial dentures may be used as a temporary or permanent solution for missing teeth. When I say, ‘permanent’… I mean that it is the ‘final treatment’ in the process- not that it will never need to be replaced, because it will.

For example you may want a bridge or implant to replace a space in the front of your mouth, but not want to be without a tooth for the 3-6 months it takes the gum to heal. In this case, an immediate partial denture may be needed as a temporary measure.

On the other hand, if you have a few gaps that require replacement, then it may be decided after treatment planning, that the best option is to restore your teeth is with a well designed cobalt chrome denture. This would be a solution to your missing teeth for a number of years to come.

Am I Suitable for a Removable Partial Denture?

‘Suitable’ means not just that your mouth is appropriate for a partial denture, but also that you are.

This largely comes down to motivation… do you really want your spaces filled? Do you understand the benefits of wearing a denture? Will you actually wear it and stick with it till it feels right? Will you look after it like you should and give it the necessary care and attention?

I have made dentures, that when I see the patient for a check up 6 months later, I find out they have hardly been worn. It seems slightly bizarre to me to go through all the stages and expense of making them, only to keep them in a drawer collecting dust. They may say, “But it rubs,” and I shake my head… huff loudly and say, “Why didn’t you come back and see me??? I could have helped!” Wearing partial dentures takes some getting used to and especially if you have never worn them before, you need to not only be aware of this but expect it.

Your medical history and conditions can influence your suitability too:

• Epilepsy

This is one medical condition where RPD’s should be avoided if possible, since there is the risk of swallowing or blocking/damaging the airway, if it is dislodged during a seizure.

• Physical problems

If you suffer from any condition (such as severe arthritis or neuromuscular disease) that makes getting the plate in and out to clean difficult, unless someone can help you- a removable denture could become a recipe for disaster, pain and eventually a complete denture.

• Mental problems

Being able to understand the instructions to care for your dentureis also really important in wearing them successfully. If you are unable to look after your dentures and remaining natural teeth or have someone to do it for you, this could spell lots of problems.

In an ideal world, we could get your hygiene up to the appropriate standard where something could be done, but certain medical conditions make achieving these changes very difficult- sometimes impossible.
How do you get someone with severe alzheimers or dementure to remember not just to brush their teeth, but to do it in the proper way… and watch their diet?. Carers generally don’t enjoy having to remove and clean dentures and teeth so the job is unfortunately somewhat neglected.

Assuming we have ruled out all the other treatment options for one reason or another, the answer to, “Am I suitable for a partial denture?” ultimately depends on another question… “Are you likely to be better or worse off at the end of the day?” You can read risks and benefits for a more detailed discussion.

What are your Expectations from Partial Dentures?

When having a partial denture, you need to be realistic about what exactly it can achieve and what your expectations are. This can be the only difference between success and failure; it is important that the dentist helps paint a realistic picture of both the treatment process and the dentures themselves.

For example, if you have never worn one before, it it is going to feel rather weird and take some getting used to. Anyone having a new partial denture made knows that it takes a bit of time to bed in properly and that some adjustments along the way, are just par for the course. It is not going to be as discrete as a bridge, or an implant and you will always need to take it out and clean it.

The best way to get a good idea of what it might be like is to look at pictures- real life examples and listen to the thoughts of people who have been wearing them.

This video series says everything I would like to say to my patients, but don’t always have the time.

Your dentist will be able to help you develop realistic expectations about your particular individual situation and your proposed treatment- as always, I advise you ask plenty of questions! Some dentures because of your mouth shape and remaining teeth, will simply not be as tight and secure as others. Now, whilst there may be no other suitable treatment options, knowing upfront that it is going to take more getting used to and that developing your muscle control will be key in wearing them successfully is so important. Otherwise you assume that something is wrong or that the dentist did a bad job and it may just be the reality of the situation.

Just recently I had a patient who had a root fracture on one of her front teeth which needed extracting; she was a young, attractive lady who obviously took great pride in her appearance.

I explained that there was nothing we could do with the tooth and that she would need to wear a plate for 3-6 months before we could consider an implant or a bridge. (Quick note- please keep in mind different dentists may approach things in different ways)- she didn’t really get what I meant until I showed her an example, then she exclaimed, “What! I have to wear that for 3- 6 months!”

With the changes that would occur in her mouth, an immediate denture was the best way to maintain her appearance, while she decided between an implant and a bridge as a more permanent solution.

Can you imagine, if I hadn’t shown her an example or discussed the timeframe till the day of treatment! She wore the plate successfully and decided to go for a dental implant which has since been completed and she is very happy. You can see how important it is to have realistic expectations.

What makes a Successful Partial Denture?

Perhaps we should start by defining a ‘successful denture’. This, as you can imagine is pretty subjective but how about we start with…

A denture that allows you to eat, speak and smile comfortably without pain and embarrassment and that doesn’t negatively affect your remaining teeth.

After reading denture risks and benefits you will appreciate, a denture can be a slow, uncomfortable and expensive way to replace your teeth, or it can be an economical solution to allow you to look, chew and function well, preserving your remaining teeth.

The ultimate success depends on 4 things:

• The dentist. Correctly designing and preparing your mouth for a removable partial denture, providing accurate impressions and adjustments, communicating this to the technician and educating you on how to care for it properly, are key to success.

• The technician. Their job is to make the dentist’s instructions a reality and to work with them in producing the best fitting, best looking, best design of denture for your mouth.

• You

(i) Realistic expectations of what your partial denture will be like is essential for your satisfaction and happiness. If a denture doesn’t meet your expectations then it is likely to be a failure, so being aware of the pros and cons is very important.

(ii) Your perseverance and ability to adapt. Understanding it takes some time to get used to wearing and chewing with a partial denture is important. You need to stick with it until it becomes second nature.

(iii) How you look after it. Taking great care to look after your denture and the teeth that support it, is crucial to success. That means storing the denture properly so it doesn’t dry out, not dropping it and cleaning it appropriately.

(iv) Diet, fluoride, tooth brushing, interpromial brushes and flossing are more important than ever in making this a stable long term solution, not a stepping stone to further teeth loss or a complete denture.

(v) Your mouth. The problems you present with and the state of your mouth at the start of treatment, is going to make a big difference to your removable denture wearing experience:

– The more teeth you have the better- the more grip and stability your denture is likely to have.

– The position of your teeth- ideally the missing teeth are spread evenly and have teeth either side of the gap for support. If you have a’ free end saddle situation’, this makes controlling the denture a bit more difficult because no tooth exists at the back to stabilise the denture. If your natural teeth have moved, tilted or over erupted, this can prolong or somewhat compromise treatment.

– The state of your teeth- the more healthy the teeth are, the more successful the denture is likely to be. Things are more likely to go wrong if teeth are heavily filled, have questionable nerves, or gum disease around them.

– The shapes and quality of your ridges- the more bony ridge you have, the better the denture can grip and resist sideways forces in a ‘mucosal bourne denture’. This isn’t such a problem where a good number of teeth remain, but the nearer you get to a complete denture the more important it becomes. Where the bone has resorbed greatly on the bottom (to become very flat) this is very difficult and often looseness is a problem.

– Your risk of disease– dental caries and periodontal disease result from plaque and if you are already high risk for these conditions, then future problems become more likely.

• The type of denture. This will itself will also play a part in the success- see our -‘Which denture is best for me‘ discussion for more information.