Hang on, let me put my teeth in

I am hoping that this will be a short blog post but I seem to have an innate ability to waffle for extended periods of time about the most simple of topics and have in fact been penalised many a time for going over word limits so I will try my best!

When I started smiles—better, I decided I would only discuss subjects that I thought would be helpful to people rather than it just being another site of definitions/a rip off of Wikipedia, and so I had planned to stay away from the basics ins and outs of dentistry however after seeing possibly the most horrific and misleading piece of advertising since L’oreal used Cheryl Cole in a full face of make-up to promote their “no need for make-up” skin care, I decided that the topic of dentures needed to be approached.

I hereby call upon the British Dental Health Foundation:

What is a denture? (they even did the heading for me!)

“People wear dentures to replace lost or missing teeth so they can enjoy a healthy diet and smile with confidence”.

Now, my idea of the picture of health involves many green crunchy foodstuffs (I’ve always wanted to use that word) such as apples/celery and high protein items like nuts and steak. Now granted, I have only had 6 and a bit years of experience listening to people WHINGE AND COMPLAIN about their dentures, but I can pretty much guarantee that no one with a denture can successfully eat any of the aforementioned food products unless they are put in a blender first. Herein lies the first major flaw of dentures.

Sadly, adverts such as the one I spoke about in the intro, and that awful one where the man and the woman go apple bobbing and you have to guess who is wearing the denture (I wish they would tell you, or write it upside down at the bottom of the screen like in magazine puzzle pages where you have to spot the difference between the 2 pictures of Miley Cyrus, it continues to bug me that I don’t know the answer) are extremely deceptive and lead to people thinking that dentures are in fact an adequate replacement for natural teeth. At this point, I feel the following statement would help.

DENTURES ARE NOT REAL TEETH. THEY ARE PLASTIC. THEY DON’T HAVE ROOTS. THEY HAVE PLASTIC BOTTOMS WHICH REST ON GUM. (METAL IF YOU HAVE A DENTIST THAT IS FEELING PARTICULARLY RICH THAT UDA YEAR more on that later). THEY BASICALLY FLOAT IN YOUR MOUTH AND THUS ARE IN NO WAY LIKE YOUR NATURAL TEETH FROM “BACK IN T’DAY”

Annnndd exhale.

Time for everyone’s favourite bit; some anatomy/theory.

This is what mouths look like when teeth are lost. The picture on the left shows only some teeth missing whilst the gentleman (I’m assuming it’s a gentleman otherwise it’s a very stubbly lady) has sadly lost all of his teeth and is what we call, edentulous.

What I am trying to demonstrate here, is that a plastic pre formed surface fits against your gum. Your gum is squishy. In some people (usually those who have lost their upper teeth but still have some lower front teeth) their gum is particularly squishy. We call this “flabby ridge” (seriously, its in text books and everything). It is for this reason that the advert I mentioned right back at the start made me so furious. I have inserted the link below should any of you wish to subject yourself to some irritating American advertising.

What makes me most angry is that she suggests using Fixodent will stop your denture moving ENTIRELY. This is of course absolute rubbish. It will be “stuck” to gum, which will move. Similarly, she is suggesting that this will work wonders in the lower jaw. Do a quick test for me, have a feel of the bottom of your mouth – the bit under your tongue. It is pretty much covered in saliva if not pooled in the stuff. Sadly Fixodent is not waterproof. Thus, you can put layers of the stuff on your denture and within minutes it will be washed away and so you might as well just squirt some of the tube in your mouth and swallow it and save yourself the hassle.

While denture fixatives are extremely helpful for things like upper dentures they are pretty much useless on partial dentures particularly in the lower jaw.

Back to the British Dental Health Foundation:

Why should I wear dentures?

“Full dentures, to replace all your own teeth, fit snugly over your gums.”

Misconception number 1: They should indeed fit snugly over your gums however the fitting surface of the denture is made of a hard plastic material, and your gums are not. They are soft. Especially if you suffer from my aforementioned favourite dental condition, “flabby ridge”. 

Thus as I explained above, you need to accept that no denture will ever fit you “snugly” in every position your mouth will ever be in. If we make the denture fit when you are biting full force, they won’t fit when you have your mouth relaxed because the gum will be a different shape – imagine pinching your cheeks. The shape your cheeks go when pinched is dramatically different to the shape they are naturally. The same applies to your gums.

Whilst I seem to be a painting a negative picture, it is only to emphasise that dentures do not stay in by how they are made. This is of course a factor, and if you have shoddy dentures then no amount of practice will help you, however it is all about how you control them. Just as people take time to adjust to an artificial limb, it takes time to adjust to artificial teeth. Fortunately the muscles of your mouth – including the cheeks and tongue – are extremely powerful. Over time, your tongue adapts to gently rest against the denture and hold it in place. I have seen people function with broken dentures because of their muscular control. Yes, someone came to me with their denture split into 2 pieces and they were continuing to wear and eat with it just fine. However it takes perseverance.

Partial dentures replace teeth that are missing and can sometimes be supported by the teeth you have left. If you have gaps between your teeth, then your other teeth may move to take up some of the space, so you could end up with crooked or tilted teeth. This could affect the way you bite and could damage your other teeth”

Another misconception was brought to my attention by the website link for the above info from the British Dental Health Foundation. http://www.dentalhealth.org/tell-me-about/topic/older-people/dentures. 

Those eagle eyed readers amongst you will notice the highlighted phrase “older people”. Firstly, what is “old”. There are many people I could offend by attempting to put an age on it, and therefore I shall play the “don’t shoot the messenger” card and allow someone else to take the flack. CBS Statistics Netherlands seem to define “old” as over 65. 

They reckon that 6 out of 10 denture wearers fall into this over 65 category. Which means that 4 out of 10 people with dentures are under 65 which is a fairly significant number to me.

The United States National Health and Nutrition Examination Survey, 1999–2004 has a slightly different slant.

Age	Mean Number of Permanent Teeth
20 to 34 years	26.90
35 to 49 years	25.05
50 to 64 years	22.30

The normal number of permanent teeth is 32 (including wisdom teeth which wouldn’t be replaced on a denture because as mentioned in previous blogs, they are fairly useless) and so let’s work on a total of 28 teeth. There is not really a minimum number of teeth to be lost before a denture is provided – sometimes a denture may be provided to replace one tooth, for instance if a front tooth is knocked out. Therefore, as you can see in the table, the figure for the 20-34 age group shows an average loss of at least 1 tooth. By age 49, the average amount of teeth lost goes up to just under 3.In the final category of 50-64 year olds the average tooth loss is slightly under 6 teeth. Which means that anywhere from 20-64 i.e. before hitting the ripe age of 65 (aka old), depending on the person and how many teeth they are happy to live without, any of these people could be provided with/be wearing a denture to replace the average 1-6 teeth they have lost.

Let’s view it another way

Characteristic	Percentage with no Remaining Teeth
Age
20 to 34 years	(not enough data)
35 to 49 years	2.63
50 to 64 years	10.13

The above table shows us how many of each age group have no teeth left and so are almost definitely wearing dentures. Again, as expected the largest percentage of people with no teeth is in the 50-64 age group, however this is still only 7/8% higher than the same figure for the 35-49 age group.

These are USA figures, but the UK percentages are fairly similar. The table below is from the most recent Adult Dental Health Survey conducted in 2009.

 

Again, whilst it shows that between 15 and 45% of those aged 65 and over have no teeth, 6% of people under 65 also had no teeth, which out of several thousand surveyed means several thousand people likely to be wearing dentures. Of course those with no teeth may also choose to have no dentures, and there are a variety of areas in between where there are some teeth missing and some teeth still present and therefore dentures would still be a viable option. In fact this idea is nicely summarised by the aforementioned survey “13 per cent [of people included in the survey] had natural teeth and dentures; 6 per cent were edentate with dentures; and less than 0.5 per cent were edentate with no dentures”

Now of course, I am not denying that the majority of denture wearers are in fact “getting on a bit” it is a horrible bias that leaves us dental folk in a very difficult position when we advise someone that their best option is to have a denture made for them, because they imagine the things their granny used to put in a cup by the side of her bed at night and the reality is that we can make things now that look pretty damn good. The problem is that dentures – however they are made and however fancy the practice you go to looks (imagine lots of glass panelling and flat screen tv’s) – are lumps of plastic. For this reason they will never be like the teeth you lost but as you will know from reading my implant post (which I’m sure all of you did) sometimes it is the only option left to you.

See next subheading.

Eating – or at least trying to.

Back to my favourite dental resource (the British Dental Health Foundation). They claim that dentures “will help you to eat comfortably”. Generally any dentist will tell you that pretty much every new denture patient they see will return within a fortnight saying “I just can’t eat with them in” or my favourites “oh the dentures are wonderful, I just take them out when I have to eat” which amuses me as why bother having dentures at all in that case?

The problem is that under the denture is squishy gum, and the teeth are plastic. The combination of these 2 things means that 1) when you bite into something the dentures move so you can’t apply the same chewing force that your natural teeth could apply 2) we all know how near impossible it is to eat with disposable plastic cutlery let alone try and cut into a steak and the same applies for plastic teeth.

Of course, there are exceptions to the rule like this fellow from a wonderful dental forum

“jroantree: I have just had top set 7 days ago. 10 teeth out, fitting 7 days before. follow up today with dentist 320 pounds, all done. I’m staying near Cape Town, come for a holiday and get your teeth fixed cheaper than UK. Eating chicken bread etc already."

Generally it takes practice. The same goes with speaking. Expect to lisp and slobber for a good few weeks after having your dentures fitted. If you are having your dentures fitted immediately after having teeth out (these are called immediate dentures funnily enough) then this will be increased because you are putting force and rubbing on a delicate area. This leads to soreness and an increase in saliva making it all more difficult so just give it time.

Now you have all the background info, I think that is quite enough waffling for today so I shall leave you with another of my favourite quotes from a dental forum.

"if any of you get a chance go have a look at the conditions some dental technicians work in, you might be shocked, particularly the cheaper/NHS part of the dental market. A lot is said of the poor, stressful working conditions of NHS Dentists, but dental technicians are a hidden, down-trodden profession”

Now before you all call the dental technician equivalent of the RSPCA I can assure you that I have met many of these poor down trodden fellows, and they are a wonderful breed and generally do not work in atrocity and squalor. Some of them even have radios on while they create their dental masterpieces.

Stay tuned for the next instalment when I go through how dentures are made and what to expect.

Reading and that

http://www.dentalhealth.org/tell-me-about/topic/older-people/dentures

http://www.cbs.nl/en-GB/menu/themas/gezondheid-welzijn/publicaties/artikelen/archief/2005/2005-1852-wm.htm

http://www.whatprice.co.uk/dentist/dentures.html

http://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/ToothLoss/ToothLossAdults20to64

http://www.hscic.gov.uk/catalogue/PUB01086/adul-dent-heal-surv-summ-them-eng-2009-re11.pdf

http://www.steinerlabs.com/images/pre_op_arch.jpg

http://cdeworld.com/images/graphics/4469/lg/figure_23.jpg

http://www.youtube.com/watch?v=Sx4T7-V4wu0