Designing Your Smile

The word “cosmetic” is used today in many contexts, but it is mostly associated with beauty and aesthetics. The term “cosmetic denture” is widely used in advertising by dental and denture providers. Denture wearers will easily see the difference in appearance with and without the denture in their mouth. Wearing a denture is in most cases a big cosmetic improvement, so, pretty much any denture can be called a “cosmetic denture”. Is it really so?...

There are many factors to take under consideration while making a cosmetically pleasing denture; many anatomical challenges can be overcome; many anatomical factors need to be considered to make the denture look natural. All our dentures are made by us in our own lab. The teeth for our dentures are custom selected for each patient accordingly to his/her anatomy and personal preferences. We incorporate the skills and the knowledge of making dentures that come together to over 40 years of experience. We are also working directly and together with the patient to assure that all personalized denture design details are taken under consideration, and that the final product functions and looks the best it can. In our clinic every denture is a cosmetic denture.

Same Day Denture

Can a denture be made in one day?
Yes, it can.
Can it be done well?
That may depend on ones personal standard and definition of “well”. It is certainly possible to rush through all the steps and make “a denture” in one day. It would not be a method of choice for me, but in case of emergency I will certainly make one.

Why do We Lose the Teeth as We Age...?

As people age, different changes occur in their bodies. The most common change that happens in the oral cavity is the loss of the natural teeth. One question that may come up is: why do people lose teeth with age? The reasons are quite complex. There are older people that have most of their natural dentition and there are others that have none. Many individual factors that have occurred in the patient’s life can influence oral disease or other conditions. Some of the most common reasons of tooth loss in older patients are: excessive tooth wear that happens over time, loss of the bone mass that contributes to the periodontal disease, an increase in difficult to restore dental caries, or impaired oral hygiene due to the neglect or medical problems. Xerostomia (dry mouth), caused mostly by some medications, is another reason for the tooth loss. The saliva in the mouth protects the teeth from bacteria that is causing tooth decay, so people with dry mouth or people who sleep with their mouth open, usually are more likely to develop plaque and dental caries, and therefore shorten the life of their teeth.

NUTRITION AND TEETH

The fact is that people with fewer teeth are not able to chew the same foods as people with all their teeth; at the same time the intake of the nutrients is diminished. With less nutritional diet, the aging population is facing more health issues, and that only co-contributes to further weakening of natural dentition and general health. Additionally, after the loss of teeth, people may become withdrawn from the family and social activities, which may affect their general quality of life. I know patients who have not smiled for many years and avoided social events because of the lack of teeth. As there are other options of teeth restorations, like dental implants, they exceed the budget of many patients. Dental prostheses are still the most affordable method of dental restoration.

Grandpa’s lost or loose fitting dentures quite often have been a subject of many jokes, but the truth is, missing dentures or bad fitting dentures are not a laughing matter at all. Most people don’t realize how difficult it is to eat foods of proper nutritional value without any teeth. Oatmeal and cream chicken soup provide only so much; eventually the body is starved for nutrition and the results of that can be very serious.

Choosing Your Denture Provider

The denture can be obtained by a patient through a dentist or a denturist. There are several states in the U.S. that have passed the legislations allowing the denturists to maintain their own practices, to work directly with the patients and to provide dentures to them. Washington State is one of those states. It is also the only state in the U.S. that has a college program for the Denturists at Bates Technical College in Tacoma, WA.

The denturists licensed in Washington State can provide the services pertaining only to the removable dental prostheses (dentures): fabricating, adjusting, fitting, and repairing. Most of the denturists also fabricate their dentures. By doing that and by working directly with the patients, they have full control of the final product. This also gives them the opportunity to design the denture accordingly to the patient’s anatomy, his or her needs, as well as cosmetic requests.

Every dentist provides a broad range of services pertaining to oral health and that makes it very convenient for the patients with various dental care needs. At the same time the denturists focus only on one aspect of dental restoration – dentures; that makes them a great choice to consider for patients looking for the denture provider. Whatever the choice, it is important for the patient to understand the process of designing and making a denture, ask the questions, talk to more than one provider, and then make a comfortable decision.

Ooops… not a great denture…

I visited a friend of mine who is a dental technician when I saw one of the dentures being worked on. I couldn’t help but comment on the unattractive design of the denture, which was not driven by the anatomy of the patient’s mouth (a dental technician works for the dental providers and follows their directions, so he or she has no influence on the cosmetic aspects of the denture – the provider works with the patients and makes those design decisions).

The upper cast shows the existing denture made a while ago; now the patient is having the lower immediate denture made. The occlusion line (bite) is highly distorted on the upper arch (the transition between the front and the back teeth should be smoother). Sometimes the natural teeth dictate the design, but in this case, on the upper arch was an existing denture which could be altered; for the fraction of the price of the new denture, back teeth could be replaced and re-set correcting the occlusion, and the new, lower denture would then follow the correct occlusion. The result would not only look much better in the patient’s mouth, but also function better.

In my practice I make sure that every possible solution is explored in order to achieve the best results for the patient – cosmetic and functional.

Denture Repair

Every once in a while a denture may need a repair. Sometimes it is the tooth that falls out; sometimes the denture falls on a hard surface and breaks the plate or chips the tooth; sometimes the family pet gets a hold of the denture, accidentally left on the night stand, and thinks it is a chew toy... (In some cases the damage done by pets can not be repaired and the new denture has to be made. This would be an expense that could be easily avoided by keeping the denture away from pets)

Another situation is when the patient is wearing a partial denture and one or more of the natural teeth have to be extracted. Usually the artificial tooth can be added to the existing partial denture. The process of adding an artificial tooth to the existing denture is easier in the acrylic partial dentures, but also possible in the metal frame partials.

In one case or another denture repairs are sometimes needed. Most can be done the same day, but in some complex cases they may take longer.

Denture Reline

A permanent denture reline is recommended when the denture does not fit properly. In most cases this is due to the gum and tissue changes in the patient’s mouth. The immediate denture usually needs to have a permanent reline done 2-4 months after the teeth extractions, when the gums are fully healed. In some cases, when the patient has other health conditions, it may take longer for the gums to heal and that fact would delay the permanent reline on the immediate denture.

A regular denture should be checked for fit by the provider about once a year. In most cases a permanent reline is recommended every 2-5 years, depending on the individual patient. The permanent denture reline will not change the look of the denture; it will change the fit of the denture and improve its function. The permanent denture reline is therefore recommended, when the condition of the teeth in the existing denture is good or better.

In some cases a soft permanent reline is done when the patient has extremely sensitive gums or tissues. Even though the soft reline is called “permanent” the reline material will usually last 1-2 years depending on wearer’s care and whether the wearer is a smoker or not. A soft permanent reline requires slightly different fabrication process and is usually a little more expensive than a hard permanent reline.

How to Clean the Denture

1. The best way to clean the denture is over the sink. A denture can break when dropped on a hard surface, so always fill the sink with water.

2. Rinse your denture thoroughly to remove loose food particles. Use cool or warm water. Never use hot water, as it can warp your dentures.

3. Use a soft bristled denture brush or soft bristled toothbrush. Apply mild soap to a brush. Do not use ordinary toothpaste, bleach or vinegar. Toothpaste is an abrasive and will create micro scratches on the surface of the denture that will attract the bacteria; using harsh chemical solutions will cause porosity on the surface of the denture which will also attract the bacteria.

4. Brush all surfaces thoroughly. Try not to brush the inner surface of your denture too hard. A light brushing is sufficient. Remember that tartar or calculus can form on the denture just as on natural teeth, so it is very important to clean your denture daily.

5. After brushing, rinse your denture well under the running water to remove all traces of soap.

6. Brush your gums, tongue and palate with a soft-bristled regular toothbrush to remove plaque and stimulate circulation. Repeat that at least twice a day (morning and night). Rinsing your denture after every meal is highly recommended.

7. Always remove your denture for the night. Your gum tissue needs time to relax and rejuvenate. While you sleep at night, soak your denture in a container filled with water.

8. Keep your dentures away from children and pets. Cats and dogs are attracted to dentures left exposed around the house. At least 1% of dentures need repairs due to the damage done by pets. Sometimes the excess of the damage is so big, that the repair can not be done and the new denture has to be made. The expense can be easily avoided.

Before and After

Properly designed denture will make a difference in function and appearance:

Partial Denture – Flexible Partial

A flexible partial is a removable dental prosthesis that restores 2 or more missing natural teeth. It usually consists of replacement teeth set in pink flexible material. There are no wire clasps placed around the natural teeth as in the conventional partials. Instead, the flexible material is molded around the natural teeth to assist in retention of the partial. The rest stops are usually placed on the natural teeth to prevent the partial from putting too much pressure on the gums during chewing. It is worth all efforts to save lower teeth, so they can be used to support the partial denture.

As the flexible partial denture provides the most comfort to the patient, its longevity is in some degree limited. Today’s technology offers few different materials to choose from for the flexible partial denture (some are even repairable) but, it’s only fair to inform the patient that flexible partial dentures do not last as long as the conventional ones; on average, it is about 3 years. They are a great option for some patients though. I would recommend them to the patients with severe bone loss in the lower jaw and having the gum ridge very sensitive to the touch (due to the nerves being exposed after the loss of bone). Still, in most cases a conventional denture with a permanent soft liner may work better and be more economical for the patient. There are no perfect solutions for restoring missing teeth; the job of a provider is to present all options to his or her patients and let them make the decisions they feel most comfortable with.

A flexible partial denture will:
· Replace missing natural teeth to restore your smile.
· Prevent “drifting” of teeth (if the missing teeth are not restored after extractions, the remaining natural teeth will move or “drift” creating spaces between them).
· Improve your bite and speech.
· Make chewing easier and more comfortable.

Advantages of the flexible partial denture:
· Comfort.
· Usually there is no need for the teeth preps as needed for the metal frame rest stops.

Disadvantage of the flexible partial:
· Lower durability than the metal frame partial.
· Possible discoloration of the flexible material.

Partial Denture – Acrylic Partial

An acrylic partial denture can be made when 2 or more of patient’s natural teeth remain in his/her upper or lower jaw, and can be used to anchor the partial. This removable partial denture usually consists of replacement teeth set in pink or gum colored acrylic resin. One or more wire clasps are placed around the natural teeth to assist in retention of the partial denture. Sometimes the metal rests are placed on the natural teeth to prevent the acrylic partial from putting too much pressure on the gums during chewing. It is worth all efforts to save lower teeth, so they can be used to support the partial denture.

An acrylic partial denture will:
· Replace missing natural teeth to restore your smile.
· Prevent “drifting” of teeth (if the missing teeth are not restored after extractions, the remaining natural teeth will move or “drift” creating spaces between them).
· Improve your bite and speech.
· Make chewing easier and more comfortable.
Advantages of the acrylic partial denture vs. metal frame partial:
· Significantly lower cost,
· No need for the teeth preps as needed for the metal frame rest stops,
· Shorter time needed to fabricate.

Disadvantages of the acrylic partial vs. metal frame partial:
· Lower durability,
· Acrylic partial restoring back teeth on the lower jaw, in the beginning may feel a little bulky behind the lower front teeth, as acrylic connector is thicker than a metal frame connector. It usually does not take very long for the patient to get used to it though.

Acrylic partial is many times called a “temporary partial" or a "flipper", but depending on the use and care, and if made well, it may serve the patient many, many years.

See also Acrylic Partial - Part II

Partial Denture – Metal Frame Partial

A metal frame partial denture is a removable partial denture (RPD) that can be made when 2 or more of patient’s natural teeth remain in his/her upper or lower jaw, and can be used to anchor the partial denture. It usually consists of replacement teeth attached to pink or gum colored plastic bases which are connected by a metal framework. In general, the metal framework consists of connectors, rest stops, and clasps built around your existing natural teeth. It is worth all efforts to save lower teeth so they can be used to support the metal frame during construction of a partial denture.

A partial denture will:
· Replace missing natural teeth and restore your smile.
· Prevent “drifting” of teeth (if the missing teeth are not restored after extractions, the remaining natural teeth will move or “drift” creating spaces between them).
· Improve your bite and speech.
· Make chewing easier and more comfortable.

Better durability is a big advantage of the metal frame partial over the acrylic partial. The higher cost, the need for the teeth preps for the metal frame rest stops and longer time needed to fabricate, would account for the disadvantages of the metal frame partial over the acrylic partial.

Immediate Denture

Immediate Denture is a removable dental prosthesis or a dental appliance, custom made for the patient who is planning to remove (extract) one, two or more teeth. Sometimes patient and his/her provider decide to extract all of the patient's teeth due to condition of the teeth or other health problems. Since an option of living without any teeth for 2 months or so is not the one preferred by most people (while waiting for the gums to heal), an immediate denture is a great alternative.

Immediate denture is made before the teeth are removed, and is inserted within 30 minutes after the extractions of the teeth. The denture works as a band-aid, controls the swelling and helps the healing of the gums.

The process of making an immediate denture includes longer after care than in case of the regular denture; after the extractions the gums are healing and shrinking, and there are many changes that happen with the tissues in the patient’s mouth. As the gums are shrinking, the denture becomes looser and requires first a temporary soft reline and later a permanent reline.

Full or Complete Denture

Full or Complete Denture is a removable dental prosthesis or dental appliance, custom made for the patient who has no natural teeth left on the upper or lower arch. Both, the teeth and the gum colored acrylic resin are custom fitted to the patient’s mouth during few appointments with his/her denture provider. The try-in version of the denture is made in wax, so the revisions in bite registration and teeth setting are easy to make. After the wax try-in is approved by the patient, the denture is heat processed and finished in the acrylic resin.

Properly made and fitted denture will improve patient’s ability to chew, talk and patient's appearance.

For Denture Maintenance and Oral Health please click HERE.

Types of Dentures

The term “denture” is commonly used to describe the removable dental prosthesis. The main purpose of the dental prosthesis is to assist in chewing, speaking and to restore the cosmetic aspects of patient’s appearance. There are several types of dentures, depending on the need of the patient. Generally they can be categorized as follows:

1. Full or Complete Denture,
2. Immediate Denture,
3. Partial Denture:
- acrylic partial,
- metal frame partial,
- flexible partial.

Many years ago the porcelain teeth were used as a standard material for the artificial teeth for dentures. As porcelain is a very hard material, porcelain teeth were very hard on the gums and bones in the patient’s mouth, making them vulnerable to accelerated deterioration. Today, acrylic resin is used to produce highest quality artificial teeth that absorb the shocks generated during the chewing much better than the porcelain teeth; therefore, they are much easier on the gums and jaw bones of the patient. Acrylic teeth are also more “quiet” as they don’t “click” as loud as porcelain teeth during chewing and speaking. In the next few posts I will present in more detail the information about different types of dentures and the process of making them.

Welcome to my Denture Info blog!

I'm Alex Garland, second generation dental technician and a denturist. I use this blog to post some information about dentures that you may find interesting or useful. Almost everyone knows someone who wears dentures. Some denture wearers can casually talk about their dentures - some don't feel comfortable to do that. The information posted here will hopefully answer some of the most common questions about dentures. At the same time I welcome any questions pertaining to dentures.

For the information about our NEW SMILE DENTURE CLINIC please visit http://www.newsmiledenture.com/ .

In our clinic, all our dentures are made by us in our own lab. In our practice we incorporate the skills and the knowledge of making dentures that come together to over 40 years of experience. We are also working directly and together with the patient to assure that all personalized denture design details are taken under consideration, and that the final product functions and looks the best it can. A best made denture sitting on the table is just a piece of acrylic resin, but in the patient’s mouth it becomes a new smile, new confidence and attitude, it becomes a mean to a better nutrition and health; in short - it improves the quality of life of the patient. It’s a great pleasure to be a part of that process. Let us be Your denture provider!

~Alex