Ladies and Gentleman

            Serving

Ladies and Gentleman

Steven H. Feit, D.M.D., P.A.

      Prosthodontist

561-338-7535 (office)

561-368-2981 (Fax)

feitsmiles@gmail.com

240 West Palmetto Park Road

Suite 220

Boca Raton, FL 33432

               ~~~~~~

Across from City Hall in the Transmedia Building

Dentures General Information

Dentures are one of several options to replace missing teeth.


What You Can Expect:

         Your Denture Information Guide

The Denture Story: 

 

PURPOSE:

The purpose of this page is to help you understand dentures.  Your understanding will allow us to have the best relationship possible.  If you understand what we are doing and why you will be a better participant in your own care which results in a better outcome. The success of any treatment will be based on your understanding, patience, motivation and desire to adapt to your new appliance. Good communication is essential to a good relationship. Happiness is where reality exceeds expectation.  You need to have realistic expectations. We want to exceed your expectations every step of the way.  We want you to refer your friends and family to us so we can help them as well. We welcome questions.

Introduction:

Welcome! So you are considering a denture.  Maybe it is a new one, maybe it is a replacement for your old one.  Your natural teeth were rooted deep in the bone in the jaw.  The roots provide anchorage to support the teeth and resist the forces of chewing. Your old had have a ligament surrounding them.  This serves many functions.  It provides you with sensation when you are biting and chewing. You had “baby” teeth and they were replaced by your “permanent” teeth.  Now you are missing your “permanent” teeth.  Can I ask you a question?  What is the definition of “permanent”?  We need to change our thinking.  Nothing is permanent.  The word should not be uttered in the realm of dentistry. We have now established that nothing is "permanent" and dentures will wear out, break and chip just like natural teeth do and can.

A denture is a custom crafted appliance made of acrylic (plastic-like material).  It floats over your gums.  Each cell in the human body is composed of 90% water.  So in essence, your denture will be resting on tiny water balloons. It has no roots for anchorage and sits on your gums.  Picture the denture sitting on millions of tiny water balloons and every time you bite or move or swallow, even with no food in your mouth, your dentures will move and rock around. How stable can that fit?  Interesting image isn’t it.  Can your denture, floating on your water filled gums function exactly the same as teeth with roots anchored in bone? Absolutely not.  No way, no how.  It is a compromise.  Some research shows the function of a complete denture vs that of natural teeth is less than 20%.  Your bite force with your natural teeth is somewhere around 200-250 pounds of force. Some a little less, some a little more, but that’s the sweet spot. With dentures, your bite force is about 50 pounds of force. That’s a significant drop off. That’s the difference between eating a steak, and eating oatmeal. Do you like oatmeal? For dinner?

The ideal solution is to replace your rooted teeth with your own new rooted teeth.  At this point in time this is not possible.  The closest things we have to rooted anchored teeth are implants.  The implant is the same material the Orthodpedic surgeon places when they put in new hips, knees, pins, plates or fixation screws.    Implants can solve many of the problems dentures cannot.  Implants can provide stability when it is lacking in your denture.  Some people try to see if they can adapt to a denture first. No one can.  Sure people you know that wear a denture will convince themselves it is as good as having their own rooted anchored teeth and that "I can eat anything I want" but that is simply not true.  It is not possible.  They are not lying to you, they are convincing themselves.  Implant treatment requires more of a financial commitment than a denture. Most often the reason a denture is worn is due to financial limitations.  It depends on what level of function you desire.  

The only constant is change so it is very important for you to understand that you will never be “done”. Your body changes throughout your life, this will cause your mouth to change and the fit of your denture will therefore change. A reline procedure re-fits the denture. This is likely needed from time to time, on an as needed basis. We need you to be understanding and appreciative that this will happen and is simply a part of the your biology, it is the way you are.  Nothing is “permanent” in dentistry. Some people like to dwell on their problems, rather than focus on the solution.  If that is your case you will never be comfortable with a denture. There is a huge psychological aspect to your acceptance of your new denture.  A very common feeling among denture wearers having a new denture made is that “the last one went right in and that was it”.  This is not usually true, it’s just that it was so long ago you don’t remember all the specifics of post op visits and adjustments you needed due to sore spots.   Also, that was perhaps many years ago and your mouth and body were quite different.  Your bone was better, larger and stronger to accept a denture.  You were younger and more adaptable and your attitude then was more tolerant.  It is said…”God doesn’t like competition”. Anything a dentist makes is a substitute only.  Everything of value needs maintenance.

Bone: Your bone is not like static concrete. Your bone is dynamic and changes shape. This is why it is possible for an Orthodontist to move teeth in the bone.  The same is true when wearing a denture.  If you have excess pressure on one side the bone will condense as a result and the denture will loosen.  In fact the bone has changed, not the denture. People will say “my denture doesn’t fit anymore”. In fact, your mouth and bone doesn’t fit anymore to your denture. It is your body change that causes this to happen. 


Most likely you are reading this because you are wearing an old denture that no longer fits well, the teeth are worn, the teeth were not placed in their correct position or you have loose, flabby tissue over your bone or a combination of these issues.  When your new denture is inserted initially it will fit.  As you wear it your bone will change even during the first few days. The denture will loosen.  Actually you have changed and your denture is the same.  Relining the denture will be needed to regain the fit.  Then your body will change again and so on.  This will continue until harmony between your biting force and your bone stabilizes.  The time frame and frequency of adjustments needed will vary from person to person. No one has a crystal ball to be able to figure exactly how your bone will respond.  This is the most important aspect you need to understand about this process.  Once balance and harmony occurs you will find your denture will remain fairly stable unless you undergo weight loss or gain which will cause corresponding changes to the contours of your mouth which affects the fit of the dentures. This makes sense.  Key to your success is allowing for this change which we call “evolvement” to take place.  Look at it like it is physical therapy.  It takes time for the body to heal itself.  You will tend to bite your lips and cheek during the evolvement phase.  This is normal and will resolve automatically as your body adjusts and finishes the evolvement process.  The exciting part is once everything evolves you will enjoy the harmony that results.  Your function will get better and better to be the best it can be with respect to chewing with a removable denture appliance

NOTE:  Some people simply cannot accept a denture.  There can be many reasons for this response.  Please know that implants can be your best option in this case.  You may need to pursue this avenue should your mouth fall into this category. 

GENERAL INFORMATION:

The techniques used in our office in making your denture are anatomically based.  That’s right, we use your anatomy to determine where the teeth need to be placed and how the rest of your denture will be shaped.  The challenge is to obtain the level of expectation that you, the patient desires or feels they deserve.  Your mouth can be full of problems, abnormalities etc. These problems are only significant if you, the, patient allows them to get in the way. So, a positive attitude is absolutely necessary. Communication is vital, please be open and honest with me so I can address all your questions and concerns.

Long-time and first-time denture wearers should know that it takes a while to get used to new dentures, and longer for them to feel natural. This is especially true of long-time wearers. Old dentures degraded slowly over time and you have adjusted to this.  The same can be said when first wearing glasses or new shoes - but I'll admit that's a poor comparison. The same advice can be given regarding difficulty with speech as well as whatever feeling we might have as to the appearance of the dentures.  Relax. Don't be in a hurry.  Time will resolve most of these issues.  The new denture will have to settle into place, the surrounding gum tissues will have to adapt to them; and you will soon learn how to keep them in position.  Denture adhesive powder/paste can only help.

The complete denture:

This design offers many advantages.  This is the principal means for rehabilitating your mouth if you have no remaining natural teeth. A custom denture is fabricated to fit the contours and shape of your mouth.  The gums provide all the support for the denture.  Suction holds the denture in place.  Suction refers to the chemical property of adhesion.  Like a suction cup holding onto the window.  There is no glue holding the suction cup to the window, yet it holds just the same.  If you were to put a little water on the suction cup and then place it on the window it would stick to window stronger than without the water.  The water fills the void between the cup and the window.  The same thing happens in your mouth.  The saliva is the water and will allow for the denture to fit the gums with better suction.  So, if you were to have a dryer mouth at times, the denture will not feel like it is as well fitted.  The fit is unchanged, the suction is weaker.

Food will get on the teeth, around the edges of the denture, and under the denture.  If you can chew well, the food will be chopped up so fine that the little particles will inevitably get between the denture and the gums.  Remove the denture and clean it well.  This way your mouth will stay fresh and clean.  You must keep up with your cleaning appointments and you must keep everything clean at home.    

Remember, if you have medical problems, stress problems, taking medications, or dry mouth; this can lengthen your adjustment time period to the new dentures. Just be patient you will learn, this learning experience is unavoidable. Many health problems (and medications) affect the mouth and the ability of the tissues to withstand your biting pressure of the dentures. 


The first phase is the actual construction of the denture appliance which includes the fittings, the second phase is the fitting and adjustment phase just after the new appliance is inserted and introduced to your mouth.  Remember, it is custom made and no one has ever worn this before.

The third phase is the after-treatment maintenance phase.  This is the most important phase.  You will need to have some adjustments from time to time.  It is considered routine maintenance.  There is a nominal fee for the adjustments, if needed at all.  The teeth can discolor, chip, break off, plaque can accumulate on the denture, etc...  With the proper attention these problems can be avoided.   

Wearing a denture will alter your taste sensation.  The denture material absorbs the temperature of the foods and liquids.  It also alters your taste sensation by lessening your ability to feel the texture of the food.  This occurs mostly for the upper denture because the palate is covered so fully.

Pre-Treatment Denture Information:

Several visits are required to make your custom denture.  These fitting appointments are performed to verify the accuracy of all the preceding procedures.  Please understand that there are several phases to your treatment.  First is the construction or fabrication phase. The second is the “wearing” phase.

The day you receive the denture to wear home is really the beginning of your treatment.  After all, no one has actually worn the denture yet.  I will need to adjust your bite and often this is done on the opposing teeth and not only on the denture itself. You may experience sores and your bite may feel off.  You may also feel it is difficult to eat, speak and swallow.  These are all normal feelings that will go away as you become accustomed to your new denture. 

I will guide you, and be there for you every step of the way. Think of your gums and bone as being like a sponge.  If you squeeze the sponge it gets smaller in volume. As you wear your new denture your gums and bone that support it will condense and compact under the normal load of your biting pressure.  This is normal and natural.  The denture will tend to feel looser and I will reline your denture to restore the fit.  This may happen several times over a period of a few months.  This is totally dependent upon your bone physiology. Usually the bone stabilizes in about a few weeks.

We like you to know as much as possible about your condition so you can appreciate what is happening and become more of a partner in your own care and treatment.  Please call us to let us know what you are experiencing so we can help you as needed. If you don’t “complain” we can’t assist you with a solution.

Four phases to completing your treatment:

The first phase is the Diagnostic Phase. 

This is when we meet with you and examine your particular situation. What we evaluate: Bone. Bony contours. Size and shape of remaining bone, called a ridge. Jaw relationship of upper to lower, Jaw joint integrity, does your jaw pop or click when opening and closing. What your previous dentures look like and how close are they to the correct anatomical position. If your old dentures are close to where they should be your new ones will be easier to adapt to.  If your old ones are far off then your treatment time will be drastically extended. 

We chat to get to know each other and make sure we get along well.  We only want to treat friends because we enjoy what we do and want our clients to enjoy their time with us also. Most importantly, we want to make sure your attitude and expectations are in line with what is actually possible.  For example if you want teeth that are not removable then this is not the treatment plan of choice for you and your needs.  The denture will be removable and you will need to take it out to keep it cleaned properly. During the examination process I evaluate your remaining bone and gums, the bite relationship and conduct an engineering analysis.  Some cases are more complex than others. I assess your particular case accordingly. 

Common Statements:

My friends tell me they can eat corn on the cob and bite into apples with their dentures.   This is generally not true. The last thing someone wants to tell is their limitations. It is just human nature.

I want the teeth way out or wide to get rid of my wrinkles. Sorry, this is not the proper way to accomplish this.  The denture teeth are placed strategically based on your own anatomy and anatomical landmarks for the best function possible.  We can refer you to a Plastic Surgeon to help with your other, unrelated issues.  Please note, when the teeth are placed as we do based on your anatomy we find the muscles and skin of the face and neck most often regains its tone and wrinkles lessen. No guarantees.  It takes time for this to occur.  Be patient.

I always wanted a wider smile, please do it in the new denture: Again, this cannot be done unless it is correct to place your denture teeth as such.

I want the whitest teeth possible.  Sure, we can help you with that.  The color is of no consequence to the functional result. Whatever color you want is what you will get.  We will ask you to sign off that you are happy just prior to completion so you have full control over the acceptance of the look of the new denture with respect to the shade.

I came in for a new denture on the upper why do you tell me I need to have teeth made for the lower? All I want is a new upper. (or vice versa)

Proper function requires balance, symmetry and proper support.  If your opposing teeth are not in their correct position, or are missing, then it is not possible to make the new denture with teeth positioned correctly and with the balance and support needed. To make a new denture without incorporating the opposing arch of teeth into the plan is a disaster and you will be less than satisfied with the results.

I will sign off that I only want to do the one arch.

No, this is usually not an option.  To knowingly make a denture to fit an incorrect bite relationship can do more harm than good.  You need to be treated properly. This is not negotiable. You deserve better. To do something knowingly wrong is not an option.

The second phase:

This includes all the steps that are necessary to make your new denture.  This construction process will usually require several visits. Time is needed in between each visit to allow our highly trained laboratory technicians to perform the required lab procedures for your treatment.  This is a custom crafted work of “art” made especially for you and designed to fit into your anatomical configuration. 

There are certain “key” anatomic landmarks that we must follow to render a predictable result.  We cannot place teeth just anywhere.  Your landmarks will dictate where things need to be and the teeth will need to be placed in their proper position. Imagine taking the blades of a scissor and separating them just a millimeter.  It may tear but it will not cut very well. So your teeth, like the blades of the scissor, need to be placed in their rightful position in the proper relationship. Many people think we can place the teeth “out there” so that they get rid of their wrinkles.  This is the role of a plastic surgeon. We are empathetic but still need to do what is anatomically correct from the dental perspective.  We would be pleased to offer you a referral to a plastic surgeon if you are interested.

Most often, if we are replacing an older denture the new teeth will look like they are not placed correctly.  This is not so.  The problem was that the old teeth may have been incorrectly positioned and you are simply used to seeing yourself this way.  The art and science of dentistry has evolved since you old dentures were made.  We know more today. You muscles will need to adapt to the new denture.  This will take time, sometimes up to a year or more to adapt. Over time your lips and muscles will regain its strength and muscle tone and everything will look correct.

During the fabrication phase, you will have the opportunity to see the set up of the teeth in your mouth so you can judge the appearance. Nothing is finalized until you accept the set up and color of the teeth.     

Third Phase: Wearing Phase:

Please note several things will be set into motion the day the new denture is placed in your mouth. The bone that supports the gums and the denture is movable, dynamic, ever-changing living tissue.  Bone is not static like concrete.  Please understand this is nothing new, Orthodontists move teeth and bone all the time during orthodontic treatment.  By placing the teeth in their correct anatomic position we will automatically be placing a correct, good force to the bone. It is not likely your old denture was placing the forces exactly where they needed to be. So when the new denture is introduced your bone will be stimulated like never before.  This is anatomically normal and correct, and we know this will occur. 

Muscles and Condensation and Compaction:

As you wear the new denture you will not be able to chew very well at first and your speech may not be the best right from the start.  Your muscles need to evolve and get used to the new denture.  This is normal.  As your muscles adapt to the anatomical configuration of the new denture you will find you will chew better and better.  As this happens your supporting bone will be getting the good forces I mentioned earlier. This will result in the compaction and condensation of your bone.  Your bone will “settle” to its correct anatomical relationship to the chewing surfaces of the teeth.  As you chew and your muscles regain their power your bone will condense and compact as it should.  Your denture will loosen a bit because it didn’t change, your bone did.  A reline is then placed to refit the denture for you while this happens.  Generally this will occur over a period of time and it is likely several relines will be needed. It is impossible to determine how much time it will take for your particular case, or how many relines you will need.  I advise you to emotionally plan for twelve to twenty four months of treatment.  It is usually much less. Each situation has its own set of complexities.  Be patient.  It all works out.

After your muscles are adjusted to the new biting situation with the new denture your bone will stabilize and maintain its contours, the compaction and condensation is completed and you are now on your way to the end of your treatment.  Sore spots will occur during this phase and if you let us know about them we can help guide you and fix them if needed.

Phase Four:  Post treatment, maintenance phase:

You will need to come in every several months for cleaning of the appliance.  The real reason you need to come in is for an oral cancer screening. From time to time you will find your denture will start to loosen.  Your body has changed and it is time for another reline.  This is normal and not a problem. Like anything maintenance is vital and needed to maintain optimum function and appearance.  You may say to yourself that you never did any of this during the years you were wearing your old denture.  Well, we know better now.

In the future you will find your denture teeth will wear.  This is normal, because you are chewing well.  A new denture will be needed at some point down the road.  No one can predict how long that will be. The only constant is change.

POTENTIAL PROBLEMS:

-denture may feel too loose or too tight

-bite may feel "off" or uneven, cheek biting

-sore spots can occur

-speech changes, difficulty in speaking

-difficulty in swallowing

-difficulty in eating

-awkwardness to place or remove the denture

-movement of the denture, the gums are mostly filled with water, the denture sits on the gums, therefore the denture sits on the water in the gums.

NOTE:
Your mouth, like the rest of your body, is in a constant state of change. Your dentures don't change. Therefore, adjustments will most likely be required.  Every six months, minimum, you need to see you for examination and maintenance.

CARE OF YOUR DENTURE: INSTRUCTIONS

-DO begin by eating soft foods until you get used to the denture

-DON'T bite the denture into place, use you fingers to press it firmly into place. DON'T use your tongue to remove it, this will cause instability of the denture and create a bad habit.

-DO place water in the sink prior to removing the dentures, if it should slip through your fingers it will land in the water, not on the hard basin which will cause it to fracture.

-DO brush the denture often, plaque and bacteria will stick to the denture as it will to natural teeth.  It MUST be cleaned. Denture toothpaste or cleaning tablets are to be used.

-DO  remove the denture for at least eight hours a day, most people will leave them out while sleeping. You don't sleep with your shoes on; give your gums a chance to rest, relax, and   "breathe".

-ALWAYS store your denture in water when not wearing it. NEVER IN A PAPER TOWEL OR TISSUE...NEVER! Paper towel and tissues get thrown out and you will forget what is in it and you will accidentally throw out your denture.  It happens all the time.   This will prevent distortion from warping

-food will most likely get under the denture when eating, simply  clean it when your meal is over.

-brush your gums gently or rub a piece of gauze over your gums,  this will help keep your mouth fresh and clean

-please DON'T adjust your denture yourself, call the office. We look forward to seeing you.  I have special instruments to make the necessary corrections.

-PLEASE CALL IF YOU HAVE ANY QUESTIONS-anytime! 561-338-7535 (office)

Our goal is to help you become as healthy as you choose to be.  This is a major departure from what you are used to. Instead of telling you how healthy you should be, we try to help you understand your choices about dental health and let you make an informed choice regarding health and treatment needs.Since mouth tissues (and our bodies in general) are constantly in a state of change, annual or biannual checkups are required.  Ill fitting dentures can cause irreversible damage to your gum tissue/bone.  Relining (refitting) the denture is a relatively simple procedure that can reestablish the fit of the denture.

The key to a great relationship is great communication.  It is important to me that you feel free to ask any and all questions.  Feel free to call to discuss any concern.  My goal is to make you so happy, to give you more than you expect, to satisfy you so fully; that you will tell your friends, family and neighbors to be referred to our office.

If you should have any questions about implants to aid in the support of your dentures let us know.  We have already discussed this topic yet feel free to ask again.

Please appreciate how very hard we are working to exceed your expectations.  This is why we have provided this detailed, lengthy information letter for you. We really do need you to refer your friends as we want to help nice, like-minded friends of yours. We appreciate the opportunity to help your family and friends.