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Should I have all my teeth pulled and get dentures??

 

 

 

 


 

toothless smile

 

I make quite a few full dentures. I do this mostly in cases where people come in with an old one that needs to be replaced. There are also cases in which people present with teeth in such bad condition that there is literally no other affordable alternative. However, many young people come to my office with numerous teeth that have what they believe are non-repairable cavities, or they may not like the appearance of their teeth because they are crooked. They expect the denture will be a simple way to correct all their problems. 

 Many of these people have avoided going to the dentist because they are afraid of what the dentist will think, or afraid of what will happen to them once they get there.  Let me make four things very clear.

1. We see people with very bad teeth ALL THE TIME.   At least half of all our patients come to the dentist the first time only because they are in so much pain that they can't stand it anymore! They become good dental patients only because of their first few bad toothaches.  You are not alone in having this problem!

2. Your fear of the pain is WAY out of proportion to the actual pain you will feel when we work on you.  Do you remember how big your dad and mom looked to you when you were a child?  When you finally grew up, they didn't look so big anymore.  Your memory of the pain involved in seeing a dentist is like that too.  Once you actually see it with grown up eyes, it doesn't look so big and bad anymore.  Many of our very best regular patients started out just like you. They sometimes come in just to say hi even when they don't have a problem because the staff is friendly, and the atmosphere makes them feel comfortable.  

3. Full dentures are a last resort!  If you are used to having even diseased or ugly teeth, you cannot even imagine how disappointed you may be with full dentures. Dentures are, in fact, a sort of myth made of plastic! (Read on and you will see why.)  I've been making them since 1978. I've seen it all!

Now 80 years old with the same teeeth4. You do not naturally lose your teeth when you get old.  This is a picture of a 73 year old man who simply brushed daily and used toothpicks to clean between his teeth all his life.  He didn't eat much sugar except when he was very young (which accounts for the one visible filling you see on the upper left back tooth).  With a little care, anyone can keep their teeth all their life!

Click here to read an exchange of e-mails between me and a patient who  got a denture and found she could not wear it.  These situations happen all the time and can be downright tragic.

 

Things your mother never told you--(about her false teeth)!

1. Having full dentures is like having fake hands. They may look like real hands, but try holding a pen to write your name with them. False teeth are not real teeth. People with them can barely chew their food,  You can put just 15% of the pressure on false teeth as you normally use to chew your food, before they lose the suction that keeps the top one in your mouth. The lower ones have no suction at all and they just sit there by virtue of their own weight, and the ability of the tongue to help them stay put. Many people find lower dentures so cumbersome that even if the top ones are reasonably successful, they do not wear the lowers except when they go out in public.

2. As soon as the natural teeth are removed, the face begins to age rapidly. When new dentures are inserted for the first time, your facial appearance remains the same...at first ....  But as soon as you walk out the door, the bone that held your original natural teeth begins the process of resorption (disappearing) which begins the process of collapsing your facial appearance.

Toothless skullNote: It is helpful to see the severe bone loss that can eventually happen after the teeth are extracted.  Compare the panoramic x-ray of a normal mouth (seen on the x-ray page ) with that of a person who has been without teeth (edentulous) for a number of years (on the implant page) and notice the amount of bone that nature can remove if the teeth are extracted at an early age. Click on the toothless skull above to read more about what happens to the bone once the teeth are extracted.

Note that bone resorption can be prevented by replacing natural teeth with dental implants soon after they are extracted.  While implants are a much more expensive alternative than keeping the natural teeth, they are still infinitely better than the problems associated with going without teeth and ending up with a full denture!

Dentures accelerate the aging process of your face because the distance between your nose and your chin begins to decrease as soon as the natural teeth are extracted. The bone that used to hold your top natural teeth begins to retreat up toward your nose, and the bone that held the lower natural teeth "goes south", allowing both the top and bottom false teeth to ride with them in the same directions.  Within a few months, your face ages several years. As a result, the denture teeth eventually begin to disappear under your lips while the lips themselves begin to flatten out.  This process continues for the rest of your life.

48 Year old without teeth for 20 years Graphic to show lines

The image  on the left above shows the facial appearance of a 48 year old woman who had her teeth removed at the age of 28.  Unfortunately, she kept her same denture the full 20 years.  This allowed the distance between her nose and her chin to collapse (this distance is called the vertical dimension).  Note the flattening or "sinking" of the lips.   As the lips flatten, they begin to develop little vertical wrinkles called ragades, or perioral Lines (marked in blue on the diagram on the right). The diagonal lines marked in yellow are called the labiomental folds.  These tend to become more pronounced as the lips, no longer supported by lower teeth and gums collapse inward, and the vertical dimension diminishes.  The lips begin to blend into the labiomental folds bringing about the illusion that the lips are a great deal longer from right to left than they really are.  The combination of sunken lips and pronounced labiomental fold give the mouth the appearance of a horizontal slit rather than the full lipped appearance of a person with natural teeth.  In some people, the diagonal lines from the corner of the nose to the corners of the lips, called the nasolabial folds (marked in red) become much more pronounced after the loss of the teeth adding to the appearance of rapid aging.

53 year old with all her teethThe edentulous (toothless) woman shown above is 48 years old.  Compare her with this 53 year old woman who  has retained all her natural teeth.  The fullness of the lips and the lack of ragades are due to the steady presence of the natural teeth throughout her life.  The nasolabial folds become apparent mostly when she smiles.  The Labiomental folds are not apparent, due to the presence of the lower teeth (and their supporting structures) which support the lower lip to keep it from sinking inward.  While this patient is chronologically older than the patient above, she looks physically younger because she kept her natural teeth.

Graphic showing facial collapse

The images above are drawn by hand, but they show the real world effect of the loss of the teeth.  The image to the left shows the profile of a middle age woman with a full set of teeth.  The center image shows what the patient would look like immediately after the extraction of her teeth.  The image to the right shows what the patient would look like at the same age if the teeth had been removed about ten years before.  If you have ever ridden the subway in any large city, you have seen people with this type of deformity.  They were not born that way.  They have simply lost all their teeth.  Click on the image to go to the  website of the International Congress of Oral Implantologists for more on this subject

Jaw resorption thumbClick on the icon to the left to find out why granny never wears her lower denture.

3. A denture is NOT forever. As dentists, we can help prevent some of the facial aging if (and only if) you return every 2 years for a reline, and every 5 to 7 years to get new dentures. If you don't wait too long, we can usually build new dentures with "longer teeth" (actually extra pink plastic that replaces the gums). We can also place the teeth somewhat further forward to fill out your lips a bit. However if you wait too long, the muscles that let you chew your food begin to shorten to accommodate the reduced space between your nose and chin (vertical dimension), and you will not be able to tolerate the increase in length of the teeth that would be necessary to restore your original vertical dimension. This is nature talking, not the dentist who will do his best to accommodate your wishes.

A denture worn too long can really do damage to the facial appearance.  Long term wear of an old denture can force huge changes in the muscles of the face which affect not only facial appearance, but functional changes in the way the patient uses the jaws.   Click here to read about my patient Popeye.  His story comes at the end of a page written primarily for dentists, dental students and other dental professionals.  The rest of the page is full of technical data on occlusion, the study of the relationship between the position of the teeth, the muscles of mastication and the corresponding position of the jaw joints.  But for readers with endurance, it will provide some insight into the secret lives of dentists and  just how complex the profession really is.

4. Dentures must be relined every two years. This means that new plastic must be added to the inside of your existing denture in order to fill spaces between the denture and the gums left vacant by the receding bone. Relines do NOT restore vertical dimension, but they do keep the denture tight and stable. If you fail to reline the denture the consequences are not good. 

As the bone recedes and more and more space becomes vacant inside the denture, most people will begin wearing stiff denture adhesives to maintain the dentures in their mouths. They tend not to notice that the teeth move around more and more while chewing food. When a denture retains suction, but begins to move around over the bony ridge that supports it, we say the denture has good RETENTION, but lacks STABILITY. When the hard denture base is in close approximation to the bone that supports it, the denture has maximum stability, but as the distance increases, no matter what type of goo you put under it, the teeth become less and less stable and are much more easily dislodged by chewing food. 

People become accustomed to the gradually developing poor fit.  They know that the appliance isn't what it used to be, and they plan to get new dentures, but simple inertia keeps them from going back to the dentist.  However, if they have waited more than two years to reline or rebuild the denture, something unfortunate happens to the tissue that supports it. Nature begins to build more gums between the bone and the denture to take up the slack.  At first this sounds good, but the gum tissue that nature builds after the real teeth are gone is soft and flabby. It's like a layer of Jell-O.  This flabby tissue adapts to the denture and provides some suction, but it won't support any weight.  In other words, the flabby new gum tissue that forms because of an ill fitting denture will not support a stable denture.  This means that when you bite food on the front or the side of the denture, it will displace causing it to move around and loose suction.

Papillary HyperplasiaThe image to the right shows an example of a very common form of flabby, redundant tissue that forms under an ill fitting denture.  It looks like little pebbles on the roof of the mouth.  This type of overgrowth is called papillary hyperplasia.  It is permanent until it is surgically removed.  Of more practical importance to the denture's stability are the thick layers of flabby tissue that form over the U shaped bony ridge, which is the area most responsible for supporting the denture during chewing.

The take-home lesson here is that even a new denture built over this flabby tissue will not fit much better than the old one.  The new denture will have the same stability problems as the old one unless the patient goes to an oral surgeon to have the flabby tissue removed before the new denture is made.

If you need to use more than a touch of denture adhesive to retain your denture, then you need a reline.  I have seen some very odd things used to take up extra space inside an old denture.  Some patients use layers of tissue paper. One patient actually presented to their dental office with a neatly trimmed slice of bologna as a makeshift "denture liner".  Using anything other than denture adhesive is a bad idea because the denture breath gets pretty ripe!

5. If you are a "gagger" (and have avoided seeing dentists to avoid gagging), you can be sure that the new denture will cause you to gag too. Probably the saddest group of people we see in this profession are those people who hate dentists because they tend to gag when anyone (including a dentist) puts something in their mouths. These people have it in the back of their mind that they can just wait until their teeth get so bad that a dentist will just put them to sleep, remove the teeth and they will wake up with false teeth and live happily ever after. 

Actually, the first part of the dream can come true. It is expensive, but you can get your teeth pulled under general anesthesia and have an immediate denture inserted. It's the "happily ever after" that doesn't pan out. Gaggers tend to go toothless a lot because the presence of the denture in their mouths makes them feel like throwing up all the time. They avoid eating at other people's houses, and will wear their dentures only when absolutely necessary. The only hope these people have is if they can afford full mouth implants.

Click here to read an exchange of e-mails between me and a patient who  got a denture and found she could not wear it.  These situations happen all the time and can be downright tragic.

What are the affordable alternatives to having all the teeth removed?

1. Missing and hopeless teeth can be replaced without extracting the good teeth. They can be replaced using Removable partial dentures. Partial dentures are much more comfortable and stable than full dentures. They do not have to cover the entire roof of your mouth for stability because they are held in by the remaining natural teeth. Even the presence of a few natural teeth remaining on either side of the dental arch can make it possible to wear a partial denture instead of full dentures. The presence of any number of real teeth can reduce (though not completely eliminate) the accelerated aging process associated with full dentures.

This man has only 4 teeth, but his all-plastic partial is as stable as a rock!  The clasps are made of plastic and are visible under my fingers.

Before ValPlast Partial ValPlast partial in placeWith ValPlast Partial

2. Even if you are unhappy with the appearance of your front teeth, it is possible to replace only the front ones with a partial denture. If you have two front teeth that are very crooked, it is possible to remove only these and replace them with a partial or bridge and avoid removing all the other teeth.

Having said this, there are always people who really DO need to have all their teeth extracted and have dentures made. These include people with all their teeth so badly decayed that they would all require root canals and crowns which can become extremely expensive, and not every patient can afford this. They include people with terminal gum disease which has caused the teeth to become loose or to change their positions so badly that repair again becomes too expensive, or likely to fail after a short while. They also include people who have been to dentists for years trying to save their teeth, but have finally given up and are just plain tired of all the bother their teeth have caused them. No matter who you are, they are your teeth, and you have a right to have them removed if you have ultimately made up your mind to do so. If this applies to you, I have prepared an entire page on the different types of dentures, and the steps involved in making them.

toothless man

Yes, this man has no teeth!
At the time of writing, he is an escaped convict.
I know you're curious.  Click on his image for more.

Everything about getting dentures

The different types of full dentures

Denture relines

 

 

 

 

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