Quality & Affordable Dentistry in Malaysia

Removable Teeth – Dentures and Partial Dentures in Selangor, Malaysia

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Man is the only animal that can continue living without its teeth. Take the teeth away from any other animal and it dies.

Take the teeth away from man and there are choices. For some, removable teeth are the only solution. Others choose the better, more permanent solution afforded by today’s technology.

In many respects, dentures are like oral wigs. Like a toupee or wig, they are but pale versions of the original, and most don’t look very good.

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Dentures are like that, too. They sit on top of your gums. Some can look pretty good. Most don’t.

But because they’re sitting on top of your gums, the force of chewing goes through the dentures to the soft tissue and bone underneath. Frequently, the soft tissue under a full or partial denture develops painful sore spots. The compression on the bone caused by the chewing on dentures inevitably leads to loss of bone. It is but a matter of time.

This loss of bone occurs in both height and width. This bone loss of the upper and lower jaws over time leads to wrinkles and for many, facial disfigurement.

Bone loss itself makes dentures more difficult to wear over time. There is just less to hold onto. I feel very sorry for the people in their 60’s, 70’s or 80’s, who see dentures as the only solution to their problem. Why? Because their ability to accommodate new dentures is decreased just because of their age.

As we grow older, our capacity for accommodation decreases. We see that on all sorts of levels. We see it in our athletic ability. We see it in our stamina. It should not be a shock or a surprise that our ability to accommodate dentures decreases as we grow older.

Many dentures are made slap-dash for economic reasons. Some people don’t know that there are other options. There are. If dentures are not custom made to fit the face, personality and chewing mechanism, people are often quick to develop that “denture look.” Worse, poorly fitting dentures worsen bone loss all by themselves. This loss of bone further worsens the fit which further worsens the bone loss. This continues in a dwindling spiral with the denture wearer the biggest loser.

The average denture wearer should have his denture relined or remade within one year of first receiving them. After three years, another reline is probably necessary.

After seven years, a new set is needed. Few denture wearers adhere to a schedule of care like this at all. In fact, the average denture wearer goes to a dentist once every 14.9 years! There is a huge gap between what should be and what the public typically does. This failure to see a need for care makes the denture experience worse and puts the denture wearer at risk for increased oral cancer, especially for smokers.

Denture Adhesives

Denture adhesives have been around a long time. These are used to help stabilise dentures. In Malaysia alone, it is estimated that over 20 million ringgit a year is spent buying this material. Evidently a lot of people want removable teeth that don’t move around!

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However, there is a problem. The greatest use of these glops, globs, powders and gels is to stabilise dentures that should have been re-made because of bone loss. Besides the taste, these adhesives leave a mess on one’s mouth. I have seen patients come in with an immense wad of this stuff, trying to ring more use out of ill-fitting dentures. It is a big mistake.

The poorer the fit of the dentures, the greater the use of the goop to hold them in place. The poorer the fit, the greater the bone loss caused by the ill-fitting dentures! The very thing that is supposed to be helping is causing more loss of bone!

Is there ever a good use for a denture adhesive? Yes, there is. When a person wants the extra security that the adhesive gives them in public places, an adhesive can help out. No one wants to see a person’s teeth fall out onto the plate in a restaurant. The real question is how much should be used? Just a tiny smidgen spread out over the whole denture. That is all that it should take to ratchet up the adherence to the tissues. It is so little that it is barely visible.

If the denture wearer is requiring more than just a little, then the likelihood is that the dentures should be replaced with better fitting ones.

What About Partial Dentures?

Given the choice between having no teeth or wearing a full denture, the partial denture can be a better choice. Why? Because a well-made partial denture distributes the bite force onto the remaining teeth as much as possible, away from the bone. This requires the partial denture to be rigid, usually made of metal and specifically made to use the teeth as anchors and retention of the partial denture.

Mistakes Patients Make With Partial Dentures?

• Failing to have good tooth support that takes pressure off the gums

• Failing to get a partial that is for more than just looks.

• Trying to use one’s partials for something else

• Lack of supporting surfaces on teeth to stop an all plastic partial from digging into the gums.

• Failing to get a rigid partial made of metal that transmits bite force to the teeth.

Just as with the full denture, the gum and bone underneath the partial recede away. Mix in time and the loss of bone could be huge. A partial denture must be carefully planned and delivered so that the patient can function with them and bone is preserved as much as possible. The goal of a partial is to stabilise tooth positions and to provide chewing surfaces to chew against. It is not as good as chewing on healthy natural teeth.

Here is a real surprise: 40% of partial dentures stay in drawers, worn not at all or just for special occasions. Frequently, a person can chew better without the partial denture!

Like a full denture, if you must choose a partial, get one customised by a real expert to fit very well. It should distribute bite force over as large an area as possible to decrease force on bone. This also means it very well may need far more time effort and expertise to get one well made. The goal of a well made partial is to provide chewing surfaces, stabilise the remaining teeth’s positions and minimise compressive force onto the bone. Remember that force on bone causes it to melt away over time.

Creating a well-made partial denture is a tall order. Even when done well, many people find partials too uncomfortable to wear. Many people consider the hooks of the partial denture fitting onto the remaining teeth to be so unsightly that they refuse to wear them.

Statistically speaking, teeth that anchor partial dentures are more likely to decay or get loose from the force put against them by the partial. If you are saying to yourself, “Why would anyone want a partial denture?” I understand. They should be avoided if possible.

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What to Do If You Are Losing Your Teeth

Removable teeth are generally a poor solution for everyone. Avoid them if you can. And if you must lose your teeth consider how you could keep some tooth roots.

Why should you keep some tooth roots? If you can bring your tooth roots to an acceptable level of health, these can help preserve bone underneath a denture. Think of it as a way of cheating the denture demons.

Tooth roots stimulate bone to maintain itself. So, keeping tooth roots to go underneath a denture helps a person maintain their bone levels. Moreover, retaining tooth roots improves chewing function. Another advantage is the nerve endings around tooth roots give you a sense of spatial awareness. In other words, you have an increased awareness of “where your mouth is” when wearing this special variety of dentures.

Dentures that fit over tooth roots are called over-dentures, meaning that the dentures fit over the roots and come in and out just like regular dentures do. To use the over-denture techniques, your dentist must perform root canal treatment on the two to four teeth to be retained. Once these procedures are completed, the crowns of the teeth are cut off, leaving the roots at the gum level. The root canals done for this procedure are relatively easy for the patient to have done. What is so terrific about over-dentures, particularly for the upper teeth, is that the roots preserve the bone and help the patient maintain his or her facial appearance. 

Over-dentures are a real God-send when dental implants don’t fit into a person’s budget. Unlike the upper, the lowers are not good candidates for this procedure because the muscles of the cheek, lips and tongue displace a lower denture and make it move around during function. An upper denture can stay put pretty nicely because of the vacuum created between the over-denture and the upper jaw. 

Wearing Dentures

The ugly truth is that many people with removable teeth never wear them. Many people, whether they have a full or partial denture, end up keeping their removable teeth in the nightstand drawer because they’re so uncomfortable.

Dentures should be cleaned well daily and left out of the mouth a minimum of four hours a day. Dentures were never meant to be worn 24/7. Would you wear your shoes every minute of every day? No, you feet need to be rested. So do your gums underneath your dentures.

Keeping Bad Teeth Too Long

Sometimes, people hold on to bad, loose or diseased teeth for too long. This is a huge mistake. Why? Diseased teeth cause far more bone loss to occur faster than having the bad teeth removed. More importantly, these infections from the bad teeth put your entire health at risk. Keeping bad teeth is a risk that just isn’t worth taking.

Some denture wearers, having kept their teeth for too long, have lost so much bone that there is hardly any bone to support and retain a denture. In some of these cases, oral surgery must be performed to expose more jaw bone. Sadly, this complicates the dentist’s work to use implants to rebuild the smile and chewing function. Often, there is not enough bone to anchor implants without doing bone grafting to rebuild the bone. Diseased, loose, failing teeth should be removed.

What to Do if You Already Have Dentures

For many people, dentures were the only option they had in the past when they lost their teeth. The reason, no matter what it was then, is now removed. Today you no longer have to wear dentures. The best option is to have dental implant treatment that protects and stimulates the bone to remain. This generally requires a number of implants sufficient to support the replacement teeth. Interestingly, the number of implants needed is dependent on the a person’s age, bite function, total body size, density of bone and total bone volume. Everyone is different so there is no standard number to use. The number, type, and size of dental implants is based on diagnosis of your individual needs.

A mistake in getting dental implants is to use too few implants, thus the bone in the jaws continues to receive compressive force, melting it away. You wouldn’t think that this would be a problem if the patient was receiving implant care, but using too few dental implants is commonplace among those dentists who are unaware of the real problem of bone loss. Any supposed economic advantage melts away also when too few dental implants cause an early demise to the replacement teeth.

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Denture Reality

The more effort, expertise and talent that are brought to bear in making dentures, the better the fit, longevity and success of denture service. Even then, physiology is working against you and the dentist. Facial muscles, the tongue and bite pressures combine to make any denture difficult, and this is doubly so for the lower dentures.

It is no surprise when economy dentures fail. True, a few people can tolerate anything, but they are the rare exceptions, only a few out of a thousand patients can muster the energy to make quickie dentures really work – to tolerate them in spite of all the problems. Many a patient has been severely disappointed to learn about the inadequacies of these kinds of dentures through first-hand experience.

Making a set of dentures that are custom fit to match your level of bone, facial appearance, muscles, tongue and jaw movements is the best denture service investment.

The Importance of Your Bite

Did you know that ninety percent of sore spots under the removable teeth on the soft tissue are caused by a mismatched denture bite? It is true and too often, ignored except by the few dentists who have spent the time, money and effort to get the training to help those that wear dentures. Recording the correct bite position in denture construction is a significant challenge. This is especially true for those who have lost significant bone already!

Clacking Dentures

You’ve probably been around someone whose dentures clack. It’s embarrassing.

They make noise all the time. Generally, that indicates one of two things. The dentures are either too close together, or there’s so little bone that the muscles in the floor of the mouth force the dentures up – making that clacking sound as the teeth of the upper and lower denture come together.

How Large Should A Denture Be?

You want a denture to be as large as possible and still go in the mouth. Why?

Because the larger the denture, the more that force is distributed over a larger area. The more the force is distributed over a larger area, the less compressive force against the bone, and therefore less bone is lost.

The problem with making dentures as large as possible is that muscle attachments get in the way, along with the tongue and the cheek. This problem is worse on the lower denture. Making an upper denture as large as possible can cause difficulties in swallowing and dislodge the upper denture.

So, it’s always a balance between muscle position, tongue position, bite function and the amount of jawbone present to support the removable teeth. The longer one wears these removable dentures, the more damage is done to the bone that remains.

Force and Ability to Chew

Normal chewing force with natural teeth ranges from 25 psi up to 75 psi, with spikes going up to 250 psi. Denture wearers experience progressive loss of chewing ability. The longer they are worn, the more difficult chewing can become. After a denture wearer has had dentures fifteen years or more, this chewing ability declines to about 5 psi!

Final Recommendations

• If you must have dentures, get the best ones possible from an experienced dentist that makes high quality dentures on a regular basis. The dentist should make customised impressions, bite registrations and customised tooth arrangement. Often custom colouring of denture bases is needed to match the colour of your gums.

• If you must have dentures, get upper over-dentures if you can. These preserve bone better and protect your face better than full dentures.

• Replace your dentures every 7-8 years.

• Get relines every 2-4 years as needed to keep your dentures fitting as well as possible.

• Let your mouth rest at least 4 hours a day by removing your denture.

• If it is possible for you, get dental implants to avoid becoming toothless. If you are already a denture wearer, find a way to get dental implants. They can change your life.

As much as we’ve told you about dentures, understand this: any time that you can use dental implants or natural teeth in a healthy mouth instead of removable teeth, you’re better off.

For some people, dentures are the only solution. In that case, get them made as well as you possibly can. But if possible, choose the alternative, dental implants.

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