Dental Retreatment (part 3):Complete and Partial Dentures (removable dental prosthesis)

 
A removable dental prosthesis is an appliance that replace some or all missing teeth, not only teeth, they may also be used to replace the missing soft tissue structures. Any artificial object used on or within a human body is considered as a foreign body. A foreign body is not readily accepted by the body. Either the body adapts or it is rejected. 

Human body has a miraculous ability to adapt to its surrounding, the same is applied to dental prosthetic treatment. In my experience so far, i have seen variety of patients ranging from uncooperative to indifferent. All the patients face the same challenge of adapting to theirs new set of removable teeth. Among these patients there were many who adapted to the artificial dental prosthesis readily but some took a while to learn how to mange the removable dental prosthesis. After delivering the removable dental prosthesis (complete or partial) a certain period has to be given for adaptation. During this period the clinician schedules followup appointments to adjust the prosthesis for the patient in areas that are creating trouble. All this is expected to be done as a part of routing procedure when a new removable dental prosthesis is given to the patient. 

When we have missing teeth we experience reduced efficiency in chewing food, at times our speech is also affected, the appearance is also affected and not to mention the psychological distress (the psychological changes will be covered separately as it is an important aspect).

There are three possibilities of removable Prosthodontic treatment:

1. Complete dentures for upper (maxillary) and lower (mandibular) jaw.
2. Single complete denture, either upper or lower jaw.
3. Removable partial denture.

Every prosthetic treatment is known to have problems since the idea of replacing missing teeth has been applied. The basic level at which the problems can arise are either due to inability to adapt to the prosthesis or due to something was wrong during clinical procedures or the dental laboratory technician has messed up in fabrication of the prosthesis. These problems can be rectified as the treatment is in the initial stages. 

After the prosthesis has been delivered and the patient is absolutely comfortable, this period of bliss continues for years (varies from patient to patient). As these prosthesis rely on the underlying foundation of the jaw, after some time the prosthesis would start posing problems.

Different prosthesis will give different problems.

Loose Fitting 

Over a period of time the jaw bone and the soft tissue that supports the removable dental prosthesis undergoes wear and tear. The common cause is bone resorption, this is a normal phenomenon that occurs due to aging. In some individuals the rate of bone resorption may be great in some less. The rate is dependent on multiple factors, primary factors are the prosthesis fitting, patients general health and patients diet contents. When a prosthesis becomes loose it is mandatory to get it checked as a loose fitting removable prosthesis would add to the discomfort, soft tissue injury and more importantly accelerated rate of bone loss. Adhesives are not the treatment for a loose fitting prosthesis , they have their own complications. The best treatment is to get the prosthesis repeated. Other option is to reline the prosthesis which the clinician will do for you. Relining is a procedure where the under surface of the prosthesis is covered by a thin layer of material that chemically binds with the existing prosthesis. In situations where the bone loss is excessive I would suggest IMPLANT supported prosthesis.

Pain

Pain if experienced in the initial days of the prosthesis, this needs to be looked at before any soft tissue injury occurs. This is a normal and verymuch expected conditiin. In previous prosthesis wearers, pain is another sign that the prosthesis is creating trouble and needs to be replaced. I recommend changing the removable prosthesis (complete or partial) every 5 years. This will maintain the health of the oral tissue and reduce the rate of bone loss due to ill fitting prosthesis. Another point I recommend to every patient who are wearing removable prosthesis is to have routing check up of the oral cavity, specially the soft tissues.


  

 Reduced Eating Efficiency

The removable prosthesis are fitted with acrylic teeth. In the olden times, porcelain teeth were used that were made of hard material and underwent almost no wear. Porcelain teeth had many disadvantages which made them less favorable to the patient and the clinician. Contrary to the porcelain teeth, the acrylic teeth undergo wear over a period of time. The rate at which the acrylic teeth wear down is dependent on the kind of diet (hard or soft) and also on the strength of the chewing muscles. Due to wear of the acrylic teeth in the removable prosthesis, there is a need to apply extra pressure while chewing as the cutting efficiency of the teeth is reduced. If the chewing efficiency of the teeth reduces its time to get new set of teeth, as increased chewing pressure will result in adverse consequences of underlying hard and soft tissues.
 

Discoloration

One of the main reason why patients want to replace missing teeth is aesthetic. Everyone has a right to look good and possess a pleasing smile. The removable prosthesis are made of acrylic material which could undergo discoloration due to various reasons. I recommend using a soft tooth brush and soap to clean the dentures. Commercially available denture cleaning  kits are available which are also effective. Tooth paste is not advisable because it contains minute abrasive particle that scratch the surface of the soft acrylic material and provides place for food to stick and invariably the bacteria start to live there resulting in rough discolored unhygienic prosthesis. The other reason for discoloration is the diet, for example high turmeric containing food causes yellowish staining. Habits such as smoking or chewing tobacco will also contribute to discoloration. Old dentures that have been in service for prolonged period would start to discolor due to limitation of the material. To rectify this problem either get new prosthesis made or get them polished by giving them to the clinician.

Broken Prosthesis

The removable prosthesis as mentioned is made of acrylic. These materials are strong but brittle. If the prosthesis is dropped, they tend to break. Care should be always exercised while cleaning the prosthesis to have a bowl or a shallow basin underneath. Repair is possible for broken prosthesis but it leaves them weak. As far as possible do not drop the prosthesis as they are not ping-pong balls. Excessive chewing forces and extremely hard food may unfortunately break the prosthesis

 

Apart from the above mentioned problems if faced please feel free to post your questions.  

Happy Smiling!