Blog | Finlay Sutton - Denture Education

Lowering the possibility of unhappy denture patients

I say to the patient that "your new dentures will be well engineered lumps of plastic. They look like teeth but don’t work like teeth - like a prosthetic hand/leg, they will not work like natural teeth. I will make them to the very best technical standard; however, I am heavily reliant on you getting used to them. Just like learning to drive a car or learning a new skill (like golf, football, golf, violin, chess etc) it takes time to get used to them. You will need to work with them rather than against them”.

The new dentures must comfortable at the end of the fitting appointment

At the fitting appointment, I ensure that the new dentures are comfortable by the time the patient leaves, as any degree of soreness will gradually worsen as the dentures are worn. Enough time must be budgeted for this, so that there is no rush.

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Biting and new complete dentures – the sandwich filling

The occlusion is designed so that the anterior teeth do not contact when the patient brings the upper and lower teeth together in centric relation. The denture teeth will normally have good positive occlusal contacts on the premolars. This means that if a patent bites a “ham” sandwich the bread and the ham may separate, with the bread being held in the mouth and the “ham” staying in the body of the sandwich because the anterior teeth will not occlude.

The occlusion on the dentures is designed like this on purpose to encourage the patent to bite and chew using the premolars rather than the incisors which reduces tipping forces on the dentures.

I discuss this with the patient as part of their consent prior to treatment and at the denture delivery stage.

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Chewing and new dentures

I discuss with the patient that learning to chew satisfactorily with new dentures usually requires at least 6-8 weeks, and sometimes longer, particularly in complex dental situations such as a flat lower ridge, support problems and with cognitive learning problems, such as dementia (adaptation and learning takes longer).

New memory patterns through neuromuscular control require time to be established for the muscles of the tongue, cheeks and lips to keep the dentures in position.

Care must be taken to separate patience with the learning process from putting up with discomfort/pain caused by the new dentures. Some stoics will soldier on, doing damage.

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Saliva flow and new dentures

Initially new dentures often cause the patient to produce more saliva than normal. Very occasionally the saliva flow can decrease and the patient’s mouth can feel dry with the new dentures. This gradually returns to normal over time. I make sure my patients are aware of this prior commencement of treatment.

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Post dam discussion – it may be further back in the upper complete denture

I have a discussion with the patient about the post dam position before treatment verbally and in a letter.

This is what I tell my patients’:

“The new upper denture may extend slightly further back in the mouth compared to your current denture. The extra extension is important in producing good suction (peripheral seal). I feel it is important for you to be aware of this prior to commencing treatment and most patients I find accommodate to this. If not, I will still be able to help but the denture may not have as good suction.”

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Dentures move during function

Dentures are removable mechanical substitutes for missing living tissues and as such exhibit movement when chewing food, talking and when the tongue and muscles of the mouth move. The patient needs to work with them rather than against them.

This improves with time with adaptation once the dentures do not cause soreness. This normally takes approximately 6 weeks. It can take some patients up to 6 months – particularly if they are elderly and new to denture wearing.

Fixative may be necessary.

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Newly fitted dentures will become sore

At the fitting appointment, I explain that the new dentures will become sore fairly soon and this is a completely normal occurrence, even for well-crafted dentures, made to the highest technical standards. I normally review the patient 1 week after fitting.

Occasionally, during the week the patient may find the new dentures too sore to wear. In these circumstances, I advise the patient to leave them out and revert to their previous set of dentures. I ask them to wear the new dentures for the two consecutive days before their review appointment, wearing them for the same length of time they would normally wear their dentures. This allows me to see exactly where the dentures are rubbing, thus enabling precisely accurate adjustment of the denture at the review.

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