Projecting data has predicted that more individuals will retain functioning dentition into old age than ever before. However, a combination of natural teeth and dentures will be common for at least the next couple of decades. Indeed, the Adult Dental Health Survey of 2009 revealed that nearly one in five adults wear removable dentures, and as the population ages, the number of people requiring prostheses is likely to rise. Consequently, managing this situation particularly among older adults will be an important part of a clinician’s remit for many years to come.
Maintained well, dentures can last several years, but how well they are fitted is of vital importance to ensure optimal comfort, appearance and function. To achieve the retention of complete dentures there first needs to be an accurate fit of the denture base and an effective border seal. Additionally, support and stability depends on the height and contour of the residual alveolar ridge, maxillary tuberosity and hard palate to resist any movement.
As a result of normal wear and changes to the shape of the oral cavity, dentures can become poorly fitting over time. Alveolar bone resorption and shrinkage to gingival ridges can cause misalignment to maxilla and mandibular occlusion
leading to weakness in the facial muscles and lack of support, giving the appearance of premature ageing. Medical conditions can cause fluctuations in body weight and bone structure; drugs such as steroids can cause alterations to the
shape of the mouth that can result in fitting difficulties. A dry mouth as a side effect of some medications can also result in a loss of suction to hold dentures in place as well as excessive soreness due to lack of lubrication. In addition, due to metabolic changes, the tissue in the oral cavity of elderly patients can be fragile and react less favourably to the pressure of dentures. These patients frequently experience irritable or sore mouths which are exacerbated by slower healing times.
Many patients experience difficulties with lower dentures that are seated within the moving environment of the lips, cheeks and tongue, which can easily dislodge the denture when speaking or eating. The lower ridge is also much smaller with less surface area to create suction or balance and is prone to excessive shrinking. These factors often cause a lower denture to move in the mouth or trap food underneath as the ridge shrinks.
Loose or poorly fitting dentures can cause discomfort; including sores, infections and irritation within the oral cavity. Furthermore, when dentures are mobile, patients can experience difficulty speaking and problems when eating leading to poor diet and nutrition. A large number of patients use a dental adhesive as an adjunct to retain
and stabilise dentures. Although studies suggest adhesives make a statistically significant improvement during chewing, swallowing and speaking, they can lead to misuse with patients neglecting recommended denture aftercare and not recognising the signs of a poor fit.
Dentures need routine maintenance and repair to ensure that they are effective in terms of oral function and patient confidence. Hard or soft denture relining includes replacing impression material with either a hard acrylic or a soft flexible material to resurface the tissue side of a denture and produce an accurate adaptation to the denture
foundation area. Research suggests that denture relining positively affects patients’ satisfaction, with improved function, chewing ability and comfort as well as better denture hygiene. Regular denture relining is important to ensure that optimum surface area contact is achieved to create maximum hold. Similarly, rebasing dentures is the laboratory process used to replace all the base material of a prosthesis. Relining and rebasing dentures sustains stability and retention, restores any lost occlusion, maintains the maxilla-mandibular relationship and also minimises bone and ridge erosion.
For obvious reasons patients do not want to be without their dentures for long periods of time and although some maintenance can be completed chair side, clinicians need the support of a reliable dental laboratory, for example one like Sparkle Dental Labs.
Denture patients should be reviewed routinely at 12-monthly intervals to enable clinicians to check for any visible wear or chips and evaluate any erosion or natural oral changes. It should also be emphasised to patients that
maintaining an optimal fit is not only crucial to guarantee comfort and function, but also to preserve the structure of the face and overall good health.
References available on request.