Dental Care

Although teeth are important to proper speech and to a pleasing smile, chewing food is the main function of a complete and healthy dentition. In the absence of all permanent teeth, a dental professional may be asked to make upper and lower complete dentures. Complete dentures consist of specially manufactured plastic, prosthetic teeth that are processed to high-impact plastic bases. The process of complete denture fabrication consists of five steps. The first two are patient assessment and making impressions or molds of the residual alveolar ridges. These steps result in upper and lower casts of the ridges upon which the complete dentures are constructed. At the third step, the patient's correct occlusion or bite is recorded. Prosthetic teeth are chosen to satisfy the patient's aesthetic and functional needs. At the fourth appointment, the patient previews the complete dentures before the dental laboratory processes the prosthetic teeth to the base. At the final appointment, the patient receives the complete dentures and begins to function with them.

In the process of complete denture fabrication, three areas can be the source of frustration and failure for both the dental professional and the patient. First, the dental professional must communicate effectively with the patient, and vice versa. Promises made by the dental professional may be untrue for a specific patient. Such promises include the following: Patients adapt easily to complete dentures; complete dentures are as functional and efficient as natural teeth; and dentures are comfortable to wear. Likewise, patients whose expectations of complete dentures equal or exceed those of natural teeth need to be educated to the contrary. Second, making the impression is critical. Complete dentures that are constructed on inadequate casts from poor impressions are too small and lack essential features for retention and stability within the mouth. A functionally stable and retentive denture must utilize all available support tissues within the mouth. A shortcut in this step may lead to an unstable, painful denture. Third, a proper occlusion or bite is essential to acceptable functioning and comfortable wearing. When the occlusion is disregarded, complete dentures may create soreness in multiple areas of the mouth. Neglect in any or all of these critical areas results in unhappy denture wearers and frustrated dental professionals.

It is important to note that medically compromised patients who suffer from xerostomia may have difficulty adjusting to and functioning with complete dentures. Saliva is responsible not only for the retention of complete dentures but also, in part, for a comfortable fit. With a substantial lack of saliva, the denture wearer's ability to function comfortably is seriously compromised.

A traditional belief is that wearers of complete dentures alter their food choices because of compromised chewing and, therefore, are not well nourished. The chewing efficiency of complete dentures and their impact on nutrition have been studied extensively. A study of 1,106 individuals of differing ages and with various numbers of natural teeth clearly demonstrated that number of teeth, not age, best explained chewing ability (Carlsson). Refitting old dentures or fabrication of new dentures should improve chewing efficiency for denture wearers; however, none to only slight chewing improvement was found when individuals were evaluated for eighteen months (Carlsson). Another study reported that, compared to those with natural teeth, subjects wearing complete dentures required greater chewing time and more chewing strokes to complete chewing tests (Wayler and Chauncey). In addition, wearers of complete dentures selected food largely on the basis of texture and tactile characteristics, preferring soft, easy-to-chew foods (Wayler and Chauncey). Investigators in a Veterans Administration study concluded that individuals wearing at least one complete denture may have self-imposed dietary restrictions that could compromise nutritional well-being (Chauncey et al.). Functionally, the maximum biting force that complete denture wearers can demonstrate is approximately 33 percent of the force generated with natural teeth (Carlsson). Thus, the traditional belief that denture wearers may have compromised nutrition appears to have been validated by research. The most carefully fabricated complete dentures, made by the most experienced dental professional, and worn by the most adaptable, proficient older adult can never deliver the performance of well-maintained natural dentition.