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Medical Forum / General / Dentistry / September 2006

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When to take the decision about full dentures thoughts and comments over the denture topic

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oldfet@yahoo.com - 08 Sep 2006 13:18 GMT
To let one thing straight: To keep the teeth in good condition is the
best.

Some thoughts and comments regarding the decision of getting full
dentures. I am sure there are many out there with different attitudes
regarding this.
To make this comments valid I have to say that I have full dentures and
got them when I was 26 and have had them for over 30 years with great
success.

Many people come in a situation with bad teeth, gum desease or
accidents. Age is not the topic here for the feelings of having the
teeth removed is greatly the same

To have success with dentures I have learned that a broad palate and
prominent gums is important. If you are fortunate to have this ,
dentures are no tragedy at all. One can eat whatever one like and talk
good and look good.

Then there are some paradoxes:
The dentists wants to keep the teeth and treat them for periodontitis
and other infection and deseases. That is what it should be. but to a
certain point. When is the limit for keeping the teeth. In my opinion
not to let the bone dissapear til there will be nearly no gums to keep
the denture in place and when is that?
The paradoxical is that better the bone is the better the dentures will
fit. There will be resorbtion all life. That will happen whether you
remove the teeth with much bone and little bone. So if the starting
point is with little bone there will soon be great problems so when to
remove the teeth? everybody will hold on to their teeth as long as
possible. But the dentists should really recommend the teeth to be
removed  when the condition for dentures are good and not let the
patient suffer with periodontitis till there is no bone left..

People have heard disaster stories about dentures and some dentists do
the same they tell how low the chewing force is and that they will be
loose and, and....
With a relatively normal mouth and gums dentures are not a disaster at
all if they are made properly. That is not always the case.
I have seen during the years many friends that have had dentures made
where the bite and the dentures are less than acceptable  with far to
much plastic especially in the s-line area of them and for those the
dentures were a disaster.

There is another thing that concerns me and that is the dentist
tendency to recommend so strongly implants. Implants are great, but
they do not inform before that implants require meticulus mouth and
prosthetic hygene and frequent visits to the dentists. The price is
ruining for some people and some are adviced to take up loans for the
treatment. I understand that implants is economical better choice for
the dentists. but if one have a stressed economy dentures is a good
substitute and function well with well designed dentures and is much,
much cheaper.  I have seen lately a couple of cases where people have
chosen implants and are satisfied with that but are nearly bankrupt due
to the tremendous high cost for their income. For some it is a years
salary. When informing them about implants they were told that implants
was the road and dentures were unacceptable. They were not told that
implants can be placed at a later stage for ex. when they had saved up
money.
People are very  vulnerable when approaching dentures .
I hope this can be a bit better. There are many excellent dentists out
there that makes good dentures, but there are also the oposite.
i hope this has created some thoughts and comments are welcome
Steven Bornfeld - 08 Sep 2006 16:23 GMT
> To let one thing straight: To keep the teeth in good condition is the
> best.
[quoted text clipped - 59 lines]
> there that makes good dentures, but there are also the oposite.
>  i hope this has created some thoughts and comments are welcome

    You make some excellent points.  I would like to add a few of my own:
    There are patients who do well with dentures; there are many who do
not.  It is not merely the shape of the gums and the residual bony ridge
(though these are important).  It also depends upon age, neuromuscular
factors, cosmetic factors and others which are to a large extent not
predictable.
    The conundrum of patients with progressive periodontal disease is a
tough one.  You should know that the alveolar bone requires the presence
of roots or implants for its maintenance.  It is true that in
progressive periodontal disease that bone is lost; but if the teeth are
extracted early the bone is lost too.  I have seen no data to support
the contention that bone is retained longer if the teeth are extracted
earlier.
    Implants are not all-or-none; placement of even a couple of fixtures
can sometimes maintain bony ridge while making overdentures possible,
and this can make for best possible long-term result for patients
without going into the truly astronomical fee region.

Steve
ryan - 14 Sep 2006 06:09 GMT
I also wear full dentures and have for more than two years. I had gu
disease which over the years never really responded to treatment.
know smoking didn't help
Fortunately my gums are reasonable promenent so dentures work quie
well for me. I can eat most things
Obvious if you have good teeth you should  keep them. But That's no
what I had
I have to say if I could live my life again I would of had my teet
out when troubles started. That is in my mid to late 30s. I am now i
my mid 50s. Why? Dentures work better than dentists say. I wouldn'
have had so much pain and discomfort. I would of got use to wearin
dentures sooner. My health would of been better. Yet in my experienc
no dentist will remove teeth until the very end. I think many peopl
suffer because of this and also are not explained what well fittin
dentures can be like. Only the bad things like you will have difficult
eating your bite will be weak you get sores and that your gums will g
on shrinking. For alot of people I think dentures are better soone
much sooner than later. If they were explained about them fully mor
would choose them

--
rya
drsethuanand@yahoo.co.in - 14 Sep 2006 10:52 GMT
dear sir, evev though you have said some valid pints regarding the
denture.in a dentist point of you his/her first priority is to save the
natural dentition.if at nothing worked out no otherway we have to go
for dentures.for dentures to be good  the concerned person should have
prominent upper and lower arch

> I also wear full dentures and have for more than two years. I had gum
> disease which over the years never really responded to treatment. I
[quoted text clipped - 21 lines]
> ryan's Profile: http://dentalcom.net/forum/member.php?userid=1267
> View this thread: http://dentalcom.net/forum/showthread.php?t=5017
ryan - 14 Sep 2006 12:17 GMT
I think that you make the point for me. To have promenent ridges th
bone must not have been reduced by gum disease. A view has to be take
by the dentist on how the disease is likely to progress and how i
responds to treatment. If the outlook is poor as it was in my case
teeth should be removed sooner so dentures fit and work better. You
going to get dentures in any event so the decision should be based o
the best outlook for denture wear and not the longest time the teet
can be retained. The dentists first duty is not to save teeth but th
patients overall wellbeing. That might be better with no teeth. I thin
this is forgotten

--
rya
Mark & Steven Bornfeld - 14 Sep 2006 14:16 GMT
> I think that you make the point for me. To have promenent ridges the
> bone must not have been reduced by gum disease. A view has to be taken
[quoted text clipped - 6 lines]
> patients overall wellbeing. That might be better with no teeth. I think
> this is forgotten.

    What we also don't forget is that some patients never do well with
dentures.  This includes those whose anatomy should be pretty good for
wearing them.
    Ten years out from the extractions, the patient whose perio disease was
allowed to progress to a terminal stage may still have somewhat poorer
bony ridges than someone who had the teeth taken out ten years earlier.
 But for these two patients (being followed over 20 years) the patient
who had the teeth extracted earlier in the disease process will have
been wearing dentures 20 years; the one whose perio was allowed to
progress only 10.  Now I'm not so sure how the ridges would compare.
    The other piece of this puzzle is just how long the teeth can be
maintained.  I've seen even patients with advanced perio disease treated
successfully, who have retained their teeth indefinitely.
    You pays your money and you takes your choice.

Steve

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001
ryan - 15 Sep 2006 03:09 GMT
Mark & Steven Bornfeld Wrote:

> What we also don't forget is that some patients never do well wit
> dentures.  This includes those whose anatomy should be pretty good fo
[quoted text clipped - 20 lines]
> Brooklyn, N
> 718-258-5001Steve

I appreciate your comments. Obviously no one knows in advance how you
going to adapt to dentures. That said I would of thought that younge
patients have a much greater chance of adapting well if there health
and there ridges are in reasonable shape

My bone loss from gum disease was widespread and more in some place
than in others so my ridges aren't that even although they have evene
out a bit as they shrink. I would not think that there would be muc
difference between the ridges of a denture wearer of 20 years who neve
had perio disease and one of 10 years who had terminal perio disease. I
fact the 10 year one is likely to be worse I would of thought. Is ther
any research on this

I am not sure that you do pay your money and take your choice. Th
early denture option is seldom offered even if the outcome might b
better. Now I have gone through with it all I know I would have don
better with getting dentures much sooner. It must of been obvious t
the dentist that I was going nowhere slowly with the treatment. All th
options should of been discussed including extractions and denture
before bone loss really started

--
rya
Steven Bornfeld - 15 Sep 2006 03:28 GMT
> I appreciate your comments. Obviously no one knows in advance how your
> going to adapt to dentures. That said I would of thought that younger
[quoted text clipped - 16 lines]
> options should of been discussed including extractions and dentures
> before bone loss really started.

    Of course I have no way of knowing your situation, or how bad your
perio disease was for how long.  I know that if a patient with
progressive perio disease either opts out of treatment or isn't doing
well, I certainly expect to discuss all options with the patient, and
respect the patient's feelings (within the limits of what would be
considered ethical).
    One other consideration that might favor early extractions is if
implant placement is anticipated--you're certainly better off if there's
still bone.  However, patients with severe perio disease are also at
greater risk for peri-implant disease, so everyone must really be aware
of all the risks involved.

Steve
Joel344 - 15 Sep 2006 01:10 GMT
> Then there are some paradoxes:
> The dentists wants to keep the teeth and treat them for periodontitis
> and other infection and deseases. That is what it should be. but to a
> certain point. When is the limit for keeping the teeth. In my opinion
> not to let the bone dissapear til there will be nearly no gums to keep
> the denture in place and when is that?

I always thought it had something to do with insurance ....

--
Joel34
 
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