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George
Washington's Wooden Teeth by
Dr. Pietrini
Contrary to popular belief, George Washington
never wore wooden teeth. He did have several sets
of teeth made from various materials, such as
human teeth, elephants ivory, hippopotamus tusk
and gold. Throughout his life, he was plagued
with dental problems, which may account for his
reputation of having a short temper.
While
the number of Americans who have lost all of their
teeth has decreased by sixty percent in the last
forty years, there are still millions of people
who wear dentures. A significant number of these
people have had false teeth for more than fifty
years. As the patient ages, health problems can
make it increasingly difficult for them to successfully
wear their dentures. Certain medical conditions
and medications can cause xerostomia (dry mouth).
Saliva is necessary to lubricate the oral tissues
and to moisten the food to allow proper chewing
and swallowing.
There
are three types of complete (full) dentures-immediate,
conventional and overdentures. Immediate dentures
are the most common and advantageous way for initial
placement of false teeth. The dentist takes impressions
and makes measurements of the mouth before the
remaining teeth are extracted. The models of the
patients jaw are prepared to estimate what the
jaw and ridges will look like after healing has
occurred. The denture is constructed and inserted
immediately after the remaining teeth have been
removed, so the patient does not have to be without
teeth while the mouth is healing. Because the
gums and underlining bone will continue to shrink
for three to six months, it is often necessary
to adjust the teeth when sore spots develop and
to reline the dentures a few weeks after they
have been placed.
Conventional
dentures are made to replace old false teeth or
when patients are willing to have all their teeth
removed and then wait for several weeks for healing
to occur. More accurate impressions of the healed
ridges can be obtained and precise measurements
and custom fitting of the teeth is possible.
An overdenture
is a removable appliance designed to fit over
implants or some of the patient's own natural
teeth. Special attachments are placed in the denture
that snap on to the implant or properly prepared
teeth to help hold the denture in place.
Today,
most dentures are made of a high quality acrylic
(plastic). The teeth can be either porcelain or
acrylic. It is usually best to use acrylic teeth.
Even though they will wear a little faster than
the porcelain type, acrylic teeth are easier to
adjust and will not cause the ridges to shrink
as quickly.
Initially,
it may take some time to adjust to new dentures.
I refer to the process as "dental gymnastics".
It takes time and a lot of practice to learn how
to feel comfortable speaking and chewing food
with your new teeth. When dentures are fitted
properly, patients should adapt rather quickly.
After the dentures have been placed, it is advisable
to have periodic examinations to check for sore
spots and other oral lesions.
A Partial Solution
by
Dr. Pietrini
Our lives are often
filled with compromises. Temporary repairs to a
house or car might be necessary before a permanent
solution is practical or affordable. When patients
have one or more teeth missing, it is advisable to
replace them with bridgework or dental implants to
prevent the teeth from shifting. Long-term, the
changing position of your teeth can increase your
chances of developing periodontal (gum) disease,
decay or problems with your bite. Depending on the
health of the remaining teeth or the costs related
to replacement of the teeth, utilizing implants or
permanently, fixed-bridgework may not be the best
option. Generally, removable partial dentures are
a less costly alternative.
Besides cost, there
are several reasons why these appliances are more
practical:
·
The
remaining teeth are periodontally compromised, so
a partial can be used as a temporary measure to
postpone the need for a complete denture
·
There
are not enough teeth capable of supporting a
fixed-bridge or the patient is not a good
candidate for implants
·
When
younger patients have lost teeth due to decay or
accidents, a partial referred to as a “flipper”
can be made until they are old enough for a
permanent replacement
·
They
can be used as a temporary replacement, while
waiting for healing prior to placing an implant or
fixed-bridge
Your dentist will
take one or more impressions of your upper and
lower jaws. Models will be made, along with a
measurement of how the jaws fit together. A color
guide will be used to select the shade of teeth
that matches your remaining teeth. Usually, the
models and bite registration are sent to a dental
laboratory for construction. Most partial dentures
are made of a durable acrylic (plastic) material
with metal clasps (hooks) that attach to the
teeth. Typically, a custom-made, metal skeleton
(framework) is used to fit against the teeth and
gums. The replacement teeth and the “gum-shaded”
acrylic are molded to the framework. Often, a “wax
try-in” is done prior to completion of the
partial. This allows your dentist to check the
bite and to give you the opportunity to check the
shape, color and appearance of the teeth.
In next month’s
article, I will discuss other designs of partial
dentures and give you tips on the use and
maintenance of appliances.
A More Complete
Solution by
Dr. Pietrini
Last month, I discussed some
of the reasons why removable, partial dentures may
be the best choice of treatment for some patients.
There are several factors that will need to be
analyzed before you and your dentist can determine
what type of partial will be best for you—price,
esthetics, the number and location of the missing
teeth, periodontal health and whether the
appliance is intended to be a long-term or
short-term solution.
While it is intended that
most partials be used for the long-term, there are
several different options in design, function and
types of materials used in their construction.
Several variations of the traditional removable
appliance, which is a combination of metal clasps
(hooks) that fasten to the teeth and are embedded
into an acrylic base, are available. When
esthetics is a concern, a precision, partial
denture may be utilized. To avoid the unsightly
appearance of clasps on the front teeth, precision
attachments can be placed. One part of the
attachment is embedded in the base of the partial,
while the other component is cast as part of a
crown or bridge. These attachments snap together
to hold the partial in place and are hidden under
the base of the partial to improve cosmetics.
Another variation of these appliances is partials
or full dentures, which snap into dental implants
or root canal treated teeth with precision
attachments. These devices are referred to as
over-dentures. The drawback to these appliances is
they are more complicated to construct and are
more costly.
Sometimes, patients require a
temporary solution for replacing teeth, because:
- Injury or disease can
result in the loss of one or more of the front
teeth necessitating a quick replacement, which
allows time to determine what will be the best
long-term solution
- The patient has several
teeth missing and eventually will need
additional extractions making it possible to add
teeth to the partial at a later date
- When one or more back
teeth are to be replaced with implants or
fixed-bridgework, a partial can be made with a
flexible material avoiding unsightly clasps
Patients frequently ask
whether removable partials can result in early
loss of additional teeth. Some studies have shown
that over a ten-year period nearly half of the
teeth that have partials attached to them will be
lost. This problem can be minimized with good care
and maintenance of the teeth and the appliance. It
is necessary to thoroughly brush and floss all of
your teeth, especially those that are used for
attachments. A partial and/or complete denture
must be brushed using toothpaste or a mild soap to
remove plaque from all surfaces. Also, soaking
appliances in denture cleansers or placing them in
ultrasonic cleaners can be useful. Never place
them in boiling water or in bleach. See your
dentist for regular check-ups to help maintain the
health of your teeth and to insure that your
partial fits properly.
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