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Are Lower Dentures Always A Problem?

While dentures are marginally adequate substitutes for missing natural teeth, the lower denture can be troublesome for many individuals.

Inherent Lower Denture Problems

• A lower denture interfaces with more movable mouth surfaces than an upper denture.
• The lower denture has less stabilizing surface to rest upon. For example, there is no broad palatal surface (roof of the mouth) as in an upper denture.
• Loss of jawbone over time brings a lower denture into closer contact with tissue extensions called frenum attachments, which create dislodging forces.

While these problems are inherent to lower dentures, every person is different and not affected in the same way. There are ways to approach these problems.

Some Considerations for Improving Lower Denture Stability

A thin band-like tissue extension (called a frenum) may attach between a jaw ridge (called an alveolar ridge) and the inside of the cheek. This strip of tissue may become active while eating or speaking and can lift a denture from its alveolar ridge. This frenum attachment may be surgically moved (this is called a frenectomy).

Alveolar ridge bone profile lessens or literally comes closer to the floor of the mouth as jawbone is lost over time. The bone loss is called resorption. This reduces the vestibule or space between the lip and alveolar ridge. Surgical extension of this vestibule (called vestibuloplasty) provides more alveolar ridge exposure for a denture to rest upon and reduces muscle pull due to a high frenum attachment.

As an alveolar ridge loses bone, it often may be built-up by surgically placing various substances beneath the gum tissue to increase both bulk and height of the ridge. This is called alveolar ridge augmentation.

As a person eats and speaks, the lips and cheeks exert forces towards the inside of the mouth while the tongue exerts an outward counter force. There is a space between the tongue and lips and cheeks, called the neutral zone, where there are balanced forces during function. These opposing forces can help maintain a denture in place, with surprising power, if the denture is fabricated so that its bulk and teeth rest within this space.

Inserting metal implants into the jawbone and fabricating a lower denture to receive and connect with these implants in various ways will help stabilize a lower denture, while still allowing for comfortable and easy removal of the prosthesis for cleaning.

Ensuring that upper and lower teeth contact optimally during function (called balanced occlusion) is a basic means of stabilizing a lower denture. If one tooth strikes on one side only, the denture will rock. Even contact or biting is a necessity. Fabrication of a denture that completely avoids contact with all potentially dislodging structures and has a metal base for strength and some weight often will facilitate stability.

What's the Best Approach?

Frequently, several approaches are combined, and not all may be suitable for a particular patient. After a thorough examination, a licensed dentist can best advise an individual as to the best means of helping stabilize a lower denture in their unique situation.

by Joseph J. Massad, D.D.S.

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.

Dry Mouth And The Denture Patient - Xerostomia

Xerostomia (Dry Mouth) and Wearing Dentures

To a great extent, dentures stay in place comfortably and in a stabilized manner by development of an intimate interface between denture surfaces and the soft tissues they rest upon. Presence of adequate amounts of saliva within this denture/tissue interface is essential. Without enough saliva, a denture will inadequately adhere to tissues, partly through loss of suction. In addition, tissues contacting a denture will become chafed and irritated without the lubricating effects of saliva.

Some Common Causes of Dry Mouth

• Medications: There are approximately 500 commonly prescribed medications that have xerostomia as a possible side effect, and this is a frequent cause of dryness.
• Aging: The amount of saliva produced by salivary glands lessens as a person ages.
li>Illnesses: Xerostomia is sometimes associated with certain illnesses or conditions such as chronic diarrhea, liver dysfunction, or Sjogren's syndrome.
• Radiation therapy: Radiotherapy that is used to treat some cancers may have reduced salivary gland function as a side effect.
• Habits: Chronic mouth breathing and inadequate fluid consumption often will cause dry mouth.

Approaches to Managing Dry Mouth

Before managing a persistent dry mouth, it is essential to first become aware of the problem, and then attempt to determine causation for the xerostomia. Sometimes the cause is easily eliminated, but in many instances, that is not possible, and the condition is persistent and often progressive. There are several approaches to managing dry mouth.

• Modify medications: If a certain medication is suspected of causing xerostomia, consultation with a person's physician may make it possible to use a different, but equally effective, drug that no longer causes dry mouth or causes it to a lesser degree. However, there often are not suitable alternatives for a particular person's individual problem. Under no circumstances should someone discontinue or attempt to change a medication without the explicit knowledge and approval of their physician -- to do otherwise may result in serious illness or death.
• Sialagogues: These are substances that stimulate the production of saliva. There are two important types of sialagogues. 1) Gustatory sialagogues such as sugar-free hard candies frequently will cause some increase in salivation, and citrus flavors such as lemon are sometimes more effective than others. While sugar-free, low-sticking gum has been suggested, the process of chewing gum could more easily irritate already poorly lubricated tissues by increasing denture movement. 2) Pharmaceutical sialagogues (called parasympathomimetic agents) sometimes improve salivation and must be prescribed by a person's physician if their health status allows such a consideration.
• Salivary substitutes: Salivary substitutes are commercially available solutions that help keep the mouth moist and more lubricated. These compounds usually must be applied frequently and they generally necessitate having a container of the substance nearby.
li>Water: Water is a salivary substitute and often is used in place of commercial salivary substitutes. Regularly moistening the mouth, and drinking increased amounts of water may both hydrate tissues and facilitate some increase in production of saliva in certain individuals. While increased intake of water is generally healthful, persons with certain medical conditions such as, but not limited to, congestive heart failure should first check with their physicians before significantly increasing their routine consumption of fluids.

Alternative Denture Therapy for Patients Suffering From Dry Mouth

Those patients who are not able to comfortably wear conventional dentures due to severe xerostomia might consider implant-supported dentures. If this course of treatment is pursued, intense oral hygiene practices are necessary to maintain healthy implants and avoid periodontal disease in the presence of reduced salivary production. A person should always consult with their dentist to determine which treatment is best for them.

by Joseph J. Massad, D.D.S.

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.