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Everything about denture pain. How to relieve dentures pain?
Denture Pain.
Anyone that has worn dentures is probably aware of the pain that they can cause. Most commonly, pain occurs in the first stages of denture wear, with the gum tissue of the mouth still sensitive from tooth removal, although discomfort and pain throughout denture use is common. Whatever pain dentures may bring the wearer, however, there are many available options to relieve the pain, aid in the healing of the mouth, and help prevent future pain. Even in later stages of denture-wearing, there are treatment options available to help relieve the pain and provide normal mouth function. Understanding how dentures work in the mouth and how personal behavior influences comfort or pain can greatly aid in understanding how best to treat denture pain.
The part of the mouth that often causes denture-wearers the greatest discomfort is the mucosa. The mucosa is the membrane lining the mouth and gums that help protect the mouth from irritants and helps the mouth absorb materials introduced orally. It is this membrane that is most easily irritated by dentures, and oral procedures such as tooth extraction are hard on the membranes of the mouth. It is this mucosa that really takes on the immediate stress of the dentures.
It is to this surface that the dentures adhere in the mouth. The mucosa covers the gums, with the dentures requiring so much suction to make a good hold. In the process, a mouth new to dentures can be unprepared for the surface contact, and the mucosa can take damage, be worn away, or be irritated, allowing pain to develop. The mucosa is the most prominent area of the mouth to take damage from dentures. Damage can be subtle, sometimes not even apparent, although injured tissue can lead to swelling, sensitivity, and sores, which can make denture wear excruciating.
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More about dentures:
Dentures are prosthetic devices constructed to replace missing teeth, and which are supported by surrounding soft and hard tissues of the oral cavity. Conventional dentures are removable, however there are many different denture designs, some which rely on bonding or clasping onto teeth or dental implants. There are two main categories of dentures, depending on whether they are used to replace missing teeth on the mandibular arch or the maxillary arch.
Patients can become entirely edentulous (without teeth) due to many reasons, the most prevalent being removal because of dental disease typically relating to oral flora control, i.e. periodontal disease and tooth decay. Other reasons include tooth developmental defects caused by severe malnutrition, genetic defects such as Dentinogenesis imperfecta, trauma, or drug use.
Advantages
Dentures can help patients in a number of ways:
1. Mastication – chewing ability is improved by replacing edentulous areas with denture teeth.
2. Aesthetics – the presence of teeth provide a natural facial appearance, and wearing a denture to replace missing teeth provides support for the lips and cheeks and corrects the collapsed appearance that occurs after losing teeth.
3. Phonetics – by replacing missing teeth, especially the anteriors, patients are better able to speak by improving pronunciation of those words containing sibilants or fricatives.
4. Self-Esteem – Patients feel better about themselves.
Types of dentures
Removable partial dentures
Removable partial dentures are for patients who are missing some of their teeth on a particular arch. Fixed partial dentures, also known as “crown and bridge”, are made from crowns that are fitted on the remaining teeth to act as abutments and pontics made from materials to resemble the missing teeth. Fixed bridges are more expensive than removable appliances but are more stable.
Complete dentures
Conversely, complete dentures or full dentures are worn by patients who are missing all of the teeth in a single arch (i.e. the maxillary (upper) or mandibular (lower) arch).
Prosthodontic principles of dentures
Support
Support is the principle that describes how well the underlying mucosa (oral tissues, including gums and the vestibules) keeps the denture from moving vertically towards the arch in question, and thus being excessively depressed and moving deeper into the arch. For the mandibular arch, this function is provided by the gingiva (gums) and the buccal shelf (region extending laterally (beside) from the posterior (back) ridges), whereas in the maxillary arch, the palate joins in to help support the denture. The larger the denture flanges (part of the denture that extends into the vestibule), the better the support. This last sentence requires comment and correction, it reveals some misunderstanding by the author as flanges usually provide stability and not support. Indeed, long flanges beyond the functional depth of the sulcus are a common error in denture construction, often (but not always) leading to movement in function.
Stability.
Stability is the principle that describes how well the denture base is prevented from moving in the horizontal plane, and thus from sliding side to side or front and back. The more the denture base (pink material) runs in smooth and continuous contact with the edentulous ridge (the hill upon which the teeth used to reside, but now consists of only residual alveolar bone with overlying mucosa), the better the stability. Of course, the higher and broader the ridge, the better the stability will be, but this is usually just a result of patient anatomy, barring surgical intervention (bone grafts, etc.).
Retention.
Retention is the principle that describes how well the denture is prevented from moving vertically in the opposite direction of insertion. The better the topographical mimicry of the intaglio (interior) surface of the denture base to the surface of the underlying mucosa, the better the retention will be (in removable partial dentures, the clasps are a major provider of retention), as surface tension, suction and just plain old friction will aid in keeping the denture base from breaking intimate contact with the mucosal surface. It is important to note that the most critical element in the retentive design of a full maxillary denture is a complete and total border seal (complete peripheral seal) in order to achieve ‘suction’. The border seal is composed of the edges of the anterior and lateral aspects AND the posterior palatal seal. The posterior palatal seal design is accomplished by covering the entire hard palate and extending not beyond the soft palate and ending 1–2 mm from the vibrating line.
As mentioned above, implant technology can vastly improve the patient’s denture-wearing experience by increasing stability and saving his or her bone from wearing away. Implant can also help with the retention factor. Instead of merely placing the implants to serve as blocking mechanism against the denture pushing on the alveolar bone, small retentive appliances can be attached to the implants that can then snap into a modified denture base to allow for tremendously increased retention. Options available include a metal hader bar or precision balls attachments, among other things.
Complications and recommendations.
The fabrication of a set of complete dentures is a challenge for any dentist, including those who are experienced. There are many axioms in the production of dentures that must be understood; ignorance of one axiom can lead to failure of the denture case. In the vast majority of cases, complete dentures should be comfortable soon after insertion, although almost always at least two adjustment visits will be necessary to remove sore spots. One of the most critical aspects of dentures is that the impression of the denture must be perfectly made and used with perfect technique to make a model of the patient’s edentulous (toothless) gums. The dentist must use a process called border molding to ensure that the denture flanges are properly extended. An array of problems may occur if the final impression of the denture is not made properly. It takes considerable patience and experience for a dentist to know how to make a denture, and for this reason it may be in the patient’s best interest to seek a specialist, either a prosthodontist or perhaps even a denturist, to make the denture. A general dentist may do a good job, but only if he or she is meticulous and usually he or she must be experienced.
The maxillary denture (the top denture) is usually relatively straightforward to manufacture so that it is stable without slippage.
A lower full denture should or must be supported by 2-4 implants placed in the lower jaw for support. A lower denture supported by 2-4 implants is a far superior product than a lower denture without implants, because
1) It is much more difficult to get adequate suction on the lower jaw.
2) The functioning of the tongue tends to break that suction, and
3) Without teeth the ridge tends to resorb and provides the denture less and less stability over time. It is routine to be able to bite into an apple or corn-on-the-cob with a lower denture anchored by implants. Without implants, it is quite difficult or even impossible to do so.
Some patients who believe they have “bad teeth” may think it is in their best interests to have all their teeth extracted and full dentures placed. However, statistics show that the majority of patients who actually receive this treatment wind up regretting they did so. This is because full dentures have only 10% of the chewing power of natural teeth, and it is difficult to get them fitted satisfactorily, particularly in the mandibular arch. Even if a patient retains one tooth, that will contribute to the denture’s stability. However, retention of just one or two teeth in the upper jaw does not contribute much to the overall stability of a denture, since a full upper denture tends to be very stable, in contrast to a full lower denture. It is thus advised that patients keep their natural teeth as long as possible, especially their lower teeth.
Source: www.wikipedia.com
References
- The inventions that changed the world, Reader’s Digest (1982) [Portuguese edition of 1983]
- Moriyama N, Hasegawa M. The history of the characteristic Japanese wooden denture. , Bull Hist Dent. 1987 Apr;35(1):9-16.
- John Woodforde, The Strange Story of False Teeth, London: Routledge & Kegan Paul, 1968
- S. E. Eden, W. J. S. Kerr and J. Brown, “A clinical trial of light cure acrylic resin for orthodontic use,” Journal of Orthodontics, Vol. 29, No. 1, 51-55, March 2002
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Denture Reline
After a new denture has been inserted, it ought to retain in the mouth quite nicely due to the fact that the shape of the inside of the denture base conforms closely to the shape of the gums. (Please note that good retention or suction of the denture does not necessarily mean that the same denture is stable.) Unfortunately, the longer you wear the denture, the more your gums change underneath it and the looser it gets. In order to restore the retentive qualities of the denture, and to prevent the production of flabby gum tissue under it, you should have the denture professionally relined at least every two years.
There are actually three types of denture relines: hard, soft and temporary.
Hard denture reline
This is the kind of reline that should be done on all full dentures every two years. The dentist removes some of the plastic from the inside of the denture and fills the denture with a soft material (think of soft putty) which, when replaced in the mouth, conforms to the contours of the tissues, then hardens to a rubbery consistency. When the denture is removed, the denture now contains an accurate impression of the shape of the gums. The denture is sent to the lab, and the impression material is replaced with pink, hard acrylic in exactly the same shape as the original impression material. When returned, the denture now conforms to the contours of your mouth and should make maximum contact with the tissues producing maximum suction. In our office, the impression is scheduled for first thing in the morning. The patient goes home without the denture, but returns later the same day (usually early afternoon) for the insert (fitting appointment).
Soft denture reline
Occasionally, a patient finds that he cannot wear the denture because his gums are too tender, and he keeps getting sore spots. In cases where the patient is unable to wear ordinary dentures because of tender gums, the denture can be relined with a material that remains somewhat pliable for a year or two before it needs replacement. The consistency of this material can range from waxy to hard rubber, and is generally less likely to give the patient sore spots than ordinary pink acrylic.
Unfortunately, by the time that a patient resorts to a soft reline material to make the denture wearable, it usually means that factors other than simple sore spots are partly to blame for the difficulties that the patient is experiencing wearing the dentures. These could include an overbuilt denture or a resorbed ridge which is so unstable that the patient must keep constant force on the teeth to keep them in place. Both of these conditions can be corrected, sometimes with less expensive simple surgery or sometimes with much more expensive implant retained dentures.
Temporary denture relines (Therapeutic relines)
Frequently, by the time a patient with an old denture finally shows up at the dentist’s office looking for a new denture, the dentures have not been serviced for such a long time that the gums are in terrible condition. They may be red, swollen and quite misshapen. Relining the old denture, or building a new one using impressions taken while the gums are in such poor condition would lead to a denture that would simply perpetuate the problem with the new appliance.
When faced with situations like this, a dentist will frequently resort to a temporary, or palliative (medicated) reline material to allow the inflammation to subside. This reline makes the denture fit much more tightly, and is usually soft and pliable. It will not last more than a few months, but the patient wears it for a few weeks until the gums return to a more normal state. After this happens, then the patient is ready for his new denture or hard reline.
Denture Pain
Wearing dentures can be a pain. That uncomfortable feeling you get from having a foreign object of your mouth is due to a variety of complex factors. The most important thing to realize, though, is that some soreness will occur from wearing dentures, while steady pain is an indication that something is wrong.
Denture pain is something of a mystery to dentists. Some patients exhibit no obvious signs of tissue damage but experience sharp pain, while other patients have no idea that their gums have become seriously damaged. That’s why you should be checked regularly by your dentist at least twice per year.
There are three main causes of denture pain.
The first cause is due to a bad fit. An improperly fitted denture could be the result of poor workmanship or the underlying bone anatomy of your jaw. Either way, the problem results from having soft gum tissue sandwiched by a hard jawbone and the hard denture base. If one portion of your tissue handles more pressure than the other points of the tissue, it can have a snowball effect. The tissue gets damaged and becomes even more sensitive and susceptible to further damage. Common symptoms of a bad fit are soreness, bleeding, and open wounds in the gums.
The second cause of denture pain is acute pressure. This comes when patients move their mouths and contact the teeth. Chewing is the most common cause of acute pressure. Hard foods are the worst for this. Patients can still experience abnormal forces on the gums under normal talking conditions or any other activity requiring jaw movement.
A third cause can simply be attributed to changing tissue conditions with age and disease. Your gums naturally lose their resilience with age and shrink. This is a common cause for denture misfit that can be fixed with a new set of dentures. The process never really stops though, so a regular schedule of checkups is the only way to avoid this.
There are a variety of topical anesthetics available to help alleviate sharp pains in the mouth from wearing dentures. They typically work for hours and can be reapplied if necessary. However, recurring pain is an indication that something is wrong. Most soreness should only be present the first few weeks after receiving a new set of dentures.
If you have constant oral pain from wearing dentures, consult your dentist immediately for a diagnosis.
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