July 1999
Dear Dr. Mady: I have finally come to terms with the fact that I am going to need all my teeth taken out or however many are left. My main concern is that I work every day and am in the public eye so I can't go without teeth for any length of time. Is there some way that I can get teeth quickly so that I won't have to take a month off of work? - Jimmy in Tecumseh
Dear Jimmy: There is no reason that you should be without teeth while you are waiting for your gums to heal from extractions, that is assuming that your teeth are ready to come out. What you have to request from your dentist, or see if you are a candidate for is IMMEDIATE DENTURES. Immediate refers to the fact that your new dentures that will replace your natural teeth will be inserted into your mouth immediately following your extractions.Immediate dentures are fabricated prior to the removal of your remaining teeth and as previously stated they are delivered right after. They may be either a single complete denture or both upper and lower complete dentures. Immediate dentures may also be made as partial dentures that will only replace certain teeth to be extracted.
If both upper and lower are needed it is advisable to have them fabricated at the same time to assure that cosmetic or bite irregularities in the natural teeth will not interfere with tooth positioning in the new immediate prosthesis.
Immediate dentures are not for everybody who needs teeth replaced. The dentulous (with all teeth) or partially edentulous patient (one with some natural teeth already missing) whose remaining teeth must be extracted is the prime candidate for immediate denture service. In the past fifteen years there has been a considerable decrease in the number of individuals requiring immediate complete dentures. Nevertheless, people in such a predicament should be spared the humiliation of going without teeth while tissues heal so that they can later be fitted for dentures.
Benefits of this treatment option are numerous and I will describe a few to you. The splinting action of these appears to reduce a considerable amount of pain and swelling after oral surgery and the gums tend to heal directly to the shape of the dentures. Appearance is affected almost immediately mainly because cheek and lip support is maintained and the tongue does not spread out and become lazy due to the loss of contact with the teeth. Also the patient is spared the inconvenience of months of inability to chew food and the inevitable digestive and nutritional compromise involved.
When constructing immediate dentures your dentist has a better ability to mimic as close as possible the natural tooth position in your jaws and therefore making adaptation simpler, especially in the upper front teeth.
Although this all sounds like a piece of cake, in reality it is a long process that is going to also take mental and physical patience on your part. As soon as you receive your new dentures you are not going to be able to go out the next day and eat anything you want. You will have to train yourself to chew beginning with soft foods and small pieces and gradually work your way up to normal everyday meals. You may never be able to eat ribs, apples or corn on the cob but a few patients have been known to.
Speech may be altered during the first few weeks after surgery but when the oral muscles adapt, things will begin to sound normal again. Taste may also be temporarily affected.
Usually your dentist will provide you with thorough written instructions on what to do, what not to do and what to expect. Also, three months of adjustments and soft liners are usually included to make up for the remodeling that takes place in the jaw bone during healing. As your jaws heal the bone will shrink mostly for about the first six months. During this time your dentist will line your dentures with a temporary soft liner or tissue conditioner to tighten them back up and make them more comfortable. After the healing is done your dentures will require a processed reline service which involves placing an entire new acrylic inside to your dentures allowing them to fit the size and shape of your jaws at that point and time. This can usually be done within one day by your dentist and his commercial dental laboratory.
Most patients seem to adapt readily to immediate dentures. The most important thing is for you as the patient to be informed and mentally prepared prior to treatment with a strong positive notion that the procedure will really benefit you. If you do not know in your own mind that you can adapt and get used to your new prostheses then you never will.
This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5
