Dentures need to be checked every 10 years so they do not affect speech or eating
‘NO! JUST pull it out! People won’t see that one, it’s at the back. If I could have taken it out myself, I would have!”
We all know only too well, a little toothache goes a long way.
While extraction can often be the immediate (and pain-relieving) answer, it’s helpful to consider what tooth loss may mean for the future.
Patients tend to think of their teeth in isolation. One tooth’s removal is seen as no particular loss. Let’s face it, we have 32 teeth. What harm can there be in losing one?
However, a closer look at the make up of the mouth will yield a very different picture.
The average patient over the age of 25 has at least two fillings and is missing at least one tooth. The tooth that’s missing is a molar tooth, usually a first molar. How can Dr Sherlock Holmes BDS know all this?
Our oldest permanent tooth is the first molar. It arrives in our mouths when we are six years old. It grinds and chews for us, as part of the molar team. It is exposed to the most wear and tear.
It is, therefore, the most likely to be restored and also the most likely to be extracted.
When that tooth’s fate is to be decided, many patients will echo the line above: “It won’t be seen! Take it out!”
This is absolutely true. In its absence, however, the neighbouring “team members” and opposing teeth have to work harder to provide the same level of chewing function.
They themselves often have been restored and, with this greater workload, tend to deteriorate faster. This can lead to another extraction, until we find ourselves on the slippery slope to that dreaded word: dentures.
Dentures are often seen as the poor relation of the prosthetic world, but for the elderly (and the not so elderly) they are a vital prosthetic, not just for how they look, but also for speech and diet.
Like many of my colleagues, I have provided a dental service for denture patients not just in surgery but also in nursing homes, monasteries, convents and day care centres.
The story is usually the same. Patients will have had serial extractions over the years leading to a partial or complete denture.
Also patients who wear dentures, unlike those who wear glasses, have no spare set. This can lead to significant problems if dentures are mislaid, lost or thrown out.
Dental textbooks all suggest that dentures need to be updated, usually every seven to 10 years. Typically in Ireland, however, this doesn’t happen.
In fact, a set of dentures may present to a dentist some 30-40 years after they were fitted. I have frequently seen dentures that are older than I am.
Imagine if you will a jacket that was specifically made for you at say, 27 years of age. Would you still wear it at 67? Not only will your body shape have changed, but also the jacket will have seen 40 years of service.
Yet the most common tale from denture patients is just that. Our face and mouths change shape significantly as we get older.
Photographs show this all too clearly. These facial changes, without the requisite upgrade, lead to ill-fitting dentures and dietary problems.
Patients are disinclined to eat tougher food stuffs. This can have an effect on nutrition and wellbeing. They are also more likely to have oral disease such as angular cheilitis ( infection at the corners of the mouth).
While these problems are easily remedied in isolation, the ageing patient often presents with other medical problems. The patient’s medical condition can influence dental health and provision of dental treatment. A simple example is that some medication causes dry mouth, which for denture wearers is a problem.
Dentures, far from being an afterthought of patient care, should be front and centre for general wellbeing.
This is particularly evident in patients who suffer from motor or neurological diseases, where muscle control is an issue.
The muscles around the face are highly defined. Think about how we laugh, cry, scowl and grin. As we get older, our muscle tone diminishes. The patient’s ability, therefore, to retain a denture is severely compromised.
So, when that troublesome tooth’s destiny is being decided and removal may prove a definitive solution, it’s the gap years that follow that may well cause problems.
Dr Paul O’Dwyer is a dental surgeon