Ask an Expert is a monthly publication with an expert in the field of dentistry answering questions that patients want answered. This week we interviewed Dr. Wendy Clark, an experienced prosthodontist and faculty member at the University of North Carolina.
What is a prosthodontist?
A prosthodontist is a specialist in restorative dentistry. After dental school we have 3 years of extra training focused on complex dental restorations, aesthetics, implants and TMJ pain. My main focus when I was in private practice was seeing very complex implant cases and full mouth cases. In academics, I work with a lot of removable prosthetics, both implant-supported and not implant-supported.
What is a removable prosthetic?
It could be a denture or a partial denture. Sometimes we create different types of bar overdentures where dentures can snap into place.
Are dentures the only option for people who have lost all their teeth?
For a long time, dentures were the only option. But fortunately, dentistry has advanced in a way that we can provide a much better option. As a matter of fact, the ADA now considers a two-implant overdenture the standard of care for the lower jaw, if a patient doesn’t have any teeth.
So essentially, offering a patient only a complete denture may not even be offering them the standard of care. Some of the other options we have now are snap-in dentures with 2 implants, all the way up to 4-8 or more implants, and a denture that essentially screws into place. Only the dentist can take it out so the patient never has to.
Aren’t dentures less expensive than dental implants?
Correct. However, implants are becoming more and more affordable. A lot of times we encourage patients to look at implants as a long-term investment. Because, over time you will have to change your dentures out anyways, which a lot of people don’t realize and they end up functioning on dentures for several decades that are sometimes causing bone loss and major tissue problems.
So, dentures cause bone loss?
Yes. Most of the bone loss occurs the first year their teeth are extracted. However, if the bone isn’t stimulated by teeth or implants then bone loss does occur over a lifetime and with some patients it is more significant than with others. There are actually studies now that show the way that a denture loads the bone actually expedites that bone loss process. So, if you didn’t wear a denture at all, you would actually experience less bone loss than with wearing a denture.
What is this “snap-in denture” thing and how does it work?
So, the snap-in denture is also referred to as an implant overdenture. And if you have a lower denture, the bone in the front of the jaw is incredibly strong and can support a full denture with just two implants. So, if you already have a newer denture and it is in good shape, you may be able to have two implants placed and your current denture can be converted into a snap-in implant overdenture.
How is an implant overdenture better than a regular denture?
Upper dentures by nature tend to be relatively retentive. The hard and soft palate anatomy is very favorable in creating suction to keep the upper denture retained and in place. The lower denture, on the other hand, is a completely different animal.
Your tongue, your cheeks, and your lips are constantly trying to push the denture out of your mouth. Some people may be comfortable and satisfied with an upper denture, but it takes a very long time to get used to functioning with a lower denture.
A lot of people tell stories about how they are talking, eating, or even yawning, and their lower denture pops right out of their mouth.
By having two implants in the front, the implants will give the denture extra retention and prevent it from slipping out of place.
Do regular dentures prevent you from chewing certain foods?
They certainly can. Getting a set of dentures is a big ordeal and a completely new learning process. You literally have to relearn how to chew with dentures, sometimes they use adhesives. Once they learn the process, many people can tolerate chewing with dentures. But, it is an incredibly challenging going from teeth to dentures.
You said tolerate dentures, does that mean dentures hurt?
They can hurt a lot. Essentially, it is a moving object you are trying to precariously balance on your gums and there is a lot of movement and rubbing, which can irritate the gums and even cause sores. Even a well-made set of dentures will have some movement, especially on the lower jaw.
Are there options for a denture patient who would like teeth that stay in place or permanent replacement teeth?
The field has progressed to a fixed option for replacement teeth. Or something that the dentist attaches to your implants that you do not take in and out. The benefit of this is that it is not going to rub on your gums so you will not have sore spots or tissue irritation.
The implants are placed far enough back that help hold the bone in your jaw for the life of the implants, which we are learning can last a lifetime. They look and feel like teeth because they are not moving around and they do not come in and out.
We know that denture wearers have a loss of chewing ability, do implants help increase chewing ability?
Absolutely! Going from a complete denture to an implant overdenture, greatly increases the chewing power that you have and the types of foods you can eat. Going from an implant overdenture to something fixed increases it even more. So, the more implant support you have and the less motion you have on your prosthetic, the better you are able to function and the more foods you are able to eat.
If you, your mom, your dad or your husband lost their teeth, what would you do or recommend they do?
I have actually had this conversation with some colleagues of mine and my personal choice would be a fixed implant bridge made of zirconia, which is a very strong material made by a quality dental laboratory.
About Dr. Wendy Clark
Dr. Wendy Clark completed her undergraduate training at the University of Georgia in Athens, GA and then earned her doctoral degree from the Marquette University School of Dentistry in Milwaukee, WI. She earned her master’s degree in clinical dentistry and certificate in post-graduate Prosthodontics from the University of Alabama at Birmingham School of Dentistry.
Her professional associations include the American College of Prosthodontists, the American Prosthodontic Society, the American Dental Association, and Delta Sigma Delta International Dental Fraternity. She holds a faculty position at University of Alabama School of Dentistry. In addition to poster presentations at national meetings, she has co-authored articles published in journals including The Journal of Prosthetic Dentistry, The Journal of Prosthodontics, and Compendium. She is an expert speaker on DentalXP and lectures nationally.
Article originally published at yournewteethnow.com.