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Missing teeth can have negative effects on your ability to chew, your ability to speak clearly, and your appearance. It can also contribute to changes in your nutrition, obesity, diabetes, heart disease, and even some forms of cancer.¹ When many (or all) teeth are missing in your lower or upper arch, dentures are typically the most cost-effective solution to restore your teeth to their most natural state possible and help address these negative effects.

While dentures are often thought of as a full replacement of all the teeth in your upper or lower arch, the term denture actually refers to a variety of appliances. A denture that serves to replace the function of all of your teeth in your upper or lower arch is called a complete denture. A denture that serves to replace the function of a few consecutive teeth, or multiple teeth in different areas of your upper or lower arch when some of your natural teeth remain, is called a partial denture. This article covers complete dentures.

There are several types of traditional complete dentures:

• Conventional denture: A conventional denture is placed in your mouth after any remaining teeth are removed, and your gum tissues have healed. The healing process will take several weeks, and you will be without teeth for that time. Although the gum tissues will generally heal in four to six weeks, complete healing of the underlying bone often takes far longer.
• Immediate denture: Immediate dentures are made in advance. They are placed on the same day that any of your remaining teeth, which are often visible front teeth, are removed. They are a useful, temporary solution to allow you to eat and maintain your appearance until your gums have properly healed and your conventional dentures are made. They can be relined or rebased for a period of time to allow you and your dentist to develop a treatment strategy for your long-term needs. While immediate dentures may be worn for five to seven months, most people become anxious to have their permanent dentures in place prior to that. In some cases, immediate dentures can function for longer periods, even years, without having to be replaced. Even so, there is no opportunity to evaluate the appearance or function of immediate dentures prior to the removal of your remaining natural teeth. Because of this, the longer-term success of immediate dentures is unpredictable.
• Interim denture: An interim denture (also called a provisional or temporary denture) is a temporary appliance to help you maintain normal chewing and facial features until your gums are healed and your conventional denture or other prosthesis is ready to be placed. An interim denture differs from an immediate denture in two ways. Interim dentures are not typically recommended when the remaining teeth need to be removed, and they are not intended to be adjusted or repaired. They are typically made as a convenience if you are missing some teeth and want a complete set of teeth before other more permanent options are completed.
• Overdenture: If some of your remaining natural teeth can be prepared to help support the denture (or if implants can be placed), your dentist may recommend an overdenture. The use of existing teeth or implants to support a denture will reduce the pressure on your gums and jawbones. This provides a better fit and helps reduce gum pain and bone loss.

What are dentures made of?

Dentures generally consist of "the teeth" and "the base" to which the teeth are attached. Each part can be made of various materials. Most commonly, denture teeth and denture bases are made of acrylic resin plastic, but each part can be made of various other materials. There is also a type of denture made of zirconium dioxide (zirconia) that is one solid piece consisting of both the teeth and the base. Your dentist will help you make the best choice of materials based on your specific needs.

In a standard complete denture:

• The teeth are typically made from porcelain or acrylic resin.
  • Porcelain teeth are typically more durable and last longer than acrylic resin teeth. They also feel similar to natural teeth and can be closely colored-matched to any remaining natural teeth. They can break if they hit a hard surface, and their hardness may more quickly wear natural teeth that they bite against.
  • Acrylic resin teeth adhere more securely to the denture base and are easier to adjust than porcelain teeth. They are also lighter in weight and less expensive to create than porcelain. However, since they are not as hard as porcelain, they tend to wear faster, which can change how they contact other teeth. They may need to be replaced more often.² Because they may wear more quickly if functioning against natural teeth, those natural teeth can begin to move from the jaw, which changes the shape of the dental arch. The jawbone beneath the denture can also resorb significantly, creating a challenging condition to treat called 'combination syndrome.' The base can be made from acrylic resin or a flexible nylon polymer that is color-matched to resemble your natural gums.
• The base can be made from acrylic resin or a flexible nylon polymer that is color-matched to resemble your natural gums. Dentures that are snapped or permanently fixed onto implants may also contain a metal frame (usually titanium, cobalt-chrome, or a nickel-chrome alloy) that provides the anchor points for the denture.
• Dentures can also be made with round metal housings lined with plastic attachment fittings that snap onto custom implant attachments. These are less costly than dentures with cast metal frames and work just as well.
• Zirconia dentures are made of a single piece including both the teeth and base. The gum line, along with the angle and color of the teeth, can be adjusted to suit your preference. When rigidly attached to dental implants, they tend to allow less food to accumulate underneath them and are stronger and more durable than any other type of denture. While they are more expensive to make, they may save you money over time since they require less maintenance. Usually these types of dentures are most appropriate for people that have not lost a significant amount of tooth-supporting bone to resorption and for those who don't require as much lip support from their denture.

How dentures stay in place

Dentures are either removable or fixed (non-removable).

Removable: Most traditional complete dentures are removable. They are held in place with a combination of suction (between the denture and the gums or roof of the mouth) and muscle forces that must be learned by the new denture wearer. Denture adhesives should be used sparingly and avoided if possible. These adhesives can change the position of the dentures in the mouth, affecting the bite relationship between the upper and lower teeth. Upper dentures are constructed to cover the roof of your mouth. They are normally held in place through suction. Removable dentures are shaped to allow muscles of the lips and cheeks to help hold them in place when those muscles contract.

If you have natural teeth that can be properly prepared, or have two to six specially-designed implants inserted into your tooth roots, overdentures can snap onto the teeth or implants that support them to provide extra support. Overdentures can also be removed for cleaning, maintenance and repair. Removable dentures are often the most cost-effective tooth replacement option.

Fixed: Fixed complete dentures may be recommended if you have implants placed to anchor the denture. Unlike overdentures, which you can remove, fixed dentures attach to implants with screws. They can only be removed by a dentist. Fixed dentures tend to be more compact than removable dentures. They often do not extend down the sides of the gums or onto the palate like removable dentures and overdentures. Like overdentures, they can be significantly more comfortable than traditional removable dentures since they are rigidly attached and do not rub against your mouth and gums. With fixed complete dentures and overdentures, it is not necessary to learn new muscle contraction patterns with the tongue and lips to hold them in place.

While most denture treatment — preparation, placement, and maintenance — can be done by a general dentist, in some cases you may be referred to a specialist (prosthodontist). You and your dentist should discuss your specific situation and desired outcome before developing a treatment strategy.

The time and cost will obviously be greater if you require other treatment (such as tooth removal or implants) prior to denture placement. If you do require additional treatment, your dentist will not begin the process of constructing and placing your conventional denture until you fully heal. The typical healing time for gums is about 8 to 12 weeks. This generally provides enough time for the underlying bone to fill in and start to mature.

Before the procedure

You and your dentist will discuss your specific situation and desired outcome before developing a treatment strategy.

• Your dentist will assess your health history and current health status. Be sure to tell your dentist if you are allergic to any specific types of metals or plastics.
• Existing dental conditions such as tooth decay, periodontal disease, grinding or clenching, and the quantity and density of your remaining jaw bone will also be considered.

• Your dentist may take X-ray images to determine whether a removable partial denture or fixed bridge is your best option for replacing a missing tooth or teeth. For example, your dentist may want to determine if the abutment teeth are sound enough to support the prosthesis or if additional treatment may be needed.
• If you plan on using an immediate or interim denture, your dentist will create a cast of your arch to build these temporary dentures. You can wear these until you are ready to have your complete dentures constructed and placed. You should expect multiple visits to have them adjusted before you begin treatment for your final placement.
• If you require crowns, implants, or other surgical procedures to prepare your dental arches for dentures, a local anesthetic may be used.

During the procedures

Once you and your dentist develop a treatment strategy and complete necessary preparations to your existing teeth, the general steps to build and place your dentures are:

• Make a series of impressions of your gums and jaws, and take measurements of how your jaws relate to one another.
• Create models, wax forms, and/or plastic patterns in the exact shape and position of the denture to be made. Typically, four appointments are needed to progress from preliminary impressions to a wax version of the denture (where the actual denture teeth are set in wax so adjustments can be made before the final dentures are produced). The wax denture will be assessed for color, shape, and fit before the final denture is cast.
• The final denture will then be created in a lab.
• Your dentist will place the complete denture in your mouth and make any necessary adjustments.

After the final procedure

Additional appointments are generally needed after your denture is placed so that if sore spots develop, the fit can be checked and adjusted. If any problems persist, be sure to consult your dentist.

• Your dentist will instruct you how long to wear your dentures and when to remove them. During the first few days after receiving your denture, you may be asked to wear them all the time, including while you sleep. While this may be uncomfortable, it is the quickest way to identify areas that need adjustment.
• At this point, you will likely be instructed to remove your dentures before going to bed. This allows your gum tissues to rest. It will also enable your tongue and saliva to stimulate and clean your gum tissue.
• New dentures may feel awkward for a few weeks until you become accustomed to them. As you become used to your dentures, these problems should subside.
  • The dentures may feel loose while the muscles of your lips, cheek, and tongue learn to keep them in place.
  • It is not unusual to experience minor irritation or soreness. You may find that saliva flow temporarily increases.
  • Dentures may initially affect your sense of taste since they cover surfaces that help you perceive taste, and they change the way your tongue manages chewing. This effect is generally temporary.
  • Eating with new dentures may be uncomfortable for a few weeks. To get used to your new denture, start with soft foods cut into small pieces. Chew slowly using both sides of your mouth. As you get used to your new dentures, add other foods until you return to a normal diet. Be particularly cautious with hot, hard, or sticky foods, including candy and gum.

Additional considerations

Cleaning removable dentures

• Dentures should be cleaned daily by soaking and brushing with an effective, nonabrasive denture cleanser to reduce levels of biofilm, bacteria, and fungi.

• When they are not in use, place your denture in water or a denture cleanser solution to help ensure your denture retains its shape, remains pliable, and keeps from drying out.
• Dentures should never be placed in hot or boiling water. This can cause them to warp. Never place your dentures in an oven or microwave. The heat will damage or destroy them.
• Hydrogen peroxide, chlorine bleach, baking soda, or vinegar have been found to be useful to remove stains. Floss or interdental brushes can also help to remove stains between the denture teeth. Be sure to rinse your dentures thoroughly before placing them into your mouth.

Cleaning fixed dentures

• You can clean the gums under complete dentures with a water flosser or interdental brush. Floss threaders and floss with a rigid end are also useful.
• It is safe to use a soft toothbrush and regular toothpaste to clean the fixed denture, implants, and gums unless they are made from plastic/acrylic. These types of fixed denture materials are more likely to wear down with ongoing use of regular toothpaste and soft toothbrushes. You can also rinse your fixed dentures thoroughly with mouthwash or salt water.

Dental adhesives

• To prevent removable dentures from slipping or moving around, you can generally stabilize them to some degree with a denture adhesive. This may be particularly effective if you have lost significant bone from the dental ridges. Well-made, properly fitted dentures shouldn't require adhesives. While adhesives may provide some stability, they often don't effectively hold dentures in place.
• Adhesives come in many forms, including creams or gels, liquids, powders, pads, or strips. If you use one of these products, use them exactly as directed. Your dentist can recommend appropriate adhesives for your specific needs. They can also help if you experience temporary or permanent dry mouth. Be careful not to use excessive amounts of denture adhesive, as it may alter the fit of your dentures and how your teeth bite together. This may also contribute to accelerated bone loss.
• You should not use adhesives to 'fix' poor fitting dentures. This can lead to gum sores and even bone damage. If your dentures fit poorly or have been damaged, contact your dentist to have your dentures adjusted, relined, or replaced.

Maintenance and repairs

• Your gum tissue and jawbones will change over time. This will lead to changes in how your dentures fit. In addition, your dentures will wear out. You should visit your dentist routinely so they can ensure your dentures are functioning properly. They can make adjustments to your dentures before you have discomfort or problems. Of course, if you are experiencing discomfort or problems, contact your dentist immediately.

• Common denture repairs include a denture reline, denture rebase, or replacement. You should visit your dentist to have your dentures examined if you have any of the following issues:
  • Ongoing inflammation beneath the denture base.
  • Adhesive is needed to keep your denture in place when you eat.
  • Your dentures will not remain in place by themselves.
  • Adhesive must be used more than once daily.
  • You will not, or cannot, wear your dentures.
  • Your denture has degraded so significantly that it is no longer stable in your mouth.
  • Your denture does not align properly with your other teeth.
  • The denture is discolored, cracked, broken, or missing.
  • There is a change in the teeth or implants supporting an overdenture.
  • It has been more than 5 years since your denture was first built.

• Your dentures will rest on your gum tissue, which can lead to tissue loss and/or bone resorption. This can cause them to fit poorly, leading to sores and irritation of the gums. Dentures supported by natural teeth or implants (overdentures) can help reduce this risk.
• Adjustments and repairs will be required throughout the lifetime of your denture. If you don't visit your dentist regularly for exams, cleanings, and denture maintenance, you risk needing a full denture replacement prematurely.
• Traditional dentures may cause some nerve pain in the jaw, particularly if you have lost significant bone from their lower dental arch.
• There are risks and considerations associated with the treatment required to prepare your mouth for dentures, such as tooth removal and dental implants.
• While removable dentures are less expensive than fixed dentures, they are typically less functional and require a greater level of maintenance.
• While fixed dentures generally provide a better fit and are more durable than removable dentures, the cost of dental implants required to support the denture can significantly increase the time and cost associated with treatment.
• Denture adhesives are not a remedy for ill-fitting dentures, which may need to be relined, rebased, or replaced to prevent sores from developing.
• Some people have allergic reactions to ingredients in certain denture adhesives. If you experience any abnormal symptoms you think are related to your adhesive, stop using it immediately and consult your dentist.

When you are missing most or all of your teeth, dental implants are usually your only alternative to conventional dentures or an overdenture. In some cases, implants can be used to support a series of fixed bridges which can eliminate the need for complete dentures. Keep in mind that not everyone is a good candidate for implants, and there are significant cost implications associated with them.

Delaying the replacement of missing teeth with dentures can lead to many physical and social issues, including:

• Poor oral hygiene.
• Problems with your jaw joints.
• Bone resorption or bone loss.
• Soft tissue trauma that may require additional treatment such as aveoloplasty or other jaw bone procedures.
• Accumulation of bacteria that may cause periodontal disease.
• Gastrointestinal or nutritional problems resulting from an inability to chew food properly or avoiding food altogether.
• Poor nutrition resulting from avoiding certain foods.
• Shifting teeth.
• Misaligned teeth.
• Bite collapse.
• A decline in your speech, self-esteem, and quality of life.

• What type of denture will serve me the best?
• What treatments will I need before I can get my dentures?
• Are temporary dentures an option?
• Am I a candidate for implants? What would that entail?
• How many visits will I need to complete this process?
• What is the best way to take care of my dentures and my gums?
• If I need to use an adhesive, what do you recommend? How do you use it?