Dentures!

March 18, 2006 5:37 PM

Help me go to the dentist prepared so that I can reasonably say "I want my remaining teeth and root tips extracted and I want full dentures"

Poverty, fear, genetics (more below), and seven years of braces courtesy of NYU Dental School when I was a kid have left me with superiourly poor teeth. Half of my teeth are root tips, the other half are mostly intact but rotting teeth.

Both my mother and maternal grandmother have been blessed with poor teeth as well. My grandmother had dentures when she was in her 30s, and when my mother was in her 30s she lost most of her teeth, too. I'm 34.

I don't work, but care for said maternal grandmother, who has severe alzheimers, have no health insurance, and live in NYC. I will have my mother foot most of this bill (mostly out of spite relating to my home care duties, but that's a whole other story;). I will attempt to find an area doctor who will give me the care that I want in a timely manner, and I would like to know as much information from any personal experiences my fellow mefi's can provide.

1. Root Tip Extractions. I've had some extractions before since I was a wee kid, so I'm fine with that. Full teeth. I've never had any root tip extractions. As I understand it, the gum is cut so that the dentist can easily access the remainder of the tooth, and if necessary, they'll break the root into chunks to extract them more easier.

a. Is this true, or am I incorrect?
b. How painful is this proceedure when compared to a regular extraction?
c. Is the heal time any different?
d. Are sutures involved? If so, how uncomfortable are they and how does it affect gumming eating?
e. How much does a root tip extraction cost? Do they price it as they do root canals, per tip? I've 15 root tips that need to be excised.
f. Anything else that I should know about, be concerned about, and the like?

2. Full Teeth Extractions. As mentioned above, the rest of my teeth are in various stages of decay, although these teeth would not require an oral surgeon, a regular dentist can yank them out.

a. Is it advisable to get full teeth extractions at the same time as root tip extractions?
b. Would it be better to go area-by-area (ie. upper left, lower left, front, etc.) full teeth extraction, or get them all in one shot? What about with full teeth and root tip?
c. Have you had an experiences having both done at the same time?

3. Dentures. I've thought about this for several years now, and because I'm not a Rockerfeller, I'd like to get dentures over implants.

a. After my teeth are out, how long do I have to wait, in general, before I can get dentures? Do they give some sort of temporary set while I'm waiting to heal?
b. What kinds of food are advisable for denture wearers? Please tell me I'll be able to eat Subway sandwiches again. I've not had a sandwich in years, and there's nothing more that I'd want to eat more than a nice sandwich.
c. Minus the pain, would you say that it's akin to getting used to braces, or a night brace, or even a retainer?
d. Is it true that you don't have to brush your teeth with dentures? I know they have them bubbly stuff, do I have to use that?
e. Are dentures really expensive?

4. It's pretty obvious that I really do want the removal of all of my teeth and that I simply want dentures. I'm really afraid that I'll meet some resistance due to my agefrom any dentist that I come across, and this really bothers me. Do I, as the patient, have the right to dictate my own treatment? Short of leaving the practice, what if my dentist is resistant, how do I go about insisting that my course is the only course of treatment I want? I'm just simply tired of the "we can save this" bullshit because I've spent years being told that a tooth can be saved to no avail.

Anything else you'd like to share?

And yes, I'll also bring items 1-3 to the table with me when I do find a dentist and oral surgeon, but I really want to go in with some sort of third-party "this is what I experienced" information so that I can feel more comfortable and more confident when talking to my doctor.

posted by missed to health & fitness (15 comments total)

I can't comment on the first three questions. But what I can tell you, in regard to #4, is this: there is such an emphasis on cosmetic dentistry these days you are sure to find a dentist/surgeon who will do the work you want. Be prepared, though, that the price for the work will probably be high, be payable only in cash and the work may need to be done in several sessions. Also, if you have any existing medical conditions, especially diabetes or anything else that would interfere with healing, you may not hear the answer you want, from any dentist/surgeon. You will also have to stop smoking if you smoke. This is not akin to getting a cavity filled, as you know--this will be surgery with all of the risks associated with it. Also, a tip, please get recommendations from friends/colleagues/whomever to get a good clinician for this job. Lots and lots of people have had this type of work done and everyone has a story to tell. Don't go through with it if you don't 100% trust the clinician. Good luck. This type of procedure can drastically affect one's self-esteem and perception and there is nothing wrong with getting what you want.
posted by FergieBelle at 5:53 PM on March 18, 2006

Both my parents had all their teeth out in their 50's, and got dentures, mostly at my mother's insistence. I think they thought this would be an improvement in their lives, and were disappointed to learn by hard experience that dentures are fairly fragile, and generally require regular maintenance, such as relining. As they grew older, they ceased wanting to go for regular dental exams, and pretty much quit wearing dentures on a regular basis. At the ends of their lives, neither of them had a set of dentures suitable for wear, despite my frequent offers to take them to the dentist, pay for new dentures, etc.

Because they basically gave up on wearing dentures, but had no teeth, their diets became pretty lackluster and bland, lacking textured foods, and containing little fruit and vegetables, except for the overcooked potatoes, beans and fruit pie fillings they liked. My father eventually developed chronic intestinal problems, and while I can't say these were due to his diet and denture problems, I don't believe his problems would have been as severe had he been able to eat a more normal diet and chew his food properly, and I heard his GI specialist say as much on one office visit I took my dad for, a year or so before he died.

Your desires for dentures may, in fact, improve your life, and I am not commenting to attempt to change your mind about your own health decisions. But do recognize that wearing dentures is bound to be an adaptation, and an ongoing and regular personal maintenance issue, and budget your time, money and resolve accordingly.
posted by paulsc at 6:18 PM on March 18, 2006

Dentures will decrease the quality of your life dramatically. Take care of the teeth you have.
posted by evariste at 7:28 PM on March 18, 2006

Why do we call the second and last set of teeth permanent, given the prevailing frame of reference toward them? If, like most people, you still think of your permanent teeth as something you'll have from age 12 until about age 35, when it's time to trade them in for dentures...that's not really all that permanent, is it? The truth is that teeth are genuinely meant to last beyond a lifetime. In the absence of disease, these small marvels of natural health are virtually indestructible: They are, in every sense of the word, permanent. Oral health maintenance during the early adult years continues to be an extension of what was learned during the formative years. At least once daily (bedtime) brushing, taping and rinsing each and every tooth surface remains the primary element of hygiene maintenance.

Another incredibly damaging misconception is that dentures are an acceptable replacement for natural teeth. False teeth are one of the most lucrative tricks in the dentist's bag, but they are dangerous to your health. More about this in another chapter; for now, however: Dentures can cost you up to ten years right off the top of an otherwise normal lifetime. Aside from cosmetic problems and a host of mental problems; aside from the inconvenience and expense and actual decrease of longevity, dentures will rob you of physical health and vitality for the balance of you life. People think of dentures as "not bad." They should think of dentures as poison.

(snip)

You have nothing to lose if we're wrong. We'll "give" you an extra ten years on your life-span if we're right. Would you like that repeated? Okay: If we're right, and you modify your oral health behavior, you might very well live an additional ten years beyond what you otherwise would have. How's that for incentive? Is that based on some sort of statistic? No, it isn't: It's a personal observation; but one we think most people can trust. Doctor Charles Mayo, founder of the famous Mayo Clinic in Rochester, Minnesota, observed that all other things being equal, denture wearers could look forward to the loss of about ten years from their lifetime.

From the books "Money By The Mouthful" and "How To Become Dentally Self-Sufficient", both by Robert O Nara.
posted by evariste at 7:36 PM on March 18, 2006

Sorry I can't answer your other questions, but my grandmother had dentures for decades, and she was able to eat sandwiches just fine. She could even chew gum (just the special kind for dentures). Her nutrition was also fine. As far as I could tell, she did clean her dentures every day, so there is maintenance.
posted by Airhen at 7:55 PM on March 18, 2006

I work for a Prosthodontist, a dentist whose specialty is prosthetic devices, dentures mostly. We see you at least once a week, someone weighing the decision between getting heroic and saving their natural teeth or letting them go and getting dentures. I can't speak to your particular case, whether you have anything savagable/usable. Although you as the patient do have the say in what treatment you consent to, if the dentist feels that he can't in good conscience remove teeth he believes you better off keeping, he does have the right to refuse treatment. From your description, that doesn't seem likely.

As my boss likes to say, on a scale of 0 - 10, full set of functional natural teeth being a 10 and having no teeth being a 0, dentures get you back to a 1 or a 2. They just don't have the function of natural teeth.

Now with that in mind, there are thousands(millions?) of people with dentures and they work well for most of them. Upper dentures rely on closing the seal against your palate and stay up with suction. Lower dentures merely rest on the lower bony ridge, such as it is. Adhesives can help, but are a pain to clean off your gums and denture.

If you have any lower teeth in good enough shape to restore/keep, a lower partial denture retained by those teeth, will give more stability and function.

There are many general dentists that can make a servicable denture, you don't have to go to a specialist, but finding that person may be more difficult. Also, the expense will be much lower with a general dentist.

Temporary dentures can be made, mostly to give you something to smile with while you heal. We almost never make lower ones, they are very difficult to use for the patient. Post-surgery, your bones/ridge take roughly a year until a complete healing is done, where you can no longer tell where the teeth used to be. We start making permanent dentures about 4 weeks after surgery, knowing with the changes as healing progresses, we will need to refit the denture a few times in that year, until a permanent rebase is placed.

As for the surgery, usually all the top ones are removed in one visit and then the bottoms (or vice versa) although sometimes all of them can be done in one time... it's just a hell of a lot to go through in one appointment. I can't speak to the fee structure, that depends on the office.

Since we are a specialty, our fees are higher than a general, we are $2750.00 per arch, $5500.00 for a set. That's only for the permanent, we also charge for the temporary one $500.00. This is a major deal for you, both financially and heathwise, get your information together along with the payment plan agreed upon beforehand. If you are seeing one dentist who can do the surgery and deliver the denture, great, but you may be dealing with a couple of offices with different policies.

As for cleaning the denture, you need to scrub off the accumulated debris daily, plaque and stains can build up on them. You don't have to use anything expensive, regular toothpaste or handsoap is fine(as long as you rinse it well) If you do get a lower partial denture, your hygiene on those remaining teeth needs to be stepped up, food and plaque can sit on those teeth under your denture and rot them.

If you do get them all removed, plan on a couple of days of discomfort(what we like to call pain) If you don't have to drive, and aren't in recovery for an addiction, you will have some nice codiene, take it, don't be a hero, you need your rest to heal. Although ibuprofen at higher doses for a few days won't be harmful and works well for dental pain.

You will be eating liquids for a few days and work up to soft soups and such, you can try for yourself what you can bear. I've had patients *scare* me with what they say they can eat less than a week post-op. What is important is to get your nutrition somehow, Ensure drinks are great for this.

If you do get a full set, upper and lower and find that you just struggle with the lower fit, you may want to consider dental implants, which can be done years down the road if your financial situation changes. In my office, we can use the denture that was already made and make it snap into two placed implant posts, so tightly that the patient needs two hands to get it out.

Good luck to you, you may be in for a struggle at first, but you will get to the otherside and be glad of it.
posted by Jazz Hands at 7:59 PM on March 18, 2006 [1 favorite has favorites]

I didn't stress enough, DO save what can be saved! Especially lower teeth, you can buy a few more years of better function, it is worth it!
posted by Jazz Hands at 8:03 PM on March 18, 2006

Oh good god, I am going to so scrub my teeth tonight! What a nightmare description.

missed, you have my deepest sympathies. What a horrible decision to have to make. I hope you find a better solution than full dentures.
posted by five fresh fish at 8:55 PM on March 18, 2006

(I can't add anything to the most excellent advice from Jazz Hands, I just wanted to say that I am SO glad that you're doing this Missed. As soon as I read your post, and saw your username, I thought I knew who you were, and the url in your profile confirmed it. Other than the teeth trauma and your grandma, I hope life is treating you well. )

Signed,

Your old planetgov coworker, Lisa.
posted by ereshkigal45 at 11:47 PM on March 18, 2006

I have an implant. It cost a total of about $2000 between the surgery and the crown. I love it, it feels just like my tooth. At least get a price quote on implants first. From
1-10, my implant is a 10.
posted by gearspring at 12:03 AM on March 19, 2006

Implants are indeed amazing. We have done a few full mouth implant/crown cases, yes, it is even better than having your own natural teeth! No decay, no toothaches, no root canals!

With the number of teeth Missed is talking about, her(his?) case could run upwards of $50,000. Implant retained dentures would run an additional (in my office) $3,000-$4,000 for "parts and service". Using the existing dentures, so you don't have to remake and get rebilled for them. And can be done at anytime in her/his lifetime. We have done cases for people in their 80s.

I forgot to also add, at 34, expect to remake your denture as it wears out, you may need 3 or 4 more in your lifetime. Some people have grinding and clenching habits that wear through the plastic quickly, others get 30 years out of them.

And even if you have no teeth, see the dentist once a year for an oral check-up. Dentists not only check out the condition of your teeth but also of the oral cavity, from the lips to the throat. We look for any suspicious lesions. Oral cancers don't get the spotlight much, but they are a very serious matter. My boss is also affiliated with our local hospital chain's oncology department. We monitor patient's oral health while they are in treatment for head and neck cancers. So get everything that looks weird checked out!
posted by Jazz Hands at 5:25 AM on March 19, 2006

Funny you should ask about Root Tip Extractions.

I went to the dentist last week to get a new cap placed on a tooth that previously had a root canal and a cap. Once he got in there, it turned out the root was cracked and the tooth was not able to be saved. I ended up getting the root extracted.

It was the single-most painful experience I have ever had at the dentist. Granted, he said that it was the second-hardest tooth he ever extracted, but still...

It sucked. I hated the experience and hope I never have to go through it again.

The only thing good that resulted from it was a prescription for Vicodin.
posted by punkrockrat at 6:39 AM on March 19, 2006

I've been going through some of this with my partner who has advanced periodontal disease [genetic, la la la] at age 30. He has good teeth, bad gums and though we are not Rockefellers, the good teeth part of it means we're working on what can be saved/managed. This addresses your question indirectly, missed, but I wanted to add to JazzHands great doctor-sided perspective a patient-sided one.

First off, our dentist RULES though we have both had terrible dentists in the past. Don't settle for talking your dentist into something he/she doesn't want, find a dentist who will work with you on the treatment you want. Obviously, you should take a dentist's profesional opinion into account, but at the end of the day you need to settle on upkeep and maintenance [both finanacial and otherwise] of what you decide on. Sometimes I think it's hard for dentists to get their heads around people willing to forego decades of future painful dentistry and settle for bad eating. I think people here have given compelling reasons for considering the denture angle again but at the end of the day it's your life.

Secondly, payment. The implant process that my partner is going through is expensive. His folks are helping him out with it. We also have signed up with a program called CreditCare which essentially is a loan-type credit card where you pay for dental bills and you have a year or 18 months to pay off the bill, making regular payments, interest free. After that, interest rates skyrocket, but for people like us who have the money but would prefer to pay over time, it's been a godsend to help us manage big bills.

As far as extractions go, he's had a few back molar extractions that turned into situations where the tooth had to be broken up and extracted by the roots. This was unpleasant, but his experience was not like punkrocket, it wasn't painful it was just gross and took forever. He had stitches that stayed in place for a week or two (soft foods only for that time) and then because of the extra work he was getting done, trying to grow back some bone to do implants, he has to chew on the other side of his mouth for a few months. He was swollen, sore and unhappy for about 2-3 days (with some serious painkillers, then back down to ibuprofen) and then just sore and grouchy the rest of the week. This was getting two root extraction-type removals right next to each other in the back of his mouth. I'm pretty sure this type of work was billed by the tooth, not by the root like they do root canals.

Hope this is helpful. My feeling is that no matter what you wind up doing, moving forward to get the problem dealt with in whatever way you see fit is a better approach than just letting the situation worsen. Good luck.
posted by jessamyn at 11:30 AM on March 19, 2006

It's been my understanding that if even a couple of the teeth can be saved, a partial plate can sometimes be fitted which uses them as anchors, and this is apparently much better than the full plate which has to be glued on daily and still slides around somewhat.
posted by ikkyu2 at 11:55 AM on March 19, 2006

We do implant retained dentures in our office.
You have a complicated case, I am not a dentist. Go see several.

Have a full set of xrays taken, insist on taking the duplicates with you on the same day. There are so many things that can effect a patient's recommended course of treatment...infection, bone loss, history of substance abuse, so be honest with all of the dentists that you see.
If you have any kind of bone loss on the upper or lower ridge, that will change the fit of your denture over time or even make it difficult to get a good fit now. Severe bone loss can impeded implant placement, so better to do it now, if in any way possibe, than to wait.

In dentistry we say that people do not buy things they need, they buy things they want. If you truly want a full set of dentures, no amount of persuasion that you would be better served by another treatment will convince you. You will go to a dentist that is willing to prepare ill fitting dentures and then reline them constantly (and at no small charge) until they break from poor alignment. But get those opinions, find out what all of your options are. You may find out that your desire for a healthy smile and the ability to eat comfortably trumps the concerns of time and money.
posted by bilabial at 2:54 PM on March 19, 2006