How to set proper denture expectations

Your patients have hopes about their dentures whether you know what they are or not, and these expectancies can make or break how they feel about the outcome. When you manage your patients’ expectations, you have a much better chance of making - and not breaking - your patient experience. 

Clark Damon, DDS, a private practice dentist in Amarillo and Dallas, TX, metro areas and a lecturer on implants for Nobel Biocare, says many practices don't communicate proper expectations with patients. He likes to lower patient expectations about dentures. 

“I find many dentists don’t do that,” Dr. Damon says. “In their mind, the dentist knows what the limitations are and what the expectations should be, but that’s not conveyed to the patient at consultation.” 

Taylor Manalili, DDS, is a prosthodontist at Glidewell Laboratories, where she's working on a postdoctoral fellowship. She agrees that many doctors do not adequately inform patients about what to expect with dentures, and then patients feel disappointed with the process and the outcome.

“A big mistake that people make, especially with new denture patients, is not informing them of what’s coming down the line,” Dr. Manalili says. 

So, how do you set appropriate expectations for your edentulous patients? Here’s what our experts had to say.

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Choose your words carefully

When it comes to talking about dentures, the words you use matter a lot. It would be best if you told your patients what dentures are and what they aren’t. It's also crucial to convey the pros and cons of them.

For a patient who's going to go into a denture for the first time, the downside to a denture is lack of function and the fact they are not real teeth, Dr. Damon says. However, he also tells his patients the benefits of going into a denture.

“It’s the most economical full-arch solution,” Dr. Damon explains. “For a patient that has teeth we cannot save, we can insert the denture immediately. Once the teeth are out, they go right in. And the third main big advantage of a denture is excellent esthetics.”

Dr. Damon is also careful to clarify for his patients that dentures are not teeth, they are a prosthesis. The word prosthesis indicates an essential distinction for his patients.

“I use that word prosthesis because it gives a mental image of somebody who has a prosthetic leg or a limb, and when we picture something like that, we automatically assume there will be challenges getting used to using it,” Dr. Damon explains. “Everybody knows if you have a new prosthetic leg, you will have changes to your daily life. But so many times patients think that a denture is teeth, which is not the case.” 

Dr. Damon tells his patients that now they will be wearing their teeth, which means there will be certain things you can and can’t do. Often, his patients have not thought of it that way. 

Dr. Manalili agrees, reinforcing how the term prosthesis is particularly critical with removable appliances. 

"It's important to remember that your new denture will not feel or function the same way that your natural teeth did," Dr. Manalili explains. "I will go over the major differences when I talk with my patients. I emphasize that they will be receiving a removable prosthesis; that their teeth will come out. The prosthesis is going to move no matter what we do. I tell them that since there is something new in their mouth, they might temporarily salivate more. Because their palate will be covered, they'r enot going to taste food the same way they used to. They may also need time to learn how to speak with their new prosthetic."

Dr. Manalili also talks about the appearance. For patients who have been edentulous for a while, she says the appearance discussion is helpful because many experienced denture patients don’t realize that they have an opportunity to alter their smile with a new prosthesis. If there's something that the patient doesn't like about his or her current smile, dentists have the opportunity to try to correct that with the new denture. However, for new denture patients, this conversation can take a different turn.

"Some patients feel when they lose their teeth, they are losing a part of themselves. It can be a very emotional time. I try to be as honest as a I can with me patients, and I tell them that nothing I say can fully prepare you for your new smile. I feel the more I can mentally prepare my patients for the challenges ahead, the easier the transition is," Dr. Manalili says.

Dr. Manalili also gives patients a chance to participate in some of the decisions. She finds when patients take a little ownership of the esthetic decisions, it can sometimes help manage the expectations-setting effort.

“When I'm selecting teeth, I'll ask the patient to show me photographs of their old smile," Dr. Manalili explains. "I like to engage the patient discussing the shape and size of their natural smile and what they liked and didn't like about it."

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Take your time(line)

Dr. Manalili always begins by explaining the timeline with new and existing edentulous patients. It can be a longer process than what she has with other prostheses she makes for patients. 

“I always discuss the timeline and tell them that it's going to take a while,” Dr. Manalili says. “I like to discuss the timeline upfront with my patients. I inform them that dentures take several appointments to fabricate. Once the prosthesis is made, it is very important to acknowledge that there is an adjustment period. Everyone's timeline is different. It helps to keep an open mind and be prepared for the worst."

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Dr. Damon agrees that many patients do not have a realistic idea about how long it takes to accustom to new dentures, even when they have had them before. Sometimes they have changed the denture teeth position or tried to show more of the teeth in the new denture. Even without significant changes, the denture teeth are still new.

“Many times, patients have ground their bite in over time as the denture teeth have worn out,” Dr. Damon explains. “When we have a brand-new set of denture teeth, it’s going to take patients a couple of months to relearn or readjust to their new teeth.” 

In addition, Dr. Damon says that many denture patients do not replace or reline their dentures when they should. The recommendation for replacing dentures varies between five to 10 years. Dr. Damon says they need a reline at about the third year. However, not everyone does that.

“If you have that patient who's trying to push it out to 10 or 15 years, they don't want to give their denture up; however, once that denture is worn, or once they've popped off a number of the teeth, they know it is time for a new one,” Dr. Damon says. “Then, they come to find me.”

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Give them food for thought

Helping patients understand what is and isn't on the menu is another crucial consideration for doctors. Many patients believe that their teeth are going to function just as well as their natural teeth. 

“Many patients think that they can go home and have a nice steak dinner right off the bat. That's definitely not the case,” Dr. Manalili says. “I'll tell my patients to start with a soft food diet and work their way up, with the knowledcge that some patients may never be able to eat that steak dinner."

Dr. Damon tells his patients there are things they can’t do. They can't eat anything by hand, like biting into an apple or eating a carrot the way they used to eat it. First-time denture patients don’t know that about their prosthesis. 

“If I were going to eat a carrot, I would probably eat it with my front teeth. If you do that with a denture, it’s going to rock down in the back,” Dr. Damon explains. “If you eat on the right side only, the denture is going to teeter totter and plop down on the left side because there's nothing that holds this in.”

Furthermore, anytime the denture pops up, food can get under it. Common culprits are poppy or strawberry seeds. 

Dr. Damon compares the feeling of having food under your denture to having a rock in your shoe. When that happens, he tells patients they should excuse themselves from the table and rinse out their mouths and the prosthesis to prevent sores. 

“The other thing about expectations is patients can no longer order what they want at the restaurant. They have to order what they can eat,” Dr. Damon says. “It’s very different, and patients have to be ready for it. As I said, dentists should lower expectations.”

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Reading is fundamental

In addition to eating, speaking is another area that can be difficult for the edentulous patient. What is worse is they don’t expect it. A study in the Journal of Dentistryin 2004 of 214 edentulous patients revealed that they all had high expectations for ease of chewing, speech, and good appearance.

Struggling to talk is one of the most common reasons patients do not wear their dentures. Dr. Manalili recommends they practice wearing and speaking with it as often as possible. 

“I'll tell them, ‘Go home and pick up a book, an article or a magazine that you like to read and start reading it out loud to yourself.’ It will help them get used to wearing it, speaking with it, and keeping it in place,” she says. "If they continue to have speech issues, it could be that the contours of the denture base may need to be adjusted."

Break dentures in and keep them well-adjusted

New dentures and the adjustment period can be frustrating for patients. When a patient is having a hard time getting used to a denture, Dr. Manalili compares it to breaking in a pair of shoes: the more you wear them, the more comfortable they get. She says that can be tricky for patients that have dentures and are getting a replacement prosthesis.

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“Because nothing beats the comfort of an old shoe,” Dr. Manalili says. 

She recognizes that new dentures are difficult for everybody. However, putting in the work upfront will help to speed up the process.

“It’s hard for many people to adjust to new dentures, but the more they are able to wear the prosthesis, the more their muscles will adapt to helping maintin the denture in a functional position. With time and practice, it can become second nature," Dr.Manalili says.

Dr. Damon says most providers do Immediate Dentures for new denture patients. Immediate Dentures allow the patients to heal for four to six months after the extractions before they come back to do. Dr. Damon says Immediate Denture patients should expect multiple adjustments during the healing phase, and a soft-liner replacement once a month. In his practice, Dr. Damon uses COE-SOFT™ (GC America) as the soft-liner material.

“As the tissue settles and shrinks, then the denture base is going to ride lower and the flanges of the denture are going to impinge on the muscle attachments, and those can cause tissue sores and discomfort. It needs to be adjusted,” Dr. Damon explains. “It’s an adjustment game for a couple of months after the teeth are out and the denture is in.

“It’s very common to have two or three adjustments with a brand-new denture," Dr. Damon adds. "The tissue has to adapt to the new denture, and it has to be adjusted in."

Dr. Damon also has to remind his experienced edentulous patients that their current denture needed adjustments, too. Typically, he says, they forget. Also, Dr. Damon says that it can take a couple of months to relearn the denture or accustom to the new teeth, especially when changes to position or esthetics are involved.

“The patients have to get used to the teeth being in different position. Maybe they bite their lips or cheek for a couple of months after a new denture,” Dr. Damon says.

Dr. Manalili says you have to explain that the try-in is close to the actual fit.

“I think some practitioners make a mistake by informing the patient that the record base try-in will be close to the actual fit. Sometimes this is the case, and with the digital era this is becoming more of a reality. However, with traditional dentures, besides the tooth position, I do not like to compare the fit of the try-in to the definitive prosthesis,” she says.

Patients bring expectations with them when they come to your operatory for dentures. These ideas can be outstanding or outlandish, depending on the patient and how much education you have engaged in with them. 

“The ultimate success of the case is going to rest in the patient's ability to accommodate to the denture. The denture is not going to work for them. They have to work for the denture,” Dr. Damon says.

“Part of our patient management is not only what goes on in the chair but what happens when the patient leaves the office," Dr. Manalili says. "The more we can prepare our patient’s for life with a denture, the more likely they will be able to accept the prosthesis. Many will need reinforcement, therefore I find myself reiterating some of these key points throughout the process. Dentures can be a life changing experience for some of our patients. My hope is that the change is a positive one, so the more prepared I can make my patient’s the most satisfied I find they are. “

References:

Smith, P.W., and J. F. McCord. (2004) “What do patients expect from complete dentures?” Journal of Dentistry 32(1), 3-7. From web. www.sciencedirect.com 28 January 2019. https://www.sciencedirect.com/science/article/pii/S0300571203001143?via%3Dihub