p2 Total tooth loss (TTL).

Do you want to lose your teeth? Do you care? Does it matter? Surely it would be much cheaper to have them all out and "be done with it" - no more fillings, no more expensive treatment, teeth like the originals, less work looking after them, "my friend had all of his teeth out years ago and he hasn't had a single problem since"?

I've been asked these questions thousands of time? Read this and then perhaps think again.

For the effect of losing just one or two teeth on your mouth, go to the last part of page14.

Disadvantages of TTL if removing teeth was thought to be the easiest way out.

Loss of natural smile

 Loss of personal confidence

 Loss of eating pleasure

Many millions of people have lost their teeth. Some lost them because that was the only treatment offered to them when they had problems: many lost them because to restore them was too expensive; others lost them because of an accident to the head. I have found that about a third of these people manage well without teeth at all or with plastic (acrylic) dentures - I congratulate them on their ability to cope.

Another third of these people manage fairly well: they get on not too bad with dentures when they are at work or in company, but as soon as they are on their own or they reach home, out they come. People tell them they have just 'got to persevere with their new dentures or just 'cope with' the problems' but there are far more problems in successfully wearing dentures than the non-wearer realizes. Non-denture owners in this group find that there is a lot they cannot eat; they get a lot of 'stick' from relatives who love them and would like to see them 'more complete'.

The tragic third are those people who don't have dentures and who find themselves in torment in company because of their appearance and those who do have dentures but who have so many problems with them that they avoid the normal company of other people. They are often friendless or shy, not going out unless necessary, except at night. This is not, for those who have access to good dentistry, because they don't try really hard to use the dentures or because they have have not tried other dentists or even because they have not spent enough money to have the best dentures possible.

It's for lots of complicated reasons but the commonest is that their gum/bone structure/shape simply cannot support a denture. Of course we dentists try all sorts of things to improve the way they are held in place or to make them comfortable - sometimes we succeed where others have failed - sometimes we achieve very little improvement or the improvement is short-lived because the mouth changes all the time. But quite often I look in that mouth and have to say: I'm terribly sorry, but there's nothing that I can do to solve your problem.

I do not know of any reliable method of determining in advance which people will be in the first third or the other two. Two brothers can be in the first group, another brother in the third.

So, for 65% of all people, some disadvantages of dentures replacing natural teeth:

Loss of facial shape. Loss of clarity of speech. Loss of youthful feeling.
Loss of effective eating. Lost - suddenly! Dentures - in bits now.
Lost confidence in sports. Might fall out! Don't laugh loud, You'll lose them! Careful at the BBQ. They burn!

There are many others: the butt of many jokes from stupid, thoughtless or cruel people / social exclusion / being misunderstood / destruction of an important part of our food intake, but, most of all, loss of total participation in the most necessary and exciting activity of all:

enjoyment of eating

all those wonderful foods from all over the world, cooked

in so many wonderful ways - you can't taste half of them

with your wallies in!

You could try a good Scottish Highland malt whisky - you'll taste that!

Full Dentures 

First made about 14 thousand years ago (a bit uncomfortable - whittled out of animal horn, bone or wood - but better to avoid the dreaded TTL).

Modern acrylic appeared in the 1940s. Not much improvement since then, because the biggest problem is loss of supporting bone - no bone height, so nothing to stop the dentures from rattling from side to side during eating or talking - so loose dentures.

Care,Cost and Comfort of dentures in comparison to a full mouth of healthy teeth.

Because the feel of dentures is not as good as that of natural teeth, pieces of food are more likely to be left on them after eating. Some foods, which would not stick to gum, cling to the acrylic base, so more care is needed after each meal. The dentures have to cleaned well each night and morning, with 'em out! All extra work and time.

In many UK practices,an excellent set of dentures would cost £800 - £2000. They should be replaced every 3 years or so. For many people, a specialist denture is the only thing that would allow relatively complete comfort with eating and speaking: I know that the best come in at around £7 - 10K.

Healthy teeth just don't cost as much to run or take as much time to care for!

Comfort of dentures against comfort of natural teeth? They don't even come close!

Partial tooth loss.

If those teeth that were lost were lost through lack of care, most of those remaining would have had some damage. The chances of keeping those remaining are poor. This is because so many of the patient's habits (cleaning, eating, etc) would have to change radically - with fewer teeth that's harder to achieve anyway. It's been tried so often - the habits do change: for a month, three months, perhaps six months. But for the rest of life? It's too much to expect. Ingrained habits of thirty years to change almost overnight? What else would? I've seen it happen a few times - I've seen all the good intentions collapse many more times.

Replacement of missing teeth with fixed structures.

Missing teeth can be replaced by bridges. But this makes looking after the remaining teeth even harder; you still need sufficient sound teeth to make it all work - and it all needs much more care and attention than natural teeth. And there's the cost.

Of course there's implants. But it's if your mouth is suitable, if you can clean, clean, clean them so well, and be careful what you drink; and of course, smoking is out; and only if you've got 20 - 50K for the job. Implants are impressive in what they can do; when they are suitable, they restore personal confidence where nothing else could and they are worth every penny/cent/centime/ lira/peseta. But remember that this is a re-gained confidence - lost when the natural teeth were lost.

 

By far the easiest, cheapest and best way of having long-lasting, structurally viable teeth is to successfully look after those naturally-occurring permanent teeth which most of us have by about 12 years old

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