It is often possible to receive dentures even with a history of periodontal disease. While the presence of gum disease complicates the process, proper treatment and preparation of the oral environment can allow for successful denture placement. Addressing the underlying disease is a necessary first step to ensure the longevity and stability of any prosthetic solution.
Understanding Periodontal Disease
Periodontal disease, commonly known as gum disease, is an inflammatory condition affecting the tissues supporting the teeth. It begins with plaque, a sticky film of bacteria. If plaque is not removed through daily brushing and flossing, it hardens into tartar, which irritates the gums.
The initial stage, gingivitis, involves inflammation, redness, and swelling of the gums, which may bleed easily during brushing or flossing. If gingivitis remains untreated, it can advance to periodontitis, a more severe form where the inflammation spreads below the gumline. This progression leads to the breakdown of the tissues and bone that hold teeth in place, forming deep pockets between the teeth and gums that harbor more bacteria.
As periodontitis progresses, it causes irreversible damage, including gum recession and bone loss around the teeth. This bone destruction can lead to teeth becoming loose or even falling out.
How Periodontal Disease Affects Denture Eligibility
Periodontal disease significantly impacts eligibility for dentures because a healthy foundation of gums and bone is essential for denture stability and comfort. Active infection and inflammation compromise the oral tissues, making them unsuitable for supporting a prosthetic device. Untreated disease means bacteria can continue to damage remaining bone and gum tissue, even after teeth are extracted.
The ongoing inflammation can lead to continued bone loss, which directly affects how well dentures fit and stay in place. Dentures rely on the underlying bone structure for retention and support; if this bone continues to deteriorate, the dentures will become loose, uncomfortable, and potentially cause sores or pain. This continued bone resorption can also alter facial structure over time, leading to a sunken appearance.
Bacteria from active periodontal disease can complicate the healing process after tooth extractions or other dental procedures. A compromised oral environment increases the risk of post-operative infections and can hinder the integration of any dental implants. Therefore, ensuring the absence of active disease is a necessary step before denture placement to ensure the long-term success of the denture.
Required Treatment Before Denture Placement
Any active periodontal disease must be thoroughly treated to establish a stable and healthy oral environment. Initial non-surgical treatments aim to remove bacteria and reduce inflammation. These often include scaling, which removes plaque and tartar from tooth surfaces and below the gumline, and root planing, which smooths the root surfaces to prevent further bacterial accumulation and help gums reattach.
Antibiotics, topical or oral, may be prescribed to help control bacterial infection. For more advanced cases where non-surgical methods are insufficient, surgical interventions become necessary. Flap surgery, also known as pocket reduction surgery, involves lifting the gum tissue to allow for deeper cleaning and reshaping of the underlying bone if needed. This reduces the depth of gum pockets, making them easier to clean and promoting healing.
Additional surgical procedures might include:
Soft tissue grafts to cover exposed tooth roots or restore lost gum tissue.
Bone grafting to regenerate bone lost due to the disease.
Guided tissue regeneration, which uses barrier membranes to encourage new bone growth.
These treatments aim to eliminate infection, stabilize the bone and gum structures, and prepare the mouth for successful denture placement.
Denture Options After Periodontal Disease Treatment
Once periodontal disease is under control and the oral tissues have healed, several denture options become available, tailored to the individual’s remaining oral structure. Conventional full dentures are a common choice if all teeth have been lost or removed due to the disease. These custom-fitted prosthetics rest directly on the gums and rely on suction and adhesives for retention.
Immediate dentures can be placed immediately after tooth extractions, providing a temporary solution while the gums heal and shrink. However, they often require multiple adjustments or relining as the mouth changes during the healing period. For patients with some healthy natural teeth remaining, partial dentures can be used to fill gaps, attaching to the existing teeth for support.
Implant-supported dentures, also known as overdentures or hybrid dentures, offer a more stable and secure option, especially where significant bone loss has occurred. These dentures snap onto dental implants surgically placed into the jawbone, which act as artificial tooth roots. The implants provide superior stability for chewing and speaking and help to preserve the jawbone by stimulating it, reducing further bone resorption that often occurs after tooth loss.
Maintaining Oral Health with Dentures
Even after receiving dentures, particularly for individuals with a history of periodontal disease, consistent oral health maintenance is important. Regular dental check-ups are necessary to monitor the health of the gums and underlying bone, even if no natural teeth remain. These visits allow the dentist to assess the fit of the dentures and check for any signs of irritation or inflammation that could signal recurring issues.
Proper daily denture cleaning is important, involving brushing the dentures with a non-abrasive cleanser and soaking them in a denture-specific solution to remove plaque and bacteria. It is beneficial to remove dentures at night to give the gums a rest and promote tissue health. Gently massaging the gums with a soft-bristled brush or clean finger can help stimulate blood flow and keep the tissues healthy.