Expert: Jeff Dalin DDS - 12/5/2004

Question
Hi- I appreciate you volunteering! I've gotten some bad but expected news. Through bad gum disease at 43, I have to have all my upper teeth pulled. I'm missing a few in the back already. My front ones were injured about 11 years ago and have become increasingly loose. One came out about 5 years ago and I've had an artificial one on a flipper (retainer). The one next to it will come out any day now. With my son's medical problems, going to night school and being a single mom, I haven't been able to make myself a priority even though I've seen the awful degeneration in my mouth. So now I have some insurance, a bit of extra money and I went to a Dentist. He says there's hope for the bottom with a Periodontist (I have an appt), but not for the top. He will need to pull them and give me an upper denture. I think th price of $1458 for this is OK, it includes reworked dentures that look like nature teeth and all the fees. I feel comfortable in this Dentist's office and I check his lisence- identified and no problems.

*So my question is about his procedure- it seems puzzling. He doesn't want to just pull them all. He wants to pull the back ones from the eye tooth back in a few seperate appts. He says it will give him a better idea about the fit of the upper and that so many people need so many re-alinments as the gums change. He things his way is best. He will then extract the hanging front tooth and others last and give the upper denture that day.

What do you think, please? Is this a common way to handle the situation? Is there something horribley wrong with pulling everything in a day and having the denture fit? I want the situation fixed and I want the bacteria out! I want to move on to the next phase with the Periodontist. Any thoughts would be appreciated!
Thanks,
Lisa

Answer
Hi Lisa,
You need a denture. You have two ways to do this. The best way is to pull all of the teeth, let you heal 4-6 weeks, and then make a denture. This allows the bone to heal and you can make the denture at that time. There is a real problem with doing things this way. You would not want to be seen in public. You would not be able to eat very well. So dentists have devised a different way to accomplish the goal of the denture. It is called an immediate denture. You take out all of the back teeth and leave the front teeth in place. You can get some good healing in the back areas. But you will still have front teeth so you will not look too bad. After the back has healed you start making the denture. You can take an impression, mount the case, set the back teeth, verify the bite, and then for the last step, take out the front teeth and place the denture at the same time. You would never be without front teeth. The back teeth are done ahead of time so that the back bone is healed and stable. If you tried to do the entire case as an immediate denture, it would not fit real well and would get loose quickly. I hope this explains why we do it in two phases...to make the denture fit better. Good luck. Please feel free to recontact me if you have any questions.

Jeff Dalin, DDS