Although I have most of my bottom teeth, I wonder if I should ask a dentist to pull my four remaining upper teeth and get a full upper denture. Or is it best to get partial dentures and work around the four teeth?

The four upper teeth are healthy. I am wearing a cheap, bulky partial denture now. I’ve seen three dentists about this. Two of them recommend a complete upper denture rather than a partial, but they want me to make the final decision. I’m at home a lot, so I mostly wear the partial denture when I eat meat or have food that requires a lot of chewing. The discomfort of the partial denture makes it challenging to speak, and I’m sure it influences how much a socialize. But we are in a pandemic anyway, so I socialize even less. Will a full upper denture look better and be more comfortable than a partial denture? My budget is about $5000. I do not want to go much higher and accumulate debt. – Thank you. Steve M. from MS

Steve,

Although we can give you some denture principles to help with your decision, we cannot recommend treatment for your case. Dr. Finley or Dr. Henderson would need to examine your teeth and mouth and review your x-rays for definite treatment options.

1. It’s Usually Better to Save Natural Teeth

Although a dental implant is the next best thing to a natural tooth, it usually better to save the natural tooth if it will not damage your oral health. But replacing teeth with a removable dental appliance—like a removable partial denture—has disadvantages. Removable appliances can put stress on adjacent teeth and slide around a little.

2. Stress on Teeth When a Few Remain

But eating on just four natural teeth puts a lot of stress on them. Although your remaining upper teeth appear to be healthy, the stress of chewing with them and the stress on the lower teeth they chew against is not healthy.

3. Bone Resorption

If you only have four upper teeth remaining, you’ve experienced shrinkage in most of your upper jaw. Consider some facts about bone resorption:

• When all your teeth are missing, tooth roots are not present to stimulate the bone. Your body resorbs the bone and uses it elsewhere.
• After 10 to 20 years, the progressive bone shrinkage causes facial collapse because you do not have enough jawbone to support your facial muscles.
• Facial collapse is most severe in the lower jaw, which can become pencil-thin. And it will be almost impossible to keep a denture in place.

4. Function of a Full Upper vs. Lower Denture

 

5. A Complete Upper Denture vs. a Few Remaining Teeth

This information applies to a well-made upper denture:

• Gentler than four natural teeth when chewing against low teeth
• An underbite can increase stress on lower teeth
• A full upper denture will be more comfortable than one or more partial dentures to replace upper teeth
• A partial denture that clips onto remaining teeth puts stress on them

Possible Treatment Options

Remember, Dr. Finley or Dr. Henderson would need to examine your teeth and x-rays before giving definite treatment recommendations. But these are possibilities:

• First option – An implant-supported partial denture or full denture secured with as few as two dental implants (small titanium screws that function like tooth roots)
• Second option – An upper complete removable denture. It will be more comfortable than a partial denture, look better, and prolong the lifespan of your lower teeth.

You will need advice from your local dentist about treatment options. The first option will exceed your budget, though. It may be possible to complete dental work in phases—receive a complete denture first and get dental implants for the denture later.

David Finley, DDS, a Monroe, LA fellow of the American Academy of Cosmetic Dentistry, sponsors this post.