Don’t Underestimate Dentures! Notes from the Front Lines of Eating Support (3)

Written by: 五島 朋幸 (Dentist)

I began providing home-visit dental care in 1997. When I first went along on home visits as an observer, I was truly shocked: not one of the patients was using their dentures.

Older people at that time (the generation born between about 1907 and 1920) had fewer teeth than older people today, and more of them must have used dentures. Yet not a single person was wearing them. Their dentures had been taken out during a hospital stay (or they had been told to take them out), and afterward the dentures no longer fit. I was still an inexperienced dentist, but I felt genuine outrage. A quarter of a century has passed since then, and yet…

Of course, from a dental point of view, there are cases where it is better to leave dentures out. But that doesn’t seem to be why they are removed when people are admitted to hospital. What I have heard on hospital wards over the years is: “Because they’re dangerous,” “Because they’re hard to manage,” “Because the patient isn’t eating anything hard.” Perhaps the problem won’t be solved unless we in dentistry clear up these misunderstandings.

Are dentures dangerous?

Even today, people are often told in hospitals and elsewhere that “it’s dangerous to keep dentures in.”

Of course, if the dentures don’t fit in the first place and can’t be used properly in daily life, forcing them in is dangerous. That goes without saying. Also, some partial dentures are small, replacing only two or three teeth. There are accidents in which such a denture comes loose for some reason, is swallowed and gets stuck in the throat. With this kind of denture, leaving it out just for the hospital stay is an option, and doing so doesn’t cause much harm.

But is there any need to remove full dentures, or large dentures replacing many teeth, that the person normally uses without problems? Not only is there no need, but removing them does considerable harm.

What happens without teeth?

In home care settings, I sometimes hear people say, “They don’t eat anything hard, so they don’t need dentures.” What do you think? If you thought, “Isn’t that right?”, let’s take this opportunity to learn what dentures are really for.

The shape of the face changes

Suppose that one day you lost all your teeth. First, the shape of your face would change. Many horizontal wrinkles would form below the eyes, giving the face the unmistakable look of someone whose teeth no longer meet. Then the lips would lose their firmness, and many wrinkles would form around the mouth.

The shape and movement of the tongue change

The changes are not limited to the face. If this condition continues for some time, changes occur inside the mouth too. A major change is in the shape of the tongue.

It is the tongue that does most of the work in chewing. Placing food on the back teeth, moving it to the other side, and sending it to the throat are all the tongue’s jobs. But when the teeth are gone, these movements disappear, and the tongue simply presses food against the roof of the mouth to crush it. The tongue, which is a mass of muscle, then loses its defined shape, becomes flabby and moves less well. As a result, it can no longer move food around properly, and the person loses the ability to chew.

Swallowing gets worse too

A further problem is that when the teeth no longer meet, the swallowing movement that works together with chewing is known to worsen as well. Coughing and choking on food, and aspiration, become more frequent.

As you might imagine, chewing strength also declines. Without firm chewing movements, the jaw just wobbles around, so the chewing muscles weaken. The position of the upper and lower jaws relative to each other can also shift.

In short, if the loss of teeth is left unaddressed, not only does the shape change, but function declines too. That is exactly why dentures are needed.

The problem is that once these changes have occurred, putting dentures in does not quickly reverse them. And many people never recover and lose the ability to chew and eat.

When dentures are left out…

This is a real case. A person who wore full dentures in both the upper and lower jaws had them taken out at the hospital right after admission. Then, with a transfer to another hospital and so on, the dentures stayed out for the several months until the person returned home. Throughout that time, the person was on a liquid diet.

After discharge, I visited the home as a home-visit dentist and first tried to have the person put in the dentures they had been using, but they couldn’t do it themselves. The lips had shrunk, and dentures that used to go in without trouble would no longer fit. I managed to put them in, but the front teeth stuck out badly, and the person said it hurt.

I then made the outline of the dentures a size smaller so they could somehow be put in, but the front teeth still protruded. When I had the person bite down, the upper and lower teeth were so far out of line that they slid past each other. This is what “taking out dentures” leads to.

This person started by practicing simply wearing the dentures, and after about two weeks the protruding look disappeared. The misaligned bite was also largely corrected. But the tongue moved poorly, and when the person tried to eat, the tongue pushed the lower denture out. While staying on a liquid diet day to day, the person kept training to eat rice crackers (senbei) with the dentures in, and after about six months was able to return to their former diet. Cases like this, where the person recovers, are rare, however.

The true value of dentures

As mentioned above, this is not about small dentures replacing a few teeth. It is about full dentures and large dentures that replace many teeth.

It is known that if a person has 20 or more healthy teeth, oral function is maintained at a fairly high level (this is the idea behind Japan’s 8020 Campaign, which aims for people to keep 20 of their own teeth at age 80). So this is about people who do not have 20 healthy teeth.

Dentures are worn to keep the mouth and the area around it in proper condition and to maintain oral function. They are by no means only for chewing hard foods. If dentures are left out because the person eats only soft foods (such as a liquid diet), swallowing function will certainly decline, aspiration (food or other material going into the windpipe) will become more likely, and the risk of aspiration pneumonia will rise.

What did you think? I hope you now understand why dentures should be kept in. Let’s not take dentures out without good reason.

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About the author: 五島 朋幸 (Dentist)

Born in Hiroshima in 1965. Graduated from the School of Dentistry at The Nippon Dental University in 1991 and began providing home-visit dental care in 1997. Head of Fureai Shika Goto (Fureai Dental Clinic Goto) since 2003. PhD in dentistry. His roles have included clinical associate professor in the Department of Oral Rehabilitation at The Nippon Dental University Hospital, lecturer in the Department of Dental Hygiene at The Nippon Dental University College at Tokyo, and part-time lecturer at Tokyo Medical and Dental University. Representative of the Shinjuku Eating Support Study Group. Since 2003, he has hosted the radio program “Doctor Goto’s Passionate Home-Visit Clinic.” His books (in Japanese) include Oral Care: Dos and Don’ts (Chuohoki Publishing) and Home-Visit Dentist Doctor Goto 1: The Dentist Comes to Your Home! (Osumi Shoten). (Profile as of the time of writing.)

This article is a contribution from a medical or care professional, re-edited by our editorial team. It provides general information as of the time of writing, and symptoms and circumstances differ from person to person. For specific decisions, please consult your doctor, dentist, pharmacist or another professional.

This is an English translation of a column originally published in Japanese by Next Co., Ltd.

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