Summary
In this CareLab Podcast episode, Dr. Joy discusses dentures and oral care in older adults, emphasizing the importance of daily denture removal, cleaning, and proper oral hygiene to prevent infections like thrush. She explains how caregivers and clinicians should integrate oral health into care plans, as dentures significantly affect nutrition, swallowing, and overall health. Dr. Joy highlights the distinction between dentures, partials, and bridges, and provides practical advice on recognizing damaged dentures, applying adhesive correctly, and adjusting meal plans for denture wearers.
She also addresses the emotional and social aspects of wearing dentures, the realities of dementia-related denture refusal, and why caregivers shouldn’t feel guilty if dentures break or stop fitting properly.
Key Questions Answered
-
Why is it important to remove dentures at night?
To prevent oral bacteria, yeast, and fungus (like Candida) from growing under the dentures, which can cause infections such as thrush. -
How should dentures be integrated into a resident’s care plan?
Care plans should identify what’s in the person’s mouth, determine if assistance or reminders are needed for cleaning, and adjust meal textures accordingly. -
What’s the difference between dentures, partials, and bridges?
Full dentures replace all teeth, partials replace several teeth and have clasps, while bridges are permanently fixed in the mouth and shouldn’t be removed by caregivers. -
What should caregivers do if a denture breaks or no longer fits?
Report it immediately—never try to repair or reinsert it themselves. The patient’s meal plan should be adjusted to softer foods until repairs are done. -
How much denture adhesive should be used and where?
Apply a thin, strategic layer (not as shown on the box) along the inner curve and center of the denture to ensure even pressure and long-lasting hold.
Transcript
CareLab Podcast
Dr. we're so glad to have you back on the Care Lab podcast. I know, well, first of all, our previous conversation was really awesome. And so if y'all haven't heard it, you need to go back and look, search for Dr. Joy and listen to that because we're not starting at the basics today. We are talking about dentures today because we didn't get into that before. And then that's such a huge deal for so many people. And so we're going to talk about dentures. So tell us, Dr. Joy, where do you want to start with this?
Joy
That's a great question. So when it comes to dentures, there's a lot to do with you guys as well in making sure that the patient can actually put in and take out their dentures. And after a certain period of time, whether it's due to arthritis, osteoarthritis, rheumatoid arthritis, God forbid a stroke, diabetic neuropathies, whether they're having tingling sensation, whether they're not having the same capabilities.
CareLab Podcast
Yeah.
Joy
Dexterity to be able to actually use their hands and able to, you know, use their dentures. That's where you guys to come, you know, guys come in and helping them, you know, adjust to their new normal, their new life and being able to take them in and out. And I know the big question is, well, why don't we just leave them in, right? And just deal with it and they can just brush their teeth and then we don't have to go through that hassle.
CareLab Podcast
Mm-hmm.
Joy
And the biggest problem we have with that is that we all have gunk in our mouth. And that gunk is going to be oral bacteria. We all know that, right? It causes gum disease. causes, you know, gingivitis. It causes cavities. But more important, huh?
CareLab Podcast
Even if you're brushing your teeth, still have these things. Yes. Yes.
Joy
Even if you're brushing your teeth, they're always there. Well, there's good oral bacteria as well, right? We need the good oral bacteria in order to help break down food stuffs. So we've got good and we've got bad, just like in the gut. I mean, everything is connected, right? We've got good biome, we've got bad bacteria that can cause problems. It's literally the same thing in the mouth. Different types of bacteria, but literally the same thing. So.
But on top of that, and what a lot of people don't know is that we also have fungus in our mouth. We also have yeast in our mouth. And under normal circumstances with a normal body, like you guys and me, our immune systems take care of that for us. And as long as we're brushing and making sure that we're keeping our mouth clean, we'll never even know in our lifetimes of ever having those organisms in our mouth, except for the denture wearer.
And unfortunately for a denture like this, this is a complete denture. This is an upper denture. As you can see, it covers the entire roof of the mouth. When this is inserted and it stays in there, a lot of stuff can grow in here. earlier this year, yeah, go ahead.
CareLab Podcast
Yeah.
Can you move that a little bit? There you go, there you go. Because that way I think it'll be easier for people. Sorry, go ahead, go ahead.
Joy
Perfect. Yeah, there you go. So inside this denture, right, can form a lot of organisms because the denture is not being taken out, the mouth is not being rinsed, you know, rinsed even just with water or, you know, a alcohol-free mouthwash, anything to help prevent those organisms from growing. Earlier this year, there was research done for the long-term care communities
where thrush or Canada albicans got to, was really elevated. And it was because of the fact the majority of the people were ones that were denture wearers, specifically complete dentures. And most importantly, the upper complete denture. The upper complete denture can host a lot of organisms in there and then they're going to develop thrush. Thrush is completely avoidable in this country. Well, it should be avoidable.
you know, everywhere, but specifically to say, you know, we, there is no reason why thrust should ever be developing in anyone's mouth. And the only reason why it's going to develop is because we have created by leaving the dentures in the mouth to let those organisms grow, multiply, divide, and really thrive. And this is a problem because if they are breathing them in, if they are, you know, swallowing these organisms, you're going to have a whole set of
medical issues, not just dental issues. So these dentures definitely need to come out.
CareLab Podcast
And I think you're I think one thing that we should pause and double click on is that you're saying this specifically because it happens frequently in some places and because they see it frequently they don't think about it as being as Troublesome as it is and so the statement that you're saying is that There's no need for anybody to be having thrush So if you're seeing it happen regularly in your facility or with your residents, that's a problem that we need to deal with
Joy
Exactly, exactly. it should be, you know, ideally, you know, when someone is being admitted into one of these homes, whether it be, you know, assisted living, you know, memory care skills, everyone should have a care plan based on knowing what's in the mouth. I mean, that goes and it is kind of a segue and we're going to revert back. But that care plan should recognize what kind of meal plan they're going to have. And how can you determine a meal plan?
CareLab Podcast
Hmm.
Joy
if you don't know what's in their mouth, right? I mean, people with full dentures that are completely without teeth, upper and lower, if they're gonna have a different meal plan, regardless of how healthy they are, regardless if they have diabetes or not, or any other myriad of medical issues, strictly because on what they can chew with, right? These are plastic teeth, these are static, and they're not gonna be able to cut through meat as well as
CareLab Podcast
Right.
Joy
you know people that have their natural teeth so that is a big deal so ideally it would start you know day one knowing what's in their mouth and so therefore there could become a care plan to determine can they take their dentures in and out do they need support with that do they need reminders maybe they just need reminders and yeah you know i know how to do it you know they've had them for how many years right maybe they just need gentle reminders but that should all be part of the care plan
The problem is most of the time those questions aren't being asked. Or if they are being asked, they're asking the loved ones instead of looking in the mouth, they're asking the loved ones, what's in your loved one's mouth? What's in your mom's mouth? What's in your dad's mouth? And a lot of times, they'll just look at them and be like, yeah, those are their teeth because they haven't been with them to their dental appointments. There's been no need up until right now.
So if I can stress anything, know what's in your loved one's mouth, know what's in your client's mouth, know what's in your patient's mouth. Because that really determines not just the cleanliness of the mouth, but how they can eat, what they can eat, and really should help determine the care plan in the morning, making sure the mouth is rinsed, then putting in the dentures, and then at night, making sure those dentures are removed, and then the mouth is rinsed or the remaining teeth are being brushed.
So I can't stress that enough. That is so important for our loved ones because we really can prevent a lot of medical issues by making sure these dentures are coming in and out. So that's the number one thing I wanted to really stress during our time together. Another thing too is we don't know a lot of dental terminology. So another problem that I see is interchanging the term bridge and denture.
CareLab Podcast
Thank
Joy
And a lot of people don't know the term in the stay at home arena, the people that are living in these long-term care communities, the term partial denture. And I have brought a couple with them to show you. So tell me how this looks.
CareLab Podcast
And we can see it pretty good, hold on one second. Before you go to the demo, because I really want to know that, because I can't tell you what my person has in their mouth if I don't know what it is called. But there's also one other important thing I want to say. Have you ever seen any patient on your caseload whose meal plan or their diet was determined by the dentures that they had? I think not a once. I think not a once. think not a once. Between the two of us, we've been in...
Joy
Better. Better.
CareLab Podcast
for some decades. Yeah, multiple decades. Multiple decades and I don't think I've ever seen it. At the closest it's been like they don't have their dentures anymore therefore they're on a soft diet. Uh-huh. But I haven't seen anybody like there or a pureed diet right. I haven't seen it be like oh because they have dentures we're not gonna do steak and meats and we're gonna do. to be on mixed soft or whatever. Yeah. Yeah, yeah. And so that's like such a keen point that you bring up and I think that OTs specifically are in a spot to like be the ones that ask this question and to be frank.
Joy
Your aid.
CareLab Podcast
I don't know how many times I've done that over the career of my career to be like super focused on that as part of like what we do. If they bring it up, sure. But if I'm leading it and asking those questions, I don't know that I've done it like as many times as I probably could have done. Yeah, I'm sure I haven't done as many times as like Coders should have. I feel like I've always been really aware of like, the dentures fit? they able to chew their food? Do they seem to be able to chew their swallow with?
the denture or the partial or whatever it is in the mouth. But have I thought about the food consistency or the, I don't think I have. like, this is, thank you. This is a great lesson. Like, I'm gonna use this in practice for sure. Totally.
Joy
Excellent. And I'm so glad to hear that. And it also goes along with my speech therapists and those that are dealing with dysphagia. Can we help at least prolong the effects of dysphagia by knowing what's in their mouth? Have they had dentures? Would it be a good idea to have those dentures in the mouth with adhesive if they're not fitting right? Should we be contacting a dentist to take a look what's in the mouth? How can we help?
CareLab Podcast
Mm-hmm.
Joy
with the swallowing, if they can masticate their food better so that it's smaller and the boli of food will actually decrease more because of what they're chewing with, therefore helping the swallowing aspects of it. So, I mean, like I said, there's a myriad of issues that go along with the number of teeth and what kind of teeth we had in the mouth, be it fake, right, know, false teeth, dentures, or their own natural teeth.
and how many natural teeth do they still have? And another thing I should also bring up too is I've also seen patients where because of their mid-stage or late stage, one of the dementias, they no longer want to wear their dentures anymore. And I will be more specific with Alzheimer's because in mid to late stage, there's a lot of apathy, right? Their self-care has gone to pretty much zero. And this goes with clean clothes as well as,
avoidance of showering, right, of bathing. But we also have that with the mouth as well, to the point where they don't, they're refusing the dentures. And so, you know, once again, I'm called in during those times to see if there's anything wrong with the dentures. Totally cool. Respect. You know, I love that. But the hardest conversations I have with families is by saying, you know what, your mom doesn't want to wear her denture anymore.
Yes, it's really hard to see her without wearing her dentures, but guess what? There's no failure to thrive. She's on a pureed diet. She's eating three squares. She's smiling, she's happy, she doesn't care, and therefore, unfortunately, neither should we. We're not going to force a situation that they don't want to be in because for whatever reason, because of their disease or whatever with the denture, they just don't want it anymore.
CareLab Podcast
Mm-hmm.
CareLab Podcast
Yeah.
Joy
And I see that more and more as I see once again. I mean, I have patients where they are completely denturists. They are completely without teeth. And I'll review the dentures once a year to make sure, do they need adhesive now? Has the bone kind of resorbed a little bit more? How well are they chewing? I talk to the nurse, I talk to the caregivers, how well are they eating with them? All that stuff to make sure that there's no failure to thrive. That's the number one thing. We wanna make sure they're thriving.
CareLab Podcast
huh.
Joy
But if they are choosing not to wear their dentures anymore, what I'm also telling the family as well is that the mouth is actually cleaner without the dentures in their mouth because there's nothing for these organisms to grab onto and to fester and to live in. So when it's a situation of they don't want to take their dentures out anymore, and it's really difficult to do, a lot of my Lewy bodies, those with living with Lewy bodies, I had that issue a lot. They're very resistant. They're very.
CareLab Podcast
Yeah.
Joy
aggressive in those situations, or if they choose not to wear their dentures anymore, which is I see with my, you know, those living with Alzheimer's, the healthier people, unfortunately, are the ones without the dentures, because it's a cleaner environment, and it's not going to cause as many issues for them in the long run. So I'm going to see a lot more thrush in my, you know, my patients that have, that it's really nearly impossible to take those dentures out because of their aggression.
CareLab Podcast
Mm-hmm.
Joy
And that's something that is also a concern for you guys as well. It's like, well, OK, they don't have their dentures anymore, and now they have dysphagia. Bring the dentist in. Can we try to get those dentures in? If they don't want to get them in, well, now you're going to have to be working with just the fact that they have dysphagia and going from there. can't deal. There's nothing more we can do for them, unfortunately.
CareLab Podcast
Yeah.
Joy
And maybe just a pureed diet and thickeners and all those things can help improve their overall health. And one more thing about the thickeners I'm gonna say about that is that if they don't have dentures in their mouth, then I don't worry about what's in the thickeners, AKA honey, AKA sugar. So I don't have to worry about new dental decay. I don't have to worry about the thrush forming because that is a food source for Canada.
for, you and it's also not a food source for the bacteria that causes gum disease. So, you know, if they're not wearing their dentures and they're on thickeners, I'm, as a dentist, I'm okay with that because I know nothing is going to be growing in this mouth because the mouth is, you know, being rinsed or whatever. And it's going to, it's, overall their oral health is going to be healthier. And that might sound really sad, but it's, it's, it's just, it is what it is.
CareLab Podcast
And I'll
CareLab Podcast
Yeah. And actually, think, you know, we can look at it as a sad thing, but it's not necessarily a sad thing, right? Like, ultimately, what you're talking about here is quality of life. Yeah. And if someone no longer wants to put in their dentures, wear a bra, like whatever it is, if that's not comfortable for them anymore, and they're actively rejecting that, no one benefits from continuing.
force that on them. And in fact, it becomes more of a risk both to that person as well as often to caregivers themselves. If you have someone who maybe like, again, your example, who might have a Lewy body, who might tend to get a little bit more agitated or can even be aggressive, you know, we shouldn't be trying to put things in those people's mouths if they don't want it because we're gonna get bit. I just want to say, you're gonna get bit. You're gonna get bit.
Joy
Well, fortunately, if they don't have teeth, there's not a whole lot they're going to be fighting with. But it's still a risk factor, and it's still scary for the caregiver. Do you know what I mean? And it's not fair to them because now they don't have the time to be doing stuff like this, to be putting, number one, putting themselves at risk, right? You're absolutely right. And number two, to really be trying to do something that you're right, it benefits nobody. But once again, it's really difficult for the loved ones
especially the ones that are coming in on a regular basis to see them and be with them and engage with them. So, know, for all these years to see them with teeth and no longer have those teeth in their mouth and realize, I mean, there's a whole myriad of, of, know, things that are going through their hearts and their minds with that, you know, now mom's at the next stage, right? Mom looks so much older now, you know, more realization sits, you know, sets in with the progression of this disease. And that's so,
hard for everybody. It's hard for the caregivers that are with them on an hourly basis. It's difficult for me, for patients that I've seen over the years and are making that decline. And it's most importantly hard for the families. And so like I said, it's a really tough conversation to have. But I do tell them they are going to be healthier potentially without them, and they're fine. They're eating well.
CareLab Podcast
Yeah.
Joy
They are still going through the motions of life. You know, their quality of life is not declined because they have chosen not to wear their dentures anymore for whatever reason.
CareLab Podcast
I want to first, want to define a couple of terms that maybe we've used for listeners who might not be as familiar with them. And then I want to switch, pivot our conversation a little bit to a topic that I'm super fascinated by with dentures. So first of all, dysphasia is when someone is having trouble swallowing and failure to thrive is a medical term that is often used for people who are losing a lot of weight and they're not, they're not eating well. Just kind of generally speaking for a reference point for everyone. Okay.
So here's my question for you though. Obviously we think about dentures as the purpose of dentures so you can chew your food. What other good reasons for dentures are there?
Joy
my gosh. So yes. So it's also social, right? It's a matter of pride, vanity, in the most positive sense of the term vanity. You know, when it's, I have a story where I had to, one of the teeth had fallen out, one of the front teeth had fallen out on a lower complete denture for someone in memory care, but she was in early stage Alzheimer's. And she refused.
Even though it was her lower denture and no one really could tell that she wasn't wearing teeth, she refused in the three days it took me to bring that denture, have him fix it and bring it back. So was 72 hour period. Like it was a real rush job for her. And she refused to go into the dining hall for any of her meals until she had that denture back. She had all her meals in her room. It was unbelievable.
CareLab Podcast
Mm-hmm.
CareLab Podcast
Mm-hmm.
Joy
And she got her denture back. Unfortunately, I had it for lunchtime. so then they were literally, they were bringing her food in and she's like, no, no, no, I'm going, I'm eating with my friends. Yeah, no, no, no, no. And we look at each other and inside I'm doing the happy dance. And now she feels like herself again. She feels whole again. I have another story where a patient just most recently
CareLab Podcast
Okay.
Joy
She had a bridge which is cemented in and unfortunately she has osteoporosis. So teeth and bones are cut from the same cloth and us women, we are more likely to have osteoporosis and she's in her early eighties. So she's had this for a while and the teeth broke off. She, she bit into something, the teeth broke off and now, you know, she has nothing up here, right? So I was able to make her an upper partial denture and the caregiver actually said they looked better than her crowns, than the bridge.
because it was old and the porcelain was beginning to chip or whatever, and these are brand new teeth. And now she's sitting, last time I saw her, was meeting a caregiver, happened to be in the lunch room, and there she is sitting with her caregiver and she's smiling. You have no idea what that does for me. She motions me over, grabs my hand, kisses it, and she's like, I love my new smile. Are you kidding me right now?
I get shivers talking about it. That is so important as well. So I'm going to give you a case in point. So a lot of times, what can happen with dentures is that, I'm just going to point this out, is that a denture can break. So I'm going to just show this. Can you see this, guys? Move it over more. There you go. Yeah. So this is the upper partial denture and the occ-
CareLab Podcast
Yeah, yeah.
CareLab Podcast
move it over this way. And also verbalize everything because just in case.
Joy
So I'm going to show it to you this way. See how it's nice and curved around? It's called curved around like this. And then here we have a shear fracture where it's broken off. And this point is really, it's really pointy. It's really, it's really sharp. Okay. So this is the piece that came out. This is a really easy fix. This is also a choking hazard, right? So you're just throwing that off.
CareLab Podcast
yeah. Yeah, for sure.
Joy
But this is not like the denture is completely, like I have to toss this out and make a new one. This is an easy fix. I send this back to the lab. It's a pretty much of a clean break. And I can send that back to the lab, have them reattach it with their special stuff. And then I bring it back to them and now they have their denture back. But it's also important for me to let the caregivers know and the nurse know that
during those three days, they might need a change of foods because this denture, we're gonna count the teeth. There's one, two, three, four, five, six, seven teeth are missing from, or six teeth are missing from this mouth. And so they may not feel comfortable enough to be eating a regular diet, which they can with that denture. But while it's gone, they might need to move down to a mechanical soft.
CareLab Podcast
Mm-hmm.
Joy
or even a pureed while they're waiting for their denture to come back. And I've got a great guy. I mean, he's amazing. We had a situation where I had to reline a denture because she was losing weight and that the lower denture was kind of even with the keys that were just kind of floating around in there. And so I had a 24 hour turnaround time. That doesn't happen all the time. If you have a good dental lab, my guy, you know, he'll do that for me. And so I picked it up.
CareLab Podcast
Mm-hmm.
Joy
you know early morning and I dropped it off the next day you know in time for dinner so that worked out really well. But the my point of the matter is is that when they are without their dentures for whatever reason and they're being fixed we also have to do they have dysphagia as well okay well if that's the case then we need to make sure during that time and the usual turn of time turnaround time is a week right so for.
CareLab Podcast
Hold on one second. Hold on one second.
It stopped. It stopped recording you for some reason. It said your phone due to, what's it say? An incoming call. Is your phone ringing?
CareLab Podcast
It's okay. It's okay. We caught it right away. As soon as it gets ended, it'll be all
Joy
Because I have it, I do not disturb.
CareLab Podcast
Mm-hmm. Yeah, I don't know. It must have something to do with using Riverside, but That's okay. Well cut that part out. You're good. You're good. It only just happened just for that right then so I don't know how to make it start again though. Do you are you gonna stop recording and then Make it start again. Yeah, it's still recording now. I think so. I thought maybe Okay, you see the little red?
Joy
Well.
Yeah, I'm so sorry. That's never happened before.
Joy
It looks like it's recording.
CareLab Podcast
light in there.
Joy
It looks like it is, it's got a red light and it's got 40 seconds.
CareLab Podcast
yeah, says you're reporting. Okay, cool.
Joy
Okay, so when someone is without their denture for a period of time because it is being fixed or whatever and they have something like dysphagia, then I need to let the nurse know, I need to let the caregiver know that maybe we need to temporarily, you know, discontinue the regular diet and have them with a mechanical soft or with a puree diet. If the patient is verbal and I can have this conversation with them,
then they'll pick and choose their menu, right? They'll be able to figure out what they can eat. But, you know, without that, you know, without that, you know, capability, then it really falls on us to make sure that, you know, they are eating appropriately and they're not, you know, having any issues, especially if they have like other issues like dysphagia. So that is a really important part when it comes to dentures as well, because, you know, like anything else, there's mechanical failure.
Right? These, mean, some of the one of these dentures I have, I think it's 35 years old, you know, I mean, it is what it is. And so things can break over time. We just bite down the wrong way. It happens to our natural teeth. Can you imagine how it can happen as often or more often with plastic? Right. And so it happens. And then that's another issue, too. It's like, OK, so now, you know, if the denture is broken and the person's non-verbal, how can we tell?
CareLab Podcast
Mm-hmm.
CareLab Podcast
Yeah, that was gonna be my question actually. It's like, let's say I am a family caregiver, listen to this right now. I'm taking care of my dad at home. I know that he has a denture, but he doesn't communicate as well with me as maybe I would like. What things, maybe three things that I can key in on as maybe the denture works fine now and it seems fine, but I need to be able to pay attention to so that I can know this if there's some changes. What things should I pay attention to?
Joy
Yes. So we're going to start with the complete denture. So with the complete denture, especially with females, we lose oral bone at a 20 % faster rate. Now the rest of the body, it's 2%, OK, for the rest of the bones. But for the jaw bones, for whatever reason, it's increased by a power of 10. So the least thing that I want to make ever for anybody is a lower complete denture.
CareLab Podcast
Okay.
Joy
especially for a woman. Because what happens over time, and it's usually within the first five years, is that the lower jawbone, the mandible, just completely flattens out. The bone does get resorbed and it does get reused into our long bones, which is kind of interesting. That bone does get recycled. However, it's not coming back, it's not growing back, we don't use it, we literally lose it. And if we don't have any retention,
for this denture to sit on, it's gonna rock and roll. So, and that's really unfortunate and that truly will change a meal plan for sure, right? And it can also aggravate the dysphagia. So that's really unfortunate. So I'm looking for looseness. I'm looking for mobility. That's number one, okay? Number two, when the denture comes out at night, you know,
Does it need to be looked at all the time? No. But if there seems to be a piece that's missing dentures are always curved around. So if there's like I showed you before that sharpness or if someone is complaining that the denture hurts, have them try to point to which side it is, have them take out the denture and examine it. Does there seem to be a part missing? Does there seem to be a tooth missing? So number one would be mobility.
Number two would be, there anything missing with this denture? And the most important thing, now I'm going to go back to the partial denture, okay, are the clasps. And we've got two different types of clasps. We've got, can you see that? The metal clasps, right? We've got metal clasps. There is a tooth that hangs in there. I'm going to get out of the way. Can you see that? The metal clasps. So there's a tooth that falls in here. So one or two things are going to happen.
CareLab Podcast
Yes.
Joy
Either this tooth can break because it can no longer handle the stress of holding this denture in on the right side, or this clasp over time, even though it's metal, can break off. And now the denture is going to hang because there's nothing to hold it up. Okay? So we're looking at how well does this denture fit when the denture gets put in and it's not staying up, the denture needs to come back out and we need to examine the denture.
CareLab Podcast
Mm-hmm.
Joy
Is there still a tooth to hold that in place? Number one, we have to lift up the upper lip in this situation as an upper partial. We need to lift up the upper lip. Check to see if the tooth is still there. Number two, we need to check to see if the clasp is still there. Has it broken off? Is it sharp? Usually it's sharp. It's a shear fracture. It's sharp. It's not going to be soft. So you know, you'll feel it, right? You're not going to bleed, but I mean, you're going to feel that it's sharp. OK, we need we need to do something about this.
Now, some people will get by with just denture adhesive. You know, they leave the denture alone. I've seen plenty of broken dentures where they're missing a clasp, they're missing a tooth, they don't care. Adhesive is working for them on that side. They're just throwing it in on the inside, right in here. And it's staying up that way. Fantastic. Leave it alone.
CareLab Podcast
Mm-hmm.
Joy
Just, know, there's no timeframe on this. So if they want to have the denture reliant, having a class put back on or the tooth today, three months from now, it doesn't matter to me, right? The mouth isn't going to change that much at this point. But if it's something where the adhesive isn't working and we need to have this denture fixed, we need to know what needs to be fixed, right? And so that's what we're looking for. We're looking for missing tooth.
CareLab Podcast
Mm
Joy
We're looking for either missing tooth that the tooth is hanging on is called a retention or retainer tooth. Or we're looking for a clasp that may be broken off. And that's pretty easy to feel and to find. And then that's when I'm called in. And then I take, it's really easy. I take a pickup impression. I take an impression with the denture in the mouth so they know the alignment of the mouth. I bring it to the lab. The lab fixes it. I bring it back to them and voila.
CareLab Podcast
What?
Joy
denture is fixed again and it can last another 40 years. You know what I mean? So it's really important to know now there's other kinds of clasps and these are the clasps that tend to break off more and these are the acrylic clasps. So this is an acrylic clasp. Okay, so this is a clasp right here that's acrylic. It's made from the same material as the actual framework of the denture.
CareLab Podcast
Mm-hmm.
Joy
This is a flexi denture. I don't know if you can see this or not, but I'm literally bending this denture. If I bend it too hard, it will break because it's been dry for a while. But this is an acrylic clasp. This is another acrylic clasp right here. So that's something that we really need to be concerned about. If it's an acrylic clasp, then a lot of times, unfortunately, they can't add acrylic to acrylic. I might need to make.
CareLab Podcast
Mm-hmm.
Joy
a whole new denture. So I will always recommend the metal one because they can literally melt off, melt this off and solder on new metal so that it fits. Can't do that with the acrylics. So that's really important to understand. And when it comes to partial dentures, these are not bridges. These are removable oral appliances. These have to come out at night. Unlike
CareLab Podcast
Yeah.
CareLab Podcast
Mm-hmm.
Joy
A fixed bridge. A fixed bridge is going to be heavier. It's going to be made out of metal. So on the inside, when you look at it, it's going to be white metal. And you're never, ever, ever going to see clasps. OK? So that's very important to understand. So if something comes out of the patient's mouth and it's more than one tooth, we need to examine this. Is it a partial denture?
CareLab Podcast
Uh-huh.
Joy
that we can just clean off and let's see why it fell out. Did a tooth break or did the clasp break or is it a bridge that we should not put back in? It fell out for a reason. We can't just put back in without actual dental glue, okay, dental either bonding agent or cement to be able to fix back into the mouth because otherwise it's a choking hazard.
And the biggest thing that I tell the caregivers is that if this ever happens to one of their patients, one of their clients, it's not their fault. A lot of times they feel guilt. I must have done something wrong. I must have brushed their teeth too hard this morning before breakfast. No, no, no, no, no, no, no, no. These people are older adults. They have old dentistry in their mouths. Nothing lasts forever.
CareLab Podcast
Mm.
Joy
Right? And a lot of people are outliving their dentistry and this happens and that's okay. But you need to say something because if you don't say something, then you want to have failure to thrive. That's how it happens. Or then the loved one is going to come in. Where's her teeth? no, no, no, no, no, no, no,
CareLab Podcast
Right.
CareLab Podcast
Yeah.
Joy
fell out and now we need to address that situation so they can have their normal life back. It's okay. So there's, like I said, I've seen this so many times where they feel bad that they've done something wrong. No, it's okay. Let the powers of be know. See something, say something. Let's address it. Let's take care of it. Let's move on.
CareLab Podcast
Yeah.
CareLab Podcast
Yeah. So just to just to clarify there and correct me if I'm wrong, because I might be wrong. I may have missed something here. So a denture is something it could be a full or a partial denture. It should always come out at night and be clean. A bridge is fixed in the mouth. It stays in there. And if that comes out, we don't try to put it back in. We let the powers of be know and we get it repaired. Yes. OK, got it. All right. I have one.
Joy
Yes!
Joy
And it's always gonna be heavier. You're just gonna feel it by weight. I mean, it's because it's metal-based. So it's definitely gonna be heavier than a partial.
CareLab Podcast
Sure. Gotcha. I have one last question. How, because I think that this is something a lot of caregivers ask, how much adhesive should you put in a denture?
Joy
I hate, hate, hate, hate the little diagram that they show on the boxes. it drives me crazy. Drives me crazy. So complete up redemption, right? We're gonna start with that. You're gonna ignore what it says on the box. You're going to put a thin strip. See now this is, see how it's curved inside? And we're putting it on the inside. So we're literally putting it about a good, I'm gonna say,
CareLab Podcast
huh.
Joy
half an inch up from here because we don't want them swallowing it. Once the denture goes in, we press it in, we don't want it going out, right? So we're going to start from like about here, not here, here. We're going to work our way around.
Okay, and then we're going to, this is a very important part for retention. We want to go across here. Once again, not at the tip, you're wanting to go a little bit in and then across here. This will help prevent food coming in. It will also help prevent when they're chewing for the denture to drop. So if I'm wearing it, it will prevent the denture from dropping because you have this adhesive here. And then last step.
CareLab Podcast
huh. Mm-hmm. Mm-hmm.
Joy
I'm going to make like a window pane or across a T going in the middle. We want adhesive on the palette. Once again, we don't want food going in. We want the denture to be balanced. And the best way to have the denture balanced is by making sure that we are putting material, the adhesive across. Now that might seem like a lot, but you want this to last eight hours. You want this to last for three squares. That's what you do.
So once again, you're gonna follow the inside border, leaving the first like half inch free. You're gonna go across the back. You're gonna make a T in the middle. And then you want first, you want the denture to be dry. You're gonna put it in, if you have to put it in for them, then bilateral on the thumbs. So I'm usually behind them doing this. I tell show do, I'm telling them what I'm doing. I show them what I've done and now I'm gonna do it.
CareLab Podcast
Mm-hmm.
CareLab Podcast
Okay.
Joy
I have to bring the cheek out to get it in. And now I'm putting it in and now bilateral equal pressure with my thumbs, whoops, but with my thumbs to make sure that the adhesive is engaging. And because if they're wearing a complete upper denture, fortunately their gag reflex is pretty much slim to none at this point in time. So I also will press from the roof of the mouth. I'll press on here too to make sure this adhesive is engaged.
And I'm going, you but I don't want to press on one side because it no matter how much it used to be put in, if I'm pressing, if I'm pressing, you know, here, right, and I'm not pressing on this side, it's going to drop because it's all connected, right? So I'm going to make sure that I'm pressing bilaterally both sides equally so that the adhesive is engaging. I'm rubbing, I'm rubbing along the teeth, you know, inside the mouth. And I'm once again, I end by pushing on top into the roof of their mouth.
CareLab Podcast
Mm-hmm.
Joy
And then I want to wait for a good five minutes before I consume anything. When the adhesive first comes out, it's not that sticky. It becomes sticky over time and with body heat. So yeah, so we're not handing them the denture with the adhesive in at their breakfast table. Do you know what I mean? I mean, I'm being a little, you know, I'm exaggerating a bit, but you're not handing it to them and then handing them some water. Because then the adhesive is not going to work. The adhesive is water soluble.
CareLab Podcast
Okay.
CareLab Podcast
Yeah. Yeah, but it takes time.
CareLab Podcast
Mm-hmm.
Joy
So yeah, so you wanna make sure that that's in, if you can ask the patient, if you can ask the client, does it feel secure? Yes, fantastic. And then they can go about their business and then by the time they get to breakfast, it's set, it's in and they can eat comfortably and confidently. So that's a really big deal. Same thing with the lower denture. So with the lower denture, I'm gonna do the exact same thing. I'm just going to go along, once again, not going to the tip, but I'm gonna go around.
All the inside push and then once again bilateral pressure and then I'm kind of but you know if I'm going on one side I'm making sure that I'm doing both at the same time. So if I'm pushing in the front I'm pushing them both sides and then I'm pushing in the back. But you're really the best place to do it is smack dab in the middle of the denture and that's true for the upper one as well. Once again tell show do I'm telling them what I'm doing which one is easier to put in first if they're completely adentialist the upper one the upper one is bigger.
It needs more space to get into the mouth. With the lower one, you really don't need a lot of times to pull back on the lip to insert it. The upper denture, you will. And before that's done, you want to take a look at their lips. How dry are they? Are we going to crack them? Are we going to hurt them? You know, so we, mean, even if it's just water, if you don't have Azalea, there's no lip balm, totally fair. As long as they're somewhat moist.
CareLab Podcast
Yeah,
Joy
I don't care if the mouth is moist while the denture is going in. That doesn't bother me at all. That actually creates a better seal on the upper denture. But take a look at those lips. I've made that mistake. I've hurt them, and now the lip is bleeding. They're on blood thinners, and I'm sitting there with tissue holding it for them. I feel so bad. So it's happened to me too. But it's really important that it happened to me so I can pay it forward.
CareLab Podcast
Yeah.
Joy
and explain what not to do. Been there, done that. So when it comes to a partial denture, you're going to do the same thing. You want to apply it right where the teeth are, right? Because they're chewing, right? This is mechanical. We want to make sure that they're using their teeth. So I'm going to do the exact same thing. I'm going to apply it right underneath in that curve, in that space where that is on both sides.
CareLab Podcast
Yeah. Yeah. Yeah.
Joy
Some people, like I said, if they have a broken clasp and they only want it on the one side because the clasp is retaining on the other, cool. That's fine. But for a partial denture, we can't tighten the clasps anymore, or like once again with the acrylic ones, I can't adjust these. I can't tighten that. So once it's like this, it's like that. So now this is an upper partial as well.
You know, and now they've lost some bone and it's not sitting as well. I am going to put it once again, leaving the back part alone. I'm going to put it all around the inside. And then and then place it and once again, using the teeth to push up and make sure that there is a good seal. Does that help? Does that make sense?
CareLab Podcast
Yeah. Yes. Yeah. And I would encourage, I think you did a pretty good job kind of describing it, but I would encourage if you are needing a little tutorial on this, check out, and you're not already watching this, check out the YouTube version of this where you can actually see what Dr. Joy is doing and you can see the different styles of denture. That's probably really helpful in this scenario. Dr. Joy, thank you so much for being on HairLab. feel like we've got a resident dentist on HairLab.
Joy
self
CareLab Podcast
Yes, we appreciate you being on and tell everybody if they want to hear more from you, how they can find you.
Joy
Absolutely. The best way of reaching me is by email. So my initials JVPdent at gmail.com. Please feel free to email me with any of your questions. I'll be more than happy to help. And pictures speak a thousand words. So if you have a denture or your loved one has a denture and there seems to be a problem with it, but you're not sure, take a picture of it, email it to me. I can pretty much diagnose with some really good pictures.
please feel free to contact me anytime.
CareLab Podcast
And of course, if you have more questions about dentistry or general questions about oral care or anything like that in general, please feel free to put those questions in the comments. We would love to have Dr. Joy back on again sometime to answer those types of questions. Dr. Joy, again, thank you so much for being on this episode of Care Lab. Dear listener slash viewer, if you made it to the end of this episode, take a second to like, subscribe, share, follow. Leave a comment, leave a review. These are the best ways to help other people find this content.
that you also found helpful today. We'll see you next week right back here on Care Lab. Bye. Bye, everybody.
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