I will soon be left with only my upper two front teeth on top. I still have most of my bottom teeth. Would it be better to have the last two removed and go with a full upper, or keep the two front teeth and work around them?
Here are more details: I will be left with only my two front teeth on top, they are very healthy, and I assume would last many more years. I have an underbite. I have a cheap upper partial—big, bulky, cheapest material. Some dentists are saying I will be happier with a complete upper, rather than a partial to accommodate the two healthy front teeth. Some are saying ‘it’s up to you.’ Right now, I can accomplish some eating with just the front two upper teeth and most of my lowers. That means I only wear my upper partial for things like meat or nuts, etc to aid grinding. Speaking with the current uppers is challenging, so I only wear them on the rare occasions where I am going out to socialize, etc. I guess what I am saying is, I can’t change my mind after I have the front two out. Will a full upper be more comfortable than a partial? I assume it would look better.
I am on a fairly tight budget. ($5000 would be my absolute max) I am 54 and would like to feel better about socializing.
It is hard to track down people that have been in this situation and ask, hey, are you glad you got the last two pulled? did the advantages outweigh the disadvantages? If you were in this situation, what would you do? Thanks : )
– Mike from Plattsburgh, NY
(See Dr. Hall’s answer below.)
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I need a strong disclaimer before I start trying to answer your question, and that is that I can’t give you any definitive answers without an in-person examination, looking at x-rays, etc. But I’ll give you some principles to hopefully help guide your decision.
The first principle is that it’s almost always better to save natural teeth when they are savable. Replacing a natural tooth with a dental implant comes fairly close to the value of having a natural tooth, but replacing teeth with a removable appliance has a lot of disadvantages. When they aren’t anchored they will always slide around a little at least.
Having said that, in your situation where you are doing some of your eating on just those two natural teeth, that is putting a lot of stress on those teeth. You say that those two are strong and healthy. I take that evaluation with a grain of salt, knowing what I know about how stresses affect teeth. And then you have the lower teeth that they chew against—that stress can’t be good for them.
Another principle is that an upper full denture functions much better and is more comfortable, easier to chew with, than a lower. The upper is held in by suction and doesn’t move around much during function. The lower, because your tongue is in the middle, has no suction. It has to rely on gravity and control by your tongue and cheek muscles to stay in place.
Another principle is that when your teeth are gone, you have bone resorption. Your body will take the bone that used to support those teeth and use it elsewhere in your body. After 10 or 20 years, you end up with a condition called facial collapse, where your face has shrunk and most of the jawbone is gone. But the effects of facial collapse are much more severe on the lower, where you can end up with a pencil-thin mandible that has sharp ridges making it almost impossible to have a comfortable removable denture. On the upper, however, it is almost always possible, even with significant bone loss, to make a serviceable upper denture that has some suction to it. Besides that, you already have bone resorption in most of your upper jaw—your body only saves the bone right in the vicinity of the remaining teeth.
A further principle is that a well-made upper removable denture, when it is chewing against lower natural teeth, is much more gentle on those teeth than upper natural teeth, especially if there aren’t many natural teeth. An underbite, depending on how severe it is, can put more stress on the lower teeth.
Putting this all together and applying it to your situation, I’ll give you some idea of what you can do and what you can expect. Again, remember my disclaimer that I haven’t seen you or your x-rays, so I can’t say anything definitively. In a situation like yours, the very best clinical treatment would be to replace the missing upper teeth with dental implants, such as with an implant-supported partial denture. The problem with that for you is that it would blow your budget. You could limit the implant support to two implants, and that could maybe get you within striking distance of your budget.
To stay within your budget, my opinion would be that sacrificing those remaining two natural teeth and having a complete upper removable denture made would be an acceptable solution. It would look much nicer than your partial with two remaining natural teeth, it would be an improvement in chewing comfort, and it would help prolong the lifespan of your lower teeth. Run that idea by your local dentist who has examined you, feel free to share my input if you want, but go with your dentist’s recommendation.
Best of luck,
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
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