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I can’t stop gagging wearing my upper denture

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Dr. Hall
I got an upper denture but can’t stop gagging. What can I do?
– Teri from Peoria, IL

(See Dr. Hall’s answer below.)


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Teri,
That can be a tough problem, but let me suggest a couple of possible solutions.

drawing of an upper jaw with four implants embedded in the jawbone, and replacement teeth positioned ready to be fastened to themThe best and easiest solution would be to have an implant-supported denture. A removable denture, to get appropriate suction (because that is what holds it in), has to cover your entire hard palate. An implant-supported denture only needs to cover the gum tissue. So there would be no triggering of the gag reflex.

But, if that is beyond your budget, it may be possible to solve the gagging problem without going to implant support.

A photo of two dentures on plaster casts, one extended to the vibrating line and one cut to be short of that line

Screenshot

Ideally, the base of your denture should extend to the limits of your hard palate, to what we call the “vibrating line,” which is where your soft palate begins. If that makes you gag, it may be possible to get adequate suction without going back that far. A prosthodontist in Lancashire, England, Dr. Finlay Sutton, has published his technique for providing upper dentures to patients with an extreme gagging problem. On the left is his photo of two dentures on plaster casts. The upper shows the denture extended all the way to the vibrating line. The lower photo shows a denture trimmed to be short of that to accommodate patients with a severe gagging problem. It has to be trimmed expertly, because if it is trimmed too much or in the wrong places, it will weaken the suction too much to the point where the denture won’t stay in.

It is also possible that your dentist has made your denture to extend onto your soft palate, which is wrong for any patient. If you suspect that is the case (because you normally don’t have a gagging problem), I would get a second opinion.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

Should I save my two last good upper teeth?

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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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Mike,
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,
Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

My new denture won’t stay in

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Hello Dr. Hall,
I had all upper teeth extracted several years ago and got a denture, and now I need a new denture. So I picked a dentist who said he could get me a good-fitting denture.

Anyway, he did the impression was done followed by a wax bite and then two wax try-ins. When I had the second wax try-in I informed the dentist that it wasn’t staying in. He said the wax try-in is just about the teeth. But then, when I got my new denture, there was no suction at all and it wouldn’t stay in. The dentist said I have to give my gums time to adjust to the new denture and come back in a week to be evaluated. I returned in a week with NO change. I told him I love it WHEN it stays in, which isn’t very often!

He thought that maybe the problem was that my bite was off, so he took my denture and ground on it, maybe four times, each time checking my bite again! Then he put Fixodent on it, put it in my mouth and said to use the Fixodent and come back in (another) week to give my gums time to adjust to the denture. Let me also add that he ground down 3 molars on each side of the inner side of the denture to practically nothing.

I overheard him say to an assistant about maybe doing a reline. ???????

My question is: Why would he think a reline will work when the original impression (done only a month earlier) didn’t work???? My suspicion is the original impression wasn’t right and he wants to just do a “reline” to save HIM money instead of re-doing my new $1225.00 denture AND owning that he, the lab or somebody in his office screwed up.
Am I on the right track here or am I missing something? My next appointment is next Wednesday after having to do the Fixodent for a week. This isn’t what I signed up for.

– Carol from California


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Carol,
While your dentist isn’t innocent of all dental transgressions here, a reline should be the appropriate remedy for your problem of the denture not staying in.

I going to try reading between the lines about the procedure your dentist went through in order to give you some insight into what is going on. If you have indeed told me everything that went on with your getting this denture made, your dentist skipped a couple of steps that he was taught in dental school. But this is a common practice. There is a lot of price competition in the denture market, and the way a dentist trims the cost of a denture is by skipping some steps. Most of the time the end product is a perfectly adequate denture. In your case, it sounds like the denture is okay except for the fit, and a reline should take care of that problem. Something didn’t turn out right in the impression process, and a reline basically re-does that impression.

The best, most accurate impression is done with a two-step impression. I actually used to use a three-step impression. I would take a preliminary impression with alginate, from which I would make a preliminary model of the jaw and my assistant would use that model to make a custom tray specific for the patient. Other dentists will use a special moldable stock tray which many dentists say are as good as a custom tray. But the important part of the impression is the next steps. A heavier impression material is used to register what will become the borders of the denture. The process is called border molding. It’s the border of the denture that is responsible for the suction of an upper denture. To create suction, you want the border to press into the tissue a little, which is why the dentist will use a heavy-body impression material. This will be followed by what is called a wash—a light-body material that fills up the interior of the impression that registers all the tiny details of the soft tissue. When this impression is shortened to one step, a medium-body material is used. As I said, the result will usually be an adequate denture, but the dentist will save chair time which saves on the cost, which is usually, but not always, passed on to the patient.

With your denture reline, your dentist will most likely use the denture he made for you as a custom tray and should get a more accurate impression than he got the first time. If he hasn’t done that impression yet, I would ask him to use a two-step impression, if he didn’t do that in the first place.

This that he told you that the gums needed to adjust to the new denture sounds to me like a stalling tactic. Gums don’t adjust to a new denture. As far as the fit of the wax try-in, he was correct that the base used for the wax try-in is made to be an approximate fit. If it is made to an exact fit it will abrade the model on which it is made and thus compromise the final fit of the denture. The wax try-in is done just to check the positions of the teeth and to make sure you like their appearance.

I hope this is helpful.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

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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