2010年4月13日 « トップへ » 2010年4月15日


Concerning Dentures for Young People in their 30s and 40s

Q. Do young people also get dentures?
I was diagnosed with gingivitis in my late 30s. I have suffered from cavities, inflammation, and pain for many years, but every time I went for my periodic checkup, my dentist just cleaned the plaque from my teeth without mentioning anything about gingivitis. When I finally mustered up enough courage to change dentists, I was shocked to find out that the bone of my three upper molars on either side had rotted and would no longer last. I was told that more bone had begun to rot. The bone has become too thin to support implants making the procedure too difficult. Do young people also get dentures?

A. We receive many questions about young people and dentures.about young people and dentures.
"I'm too young for dentures. It's embarrassing."
"I can't talk to my friends or family about this."
"I'm nervous about seeking consultation"

We hear from many people who share the same apprehensions. A lot of people know that their teeth are getting worse but avoid consultation due to anxiety.

In recent years consultations with young people concerning whether they should choose dentures or implants have increased drastically.
Our clinic has adopted the telescope system, a technique developed in Germany, the world leading country in denture technology. This technique completely changes the conventional image of dentures. Clasps are completely invisible and no shifting occurs while eating.
They are esthetically superior just like implants. And there is no need to remove them before going to bed at night. They feel like a part of you.

If you have only lost 1 or 2 teeth, then it may be better to choose implants. But if you have already lost more than a few teeth, then it would be rather risky to treat all of them with implants.

Implant treatment lasts for 40 years at best. If you have numerous implants put in in your late 30s, then it is hard telling the difficulties you may encounter 40 years later in your 70s.
This is where our telescope system comes in. With the telescope system, dentures can be adjusted and used continuously for a very long time. Also, no one will be able to tell that you are wearing dentures.

There are many patients who have undergone telescope system treatment at our clinic I their late 20s.
One patient who underwent our Riegel telescope treatment 7 years ago in his late 20s has been coming in for monthly maintenance and has not required adjustment or repair to his dentures at all. He also put on a few pounds since he is able to enjoy meals unhindered by dental equipment but that is another story. He is not the least bit embarrassed about getting dentures at his young age.

We also conduct consultations through mail. Please feel free to contact us.

Dentures in Your 30s
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I was told that may facial expression would change when I get my teeth fixed...

This is a question answered by Dr. Inaba, representing dentists, in a feature article from a home magazine titled, Famous Doctors Answer Questions from Concerned 40-Somethings,

Q. The other day I took my mother to the dental clinic. She is going to be 66 years old this year but her face looks older. Many people think she is in her mid-70s. Not only does she seem older than her peers, but there is something about her expression that makes her look somewhat impoverished. She has always had all of her needs met and she is now living with me, her daughter. I don't think she should look so worn...

My mother doesn't like to visit the dentist, even if it is only to receive treatment on a single cavity like it was the other day. She really never goes to the dentist on her own. I was finally able to get her there the other day and the dentist suggested that she have 3 false teeth put in where she had already lost her teeth. She got right up and headed straight home upon hearing that. The dentist told me that since she had left those 3 spaces toothless for such a long time, her chewing functions have deteriorated and it has even had an effect on her bone. He said that this is one of the reasons for her emaciated look.

I don't quite understand a lot of the more difficult things that he said, but I do recall him saying "If she just gets those 3 teeth fixed, she will look 5 years younger at least". After he told me this, I couldn't help but think to myself that she certainly would look younger with her upper teeth numbers 3, 4, and 5 intact. Is it really possible to regain a youthful look by having your teeth fixed? I want to convince my mother to go in for treatment and I was wondering if you could help me find the right words. I would love her to get treatment as soon as possible so her grandchildren can play with her and look upon her beautiful face the way it used to be.

Also, I am sorry to bother you with more questions, but I was told I should replace the metallic fillings in my lower teeth with white-colored false teeth. You can see them when I laugh and it can be quite embarrassing. I heard that this could give me a brighter look so I was thinking about getting that taken care of as well. But if it won't help, I might regret getting treatment. Do you know how much this procedure could help my smile? Also I am willing and able to pay for treatment even if it comes out to be a little pricey.

A. Leaving the mouth with 3 missing teeth can have a negative effect on mastication functions (chewing functions). Just as your dentist has said, when you lose teeth the bilateral balance of the mouth is lost and the muscles on the side of the jaw where teeth are missing will deteriorate. As a result, facial features will most certainly lose their balance. Therefore, I absolutely recommend putting in false teeth.

You can see from the profile of someone who has lost teeth that their upper and lower lips sink inwards (left), but when the same person uses dentures, you can see that their natural features are restored (right).

Our appearance is also related to our personality

Just as people are told to take responsibility for their appearance after turning a certain age, it is said that people are responsible for creating their own countenances. In our society, the countenances of people who run companies, are in positions of responsibility, or have a business, are shaped by their various lifestyles. People who have healthy teeth give a nice impression to people around them and it is even said that our teeth say something about our level of education. Long ago people did not worry so much about poor tooth alignment or missing teeth. But in recent years, the state of our teeth has become an indicator of our status. For that reason, it seems that our appearance is beginning to tell a lot more about our personality.

It is true that fixing your teeth can make you look younger. But it is not just the teeth that effect the countenance. If someone stays at home all day with a negative attitude, that will add to their dreary demeanor. Nothing is more important than getting out of the house and interacting with people positively. The condition of your teeth is just one part of that equation. It is possible that if your mother has her teeth fixed, she may become more optimistic. This is why I recommend that you help her get dentures.

It is ideal to have your teeth fixed to look more natural

You also brought up the issue of your metallic teeth. We dentists always wish that our patients can have a natural smile of nice pearly whites just like the ones their parents gave them. It is important to have your teeth fixed so that no one can tell that you have had treatment done at all.

In recent years, most tooth disease has become preventable. With the correct oral care, you can protect against cavities and pyorrhea. But in the unlikely case that you do suffer from tooth disease, it is best if you can repair your teeth to their natural state. So for that reason, I think that you should aim for white teeth.

Nowadays, natural looking ceramic teeth are mainstream, but since Japanese healthcare does not yet cover ceramic teeth, people who are limited to health insurance must settle for metal crowns. With that said, we must remember that in some countries, health insurance only covers preventative medicine. That is, from the perspective of, "Since we know the cause of a disease and it is preventable, then if you suffer from the disease, it must be your own fault" and the idea that "Prevention can be paid for from a public source (medical insurance), but treatment must be covered by the individual, out-of-pocket", many countries require that citizens pay for their own treatment expenses. Please see your doctor and have your teeth restored to a better feeling, more natural state.

Changes of the face overtime

I do not know the detailed condition of your mother's face and the inside of your mouth, I can only give you a general answer. Please forgive me for this. You say that your mother looks older than her peers. Many factors affect how peoples' faces look.

When we are children, we inherit our facial features from our parents through genetics. Our parents' features present themselves in our face and there is nothing anyone can do to change this. In Japanese this is called umaretsuki, or 'the face we are born with'. Our faces tend to be rounder when we are young and our skin more supple. We have tight beautiful faces when we are young and at this age we have baby teeth. But they are replaced by adult teeth, our jaws take shape and the area under our noses develops giving us adults a longer face. Our faces are finished growing when we become adults and they begin to change in a different way as we age.

Faces change shape as people gain and lose weight. There are also changes associated with the environment. People who work outside all of the time will certainly have a peculiar look, and people who struggle with illness may lose weight and experience further changes in their face.

Changes to the eyes and mouth stand out the most

Changes that human beings cannot avoid are changes that accompany aging. Especially in your 66 year old mother's case. She has entered a time in her life when the changes are most apparent. Her hair is turning white and the muscles in her face are becoming thin. Changes to the eyes and mouth stand out the most. Some people have large bright eyes, others have small friendly eyes and some have beautiful almond-shaped eyes. The eyes have the largest effect on our expressions. When we are joyful our eyes open wide, when angry they close to a point, and when we age, they begin to gather wrinkles and the pockets of fat under them begin to stand out.

The mouth, just like the eyes, also has a large influence on our expressions. You can usually tell the extent of the expression in our eyes, how happy or how sad we are, by the shape of our mouths. For example, a joyful expression is characterized by glinting our eyes and loosening the tension in our lips. The happier we are, the wider our smiles open up. That is to say, we show how happy we are or how fun something is by how we open our mouths. Following this line of thought, we can say that the eyes and the mouth work together as a pair and that expressions are none other than composites of the various parts of our faces.

The characteristics that are visible around the mouth of an aging person are thin muscles and wrinkles under the nose. People with healthy teeth usually have less wrinkles, but when people lose their teeth the lips, which have lost their support, are pushed inwards by a group of muscles called the orbicularis oris muscles, creating may wrinkles.

You have said that your mother is missing her numbers 3 through 5 teeth in the upper right. Either side of her lips must be sinking inwards. I imagine that she must look thin with no teeth there.

I recommend that she gets treatment soon so that she can lead a happy life.

Patients who use Dr. Inaba's dentures truly have beautiful smiles, don't they!

I am having a difficult time because my partial dentures don't fit

Q. The other day I had partial dentures made through health insurance. I am having a hard time because they do not fit.

This problem concerns dentures for my left and right molars on the lower jaw (4 of my left molars and 3 of my right molars are tied together with wire and are holding my dentures in place with spring metal parts). It is so severe that I have not yet been able to keep my dentures in for a whole day. Yesterday I went to the hospital for the first time in a while to fix the parts that were hitting against my teeth. Even though they fixed the parts for me, I still feel like my bite is weak. In fact it is so weak that it is still easier for me to take out my dentures completely when I eat. (Maybe I shouldn't force myself to use dentures at all?) I have had the nerves in my remaining teeth treated and the dentist told me that they are weak.

They kind of float up when I am chewing and they were pretty cheap (about 7000 yen). I suppose for that price I shouldn't expect anything more precise.

A. There are usually 14 bottom teeth, not including the wisdom teeth. So you seem to have lost 7 of those, or half of them, right?

Currently, Japan's health insurance-covered treatment method is to provide dentures that use metallic springs called clasps that hold dentures in by hooking them to remaining teeth. Since these springs are simple devices, it is common to experience an awkward feeling due to the dentures moving as they react to the force of your molars grinding food. Also, since artificial plastic teeth and natural teeth are completely different in hardness and shape, it is thought that these dentures cannot function very well. The grooves of your teeth are not random. They are in fact made according to rules that govern the back and forth and side to side movements of grinding. However, dentures covered by health insurance are made to have flat shapes that make it nearly impossible to grind food.

Everyone has a relaxed position unique to their own mouths (the central position), and if the dentures don't match up to that position when chewing, it can feel awfully awkward. The bite alignment plane is very important and basically should be bilaterally symmetrical. Sometimes when examining a patient whose dentures don't fit, we find that this standard is not met. I think that all of these factors lumped together can cause patients to feel that their dentures just don't fit nicely.

The good thing about the dentures that use clasps is that they are covered by insurance and can be used as false teeth after having teeth extracted. There are a few negative aspects about them though. First, if you use them for too long, the teeth supporting the springs can come loose. This is because every time you attach or detach them, they are placing a burden on your teeth, and whenever you chew food, your dentures wiggle around and in turn the teeth supporting them wiggle as well.
The positioning of the clasps is the same positioning that we dentists place our tools in when extracting teeth. Since the clasps are mimicking these actions slowly and over an extended period of time, before you know it, you could be suffering from loose teeth and symptoms similar to pyorrhea. The result is that you may lose these teeth. Also, these dentures are not so esthetically pleasing since they are riddled with metallic clasps. In Germany, a highly developed nation in denture technology, dentures that use clasps are so outdated that they are no longer even covered in textbooks in dental universities.

+ The bite is so weak that it is easier for me to take out my dentures completely when I eat. (Maybe I shouldn't force myself to use dentures at all?)

In response to this, I would have to say that of course it is better to eat with your dentures in. The reason for this is that the upper teeth and lower teeth maintain a balance when they come together biting. If you remove either top or bottom, your teeth can become weaker or start to extend out due to lost function. It is very difficult to adjust the bite alignment plane of a mouth with teeth that have begun to extend out.

One more thing is that without molars, the jaw joints will deteriorate. Bite alignment and joint movement work as a pair, so without molars there is an incredible extra burden on the joints. Muscle movements that pull on the joints are connected to joints in the neck that support the head. This is why these problems can cause other symptoms such as stiff shoulders, back pain, and headaches.

So is there one treatment method that can solve your problems?
One treatment option relies on implants.
This method calls for inserting a titanium plate into the bone of the jaw to create a foundation. In this patient's case, 7 implants would be placed into this foundation.

But in this case,

+ He has had nerve treatment and the dentist has informed him that his teeth are weak. So in this patient's case, instead of implants, I would recommend dentures made using the Riegel telescope method developed in Germany.

'Riegel telescope' is a type of denture technology from Germany first introduced to Japan by Shigeru Inaba (our clinic's advisor). Advisor Inaba spent a year and a half learning the authentic 'Riegel telescope' method directly from Professor Koerber at Tubingen University in 1978.
Since it requires a high understanding of oral theory and skill, this technology is not yet widely practiced in Japan. So we are working hard to spread knowledge of Riegel telescope.

It would cost 400,000 to 500,000 yen per tooth to replace your lost teeth with implants. It is no wonder that a set of dentures that cost 7000 yen, or 1000 yen per tooth, are causing you discomfort.

Konus Krone

Q. I have a question concerning my 65 year old mother who has dentures. 5 years have passed and she is still not used to the dentures that she got through health insurance. I am looking into Konus Krone dentures for her. Her lower bridge has come out and she only wears her upper full dentures when she leaves the house. She says that she feels pain and that it is difficult to bite. I searched for a dentist specializing in dentures and asked his advice. He said that they could leave 4 teeth in her lower jaw and she could have Konus Krone dentures made.

1. Are Konus Krone dentures more comfortable to wear than dentures covered by insurance? What is the difference? (Are there many people who cannot get used to health insurance dentures who choose Konus Krone instead?)
2. Do they last? How do they compare to health insurance dentures in lifespan?
3. Her current dentist suggests that if we decide to spend the money, we could have upper dentures made through insurance and make use of her bottom teeth to have Konus Krone dentures made. Is it really OK to spend so much money on the bottom teeth and so little on the top ones?

A. First, it is actually quite common for people to have never heard of Konus Krone dentures, so let me explain about them a little bit. Konus Krone are dentures developed in Germany. This is one of the many types of the telescope system, which has a longer than 100 year history in Germany. Konus, of course, refers to the conical shape, and 'Krone' refers to the internal and external crowns used to hold the dentures in place (it is a double crown method).

The angle of the inner crown is 6 degrees (the Konus angle), and retentive force is produced by the wedging force of the inner and outer crowns. If you can imagine stacking paper cups, these dentures work very much in the same way. After putting these dentures on, the internal and external crowns fit into place and will not come apart. This angle can be adjusted to match the condition of the patient's teeth. As for removing them, there is an indentation in the dentures where you can slide your finger to lift and remove them.

These dentures do not fall off on their own during daily activities.
Fundamentally, Konus telescope cannot be used on teeth that lack nerves. This is because the retentive force is transferred directly to the supporting teeth, and if those teeth are nerveless and weak, there exists the danger of uprooting them completely. Also, there is the possibility of contraindication from left over teeth in the jaw. Therefore it is important to have a proper examination, diagnosis, and treatment method. If done correctly under the right circumstances, these are superior dentures that can last for many tens of years.

With that said, I'll answer your questions one by one.

1. Are Konus Krone dentures more comfortable to wear than dentures covered by insurance? What is the difference? (Are there many people who cannot get used to health insurance dentures who choose Konus Krone instead?)

The feel of Konus Krone dentures as compared to that of health insurance ones is completely different. Usually, when a patient only has 4 teeth remaining, Japanese health insurance only covers dentures with wire springs called clasps. The clasps stick to the teeth, but the dentures are not technically attached. This means that there is a lot of movement.
When dentures move around, it creates the awkward sensation of having a foreign object in the mouth. As opposed to this, Konus Krone dentures are attached firmly by the wedging force of the internal and external crowns and this means that there is no extra movement in the mouth. For this reason, many patients who cannot get used to health insurance dentures find relief with Konus Krone ones.

2. Do they last? How do they compare to health insurance dentures in lifespan?

When the teeth that support the clasps of insurance covered dentures fall out, it is necessary to have the dentures remade from scratch. In Japan, you are allowed to have these kinds of dentures remade over and over again if they do not fit or if they break, but with these German dentures there is no need to have them remade at all. They can be adjusted to fit the changing shape of the mouth. So it can be said that they are made for long-term use.

3. Her current dentist suggests that even were we to spend money, we could have upper dentures made through insurance and make use of her bottom teeth to have Konus Krone dentures made. Is it really OK to spend so much money on the bottom teeth and so little on the top ones?

It would be meaningless to go through all of the trouble to treat the bottom teeth but leave the top teeth with an implement that is not matched. The bottom and top teeth work as a pair. No matter how well the bottom teeth work, if the top teeth are not in synch, it will be impossible to eat and speak correctly.
They are also made out of completely different materials. The prosthetic teeth in Konus Krone dentures are made by Dr. Strack design. They are superior in function and beauty. Prosthetic teeth in dentures covered by insurance are made from a very soft plastic. If your mother gets insurance-covered dentures for her top teeth and Konus Krone dentures for her bottom teeth, it will be very difficult to get them to match since they will be made at different labs by different technicians.
I recommend that if you do choose to go that route, you should at least have the top dentures made with the same materials that the Konus Krone dentures are made with, and make sure that the dentist uses an articulator (a bite alignment device) to match the bite as accurately as possible.

I am self-conscious about wire hooks in partial dentures.

About partial dentures with invisible wires

Q. I have had the second to last molar on my lower jaw removed and now there is a bridge connecting my deepest molar to the third molar. I recently went to the dentist and learned that these two molars had gingivitis so I got them removed. Now I am missing all three of those teeth.

The dentist recommended that I get partial dentures covered by health insurance, but he also told me that my good teeth that the wires clasp onto are susceptible to gingivitis. When I mentioned that I am worried about the wires being visible, he suggested implants. But, I am afraid of surgery. Are there partial dentures that are better than those covered by insurance and have invisible wires?

A. Currently dentures made using Japanese health insurance use metal springs called clasps. The clasps are attached to the teeth, but there is no adhesion.
Because of this, when the dentures move the teeth also move. These movements exert a force that can lead to the tooth gradually becoming loose and falling out.
These dentures are constantly moving inside of the mouth because they are attached to the teeth using springs. When we dentists extract teeth, we do so by exerting a side to side force. It is the same exact movement caused by insurance-covered dentures.
Germany, which is a leading country in denture technology, doesn't even teach about partial dentures that use clasps anymore at national dental universities. This is because these kinds of dentures cause tooth loss.
There are a few types of dentures that do not move around in the mouth and that are nearly undetectable as dentures. Some of these include Konus Krone, Riegel telescope, CSP, and Milling dentures.
None of these options are covered by insurance, but they have invisible wires and are so comfortable to use that they become a part of your own body.

Let me tell you how we would treat 3 missing teeth with partial dentures made using Riegel telescope.

Subduction (movement) of the dentures can be great when biting with insurance-covered clasp dentures because they use simple metal springs that grab onto the teeth. This force is transferred directly to the teeth and will eventually cause them to become loose due to wiggling.
In contrast with this, Riegel telescope dentures will link and secure the 2 teeth used as a foundation, and those teeth will be double crowned. Retention force is provided by a small locking mechanism and the dentures are held firmly in place by closing this lock.

The subduction (movement) of dentures made using Riegel telescope is limited to 300 microns when biting.
Of course this provides a firm bite and the dentures feel like your own teeth. It can be said that Riegel telescope dentures feel as much a part of your own body as implants would.

2010年4月13日 « トップへ » 2010年4月15日