What causes floppy dentures?
Older patients often have floppy dentures. There are three issues that could be causing the problem; and usually it is a combination of all three, rather than just one.
Weight loss. The first thing to consider with floppy dentures is that the patient has had weight loss. The first area of the body where weight loss occurs is in the gums. That is going to impact the fit of the dentures. A person can go into ICU on Monday and have dentures that fit very well, and within two or three days they are starting to flop because of lost weight. You have to be very careful whenever there is weight loss and floppy dentures because now there are going to be sores on the hard palate and the gums. That is going to create a painful chewing process for patients. They usually do not want to put the dentures in at that point. That puts us in a difficult situation for identifying the diet that is most appropriate for them. If the dentures are beginning to flop because of weight loss, we need to figure out how to get the dentures secured. Are we going to use denture adhesive? Are we going to have them realigned? There are different ways that we could address that problem.
Dry mouth. The second thing that creates a problem with floppy teeth, in addition to or instead of weight loss, is dry mouth. Dentures sit on saliva to adhere to the gums. If the patient does not have any saliva - whether that is due to medication issues, or a disease process, or a combination of both - the dentures are going to become very floppy and will cause sore gums, pressure sores, or even lacerations of the mucosa. Additionally, the person’s tongue tends to stick to the palate. It is just a very dry environment. This creates another problem because a dry mouth is a breeding ground for bacteria. This makes oral care even more critical than it would be in a healthy individual. So, not only might we have to use denture adhesive, or have the dentures realigned, but we may also need to address the dry mouth.
If a patient has a dry mouth and is not producing saliva, like we often see in older patients or cancer patients, that then is going to create a problem in the esophagus. There is a process called esophageal acid clearance, and saliva is needed to wash the acid back down the esophagus. If there is not enough saliva, then the pepsin - the acid that comes out of the stomach – is more likely to irritate the mucosal lining, and that can create Barrett's Esophagus, and some other problems as well. So, we really need to look at the dry mouth.
Bone resorption. The third cause for floppy teeth is bone resorption. Three years after removing the teeth, you will have lost about 50% of your bone ridge. The earlier the tooth loss happens, the quicker this process occurs. When there is nothing to glue the dentures onto, I do not care how much denture adhesive you put on, it is not going to work very well. We had a gentleman in one of our facilities that really did not have a lot of bone for his bottom plate. When he would go through the meal process, and begin to chew, the dentures literally almost turned upside down in his mouth. We had to take out those teeth. If you cannot secure the dentures, I would suggest you really consider taking them out, because they do bad things if they are flying around the mouth.
So, weight loss, dry mouth, and the loss of bone support are three factors that contribute to floppy dentures.
Please refer to the SpeechPathology.com course, Sensory Changes in Adults: Impact on Swallowing & Diet Selection; Part 2, for more in-depth information about sensory changes in the aging population that impact diet selection and therapy planning.