Dentures and Stroke

After a stroke, many survivors have difficulty with old—and even new—dentures fitting properly. Each case, of course, is individual and different, but a few common problems do occur.

Stroke patients with full dentures usually have the most difficulty. Partial dentures, which have support from natural teeth, are less of a problem. If someone does have a set of full dentures that is 25 years old, these likely do not fit very well any longer, apart from stroke-related problems. But interestingly, under normal circumstances, a person may still function reasonably well, using older dentures. People manage to use them beyond the time that they fit accurately because they have learned to compensate by stabilizing them with their muscles—they have learned to juggle them over the years, as the fit slowly changes. They can, in fact, be very satisfied with the dentures, even though the fit has changed. After a stroke, however, patients often lose some of their muscular coordination, either immediately or over time. This is also a consequence of general aging, and this problem starts to arise, even with older people who have not had strokes. As coordination drops, patients have difficulty with their dentures, and the accurate fit is no longer there to help them out.

Another complication is also simply that, during aging, there are a lot of physical changes that start to occur rapidly—hair loss, drooping faces, curved backs, etc. Bony changes (that is, loss) can also accelerate in the mouth, which reduces the physical support foundation for the dentures. Bone loss is continuous without natural teeth in the mouth, and over time, there is just not enough left to stabilize full dentures. Fixodent, though helpful, cannot replace the level of stability that once existed when more bone was present. Strokes can have an accelerating influence on aging, especially if patients are not eating as well, but these things also often happen just from getting older.

Finally, one of the most common influences on this problem for stroke patients is that many of the medications which are now prescribed reduce saliva production. Saliva is essential for any denture to remain stable and, without it, retention suffers a great deal. Denture stability is reduced because the capillary action of a fluid between the denture and the tissues is gone. It is similar to the retention differences you see between a dry plastic suction cup on the window and one which you have licked. The adhesion and vacuum created is much better on the wet one. The lack of lubrication also causes many more mucosal injuries to occur from the dentures. The "oil" has been reduced, the parts start scraping, and the resulting injuries do not heal well.

There are often other problems involved in each case, but on a more individual basis. Situations mentioned here are difficult to change. Changing medications is often a choice between more saliva, and dealing with depression, hypertension and many other disorders without pharmacological help. It is hardly a sensible trade-off. There are some artificial salivas on the market, and they do help some people, but they need to be constantly used, and the dentures need to be removed each time they are used to allow it to get on the mucosa.

It helps to keep the dentures out of the mouth as much as possible, to allow the tissues to rest. They should, at a minimum, be left out over night. Many patients do not do that, but it can help in some instances.

Another thing to consider is having new dentures made. However, because of the difficulties discussed here, such dentures should be made by a specialist in prosthetics—a prosthodontist. Full dentures are not a large part of most general dentists' practices, and, while there are some in the general dentistry community who are very good in this field, finding out who they are is almost an impossible task. The best thing to do, then, is look for the credentials of someone who has had specific training in the area. Such professional fees are higher, but such individuals should be able to look at the situation and advise if new dentures would really help, and if so, the patient will have the best results.

What about implants versus dentures? Implants are wonderful if (1) they can be effectively placed in the patient—not always an option due to health and/or bone quality, and (2) if they are affordable for the patient—they are very expensive and seldom covered by insurance. However, we have a number of patients who could no longer wear their dentures until implants were placed to help support them. That is another subject, however, and one that could also be addressed with a prosthodontist.

© Jon B. Rampton, D.D.S.

SAFE (Stroke Awareness for Everyone, Inc.) has been given permission to reproduce this article by its author, Jon B. Rampton, D.D.S. Dr. Rampton is Associate Professor and Director, Division of General Practice, at the Medical University of South Carolina.