Q. Your recent article responding to a gentleman with aging teeth like mine is very interesting to me. I am very grateful to finally find a column related to teeth. Thank you.

My situation differs in that I can no longer afford expensive procedures and, in fact, I no longer want to go through more difficult work on my teeth. I am 73-years-old and in terrific health, happy, employed, and wary of spending more thousands of dollars on caps, bridges, fillings, extractions, etc. I have spent many, many hours in the dentist chair and many thousands of dollars.

I have only nine teeth remaining on the top and about the same on the bottom. All of my front teeth are intact, mostly caps. While I am not happy without back teeth, I feel I have done my best in caring for my teeth.

My question is: At what point do I say enough? Pull them and make me some dentures? Do I continue to do whatever is necessary to keep the remaining teeth? I want to retire this year (I’m going to be 74) and will be on a fixed income. What would you suggest please?

– Grammy Kathleen

A. It is a shame that after all the effort and dollars that you have put in over the years, you are left in such a compromised state. I clearly understand.

What is puzzling is why the deterioration continues. At this point your decay rate should not be a problem assuming you have a diet fairly low in sugar and good daily hygiene. You do not mention that any of these teeth are loose, so I guess you do not have gum disease. All of that means that extracting any of your teeth would be for elective reasons.

You are considering complete dentures and yes, once you remove all your teeth, aside from readjusting the dentures in the coming years, most of your dental expense would be minimal. With retiring and being on a fixed income without the desire for surprises, dentures are an option.

For many, complete dentures can look good and function adequately. My advice is that only an upper denture can be fairly predictable. Your upper jaw is not moveable and being attached to your skull makes it a much easier dental arch to restore with a denture that looks good, stays in place and functions well after a period of time getting used to them.

Since the lower arch is moveable, a conventional lower denture is not so adequate. With the arch moving and no real ability to maintain a seal so that the denture will stay in place, these restorations are often unsatisfactory.

We do, today, have other ways to keep dentures in place and this is with implants or even saving a few teeth in each arch and making tooth supported dentures, similar to implant supported ones.

It is very hard for someone like me who has desired to save teeth my entire career to recommend extraction at any point if it is elective. But I clearly understand your need to explore all options.

One approach that I like is seeking the help at a dental school. If you go to one, you have the advantage of knowing that you will be getting excellent treatment usually at a very minimal cost. Yes, students and maybe residents would be doing the treatment but all of that is overseen by, for the most part, very qualified and competent faculty. The only problem in the dental school is getting there and realizing that it takes much more time to deliver the care. That means quite a few more visits than in a private practice. My usual advice is that if you have more time than money and are not in a big hurry, the teaching institutions are an excellent place to start. Even if you go there just to get a work-up, diagnosis and treatment plan, you will then have that in hand to give you a sound basis for decision making when you are ready for it.

Remember also, that nine teeth against nine teeth, which it seems is what you have, can function fairly well. Yes, it puts a lot of stress on those teeth but if you have no habits such as grinding and clenching and use them carefully to chew to start the digestive process, you may be able to put off the ultimate decision for a while longer.

I would first carefully explore the health and function of your remaining teeth. If they satisfy your need for cosmetics and function, I might stay with them for a while. Once extracted, it is irreversible.

Secondly, I would gather treatment plan information for a complete denture only on the upper jaw, putting as much effort and dollars into saving the teeth in the lower jaw since that is the harder to restore.

Also look into the tooth supported and implant supported option if the lower teeth are to be extracted. I do not believe you need to think of that for the upper denture.

Kathleen, I hope I have helped at least to get you started in the right direction and if more questions come up, please put them to me. This process and decision may take some time.

Dr. Richard Greenberg of Ipswich practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question or comment about the column? Email him at [email protected].


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