HIGHER COUNCIL OF PRACTICES QUALIFIED IN DENTAL IMPLANTOLOGY

International body for assessment of validation and homologation (Canada)

The reasons for dental implants

Our first professional duty is to inform you of the fact that once you have had your teeth taken out, you start down the slippery slope of bone resorption, facial collapse, impaired health and reduced life expectancy.

Gradual bone loss in the lower jaw: bone loss is continuous and inevitable. In the absence of tooth roots, which normally transmit the chewing pressure to the bone cells, the jaws are resorbed at a rate of 0.5 to 1 mm per year

The prematurely aged face of this young woman in her mid-thirties  clearly shows the disastrous effects of progressive bone loss in the jaws. The bone loss here began as soon as her teeth were taken out, when she was a teenager. The characteristic sunken lips and the projection of the chin towards the nose, both of which are more and more prominent, have contributed to facial collapse.


In the presence of this type of situation, prostheses on implants fitted by your practitioner restore a correct position, provide support for the lips and ensure that there is a harmonious distance between the chin and the nose.

 IS THE HEALTH OF DENTURE WEARERS REALLY IN DANGER if the dentures are unstable?

Nutritional and digestive risks linked to total and partial loss of teeth
Chewing has advantages that should be better known!!!
Its role is to prepare food before it goes through the digestive tract.

This is because chewing:
• Enables us to eat a wider variety of foods
• Makes us feel full up
• Combats weight gain
• Improves digestion
• Enables us to absorb nutriments such as vitamins, minerals, proteins and dietary fibre
• Is essential to keep us in good health.

The loss of teeth considerably reduces the chewing function
• The state of the teeth plays a major role in chewing efficiency
• People who have all their teeth have considerable chewing efficiency =100%
• The loss of the back teeth reduces chewing efficiency by 50%, and the loss of all the teeth results in a reduction of 80 to 90%; this means that wearers of full sets of dentures have a chewing efficiency of only 10 to 20%.

Chewing for denture wearers 
Denture wearers suffering from bone resorption at an advanced stage leading to instability/inefficiency of their dentures:
• Have forgotten the extraordinary chewing efficiency of natural teeth (100%) that they lost 20, 30 or 40 years ago
• Are unaware that their chewing ability has been reduced by 80 to 90%
• Tire quickly when they chew
• Often overestimate their eating capacities: they tend to swallow their food straightaway without crushing it completely.
• Often content themselves with extracting the juices and tastes of food

Chewing and the digestive function

The digestive system assimilates the nutritious elements or nutriments that are contained in the food we eat. Digestion of food frees particles that are small enough to be assimilated in the organism, nutriments. These nutriments are absorbed by the bloodstream that distributes the particles throughout the organism.

The mechanical process of breaking down food starts in the mouth
Teeth and chewing:
• The food eaten is divided up into smaller pieces
• Easier to swallow
• Easier to digest

During chewing:
• The salivary glands are stimulated
• Secretion of saliva

Digestion starts in the mouth…
The water and mucus in saliva humidify and liquefy food
The salivary amylase starts the process of digesting starch

Chewing and digestion
During chewing: in the “cephalic phase”, hormones come into action to prepare the stomach for the mouthful of food it is about to receive

This function is affected by the loss of the teeth: the stomach is thus not ready to receive a mouthful of food that has been insufficiently chewed, and this has harmful consequences for the digestive tract as a whole, such as: stomach ulcers, gastric hyperacidity, discomfort or slow digestion, constipation, chronic diarrhoea, irritable colon, etc.

Correct chewing prepares the stomach for the mouthful of food it will receive. The arrival of that mouthful of food in the stomach leads to secretion of a hormone in the blood: gastrin, synthesized in the glands located in the stomach lining. Gastrin stimulates the production of gastric juice, a solution rich in hydrochloric acid (HCL) and mucus. When the stomach lining contracts, it enables the gastric juice to mix with the mouthful of food and transform it into chyme

Chewing and intestinal disorders

The fact of swallowing large mouthfuls that have not been chewed sufficiently is linked to several types of digestive problems.

Types of digestive problems linked to insufficient chewing 
• Extra work for the stomach, leading to increased discomfort or slow digestion, gastric hyperacidity, stomach ulcers, etc.
• Increased occurrence of constipation, irritable colon, diarrhoea, etc.
• Significant increase in the quantities of medicine taken to deal with gastrointestinal problems

The findings of certain studies...
Several epidemiological studies have shown increased frequency of digestive problems among wearers of dentures.

The findings of certain studies...
Malhotra, a doctor with the railway companies in India:
• Comparison of the incidence of gastric affections among two groups of employees with completely different eating habits.

Population in the Punjab, in the northwest of the country:
• Ate solid foods that involved prolonged chewing
• Less likely to develop gastric ulcers.

Population in the Kashmir and Assam, further east:
• Ate soft food swallowed quickly
• more likely to develop gastric ulcers.

To conclude, the dietary fibre contained in raw and solid foods is essential for correct functioning of the stomach and for health in general. Furthermore, the Canadian dietary guide underlines the importance of a diet that is rich in fibre, whereas for many denture wearers it is difficult or even impossible to put these recommendations into practice.

A study published in Public Health Nutrition in June 2001, in which 753 autonomous persons aged 65 and over and 196 persons living in institutions were interviewed, leads to two conclusions:

1) Over half the toothless persons wearing dentures find it all but impossible to eat raw carrots, apples, steak and nuts; they are thus forced to turn to soft food that is lacking in dietary fibre, proteins, calcium, iron, niacin and vitamin C.

2) About 20% of those wearing removable partial dentures attached to the remaining natural teeth stated that they had great difficulty eating  raw carrots, apples, steak and nuts; the difficulties increased with the number of teeth removed or missing.

Another study, carried out by Renaud (1980) states that:
• 92% of denture wearers limit themselves to a soft diet, and 66% of them swallow large mouthfuls of poorly chewed food, while 54% say that they avoid eating raspberries, cucumbers and tomatoes because the pips can get under the lower denture and hurt their gums ...

The recent studies carried out by McGill University, covering the long-term impact of unstable dentures and inefficient chewing on the health of toothless patients, arrive at the following two conclusions:

1) Classic dentures do not provide sufficient chewing efficiency to ensure continued good health among denture wearers, who have to fall back on soft food that is richer in fat and cholesterol and contains less dietary fibre, vitamins, minerals and proteins; this combination leads to a 10% increase in the risk of cardiovascular disease, and it also reduces life expectancy by 6 years according to a recent Japanese study (2001).

2) Denture wearers would be in better health and live longer, happier lives if they were to opt for prostheses on implants rather than classic dentures for their lower jaw.

Another field that remained unexplored UP TO NOW …

Headaches and migraines associated with stability problems for dentures
It is now known that headaches and migraines can be caused by unstable dentures, in two ways:

1) A pain is felt in the region of the temporal mandibular joints and it spreads towards the temples: if dentures are better stabilized, this reduces the muscular spasms that are apparently the cause of these headaches.

2) Bouts of migraine occurring invariably after meals and after eating partially chewed food. The frequent relief from migraines that has been reported to us is apparently linked to a more balanced diet and reduced digestion problems.

Malnutrition and the state of the teeth

It has been shown that malnutrition among elderly patients who are hospitalized is often linked to the loss of teeth and the instability/inefficiency of dentures placed on jaws with bone resorption. Thus the fact of keeping natural teeth in place or wearing  stable, efficient dentures enables people to avoid many  malnutrition and health problems. (Oral Ds. 1999 Jan; 5(1): 32-38)
 

Elderly people with reduced autonomy and poor health
According to an extract from the Quebec oral and dental health network: poor oral and dental health can lead to a state of nutritional deficiency and affect health, which in turn results in the necessity of taking these persons into care centres several years (10 years) earlier than would otherwise have been the case, while a Japanese study carried out in 2001 states that denture wearers die 6 years earlier than people with at least 20 natural teeth.

Impact of the various therapeutic approaches

Initial objective of intervention
“To enable people to eat raw food and food rich in fibre, that they have had to go without for several years”. This fresh source of nutriments is bound to have a beneficial effect on the digestive tract, especially the intestines, and help to maintain an optimum state of health.

The importance of nutrition for health
According to the dietary guide, it is necessary to eat plenty of varied fruit and vegetables, together with whole grain cereal products: these types of food are recognized as being essential to stay in good health. It would seem rather difficult for denture wearers to follow this recommendation.

An economic study of dentures
The fact of wearing dentures held in place by implants could constitute an efficient mode of readjustment for people with chewing problems. This solution would seem to be more efficient than conventional dentures. Researchers in the network have compared the direct and indirect costs of these two types of dentures (removable dentures and those on implants) together with their efficiency, and they conclude that the extra cost linked to prostheses on implants is more than made up for by a better state of health and well-being.

During an international symposium held at McGill University in May 2002, experts from all over the world came to the following conclusions:

1) Toothless people would be in better health and live happier lives if they opted for dentures on implants rather than classic dentures for their lower jaw.

2) Over a considerable period, international dental literature has covered the problems of bone resorption, digestive and gastrointestinal problems, headaches, neck pain and earaches suffered by many wearers of full sets of dentures.

3) The studies carried out by McGill University show that chewing difficulties following the loss of teeth lead to malnutrition that results in reduced intake of vitamins, minerals, dietary fibre and proteins. This malnutrition can lead to increased levels of body fats, higher cholesterol levels in the blood and cardiovascular diseases, which in turn can lead to earlier death.

4) The loss of teeth results in major health problems. It constitutes a handicap under the criteria of the World Health Organization, as a conventional lower denture can only restore 20% at best of the chewing function normally provided by natural teeth.

5) Dental implants are now becoming the standard method used to replace lower teeth while protecting your health!

ILLUSTRATED solutions

• Chew a steak, raw vegetables and nuts efficiently and with pleasure
• Preserve your jaws, your face, your health and your self-confidence
• Bring a major improvement in the quality of your life and find a way of living longer

The consensus is the standard proposed by McGill University:
dentures on implants must replace classic dentures on the jaw¹!

As from May 2002, the new standard for efficient replacement of all the lower teeth is no longer a classic denture, but a prosthesis stabilized by at least two implants. Thus a prosthesis on implants for the lower jaw has become the new standard because classic dentures often fail to restore sufficient chewing ability to ensure continued good health!

Important reflections

Your practitioner is a professional health specialist who can accompany you along the path of reflections that will have the strongest impact on  protection of your health and your face for the years to come …

Although the information provided on this site clearly shows the cascade of harmful consequences, for the face and health alike, that stem from the loss of teeth and the fact of wearing unstable classic dentures on the lower jaw for long periods of time, it is dialogue with your practitioner² that will really provide you with the elements necessary to make a well-informed decision³.

Denture wearers would be in better health and live happier lives if they opted for dentures on implants rather than classic dentures for their lower jaw.

1- Articles summing up the new standard for the general public were published on 10 June 2002 in la Presse, le Soleil, le Journal de Montréal, la Tribune, le Quotidien, and other Canadian newspapers.
2- Your practitioner is responsible for making, mounting and adjusting dentures on implants. The dental surgeon* is responsible for fitting the implants.
3- The fact of fitting implants involves risks that will be explained to you clearly when you consult one of the practitioners and one of the dentists*. In some very rare cases, it may be preferable not to fit implants.
WARNING: the information set out in this document represents an opinion held jointly by practitioners and dental surgeons* who are members of the Higher Council of Practitioners Qualified in Dental Implantology and it has to be completed by dialogue with the professional specialists whom you usually consult and by further reading, in the knowledge of the fact that points of view differ from one author to another and from one professional specialist to another.
*A dental surgeon is a general dentist.