Friday, 12 October 2012 15:35
Last Updated on Friday, 12 October 2012 17:05
SInce this is the time of year for halloween parties, I thought I would take this opportunity to discuss the facial changes in denture wearers, commonly referred to as "witch's chin." There will be no tricks, but we will be offering a treat to all individuals currently wearing dentures or a single denture. Essentially, the face (soft tissue) changes shape because of the underlying bone changing shape.
Witch's chin starts when a patient loses all their teeth and begins wearing dentures. Each year, for the remainder of the patient's life, that patient will continue to lose bone in their jaws from disuse atrophy. Disuse atrophy does not only occur in the jaws. For example, I lifted weights regularly while playing basketball in college. My body swelled to 185 pounds. Now I weigh 165 pounds because I no longer lift heavy weights. My muscles shrank in size because of disuse atrophy. I view disuse atrophy as a universal human law because I can relate other human qualities to it. For example, I have not retained any of my language education from high school nor college. I can't speak Spanish or German fluently anymore, because I stopped conversing in those languages upon graduation of college. The difference between the different atrophies are: I can build my muscles back up to 185 pounds if I chose to do so. I can relearn forgotten languages and speak them again. However, the effects on the jaws are not as responsive. Once you lose it, it is gone forever. We lack the capabilities in modern dentistry/science to grow the patient's bone back. We have some interesting, inapplicable capabilities like distraction osteogenesis which can help build bone in isolated areas. Physicians use bisphosphonates such as fosamax and boniva to help preserve the bone in osteoporotic individuals. Neither are suited to solve the problem of witch's chin and loss of bone from the jaws in denture wearers.
Obviously the best solution is prevention. Prevention of dental decay and periodontal disease will help patients retain their teeth longer. These measures do not help the 30 million edentulous patients in the United States of America, whom already lost their teeth and are wearing dentures. For some individuals currently wearing dentures, there is a solution to prevent future facial changes. That solution is dental implants.
Before we discuss why dental implants stop the disuse atrophy, let us first discuss why the facial changes occur in the first place. In 1892, a German surgeon Julius Wolff stated that bone remodels or changes when excessive loads are placed on it. For example, martial artists have increased bone density in their striking arms and legs from hitting and kicking things. Weight-lifters have increased overall bone density as a result of their training. Surfers, namely knee-paddling longboarders, will get bony growths on their knees as an adaptive reaction to the weight distribution onto their knees, called "surfer's knots." In 1922, Misch described the skeletal structure of a 90-year-old woman without teeth for several decades. Bone needs stimulation to maintain it's form and density. Therefore, we see patients without teeth for long periods of time, losing the bone in their jaws from lack of stimulation (no teeth.) These patients undergo a slow deformation of their face causing a predictable outcome. They will develop a "reverse frown" as their face begins to change. These individuals typically are unaware of this due to the slow process and not visiting dental offices because they feel no need to visit a dentist without teeth.
The soft tissue, this man's face is beginning to change due to the bone loss. This makes him look unhappy, upset, even when he tries to smile. In addition to the disuse atrophy, dentures rest on the tissue of the jaws, blanching out the blood vessels. This decreases blood flow to the area which contributes to the rate of bone loss. We lose bone 4 times faster in the back of our lower jaw than we do in the front of the jaw. This results in the "reverse smile" or frowned look. If no intervention is planned, the anterior jaws start to lose bone more rapidly causing the chin to rotate upwards, termed a "witch's chin."
The chin will continually rotate upward until the patient expires. This is not the way most of us want to be remembered by our grandchildren. The solution is simple. By placing dental implants under the denture, we can simulate tooth function. The simulated tooth function stimulates the jaw preventing future bone loss. By preventing the bone loss, we prevent the facial changes seen in these pictures. Ultimately, without dental implant intervention, some long-time denture wearers end up as oral invalids, unable to wear a denture with advanced bone loss rendering dental implants impossible. I met many of these individuals while volunteering dentistry at local nursing homes throughtout the seacoast. Garbled speech, inability to be understood, unable to chew food, dehumanized these individuals. They were left isolated due to their inability to communicate with their own peers while at the nursing home. The key is to not let your loved ones progess to that state. Prevention is key.....even if you are missing all your teeth!
If you know someone that wears dentures, have them visit a dentist to determine the level of bone loss. At our office, the following protocol is typical:
1. Patient visits our office and has a 3-D CT scan taken in about 30 seconds. The computer takes about 2 minutes to create a virtual model of the patient's skull.
2. We analyze and measure the available bone to determine the progression of bone loss.
3. We offer recommendations by creating a treatment plan to prevent future bone loss with dental implants. Some dentures can be converted and used to attach to the dental implants without purchasing a new denture.
4. Some patients can have implants placed and the denture attached to the implants immediately. They walk in with dentures, they walk out with a denture screwed into their new implants.
5. We create different options (2 implants up to 15 implants) dependent on your budget and can even stage treatment over several years if it is in the best financial interest to our patients.
6. Last but not least, we are offering ALL DENTURE WEARING PATIENTS, a free CT scan and free implant consultation for the remainder of 2012. (nearly $500 in diagnostics saved)
Have a safe and happy Halloween!!