Upcoming extractions & going from partial upper to full upper & lower dentures

[Loreli]

Hello,

This is my first post on here.
I'm going to keep this as short as possible, writing my history will only set me off.
I have extreme phobia of dentists but have 7 (at minimum) appointments coming up.
The only way I can have any treatment is to take four diazepam. I think the tablets the doc gives me are 5mg so that'd be 20mg for the appointment itself plus, last time I think I was also told to take a couple the night before the day of treatment.
On 18th April I am having my three remaining upper teeth removed, a week later, 5 lower left teeth, two days after that 6 lower right teeth.

Size, shape of new teeth - I have a partial which I've had for the past 6 years for my four front upper teeth.
Last time & this time, when I asked the dentist about what teeth would be best for me & suit me best he said 'You can have what you want, go & find some pictures'.
I chose badly for the partial, they are too big & make my upper lip stick out un-naturally. This time I want to choose better.
I've spent weeks searching online for some decent photos and teeth that might be right for me based on my face shape, lip shape etc. I ended up calling to ask reception if there were any photos or guides I could use to help me with this.
The receptionist spoke to the dentist who - this time around - has said he will speak to me about size, shape atc.
I have a treatment plan with very time limited appointments. EG: I have 3 extraction appointments for my remaining 3 upper teeth for 30 mins, followed by lower left 5 extractions 40 mins, lower right extractions 40 mins.
The next appointment after extractions will be for a first set of impressions - but again, that's only a 20 minute appointment.My first question is: At what stage is my best time to get his attention to speak to me about size, shape etc of my new teeth?
There doesn't seem to be 'time' allocated to it & when I got the partial, he didn't give me any help, it just wasn't discussed. I just had to send him a photo of someone's front teeth.

Re-lines - With my partial, there was no option to do a soft reline to improve the fit as my gums shrunk (they shrunk a lot!). In the end I had to get a hard reline done at around 5-6 months by which time no amount of glue would keep my teeth in my mouth. The partial was only useful for aesthetic reasons & I have never been able to bite with it as my lower teeth are too weak. Since then I have just used more & more glue to keep them in place.
I mentioned re-lines to my dentist this time around & he said they would be 'years & years down the road'. So it sounds like he doesn't do soft re-lines at all, not even on full dentures.
I'm getting anxious about this as I am no good at all at artsy / crafty stuff & I would be in a mess if I have to do a soft reline at home & potentially destroy my new teeth which I am paying a lot of money for.
With my partial the gums shrunk really quite quickly - after about 2 or 3 weeks & as mentioned above I wasn't using them for biting with (plus I can't chew anyway as my back teeth are too weak & wobbly).
I REALLY want to have the ability to bite & chew with dentures though if it's at all possible - but if they won't fit for a few years (until hard reline time) after my gums shrink I'm still going to be left being unable to bite or chew.
What should I do?

Thanks
Loreli

 

[drhirst]

Hi Loreli,
Well done on facing your fears and getting this all planned out.

20mg of Diazepam is certainly going to help, I am sure you are already aware of this, but I must remind you that there is no way you should consider driving yourself on that day. It would be illegal and very dangerous.

As far as choosing the shape and size of the false teeth goes, this is really tricky. If you have a photo of yourself when you were happy with the appearance of your teeth, then this is the best guide for the technician who will be making your teeth. Apart from that, leave it to the technician. They have years of experience and will be able to make a good guess based on the size of the gaps and the models of your teeth.
Soft relines are not any better than hard relines in these situations, so I would not worry too much about that. Whatever you do the denture will need replacing in about three months due to the gum shrinkage. Although that sounds bad, it is an opportunity to get the tooth shape just right. When you are making a new denture without taking out further teeth, you have a stage called the “try in”. At this appointment you have a mockup denture made of the actual teeth set in a pink wax base placed in your mouth. You will be able to see exactly what the final denture will look like and if it is not looking good have the teeth change easily until you are happy. I normally find they come back right after one or two attempts.
So, this new denture at three months should allow an excellent fit and appearance with stressing over trying to pick out the shape yourself.

Hope this helps

Lincoln

 

[Loreli]

Hi Lincoln,
Thanks for the reply.

I am walking to the dentist & don't own a car anyway so that's no issue with diazepam.

I'm not getting another denture made in three month or anytime later down the line.
This is my one shot at getting it right.

All that will happen at some point years away is that this denture will need a hard reline.

Maybe if I list out all of the appointments I will be having & the time he is giving each it will be clearer.
18th - upper 3 extractions - 30 mins
25th - lower left 5 extractions - 40 mins
27th - lower right 6 extractions - 40 mins
Further appointments not yet booked:
Primary denture impressions - 20 mins
Secondary denture impressions & bite visit - 30 mins total for both
Denture try in - 20 mins
Full final denture fit - 30 mins
That's the full plan & he said it would all be finished within 2 months.

As I mentioned above he gave no help with choosing the teeth for my partial for four teeth 'You can have whatever you want, go find some pictures' is what he said & he said the same this time too.
When I got the partial the choice I made of teeth was bad, the teeth are too big for my face & mouth. At this last appointment he agreed that I made a terrible choice.

I have no photos of me smiling with teeth, my teeth have never been nice nor straight. Bad genetics I think. My Dad had crooked teeth & when he was 21 he chose to have all his teeth out & got them replaced with full dentures.

Within the appointments & timings above I need to suss out the best time to bring up teeth shape again but I don't know how long the processes described above take & which appointment to absolutely make sure I can get him to listen to me / help me.

If I end up needing soft relines until all the shrinkage has done it's thing would I be better going to a different dentist maybe? Or would I be best to just get hard relines when I really need them & until all my shrinking is pretty much done?
I asked for a soft reline on my partial at about 5 months but the only option was a hard reline.

Whenever I mention relines he waves his hand in the air, dismisses me & says 'that's years & years away'

 

[drhirst]

@Loreli
On 20mg I would still not advise crossing roads unaccompanied as your judgement may be very impaired.
I would not worry about soft relines, they are they are never normally indicated for partial dentures and very rarely used for anything other than a full lower denture.
If you have a hard reline on your this denture sometime down the line it will still not be as good as a new denture.
As for selecting the shape of the teeth , let the technician choose the teeth. At the 20 minute try in appointment you will be able to see what they look like and ask for them to be changed if it does not look right. You could bring a family member for friend along to help with the decision.

 

[Loreli]

Please don't worry about the diazepam. I have no roads to cross, I don't drive - this is not an issue.
I only mentioned it due to my dental anxiety - that's all.

I will simplify my main question:
I'm not asking about relines for a partial dentures.
I am asking about soft relines for full upper & lower dentures as it seems my dentist does not do soft relines and I will need to wait several years for a hard reline.
Is this normal?
Should I find another dentist at the point where gum shrinkage means my dentures will not stay in place even with adhesive?

 

[Gordon]

There's no need for a soft reline in 99% of denture cases, they have lots of disadvantages and very few advantages.

Immediate full dentures can need relines in about 6 months, but not all of the time in every case, it varies a lot between different people.