Nutritionally Speaking: Chewing Food With Dentures

Dear Dr. Meinig: My husband is soon going to have all his teeth out and new ones put in right away. I feel he is going to have an awful time eating, and I am lost as to what to feed him. I am confident you might have some good ideas about what he should do, so would appreciate your divulging a bit from nutrition and giving us your views on these matters also. – C.L.

 

Dear C.L.: Everything about the use of artificial teeth is really a nutrition problem. Patients and even dentists become so involved with the other problems involved such as: Pain of poor teeth, bad appearance, and infection, that they often forget the main reason for teeth is to masticate food.

While new full upper and lower dentures are the biggest challenge to patients, most of what is to follow also applies to those who have partial denture replacements. People generally realize that a soft diet is necessary in the beginning, but surprisingly, some do expect to go right out and chew a big steak. Actually, no matter how delicately constructed, new teeth are quite a mouthful. The tendency is for the tongue, lips and cheeks to want to push them out. It is only our mental acceptance of the problem that enables our brains to instruct facial muscles and tissues to learn how to hold and control the new teeth.

Light, soft, nourishing small meals are called for: Soft boiled eggs, egg nogs, baked potatoes mashed up with butter, steamed vegetables mashed, soup, whole grain cooked cereals, fish, poultry, rare hamburger, banana and other bland fruits. Make the knife and fork do most of the work of the teeth by using them to cut and mash the food.

Avoid drinking fruit juices and eating citrus fruits, as their acidity and sugar content often cause sores and eruptions in the mouth that will be blamed on the new dentures. Remember, protein is necessary for healing and repair of tissues, so don’t avoid meat, fish or eggs. If cooked rare, meat, fish and poultry are easy to cut into small pieces or grind, and will readily be tolerated and digested. Do avoid more than one alcoholic drink, for the incidence of postoperative pain is much greater in those who try to drown their sorrows. Some patients find baby foods are particularly helpful at this time.

A good multiple vitamin-mineral supplement, plus calcium and vitamin C, are suggested throughout life. Most new dentures today are immediate replacements. That is, when the last remaining teeth are extracted the dentures, which were made beforehand, are inserted immediately after the teeth are removed. People tend to fear this procedure, but it makes the healing much less uncomfortable. The denture base actually acts as a bandage over the new extraction areas. Many dentists place medications in the base to encourage healing and reduce discomfort. If there is too much pressure anywhere, it usually isn’t in the surgical area.

The teeth must be left in continually as if left out even for a brief period swelling will occur that can make it impossible to reinsert the teeth for about two weeks. Dentists have the patient return in 24 to 48 hours to remove the teeth and give postoperative care. If the dentures are too tight, too loose, or uncomfortable, adjustments are made. I personally instruct patients to leave the new teeth in 24 hours a day—taking them out only to clean them. Rinsing the mouth with warm salt water is soothing (¼ to ½ teaspoon salt to a glass of warm water). After the first 30 days some dentists suggest leaving dentures out during sleep, in order to give the mouth tissues some rest. Except for people who grind their teeth in their sleep, I do not find nighttime use a problem, so I leave the decision up to the patient.

Naturally when first inserted new teeth are quite a mouthful. They feel bulky, awkward, too loose, and at the same time, too tight. Because artificial teeth are the best of all replacements of lost body parts and in most cases look so natural, patients do at times become overly fearful that their beginning difficulties are abnormal. They remember a friend or relative who has had dentures for many years, who swears he ate everything right away, and had no sore spots or adjustments. With time, most people do forget the problems that occurred. I can’t tell you how many patients after years of using dentures have told me how great a job I did, and how they never needed adjusting, until I showed them my old treatment record that listed six or eight adjustments.

When people are discouraged, it helps to remind them that if they had an artificial leg they would expect to use crutches for a while, and would realize that a learning period is necessary, and that new teeth also require similar reeducation.

There are some other problems that should be mentioned. One that proves somewhat annoying is an increase in the amount of saliva. This is quite natural as whenever anything is put in the mouth, the glands respond with a flow of saliva. In time, this will decrease and become normal again.

Most people have some thickness of speech in the beginning: The strangeness of the new surroundings to the tongue often creates some difficulty with “CH” and “S” sounds. The practice of reading aloud helps, as does repeating words like, swim, sixty-six, church and children over and over. With such practice, the tongue will more quickly adjust to its new environment. A phone call to a close friend or relative is also helpful, as over the phone, patients feel the sounds are much worse than they really are.

Just how long it takes one to become proficient varies considerably, but most people overcome the major difficulties by the end of three weeks. Graduation from soft foods to harder ones also is variable. Dentists as well as patients feel that biting on food should result in its mastication. However, new denture patients find the food seems to slither from side to side and never gets cut up. The reason doesn’t lie so much in the teeth and bite, although these are important, but is concerned with how the lips, cheeks and tongue hold the food between the teeth, so that it can be cut and ground. It is much like a brand new pair of scissors: if you do not hold the paper or material properly, the scissors, no matter how sharp, will not cut. Similarly, teeth will not cut food until the tongue, and lips are re-trained to hold between the teeth. It takes some time to educate the muscles of the tongue, cheeks, and lips to their new function, and to perform in the new way. Eventually it becomes automatic.

While learning this process, it is helpful if one tries to chew on both sides at once as this helps to keep the dentures from rocking. Biting of apples, corn on the cob, or sandwiches is very difficult; those who are quite good at it usually push the item up and backward against their upper teeth. This seats the upper denture tighter–while biting and tearing, as done with natural teeth, tends to loosen the artificial teeth.

Even with much experience, most people find they have a few things they just can’t eat or chew very well. Nuts are the most frequent, and lettuce is second. I have had patients who could chew all kinds of nuts and tough meat, but couldn’t manage a piece of white bread.

To a great extent, the frequency of some spots and adjustments depends on how much the gums are shrinking. While this is fairly stable in 60 days, most people continue with shrinkage of the gums throughout life. As the gums shrink, the dentures gradually change their positions and relationships with one another. This may or may not result in soreness or looseness. Excessive gum shrinkage is related to the use of: Sweets, caffeine products, refined foods, soft drinks, alcohol, and low calcium diets.

Denture patients generally like to feel they are through with the dentist, but they should be examined periodically as difficulties do develop. Denture adhesives can conceal the need for adjustment or relining and this can result in damage to the gums. 

Cleaning of dentures is very important to the health of the gums. Before removing the dentures, it is a good idea to fill the basin with water, as most teeth and dentures are broken by dropping them in the basin. Dentures can be repaired, but it is a nuisance that often can be avoided. A good denture brush and soap and water followed by thorough rinsing are excellent. Baking soda is also a good cleanser and denture cleaners are available. But, nothing beats a good denture brush and a thorough brushing. Don’t try sterilizing in very hot or boiling water, as heat can change the shape of the denture.

Your husband’s third set of teeth (his new dentures) will never be quite the same as natural ones in good repair. But they are so much better today, than living with serious tooth problems, that he will no doubt, after this preliminary period, be glad that he made the change.