Consumer Perspective

          The Importance and Purpose of having Dentures

           Health Implications
            Rehabilitation implication
            Loss of Vertical Dimensions
Standard of Dentures
Retention of Dentures
The Conventional Clumsy Procedure
Making dentures - (Slideshow)
Denturism is pro-denture wearer, not anti-dentistry.
Patient Perspective and Denture-satisfaction
            Critical aspects of clinical procedures that impact on technical accuracy
            Delegation of tasks and responsibilities 
Individualized Dentures 
            Common complaints
            Appropriate natural appearance
            Tooth Selection
            Direct communication
            Before and After Gallery - (Photographs)
Photographs)
Recognition of Denturists as the most Efficient denture service providers
The price of dentures

Availability fee of dentists
Direct savings from direct service
Incentives to serve the poor
Fees of Dentists and Dental Technicians in SA for 2006 with speculated fees for Denturists
Calculations for table

Consumers Freedom of Choice

 

The Importance and Purpose of having Dentures:

Health Implications

The profound and disabling effect of tooth loss on various aspects of health and general health has been well recorded [1]. Practically all animals starve to death when they lose their teeth. Fortunately the modern human being can survive without teeth, due to an advanced lifestyle, but is severely affected. Oral health is absolutely essential for total systemic health. It is vital to restore the mouth to its original state. The structure of the teeth and soft tissues that were once there needs to be replaced; otherwise your health and quality of life will be compromised. An inadequate denture or lack of dentures may both result in poor oral health. The fact that “quacks ” are providing a denture service under unhygienic conditions creates a threat of transmittable diseases, including TB, Hepatitis B and possibly HIV/Aids.  

Unrehabilitated tooth loss has the effect on a person being denied from the most basic pleasure of eating and enjoyment of food, and limits the texture and range of foods one can consume. A number of studies have indicated that missing teeth is linked to a qualitatively poorer diet, for example: in studies on US veterans (Chauncey et al 1984), Canadians (Brodeur et al 1993), and Finns (Ranta et al 1987), subjects with impaired dentition preferred soft, easily chewable foods that were low in fiber and had lower nutrient density than foods eaten by people with intact dentition. In the elderly, edentulousness and poor oral health may contribute to significant weight loss, which may effect overall health (Blaum et al 1995, Ritchie et al 2000, Sullivan et al 1993). People of any age are healthier if they are well-nourished. Well-nourished older people feel better, recover faster from illnesses, spend less time in the hospital, and can possibly live independently longer than older people who don't eat well. Ill-fitting dentures and poorly designed dentures can both lead to Biomechanical Nutritional Impairment (BNI). Many BNI victims suffer from a lack of nutrition due to non-functional dentures. They are unable to masticate their food properly, and in many cases, cannot chew their food at all, or even have to remove their dentures completely in order to eat. Others reside in nursing and rehabilitation centres. Many are dependant on acid reflux medication and tube feeding, which creates an exorbitant expense to Medical Schemes. All of the above shortens the lifespan of individuals.[2]

For persons without all or some of their natural teeth in one or both arches, the use of a complete or partial denture and the quality of the denture used are important aspects of their oral health, nutritional health, general health and social functioning. Teeth are essential requirements of speech and mastication. Having dentures or not, impacts on the emotional, psychological and social well being of denture wearers [3]. The social stigma attached to edentulism (toothless ness) often impacts negatively on an individual’s self esteem, human dignity and employability capacity, which contributes to an inability of elevation out of the poverty spiral. The provision of dentures should therefore be seen as an integrated part of poverty alleviation and the maintenance of human dignity.  

Losing one's natural teeth can have a significant impact on both the physical and psychological health of the edentulous person. People may face traumatic experiences when they lose their teeth, such as rejection in the job market where personal appearance can be crucial in obtaining employment. While the cultural context of wearing dentures is cosmetic, there are some definite effects on physical health as well, especially for the elderly edentulous [4]. Their food choices may be dictated by the fact that they have either no natural teeth or ill-fitting dentures. Poor nutrition may in turn result in a myriad of nutrition-related health problems [5].

Rehabilitation implications

It is the individual’s constitutional right to have access to a balanced diet and the right to rehabilitation [6]. Elderly patients have the right to be treated with dignity [7]. The speech-impaired, the deaf, the blind, and the physically disabled have the right to be rehabilitated to their full human potential [8]. Those with a toothless disability especially the poor and the old have a basic human right to be treated with dignity, by given the opportunity of rehabilitation to their full speech, mastication and oral health functioning, by having the right of access to an affordable safe denture service and the freedom of choice [9], as was principally entrenched in the Older Persons Act (Act 13 of 2006). 

Your dentures are important to the way you look and feel. Removable partial dentures restore a person’s natural appearance and greatly improve the ability to chew and speak clearly. A properly made partial dentures does not harm remaining natural teeth. A partial denture may prevent your natural teeth from shifting or drifting into the space left by the loss of a natural tooth. In fact, a partial denture may help maintain the position of your natural teeth by providing them with additional support [10]. With a well-designed denture you may once again speak clearly and eat comfortably – and the newly found support for facial muscles is in fact in some cases like having a non-surgical facelift! A recent study [11] conducted with a sample of 63 patients at the University of the Western Cape, showed that the social and psychological impact of dental disease and toothloss was significantly improved by the supply of complete dentures. Denture satisfaction was an important factor.  Significant improvements were recorded in their oral function and everyday lives and the quality of life in almost all domains of denture wearers. Read the Profile Stories of two edentulous patients assisted by The Society, Jannie  and Aggie , to appreciate the impact of not having dentures  and the effect of oral restoration on quality of life.

Poorly fitting dentures can lead to bite problems, speech impediments and tissue irritations [12]. Leaving this condition unchecked can lead to complicated situations in the future. Denturists are expertly qualified to assess existing dentures for structural integrity such as cracks, chips, and broken or loose teeth. The denturist can provide advice regarding a course of action to remedy such situations, including repair, cleaning and general maintenance of appliances and adjustment to clasps. A denturist also provides education to denture wearers on how to clean and care for their dentures and mouth cleaning-procedures. Similarly denture wearers need to understand the reaction of their oral tissues to new dentures, the effects of bone-resorbtion, how to deal with denture related complications and how to accommodate allergic reactions. 

Loss of Vertical Dimensions

Vertical dimension is the term used to describe the distance your mouth is held open by your dentures. In other words if you were to remove your lower denture and then close together you would appear to have an extreme vertical dimension loss. Obviously this would be an exaggeration but even a little loss can have some startling effects. With every year you wear your dentures the bony ridge that lies underneath will resorb slowly allowing your denture to settle in deeper. Denture teeth will also wear down, although very slowly. The combination of these two things results in loss of vertical height [13].

Resorbtion of the lower jaw after losing the natural teeth, showing loss of vertical height over a period of 10 years.

 

From an esthetic point of view this loss in dimension can appear as a more sunken in face, with a deepening in the creases at the corners of your mouth and for some the appearance of a frown. If this over-closure continues, you will also note the jaw beginning to thrust further forward adding even more to a crumpled expression. Loss in vertical height also affects your ability to chew as your TMJ (Temporal Mandibular Joint) begins to work beyond its natural range, decreasing your power and your effective chewing ability. Long term effects of the pressure created on the TMJ condyles can result in a number of symptoms; a clicking or popping sound when chewing, itchiness in the ears, pain or inflammation in the joint, or loss of hearing. All of these are possible side effects of a diminished vertical height and TMJ syndrome.

Denturists encounter patients who are well on their way with these sorts of problems, on a daily basis, due to the fact they have been wearing the same dentures in excess of ten years with no notice of these slow changes taking place. Fortunately dentures can be redesigned in a manner that holds your jaws further apart, returning you to your more natural and healthy profile [14]. See Relines, Rebases and Repairs for further explanation of the implications of bone resorbtion.

Although a denturist can reverse many of the detrimental effects of vertical loss with a solid rehabilitation program, cases that have gone too far may never be fully recovered. There is a limit to the changes in vertical height restoration that the facial muscles can adapt to in any treatment period, and it will often have to be staggered over a period of several years. This is why it is so important to make annual check ups part of your routine. The cosmetic benefits are sometimes startling with changes in appearance being similar to a face-lift. Visible lines and wrinkles have been reduced/softened, and lips appear fuller and more supported [15].

The following cases illustrates how a new properly designed denture restores a person's facial dimensions, and with it all the implications of functional eating, speaking, dignity and self-esteem:  

  Loss of Vertical height   :  Restoration of facial support

   

    With acknowledgement to Kevin Campbell Denture Clinic, Nothamptonshire, UK at www.naturaldentures.co.uk

With acknowledgement to Minuk Denture Clinic, Winnipeg, Manitoba, Canada at www.minuksmile.com

 

Softening of lines and wrinkles, fuller lips and support

    

With acknowledgement to the Barry A Lewis Denture Clinic, BC, Canada at www.dentureclinic.com

With acknowledgement to Oliver Meier, New Zealand

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[1] Johan Hartshorne Denturism – Report on a feasibility study in the Western Cape, SADJ September 2001, Volume 56 No 9
[2] Everett van den Eeden DDM, CD,CDT Denturists - The Solution to America's Denture Crisis. Global Professionals Publication 2007 ISBN 978-0-9794403-0-4 Page 27
[3] DF Malherbe, LA Steyn, C Du Plessis, Z Fatagodien. Clinical Dental Technology: A Quest For Equity In Oral Health Care by The Society for   Clinical Dental Technology, 1998 Ó. Motivational Report to the SADTC, Minister of Health and the Department of Health.
[4] Boyle MA, Hamilton EM, Whitney EN - Understanding Nutrition 1984
[5] Federal Trade Commission, :"The Sale of Complete Dentures: Effects of Present & Alternative Regulations," 1980
[6]  Access to Health Care Tenet, Bill of Rights, the Constitution of the Rep of SA, Act 108 of 1996.
[7] Human dignity Tenet, Bill of Rights, the Constitution of the Rep of SA, Act 108 of 1996.
[8] Dr Manto Tshabalala-Msimang, Minister of Health. Debate on the State Of The Nation Address, 10 February 2004.
[9] Memorandum by The Society for Clinical Dental Technology to the Human Resources Cluster of the National Department of Health as a GENERAL MOTIVATION FOR THE ESTABLISHMENT OF A CATEGORY OF CLINICAL DENTAL TECHNOLOGIST IN ORAL HEALTH CARE. – In response to the Draft Strategic Framework for Human Resources for Health Plan. August 2005  
[10] Brookswood  Denture Clinic, Langley, BC, Canada at www.yourdenture.com
[11] Razia Zulfikar Adam. Do Complete Dentures Improve The Quality Of Life Of Patients? MSc thesis. Faculty of Dentistry and World Health Organization (WHO) Oral Health Collaborating Centre, University of the Western Cape. March 2006 
[12] Chris Pine, Denturetech Denture Clinics in Albany, Orewa, Henderson, New Zealand at www.denturetech.co.nz
[13] Barry A Lewis DD. Cosmetic dentures and vertical height. Barry A Lewis Denture Clinic, Nanaimo, BC, Canada at www.dentureclinic.com 
[14] Campbell K, DD. Complete dentures: A Clinical Review. The Kevin Campbell Denture Clinic, Nothamptonshire, UK  at www.naturaldentures.co.uk
[15]  Cosmetic dentures and vertical height. Barry A Lewis Denture Clinic, Nanaimo, BC, Canada at www.dentureclinic.com

 

Standard of Dentures 

The Department of Public Health, of the University of Helsinki, in Finland conducted in-depth correlation studies about co-operation and competition [1],[2] between dentists, denturists and dental laboratory technicians and especially about the clinical quality of the dentures [3] and the oral health of subjects wearing those dentures [4] in Finland. This study investigated provision of dentures by dentists, denturists and laboratory technicians to elderly Finnish World War II veterans. From a sample of 550 men, 362 subjects were both interviewed and clinically examined. The subjects were asked a range of questions related to their oral health and dentures. Although the literature acknowledges that denture wearers experience denture satisfaction on completely different criteria than dentists do [5],[6],[7],
[8] clinical examinations were carried out by one dentist using well-defined criteria and without knowing the information the respective subjects had given in the interview, or who had provided the dentures. Various aspects of this research had been reported in at least 4 reputable international scientific publications during 2002 and 2003. It was concluded that cooperation between dentists and denturists was common. Prof. Risto Tuominen further reported that those oral healthcare professionals, who referred their patients to the other profession, also benefited themselves by receiving more patients on referral from them [9].

Complete dentures illegally provided by dental laboratory technicians, fitted less well in tuber and alveolar areas and had poorer retention than those provided by either dentists or denturists. Complete maxillary dentures provided illegally by dental laboratory technicians, had higher occurrence (60%) of some unacceptable characteristics than those (43%) provided by dentists or denturists. (Dental technicians have no formal clinical training, as dentists and denturists do – evident in this study) The difference between complete Mandibular dentures was also obvious, 86% versus 59%, although statistically non-significant. Of those partial maxillary dentures provided by dentists 53% had some unacceptable characteristics, compared with 80% of those illegally provided by denturists or laboratory technicians (Non-significant). In the case of partial Mandibular dentures, 36% of those provided by dentists and 32% of those by denturists or laboratory technicians had some unacceptable characteristic (Non-significant). Illegal provision of removable dentures (and the accompanied lack of specialized clinical training) seemed to be related to decreased clinical quality [10]. The proposed legalization and accompanied clinical training in providing partial dentures will evidently be in the patients’ interest, as a significant portion of subjects already demonstrated to prefer this alternative category of service provider .                                                                                             

Denturism has an important place, as a Para dental arm of dentistry and its implementation should be supported wherever there is a need for it. Dental trainees are qualifying with fewer technical skills than was the case in the past. Technical and clinical skills can only be acquired after many hours of laboratory and clinical hands-on time. Denture prosthodontics is a science and an art and is in fact one of the most challenging branches of dental practice in which to succeed. A course devoted to specializing in denture prosthodontics must lead to a superior clinician in the Denturist than in a Dentist [11]. In relation to the technical skills to manufacture dentures, nobody has ever questioned the competence and expertise of dental technicians [12]. In this regard, their ability to provide a comprehensive removable prosthetic service of superior standard after undergoing clinical training should be commonsense. Direct communication, therefore less miscommunication, must also lead to improved denture satisfaction. in addition a denturist focused on denture work alone will get much more experience and skill in this speciality than a dentist who only sees a denture patient occasionally, thereby leading to superior quality of work.

There are of course limitations to the clinical scope of the Denturist but an important aspect of the training would be to be aware of those limitations. When they are exceeded the place of referral should be the specialist prosthodontist who then does have the required skills, or to a GP dentist known to have the relevant skills and these would be among the older and more experienced practitioners [13] who also had proper technical grounding during their studies. As a result of the de-emphasis of some aspect of prosthetic training, many newly qualified dentists experience basic fundamental shortcoming in the provision of denture services. Denturists focus solely on prosthetics both during training and full time practice, and serves only denture patients all the time, and will obviously be more competent and provide better dentures than a dentist with superficial training in prosthetics and who only sees denture patients every now-and-then.

In a recent study [14] in Michigan, the benefits of denturism in other US states for over twenty-five years was demonstrated. The publication highlighted how and why other US states have licensed the specialized practice of denturism, and how their citizens have benefited from its safe and high quality denture care delivery system at better affordable levels. It empowers all levels of society to understand, not only the pain and suffering that America’s denture wearers are experiencing, but also the related social, economic and health issues that are linked to the crisis. Citizens have a rapidly growing need for denturist care. The book’s message is critical, since many dentists are discontinuing to offer denture services, dental schools have cut back their curriculum hours in denture training for dental students by 90% over the past thirty years and over the next ten years, one-third of all dentists who currently provide denture care are expected to retire from practice, leaving the US denture population in a vacuum.

 

[1] Tuominen R. Department of Public Health, University of Helsinki, Finland. Cooperation and competition between dentists and denturists in Finland. Acta Odontol Scand. 2002 Mar;60(2):98-102
[2] Tuominen R. Department of Public Health, University of Helsinki, Finland. Removable dentures provided by dentists, denturists and laboratory technicians. J Oral Rehabil 2003 Jan;30(1):55-9
[3] Tuominen R. Department of Public Health, University of Helsinki, Finland. Clinical quality of removable dentures provided by dentists, denturists and laboratory technicians. J Oral Rehabil 2003 Apr;30(4):347-52
[4] Tuominen R. Department of Public Health, University of Helsinki, Finland. Oral health in relation to wearing removable dentures provided by dentists, denturists and laboratory technicians. J Oral Rehabil 2003 Jul;30(7):743-8
[5] Lamey, PJ Dr, School of Clinical Dentistry. Queen's University of Belfast. Influence of psychological factors on the acceptance of complete dentures. Gerodontology, Volume 18, Issue 1, Page 35-40, Jul 2001, doi: 10.1111/j.1741-2358.2001.00035.x
[6] Hendricks SJH, Wilson V, Angelilo I, Patients satisfaction and dentist’s evaluation of dentures in South Africa. J of DASA March 1996,51, p143-147
[7] A. Mersel, I. Babayof, D. Berkey J. Mann . Variables affecting denture satisfaction in Israeli elderly:a one year follow-up. Gerodontology, Volume 12, Issue 2, Page 89-94, Dec 1995,  
[8] Vassiliki Anastassiadou and M. Robin Heath Gerodontology 2006; 23; 23–32 The effect of denture quality attributes on satisfaction and eating difficulties
[9] Tuominen R. Department of Public Health, University of Helsinki, Finland. Cooperation and competition between dentists and denturists in Finland. Acta Odontol Scand. 2002 Mar;60(2):98-102
[10] Tuominen R. Department of Public Health, University of Helsinki, Finland. Clinical quality of removable dentures provided by dentists, denturists and laboratory technicians. J Oral Rehabil 2003 Apr;30(4):347-52
[11] Professor Cyril Thomas. Former South African Prosthodontist, Formerly: Head of Dental Prosthetics, University of Stellenbosch. Formerly: Deputy Dean and Head of Prosthetic Dentistry, University of Sydney. Director of Clinical Dentistry, University of Sydney E-mail to The Society- 3/07/2007  
[12] DF Malherbe, LA Steyn, C Du Plessis, Z Fatagodien. CLINICAL DENTAL TECHNOLOGY: A QUEST FOR EQUITY IN ORAL HEALTH CARE by The Society for Clinical Dental Technology, 1998 Ó. Motivational Report to the SADTC, Minister of Health and the Department of Health  
[13] Thomas. C Prof. Prosthodontist, Formerly: Head of Dental Prosthetics, University of Stellenbosch. Formerly: Deputy Dean and Head of Prosthetic Dentistry, University of Sydney. Director of Clinical Dentistry, University of Sydney E-mail to The Society on  03/07/2007    
[14] E Van den Eeden, DDM, CD, CDT,  "Denturists – The Solution to America’s Denture Crisis". (May 16, 2007) Michigan Denture Reform Committee. 160 pages. Global Professionals 720 E. Eighth St, Ste # 1., Holland, Michigan 49423; (616) 355-5500, Fax (616) 355-5502 ev3000@sbcglobal.net

 

Retention of Dentures

Retention probably tops the list of all the things that may concern denture wearers. Retention in this context essentially refers to the ability of your denture to remain stable and snug to your ridges while speaking and eating. Capillary retention and saliva-aided suction principally hold in upper dentures. For most patients this provides ample retention. In case this proves inadequate, there are a number of potential factors that could have an influence, namely:

• Size of Ridge
• Amount of saliva - Dry Mouth
• Shape of palate
• Position of Post Dam seal
• Malocclusion
• Resorbtion of ridges or mobile (flabby) ridges

The way that a lower denture is retained in the mouth is very different to that of an upper denture. The ability to wear a lower denture tends to be more of an acquired skill, rather than a given. Lower dentures have little or no suction, and rely on the combined use of the muscles in your cheeks, tongue, and the floor of your mouth learning to work with the denture, helping to stabilize and limit movement. This skill takes time to develop and is often where patients express frustration with dentures that tend to be somewhat mobile when speaking and chewing. As time passes this mobility diminishes and most patients have adapted in two to four weeks.

The size of a lower ridge can also be a determining factor for retention of a  denture. Patients who have lost their natural teeth for many years have often suffered great resorbtion leaving a diminished and flat ridge for the denture to fit to. This in turn allows more movement of the denture when chewing and can lead to more sore spots or bruising of the tissue. It is not uncommon to have patients complain that their ability to function well with lowers declines as they get older. Another significant difference between upper and lower dentures is the amount of ridge covered to distribute your bite force. Upper dentures covers the entire palate while a lower must have a large portion cut away to accommodate your tongue and only rests on a narrow strip of soft tissue adjacent to the lower ridge.      

The components required in denture design to create good stability, and comfort includes the following factors:

• Good undistorted impressions that yield an accurate fit spreading the bite load out over the entire ridge.
• Proper denture border lengths that allow for free movement of musculature and tissue attachments or frenum cords.
• Molars that are placed proximate to the center of the ridge so as not to ride see-saw over the ridge when chewing.
• Proper occlusion between upper and lower denture, meaning that in your normal bite position all molars must strike together evenly, creating an uniform application of bite force down on to your ridge.
• Correct vertical placement of teeth. Teeth that are placed too high off a lower ridge will create more leverage to rock the denture.
• Dental implants. Although somewhat costly, these may be the only solution for some patients when the first five components have been met and the patient still struggles with retention.

Beyond good lower denture design, there really is no substitute for a solid big lower ridge and the ability of a patient to adapt well to the challenge of wearing an artificial substitute for what he/she was meant to, by nature. The fragmented conventional procedure of denture delivery through a go-between creates boundaries of communication between the various stakeholders involved the process and can seldom provide the same results as when the procedures are all done by the same person who personally takes responsibility for the correct fit and retention of the denture.

 

The Conventional Clumsy Procedure:

As a result of the monopoly created in law for dentists to supply and sell dentures, dental technicians who manufactures the appliances are legally restricted (as a criminal offence ) from any contact with the patient for whom the denture are intended [1]. Consequently, the dentist has to facilitate all the clinical procedures as a go-between and instruct the dental technician of the details required to make the denture.    This fragmentation of the denture delivery process creates a systems flaw that interferes with the transfer of important information between the manufacturer and the consumer.

Communication at best can be confusing and relaying instructions for alterations through a third party or a fourth person often ends in misunderstandings. Any communication between dentist and dental technician with regards to what the particular patient needs or how the denture should be made is very often limited to some remarks that the dentist’s chairside assistant might decide to write on the dental technician’s laboratory work slip. Essential information is all too often omitted, resulting in the dental technician having to phone the dentist while he/she is busy working on another patient and often can’t remember the required details about the case under enquiry. Dentists have a very tight schedule and staggered appointments, and invariably emergency cases wedged in between, which seldom leave time for discussions with dental technicians at the time when they have a telephonic enquiry. Invariably dentists have to depend on their dental assistants to facilitate much of these enquiries on their behalf, or personally phone back later. Patients' appointments often have to be rescheduled because there is often insufficient time left to do the laboratory work in time for the original appointment, by the time a simple enquiry about crucial omitted information  is resolved. Dental Technicians often have to use their own initiative without having the opportunity to see for themselves what needs to be done. All-round frustration results when the next step is done and the result are unsatisfactory [2]. The patient loses confidence in both the dentist and the dental technician when numerous attempts have to be made before a more or less workable denture eventually results[3]. This frustration about the clumsy procedure is no reflection on the competency of any dentist or dental technician; it is simply a systems-flaw that results from the prevention of direct consultation of the manufacturer with the person for whom the denture is intended, and the resultant absence of the transfer of important requirements because of working through a go-between. Fragmentation of the denture delivery procedure into compartments by a variety of categories leads to preventable frustrations.

This conventional process is clumsy[4] and because the work needs to be sent backwards and forwards between the dental laboratory and the dental surgery, often unnecessarily time consuming. All of these procedures require additional staff involvement and the repetition of some procedures adds to the price of the denture service to the patient. Many clumsy procedures that have been designed to translate information to the person doing the technical work can be simplified if the same person does all the procedures personally and do the required alterations while the patient is present.

Currently the frustrated dentist often ends up referring his “difficult ” patient directly to the dental laboratory to “fix it ” (an illegal procedure not provided for in the monopoly that dentistry have created for the profession), where it is often found that the patient had quite legitimate reasons for dissatisfaction with the denture made on instruction of the dentist[5]. Once the person making the denture and the person wearing the denture gets to communicate directly with one another, an optimal functional denture and denture satisfaction results, with happy smiles all-round. The fact that the Denturist is solely responsible for both the clinical and technical procedures results in a more individualized and properly constructed denture and achieves optimal denture satisfaction. There is simply no argument against this fact[6]. The expansion of the oral health team to include Denturism is effective human resource development and a productive service-efficiency improvement[7].

A dentist, substituting as a go-between and contracting out the manufacture of the denture, to a commercial dental laboratory, preventing direct communication between the manufacturer and the denture wearer, frequently ends up with an unsatisfied patient getting frustrated with both professions involved, and a denture that often needs to be remade. Many unsatisfied denture-patients move on and travel from one dentist to another, accumulating many unsuitable dentures in a quest for a functional result[8]. This clumsy, often-flawed system could be improved dramatically by providing the consumer with the choice of direct access between the end-consumer and the manufacturer without the interference of a go-between that serves no justifiable purpose other than to inflate the costs. The introduction of this proposal will have the effect of[9],[10]:

• Choice for consumers on how and from whom they access dental services

• More efficient use of dentists’ skills and time  

• More efficient use of dental technicians' skills and time 

• Direct communication between manufacturer and end-consumer 

• More efficient denture service

• Improved access to dental care for consumers

• Competition exerting downward pressure to lower consumer prices (See Effect of Competition on the Cost of Dentures)  

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[1]  Section 59 of Act 56 of 1979, and Section 27 &38 of Act 19 of 1979 reserves certain procedures for gain, exclusively for dentists.
[2] Consistent reporting by members of The Society
[3] DF Malherbe, LA Steyn, C Du Plessis, Z Fatagodien. Clinical Dental Technology: A Quest For Equity In Oral Health Care by The Society for   Clinical Dental Technology, 1998 Ó. Motivational Report to the SADTC, Minister of Health and the Department of Health.
[4] Duffy Malherbe.  Provision Of Removable Prosthetics By Denturists – What Is The Controversy? International Dentistry South Africa, Laboratory World. Vol 8 No 1. Jan 2006
[5] Consistent reporting by members of The Society and dental technicians generally in contact with denture wearers
[6] International Federation of Denturists www.international-denturists.org/Denturism/Patient Perspective
[7] Memorandum by The Society for Clinical Dental Technology to the Human Resources Cluster of the National Department of Health as a GENERAL MOTIVATION FOR THE ESTABLISHMENT OF A CATEGORY OF CLINICAL DENTAL TECHNOLOGIST IN ORAL HEALTH CARE. – In response to the Draft Strategic Framework for Human Resources for Health Plan. August 2005
[8] General feedback from denture wearers, confirmed in the Consumer Testimonials on our Homepage.
[9] Office of Fair Trading Report into private Dentistry in the UK 2003
[10] Irish Competition Authority Report into the professional services of Dentists 2005  

 

Making dentures - Slideshow

To see how dentures are made, click on the        button. Watch the slideshow and see the

difference between the conventional often clumsy procedure and the specialized more efficient proposal of denturism.

When the first slide opens, click on the small square icon on the far right corner of the bottom bar to start a Full Screen Slideshow

If you can not access the above button click on Making Dentures

Recognition is hereby acknowledged to Harry Hayn and Mohutsuwa Kgothule for making their photographs available for use in this slideshow

 

Denturism is pro-denture wearer, not anti-dentistry:

There are many competent dentists providing sterling services to their patients and communities and The Society’s campaign should not be construed as criticism against the dental profession. In fact, The Society has always propagated better communication, co-operation and referrals between denturists and dentists to serve the patient better. However, it is well-known that some dentists do not like doing denture work and would prefer not to. For various reasons they often find it an inefficient system with numerous time consuming retries and costly remakes resulting in frustrations to the dentist, the dental technician and especially to the patient[1]. It has often been reported that many dentists have confessed that that they would much rather see other patients for procedures that they can earn much more from, than from a denture patient.

The drive for Denturism has always been about Human Resource Development and about Dental Technicians striving to serve the denture wearing public directly, without having to work as if blind-folded with another person’s hands[2]. Currently Dental Technicians may not have any contact with the person for who the denture is intended, because only a dentist may legally do any intra-oral clinical procedure that relates to denture delivery. By the introduction of Denturism, an equitable balance can be found between professional development of dental technology on the one side of the scale and a more efficient service to the denture wearer  on the other side, by removing the counter-productive implications resultant from working through a go-between[3]. The introduction of Denturism provides efficient specialization for both the denturist providing removable prosthetics and also for the dentist to focus on the important role of maintaining oral health and fighting tooth decay. The patient's needs are served more efficiently, while the referral protocol remains that allows for the patient to be referred to other health professionals (when appropriate) for specialized procedures that is beyond the Denturist's scope of training.

Internationally the emphasis in dentistry has shifted to crown & bridgework and implants to treat the partially edentulous population. As a result there has been a trend in dental schools to reduce and in some instances even eliminate removable prosthetic coursework from their curriculum. The highly trained dentist of the future, who must be qualified to advise on all matters of health in any way connected with the oral tissues, do not have the time or the skills to commercialize himself by the manufacture and sale of dentures[4]. Dental technicians who have the manual dexterity and technical skills and are already professional in making dentures, and should do this work[5] in direct cooperation with the denture wearer. They already receive tuition in anatomy & physiology. They need a modified course of instruction in oral pathology recognition and the clinical procedures of denture delivery so that they can refer when necessary. Internationally Denturist-students spend much more time on technical and clinical education than dental students in removable prosthetics[6]. Naturally this new cadre should be controlled and registered by the appropriate authority.    

Unlike dentists, denturists do not perform invasive procedures, they do not administer general anesthesia and they do not prescribe drugs; therefore their practice does not pose a public health risk. Dentures are a reversible procedure; if they cause any irritation whatsoever, all the patient needs to do is to remove it from the mouth and return for further service/adjustment.[7]

Denturism is about bringing the consumer and the manufacturer into direct contact  with one another without the inevitable misunderstandings and economic consequences that is associated with working though a go-between. The fact that the Denturist as an expert is personally responsible for the chair-side as well as the technical procedures and direct communication with the end-user, results in a more individualized and optimally constructed functional denture[8]. The expansion of the oral health team to include Denturism is effective human resource development and a productive service-efficiency improvement[9]. If it also gives the consumer the added freedom of choice as to whose services to utilize, the fact that this additional option that comes into play will provide a responsible, safe and compassionate service at generally better affordable rates should be welcomed by all. 

In many countries, patients have a right to choose care and services from among a range of qualified dental health care professionals. With the evolution of international base-line competencies, and the development of first-rate retraining and upgrading opportunities, Denturism has come of age [10]. The acceptance of denturists in Oregon in particular and the Northwest United States in general has improved greatly over the last few years. Most enlightened dentists view denturists as colleagues who provide competent, professional continuity of care to their patients [11]. In countries where Denturism has been long-established, dentists are admitting that they were more than adequately compensated for the loss of some denture patients due to the competition, in the form of new referrals from denturists for other procedures [12]. It is reported from many countries that there is a new trend to include dentists, specialists, denturists, oral hygienists and therapists in group practices to provide the whole range of oral health services by a specialized workforce to their communities [13],[14]. 

Patients must be free to select the type of service that best meet their needs in terms of personal care, well being and affordability[15]. South African denture wearers should also be afforded that freedom. In order to protect the Public interest, The Society is in the process of compiling a Code of Conduct and a Patient Charter that will be binding on all practitioners upon registration of this new category. This Code is currently under revision and will be posted on this website soon.  See The Society Campaign.

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[1] Consistent reporting by members of The Society and dental technicians generally in their interaction with dentists and with denture wearers, also confirmed in the denture wearers petition on our Homepage
[2] Memorandum by The Society for Clinical Dental Technology to the Human Resources Cluster of the National Department of Health as a general motivation for the establishment of a category of Clinical Dental Technologist in Oral Health Care. – In response to the Draft Strategic Framework for Human Resources for Health Plan. August 2005.
[3] Duffy Malherbe Obligation of the SADTC to promote Denturism, Memorandum by The Society to the SA Dental Technicians Council, 22 August 2005
[4] Mr. CL Frizzel HD DRCS (Edin) LDS (Birm): A Plea For A Special Dental Course. The Dental Magazine and Oral Topics, Vol 60, April 1943
[5] Mr. CL Frizzel HD DRCS (Edin) LDS (Birm): A Plea For A Special Dental Course. The Dental Magazine and Oral Topics, Vol 60, April 1943
[6] Duffy Malherbe.  Provision Of Removable Prosthetics By Denturists – What Is The Controversy? International Dentistry South Africa, Laboratory World. Vol 8 No 1. Jan 2006
[7]  E Van den Eeden, DDM, CD, CDT,  "Denturists – The Solution to America’s Denture Crisis". (May 16, 2007) Michigan Denture Reform Committee. 160 pages. Global Professionals 720 E. Eighth St, Ste # 1., Holland, Michigan 49423; (616) 355-5500, Fax (616) 355-5502 ev3000@sbcglobal.net
[8] International Federation of Denturists www.international-denturists.org/ Denturism/ Patient Perspective
[8] Memorandum by The Society for Clinical Dental Technology to the Human Resources Cluster of the National Department of Health as a general motivation for the establishment of a category of Clinical Dental Technologist in Oral Health Care. – In response to the Draft Strategic Framework for Human Resources for Health Plan. August 2005.  
[9] Gerry Hanson Globalization of Denturism Presentation by the CEO of the International Federation of Denturism to the National Denturist Association (US, May 2005) and the Australian Dental Prosthetists Association (Sydney, August 2005).  
[10] Joe Coss (Outreach and Education Coordinator) - Oregon State Denturist Association. E-mail to The Society- 28 June 2007 02:08
[11] Jan Jansen quoting Prof Risto Touminen, Helsinki, Sweden in Internationaal Nieuws, (October 1989) Tandprotetisch Nieuws.
[12] Professor Cyril Thomas. Former South African Prosthodontist, Formerly: Head of Dental Prosthetics, University of Stellenbosch. Formerly: Deputy Dean and Head of Prosthetic Dentistry, University of Sydney. Director of Clinical Dentistry, University of Sydney. E-mail to The Society- Tue 03/07/2007
[13] Dr Kenneth Kais, DDS Dean of Bates Technical College, Washington. E-mail to The Society- 2007-06-25
[14] International Federation of Denturists www.international-denturists.org/ Denturism/ Patient Perspective  

 

Patient Perspective and Denture-satisfaction:

World wide, dentists often argue for direct supervision of Denturists. In whose interests do they really speak? By taking a patient-centered look at the process of having dentures made, one can more clearly illustrate both the impact on patients and also potential savings [1]:  

 

	Dentist	Denturist (Clinical Dental Technologist)
First visit	·          Mouth examined and preliminary impressions made. ·          Work collected by dental technician. ·          Custom impression trays made. ·          Work returned to dentists	·          Mouth examined and preliminary impressions made. ·          Construction of custom trays by the Denturist
Second visit	·          More accurate impression made using custom trays. ·          Work collected by dental technician. ·          Plaster models and record bases for bite registration completed. ·          Work returned to dentist	·          Muscle moulding, Final impression is obtained. ·          Master casts, record bases and occlusal rims are constructed by the Denturist
Third visit	·          Bite registration. ·          Tooth selection. ·          Work collected by dental technician. ·          Mater casts articulated and setting-up teeth. ·          Work returned to dentist	·          Vertical Dimension and occlusal registrations are established ·          Tooth selection ·          Mater casts articulated and set up of teeth is accomplished by the Denturist
Fourth visit	·          Try-in (possibly repeated, resulting in another visit) ·          Work collected by dental technician. ·          Processing and trimming of completed denture. ·          Work returned to dentist.	·          Try-in ·          Immediate corrections are possibly due to technical expertise of the Denturist. ·          Processing and trimming of completed dentures.
Fifth visit	·          Insertion of completed denture. ·          Adjustments are made. ·          Errors, misfits collected by dental technician (if necessary starting over from the beginning)	·          Insertion of completed denture. . ·          Adjustments are made. Immediate corrections and alterations are made by the Denturist

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The facts speak for themselves from this graphic table. All the transportation to and from the dental surgery and back to the dental laboratory can all be eliminated by the implementation of Denturism. Visitors may view a slideshow on Making Dentures that illustrates the difference between the conventional clumsy procedure and the proposed efficient specialization. On the current account of dental laboratories delivery fees already contributes to ±10% of additional expenditure[2]. In addition, many of the miscommunications, misunderstandings and remakes could be prevented, saving a lot of time and materials wasted unnecessarily  (at least another 10% saving)[3] Denturists are in the best position to pinpoint and correct problems and intricate adjustments simply because they have the training and dexterity skills to do both ends of this job[4]. That ensures optimal fit, correct function, maximum comfort and general well being of denture wearers, and the referral of the denture wearer to other Oral Health Team members when necessary or appropriate. The fact that the Denturist as an expert is solely responsible for both the clinical and technical procedures results in a more individualized and properly constructed denture and results in optimal denture satisfaction. There is simply no argument against this fact[5].

It has been reported that denture wearers experience denture-satisfaction differently than what dentists evaluate clinically [6],[7],[8],[9].  It is about comfort of fit, aesthetic natural appearance and balanced function when speaking and eating[10],[11],[12]. See Individualized Dentures. Many dissatisfied denture-patients move on and travel from one dentist to another, accumulating many unsuitable dentures in a quest for a functional result[13].  

Critical aspects of clinical procedures that impact on technical accuracy

The clinical procedures in denture provision that dentists normally perform as a go-between are:

 

q        the taking of impressions,
q        the registration of the bite-relationship,
q        try-in of the artificial teeth set-up on a wax base,
q        insertion of the finished denture.

The taking of impressions of the mouth and the bite-registration is, in essence, measurement-procedures that form part of the preparation stages during the design phase of denture-provision. After the artificial teeth have been arranged by a dental technician on a wax base in the relationship determined by the bite registration, this wax denture needs to be evaluated in the mouth [14]. At the try-in stage various crucial technical aspects of the denture design must be checked and adjusted if necessary, including:  

q        the correct set-up of the artificial teeth in the correct jaw relationship (bite)
q        the stable fitting of the wax bases conforming to the soft tissues of the mouth
q        the position of the arches in relation to the ridges
q        the position of the centre line
q        the horizontal and vertical dimensions
q        functional balanced occlusion and sideways movements
q        the amount of free-space
q        the amount of anterior teeth showing when smiling
q        the amount of lip-support and flange design
q        the selection of artificial teeth with relation to size, shape and color (shade)
q        the alignment of teeth with relation to aesthetics and the denture wearer’s needs and preferences
q        the amount of tongue space with reference to speech articulation  

When all these crucial aspects are balanced, the denture will have the optimal function and appearance [15] - denture satisfaction [16]!

Let's elaborate on a simple example. Before dentures are transferred into acrylic and completed, they are tried-in the patients mouth to make sure the design and tooth arrangement are acceptable as an indication of some of the above criteria. A denture try-in looks similar to a denture; but instead of teeth being set in pink acrylic denture base, they are temporary set into a wax denture base - for the purpose of making corrections possible. If the patient were to notice something not to be in total harmony with the patient's anatomy, physiology, or ability to function, it is the dentists responsibility to convey his/her evaluation to the laboratory with clear instructions on how to correct the setting of the teeth. As a result of the de-emphasis on technical proficiency in the insufficient training curriculum of dental students, newly graduated dentists sometimes do not have sufficient insight into denture design and dental laboratory tooth arrangement techniques and procedures to properly instruct the laboratory as to what correction to make [17]. For further elaboration on this matter, see also Dentist's deficient training in Prosthetics

Delegation of tasks  and responsibilities 

Many denture wearers can testify that their dentists are too busy to waste their valuable time on mundane procedures involved with denture-provision, such as taking the impressions and bite-registration, trying in of dentures, and handing over the completed dentures. In some practices, dentists get their dental assistants to take over clinical responsibilities of denture provision and also facilitate the procedures of the crucial try-in stage[18]. These assistants are not trained for this function and do not know what to check for or how to correct any adjustments or complications. Due to superficial training in this specialist field some dentists are simply not competent in all the technical aspects of denture provision and are quick to refer the patient to the dental technician to sort out, at the onset of the slightest complication. Many dentists' patients are referred directly to dental technicians for repairs and other denture procedures (including remakes), which dentists cannot relay or do themselves as a go-between. Dental Technicians have to provide these services for free [19].

Even with the go-between being a competent conscientious dentist (even experienced in denture provision), attempting to communicate as clearly as possible the individual needs and problems of the patient and specific complications, it is almost impossible for anyone to produce exactly what is required without seeing the patient personally[20].

 The fact that the Denturist as an expert is personally responsible for the chair-side as well as the technical procedures and direct communication with the end-user, results in a more individualized and optimally constructed functional denture [21]..The expansion of the oral health team to include Denturism is effective human resource development and a productive service-efficiency improvement [22].  

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[1] PATIENT PERSPECTIVE International Federation of Denturists www.international-denturists.org/ Denturism/ Patient Perspective
[2] Letter to the Editor from Mohutsuwa Kgothule. International Dentistry South Africa. Sept/Oct 2006
[3] Letter to the Editor from Mohutsuwa Kgothule. International Dentistry South Africa. Sept/Oct 2006
[4] DF Malherbe, LA Steyn, C du Plessis, Z Fatagodien CLINICAL DENTAL TECHNOLOGY: A QUEST FOR EQUITY IN ORAL HEALTH CARE The Society for Clinical Dental Technology - Copyright © 1998. Motivational Report to the SADTC, the Minister of Health and the Department of Health
[5] PATIENT PERSPECTIVE International Federation of Denturists www.international-denturists.org/ Denturism/ Patient Perspective
[6] Lamey, PJ Dr, School of Clinical Dentistry. Queen's University of Belfast. Influence of psychological factors on the acceptance of complete dentures. Gerodontology, Volume 18, Issue 1, Page 35-40, Jul 2001, doi: 10.1111/j.1741-2358.2001.00035.x
[7] A. Mersel, I. Babayof, D. Berkey J. Mann . Variables affecting denture satisfaction in Israeli elderly: a one year follow-up. Gerodontology, Volume 12, Issue 2, Page 89-94, Dec 1995,  
[8] Vassiliki Anastassiadou and M. Robin. The effect of denture quality attributes on satisfaction and eating difficulties. Heath Gerodontology 2006; 23; 23–32
[9] Hendricks SJH, Wilson V, Angellilo I. PATIENTS SATISFACTION AND DENTIST EVALUATION OF DENTURES IN SOUTH AFRICA. Journal of DASA, March 1996. 
[10] R. F. Souza, L. Patrocínio, A. C. Pero, J. Marra & M. A. Compagnoni. Reliability and validation of a Brazilian version of the Oral Health Impact Profile for assessing edentulous subjects. Journal of Oral Rehabilitation, 23-May-2007
[11] Janice S. Ellis, PhD, BDS, FDS RCS, PGCE; Nanita D. Pelekis, DDP, MSc; and J. Mark Thomason, PhD, BDS, FDS RCS. Conventional Rehabilitation of Edentulous Patients: The Impact on Oral Health-Related Quality of Life and Patient Satisfaction. Journal of Prosthodontics, Volume 16, Issue 1, Page 37-42, Jan 2007
[12] René La Cour. Aesthetics of Removable Dentures - A Guide to natural looking dentures.  Precht Dental, Denmark. 1999
[13] Consistent reporting by members in contact with denture wearers.  
[14] Basker RM, Davenport JC, Tomlin HR, Prosthetic treatment of the edentulous patient.
[15] Dental Laboratory Technology: Prosthedontic Techniques (1968) Commissioned by the University of North Carolina
[16] Aesthetics of Removable Dentures – a Guide to Naturally Looking Dentures. René La Cour - Precht Dental, Denmark. 1999
[17] E Van den Eeden, DDM, CD, CDT,  "Denturists – The Solution to America’s Denture Crisis". (May 16, 2007) Michigan Denture Reform Committee. 160 pages. Global Professionals 720 E. Eighth St, Ste # 1., Holland, Michigan 49423
[18] Consistent reporting by members of The Society in contact with denture wearers. 
[19] Section 59 of Act 56 of 1979, and Section 27 &38 of Act 19 of 1979 reserves certain procedures for gain, exclusively for dentists.
[20] Memorandum by The Society for Clinical Dental Technology to the Human Resources Cluster of the National Department of Health as a GENERAL MOTIVATION FOR THE ESTABLISHMENT OF A CATEGORY OF CLINICAL DENTAL TECHNOLOGIST IN ORAL HEALTH CARE. – In response to the Draft Strategic Framework for Human Resources for Health Plan. August 2005.
[21] PATIENT PERSPECTIVE International Federation of Denturists www.international-denturists.org/ Denturism/ Patient Perspective 
[22] Memorandum by The Society for Clinical Dental Technology to the Human Resources Cluster of the National Department of Health as a GENERAL MOTIVATION FOR THE ESTABLISHMENT OF A CATEGORY OF CLINICAL DENTAL TECHNOLOGIST IN ORAL HEALTH CARE. – In response to the Draft Strategic Framework for Human Resources for Health Plan. August 2005    

 

Individualized Dentures:

No two people are exactly alike, thanks to the unique interplay of thousands of natural variables…from the color of our hair and eyes, to the tone of our skin, to our height and the build of our bodies. None of us are exactly symmetrical either, eg. one ear might be slightly smaller or lower than the other, as your lip might pull up slightly more on the one side than the other when you smile. These subtle "blemishes " makes us unique and natural-looking.  Smiles gain their beauty from the size, color and shading of our teeth, as well as from the way our teeth are positioned in our mouths.

Good looking dentures are not usually "piano key " or "picket fence " arrangements, where “snow white” teeth are arranged in a perfect row. While such arrangements may be comfortable and allow you to chew your food, these dentures generally look like dentures…They look like "false teeth ". On the other hand, modern dental technology has developed personalized dentures that can be as natural-looking as the teeth you were born with. The personalized modern denture provides a softer, more realistic appearance that can make your smile much more natural-looking.

Common complaints 

When dentures are first inserted they fit the gum snugly. There is no substitute for a well-fitted denture, and to make sure that you have no problems always have your dentures checked regularly by a competent clinician. Over time shrinkage occurs in the gum that supports your dentures or dentures are worn down, leading to the lower jaw moving out of its correct position with the upper jaw. This can sometimes lead to a number of problems. The facial muscles can virtually collapse giving the appearance of premature aging. Other symptoms which may occur include; 

• cracked and continually sore corners of the mouth

• a dull pain in or around the ear

• a clicking noise when chewing

• dizziness

• headaches

• burning sensation in the throat, tongue and side of the nose

The natural appearance of a denture is an important facet of denture-satisfaction. All too often a patient's appearance is negatively influenced by an unimaginative artificial-looking denture that is not in harmony with the face and age of the patient. Common complaints/shortcomings of existing dentures includes [1],[2]: 

• teeth unnaturally white, 

• no definition of tooth arrangement, 

• teeth slanted to one direction, 

• lack of vertical support causing a collapsed (sunken) appearance, or the other extreme; 

• showing too much teeth - giving a horsy look. 

• arch of teeth wrongly placed with uneven or insufficient lip and facial support

• loose worn dentures

This is often the result of ignorance or the consumer being uninformed due to not having access to sound advice. During the conventional procedure, the transfer of important information between the patient and the dental technician that makes the denture, through a dentist go-between is at best very limited and often insufficient, but generally almost non-existent. Incomplete order forms sent to dental laboratories often, contains no more than the dentist's and the patient's surnames. That is all, some impressions inside impression trays with no indication of the type of work needed on the work order slip, not even a completion date, or a shade [3]. Dental technicians daily wastes long hours on the telephone, trying to get some basic information that was omitted from work orders from dental surgery staff, while the dentist is busy working on another patient. Sometimes denture wearers have no option or choice in what they get. 

  Do you get what you ask for, or do you have to accept what you get?  

 

Appropriate natural appearance

The following are important factors to take into consideration when a natural looking denture and satisfied consumer is to be achieved [4],[5]: 

• Selection of tooth length, size and shape to suit the individual

• Shade of teeth matching complexion, hair colour and age

• Characterized placement of individualized teeth to enhance natural appearance

• Lip, facial and vertical support

• Line of teeth on a level plane incorporating the facial anatomy.

• Smile line incorporated in the balanced placement of the individual teeth.

• Direct communication and co-operation between manufacturer and consumer

Often patients have a mindset that since they have lost their own teeth, the new ones might just a well be perfect to "improve " their personal aesthetics, to regain a youthful appearance, and insist on small white teeth, set-up in a perfect straight arrangement. Once it is explained that it actually detracts from your appearance because it is too obviously artificial when the dentures are made up of teeth that are much too light for your age and too small for your face, such patient is often ready to consider constructive advice and suggestions from their Denturist.

Generally denture wearers want dentures that are unobtrusive, as if they were not wearing dentures [6]. In most cases, they do not know which shade, surface structure, and shape of tooth will be in harmony with their face for a more natural look. It is the duty of the clinician, the dental professional to pass on their knowledge to the consumer, selecting the teeth together[7]. The appearance of your dentures can often be improved to look very natural, to fit your personality and enhance your self-esteem by working closely together with the professional who will personally make your denture. Your age, gender, personality, face-shape and skin tone should all be taken into consideration when selecting teeth.  Until now, patients have been denied from having direct access to the manufacturer of their dentures in South Africa and had to accept what their Dentist provides through a dental technician working in isolation from the patient, often with insufficient information [8]. 

Tooth Selection

Color : Today trends tend to be more towards lighter shades with patients often requesting shades that are perhaps too light for their skin color. Obviously we all want a healthy bright looking smile. However, a smile that looks like a denture is neither. Indicators to consider includes complexion, hair colour and age. Tooth shades tend to include varying intensities of undertones of the colors of yellow, brown or gray, and made in 2-4 layers of color with darker necks and more transparent tips.

Size : Size of tooth is critical. Teeth that are too large tend to give one a "horsy appearance " . On the other hand teeth that are too small tend to make other facial features, such as your cheeks, nose and lips seem relatively large. Small "mousy " teeth set up on a flat plane looks very artificial. A denturist have the knowledge to give sound advice and guidance.

Shape : There are numerous methods employed to determine the shape of teeth, based on such criteria as the shape of the head, bodily structure and male or female characteristics. The shape of one's face is an important indicator of dominant anatomical form. Although there are many variations in tooth form, patients are generally placed into four categories as follows.

 

Another important indicator for tooth form can be obtained from the shape of the maxilla. From the vast range of maxillary forms identifiable, three basic types can be inferred: square, triangular and oval. Almost all grades of artificial teeth used for dentures can also be grouped in these tooth form groups.

  Triangular Tooth Shapes            Square Tooth Shapes                 Oval Tooth Shapes                 

Characterization : Many denture clinics carry a wide selection of teeth that will often include characterized or cosmetic teeth. These are teeth that have multi-shades blended in along with decalcification, small fractures or composite fillings. The intent being to more realistically blend in with other natural dentition [9].

In selecting a tooth a careful evaluation is made of the physical character of the face including its size, slope and contours as well as any slight differences between the left and right sides. Age and the basic coloration of hair, eyes and complexion are also noted. Then all of these factors are weighed and compared so that the selection of teeth and final design of the denture is attractive and natural. The appearance of your dentures can often be improved to look very natural, to fit your personality and enhance your self-esteem by working closely together with the professional who will personally make your denture [10]. For photographic evidence,  see also examples in the Before & After Gallery  below. A Denturist can give expert advice, based on knowledge and experience, but the patient is the consumer, who will be wearing the denture and must have the ultimate choice, as informed consent  to continue construction with the agreed choice of teeth. 

Direct communication

During the conventional procedure, even with the go-between being a competent conscientious dentist (even experienced in denture provision), attempting to communicate as clearly as possible the individual needs and problems of the patient and specific complications, it is almost impossible for anyone to produce exactly what is required without seeing the patient personally. Until now, the institution of denturism have been denied from consumers in South Africa. They have to accept what their Dentist provides through a dental technician working in isolation from the patient, often with insufficient information. Direct access and communication of the denture wearer with the manufacturer of their denture can vastly improve the level of denture satisfaction of denture patients and develop realistic expectations [11].

It is important for a denturist to know if there was specific aspects of previous dentures that the consumer disliked or do not want to be repeated. Denturists communicates with their clients about their functional and aesthetical needs, their likes and dislikes, what is technically achievable and can alter the wax try-in to suit the individual's preferences. Such alterations can be done while the client is present and tried-in or re-tried-in to the individual's satisfaction. Often attempts to mimic the appearance of the individual's natural teeth prior to wearing dentures copied from old photographs, results in a higher degree of denture satisfaction and self-confidence[12]. 

A more personalized arrangement of the anterior 8-10 teeth can include a variety of masculine or feminine appearances, such as selecting the right shape, size and shade (colour) of tooth, using a variety of different shades of teeth, or characterized teeth, to look more natural, leaving strategic gaps between specific teeth, tilting, twisting or overlapping some teeth and taking into account uneven lip-retraction when the individual smiles[13]. The amount of teeth showing, the extent of lip support, or lack thereof can make a profound difference to a patient's aesthetics, definition of facial muscles and expression [14]. Denturists are experts in the creation of individualized dentures in co-operation and consent with the consumer, who ultimately have to live with the denture and see it smile back at you every time you see yourself in your mirror.

The fact that Denturists as the expert category in their field of artificial dentures is personally responsible for the chair-side as well as the technical procedures and direct communication with the end-user, results in a more individualized and optimally constructed functional denture  and consumer satisfaction [15]!

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[1] Brookswood  Denture Clinic, Langley, BC, Canada at www.yourdenture.com 
[2] Testimonials of patients to Minuk Denture Clinic, Winnepeg, Manitoba, Canada at www.minuksmile.com 
[3] Consistent reporting by members of The Society and dental technicians generally
[4] Barry A Lewis Denture Clinic, Nanaimo, BC, Canada in Tooth selection at www.dentureclinic.com 
[5] Chris Pine, Denturetech Denture Clinics in Albany, Orewa, Henderson, New Zealand at www.denturetech.co.nz
[6] James Connelly, Mainstreet Denture Clinic, Vancouver, Canada. at www.mainstreetdenturist.com
[7] La Cour R. The precise selection of anterior teeth  - International Dentistry South Africa. Vol. 8 No. 1 January/February 2006
[8] DF Malherbe, LA Steyn, C du Plessis, Z Fatagodien CLINICAL DENTAL TECHNOLOGY: A QUEST FOR EQUITY IN ORAL HEALTH CARE The Society for Clinical Dental Technology - Copyright © 1998. Motivational Report to the SADTC, the Minister of Health and the Department of Health  
[9] Cosmetic dentures and tooth selection. Barry A Lewis Denture Clinic, Nanaimo, BC, Canada at www.dentureclinic.com
[10] René La Cour. Aesthetics of Removable Dentures - A Guide to naturally looking Dentures.  Precht Dental, Denmark. 1999
[11] Memorandum by The Society for Clinical Dental Technology to the Human Resources Cluster of the National Department of Health as a GENERAL MOTIVATION FOR THE ESTABLISHMENT OF A CATEGORY OF CLINICAL DENTAL TECHNOLOGIST IN ORAL HEALTH CARE. – In response to the Draft Strategic Framework for Human Resources for Health Plan. August 2005.  
[12] Oliver Meier from Kaimai Dentures, New Zealand
[13] Aesthetics of Removable Dentures – a Guide to Naturally Looking Dentures. René La Cour - Precht Dental, Denmark. 1999
[14] Barry A Lewis. Cosmetic dentures and tooth selection.  www.dentureclinic.com 
[15] PATIENT PERSPECTIVE International Federation of Denturists www.international-denturists.org/ Denturism/ Patient Perspective  

 

Before and after Gallery

(Images in this Before & After Gallery is displayed with the permission and gracious consent of the Denturist that made the replacement dentures)

From the following BEFORE and AFTER photographs, a marked difference can be seen between the old worn dentures (or sometimes brand new but unsatisfactory ones) and the enhanced appearance of a personalized denture made by a denturist working directly with the patient:

 

Case 1: The upper denture on the left does not match the lower natural teeth. The denture teeth are too white, uncharacterized and uniformly arranged. The new denture on the right for the same patient matches the natural lower teeth better due to characterized teeth and a more natural uneven arrangement of the teeth itself.

     

With acknowledgement to René La Cour (Denmark) as published in International Dentistry South Africa Vol 8 No 1 Jan 2006.

 

Case2: The old  dentures on the left looked artificial because they were set up in a flat plane and because the size of teeth used were much too small for the patient's face. Note the more youthful appearance of the new dentures on the right, created by  improved lip support and by selecting a shape and size of tooth to compliment the patient's face and personality.

With acknowledgement to Brookswood  Denture Clinic, Langley, BC, Canada at www.yourdenture.com 

 

 

Case 4: The patient never had dentures before and did not want to look into the camera. Her new dentures were provided through a mobile service in the privacy of her home. Note the difference in facial expression and the sparkle in her eyes after a natural looking denture that enhances her appearance and personality, had been fitted. The spontaneous happiness that radiates from a satisfied patient's face when a successful denture is placed, is what provides job-satisfaction to a Denturist! 

  

Photographs with acknowledgement to Oliver Meier - Mobile Denture Service, New Zealand

 

Case 5: Due to resorbtion of bone in the upper ridge, the old dentures on the left were not showing enough anterior teeth and the posterior teeth therefore appears to be hanging, a common appearance of worn artificial dentures. After opening the bite to compensate for resorbtion and correcting the height of the occlusal plane, the new denture have improved anterior aesthetics, with full facial support.  

  

With acknowledgement to Minuk Denture Clinic, Winnepeg, Manitoba, Canada at www.minuksmile.com

 

      Case 6: Josiah worked as a Griller in a popular Durban Steakhouse when he lost his two upper central incisors ±10 years ago. Due to social stigma associated with edentulism, he was about to loose his job unless he could have the gap filled. He desperately needed a denture, but the fee quoted by dentists was beyond his economic ability. Eventually a compassionate dental technician visitor to the Steakhouse took impressions and made him the partial two-teeth denture for free. This denture has since been relined and is still a successful appliance that has served him well. 

      

With acknowledgement to the compassion of a dental technician

 

Case 7: This is a classical case starting off as a partial denture, with periodic additions as the remaining natural teeth were sporadically lost, resulting in a worn poorly fitting denture with unnatural artificial steps. The last remaining maxillary teeth were removed and vertical height restored, following the correct posterior plane and curves of the new full upper denture. A pleasing  anterior mould was selected to suit the patient's face and character. Note the the intra-oral photographs showing the "invisible" clasping units of the new lower thermoplastic partial denture that replaces the previously unsightly metal clasps on   ³ ┐+┌³   

  

  

With acknowledgement to Minuk Denture Clinic, Winnipeg, Manitoba, Canada at www.minuksmile.com

 

Case 8:  The patient presented with two upper laterals on a partial denture with poor esthetics. The other 4 anterior teeth are over-erupted and appears very long. A thermoplastic partial denture was designed to fit over and partially cover the necks of these teeth to create an esthetically more pleasing result. The denture is placed in warm water before insertion, to allow the elastic wings to soften and flex over the undercut areas during placement.   

Photographs with acknowledgement to Oliver Meier (New Zealand)

 

Case 9: This patient's old dentures were completely worn and did not show any teeth unless he was smiling. Surprisingly, he had no tissue damage, or denture stomatitis as a result of the sharp edges left from broken flanges and a worn distorted gold tooth. This patient was served at home. Note the youthful appearance that has been achieved with the new denture. Nuri's only complaint was that his grandchildren does not run away anymore, when he pulls scary faces at them! 

   

          

Photographs with acknowledgement to Oliver Meier (New Zealand)

 

Case 10: A Gummy smile! The mould of tooth in the old denture was too short and the lip line too low. Due to a longer tooth that shows less gingiva, set up in a more natural arrangement, the new denture shows a marked improvement in aesthetics. Direct communication with a denturist often results in a more pleasing smile that suits the consumer and creates a higher degree of denture satisfaction.

With acknowledgement to Minuk Denture Clinic, Winnipeg, Manitoba, Canada at www.minuksmile.com

 

Case 11: This denture provided through the conventional route is an extreme example of unacceptable esthetics.  Note the upper extremity of the denture exposed under the smile line. The occlusal plane is much too low showing far too much teeth and gums, and the whole arch has been set up too far forward. The height of the tooth necks has been carved at uneven heights leaving  the centrals and canines too long. The smooth untextured gingiva appears puffy and artificial. The end result of the new denture on the right provided by her Denturist is a pleasing normal natural appearance.

             

Photographs with acknowledgement to Oliver Meier (New Zealand)

 

Case12: This denture wearer was hardly showing any teeth. The size and shape of the old chipped denture-teeth were copied, as it suited the shape of the denture wearer's face. The vertical height was corrected. Note the amount of teeth showing in the new denture and the difference it makes to the appearance of the patient's face 

With acknowledgement to Brookswood  Denture Clinic, Langley, BC, Canada at www.yourdenture.com 

 

Case 13: This patient wanted the immediate denture to look exactly like her natural teeth before the periodontal disease moved her teeth.  A full upper denture has now been placed directly after the oral surgeon removed the teeth. In accordance with a 5-year old picture the Denturist made the gab between ¹ ┘+└ ¹ smaller and the teeth are not as long as before. The asymmetric modeling plus the use of characterized teeth with a few extra stains, matches the lower natural teeth. This level of personalized aesthetics and satisfaction can seldom be achieved other than through direct consultation and cooperation with a denturist.

     

With acknowledgement to René La Cour (Denmark) at www.tnd.dk/tnduk/TNDARTICLE.html  

 

Case 14: This patient presented with a worn denture showing too little teeth and loss of vertical height. With the aid of an old photograph taken shortly before losing her natural dentition, her denturist assisted her to choose a mould and shape that made it possible to mimic and bring back her smile from a much younger era. The correct recording of the smile line is evident! 

Photographs with acknowledgement to Oliver Meier (New Zealand)

 

Case15: Wow! This is a non-surgical make-over, created by a denturist who provided a personalized denture, that prompted the patient to also get a new hairstyle. These photographs says it all without the need for any words.  And the satisfied approval shows in her eyes!

  

  

With acknowledgement to Minuk Denture Clinic, Winnipeg, Manitoba, Canada at www.minuksmile.com

 

Case 16: The transforming effect of Immediate dentures:  It has been said that one's eyes is a reflection of your soul! Due to circumstances Jannie was in a state of dental havoc. The Society used his example as a profile case to demonstrate the need for alternative affordable dental care and provided him with one of our first free sets of dentures under the Humanitarian Outreach Program. As the photographs demonstrate, his human dignity was restored. Read it all in Profile Stories.

 

        

 

                    

 

With acknowledgement to all the sponsors and practicing denturists that supports our HOP through sponsoring materials, professional time and sound advice.

 

 

 

Recognition of Denturists as the most efficient denture service providers:

Denmark is the only country in the world where Dentists have never managed to get a monopoly on the selling and provision of dentures[1]. However, since 1958, in 34 States individual Parliaments have rejected that monopoly after conceding that Denturists can best deliver the provision of dentures. During the past 50 years, since Denturism was first legalized in Alberta, Canada and Tasmania in Australia, every single state and province in both Canada and Australia have passed their own Denturism legislation on their own merits, a total of 17 pieces of legislation. In Australia, full & partial dentures and mouthguards  are uniform scope of practice in all states and recently Victoria, New South Wales, ACT and Tasmania have also included implant retained over-dentures. Only in one state  have the legislation for the practice of Denturism ever been withdrawn, in the USA, because the provisions insisted on by dentists made it impossible for anybody to qualify. In another state, Maine, similar unjust provisions have eventually been withdrawn and the profession is flourishing ever since.

Recently, as a result of the recognition of professional qualifications for Denturists by the European Union[2] and the right of movement of workers to practice their profession in any member state within the EU[3] at least another 6 countries are now involved in various stages of the process to push for legislation for the purpose. Denturism legislation has finally gone through its final reading during August 2005 in the UK, the first new piece of legislation since the 2004 Prince Edward Island initiative in Canada and the 1994 Washington Denturist Law. In various other countries a Denturist Bill is in some stage of discussion or consideration[4] including Slovakia, Belgium and various States in the USA such as Massachusetts, Michigan, Pennsylvania, Louisiana, California, Florida, Kentucky and Minnesota. Some States such as Maine and Oregon are working to expand their scope of practice to conform to global trends and include all removable prosthetics.

The best testimonial for the profession of Denturism is their flawless track record[5]. Denturism is so practical and safe to the public that the US Federal Trade Commission after conducting a five year study sent all state governments a letter of recommended rule-making; encouraging them to institute the profession of denturism in their state[6]. The truth remains; Denturists are highly trained health professionals. They produce a better end product. They have been known to satisfy their patients at a much higher standard. In the USA they can deliver a set of dentures to the public at half the cost of what American dentists charge.[7] It is reported from Australia that the provision of dentures by Denturists is so effective, that Dental Schools are now considering discontinuing denture training for dentistry students.

As with other allied health professions where the relationship between those with a historically defined role and those with an emerging role collides over concerns about standards, patient care, and control - Dentists and Denturists have globally been subject to inter-professional rivalries and struggles for mutual respect and understanding[8]. Historically, the relationship between Dentists and Denturists has in most countries been ambivalent at best, and more often than not, hostile and antagonistic. Legislation, and by implication, community dental health care, has often been shaped and defined by inter-professional conflicts and rivalries[9].  In Ireland the Minister of Health requested the Dental Council  to introduce a denturism scheme since 1993, and although the Department of Health in 2005 accepted official policy to introduce Denturism as soon as possible, the Dental Council have remained stubborn throughout and refused a Court recommendation that it is a desirable scheme[10]. Globally the popularity of Denturism is spreading gradually with most of the initial legislation being upgraded to keep track of global developments and bringing the work demarcation in line with local demands and international tendencies[11]. See also EU recognition of Denturist qualification.

Clinical dental technologists will provide competition to dentists for the range of services they are qualified to provide, thus putting downward pressure on the prices of these dental services. This is the case in other countries where clinical dental technicians are legally recognized including Australia, Canada, Denmark, Finland, Mauritius, the Netherlands, New Zealand, Switzerland, UK, USA, etc[12]. The 2003 Office of Fair Trading Report into private Dentistry in the UK and also the 2005 Irish Competition Authority Report into the professional services of Dentists both did in depth investigations into the results of restrictive practices of denture provision.  In conclusion both Reports made specific direct recommendations for the immediate introduction of a class of Clinical Dental Technician to provide this service in competition to dentists, as it will inevitably improve the efficiency of the service and decrease the cost to the patient[13].

Claims such as those suggesting that dentures supplied by Denturists "cause cancer " fail to be supported by any empirical data. Such claims are, in fact, undercut by case studies from Canada, Finland, Tasmania, Australia and other countries where Denturists have been successfully integrated into community dental health care programs for several decades. None of the negative health claims made by dentistry in order to protect it's monopoly have been supported by any credible evidence . The only "health risks " appear to be related to occasional ill-functioning and ill-fitting dentures rather than to the impact of any integrated flaw in the service delivery system, which is a claim that dentists can’t make themselves[14].  

The fact that the Denturist as an expert is personally responsible for the chair-side as well as the technical procedures and direct communication with the end-user, results in a more individualized and optimally constructed functional denture. In the final analysis, the expansion of the Oral Health Team to include Denturism is effective Human Resource Development and a productive service-efficiency improvement. See also Acceptance of legislated practice

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[1] Report by Viggo Bramstoft from the Danish Denturist Association to the 2002 IFD Conference. www. International-denturists.org/Country Reports 2002
[2] The Committee of the Environment, Public Health and Consumer Protection has recommended that DENTURISM SHOULD BE EXTENDED TO ALL COUNTRIES WITHIN THE EEC (now the EU) - Report by FA Wijsenbeek (Member of the European Parliament for the Netherlands) at the Annual Congress of the IFD in Mandelieu France, 28 September 1989.
[3] The TREATY OF ROME provides for the freedom of movement of workers throughout member countries of the EU. This implies that a qualified Denturist in his own country would be allowed to practice his profession in any member country whether denturism is professionally recognized in that country or not
[4] International Federation of Denturists www.international-denturists.org/Denturism/2004 Country Reports
[5] FEDERAL TRADE COMMISSION REPORT. - American Denturist Advocacy Council – a Public Information Website: www.usdenturist.com/Facts/Federal Trade Commission report
[6] FEDERAL TRADE COMMISSION REPORT. - American Denturist Advocacy Council – a Public Information Website: www.usdenturist.com/Facts Federal  Trade Commission report
[7] FEDERAL TRADE COMMISSION REPORT. - American Denturist Advocacy Council – a Public Information Website: www.usdenturist.com/Facts/Federal Trade Commission report
[8] International Federation of Denturists www.international-denturists.org/Denturism/FutureCollaboration 
[9] International Federation of Denturists www.international-denturists.org/Denturism/ 
[10] International Federation of Denturists www.international-denturists.org/Denturism/2005Country Reports  
[11] Gerry Hanson GLOBALIZATION OF DENTURISM Presentation by the CEO of the International Federation of Denturism to the National Denturist Association (US, May 2005) and the Australian Dental Prosthetists Association (Sydney, August 2005).   
[12] 2003 OFFICE OF FAIR TRADING REPORT INTO PRIVATE DENTISTRY IN THE UK www.oft.gov.uk/market+investigations/ investigations/ dentistry 
[13] THE COMPETITION AUTHORITY REPORT: COMPETITION IN PROFESSIONAL SERVICES – DENTISTS/ Executive Summary. Dublin, Ireland. December 2005. www.tca.ie  
[14] FEDERAL TRADE COMMISSION REPORT. - American Denturist Advocacy Council – a Public Information Website: www.usdenturist.com/Facts/Federal Trade Commission report

 

The Price of Dentures:

Availability fee of dentists

Due to the wide range of services dentists provide and the cost of specialized training and equipment, a high hourly-rate has to be charged to cover the expense as an availability fee. If the cost of keeping a dental surgery open, is not recouped equitably from everyone that utilize the services available, the business of dentistry will soon run at a loss. The current labor rate for dentists is calculated at R550-650/hour. 

• The restoration of natural teeth due to attrition, oral disease and mutilation by means of filling, 
• preparation of natural teeth to place crowns and bridges and cementing them in place, 
• the extraction of non-vital teeth and roots, 
• tooth-planing and root-canal treatment, 
• cleaning, scaling and polishing of a patient's natural teeth, and 
• extracting of both primary and secondary teeth, and 
• the taking of intra and extra oral X-rays of natural teeth 

are only a few of the random procedures a dentist could provide on natural teeth. The equipment needed and material stocks are kept available; the knowledge and skills to perform such procedures all come at a cost and are available to all the dentist’s patient. The dilemma is however, that a full denture wearer have no need for these or other services relating to natural teeth as he/she has already lost all their natural teeth. When a person only need dentures it is wasteful to pay for the availability of services they do not need and can not utilize!

Direct savings from direct service

All the back-and-forth deliveries between the various stages (4-6 deliveries) during the customary procedures of denture provision will be prevented when the patient goes to a denturist. The delivery charge makes up almost 10% of the current dental laboratory fee, which will be saved if the go-between is by-passed to create a direct one-stop denture service. In addition, many of the remakes as a result of insufficient communication and misinterpretation could be prevented, saving a lot of time and materials wasted unnecessarily (possibly another ±10% saving). Soon dental technicians will be forced to add an administration fee  to their invoice, to be paid over to the dentist as an incentive to pay their accounts for the work the dentist ordered him/herself on contract for their patients. This administration fee is presented as the expense dentists have to occur to recover dental technicians fees from their own patient. However, there is no contract between the dental technician and the dentist's patient. Obviously, denturists' clients would be saved from such expenses. Currently the labor rate for dental technicians is calculated at R168/hour (+VAT). (+VAT). Denturists will charge similar rates for the clinical procedures they perform.

There are no reasons why Clinical Dental Technology will not provide the public in South Africa with the opportunity for substantial savings, to the magnitude of ± 30 % (conservative estimate) on the cost through a dentist, while at the same time including safeguards to protect the oral health of the public. A projected saving of R85 million annually (1998 estimation) to the economy should no longer be ignored. At current fees the potential saving exceeds R200 million annually. However, the biggest advantage of Denturism is the improvement in efficiency of the denture delivery system and general improvement of denture satisfaction. Many of the old and the poor who cannot afford the customary procedures, will welcome this service. 

Incentives to serve the poor

Considering the incidence of poverty amongst some communities, there will probably always be those that will never be able to afford dentures at any fee, unless the State subsidizes the service. Once Denturism is instituted, the reason for having dentures made by “quacks ” will in all likelihood become obsolete, especially if denturists are allowed to have satellite clinics and provide mobile services also in the rural areas. The provision of dentures is as basic as it gets in Oral Health services. If the National Medical Scheme recognizes this fact and agrees to include the expenses of CDT’s to serve the denture needs of the indigent population as the National Health Scheme in the UK did, it could become an affordable and cost-effective service. If the annual R500 million tax incentives allocated by the State for scarcity services in the rural areas are made applicable on privately practicing CDTs it could likewise be an effective incentive for them to serve those communities, especially if they could utilize the facilities of district clinics. This type of partnership between the State and CDTs could be beneficial to the indigent rural population who happens to be high in edentulism and have high needs for dentures.

“None of the programs out there do anything to help older people with dental costs,” said a pensioner recently after hearing about the Denturism initiative of The Society for Clinical Dental Technology. “If this would go through, it would have an overwhelming impact on older denture wearers.” Internationally proponents of the idea say that it’s an effective, cost-saving way for people, particularly those of limited means, to get false teeth. The cost saving is estimated at more than 30 percent and in some countries it could be up to 50 percent as has been proved for several decades in those countries where Denturism has been long established. See also Effect of Competition on the Cost of Dentures   

For as long as no open debate by all stakeholders is allowed, the controversy remains and in the meantime, the old and the poor, the denture wearing public, are annually wasting large sums of money they do not have, on unnecessary expenses. With the ever-increasing cost of health-, and especially dental services, the spiraling increases in medical schemes premiums and the general state of the economy, it is not surprising to find that few denture wearers (of whom the majority are pensioners) can afford to pay the current dentists' fee for a set of false teeth. The state, through the public sector, cannot supply the existing backlog in the demand for artificial dentures. The time have now arrived to start a public awareness campaign to inform the public of the advantages of Denturism and to lobby for their support in this initiative! 

Because of the cost-effectiveness and specialized nature of their services, the dental consumer has globally been Denturism’s greatest ally. This is why public initiatives and referendums have typically been the more successful route to legalizing Denturism. “When the issue goes to the public, that’s when it wins,” says Paul Levasseur, President of the International Federation of Denturists. “If you look at the history of medicine, physicians were given carte blanche; they handled everything. As they realized they couldn’t do it all, complementary, support professions developed,” explains Levasseur. “Just as this situation has worked well for the medical community, dentists and the government need to see how professional offshoots could benefit dentistry, and more importantly – the dental consumer.”

Fees of Dentists and Dental Technicians in SA for 2006 with speculated fees for Denturists :

Procedure (all including VAT)	Dentist Clinical Fee  (*)             (**)	Dental Technician Lab Fee (L)	Customary Fee (Dentist + L)	Denturist Lab Fee	Denturist Clinical Fee	Denturist   Total Fee	% Saving
F/F	R1185      (R4815)	R1735.00	R 2920	R1615.00	R 400.00	R2015	31%      (69%)
4 tooth P/- Acrylic	R   580      (R1765)	R   650.00	R 1230	R   590.00	R 300.00	R   890	28%      (63%)
4 tooth P/- Metal	R1230      (R4461)	R1754.00	R 2985	R1664.00	R 400.00	R2064	31%      (67%)
Reline	R   360      (R  1203)	R   352.00	R    712	R    292.00	R  200.00	R   492	31%      (68%)
Repair (without impression)	R      90        (R  280)	R   235.00	R    325	R    175.00	N/C	R   175	46%      (66%)

 

If you can not access the button above, click on Calculations for table

 

The Dentists Clinical Fees listed above for some typical prosthetic procedures are the National Reference price list for Medical Schemes (*), effective from January 2006. Many dentists do not charge according to these fees but have "contracted out" in order to charge more.  The patient is then liable for the outstanding balance. The amount in brackets is the fee recommended by the HPCSA (**) as from 28 November 2005. The labor rate of dentists for procedures not listed on the schedule is calculated at R550 - R650/hour and in some communities apparently up to 30% more. 

The Dental Technician Laboratory Fee for the listed procedures are what is specified in the Government Gazette No 28247 Vol 485 of 25 November 2005 in respect of work done on contract for dentists. These fees had always been a fixed fee but higher fees may now theoretically be charged by prior agreement with the dentist and the dentist's patient. The dentist is by contract liable for full payment to the dental laboratory. The labor rate of Dental technicians for procedures not listed in the Government Gazette and for remakes, is calculated at R168/hour(+VAT).  

The Denturist Laboratory Fee is the Dental Technicians Lab Fee minus the delivery charges that will become redundant because Denturists do the clinical as well as the Lab work themselves and will not have to transport the work between the clinical area and laboratory for every clinical stage . 

The Denturist Clinical Fee is calculated on the basis of the hourly labor rate that dental technicians are remunerated, multiplied by the amount of hours that the clinical procedures takes. The clinical procedures for a Full upper and lower set is calculated at 2 hours,  a partial denture is calculated at ±1½ hours and for a reline of a denture 1 hour. No clinical fee would be charged for a repair if no impression was needed. Consumables such as impression materials was not taken into account because of the relatively low cost at the volumes consumed.

The % Saving is the conventionally combined Dentists Clinical Fees plus L (Dental Technician Laboratory Fee)  minus the combined Denturist Laboratory Fee and Denturist Clinical Fee:  (■+■) - (■+■) = Saving. The % shown in brackets is the amount saved by denturists compared to what the HPCSA allows dentists to charge.  

In practical terms, this means that a patient currently pays between R3000 and R6500 for a full set of dentures where a denturist may be able to supply a denture at ±R2000 (minimum 31% saving). A partial metal denture would cost between R3000 and R6200 where a denturist may be able to supply directly at ±R2100 (conservatively calculated 31% saving).

 

Consumers Freedom of Choice:

The provision of removable prosthetic appliances by denturists will extend the consumer’s choice of categories of service providers available. The patient who can not afford the prices charged by a prosthodontist, have the right to consult a general practicing dentist, to provide appliances manufactured by a dental technician sub-contractor. Those in need who can not afford the dentist’s fee, are caught up in a system at present where they are forced either to satisfy their needs at ill-affordable rates, or through illegal avenues, or to go without. This is not a fair choice of options!

The introduction of denturism will go a long way to ensure high quality dentures and other removable appliances, a highly efficient one-stop service,  at cost-effective and better-affordable prices. These principles are observed and well documented in Canada, the Netherlands and as a matter of fact in all 34 countries and states where the category has been legislated. The introduction of denturism has indeed resulted in a downward trend in prices where the category was introduced.  However, in South Africa where denturism is not yet introduced, due to the high cost structure of conventional procedures and providers, a large section of the population have no other viable option than to obtain their dentures from untrained, unscrupulous, "unregistered dentists ", commonly called "quacks ". This route of denture provision often takes place at the risk of cross infection of a number of communicable diseases and normally without the opportunity of any recourse after delivery of this "cheap and nasty " service. It seems illogical to spend many millions annually on special campaigns to inform people and combat the spreading of Hepatitis B, TB and other communicable diseases, and turning a blind-eye to the cross-infection and re-infection of the very same diseases (possibly even HIV/AIDS) due to unhygienic practices of quacks. The State and all professions concerned should discourage this option with all the power in it’s influence sphere, by allowing a cost-effective and safe alternative to evolve.  

By including denturists on the oral health team, denture-clients would be free to select the level of service that best meet their needs. In this way they will decide for themselves what they can afford, what aesthetic result they will be satisfied with, what kind of personal care they require. Their personal preference will be the deciding factor.

The public should have the right to choose whether they want their dentures made through a dentist go-between and dental technician sub-contractor, or directly by a denturist. The consumer, who cannot afford the services of a dentist, will as an alternative have a cost-effective professional service available to them. This concept, in essence, embraces the policy of the current Government to empower the people, by creating access to affordable services. 

 

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