My relative won't wear their denture: what should I do?

The sentence families say most often is this: 'We couldn't get them used to it; they're just being stubborn.' In fact, most people who do not wear their denture are not being stubborn; it is uncomfortable when they wear it, and they have given up explaining that. Someone who has raised their complaint a few times and been told 'you'll get used to it' stops mentioning it at some point and quietly puts the denture away in a drawer. That is why the first thing to do is not to persuade them but to find out the reason.

The most common reason is the denture becoming loose. After teeth are lost, the jawbone starts to shrink because it no longer carries any load, and its shape changes over the years. The denture, however, was made to fit the shape on the day it was first made. As the bone changes, the denture stops fitting: it moves when they talk, slips when they eat and falls out when they laugh. This is not clumsiness on the patient's part; the base underneath has changed.

The second is rubbing and sores. When one spot on the denture presses on the lining of the mouth, a painful sore forms there. The person changes the way they chew to protect that area, then wears the denture less, then stops wearing it. The solution in this situation is often an adjustment taking a few minutes; but someone needs to know that, and they need to come to an appointment.

The third is the palate. An upper denture covers the palate, and this changes two things at once: in some people it triggers the gag reflex, and in almost everyone it reduces the sense of taste and temperature. Someone who has lost the pleasure they took in food also loses the wish to wear the denture. From the outside, this is one of the hardest reasons to understand, because the person often puts it as 'food has no taste'.

The fourth is a dry mouth. Saliva forms a thin film that helps the denture cling to the lining of the mouth; when there is less of it, the denture both fails to stay in and rubs, causing sores. A dry mouth is common in older age and can be a side effect of medicines being taken. The fifth is manual dexterity: a tremor, joint problems or loss of sight make it hard to put the denture in, take it out and clean it without help.

All of these share one consequence, and it is usually noticed late: the diet narrows. Meat, vegetables and fruit that are hard to chew drop off the menu, replaced by soft and usually carbohydrate-heavy foods. Weight loss, weakness and social withdrawal follow from this. In an older person, a narrowing diet stops being a problem in the mouth and becomes a matter of general health.

The following are the routes to discuss after an examination. None of them involves pressuring the patient; all of them aim to remove the reason.

The sequence below both makes the conversation easier and stops going to an appointment from turning into a confrontation.

1. 1

   Ask without blaming

   Instead of 'why won't you wear it?', ask 'what bothers you most when you wear it?' The first question makes people defensive; the second brings information. The answer you get shows directly where the solution lies.

2. 2

   Note down the specifics

   How long they have not been wearing it, where it hurts, whether it moves when they talk or when they eat, whether their mouth is dry, whether they have lost weight, which foods they have given up. These are the questions that will be asked at the examination; going prepared saves time.

3. 3

   Take the denture with you

   The denture that is not being worn is the most important part of the examination. Wear, cracks or a poor fit on its inner surface can be seen from it. Going while the denture stays forgotten in the drawer is as good as not going at all.

4. 4

   Take the list of medicines

   Medicines that cause a dry mouth are commonly taken and directly affect the situation. The list should be written down; photos of the boxes also work.

5. 5

   Leave the decision to them

   Listen to the options that come out of the examination together, but let them make the decision. People stick with a treatment they have chosen themselves far better than with a decision made on their behalf.

6. 6

   Support their eating in the meantime

   The solution may take a few weeks. During this time it is important that their protein and fluid intake does not drop; talk about options that are easy to chew but nourishing.

From the least to the most extensive. The decision is made according to the person's health and wishes.

The real harm in this situation shows up not in the mouth but outside it. The following are the ones most often noticed late.

Whichever route is chosen, support in the first few weeks decides the result.

1. The first few days

   With an adjusted or new denture there is a period of a few days to get used to it. Slight discomfort during this time is normal; but a sore that hurts in one particular spot is not normal and needs a check-up.

2. The first week

   A check-up is planned for any spots that rub. This appointment should not be skipped: a pressure spot that is not adjusted in the first week can result in the denture never being worn again.

3. The first month

   Look at whether their diet is widening. If they can eat meat and vegetables again, the solution has worked. If the menu is still narrow, the cause may still be there and should be reassessed.

4. The long term

   With removable dentures, because the bone keeps shrinking, regular check-ups and occasional relining are needed. If they have moved to a fixed solution, check-ups focus on the tissue around the implants.

The solutions here are on very different scales: from an adjustment taking a few minutes to a full-mouth plan. These are the items that decide it:

Whether the existing denture can be saved

Adjusting and relining are the lowest-cost route. If the denture is very old or the shape of the bone has changed a lot, a new denture comes into consideration.

Whether implant support will be added

There is a big difference between stabilising a denture with a few implants and having a fixed bridge made. Both are possible; which one is suitable depends on the state of the bone and their general health.

General health and extra preparation

In an older patient, the medication routine, long-term conditions and, if needed, their GP's opinion are part of the plan. This item affects the timetable more than the cost.

How long treatment takes

With a plan spread over months, the patient and the person accompanying them have to make many trips back and forth. In older age, this can be the item that does not appear in the quote but is the most demanding.