17. The British Dental Journal sets out the instructions for the construction of partial dentures and explains the importance of communication and the interaction between the patient, dental team, and dental laboratory during the denture making process. It sets out the following stages for denture construction:
• primary impressions of the mouth • secondary impressions of the mouth • bite registration stage • try-in stage • fit stage.
18. We explain these stages in more detail later on in our statement.
19. Mrs U complains Sherwood Dental Practice made dentures which did not fit her properly and after several follow-up appointments the dentures did not sit on her gums properly and did not fit or feel right. She also complains she was told the work carried out was fine and that the dentures could take her several months to get used to. Mrs U requested a refund which was declined by the Practice.
20. The Practice said as it was Mrs U’s first time wearing dentures it would take her time to adapt to them and it declined to refund the cost. It said on appointments on 30 November and 11 December the dentures were found to be seating well to her gums and easy to fit.
21. The dental practitioner explained dentures may not fit as tight as expected and it would take time for Mrs U to control and get used to them as she had not worn dentures before. Mrs U’s upper and lower dental impressions were taken so the mould for her acrylic partial dentures could be created.
22. Mrs U returned to the Practice on 6 November where the plaque in her lower teeth, gum disease and bone loss were discussed. She also underwent an examination to assess her gum health. The dental practitioner took secondary impressions of her upper and lower dentures as well as trying upper and lower special trays in her mouth.
23. On 14 November dental staff carried out a bite registration on Mrs U which is where a patient’s bite is recorded so the laboratory can replicate the exact bite when they add teeth to the dentures.
24. Mrs U attended the Practice on 21 November for a ‘try-in’. This is the stage where teeth are added to a wax denture base so the appearance, fit, retention, occlusion (how the teeth meet / how the patient bites) are checked. If there are issues or adjustments which need to be made, another try-in session can be arranged before the fit stage which is the final fitting of the denture.
25. The records show Mrs U was happy with the shade of her teeth and how they met together. She did raise concerns that they were loose, and the dental practitioner explained the final acrylic dentures should be better fitting. Mrs U was told the dentures were a removable dental appliance and that it might take time for her to adapt to and for the muscles in her mouth to get used to the dentures.
26. The dental practitioner also explained the risks with dentures and that they can be loose and may require the uses of dental adhesive to prevent the dentures moving which Mrs U indicated she understood.
27. Mrs U attended the Practice on 30 November for the ‘fit’ stage where her upper and lower dentures were fitted. The records show they were ‘seating nicely, stable and retentive’. Mrs U told the dental practitioner she didn’t feel the dentures were natural and she was told they would take time to get used to especially as she had not worn them before, and her muscles needed to learn to adapt and control them.
28. She agreed to try for a week and return to see if any adjustments may be needed. Mrs U was also given care advice on her dentures including to leave out at night and clean them with soapy water and soft brush or denture cleaning tablets.
29. Mrs U returned for a review of her dentures on 11 December where she said she felt they were not sitting correctly, she had a gap under her lower denture, the upper left wire was sticking out and catching her skin. She also said the dentures were bulky and not flat with her gums. Her examination revealed no sore patches, and her upper dentures were recorded as seating well.
30. The dental practitioner identified a clasp on one of her upper left teeth which Mrs U indicated was uncomfortable and so the clasp was removed and filed down. The dental practitioner also narrowed the width between two of her lower right teeth to allow the denture to sit more naturally.
31. Mrs U indicated she was still unhappy with her dentures saying they did not feel natural. The dental practitioner explained as they were removable, they would not feel the same as natural teeth and it could take months for her to get used to them. They also said Mrs U would need to wear the dentures so they could identify any problems which could be adjusted. She said she would still like a refund and complained to the Practice on 14 December.
32. The Practice declined to refund the charges for Mrs U’s treatment and said she should keep trying the dentures for a few months as she was a new denture user and she needed to become accustomed to wearing them. It recommended she book a routine check-up in March so the Practice could carry out a full examination and review her dentures.
33. Mrs U attended the Practice for a further review on 5 January 2024. She was examined and no issues were found with the fit although she would only allow the upper dentures to be assessed. The dental practitioner explained they would not be able to assess where the lower denture might be catching if she did not wear it. The records also say she told staff she had not been wearing the dentures as she didn’t like them.
34. She spoke with the senior dentist and practice owner about getting a refund and was told they would be unable to do this as the dentures were in working order and that Mrs U had not adapted to it. The records indicate she refused to take her dentures with her and requested they be discarded.
35. Mrs U informed the Practice she was going to take legal advice. The senior dentist offered to treat Mrs U privately at the practice and discount her private dentures based on how much she had paid for the NHS set which she declined. Mrs U was invited for a second opinion with another dental practitioner.
36. Mrs U attended the Practice for a second opinion on 24 January where she said she was still unhappy with the fit of her dentures which were assessed to be fitting well. She reported wearing the dentures for a couple of hours but was unable to speak as she could feel her tongue on the palate of her dentures which the dental practitioner said was normal and with repeated wear, she would get used to it.
37. We sought clinical advice to better understand Mrs U’s situation. Our dental adviser explained first-time denture users can experience discomfort when making the transition from a natural tooth to a denture. It can take anything from a few weeks to six months for a patient to get used to wearing a denture.
38. Our dental adviser said communication in the initial stages of the provision of dentures is important and that the Practice did assess Mrs U appropriately. It went through the correct stages to measure and fit her dentures in line with British Dental Journal guidance we have mentioned earlier. It also advised Mrs U of the risks of wearing dentures on several occasions and explained it could take her months to get used to them. Mrs U was given a review and a second opinion with a different dental practitioner who concluded there was no issue with the fit.
39. Our dental adviser also said there can be challenges when dentures are ordered. There may be discrepancies with the laboratory making the dentures, but we cannot know if this was the case with Mrs U’s dentures. Our dental adviser noted some of the potential challenges were anticipated at Mrs U’s appointment on 30 October 2023 prior to starting her denture provision and her concerns about the ‘unnatural feeling’ of the dentures were acknowledged and she was invited back to see whether adjustments might be needed.
40. All this considered, it appears that Mrs U was, unfortunately, taking a long time to get used to her dentures. This is fairly common and does not necessarily mean that something has gone wrong in how they were made and fitted. The Practice appropriately explained to her how she might find the dentures initially and encouraged her to persevere with them. Regrettably, it seems she was unwilling or unable to do this.
41. That is not a criticism of her – we understand that it must be very difficult to live with uncomfortable dentures. We are satisfied that the Practice acted in line with the applicable guidance for each step of the process and took appropriate steps to try and resolve the issues she was having as they arose. Because of this, we have decided not to investigate this complaint further.
42. We acknowledge this has been a difficult experience for Mrs U and she has told us she was unable to smile for several months, and she felt very self-conscious. We hope she is reassured the Practice did not miss any of the clinical steps in the assessment and fitting of her dentures.