I often run into a situation where a patient is considered “border-line” between the options of building a bite around remaining existing teeth, or extracting them and considering alternatives such as full dentures.

This decision is based on two main factors. The patient’s desire, health, and the esthetics of the remaining teeth and bone are the most important.

More often than not, the patient has either had a bad experience at the dentist and is fearful, or has had dentistry done previously and it hasn’t been maintained professionally.

We all know life can also get in the way. Children are usually put first. Medical issues can derail even the best intentions. Disruption of income and other stresses can all have their toll.

Obviously, everyone is different and needs to be evaluated individually.

I would say that about 50 percent of the cases I see locally fall into the category of poor oral health (gum disease and tooth decay) with multiple broken and missing teeth.

If very severe, it’s an easy decision to discuss removal of the remaining teeth and go with replacements such as a full denture, implant supported denture, or a fixed implant supported appliance.

The opposite end of the spectrum accounts for another 45 percent, where keeping and maintaining existing teeth applies.

Missing teeth can be replaced with partial dentures, fixed bridges and implants. Mild to moderate gum disease can be treated and maintained, given willingness by the patient to cooperate with treatment recommendations.

Tooth decay can be treated with fillings, crowns, onlays and veneers.

The remaining 5 percent are the most challenging to diagnose and treat. A lot weighs on the prediction of the future health of remaining teeth and bone, patient desire, and cooperation in maintenance.

A thorough evaluation of the dental possibilities and creativity apply. The resultant outcome still has to include maintainability, longevity, function, esthetics and comfort. Any compromise in any one of those factors needs to relayed to the patient by educating them as to what the future will hold.

Dentures have their place. Deciding when to use them is the key. They are not for everybody.

Taking time to “chew” on this decision will help with real chewing in the future.

James G. Jenkins, D.M.D. is the owner of Bluffton Dental Care in Bluffton.