“I work with so many different kinds of patients with different personalities
and different needs. I learn a lot from them! It’s a wonderful privilege
for me to help people in this way.” —Angela Summer
By Cat Saunders
Whether you have missing teeth, restored teeth, or a full set of natural teeth, this interview is for you. According to the latest (2004) National Health and Nutrition Examination Survey for the United States, people are keeping more of their teeth longer. However, tooth loss is still far too common—and, for the most part, preventable.
Bear with me while I give you a few eye-opening statistics from the study. For one thing, out of a total of 32 teeth (including wisdom teeth), adults aged 20-34 had a mean number of 26.9 teeth. Statistically, this means that half of the adults aged 20-34 had more than 26.9 teeth, and half had fewer.
For adults aged 35-49 years, the mean number of teeth was 25.05. For adults aged 50-64 years, the mean average was 22.3. Now consider that last number for a moment. Put another way, it means that 50% of adults aged 50-64 are missing ten or more teeth.
Beyond that, an updated study from the same organization for 2005-2008 revealed another distressing statistic. That is, nearly 23% of adults 65 and older were missing all of their natural teeth. That means nearly one in four senior citizens have none of their own teeth left.
Fortunately, these numbers have been improving. Even so, millions of Americans are walking around with missing teeth and suffering because of it. Many of these people may not realize how important it is to restore their teeth in some way. And many may not understand the causes of tooth loss or what they can do to prevent it.
Perhaps, like me, you know firsthand how much work it is to chew without a full set of molars. Or perhaps, like me, you know how embarrassing it can be to smile with big holes in your mouth. If so, then you are probably already missing some of your own teeth. Either way, I hope this interview can help even one person to experience less pain, shame, or fear in relation to their teeth. If so, it will be worth its weight in gold.
According to the National Denturist Association, “A denturist is the only professional legislated exclusively to serve individuals with removable dental prosthetics. The denturist’s entire required curriculum of study focuses on the oral health of those individuals needing a dental prosthetic and the actual fabrication of that appliance. Everyone needing a removable dental appliance should have the privilege to choose this highly trained professional.”
I met denturist Angela Summer in October 2011 after losing yet another molar. That extraction left me with a grand total of 21 out of 32 natural teeth. (June 2017 update: I’m now down to 20 of my own teeth. You can read more about why I’ve lost so many teeth later in the interview.)
By the time I got to extraction #11 in 2011, I had so many holes in my mouth that I wondered what to do next. I asked the staff at the oral surgeon’s office if I should have my dentist make partials for me, or if I should see a professional denturist.
The staff immediately started raving about a denturist named Angela Summer. They said she did wonderful work. They also said she treated patients like family and took very good care of them. The receptionist also said she took her own mother to see Angela, and Angela was a godsend.
The summer before I heard about Angela from my oral surgeon’s staff, I’d noticed and saved an ad for her from Seattle Woman Magazine. Aside from an intuitive sense that I might be better served by a denturist, I liked Angela’s photo. She looked warm and friendly and kind. The deal was sealed when the staff at my oral surgeon’s office started raving about Angela. I called her office, took advantage of her free consultation, and started working with her.
The removable, flexible partials Angela made for me changed my life profoundly. They restored my smile and my ability to eat comfortably again with a full set of teeth. Because of this, I asked Angela for an interview to “give back” and help others by providing important information. Before we jump into my in-depth conversation Angela, I’ll give you a brief bit of background about her.
Angela originally trained as a dentist in her native Philippines. She came to the United States in 1991, knowing she wanted to do something related to dentistry. But in order to be a dentist in Washington State, she would have been required to start from scratch. Or she would have to go to another state for an advanced standing program. Some of the small handful of states that license denturists would also have allowed her to simply take an exam.
Since her (late) father lived in Seattle, she decided to stay in Washington. She took a job as a dental assistant and also applied to some schools for their advanced standing programs. Then in 1994, Washington passed a law that allowed denturists to practice independently in the State. Prior to that, Washington residents could only get dentures and other removable appliances from dentists. The dentists would take impressions and then send the work out to dental labs.
When Angela worked as a dental assistant, she met a colleague who had built dentures and other removables in a dental lab. He later became a denturist with his own practice after the 1994 law took effect. This colleague introduced Angela to the profession. Later he encouraged Angela to take the exam, which she passed the first time.
Angela became the protégé of her denturist mentor. She worked under his wing for three years while she continued to support herself as a dental assistant part-time. Eventually, Angela’s mentor referred her to a denturist on Queen Anne (in Seattle) who was close to retiring. The retiring denturist let Angela “test drive” his practice for a period of time before she bought it and moved it to North Seattle in 1999. She’s been there ever since.
Cat: What was it like for you when you first started your practice as a denturist?
Angela: When I first started, I had fears about being young (I was in my early 30s), female, and a foreigner. A lot of the denturists were older. When the law passed, there were probably only three or four women denturists. So I wondered if people would even consider me to provide the service.
Cat: How has it turned out?
Angela: It’s actually been pretty great! At least my patients know I’ll be here for a long time. They know I’m not going to retire in five or ten years!
Cat: Good point! Do people come to you for help in deciding what to do about missing teeth?
Angela: Yes, because there are many things to consider. A patient’s choices also determine whether they can work with me. If not, they’ll need to see a dentist, an oral surgeon, or a prosthodontist. A prosthodontist is a dentist who specializes in dentures and other removables. Prosthodontists can also do bridges and other dental work.
In my profession as a denturist, I am limited to working with removables. This includes dentures and various kinds of partials. I cannot do bridges or implants or perform any other forms of dentistry.
Actually, I like the so-called limitations of my profession. I get to work directly with patients, but most of my technical work is done outside the mouth. I take impressions, construct dentures, and adjust the fit of my patients’ removables.
In my work as a denturist, there’s a great deal of professional satisfaction. This is especially true when people need a complete set of dentures and undergo the transformation to a beautiful smile and a healthy bite.
I want to get back to your question about options. There are a number of options for people who have missing teeth, among which are removables (dentures or partials).
Each of the options has its own advantages and disadvantages. I can discuss dentures and partials in detail, but I also encourage my patients to consult a dentist and/or prosthodontist about other options. That way, each patient can make a well-informed decision.
Cat: According to the National Institute of Dental and Craniofacial Research, periodontal disease is the most common cause of tooth loss for American adults. However, my tooth loss was caused by multiple kinds of trauma.
As a young teen in the 1960s, I had braces. Orthodontists didn’t know as much then as they do now about the relationship between the jaw, the skull, and the body. Jaw alignment affects TMJ (thermo mandibular joint) issues and also affects spinal alignment. In my case, the orthodontist removed two healthy upper incisors. Braces then pulled my upper teeth into a tighter formation. Gradually, this process forced my lower jaw back and to the left to make it fit under my altered upper jaw.
This gave me a beautiful smile, but it set me up for a lifetime of TMJ problems and neck/spine misalignment. In turn, this resulted in tooth destruction (from grinding) and chronic pain. It also cost me tens of thousands of dollars (and counting!) for various forms of compensatory dental and medical treatments.
Aside from braces, I was bulimic from 1972-1980. This was long before there was much public awareness about eating disorders or their effects on teeth. Even though I had always practiced good oral hygiene, I had no idea—until it was too late—that my TMJ problems, on top of eight years of bulimia, would damage my teeth so severely.
In 1980, I started working with a holistic dentist who noticed the erosion on my teeth. He correctly guessed that I had been bulimic and he brought this up in a very sensitive way. His kindness made it safe for me to trust him and let him help me.
To restore nine of my most damaged molars, he had to grind them down and rebuild the surfaces with gold crowns. The crowns have required ongoing care and occasional replacement. Every time a crown is replaced, it causes more trauma to the tooth. So in addition to having four impacted wisdom teeth extracted when I was a teenager, I also lost two incisors to braces. Then I lost six molars over twenty years from the long process I just described.
From 1996 until 2006, I had only one missing molar. So I only needed a small, single-tooth removable made by a former dentist. After losing four more molars between 2006 and 2011, I realized I needed to face the music and get over my shame about needing partials. The truth is, my shame about having so many holes in my mouth was worse than my shame about needing partials, so I got over it and came to see you.
To publish this interview, I had to go through a few more layers of shame because now I’m telling the whole world that I wear partials! Obviously, I’m not alone in preferring to keep this a secret. But hopefully, sacrificing my privacy will make people feel safer about getting help for themselves if they have missing teeth.
During our initial consultation, you said that you can make partials for people immediately after extractions. That’s different from what my former dentist told me. He said I had to wait a few months.
Angela: Waiting a few months would actually be ideal.
Cat: But it’s kind of hard to walk around with big holes in your mouth!
Angela: Yes, especially if you’ve lost your chewing or support teeth, which are the molars in the back. That’s what holds your bite, not the front teeth.
People can definitely get a partial or even a full set of dentures immediately after extractions.
Normally in these cases, I see the patient before they even have the extraction work. That way, I know which teeth are going to be pulled. After I take impressions, I can build the partial or the denture by doing my own “extractions” of the appropriate teeth in the model.
I then estimate what the gum line around the missing teeth will look like after the extractions. I build the partial or denture over that. It will not be a precise fit, but it will fit. There will be little gaps here and there. These can be adjusted in the patient’s mouth after the extraction is done, using liners or other fillers to make it fit comfortably.
Cat: When someone has all their teeth removed, are there individual tooth “holes” along the jaw with gums in between. Or is it like one big trough from all those extractions?
Angela: There are a lot of individual holes in the jaw bone, with gums in between.
Cat: You said that a partial or denture can be placed immediately after extractions. How soon do you mean?
Angela: Immediately, right at the surgeon’s office even. I can fit the partial or denture right after the extraction is done, once any necessary stitches are in place. That way, the patient can leave the office with a brand new smile.
Cat: That’s incredible!
Angela: The partial or denture that’s placed immediately may only work temporarily. But sometimes it fits so well it can be permanent. For partials, if people are only missing a few teeth, they may wait until the mouth heals before getting them fitted.
When people have all their teeth removed, it changes the whole structure of the mouth and the face. This can be upsetting for people. In these cases, they will probably want to get dentures right away instead of waiting.
Cat: Plus they can’t eat.
Angela: Well, they can’t eat in the first few days anyway, since they need to be on a liquid diet for a while.
Cat: Doesn’t it hurt to put a denture over the extraction wounds?
Angela: After extractions, dentists often put the patient on painkillers for a few days. We work closely with the dentist to ensure minimal pain and discomfort.
Cat: I wonder if you’d talk a bit more about the bite. You’ve talked about the importance of reconstruction work following extractions. Something needs to fill the space between the missing teeth, so the remaining teeth stay in place.
Angela: Yes, teeth can “migrate.” Teeth seek contact, so if there is a missing tooth, the teeth adjacent to the extraction site will migrate to find contact.
For example, if you lose a tooth on the bottom, the tooth above it on top will “super erupt.” That’s because it’s trying to seek something below it to hit. The same thing will happen on the bottom if a tooth above it is missing. The lower tooth will gradually move upward because it’s trying to make contact with something.
Cat: Wow! The teeth on the bottom will actually go up?
Cat: How about sideways movement? What happens to the teeth on either side of a missing tooth?
Angela: The teeth on either side may move, tilting sideways and collapsing in on the space, which obviously changes your whole occlusion.
Cat: Wouldn’t that also cause problems with the gums and the bone around the moving teeth?
Angela: Yes, it can cause potentially serious problems. In such a situation, a person should always consult a dentist. After consultation with a dentist, if someone is considering dentures, I would of course be glad to consult with them as well.
Cat: As I mentioned earlier, braces permanently misaligned my bite decades ago in a way that can no longer be fixed. Because of that, I figured the best solution was a partial that would keep my teeth from migrating and give me a nice smile again.
I didn’t think you’d be able to make something I could eat with. I’d never even been able to eat comfortably with the single-tooth partial a former dentist made for me.
You kept saying you wanted me to be able to eat with my partials. And you kept working on the design until you succeeded. I remember when I first tried eating with the upper and lower partials you made. It worked. I was stunned! Until I started eating with a full set of teeth again, I didn’t realize how hard I’d been working all those years just to chew!
Aside from how much easier it is to eat, your partials feel so good that I want them in all the time. With my single-tooth removable, I immediately took it out when I wasn’t around other people, because it bugged me. It’s not that it hurt. I just didn’t want it in my body.
Your partials have been a completely different experience. Somehow they make me feel stronger. I remember you did kinesiology (muscle-testing) for me with and without the partials after you made them. Kinesiology tests showed the same thing—my body is stronger with the partials in place.
There are probably dentists who do a great job with partials and dentures. Even so, I think it makes a lot of sense to see a denturist for removables because it’s the denturist’s sole focus. Also, as far as I know, dentists take the impressions for removables, but they send the molds to a lab. The lab technicians never even see the patient.
Angela: That’s a big difference. With my patients, I get to know their issues because they talk with me and I can see directly what’s happening with their teeth.
When you talked about your situation, it brought up another point. I’ve seen a lot of patients who still have all their front teeth and think it’s okay not to replace missing molars. But the back teeth support the structure of the skull. When a person with missing back teeth doesn’t have them restored, it can potentially lead to other problems.
Cat: Do you ever have patients who aren’t able to eat with their partials or dentures?
Angela: Yes, definitely. In some cases, it’s simply a matter of us continuing to work together to find a solution that’s comfortable. This may take longer for some people than for others. In other cases, people may not be emotionally ready to accept that they have something artificial in their mouth.
Cat: You mean they won’t even try to eat with them?
Angela: That doesn’t happen very often. But because it can happen, I try to prepare patients beforehand by talking with them about their concerns. I won’t even start a case until a patient assures me they are emotionally ready to have something artificial in their mouth.
Cat: What do you do if someone isn’t emotionally ready?
Angela: Patients may be in so much pain that they’re almost ready to move forward with a removable. In that case, it’s more a matter of giving them reassurance that I will take care of them and be there for them.
That is why I provide a whole year of follow-up care at no additional charge for my patients. I’ve found that it helps relieve people’s anxiety to know they can come in anytime—without further charge.
With a full set of dentures, for example, it usually takes a year for the bone to fully heal. In that time, there will be changes in the jaw and the occlusion. Dentures involve a lot of adjustment for the patient, both physically and emotionally. So I reassure them that I’ll be there to support them through the entire process.
Cat: Would you describe the healing process for someone who has had all their teeth removed prior to getting dentures?
Angela: The first three days are critical. I work closely with the dentist to integrate the use of the dentures in a way that is most beneficial for the patient. For example, in some cases, the dentist determines that wearing the dentures immediately following the extractions can help in reducing pain and swelling.
Often, we’ll have the patient wear the dentures for three days without removing them. At that point, the swelling and pain will be significantly reduced. In most cases, after a week, the patient feels fine.
Cat: In your office, I noticed brochures for a removable that gives you an instant perfect Hollywood smile.
Angela: These are so-called “snap-on smiles.” I don’t do them very often, but I have made three or four of them for people. Some people get them for a special occasion, and they can even eat with them.
Cat: They look great, but they don’t seem like a permanent solution.
Angela: Right, snap-ons are purely cosmetic. They’re plastic and go over your teeth. I made snap-ons for a couple that had a special event coming up. One of them needed a lot of restoration work, probably $30,000-$40,000 worth. A snap-on upper cost only a small fraction of that amount. So the patient opted for a snap-on in order to have a nice smile for the event.
People may also get snap-ons to evaluate their particular situation. If they need major restoration work, they might wear snap-ons for a while. This allows them to re-establish their new bite and see how comfortable they feel with it. This is only applicable after a full-mouth evaluation of a dentist.
Cat: What’s the biggest complaint you hear from people about dentures or partials?
Angela: The fact that food gets under them. People may also have trouble with discomfort, especially with the lower ones. People don’t usually notice the upper denture or partial. But some people complain that they are always aware of the lower one feeling in the way.
Cat: You told me during my initial consultation that there are three different options for partials. Would you talk about those?
Angela: One is acrylic and one uses a form of flexible nylon material. A third kind uses a metal-cast base substructure embedded in flexible nylon or acrylic. I make acrylic partials in-house and send my metal and flexible designs to a lab for construction.
The advantage of acrylic partials is that I can add more teeth to them, if someone has another extraction. Flexible partials are (obviously) more flexible and also lighter. They work better for patients who are allergic to metal or acrylic. Allergy problems don’t happen very often with flexible partials, because of the nylon material.
As I mentioned, metal reinforcing can be used inside acrylic or flexible partials. This depends on people’s needs and whether or not they can tolerate cast metal in their mouth.
Cat: How long do partials or dentures last?
Angela: It depends on a person’s diet and oral hygiene. Structurally speaking, a good set of dentures or partials can last 5-10 years. A removable might not last as long if the person eats a lot of meat, which requires more chewing. Or the removable might not last as long if they have a high fiber diet, which is more abrasive. People with stronger jaw muscles can cause more wear when chewing. Also, people who clench or have TMJ problems might not get as many years of use from their dentures or partials.
Cat: Is there anything else you’d like to mention that I haven’t asked about yet?
Angela: Many people come to me in their 70s or 80s needing replacement teeth. Their first question is, “Is it really worth it? Am I going to live that long?”
I can’t predict how long they’re going to live, but they have an issue right now with their teeth. The real question is, do they want to make that issue better or do they want it to stay the same? It’s their choice.
Sometimes their adult children are involved in the decision. The children ask me if their elderly parent really needs new dentures if they’re 80 or 90. I ask adult children to sincerely consider why their parent is in my office right now. It’s because he or she has a problem—either they can’t chew, or they’re in pain, or both.
Cat: Not being able to chew comfortably is a significant problem for anyone, much less an elderly person. The person may avoid eating. Or if they do eat, they may not be able to assimilate food properly. If they can’t eat normally, it can even impact their social lives.
Angela: Yes. For many people, meals are a highlight of their day. So doing whatever it takes to support their chewing function is really important, whether it’s for a short time, a few years, or even longer.
Cat: Before we stop, I want to mention one more thing I appreciate about the way you work. I like that you give people a free initial consultation, so they can discuss their situation and see if you can help.
Angela: Yes, I’ve always done that for people. I know it’s a big deal to have your teeth restored, and I want people to know all their options.
Restoring teeth is not just about looking good; it’s also about restoring function. That’s why I like what I do, because I really get to help people. I work with so many different kinds of patients with different personalities and different needs. I learn a lot from them! It’s a wonderful privilege for me to help people in this way.
This interview was published in September 2014 and updated in June 2017.
To make an appointment with Angela Summer, please call her office at (206) 440-1500 or email her staff at email@example.com.
To learn more about Angela and her work, please visit dentaldenture.com.
Cat Saunders, Ph.D., is a counselor in private practice in Seattle, Washington. She is also the author of Dr. Cat’s Helping Handbook: A Compassionate Guide for Being Human (available through Amazon). Contact Cat by emailing her or by calling 206-329-0125 (24-hour voicemail).