its all about how patient complains and feels after denture insertion.

1. Post insertion complaints in
complete denture
Ashwini Narayankar
Reader, Department of Prosthodontics
S B Patil Dental college, Bidar

2. Post insertion
complaints in
complete denture
Pain
Clattering of
teeth
Appearance
Inefficiency
Poor
retention
Instability
Food under
denture
Biting the
cheek and
tongue
Altered
speech
Discomfort
Nausea

3. Pain
 Overextension of the
Periphery
 Poor fit
 Poor retention, rocking, tilting
 Insufficient relief
 Denture rock on hard area

4. Incorrect centric occlusion
 Wrong A – P relationship
 Centric occlusion
 Treatment
 Uneven pressure
 Thin spatula / thin celluloid strip

5.  Over open
 Increased VD
 Teeth jar, clatter, too high
when eating and talking
 Treatment
 Over closed
 Old dentures
 Loss of VD (RRR)

6.  Costen’s syndrome
 Prolonged over closure
 Deafness
 Tinnitus
 Tender over TMJ
 Neuralgic symptoms
 Dryness of mouth

7. Cuspal interference
 Dragging action during excursive movements
 Pain, sore areas
 Diagnosis
 Treatment

8.  Teeth off the ridge
 Setting upper teeth more buccally
 Pain – upper buccal and maxillary tuberosity
 Mastication

9.  Retained root or unerupted tooth
 Direct pressure on area already tender, prevents
drainage, stimulate eruption of tooth
 Diagnosis: sinus, unerupted tooth, hard swelling,
X – ray
 Treatment

10.  V – shaped ridge
 Lower denture
 Sharp ridge of bone
 Pain on the side of eating, severe after meal
 Alveolectomy, relining
 Mental foramen
 Resorption
 Pain similar to neuralgic
 Adequate relief

11.  Irregular resorption
 Rough, sharp spicules of bone
 Gentle palpation and X – ray
 Alveolectomy, relining
 Pathologic conditions
 Allergy
 Methyl methacrylate, incomplete polymerization
 Burning sensation, inflamed, irritation
 Upper denture > lower denture (saliva)

12.  Rough fitting surface
 Infection with monilia
albicans
 Rough surface – sec. infection
 diet, night denture wearing, long
antibiotic therapy
 Polish surface, fungicide
 Remove dentures at night and keep in
dilute hypochlorite (Milton)
 Hot Hypochlorite mouthwash, hot fluid
held

13.  Swallowing and sore throat
◦ Overextension – upper denture , excessive pressure in
hamular notch
◦ Lower – distally in lingual pouch
 Undercuts
◦ Painful
◦ Alveolectomy

14.  Poor oral hygiene
 Deep posterior palatal seal
 Psychologic
 Bruxism/Clenching
 Trapped movable tissues

15. Appearance
 Nose, and chin Approximating
 Excessive free way space
 Cheeks and Lips Falling In
 Long edentulousness
 Tone of facial muscles
 Maxillary - resorption

16.  Angular Cheilitis or Soreness of the Corners
 Loss of VD and muscle tone
 Fissures
 Secondary infection with Monilia albicans

17.  Colour, Shape and Position of Anterior Teeth
 Colour: too dark or too yellow
 Shape: Artificial teeth usually look larger
than natural
 Position: teeth are too far back in the
mouth, or are too far forward
Neutral zone

18.  Amount of Tooth Showing
 Upper anteriors
 Age

19. Inefficiency
 Inability to Eat Anything
 New dentures – impatient
 Psychological approach

20.  Inability to Eat Meat
 New dentures
 Flattening of the cusps
 Cusp less Posterior Teeth.
 Unbalanced
 Cuspal Interference
 Inexperience

21.  Dentures Dislodged by Eating
 Cuspal interference
 Unbalanced Articulation
 Upper Teeth Outside the Ridge
 Insufficient Tongue Space
 Periphery Overextended - posterior lingual pouch
 Inexperience

22. Poor retention
 When opening the Mouth
Lower denture lifts, upper one drops
• Overextension
• Tight Lips
• Tongue Cramped
Posterior teeth are tilted or set lingually

23.  Underextension – maximum denture bearing area
 Lack of Peripheral Seal
 Lack of very thin watery saliva – upper denture
 When Coughing or Sneezing
 Explain patient about pressure changes

24. Instability
 When Eating
 The Defensive Tongue

25. Clattering of teeth
 Too Great a Vertical Height
 Gross Cuspal Interference

26. Nausea
 Denture Slightly Overextended
 (b) Denture Underextended
(i) Intermittent Contact
(ii) A Palpable Edge
 (c) Thick Posterior Border
very common

27. Discomfort
 Cramped Tongue Space
 Altered Vertical Height
 Altered Occlusal Plane

28. Altered speech
 Thickness of the palate – temporary inconvenience
 Whistling
 Biting the cheek and tongue
 Cheek Biting
Insufficient Overjet
Reduced Vertical Height
 Biting the Tongue
Less tongue space

29. Food under the tongue
 New dentures
 Learn to control food
 Peripheral seal – scraping model

30. Symptoms/clinical
findings
Cause Treatment
Discrete painful areas Pearls or sharp ridges of
acrylic on the fitting
surface
Locate with finger, or
snagging dry cotton wool
Fibres, ease denture
Pain on insertion and
removal, possibly
inflamed mucosa on
side(s) of ridges
Denture not relieved in
region of undercuts
Adjust, clinician should
only insert denture and
then remove it - not
occlude as this may
confuse an occlusal fault
with support problems
Areas painful to pressure Faulty impressions,
damage to working cast,
warpage of denture base,
retained root, torus
Use disclosing material to
accurately locate area to
be relieved. If severe,
remake may be required.
Consider removal of root
J. F. McCord and A. A. Grant, Identification of complete denture
problems: a summary, British Dental Journal 2000; 189: 128–134

31. Over-extension of
lingual flange.
Painful
mylohyoid ridge;
denture lifts on
tongue protrusion;
painful to swallow
Over-extended lower
impression
Determine and
relieve accordingly
Generalised pain
over denture-
supporting
area
Under-extended
denture . Check for
adequacy of FWS
Extend denture
insufficient FWS,
remake
Lack of relief for
frena or muscle
attachments. Sore
throat, difficulty in
swallowing
Peripheral over-
extension resulting
from impression
stage
Relieve

32. Symptoms/clinical
findings
Cause Treatment
Related to occlusal
surfaces
Pain on eating in
presence of occlusal
imbalance
Anterior prematurity
or posterior
prematurity,
incisal locking, lack of
balanced articulation
Selective grinding.
If severe
error remount using
facebow and new
interocclusal records
Pain and/or
inflammation on labial
aspect of lower ridge
If no impression
surface defect, may
be lack of incisal
overjet causing
incisal locking
Reduce incisal
vertical overlap,
resetting the incisors
may be required

33. Symptoms/clinical
findings
Cause Treatment
Pain about periphery of
dentures possibly
accompanied by pain in
masseter and posterior
temporalis muscles
Vertical dimension of
occlusion more than
patient can tolerate
If excess less than 1.5
mm, grind to provide
FWS.
If greater than 1.5 mm,
re-register to reset
dentures at new OVD
Cheek and or lip biting For cheeks - functional
width of sulcus was not
restored (support),
For lips - poor lip support
For cheek biting, restore
functional width of sulcus
For lips, reset lower
incisors
Tongue biting Teeth placed lingual to
lower ridge
Remove lower lingual
cusps, or reset teeth
Related to polished
surfaces
Pain at posterior aspect
of upper denture on
opening
Flange on buccal aspect
of tuberosity too
thick and constraining
coronoid process
Define area involved,
relieve and repolish

34. Symptoms/clinical
findings
Cause Treatment
Burning sensation
over upper denture
supporting tissues
Burning mouth
syndrome often seen
in middle-aged or
elderly females
Correction,
Multivitamin,
antidepressant,
Refer to Consultant
Beefy red tongue,
possibly glossodynia
Vitamin B12/folate
deficiency
Refer for medical
treatment
Frictional lesions,
mucosa may adhere
to probing finger, dry
mouth
Xerostomia,
commonly side effect
of prescribed drugs
sugar-free
citrus lozenges may
help, artificial saliva

35. Presence of
herpetiform ulcers in
mouth
Herpes simplex or
Herpes zoster virus.
coincidental to the
condition.
( acyclovir)
Painful ’click’ related to
TMJ on opening
and/or closing mouth
and/or tenderness
of muscles of
mastication
rapid change on OVD
either increase or
decrease, psychological
aspects
special care to
registration and
vertical dimension
Patient complains of
allergy to denture
material
Rare symptoms may
relate to higher residual
monomer content of
acrylic
Rebase polycarbonate
resin
Painless erythema of
mucosa related to
support of (usually)
upper denture, may be
accompanied by angular
cheilitis
Denture-related
stomatitis. ill-fitting
denture plus
opportunistic candidal
infection. iron or folate
deficiency
Best to leave denture
out until condition
clears,
tissue conditioners
prior to remake.
antifungal and
antibacterial
agents (eg miconazole)

36. Symptoms/clinical
findings
Cause Treatment
Lack of peripheral
seal
Border under-
extension in depth
and width. disto-
buccal aspects of
upper
border, mould
digitally
chairside reline
Inelasticity of cheek
tissues
Consequence of
ageing process;
scleroderma,
submucous fibrous
Mould denture
borders

37. Xerostomia Reduces
ability to form a
suitable seal
Medication, head
and neck region,
salivary gland
disease
Prescribe artificial
saliva where
appropriate
Neuromuscular
control
Essential for
successful
denture wearing:
speech and eating
difficulties occur
Basic shape of
denture incorrect
Removal of lingual
cusps of posterior
teeth. Flatten
polished lingual
surface of lower
from occlusal
surface to periphery,
Denture adhesives

38. Symptoms/clinical
findings
Cause Treatment
Denture borders
Over-extension in
depth
Slow rise of lower
denture when mouth
half open, Deep post
dam on upper base
may cause pain
If buccal to
tuberosities, denture
displaces on mouth
opening, or cheek
soreness occurs.
Thickened lingual
flange
Slightly under-extend
denture flange and
accurately mould,
Check borders of
record rims and trial
dentures Deep post
dam
Overextension in
width
Cheeks appear
plumped out.
Design error Reduce over-
extension

39. Symptoms/clinical
findings
Cause Treatment
Occlusal errors Uneven tooth
contact causing
tilting of - disrupts
border dentures will
shift on supporting
tissues
Adjust occlusion,
use cuspless teeth
where appropriate
Ulceration labial to
lower ridge
Excessive vertical
overlap of anterior
teeth. Occlusal
contact on this
’inclined plane’
causes denture to
slip forward
Reduce height of
lower anteriors.

40. Fibrous
displaceable ridge
Masticatory forces
tend to
cause denture to
sink into and tilt
towards supporting
tissues
Reline, provide
many vent
holes, low viscosity
impression material
Bony prominence
covered by thin
mucosa (eg tori)
Denture rocks over
prominence
which may be
covered with
inflamed tissue
excessive relief, loss
of retention may
result
Pain avoidance
mechanisms
Use of excessive
amounts of
fixative, or self-
applied reline
material, or even
cotton wool, to
attempt to relieve
contact with
supporting tissues
Eliminate the cause
of pain

41. Symptoms/clinical
findings
Cause Treatment
Noise on
eating/speaking
Excessive OVD,
occlusal
interference, loose
dentures
Address specific
faults or remake as
required
’Jaws close too far’ Lack of OVD, so
that mandibular
elevator muscles
cannot work
efficiently
May increase up to
1.5 mm by
relining but if
deficiency is greater,
remake denture

42. Cannot open mouth
wide enough
for food’.
Excessive OVD Can remove up to
1.5 mm from
occlusal plane by
grinding, remake
Speech problems
Uncommon, May
affect sibilant (eg s),
bilabial (eg p,b),
labiodental (eg f.v)
check that
problem with old
dentures
Check for vertical
dimension, Palatal
contour
Gagging May be loose
dentures, thick distal
border of upper
denture: lingual
placement of upper
posterior teeth
Construct dentures
to maximise
retention and
minimise displacing
forces.
Psychological
assessment

43. Appearance
shade of teeth too
light or dark; mould
too big/small;
arrangement too
even or irregular or
lacking diastema
Patient failed to
comment at trial
stage, swayed by
family or friends.
Assessment of
patient’s aesthetic
requirements. Use
photographs,previous
dentures.
Too much visibility of
teeth
Level of occlusal
plane unacceptable,
lip support
Accurate prescription
to laboratory
Creases at corners of
mouth
Labial fullness and
anterior tooth
position may be
inaccurate. OVD
may be inadequate
Adjust tooth position
as appropriate.
If OVD problem, re-
register jaw
relations
Colour of denture
base material
’unnatural’
Patient’s skin colour Remake using
suitable base
material

44. Review of literature
 Food accumulation under the denture bases, the
instability of the denture, esthetic problems and
incorrect height of the occlusal plane
 Nafiseh, Complications of Complete Dentures Made in the Mashhad
Dental School, Journal of Mashhad Dental School, 2007; 31:1-3

45. Review of literature
 Incidence of IFH was higher in women than in
men, the incidence of IPH was similar
 30-60 year-old group
 Denture wearing period
 In the maxilla, the incidence of IFH was higher
than IPH
 Canger, Denture-related hyperplasia: a clinical study of
a turkish population group, Braz. Dent, 2009;20:45-49

46. References
 H.R.B. Fenn, Clinical dental prosthesis, 1986, First
Edition, pp – 365 – 391
 Grant et al, Complete Prosthodontics problems,
diagnosis and management, 1st edition, 1995,
Mosby Wolfe Publications, Europe, pp 33 - 88
 Sheldon Winkler, Essentials of complete denture
Prosthodontics 2nd edition, 2004, AITBS
Publishers, pp 318 - 330
 Boucher, Prosthodontic treatment for edentulous
patients, 10th edition, 1994, B I Publications,
298-313

47.  Charles M Heartwell, Syllabus of complete
dentures, 4th edition, 1984, Varghese Publishing
House, 407 – 420
 Deepak Nallaswamy, Textbook of Prosthodontics,
1st edition, 2003, Jaypee Publications, 169-175
 John J Sharry, Complete denture Prosthodontics,
1962, McGraw Hill Company, 331 – 336
 Nafiseh, Complications of Complete Dentures
Made in the Mashhad Dental School, Journal of
Mashhad Dental School, 2007; 31:1-3

48.  Denture complaints.ppt
 Robert W. Loney, Complete denture manual,
2009, 75 - 76
 J. F. McCord and A. A. Grant, Identification of
complete denture problems: a summary, British
Dental Journal 2000; 189: 128–134
 Canger, Denture-related hyperplasia: a clinical
study of a turkish population group, Braz. Dent,
2009;20:45-49
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