prosthodontics

1. Patient Complaints
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Patient Complaints and Effective Measures
for their Diagnosis and Treatment
Proper examination of the denture in the patient’s mouth
as well as questioning the patient carefully about his denture
wearing experience are very important to arrive at the proper
cause of the problem.
Patient's complaints following partial denture insertion
usually fall under any of the following categories:
I- Pain or discomfort arising from the soft tissues or
the underlying edentulous ridge:
This may be due to any of the following:
a) Soreness under the saddle:
1) Nodules of acrylic resin on the tissue surface of the
prosthesis. An excellent method of checking for roughness
or small nodules of acrylic resin on the tissue surface is by
passing the tip of the finger on the tissue surface of the
denture.
2) Damage to the model resulting in prominence in the fitting
surface of the denture.
3) Uneven contact or premature occlusion may also result in
pain or soreness under the saddle.

2. Patient Complaints
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4) Excessive displacement of the mucosa during impression
making may lead to pain under the saddle.
5) A high vertical dimension of occlusion will also result in
pain under the saddles.
b) Redness, laceration or ulceration at the ridge area:.
This may be due to any of the following:
• Rough tissue surface of the denture: This condition will
usually start as an area of slightly increased redness or
translucency and then actual ulceration occurs which, may
or may not be accompanied by pain. In dealing with this
condition, the area of soft tissue in question is dried with a
piece of gauze and marked with an indelible pencil. The
partial denture is then seated in place where the area
requiring relief will be marked by the ink being transferred
to the fitting surface of the denture where it is corrected
using a suitable stone.
• Presence of occlusal discrepancies or prematurities: This
condition is more common with free-end saddles than with
bounded saddles since the ridge bears a higher proportion of
the load in case of free end saddles.
• Pain under the saddles is more commonly encountered when
the ridge is covered by a thin atrophic mucosa.

3. Patient Complaints
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• Occlusal prematurities can be corrected by placing blue
articulating paper between the upper and lower jaws and the
patient is asked to close in the tooth position three to four
times and the occlusal prematurities are corrected by
grinding.
• After correcting the occlusal disharmony, the painful
symptoms can be treated by using hot saline mouthwash
three to four times daily with the partial denture out of the
mouth.
c) Soreness at the area of denture borders:
This is usually encountered as an inflammatory or
ulcerated area at the site of tenderness. The most common
causes of this condition:
• Over-extension of the denture borders.
• Presence of sharp areas or roughness at the denture borders
may be another cause.
• After reduction of the offending area from the denture
borders, the surface must be re-polished perfectly.
• The common sites of peripheral soreness occur in the lingual
flanges of lower partial dentures and buccally at the anterior
end of lower partial dentures and also buccally in case of
upper dentures.

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d) Pain arising from a tooth or group of teeth:
This is a serious complaint as it usually indicates that a
continuous load greater than the physiologic limit of the
periodontium is being placed upon the tooth or group of teeth
concerned.
This pain is usually due to that the retentive arm is
exerting too much pressure on the tooth, which is not being
adequately reciprocated, and thus excessive stress is applied to
the tooth. In these conditions, the clasp arm is re-adjusted into
its correct position.
For the correction of this condition, the use of disclosing
wax will be helpful to pinpoint the area of metal or resin that
requires relief in order to prevent this undesirable tooth
movement.
Also, occlusal interference between the metal of the
denture in one arch and a natural tooth in the opposing arch
may result in pain or discomfort. These areas can be determined
using articulating paper or occlusal indicator wax strips.
Proper examination of the patient's mouth should be
carried out to eliminate the possibility of undetected caries or a
leaking filling.
II- Difficulties during mastication:

5. Patient Complaints
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• This condition is commonly encountered in patients who
had lost their posterior teeth for so many years and thus they
lost the neuromuscular skills required in grinding the food.
These patients should be informed that a reasonable time is
required to relearn the masticatory process.
• Inability to chew may be caused by the patient taking too
much food into the mouth at once or the use of dough or
sticky food.
• Lack of sharpness of artificial teeth. In this case additional
sluiceways and grooves should be added to the occlusal
surface to increase the cutting efficiency.
• Unbalanced articulation or inefficient clasping of the denture
can result in slight movement of the saddle away from the
mucosa causing some difficulties during mastication.
• Food lodgment around the denture during mastication is
annoying to the patient and is usually due to the denture
movement during function or to an improper denture design.
III- Movement of the denture during function:
• This commonly occurs when the retentive clasp tips were
not adjusted properly into the retentive undercuts. Careful

6. Patient Complaints
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adjustment of the retentive clasp arm position can be carried
out using suitable pliers at the chair-side.
• Also a defect in the occlusion such as cuspal interference or
premature contacts may result in denture movement during
function and may or may not be accompanied by pain under
the saddle.
• Over-extension of the saddle peripheries will result in
denture movement during mastication especially in case of
long free-end saddles.
• Denture movement during mastication may be due to
improper positioning of artificial posterior teeth relative to
the tongue or cheek muscles or encroachment of the lower
teeth on the tongue space. This may occur in free-end saddle
cases and not likely to occur with bounded saddles.
• When the retention of the partial denture is partially
dependant upon peripheral seal as in case of long saddle
class I upper denture, any deficiency in the peripheral
extension will markedly affect the retention, particularly
during mastication.
IV- Difficulties during speech:
This complaint is not frequently encountered with
removable partial dentures. It is usually associated with the

7. Patient Complaints
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placement of maxillary artificial anterior teeth. If the teeth are
not being placed far enough labially, the speech will be
adversely affected. Also, the contour of the maxillary major
connector over the rugae area (the anterior part of the palate)
will also affect the speech.
The position of maxillary or mandibular premolars will
occasionally affect the speech. The placement of these teeth too
far lingually will impede the action of the tongue and thus,
pronunciation will be affected. However, the placement of these
teeth too far buccally, air will escape between the tongue and
the teeth and whistling or slurring of speech will result.
The patient should be given a reasonable time to adapt to
the partial denture and to the position of artificial teeth (about
one to two weeks) because some initial disturbance of speech is
expected. Reading aloud is one of the best methods in helping
the patient to adapt to the partial denture.
However, if speech disturbance continues, consideration
should be given to repositioning of artificial teeth or decreasing
the thickness and altering the contour of the palatal major
connector.
V-Tongue or cheek biting:
• Tongue biting frequently occurs when the artificial teeth
have been positioned too far lingually decreasing the tongue

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space. Recontouring the lingual surfaces of mandibular
posterior teeth is the solution. However, if the tongue biting
continues, the artificial teeth will have to be removed and
reset.
• If the lower posterior teeth have been missing for a long
time, the intrinsic muscles of the tongue will lose tonus and
will broaden to fill the space once occupied by the natural
teeth. After denture placement, the tongue will regain its
normal shape in time and thus initial tongue biting may
occur.
• Cheek biting or trapping the buccal mucosa between the
maxillary and mandibular posterior teeth frequently occurs
when the artificial teeth have been positioned with
insufficient horizontal overlap or the teeth may have been
set too far buccally to the edentulous ridge. This may be
corrected by rounding the buccal cusps of mandibular
artificial teeth inward to control cheek biting by increasing
the horizontal overlap or resetting of the artificial teeth if the
problem continues.
• If the natural posterior teeth have been missing for a long
period of time, the buccinator muscle tends to sag into the
space created by the loss of teeth and thus may cause initial
cheek biting after denture placement. However, after the

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prosthesis is worn for some time, the muscles will regain its
normal tone and resume its original position.
VI- Nausea or gagging:
• This is often a complaint of maxillary partial denture
wearers, although, excessive disto-lingual extension of
mandibular partial dentures may also be responsible. This
complaint is not common with palatal bar designs provided
that they are well fitting and properly placed far enough
forwards to be free from any impingement upon the hard
and soft palate junction.
• An over-extended plate design over the soft plate will result
in gagging and must be re-contoured properly.
• Nausea may also occur if a space exists between the palatal
plate and the tissues in the post-dam area. In this condition
movement of the denture during function usually occur
affecting retention.
• If only a light post-dam-tissues contact exists, a tickling
sensation during function occurs and will be nauseating to
the patient.
• Thick posterior palatal margin of non-metallic plate may
also cause gagging.

10. Patient Complaints
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A patterned surface simulating the rugae is preferred then the
smooth polished plate, which, is described, as “slimy” by
some patients.
VII- Excess salivation:
Presence of the denture in the mouth will result in
stimulation of the salivary glands. The secretion returns to
normal after a short period of accommodation to the denture.
VIII-Teeth clattering or noise:
• This complaint may be due to a high occlusal vertical
dimension and inadequate retention causing the denture to
move during function and clattering against the opposing
teeth.
• Uneven occlusion and presence of occlusal discrepancies
may cause this problem.
Acrylic resin teeth are usually less noisy in function than
porcelain teeth.
IX- Burning sensation:

11. Patient Complaints
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This condition is a local manifestation of a general
condition. It is common in females in the menopause stage.
Sometimes the patient may be allergic to acrylic resin but this
condition is very rare.
X- Appearance:
This usually occurs due to insufficient care during the
try-in stage specially if a large number of anterior teeth have
been replaced.
The bulk of the denture labially may cause the patient to
feel under fullness of the lips but the musculature may
accommodate to the changed condition after a short time
period.