Post insertion complaints in cd patients/ oral surgery courses

Post Insertion complaints
In Complete Denture
Patients
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

• Introduction
• Review Of Literature
• Complaints and treatments
• Conclusion
• References

Introduction
• A complaint is an utterance of pain,
discomfort, or dissatisfaction.
• It requires patience on the part of patients
and patience, skill and experience on the
part of dentists to correct many problems
associated with the use of dentures.
• Dentists also need thorough knowledge of
anatomy, physiology, pathology and
psychology..

• They must be capable of differentiating
between normal and abnormal tissue
responses.
• When a prosthodontist have a knowledge of
basic sciences and the skill and experience
to investigate these problems, they will
readily see that in majority of the instances
the problems are not real and not
psychosomatic.

• John MT, Slade GD et al 2005 did a study
sought to investigate problems reported by
patients before and after prosthodontic
treatment. They concluded that the number
of problems decreased substantially after
prosthodontic treatment. Fixed partial
dentures more effectively influenced the
problems reported before treatment than did
removable partial or complete dentures.

• Roessler DM et al. 2003 Before treatment
even begins, the patient's motivation for
denture treatment and emotional attitude
towards dentures must be evaluated.
Patients will thereby gain realistic
expectations of what can and cannot be
achieved, and dentists will understand what
the patient really wants. Finally, patients
must be informed that continued success
depends on regular denture maintenance at
home combined with periodic consultation
with the dentist

• Dervis E. et al 2002 did a study to
investigate relationships between patient
complaints with complete dentures and
several factors such as age, gender,
medical status and denture faults. Six
hundred patients who received new
dentures were assessed three months after
insertion of the dentures.

• No significant relationship was found when
age, gender, and medical status were
compared with patient complaints.
Statistically significant relationships were
observed between denture construction
faults or the condition of the patient's
denture bearing mucosa and patient
complaints.

• Yoshida M, Sato Y, Akagawa Y. 2001 did a
study on the correlation between the quality
of life (QOL), defined as overall satisfaction
with daily life, and denture satisfaction in
elderly complete denture wearers and
concluded that edentulous elderly people
who are well satisfied with their daily lives
are also satisfied with their complete
dentures.

• Albert A.M. et al 1997 did a study on the
concept “prosthetic condition”, which
combines the quality of complete dentures
and residual alveolar ridges. They
concluded that . Logistic regression analysis
demonstrated that no variable of the
“prosthetic condition” proved to explain the
denture satisfaction. Some variables of the
“prosthetic condition” had a significant but
not relevant correlation with some denture
complaints.

• Muller F et al, 1995 did a study on Studies
on adaptation to complete dentures. The aim
of the study was to evaluate the oral
stereognosis and tactile sensibility in
edentate subjects and relate these to patient
age and capability of adaptation to new
prostheses. In conclusion, the results cannot
support a relationship between high oral
stereognosis and adaptation problems.
However, good denture retention facilitates
the adaptation process.

• Champion H et al in 1995 investigated into
the problems experienced by 114 referred
patients with complete dentures who were
considered to be difficult or to have difficult
prosthodontic problems. The commonest
problems were those of pain and lack of
retention, mainly due to occlusal
discrepancies and excessive VDO.

• Treatment was carried out on an individual
basis with a large proportion of dentures
being remade. However, a small number
was satisfied by counseling alone without
procedural treatment. The overall success
rate for treatment was 80 per cent.

• Basker RM, Beck CB, et al 1993 did a
survey of the dissatisfied denture patient. In
this study a wide range of tests was applied
to complete denture wearers attending for
treatment at Leeds Dental School, including
an extensive interview and questionnaire,
clinical examination and a personality
assessment. In the majority of cases
technical errors in denture construction
accounted for the presenting complaint. It
was not possible to identify a factor or group
of factors common to those patients who had
suffered chronic denture problems.www.indiandentalacademy.com

Problems and treatments
• It is impossible to discuss every complaint
which may be made by a patient but the
following are the most common and will
give a comprehensive outline of how the
dentist may diagnose their causes and
how they should be treated

Most complaints will fall under one of the
following headings, although frequently a patient
will have more than one complaint:
1 Pain and discomfort.
2 Appearance.
3 Inability to eat.
4 Lack of retention and instability. .
5 Clicking of teeth.
6 Nausea.
7 Inability to tolerate dentures.
8 Altered speech.
9 Biting the cheek and tongue.
10 Food under the denture.
11 Inability to keep denture clean.www.indiandentalacademy.com

• Pain & Discomfort
– Over-extension of the periphery
– Poor fit
– Insufficient relief
– Occlusal faults
• Wrong antero-posterior relationship
• Uneven pressure
• Excessive vertical dimension
• Cuspal interference

Over-extension of the periphery
• This is by far the most common cause of pain
with new dentures.
• It is due to incorrect moulding of the
impression or incorrect outlining of the
denture on the cast and is visible in the
mouth as an area of hyperemia or an ulcer,
depending upon how continuously the
denture has been worn, or how gross is the
over-extension.

Treatment:
• Apply pressure-indicating paste to the
periphery and insert the denture. On removal
an area of wipe-off will be seen.

• An alternative method is to dry the mucosa,
touch the inflamed area with methylene blue
or an indelible pencil and insert the denture.
• Remove the denture and ease the
periphery with a small carborundum stone or
a bur except in cases of severe ulceration
this will give immediate relief, but remember
that the area is slightly edematous and
therefore only the minimum material should
be removed from the denture.

• If the denture is an old one, the over-
extension may be due to alveolar resorption
and the slow, chronic irritation may have
caused a local hyperpla-sia. Cut back the
denture periphery and line the fitting
surface with tissue conditioner or black
gutta percha.
• When the hyperplasia has reduced, or been
removed surgically, construct new dentures

Poor fit
• This is easily detected by the poor
retention, rocking, tilting and inability to
seat the denture accurately in any
position.
• The movement of the denture rubbing the
mucosa causes pain, and patches of
redness are sometimes visible.

• Treatment: New dentures, but the old
ones can be worn in the meantime with a
lining of tissue

Insufficient relief
• This may occur over a prominent bony area,
such as the buccal canine region where the
bone has been expanded at the time of
extraction. The denture moves over the hard
area causing pain. The painful area is red
and possibly ulcerated.

• Treatment: apply pressure indicating
paste to demarcate the area and ease the
contact surface with a carborundum stone.

Occlusal Faults
• Wrong antero-posterior relationship
When the teeth occlude the mandible will
not be fully retruded. Attempts to retrude it
will drag the dentures against the mucosa as
they are locked together by the interdigitation
of the teeth. This is often difficult to diagnose
but can be seen by watching closely while
the patient slowly approximates the teeth
and increases the occlusal load.www.indiandentalacademy.com

• At some stage in this movement the lower
denture will be seen to shift. This is often
associated with a complaint of looseness.
• Treatment: if only slight it can be cured by a
check record, remounting and grinding of
the dentures; if gross, place occlusal pivots
to reposition the lower denture

Occlusal Faults: Uneven pressure
• This may be the result of faulty setting of the
teeth and, if so, is usually very slight.
• More commonly it is the result of tilting of the
record blocks, undetected at the trial stage.
• Pain is due to trauma caused by the one-
sided pressure and is then confined to the
crest of the alveolar ridge on that side;
sometimes small hyper keratinized areas are
to be seen, as in an excessive vertical
dimension.

• Diagnosis can be made by trying to insert a
thin blade between the posterior teeth, first
on one side, and then on the other, with the
teeth in firm contact.
• Lesser degrees of error can be detected by
inserting a thin mylar strip on either side
between the occlusal surfaces of the
posterior teeth while the patient closes just
sufficiently to hold them in place.
• The strip on the side of the heavy pressure
will be immovable while that on the opposite
side will be easily withdrawn.

• Treatment: if the error is small the areas of
heavy contact are detected by marking
paper and the fault corrected by grinding or,
better still, by remounting with a check
record and adjusting the occlusion on the
articulator.
• If the error is large, temporary improvement
can be effected by adding cold-cure acrylic
to the side of lighter pressure. When
symptoms reduces either replace the
posterior teeth or remake the dentures.

Occlusal Faults: Excessive vertical
dimension
• This is due to an error at the registration stage
and it is almost always due to increasing the
vertical height beyond normal limits.
• Pain is associated with the crest of the lower
ridge, as distinct from the lateral surfaces, and
small white patches may be seen in the painful
area.
• Easing the denture over these white patches
gives immediate relief from pain, but within a few
days the patient usually returns with the same
complaint in a different site.www.indiandentalacademy.com

• In nearly all cases of excessive height the
patient also complains that the teeth jar,
clatter, are 'in the way' or 'too high' when
eating, and sometimes when talking.
• Treatment: if the occlusal plane of the upper
is judged to be correct make a new lower
denture to a decreased vertical dimension;
otherwise, new upper and lower dentures.

Occlusal Faults: Insufficient vertical
dimension
• Pain from this cause is not normally
associated with new dentures.
• It is almost always the result of loss of
vertical height through alveolar resorption.
• The pain is often indefinite in locality and
may be associated with temporo-mandibular
joint dysfunction and
its symptoms of facial
or joint pain.

• Treatment - is aimed at restoring the
vertical height and stabilizing the occlusion
by occlusal pivots, followed by new
dentures.

Occlusal Cuspal interference
• A dragging action will be exerted on both
upper and lower dentures during all lateral
and protrusive movements with the teeth in
contact if cusped posterior teeth are used :
– With a plane-line articulator.
– With a moving-condyle articulator if care has not
been taken to obtain balanced articulation.
• The same effect may result from an
excessive vertical overlap or an incorrect
incisal guidance angle.

• This dragging will cause pain with well-fitting
dentures and also instability with those
having poor retention.
• The pain is usually widely distributed and
often only experienced when attempting to
eat, although 'empty mouth' grinding
movements exacerbate the problem.
• Sore areas may be found on the labial or
buccal surfaces of the alveolar ridges, and
on the lingual surfaces of the lower ridge.

• The patient often removes the dentures after
a few hours because of the discomfort.
• This condition can easily be detected by
asking the patient to grind the teeth, when
shifting of the dentures can be seen.
• Another simple method of diagnosing this
fault is to hold the upper denture in place
between the finger and thumb above the
canine teeth and ask the patient to grind the
teeth." The dragging can easily be felt.

• Treatment: If the cuspal interference is
slight, or confined to only one or two teeth, it
can be corrected by the careful use of
marking paper and grinding.
• The taking of a check record and adjusting
the occlusal surfaces on the articulator is the
most accurate method of correcting this
error. If the interference is gross, new
dentures with balanced
occlusion will be required.

Teeth off the ridge
• Pain from this cause is confined chiefly to the
upper buccal sulci and maxillary tuberosities.
• It is usually the result of setting the upper
teeth too far buccally in an attempt to
overcome marked discrepancies between the
size of the upper arch and that of the lower,
combined with lack of peripheral seal and
incorrectly shaped polished surfaces.

• During mastication the upper denture tilts,
digging the periphery of the denture into the
mucosa on the working side and pulling it
down over the tuberosity, or other undercut
area, on the opposite side.
• The actual tilting can be seen if the patient
bites on a wooden
spatula placed on
the posterior teeth,
first on one side
and then the other.

• Treatment:
Some relief may be obtained by
removing all four last molars and reducing
the bulk of base acrylic over the
tuberosity. This gives more space for the
tongue to control the upper denture. New
dentures with the above faults corrected,
are the most effective treatment.

Retained root or Unerupted tooth
• Pain may be caused by direct pressure on an
area which is already tender and will be felt very
soon after inserting new dentures.
• It may also be caused by a well-fitting denture
preventing draining from an undetected sinus.
• Well-fitting, functional dentures appear in some
cases to stimulate the eruption of unerupted
teeth.
• The painful area will usually be localized and
often close inspection will reveal the cause.

• Diagnosis should be confirmed by
radiograph.
• Treatment:
Extraction of the root or tooth followed
by relining of that part of the denture. If for
some reason extraction is contraindicated,
then relief may be given by easing the
denture over the area.

Narrow Resorbed Ridge
• This is more usually associated with the
lower, and caused by the denture pressing
the mucosa against the sharp ridge of bone
during mastication.

• The pain is worst on the side habitually
used for eating, but it may be widespread
with an associated burning sensation.
• It is most severe during, and immediately
following, a meal, and is increased by
perseverance on the part of the patient.

• Treatment: in the lower, alveolectomy
followed by relining the denture may be
considered but relief over the bony
irregularities is often the best treatment.
• In the upper, relief over the crest of the
alveolus is usually sufficient since the
palate can resist the masticatory loads

Mental foramen
• Under normal conditions the mental foramen is
situated on the buccal surface of the mandible
below the lower alveolar ridge and is thus
outside the denture-bearing area.
• If, however, gross resorption of the alveolar
and basal bone has taken place, the foramen
may come to lie on the crest of the ridge and
so be subject to pressure from the denture.

• When a new denture is constructed to these
altered conditions, adequate relief should be
given for the mental nerve.
• The pain may be localized to the immediate
vicinity of the mental foramen, or it may be
referred, and is then felt as a pain in the side
of the face or in the lips and chin.
• It can usually be diagnosed by locating the
mental foramen by radiograph.
• Treatment: relieve the denture so that the
nerve cannot be subjected to pressure

Irregular resorption
• Sometimes, because' of alveolar resorption,
an area is found which is rough, with a
number of sharp spicules of bone, and if the
mucosa covering it is thin, pain will be
caused by pressure on it.
• This is very similar to the pain associated
with narrow resorbed ridges except that it is
localized.

• The uneven alveolus can be detected by
gentle palpation and confirmed by
radiograph.
• Treatment: surgical smoothing of the
affected area followed by relining the
denture. Treatment by surgery in such cases
is often disappointing as the area remains
tender for a long time and so simply
relieving the denture may be a better
treatment

Rough contact or fitting surface
• If a denture has been processed on a cast
with a porous surface small pimples or blebs
will be found on the contact surface where
the acrylic has been forced into the small air
bubbles of the cast.
• Normally these pimples are removed by the
technician, but if they are overlooked the
patient will complain of pain under pressure
and a local area of inflammation can be
seen.

• Treatment: remove the roughness from
the denture and polish lightly. Always
inspect a denture when it is dry, under a
good light and magnification, to detect
surface roughness or blebs.

Swallowing and sore throat
• These two complaints are listed together as
they are different ways of describing pain
arising from the over-extension of a denture.
• The cause in the upper is extension on to the
soft palate with trauma in the post-dam
region or excessive pressure in the hamular
notches, while in the lower it is over-
extension distally in the lingual pouch.
• The pain ceases if the denture is left out, and
starts again soon after its reinsertion.

• Treatment:
The patient will usually know which
denture is at fault and examination of the
regions described will show a slight redness
or ulceration.
Reduction of the over-extension
produces relief, although the symptoms may
persist for some time

Undercuts
• Sometimes the dentist will make use of an
undercut area which, in his judgment, is
unlikely to cause pain, and although the new
denture was inserted with comfort, the
patient returns with the complaint that
inserting and removing the denture is
becoming increasingly painful.
• The maximum bulge of the alveolus in this
area is found to be red and painful, and in
some cases ulcerated.

• Treatment:
It may be possible to insert this side of the
denture first, quite painlessly, and then the
opposite side, removing it in reverse order.
If this maneuvering is not successful the fitting
surface must be cut away until the denture can be
inserted comfortably but the periphery must not be
reduced in height. Often the flange will be too thin
to allow acrylic to be removed from the fitting
surface and if this is so the flange must be
thickened by the addition of more material. Should
this easing ruin the retention, as is likely to be the
case if much has to be cut away, an alveolectomy
will be necessary followed by a new buccal or
labial flange.

It might be helpful to list the causes of pain or
discomfort following the fitting of dentures.
1. Localized painful areas with ulceration:
• Blebs and surface irregularities. Periphery too
sharp.
• Post dam too deep.
• Edges of relief areas.
• Lack of relief.
• Occlusal error.
• Excess periphery.

2. Localized painful areas without ulceration:
• Upper displaceable ridge.
• Rough bony alveolar ridge.
• Dental remnant.
• Mental foramen.
• Mylohyoid ridge.
• Buccal prominence of tuberosity.
• Lack of relief, e.g. incisive papilla.
• Excessive vertical dimension.
• Peripheral over-extension.
• Denture into undercuts.
• Cramped tongue space.www.indiandentalacademy.com

Appearance
• In spite of the greatest care on the part of the
dentist to obtain the patient's full approval of the
appearance at the trial stage, there will always be
some patients who are dissatisfied with their
appearance when wearing the finished dentures.
• The patient should not be condemned too severely
for this inconsistency, as it is difficult to form a
considered opinion on all details of facial
appearance when sitting in a dental chair, in
strange surroundings, with trial dentures in the
mouth, and being asked to criticize the work of a
professional person.

• The number of patients who. are dissatisfied with
their appearance with the final dentures can be
much reduced if the dentist insists on a relation or
candid friend being present at the trial stage,
although it has to be stressed that the appearance
cannot be fully assessed until four to six weeks
after insertion of the finished dentures.
• This is because of the adaptation of the lip and
facial muscles to the underlying teeth and denture
bases.
• This is the basis of the problem of judging the
appearance at the trial stage.

Facial appearance
• Patients may complain that the nose and chin
are more prominent or are approximating.
• This is due, in the case of old dentures the
patient is wearing, to continuing alveolar
resorption and the spatial change of position
of the dentures in relation to the skull as a
whole.
• If this complaint is voiced after delivery of the
new dentures it means a failure to restore the
occlusal face height correctly.

• The same causes operate in complaints of
the lips and cheeks falling in, although this
is more likely to be due to the teeth of new
dentures being set too far lingually and to
insufficient width of the buccal and labial
flanges.

Dissatisfaction with teeth Colour
• This complaint is almost invariably that the
teeth are too dark or too yellow, but before
changing them it must be explained to the
patient that natural teeth darken with age
and that very lightshaded teeth look more
artificial than darker ones.
• Treatment: comply if possible with the
patient's request for lighter teeth, usually by
a compromise between the shade chosen
by the operator and that chosen by the
patient.

Shape
• Few people are sufficiently observant to be able to
describe the shape of their lost teeth and are likely
to say vaguely, when referring to their dentures, that
'they don't look right'.
• Shape is closely bound up with size, and a different
make of tooth of the same basic shape and size
may well look more natural.
• Artificial teeth usually look larger than natural teeth
of identical size, probably because their mesial and
distal surfaces are not so rounded, and so the eye
is. able to focus on their width more accurately.

General dissatisfaction
• One of the most difficult cases to deal with is that of
the patient, fitted with new dentures, who returns a
few days later with the vague remark that he 'does
not like them'.
• He can specify no particular complaint and it will be
found on questioning that comfort, retention,
stability and efficiency are not at fault; so the
conclusion, which is invariably right, is that it is a
question of appearance.
• It may be due to diffidence on the part of the patient
unwilling to make a specific complaint that would
appear to criticize the dentist's skill.

Inability to eat
• This complaint is mainly confined to patients
who are wearing complete dentures for the first
time, and are impatient at the time spent in.
acquiring new habits of eating.
• Careful attention by the operator to the
psychological approach to denture wearing, will
eliminate this complaint except in rare cases,
and these must be persuaded to persevere, so
that they will either learn anew how to eat or will
define some specific complaint which can then
be remedied.

• Difficulty may be encountered with certain fibrous
foods and this is likely to be due to lowcusp or
zerocusp posterior teeth, lack of interdigitation of
posterior teeth, the use of acrylic teeth in a patient
used to porcelain, unbalanced occlusion, or a
locked occlusion arising from setting teeth on a
planeline articulator.
• These faults may also cause the dentures to
dislodge during eating, a further complication being
a restricted tongue space which may occur if the
upper teeth are set directly over the ridge, if the
lower posterior teeth overhang the tongue or if the
posterior teeth, particularly the lowers, are too
broad.

• The posterior natural teeth are often lost
some time before the anterior ones, with
the result that a habit is formed of eating on
the anterior teeth. When complete dentures
are being worn for the first time, it is only
natural that the patient should try to
continue his previous eating habits with bad
results.

Lack of retention and instability
• When opening the mouth patients more often
complain that the lower denture lifts than that the
upper one drops.
• If this lifting only occurs when the mouth is
widely opened it may be explained by what is
commonly known as a low tongue position.
• When a dentate person opens the mouth wide
the tongue remains back in the mouth to protect
the oropharyngeal isthmus while in an
experienced denture wearer the tongue falls
forward to stabilize the lower denture.

• If the low tongue position persists in
edentulousness then the denture is likely to
rise on wide mouth opening. Explanation of
this will help the patient to counteract the
problem.
Other causes are given below.
Over-extension
This has already been discussed under the
heading of pain, the difference in these
cases being that the overextension is so
slight that the tissues do not make constant
contact with it, and consequently soreness
does not arise.

Tight lips
• These can be a most difficult problem when in
conjunction with a flat, atrophic lower. The
inward pressure from the lips will seat the
upper denture more firmly in position but will
push the lower denture backwards and up the
ascending ramus.

• Treatment: Remake with the lower anterior
teeth set more lingually, with a labial
concavity on the denture, and with the
maximum extension in the region of the
retromolar pads. Denture space techniques
are useful and surgical vestibuloplasty
must be considered.

• Tongue space If the lower posterior teeth
are tilted or set lingually they produce an
undercut area into which the wide middle
third of thy tongue will press. Movements of
the tongue then lift the denture.

• Treatment: reduce the width of the lower
posterior teeth by grinding off the lingual
cusps. This effectively alters the
downward facing lingual surface to an
upward facing one more favourable to
tongue control

Under-extension and lack of peripheral seal
• This fault is by no means uncommon, and its
effect on the retention of the denture is most
marked. Maximum retention cannot be
obtained without covering the greatest
possible denturebearing area.
• Some clinicians produce this fault by placing
excessive tension on the soft tissues during
the peripheral moulding of the impression,
through their desire to avoid overextension.

• Where this cause is suspected of being
the fault, it can be checked by adding
tracing stick round the periphery, moulding
it carefully and noting the result. A
conventional reline can then be
undertaken

• Lack of saliva There is no specific
treatment for this condition but palliative
treatment such as artificial saliva will help the
patient
• When coughing or sneezing Occasionally
a new denture wearer will complain that his
upper denture falls and his lower denture
lifts, whenever he coughs or sneezes
violently.

• Treatment: it must be explained to the
patient that when coughing or sneezing the
soft palate rises suddenly and there is a
moment when the pressure of air in the
mouth is considerable so that the peripheral
seal of the upper denture is broken and it is
liable to fall; the unusual muscular
movement causes the lower denture to lift.
There is no way of preventing these
movements of the dentures, but covering the
mouth with a hand or handkerchief is an
obvious suggestion

Clicking of teeth
Patients are often less disturbed by contact of
teeth than relatives who are irritated by the
noise. The main causes are:
1. Excessive vertical height causes the
dentures to contact during speech,
particularly the sibilant sounds, as the
mandible moves vertically through the
speaking space

2. Movement of the lower denture from whatever
cause is very liable to lead to clicking of the
teeth, particularly the molars if the distal part of
the denture rises
3. Cuspal interference or lack of balanced
occlusion is a likely cause of faulty tooth
contacts. Particular attention should be paid to
the retruded contact position as faults here are
often missed in the examination of the
occlusion.

4. Porcelain teeth by nature of the material
create more impact noise than acrylic; a
problem increased if the patient has been
used to acrylic for many years.

Nausea
• It is because of light or intermittent contact on the
soft palate or back of the tongue, and the patient's
complaint is almost invariably 'that the upper
denture goes too far back and makes me feel sick'.
The causes are given below.
1. Denture slightly over-extended Movements of
the soft palate cause intermittent contact with the
denture and this may be diagnosed by observing
the relation of the posterior border to the vibrating
line.
Treatment: remove the excess and readapt the
postdam if necessary.

2. Denture under-extended: If the posterior
border of the upper denture does not
extend beyond the hard palate it cannot
compress the soft tissues sufficiently to
maintain close contact under all normal
conditions, and this will often cause nausea
because of the intermittent contact and
tickling effect at the back of the palate. A
posterior edge which lies too far: forward is
detected by the dorsum of the tongue and is
a common cause of nausea.

3. Thick posterior border This is a very
common cause of nausea resulting from
the dorsum of the tongue being irritated by
the thick edge. The edge of the upper
denture should be thin, and slightly
embedded in the compressed mucosa, so
that the tongue is unable to detect any
definite junction between denture and
palatal mucosa

4. Protrusive imbalance If the occlusion is
not balanced "in protrusive imbalance
there is a heavy contact on the incisors
and no contact between the molars. This
produces movement of the back of the
upper denture which causes saliva to
collect at the posterior border and a
tickling effect, leading to nausea.

Inability to tolerate dentures
• Patients sometimes complain that new
dentures are not comfortable but can give
no specific cause for complaint. These
cases are difficult to diagnose since they
are not accompanied by pain, and
retention appears to be satisfactory, but as
the patient has nearly always previously
worn dentures a careful comparison of the
new with the old will generally give a clue
to the cause.

1. Cramped tongue space This is the most
common reason for this complaint, the
teeth on the new upper denture having
been set on the crest of the alveolar ridge
which has resorbed considerably since the
older denture was made. Since the
resorption is greatest on the buccal and
labial aspects of the upper ridge, the teeth
are now mounted
nearer to the midline,
so decreasing the
tongue space.www.indiandentalacademy.com

2. Altered occlusal plane As in the case
of an altered vertical height, the position
of the occlusal plane is unlikely to have
been changed by more than a few
millimetres, but even a slight alteration
will require some adjustment of muscular
movement and control, particularly the
tongue.

3. Unemployed ridge This type of ridge is
a common cause of discomfort and
inability to wear a new complete lower
denture because the latter applies
pressure on tissue not previously loaded.

4. Changes in shape Very often when new dentures
are made with marked changes in form and
dimension of the periphery or polished surface as
compared with the patient's existing dentures there
is difficulty in tolerating the change, particularly in
older patients.
• Treatment: unless any of the above-mentioned
factors are gross the patient should be encouraged
to persevere for several weeks, by which time, in
most cases, the discomfort or intolerance will have
disappeared; if not, then nothing remains but to
modify the dentures or remake them if the cause of
the problem has been diagnosed.

Altered speech
• When complete dentures are first worn there is
always some temporary alteration in speech
owing to the thickness of the denture covering the
palate, necessitating slightly altered positions of
the tongue. Commonly this is only a temporary
inconvenience, most rapidly overcome by the
patient reading aloud; when there is an altered
position of the upper incisors, a change in their
palatal shape, any reduction of tongue space, or
alteration in occlusal level, adaptation may be
very difficult even with perseverance.

• Treatment: the dentures must be remade
paying particular attention to the principles
and to the correct restoration of the
denture space, defined as the space in the
edentulous mouth formerly occupied by
the teeth and supporting tissues which
have since been lost.

Cheek biting
1. Insufficient ovetjet
2. Reduced vertical height
1. Insufficient ovetjet The normal occlusal
relationship of the posterior teeth is with
the buccal cusps of the upper teeth
outside those of the lower teeth; this
arrangement, along with the correct
peripheral width on the dentures,
normally prevents the cheeks getting
caught between the teeth..www.indiandentalacademy.com

• If for any reason this arrangement has
been altered, or if a patient has very lax
cheeks, cheek biting may occur
• Treatment: Increase the buccal overjet
and make sure the peripheral form is
adequate in width and height. In some
cases it may be necessary to remove the
last molar teeth or grind the buccal
surfaces of the teeth

2. Reduced vertical height If the vertical
occlusal dimension of the dentures is
reduced, the resultant bunching of the
cheeks allows them to be trapped between
the occlusal surfaces of the teeth as they
occlude. This may also occur if the occlusal
plane of either denture is' incorrectly
positioned.

It should be remembered that when the
natural teeth are lost there is no record
of the occlusal position of either the
upper or lower teeth and the selection of
the occlusal plane in complete dentures
is entirely empiric.
Treatment: restore the vertical dimension
or change the occlusal plane

• Biting the tongue This is almost
invariably due to a decrease in the tongue
space occurring when fitting new dentures
for patients already wearing dentures, but
it may also be due to changes in occlusal
level as mentioned above

Food under the denture
• This complaint is usually made by patients
wearing dentures for the first time and who have
not yet learnt how best to control the food.
Undoubtedly a perfect peripheral seal will prevent
the ingress of food beneath the denture, but
perfection is not always attained and, owing to
alveolar resorption, never maintained. Scraping a
groove on the cast, along and near the entire
periphery of the denture, is sometimes carried out,
but this food-line, as it is termed, causes
inflammation and ulceration and should not be
undertaken www.indiandentalacademy.com

• Treatment: this usually consists of covering
the maximum possible area and obtaining an
adequate peripheral seal; thereafter, only
perseverance by the patient can bring about
any improvement.

Inability to keep denture clean
• This complaint may be caused by:
1. Inadequate laboratory work by the
technician, especially failure to polish all
round each tooth before setting in wax.
Careless waxing and flasking are common
faults. It is not possible to polish acrylic in
the interdental space, or the col between
teeth, if the original wax was rough or
incorrectly designed.
2. Loss of original polish by patient's use of
hard household abrasives.
T

3. Failure of patient to clean the dentures
regularly or efficiently. Many denture patients
also wear spectacles but often the dentures
are cleaned in the bathroom under poor light
when the spectacles are not worn. Cleaning
is therefore not always done properly.

4. Incorrect use of denture cleansers. These
cleansers may be listed:
(a) Oxygenating cleansers containing alkaline
percarbonates or peroxides.
(b) Hypochlorite solutions containing dilute
sodium hypochlorite.
(c) Mineral acid, usually dilute hydrochloric acid
(d) Powders and pastes containing mild
abrasives, precipitated chalk or hydrated
alumi-na.
(e) Liquid detergent.

• List of factors resulting in discomfort
related to the impression surface of
dentures
• Pearls or sharp ridges of acrylic on the fitting
surface arising from deficiency
• Denture not relieved in region of undercuts
• Pressure areas resulting from faulty impressions,
damage to working cast, warpage of denture base.
• Over-extended lower impression:
• Under-extended denture base
• Post dam too deep

List of factors resulting in
looseness of dentures arising
from decreased retention forces
• Lack of peripheral seal
• Inelasticity of cheek tissues
• Occlusal error subsequent to warpage
• Xerostomia
• Neuromuscular control

• List of factors resulting in looseness of
dentures: arising from increased
displacing forces
• Denture borders
– Over-extension in depth.
– Deep post dam on upper base
– Overextension in width
• Poor fit to supporting tissue
• Recoil of displaced tissue lifts denture
• Denture not in optimal space

• List of factors resulting in looseness of
dentures arising from increased
displacing forces - occlusal and
anatomical factors
• Occlusal errors
• Ulceration labial to lower ridge
• Fibrous displaceable ridge
• Bony prominence covered by thin mucosa (eg
tori)
• Non-resilient soft tissue
• Pain avoidance mechanismswww.indiandentalacademy.com

• List of denture problems associated
with problems of adaptation
• Noise on eating/speaking
• Eating difficulties
• Blunt teeth’
• Jaws close too far’
• Cannot open mouth wide enough for food
• Speech problems
• Gagging
• Appearance
• Too much visibility of teeth
• Creases at corners of mouth
• Colour of denture base material unnatural’www.indiandentalacademy.com

• Factors resulting in discomfort - factors with
possible systemic associations. Some of these
conditions may occur several months post
insertion
• Burning sensation over upper denture supporting
• tissues
• Beefy red tongue, possibly glossodynia
• Frictional lesions related to dentures,
• Tongue thrusting. Empty mouth ’chewing’.
• Presence of herpetiform ulcers in mouth
• Painful ’click’ related to TMJ
• Patient complains of allergy to denture material
• Painless erythema of mucosa related to support of
(usually) upper denture, may beaccompanied by
angular cheilitis

Summary and Conclusion
• At the conclusion it is worth stressing the
eight most common causes of problems
with complete dentures:
1. Incorrect antero-posterior: relationship of
the mandible to the maxilla.
2. Premature contacts in retruded contact
position.
3. Lack of occlusal balance in: eccentric
mandibular positions

4. Vertical dimension excessive and therefore
inadequate freeway space and interference
with speaking space.
5. Cramped tongue space a teeth set too far
lingually.
6. Inadequate periphery leading to poor
retention and failure to restore lips and
cheeks to the pre-extraction form.
7. Under extended denture bases.
8. Failure to recognize design of existing
dentures

References :
• Principles and practice of complete dentures:
Iawo Hayakawa
• Essential Of Complete denture Prosthodontics
; Sheldon Winkler
• Textbook of complete Denture: Charles
Heartwell.
• Complete denture prosthesis John J. Sharey,
• Prosthodontic treatment for ednentulous patients
Carl ‘O’ Boucher,

• Int J Prosthodont. 2005 Mar-Apr;18(2):124-31.
• Eur J Prosthodont Restor Dent. 1993 Dec;2(2):73-
8.
• J Oral Rehabil. 1995 Oct;22(10):759-67
• J Prosthet Dent 1997;78:472-8.)
• Int J Prosthodont. 2001 Jan-Feb;14(1):77-80.
• Br Dent J. 2000 Jan 8;188(1):10-4.
• Br Dent J. 1997 Apr 26;182(8):313-7.
• Int J Prosthodont. 2005 Mar Apr; 18(2): 124-31.

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