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PATIENTS COMPLAINTS &
EFFECTIVE MEASURES FOR
THEIR DIAGNOSIS &
TREATMENT:
GROUP M
BDS/1003/17
• It should be expected that dentures will be satisfactory & that any
complain will be of minor character.
• Sometimes, However even with the greatest care skill & technical
ability, a patient may have serious problems.
• Complain could be due to:
• A fault in the denture or
• Due to patients lack of understanding on their part.
• It is therefore important to explain and inform the patient about
difficulties associated with denture wearing.
• 1st step : Diagnose what is wrong.
• Patients expression of complaint may be misleading.
• It is therefore important to carry out an examination of the denture in
the mouth and to question the patient carefully on their denture
experiences.
Various Complaints include:
1. Pain
2. Tongue biting.
3. Cheek biting.
4. Movement of the denture.
5. Difficulties During mastication
6. Difficulties with speech.
1: PAIN
• Tissue irritation and inflammation is the main source of pain related
to RPD.
• May be presented by patient in form of:
a) Soreness of sulcular epithelium.
b) Soreness beneath denture base
c) Pain in or around standing teeth
A) Soreness of sulcular epithelium.
• It may appear in the form of hyperemia (red line), a break or cut in
the vestibular sulcus, ulceration, localized or generalized tissue
irritation.
• Caused by:
1. Over extended denture flange.
2. Rough or sharp denture border.
3. Occlusal interference in lateral & protrusive excursions.
4. Non-Rigid connections between the saddles.
5. Inaccurate Peripheries.
DDX
• Prior to placing the denture in the patient's mouth, the denture borders should be examined
to ensure that they are not rough, and that no flare of the labial and buccal tissue surface is
present.
• Checks on peripheral extension may be made by, retracting the labial and buccal tissues
after seating the denture in place.
• The denture flanges should be long enough to accommodate the functional movements of
the border tissues without displacement. If it displaces the border tissue, it is over extended.
• Over extension can be evaluated further by placing pressure indicator paste on the suspected
area.
• The denture is seated in position, and the patient is asked to go through functional
movements of the border musculature. The material will be washed out if over extension is
present.
• Over extensions are corrected by cautious removal of the excess denture border with the use
of pressure indicator paste to locate the exact place and extent.
DDX contd
• Occlusal interference in eccentric jaw positions will result in a lateral or
posterior thrust of the lower and upper denture causing peripheral soreness.
• Can be identified by using articulating paper, or by remounting the denture on
an articulator using intra-oral records.
• Blue articulating paper is placed between the jaws and the patient is
asked to close first in centric position, and then in lateral and protrusive
positions.
• The Occlusal surface is examined to detect whether there is any premature
contact at each jaw position.
• If occlusal interference it present, will appear as a colored ring around a white
center.
• Premature contact is ground, and the procedure is repeated until multiple
uniform contacts are present to equilibrate the occlusion.
DDX Contd
• The narrow or too thin major connector allows flexing and rolling of
the saddle (to move lingually).
• This condition is frequently associated with inflammation of the
tissue beneath the major connector, and excessive denture
movement during function.
• This can be detected by careful inspection of the partial denture, and
intra-oral examination.
B)Soreness beneath denture base
• More common beneath distal extension PD than in tooth borne PD
since tissues take higher proportion of load.
• Complaint may be associated with Soreness at the periphery that may
be Generalized or Localized.
Generalized Soreness beneath denture base
• Causes:
1. Excessive tissue displacement during impression making.
2. Incorrect orientation of metallic framework and base.
3. Increased VDO.
4. Excessive soft tissue compression during jaw relation recording.
5. Disharmony between centric relation and centric occlusion.
6. Lack of balance of contacts in eccentric relations.
7. Allergic reaction to denture base material.
8. Unfavorable denture bearing tissue.
9. Poor Oral Hygiene.
Localized soreness beneath denture base
• Repeated application of excessive force to a denture bearing support
tissue.
• May occur due to:
a) Occlusal prematurity in centric or eccentric jaw position
b) Insufficient relief of bony prominence
c) Pressure from a denture base
d) Irregularities on tissue surface of denture
• Occlusal prematurity-the use of celluloid strip or articulating paper
when pt closes in centric jaw position
• .+ve if lack of multiple uniform contacts
• Bony prominences-visual and digital exam on the ridge/use of
pressure indicator paste-reveal insufficient relief
• Pressure from denture base –checked using pressure indicator paste
• May be due to; soft tissue displacement during impression making,
damage of the model, dimensional change of acrylic resin during
processing
• Irregularities on tissue surface confirmed by visual and digital exam
C)Pain In or around standing teeth
• Serious, indicates continuous load excess to physiologic limit of the tooth
•Causes include:
1. Excessive bulk or improper tapering of clasp arm
2. Improper clasp arm for tooth- tissue supported rpd
3. Traumatic occlusion
4. Loss of tissue support from the extension base
5. Inadequate reciprocal clasps
6. Non- rigid connection between the saddles
7. Gingival impingement and lack of physiological gingival stimulation
BDS/02/18
Tongue or cheek biting
2) Cheek biting
• Causes:
• Loss of tone of the cheek
masculature.
• End to end relationship of the
buccal cusps of posterior teeth.
• Decreased VDO
Differential Diagnosis
Correct shaping of the buccal flanges and increase of the horizontal
overlap of posterior teeth can eliminate cheek biting caused by lack of
muscle tone.
Decreased VDO causes the buccal mucosa to be caught up easily btwn
the teeth.
3) Tongue biting
Causes
• Improper bucco-lingual position of posterior teeth.
• Level of the occlusal plane is too low .
Differential diagnosis
• Placement of posterior tooth too far lingually will cause insufficient
tongue spacing and tongue biting.
• The dorsum of the tongue ahould be above the plane of occlusion.
4) Movement of the denture
Causes:
1. Faulty occlusion.
2. Light clasping.
3. Overextended denture base.
4. Improper position of posterior teeth.
5. Lack of peripheral seal.
6. Lack of indirect retainer .
Differential diagnosis
• Lack of multiple uniform tooth contact during eccentric jaw positions
indicates interferences in eccentric position. Any cuspal interference
or premature contact should be eliminated by occlusal grinding.
• Adjustment of the clasp to engage deeper into the undercut is
desirable.
• Overextension of denture peripheries will cause movement and
soreness of sulcus.
Cont...
• Improper position of posterior teeth will cause the tongue or the
cheek muscles to exert lateral pressure on the denture.Encroachment
of lower teeth into tongue space may cause movement. Posterior
teeth set outside the ridge will bring about displacement of free end
saddles.
• The saddles should be extended to the optimum depth around the
tuberosities when the retention is partially dependent upon
peripheral seal.
5) DIFFICULTIES DURING MASTICATION:
Inability to Chew.
• May be caused by:
• Patient taking too much food at once.
• Cuspless, blunt or flattend denture teeth.
• Decreased or increased VDO.
• Soreness of the denture bearing area by faulty occlusion.
Food gets under the denture.
• Caused by:
• Unbalanced Occlusion, Occlusal
interferences in centric or eccentric
positions.
• Inefficient clasping.
• Inaccurate Denture base.
• Loss of tissue support due to ridge
resorption.
• Lack of tissue fit at margins of palatal &
lingual plates.
Food lodgment around the denture.
• May be caused by errors in PD design.
• Relation of upper margin of bar to neck of tooth should permit self
cleansing by tongue and saliva.
• Further sufficient space should be provided (5mm) btn vertical
components of the frame to prevent food accumulation.
• Rough unpolished crevices may cause food to adhere readily.
6) DIFFICULTIES WITH SPEECH:
DIFFICULTIES WITH SPEECH
1. Encroachment of the tongue space
2. Poor denture retention
3. Excessive salivation
4. Improper LL position of ant teeth
THANK YOU!

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14. PD Patients Complaints after deliver

  • 1. PATIENTS COMPLAINTS & EFFECTIVE MEASURES FOR THEIR DIAGNOSIS & TREATMENT: GROUP M BDS/1003/17
  • 2. • It should be expected that dentures will be satisfactory & that any complain will be of minor character. • Sometimes, However even with the greatest care skill & technical ability, a patient may have serious problems. • Complain could be due to: • A fault in the denture or • Due to patients lack of understanding on their part. • It is therefore important to explain and inform the patient about difficulties associated with denture wearing.
  • 3. • 1st step : Diagnose what is wrong. • Patients expression of complaint may be misleading. • It is therefore important to carry out an examination of the denture in the mouth and to question the patient carefully on their denture experiences.
  • 4. Various Complaints include: 1. Pain 2. Tongue biting. 3. Cheek biting. 4. Movement of the denture. 5. Difficulties During mastication 6. Difficulties with speech.
  • 5. 1: PAIN • Tissue irritation and inflammation is the main source of pain related to RPD. • May be presented by patient in form of: a) Soreness of sulcular epithelium. b) Soreness beneath denture base c) Pain in or around standing teeth
  • 6. A) Soreness of sulcular epithelium. • It may appear in the form of hyperemia (red line), a break or cut in the vestibular sulcus, ulceration, localized or generalized tissue irritation.
  • 7. • Caused by: 1. Over extended denture flange. 2. Rough or sharp denture border. 3. Occlusal interference in lateral & protrusive excursions. 4. Non-Rigid connections between the saddles. 5. Inaccurate Peripheries.
  • 8. DDX • Prior to placing the denture in the patient's mouth, the denture borders should be examined to ensure that they are not rough, and that no flare of the labial and buccal tissue surface is present. • Checks on peripheral extension may be made by, retracting the labial and buccal tissues after seating the denture in place. • The denture flanges should be long enough to accommodate the functional movements of the border tissues without displacement. If it displaces the border tissue, it is over extended. • Over extension can be evaluated further by placing pressure indicator paste on the suspected area. • The denture is seated in position, and the patient is asked to go through functional movements of the border musculature. The material will be washed out if over extension is present. • Over extensions are corrected by cautious removal of the excess denture border with the use of pressure indicator paste to locate the exact place and extent.
  • 9. DDX contd • Occlusal interference in eccentric jaw positions will result in a lateral or posterior thrust of the lower and upper denture causing peripheral soreness. • Can be identified by using articulating paper, or by remounting the denture on an articulator using intra-oral records. • Blue articulating paper is placed between the jaws and the patient is asked to close first in centric position, and then in lateral and protrusive positions. • The Occlusal surface is examined to detect whether there is any premature contact at each jaw position. • If occlusal interference it present, will appear as a colored ring around a white center. • Premature contact is ground, and the procedure is repeated until multiple uniform contacts are present to equilibrate the occlusion.
  • 10. DDX Contd • The narrow or too thin major connector allows flexing and rolling of the saddle (to move lingually). • This condition is frequently associated with inflammation of the tissue beneath the major connector, and excessive denture movement during function. • This can be detected by careful inspection of the partial denture, and intra-oral examination.
  • 11. B)Soreness beneath denture base • More common beneath distal extension PD than in tooth borne PD since tissues take higher proportion of load. • Complaint may be associated with Soreness at the periphery that may be Generalized or Localized.
  • 12. Generalized Soreness beneath denture base • Causes: 1. Excessive tissue displacement during impression making. 2. Incorrect orientation of metallic framework and base. 3. Increased VDO. 4. Excessive soft tissue compression during jaw relation recording. 5. Disharmony between centric relation and centric occlusion. 6. Lack of balance of contacts in eccentric relations. 7. Allergic reaction to denture base material. 8. Unfavorable denture bearing tissue. 9. Poor Oral Hygiene.
  • 13. Localized soreness beneath denture base • Repeated application of excessive force to a denture bearing support tissue. • May occur due to: a) Occlusal prematurity in centric or eccentric jaw position b) Insufficient relief of bony prominence c) Pressure from a denture base d) Irregularities on tissue surface of denture
  • 14. • Occlusal prematurity-the use of celluloid strip or articulating paper when pt closes in centric jaw position • .+ve if lack of multiple uniform contacts • Bony prominences-visual and digital exam on the ridge/use of pressure indicator paste-reveal insufficient relief
  • 15. • Pressure from denture base –checked using pressure indicator paste • May be due to; soft tissue displacement during impression making, damage of the model, dimensional change of acrylic resin during processing • Irregularities on tissue surface confirmed by visual and digital exam
  • 16.
  • 17. C)Pain In or around standing teeth • Serious, indicates continuous load excess to physiologic limit of the tooth •Causes include: 1. Excessive bulk or improper tapering of clasp arm 2. Improper clasp arm for tooth- tissue supported rpd 3. Traumatic occlusion 4. Loss of tissue support from the extension base 5. Inadequate reciprocal clasps 6. Non- rigid connection between the saddles 7. Gingival impingement and lack of physiological gingival stimulation
  • 18.
  • 19.
  • 21. 2) Cheek biting • Causes: • Loss of tone of the cheek masculature. • End to end relationship of the buccal cusps of posterior teeth. • Decreased VDO
  • 22. Differential Diagnosis Correct shaping of the buccal flanges and increase of the horizontal overlap of posterior teeth can eliminate cheek biting caused by lack of muscle tone. Decreased VDO causes the buccal mucosa to be caught up easily btwn the teeth.
  • 23. 3) Tongue biting Causes • Improper bucco-lingual position of posterior teeth. • Level of the occlusal plane is too low .
  • 24. Differential diagnosis • Placement of posterior tooth too far lingually will cause insufficient tongue spacing and tongue biting. • The dorsum of the tongue ahould be above the plane of occlusion.
  • 25.
  • 26. 4) Movement of the denture Causes: 1. Faulty occlusion. 2. Light clasping. 3. Overextended denture base. 4. Improper position of posterior teeth. 5. Lack of peripheral seal. 6. Lack of indirect retainer .
  • 27.
  • 28.
  • 29. Differential diagnosis • Lack of multiple uniform tooth contact during eccentric jaw positions indicates interferences in eccentric position. Any cuspal interference or premature contact should be eliminated by occlusal grinding. • Adjustment of the clasp to engage deeper into the undercut is desirable. • Overextension of denture peripheries will cause movement and soreness of sulcus.
  • 30.
  • 31. Cont... • Improper position of posterior teeth will cause the tongue or the cheek muscles to exert lateral pressure on the denture.Encroachment of lower teeth into tongue space may cause movement. Posterior teeth set outside the ridge will bring about displacement of free end saddles. • The saddles should be extended to the optimum depth around the tuberosities when the retention is partially dependent upon peripheral seal.
  • 32. 5) DIFFICULTIES DURING MASTICATION: Inability to Chew. • May be caused by: • Patient taking too much food at once. • Cuspless, blunt or flattend denture teeth. • Decreased or increased VDO. • Soreness of the denture bearing area by faulty occlusion.
  • 33. Food gets under the denture. • Caused by: • Unbalanced Occlusion, Occlusal interferences in centric or eccentric positions. • Inefficient clasping. • Inaccurate Denture base. • Loss of tissue support due to ridge resorption. • Lack of tissue fit at margins of palatal & lingual plates.
  • 34. Food lodgment around the denture. • May be caused by errors in PD design. • Relation of upper margin of bar to neck of tooth should permit self cleansing by tongue and saliva. • Further sufficient space should be provided (5mm) btn vertical components of the frame to prevent food accumulation. • Rough unpolished crevices may cause food to adhere readily.
  • 35.
  • 36.
  • 37.
  • 38.
  • 40. DIFFICULTIES WITH SPEECH 1. Encroachment of the tongue space 2. Poor denture retention 3. Excessive salivation 4. Improper LL position of ant teeth

Editor's Notes

  1. ORONI
  2. PUDLAE2I2
  3. IIPO
  4. LIGETIN-R